Gerontological Nursing 10th Edition By Charlotte Eliopoulos Test Bank

Type:

Test Bank

Resource:

Gerontological Nursing

Edition:

10th Edition

Author(s):

Charlotte Eliopoulos

Gerontological Nursing 10th Edition Eliopoulos Test Bank Chapter 1 The Aging Population Test Bank MULTIPLE CHOICE 1. The nurse explains that in the late 1960s, health care focus was aimed at the older adult because: a. disability was viewed as unavoidable. b. complications from disease increased mortality. c. older adults needs are similar to those of all adults. d. preventive health care practices increased longevity.

ANS: D Increased preventive health care practices, disease control, and focus on wellness helped people live longer.

DIF: Cognitive Level: Comprehension REF: 2 OBJ: 2 TOP: Aging Trends KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 2. The nurse clarifies that in the terminology defining specific age groups, the term aged refers to persons who are: a. 55 to 64 years of age. b. 65 to 74 years of age. c. 75 to 84 years of age. d. 85 and older.

ANS: C

The term aged refers to persons who are 75 to 84 years of age.

DIF: Cognitive Level: Comprehension REF: 2, Table 1-1 OBJ: 1 TOP: Age Categories KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 3. The nurse cautions that ageism is a mindset that influences persons to: a. discriminate against persons solely on the basis of age. b. fear aging. c. be culturally sensitive to concerns of aging. d. focus on resources for the older adult.

ANS: A Ageism is a negative belief pattern that influences persons to discriminate against persons solely on the basis of age and can lead to destructive behaviors toward the older adult.

DIF: Cognitive Level: Comprehension REF: 5 OBJ: 3 TOP: Ageism KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 4. The nurse points out that the most beneficial legislation that has influenced health care for the older adult is: a. Medicare and Medicaid. b. elimination of the mandatory retirement age. c. the Americans with Disabilities Act. d. the Drug Benefit Program.

ANS: A The broadest sweeping legislation beneficial to the older adult is Medicare and Medicaid.

DIF: Cognitive Level: Application REF: 16 OBJ: 6 TOP: Legislation KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 5. The nurse clarifies that a housing option for the older adult that offers the privacy of an apartment with restaurant-style meals and some medical and personal care services is the: a. government-subsidized housing. b. long-term care facility. c. assisted-living center. d. group housing plan.

ANS: C Assisted-living arrangements offer the privacy of an apartment or condominium with meals prepared and served, limited medical care, and a variety of personal services.

DIF: Cognitive Level: Application REF: 14 OBJ: 9 TOP: Housing Options KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The 75-year-old man who has been hospitalized following a severe case of pneumonia is concerned about his mounting hospital bill and asks if his Medicare coverage will pay for his care. The nurses most helpful response is Yes. Medicare: a. pays 100% of all medical costs for persons older than 65. b. Part B pays hospital costs and physician fees. c. Part A pays for inpatient hospital costs. d. Part D pays 80% of the charges made by physicians.

ANS: C Medicare Part A pays inpatient hospital costs, Part B pays 80% of physicians charges, and Part D helps defray prescription drug costs.

DIF: Cognitive Level: Application REF: 16 OBJ: 6 TOP: Medicare Provisions KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 7. The daughter of a patient who has been diagnosed with terminal cancer asks which documents are required to allow her to make health care decisions for her parent. The nurses most informative response is: a. Advance directives indicate the degree of intervention desired by the patient. b. A Do Not Resuscitate document signed by the patient transfers authority to the next of kin. c. A durable power of attorney for health care transfers decision-making authority for health care to a designated person. d. A living will transfers authority to the physician.

ANS: C A durable power of attorney for health care transfers the authority for decision making to a designated person.

DIF: Cognitive Level: Application REF: 19 OBJ: 11 TOP: Advance Directives KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 8. The daughter of a resident in a long-term care facility is frustrated with her 80-year-old mothers refusal to eat. The nurse explains that the refusal to eat is a behavior that is an: a. effort to maintain a portion of independence and self direction. b. indication of approaching Alzheimer disease. c. effort to gain attention. d. indication of the dislike of the institutional food.

ANS: A

Loss of independence and control is a significant issue for the older adult. Some residents will exercise whatever control they may retain.

DIF: Cognitive Level: Application REF: 21 OBJ: 11 TOP: Loss of Independence KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 9. The nurse clarifies that the conditions of a living will go into effect when: a. the patient declares that desire in writing. b. a family member indicates the desire for curative therapy to cease. c. two physicians agree in writing that the criteria in the living will have been met. d. the physician and a family member agree that the criteria in the living will have been met.

ANS: C Two physicians must agree in writing that the criteria of the living will have been met before the document can go into effect.

DIF: Cognitive Level: Application REF: 19 OBJ: 11 TOP: Living Wills KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 10. In the 1980s, Medicare initiated a program of diagnosis-related groups (DRGs) to reduce hospital costs by: a. classifying various diagnoses as ineligible for hospitalization. b. allotting a set amount of hospital days and prospective payment on the basis of the admitting diagnosis. c. specifying particular physicians to treat specified diagnoses. d. using frequency of a particular diagnosis to set a payment schedule.

ANS: B

DRGs set up a system of preset hospitalization time and payment on the basis of the admitting diagnosis.

DIF: Cognitive Level: Comprehension REF: 16 OBJ: 6 TOP: DRGs KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 11. When discussing extended care with a patient who has had a hip replacement and needs physical therapy, the nurse would recommend a(n): a. basic care facility. b. skilled care facility. c. subacute care facility. d. assisted-living residence.

ANS: B Skilled care facilities offer not only basic care but also services from trained licensed professionals such as nurses, physical therapists, speech therapists, and occupational therapists.

DIF: Cognitive Level: Application REF: 16 OBJ: 9 TOP: Extended-Care Facilities KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 12. The 80-year-old woman who is recovering from a stroke is being sent to an extended-care facility. She is concerned about the expense. The nurse can allay anxiety by explaining that Medicare will cover extended-care facility costs: a. for a period of 30 days. b. for a period of 45 days for physical therapy. c. for a period of 100 days for needed skilled care. d. until she is able to be discharged home.

ANS: C

Medicare will cover extended-care costs for 100 days while skilled care is being applied to the resident. After 100 days, the resident must revert to private pay or ancillary long-term care insurance.

DIF: Cognitive Level: Application REF: 16 OBJ: 8 TOP: Extended Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 13. The senior citizen political action group that uses volunteers and lobbyists to advance the interests of older adults is the: a. American Association of Retired Persons (AARP). b. National Council of Senior Citizens (NCSC). c. National Alliance of Senior Citizens (NASC). d. Gray Panthers.

ANS: A The AARP uses volunteers and lobbyists to advance the interests and welfare of older adults.

DIF: Cognitive Level: Knowledge REF: 12 OBJ: 7 TOP: Political Action Groups KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 14. The nurse gives an example of the caregiver who is guilty of elder abuse as the: a. daughter who uses her mothers Social Security money to purchase her mothers medication. b. son who puts an alarm on the front door to prevent his mother from wandering out of the house. c. wife who allows her mentally competent husband to refuse to take a bath for a week. d. frail spouse who is unable to bathe or change the clothes of her physically dependent husband.

ANS: D Unintentional abuse or neglect can occur when the caregiver lacks the stamina to meet care needs. Even though physically unable, the frail wife is guilty of elder abuse. The wife should seek assistance to prevent neglect.

DIF: Cognitive Level: Analysis REF: 22 OBJ: 13 TOP: Elder Abuse KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 15. The nurse cautions that the most frequent response to elder abuse by the abused older adult is: a. anger. b. physical retaliation. c. notification of authorities. d. nothing at all.

ANS: D Fear of retaliation or abandonment keeps most abused elders silent.

DIF: Cognitive Level: Application REF: 25-26 OBJ: 14 TOP: Response to Abuse KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 16. Many nurses today do not seek careers in gerontology because: a. the physical work is too difficult. b. their technological skills are not used. c. there is not enough challenge. d. there are limited options for employment.

ANS: B

Many nurses feel that their technical skills will not be used in the care of the older adult. There are many employment options that offer challenge and fulfillment.

DIF: Cognitive Level: Application REF: 5 OBJ: 2 TOP: Employment Options KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 17. The nurse clarifies that the term baby boomers refers to persons who: a. entered school in 1945. b. served in the military in World War II. c. were born between 1946 and 1964. d. were eligible for Social Security benefits in 2000.

ANS: C Baby boomers are those born between 1946 and 1964. The impact of the retirement of this cohort is unprecedented in terms of the impact on society.

DIF: Cognitive Level: Comprehension REF: 8 OBJ: 5 TOP: Baby boomers KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 18. Restraining an older adult in a recliner to prevent wandering is an example of: a. physical abuse. b. neglect. c. emotional abuse. d. self-neglect.

ANS: A Physical abuse is any action that causes physical pain or injury. Inappropriate use of drugs, force-feeding, physical restraints, or punishment of any kind are examples of physical abuse.

DIF: Cognitive Level: Application REF: 23 OBJ: 13 TOP: Types of Abuse KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 19. Nonprovision of medical care because of lack of finances is an example of: a. physical abuse. b. neglect. c. emotional abuse. d. self-neglect.

ANS: B Neglect is a passive form of abuse in which caregivers fail to provide for the needs of the older person under their care. Failure to provide necessary medical care may constitute neglect because with no means of going to the doctor or pharmacy, the older person may suffer or even die.

DIF: Cognitive Level: Application REF: 23 OBJ: 13 TOP: Types of Abuse KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 20. Health care workers eating a residents candy without permission is an example of: a. physical abuse. b. neglect. c. emotional abuse. d. self-neglect.

ANS: C Emotional abuse is more subtle and difficult to recognize than physical abuse or neglect. It often includes behaviors such as isolating, ignoring, or depersonalizing older adults. Health care workers eating a residents candy without permission is an ignorant behavior that can be depersonalizing.

DIF: Cognitive Level: Application REF: 23 OBJ: 13 TOP: Types of Abuse KEY: Nursing Process Step: N/A MSC: NCLEX: N/A MULTIPLE RESPONSE 1. The nurse is aware that a persons attitude about aging is influenced mainly by his or her __________. (Select all that apply.) a. life experiences b. income level c. level of education d. current age e. occupation ANS: A, D A persons current age and life experiences are the main influences on his or her attitude relative to aging.

DIF: Cognitive Level: Comprehension REF: 4 OBJ: 2 TOP: Attitudes toward Aging KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 2. Gerontology encompasses application to __________. (Select all that apply.) a. appropriate housing b. health care c. public education d. business ventures e. government-sponsored pensions ANS: A, B, C, D

Gerontological concerns extend and influence provision of appropriate housing, health care, public education, business ventures, and political stands relative to the welfare of the older adult.

DIF: Cognitive Level: Application REF: 2 OBJ: 1 TOP: Gerontology KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 3. Medicare Part C allows eligible persons to receive Medicare benefits via the services of private insurance companies through the services of a __________. (Select all that apply.) a. health maintenance organization (HMO) b. preferred provider organization (PPO) c. provider-sponsored organization (PSO) d. private fee for service organization (PFFS) e. medical service organization (MSO) ANS: A, B, C, D Medicare Part C allows benefits via the services of managed care organizations. Medical service organization is not one of them.

DIF: Cognitive Level: Comprehension REF: 17 OBJ: 6 TOP: Medicare Part C KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 4. The nurse is aware that a familys emotional response to an aging loved ones attempts to cope with diminishing abilities and increased care needs would include __________. (Select all that apply.) a. grief b. anger c. frustration d. loss e. resentment

ANS: A, B, C, D As the family witnesses the decline of a loved one and attempts to respond to the increasing care needs, the emotional responses are varied and changing. The responses include grief, anger, frustration, loss, and confusion.

DIF: Cognitive Level: Application REF: 21 OBJ: 11 TOP: Impact of Aging on the Family KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 5. The nurse outlines the characteristics of the typical caregiver for an aging family member as __________. (Select all that apply.) a. 32 years of age b. female c. having full-time employment d. having a care recipient older than 70 e. giving care for an average of 18 years ANS: B, C, D, E The average age of the caregiver is 46.

DIF: Cognitive Level: Application REF: 20 OBJ: 11 TOP: Characteristics of Family Caregiver KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 6. The nurse reminds a family that indicators of self-neglect in the aging person include __________. (Select all that apply.) a. misbalanced check book b. reduced personal hygiene

c. increased alcohol consumption d. irritability e. loss of weight ANS: A, B, C, E Indicators may be to manage personal finances, reduced hygiene, substance abuse, and loss of weight due to inability to obtain adequate food. Irritability is not a consistent characteristic.

DIF: Cognitive Level: Application REF: 22 OBJ: 11 TOP: Self-Neglect KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 7. The nurse reminds a group of prospective caregivers that elder abuse may take the form of __________. (Select all that apply.) a. causing physical harm b. misappropriation of finances c. psychological intimidation d. emotional depersonalization e. abandonment ANS: A, B, C, D, E Elder abuse may take the form of physical injury, misusing the older persons finances for personal gain, psychological intimidation, and depersonalization and abandonment.

DIF: Cognitive Level: Application REF: 25-26 OBJ: 13 TOP: Elder Abuse KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 8. The nurse explains that research done by the National Institute on Aging found that __________. (Select all that apply.)

a. older patients receive less information regarding health management than younger patients b. information on lifestyle changes were directed at younger people c. older patients were denied timely appointments for evaluation of acute illnesses d. rehabilitation programs offered limited services to the older adult e. older patients receive less evaluation and fewer treatment options for acute illnesses ANS: A, B, D, E The study showed there was less information on health management and lifestyle changes.

Rehabilitation programs were limited in their service to the older adult, and only 47% of physicians interviewed felt the older patient received the same evaluation for acute illnesses.

DIF: Cognitive Level: Application REF: 5 OBJ: 2 TOP: Attitudes toward Aging KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 9. The Nursing Competence in Aging initiative advocates enhancing nurses __________. (Select all that apply.) a. knowledge in gerontics b. skills in geriatrics c. opportunities for employment d. political sensitivity for the older adult e. attitudes related to the older adult ANS: A, B, E The Nursing Competence in Aging initiative advocates for all nurses greater knowledge, skills, and broader attitudes toward the older adult.

Chapter 2 Theories of Aging MULTIPLE CHOICE

1. A theory differs from a fact in that a theory: a. proves how different influences affect a particular phenomenon. b. attempts to explain and give some logical order to observations. c. is a collection of facts about a particular phenomenon. d. shows a relationship among facts about a particular phenomenon.

ANS: B A theory is an unproven concept that attempts to explain and give some logical order to observations. For a theory to become a fact, there must be reproducible evidence.

DIF: Cognitive Level: Comprehension REF: 28 OBJ: 1 TOP: Fact vs. Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 2. The biological theory of aging uses a genetic perspective and suggests that aging is a programmed process in which: a. each person will age exactly like those in the previous generation. b. a biological clock ticks off a predetermined number of cell divisions. c. genetic traits can overcome environmental influences. d. age-related physical changes are controlled only by genetic factors.

ANS: B The biological theory of programmed process suggests that there is a biologic clock set with a predetermined number of cell divisions that will occur before the introduction of the aging process.

DIF: Cognitive Level: Application REF: 28 OBJ: 2 TOP: Biological Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

3. The Gene Theory of aging proposes that: a. the presence of a master gene prolongs youth. b. genes interact with each other to resist aging. c. specific genes target specific body systems to initiate system deterioration. d. the activation of harmful genes initiates the aging process.

ANS: D The Gene Theory suggests that there is an activation of harmful genes that initiate the aging process.

DIF: Cognitive Level: Application REF: 28 OBJ: 2 TOP: Gene Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 4. The theory that identifies an unstable molecule as the causative factor in aging is the _____ theory. a. free radical b. molecular c. neuroendocrine d. crosslink ANS: A The free radical theory identifies free radicalsunstable moleculesthat will cause aging after accumulation in the body.

DIF: Cognitive Level: Application REF: 29 OBJ: 2 TOP: Free Radical Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

5. The nurse assesses that the patient who uses good health maintenance practices believes in the aging theory known as the _____ theory. a. wear-and-tear b. free radical c. neuroendocrine d. molecular ANS: A The wear-and-tear theory suggests that health maintenance practices will prevent wear and tear on the cells of the body and will delay the aging process.

DIF: Cognitive Level: Analysis REF: 29 OBJ: 2 TOP: Wear-and-Tear Theory KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. The nurse describes the neuroendocrine theory of aging as a complex process of: a. relating thyroid function to age-related changes. b. the effects of adrenal corticosteroids, which inhibit the aging process. c. stimulation and/or inhibition of the hypothalamus, causing age-related changes. d. adrenal medulla inhibition of epinephrine, causing age-related changes.

ANS: C The neuroendocrine theory proposes that the hypothalamus stimulates or inhibits the pituitary gland to produce hormones that initiate the aging process.

DIF: Cognitive Level: Application REF: 29 OBJ: 2 TOP: Neuroendocrine Theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

7. The nurse explains that psychosocial theories differ from biologic theories in that psychosocial theories: a. focus on methods to delay the aging process. b. are directed at decreasing depression in the older adult. c. are organized to enhance the perception of aging. d. attempt to explain responses to the aging process.

ANS: D Psychosocial theories attempt to explain the various responses of persons to the aging process.

DIF: Cognitive Level: Comprehension REF: 30 OBJ: 3 TOP: Focus of Psychosocial Therapies KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 8. The major objection to the disengagement theory is that the theory: a. justifies ageism. b. addresses the diversity of older adults. c. does not clarify the aging process. d. diminishes the self-esteem of the older adult.

ANS: A The disengagement theory seems to justify ageism by proposing that there is a mutual desire between the community and the older adult to be disengaged. According to the theory, this desire apparently does not diminish self-esteem because the older adult desires to be disengaged.

DIF: Cognitive Level: Application REF: 30 OBJ: 3 TOP: Disengagement Theory KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

9. The 80-year-old who teaches Sunday school every week and delivers food for Meals on Wheels is following _____ theory. a. Newmans developmental b. the life course c. the activity d. the disengagement ANS: C Purposeful activity increases self-esteem and maintains cognitive function well into older age.

DIF: Cognitive Level: Application REF: 30 OBJ: 3 TOP: Activity Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 10. The nurse would recognize successful aging according to Jungs theory when the nurse notes that a resident at a long-term care facility: a. takes special care to dress for dinner in a manner that pleases his tablemates. b. asks permission to sit on the patio with other residents. c. asks persons in his hall if his television is bothering them. d. wears a large cowboy hat at all times because he likes it.

ANS: D Jung describes a successful adjustment to aging as being accepting and valuing of self regardless of the view of others.

DIF: Cognitive Level: Application REF: 30 OBJ: 3 TOP: Jungs Developmental Theory KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

11. The older adult female patient is positive that the free radical lipofuscin can be counteracted by: a. avoiding animal fat. b. use of antioxidants. c. building up muscle mass. d. outdoor exercise.

ANS: B Individuals who follow this theory believe that free radicals can be reduced by antioxidants such as vitamins A, C, E, zinc, and phytochemicals.

DIF: Cognitive Level: Comprehension REF: 29 OBJ: 2 TOP: Antioxidants KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 12. A recently widowed woman moved to an assisted living community because of her hypertension and joined a group to learn how to do water color painting with other women her age. The nurse assesses that the patient is following the aging theory of: a. Jung. b. Havighurst. c. Erikson. d. Newmon.

ANS: B Havighurst proposes that the process of aging is defined by adjusting to the loss of a spouse, establishing a relationship with ones own age group, and establishing a satisfactory living arrangement.

DIF: Cognitive Level: Application REF: 30 OBJ: 3 TOP: Havighurst KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease MULTIPLE RESPONSE 1. The nurses list of age-related illnesses thought to cause the accumulation of free radicals includes __________. (Select all that apply.) a. arthritis b. colon cancer c. osteoporosis d. diabetes e. atherosclerosis ANS: A, D, E Cancer and osteoporosis are not considered to be diseases that accumulate free radicals.

DIF: Cognitive Level: Application REF: 29 OBJ: 2 TOP: Free Radical Influence KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 2. The nurse emphasizes that the relatively new theory that correlates restricted caloric intake to slowing of the aging process would probably extend the life span of the person, provided that the person __________.(Select all that apply.) a. consistently eats high-nutrient, low-calorie foods b. maintains a regular exercise program c. consumes 2000 to 3000 mL of fluid a day d. supports the diet with adequate fat-soluble vitamins e. eats only organically grown foods ANS: A, B This new theory encourages high-nutrient, low-calorie foods combined with regular exercise to delay the aging process.

DIF: Cognitive Level: Application REF: 30 OBJ: 2 TOP: Calorie Restriction Theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 3. The nurse points out that the positive outcomes from a life review, according to Erikson, would include __________. (Select all that apply.) a. wisdom and integrated self-image b. comparing self with others c. understanding self and relationships d. seeking anothers opinion of his or her achievement e. acceptance of self ANS: A, C, E Acceptance of self and understanding self and relationships with accumulated wisdom is the goal of Erikson. Seeking the opinion of others suggests that the older adult is experiencing doubt and gloom, which are negative outcomes according to Erikson.

DIF: Cognitive Level: Application REF: 30 OBJ: 2 TOP: Eriksons Developmental Theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 4. When a patient asks what can be done to neutralize the free radicals in his system, the nurse responds that antioxidant therapy is thought to inhibit free radicals. Antioxidants include __________. (Select all that apply.) a. fruits b. vegetables c. organ meat d. folic acid e. vitamin D

ANS: A, B, D Antioxidants can be obtained largely from fruits and vegetables. Organ meat and vitamin D are not antioxidants.

Chapter 3 Diversity MULTIPLE CHOICE 1. A postmenopausal black woman who has been experiencing uterine bleeding tells the nurse, I expect Ill need a total hysterectomy because when my sister had this problem thats what she had done. The nurse recognizes that this woman belongs to a cultural subgroup whose health care beliefs are most influenced by the: a. biomedical model. b. magico-religious model. c. balance/harmony model. d. personal experience.

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

DIF: Understanding (Comprehension) REF: Page 91 OBJ: 5-5 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. A Hispanic patient explains that the Hispanic culture believes that dietary management would be just as effective in managing her problems as medication, so the patients prescription has not been filled. Which action by the nurse illustrates cultural accommodation?

a. Asking the patient to give more details regarding this belief b. Discussing how to add dietary preferences into the treatment plan c. Offering to have a registered nutritionist discuss the situation with the patient d. Researching the patients proposed dietary beliefs ANS: B Cultural care accommodation or negotiation refers to those assistive, supportive, facilitative, or enabling creative professional actions and decisions that help people of a designated culture adapt to or negotiate with others for a beneficial or satisfying health outcome. The nurse can ask the patient to share more about beliefs, offer a consultation with a nutritionist, or research the beliefs, but these actions do not show accommodation.

DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 3. A geriatric nurse practitioner working with a tribe of Native Americans makes the decision to acculturate in an attempt to provide culturally appropriate care. The nurse does this best by: a. living the values of the tribe. b. researching the tribes belief systems. c. learning the language of the tribe. d. residing among the tribe members.

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

DIF: Applying (Application) REF: N/A OBJ: 5-3 TOP: Nursing process: Implementation MSC: Psychosocial Integrity

4. The nurse in an assisted living facility is practicing a form of cultural bias called ethnocentrism when: a. requesting the bridge group only use the game room for 2 hours at a time. b. encouraging Christian residents to attend mass or church services. c. repeatedly confiscating herbs and food products used in healing. d. telling potential patients who are Jewish that the facility does not have a kosher kitchen, ANS: C Ethnocentrism is a belief that ones own cultural group is superior to that of anothers. In nursing we have a unique culture and expect our patients to adapt to us rather than attempting to adapt to the culture of the patient. Confiscating items used in healing rituals shows ethnocentrism and disrespect to the resident. Limiting activities in a group room, encouraging people to attend church services of their religion, and letting prospective Jewish residents know that the facility does not have a kosher kitchen are not examples of ethnocentrism.

DIF: Applying (Application) REF: N/A OBJ: 5-6 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 5. While caring for an older Korean patient, the nurse notes that the patient answers questions regarding health history when asked but is otherwise silent and does not maintain eye contact.

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

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

DIF: Remembering (Knowledge) REF: Page 93 OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 6. The culturally sensitive nurse will recognize that an older adult patient with a high-context ethnic background will appreciate: a. not having a treatment scheduled during a favorite television program. b. both a written and verbal explanation describing how to monitor her blood sugar levels. c. a concise explanation as to why her physical therapy appointment has been canceled. d. having a conversation about her grandchildren while her dressing is changed.

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

DIF: Understanding (Comprehension) REF: Page 92 OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 7. In an attempt to be sensitive to varying cultural responses to touch, before shaking a patients hand, the nurse will: a. offer the patient his or her upturned palm. b. wait until the patient extends his or her hand. c. establish eye contact with the patient first. d. address the patient by his or her full name.

ANS: B

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

DIF: Applying (Application) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 8. A older Asian patient receiving physical therapy after hip surgery has developed a low-grade fever. The patient explains that the fever will lessen if the treatment includes the principles of yin/yang. The nurse expects to support the patient by: a. providing privacy when his shaman visits. b. arranging for his diet to include cold foods and liquids. c. planning his physical therapy so it does not conflict with meditation. d. keeping a magical amulet under his pillow.

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

DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 9. The nurse in an assisted living facility is preparing to admit an older adult patient who speaks very little English. The nurse decides that it is most important that an interpreter be present when the patient: a. indicates a desire to talk with the physician. b. is being oriented to the facility. c. is required to sign official documents. d. begins crying and is inconsolable.

ANS: C The more complex the decision making, the more important it is to have an interpreter present.

Although all situations would benefit from an interpreter, the most important time is when the patient is signing official documents that have legal implications.

DIF: Applying (Application) REF: N/A OBJ: 5-8 TOP: Communication and Documentation MSC: Psychosocial Integrity 10. When attempting to provide culturally sensitive care according to the explanatory model, the nurse asks the patient: a. Who will be able to help you when you go home? b. Do you think the treatment is helping? c. When did you first notice the problem? d. Has this illness changed your life?

ANS: D The gerontologic nurse uses this model to explore the meaning of the health problem from the patients perspective.

DIF: Applying (Application) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 11. The nurse is caring for an older adult patient in need of hospitalization. The nurse is aware this patient is a member of an ethnic group that holds a collectivist perspective on community.

The nurse best addresses the patients medical needs by: a. calling an interpreter to assure the patient is making an informed decision. b. assuring the patient that his spiritual advisor will meet him at the hospital. c. arranging for admission to a hospital that is familiar with this patients culture.

d. offering to phone the patients family and ask them to come in and discuss the hospitalization.

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

DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 12. The nurse is most effectively using the concept of future time orientation when: a. promising to help the patient call his daughter each weekend. b. offering to complete the health assessment history after the patient eats dinner. c. encouraging an older patient to keep a follow-up clinic appointment. d. arranging for a colorectal cancer screen for senior citizens.

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

DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 13. The student learns that which of the following is the best definition of culture?

a. A group of similarly appearing individuals b. Shared beliefs, behaviors, and expectations of groups c. Group beliefs about what is right and wrong d. Groups that come from the same part of the world ANS: B A culture is a set of shared and learned beliefs, behaviors, and expectations among a group of people. The individuals in different cultures may or may not look similar. Group beliefs about what is right or wrong are known as values. Cultural members may come from many different parts of the world.

DIF: Remembering (Knowledge) REF: Page 87 OBJ: 5-3 TOP: Teaching-Learning MSC: Psychosocial Integrity 14. A student nurse expresses frustration to the faculty member regarding an ethnic older adult who appears to be noncompliant. The student states, Why cant the patient just do what we teach her to do? What response by the nurse is best? a. Yes, I realize how frustrating this must be for you. b. People from her culture are never compliant. c. Maybe you can find a different way to get through. d. Culture dictates how people respond to others.

ANS: D Culture is a blueprint for responding to individuals, family, and the community. Persons from strong cultural backgrounds cannot just change their behavior when instructed to do so. The nurse explains this to the student. Stating that the nurse understands the frustration is helpful but does not give the student any information that could help him or her work with this patient.

Stating that people from a certain culture are never compliant is biased and prejudicial. Getting through to the patient implies ethnocentrism and bias.

DIF: Applying (Application) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 15. A patient from a culture that differs from that of the nurse is hospitalized and near death.

What action by the nurse best demonstrates cultural care preservation? a. Allowing the family to remain at the bedside b. Pinning a healing amulet to the patients gown c. Offering the family food and drink in the room d. Giving the family time to be alone with the patient ANS: B Cultural care preservation refers to those assistive, supportive, facilitative, or enabling professional actions and decisions that help people of a particular culture to retain and maintain their well-being, to recover from illness, or to face handicaps or death. Allowing the patient to have healing artifacts important in his or her culture nearby best demonstrates this concept. The other actions are caring but do not demonstrate this principle.

DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 16. The nurse uses the LEARN model when providing care. What event best demonstrates that this model has been successful? a. The nurse learns about the patients culture and how it impacts care. b. The patient and nurse agree on a mutually acceptable plan of action. c. The nurse listens carefully to the patients concerns and beliefs. d. The patient understands how medical care will be beneficial.

ANS: B

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

DIF: Evaluating (Evaluation) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 17. A new nurse is caring for a patient from Appalachia. The patient seems guarded and secretive, which frustrates the new nurse. What advice from the mentor is most appropriate? a. Maybe you should ask to change your assignment. b. This is a normal behavior for this patients cultural group. c. You could try to apologize for anything you may have done. d. Ask the patient why she is acting so strangely around you.

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

DIF: Understanding (Comprehension) REF: Page 87 OBJ: 5-6 TOP: Caring MSC: Psychosocial Integrity 18. A nurse is caring for an Arab American patient in the hospital. The patient has many visitors who seem to be tiring the patient. What action by the nurse is best? a. Limit the number of visitors the patient can have. b. Only allow family members to visit the patient. c. Suggest shorter visits to the patients visitors.

d. Require visitors to check in at the front desk.

ANS: C In Arab American Muslim culture, visiting the sick is a cultural value and expectation. Although the visits may be tiring, they may also be important to the patient. The nurse can suggest shorter visits so the patient can have both the visitors and more rest. Limiting the number of visitors would violate this cultural norm as would limiting visits to family only. Checking in at the front desk serves no useful purpose.

DIF: Applying (Application) REF: N/A OBJ: 5-6 TOP: Caring MSC: Psychosocial Integrity 19. A director of nursing works in a hospital that serves many Jehovahs Witness patients. What action by the nurse would best facilitate culturally appropriate health care? a. Establish a bloodless surgery program. b. Create an immunization clinic for children. c. Employ spiritual leaders from this faith. d. Allow faith healing ceremonies.

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

DIF: Applying (Application) REF: N/A OBJ: 5-5 TOP: Caring MSC: Psychosocial Integrity 20. An incapacitated older adult with dementia is brought to the emergency department by a rescue squad after falling and breaking an arm. When the patients children arrive, they are adamantly against the patient having any medical care and insist that prayer will heal the broken arm. What action by the nurse is most appropriate?

a. Allow the family to pray with the patient then escort them to the waiting room. b. Call security to keep the family from interfering with medical care. c. Check facility policies and contact the hospital social worker. d. Call the police who can force the family to accept medical care.

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

DIF: Applying (Application) REF: N/A OBJ: 5-6 TOP: Communication and Documentation MSC: Safe Effective Care Environment MULTIPLE RESPONSE 1. When attempting to reflect about personal cultural awareness, the nurse asks himself or herself which of the following quetions? (Select all that apply.) a. What image do I want to project to members of other cultures? b. What makes a culture worthy of biased treatment? c. Have my life experiences contributed to any biases regarding other cultures? d. Am I uncomfortable when interacting with members of other cultures? e. Does the patients culture rely on solid science to direct health care?

ANS: A, C, D Self-reflection implies thinking that regards how I, the individual, perceives/believes/behaves.

Awareness of ones thoughts and feelings about others who are culturally different from oneself is

necessary to become culturally aware. No culture is worthy of biased treatment. Solid science is an ethnocentric principle.

DIF: Applying (Application) REF: N/A OBJ: 5-4 TOP: Caring MSC: Psychosocial Integrity 2. What does the nurse working with older adults from many different cultures know about the demographics of culture in the United States? (Select all that apply.) a. Hispanics will become the largest minority group by 2030. b. Many persons of color are not counted in the census. c. The percentage of Native Americans/Native Alaskans will decrease. d. The number of refugees and immigrants is expected to decrease. e. Some Native Americans want to identify as specific tribal members.

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

Chapter 4 Life Transitions and Story MULTIPLE CHOICE 1. Before becoming an effective advocate for the older adult patient, the nurse must: a. be familiar with the physical and mental effects of aging. b. gain insight into the patients world by talking with and listening to him or her. c. learn the details of the patients medical and social histories. d. be a member of the patients formal support system.

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

DIF: Understanding (Comprehension) REF: Page 121 OBJ: 7-5 TOP: Nursing Process: Nursing Assessment MSC: Safe Effective Care Environment 2. To best respect an older patients autonomy when assisting him in finding appropriate, affordable housing, the nurse: a. provides examples of various options that include assistive services. b. locates housing near a senior citizen community center to minimize social isolation. c. identifies housing close to the services he will need. d. asks the patient to provide examples of where he would like to live.

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

DIF: Applying (Application) REF: N/A OBJ: 7-5 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 3. A nurse working with older adults recognizes that the patient at greatest risk for homelessness is the: a. female with a psychiatric diagnosis.

b. male with a chronic illness. c. female with a history of social isolation. d. male with an alcohol abuse issue.

ANS: A Women are increasing in numbers among the homeless older adult communities. Approximately 30% of homeless older adults have mental illness or dementia.

DIF: Remembering (Knowledge) REF: Page 131 OBJ: 7-1 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 4. A nurse volunteers at a facility that provides free lunches for older adults. To minimize the tendency of these patients to withdraw socially, the nurse: a. frequently reinforces that everyone is welcome to have lunch with the group. b. makes every effort to engage them in conversation during the meal. c. encourages them to make friends with the other patients. d. asks if they would assist those who need help with getting their food.

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

DIF: Applying (Application) REF: N/A OBJ: 7-3 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 5. When the traditional roles are blurred as an older married couple begins to experience personal disease and disability, there will most likely be: a. a rapid decline in their mental health as well.

b. a loss of self-esteem and satisfaction with life. c. increased martial stress and discord. d. increased social isolation.

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

DIF: Remembering (Knowledge) REF: Page 127 OBJ: 7-1 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 6. A 69-year-old patient who has both Medicare and long-term supplemental health care insurance shares with the nurse that he is in need of a visual examination as a follow-up after his cataract surgery. The nurse suggests that such treatment is most likely covered by: a. Medicare Part A. b. Medicare Part B. c. Medicare Part D. d. Supplemental policy.

ANS: B A vision examination is a service covered by Medicare Part B. DIF: Remembering (Knowledge) REF: Page 126 OBJ: 7-4 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 7. The nurse recognizes that health and wellness are better among the educated older adult population because they tend to: a. place a high value on health and wellness.

b. frequently take advantage of health screening options. c. have occupations that are less physically demanding. d. manage emotional stress in a more productive manner.

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

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

DIF: Remembering (Knowledge) REF: Page 124 OBJ: 7-1 TOP: Teaching-Learning MSC: Health Promotion 8. Which patient is most likely to be seen at a clinic that services older adults who are at or below the poverty level? a. A Hispanic male living with extended family b. An African American male living with a spouse c. A Hispanic female who lives alone d. An African American female who lives with her sister ANS: C The highest rates of poverty are among Hispanic women over the age of 65 who live alone.

DIF: Remembering (Knowledge) REF: Page 123 OBJ: 7-3 TOP: Nursing Process: Assessment MSC: Health Promotion 9. The nurse is addressing a senior citizens group that is composed of members who are 75 years of age and older. The nurse expects that the group will be primarily: a. widows who have never worked outside of their homes.

b. widowers with at least one chronic illness. c. females who have part-time jobs. d. males with pensions plus Social Security income.

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

DIF: Remembering (Knowledge) REF: Page 123 OBJ: 7-1 TOP: Nursing Process: Assessment MSC: Health Promotion 10. A patient who grew up during the 1930s in an urban community has been prescribed several medications for a variety of chronic health issues. To help ensure medication compliance based on knowledge of this age cohort, the nurse: a. provides a detailed explanation about the importance of taking the medications appropriately. b. educates the patient about the cost-effectiveness of generic brands of the prescribed medications. c. includes family members with the patient in the medication education plan. d. offers suggestions on ways to minimize the risk of forgetting to take medication correctly.

ANS: B Persons of this cohort (raised during the American depression of the 1930s) are generally frugal and often do not spend money, even if they have it. Suggesting a cost-effective way to purchase the medications will particularly appeal to this patient.

DIF: Understanding (Comprehension) REF: Page 121 OBJ: 7-2 TOP: Teaching-Learning MSC: Health Promotion

11. The nurse who works with veterans from the 1940s and 1950s knows that individuals in this cohort are more likely than older adults to: a. obtain preventative health services b. hoard money for times of need c. work hard to keep families intact d. be noncompliant with medications ANS: A Women and men who served in the armed forces during this time became accustomed to preventive medical and dental care. Those influenced by the Great Depression are more likely to hoard money. Families started becoming more mobile. This cohort is not as likely to be noncompliant because of cohort influences.

DIF: Remembering (Knowledge) REF: Page 122 OBJ: 7-2 TOP: Nursing Process: Assessment MSC: Health Promotion 12. An older patient appears to have few friends and little family. What action by the nurse is best? a. Encourage the patient to stay in contact with remaining family members. b. Help the patient find new social outlets and support systems. c. Assess the patient for depression or substance abuse. d. Ask the patient why there are so few friends and family.

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

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

DIF: Applying (Application) REF: N/A OBJ: 7-5 TOP: Communication and Documentation MSC: Psychosocial Integrity 13. An adult child of an older adult confides in the nurse that the patient has lost most of her friends because of her negative behavior. What action by the nurse is best? a. Ask when the patient had her last physical exam. b. Encourage the patient to be more positive. c. Ask if the patient is aware of the problem. d. Suggest the patient take antidepressants.

ANS: A Depressed or negative older adults have trouble maintaining relationships. If this is a change in status, the nurse should determine if the patient needs a checkup to look for underlying illness.

The other answers do not provide action that could possibly alleviate the situation. Giving the patient medications without a full workup is dangerous.

DIF: Applying (Application) REF: N/A OBJ: 7-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 14. A patient is not competent to manage financial affairs. What legal recourse does the older person have? a. Guardian b. Conservator c. Health care proxy d. Social worker ANS: B A conservator is appointed by the courts to handle a patients monetary affairs. A guardian helps with nonmonetary issues. Health care proxy and social workers do not manage financial affairs.

DIF: Remembering (Knowledge) REF: Page 128 OBJ: 7-6 TOP: Teaching-Learning MSC: Safe Effective Care Environment 15. An older couple is considering moving into a retirement community. What reaction by the nurse is best? a. Thats a good idea to consider at your age. b. Check on what levels of care they provide. c. Do you have enough money to afford this? d. What does your family think of this idea?

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

DIF: Applying (Application) REF: N/A OBJ: 7-8 TOP: Teaching-Learning MSC: Psychosocial Integrity 16. An older adult is planning to move to an assisted living facility. What advice does the nurse provide to the adult children? a. Let your father choose what items to take with him. b. Warn your dad there will be little room for personal things. c. It is best to pick your dad up one day and move him in. d. Be aware your dad may suffer from depression or confusion.

ANS: A Individuals who move can suffer from relocation stress, which is a negative consequence of moving. If the patient has input into the facility chosen, can take tours, and can bring cherished personal items with him or her, the chances of relocation stress lessen. Although there might be

limited room, it is more important for the family to let the patient take wanted items. Moving precipitously can increase the chance of relocation stress. The family should be warned about the negative reactions to moving that are possible, but this does not give them the ability to lessen the impact.

DIF: Application (Applying) REF: N/A OBJ: 7-5 TOP: Teaching-Learning MSC: Psychosocial Integrity 17. An adult daughter brings a patient to the gerontology clinic and reports that the patient has become increasingly withdrawn and no longer goes out during the day. What response by the nurse is best? a. Administer a mini mental state exam. b. Ask the patient why this is happening. c. Assess if the patient feels safe at home. d. Determine if abuse is occurring.

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

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

DIF: Applying (Application) REF: N/A OBJ: 7-7 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 18. An older woman lives alone. What action by the nurse is best to keep the patient from becoming a victim of crime? a. Encourage the patient to take self-defense classes. b. Tell the patient that it is okay to hang up or not answer the door. c. Have the patient install a monitored security system.

d. Ask if there is a neighbor who can check up on her.

ANS: B Older people who are lonely may welcome visits from unscrupulous visitors. They are also less likely to hang up the phone or close the door to avoid appearing impolite. The nurse can best help this patient by telling her such behavior is not only all right, it is important for her safety.

The other actions are also possible but can be costly, and the patient may not have a reliable neighbor.

DIF: Applying (Application) REF: N/A OBJ: 7-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment 19. The nurse is presenting an educational workshop at a senior center where most of the patients will be 75 years or older. What does the nurse consider about this population when designing the presentation? a. Most of these patients only have a high school diploma. b. Many patients will be illiterate so handouts should be simple. c. A great number of patients never attained a high school. d. A lot of these patients went to college on the GI bill.

ANS: A Educational attainment differs with age cohorts. In this age group, the highest number of persons attained a high school diploma.

DIF: Remembering (Knowledge) REF: Page 121 OBJ: 7-2 TOP: Teaching-Learning MSC: Health Promotion MULTIPLE RESPONSE

1. When preparing an educational program focused on chronic illnesses that at least a third of the older adult population is likely to experience, the nurse includes information on which of the following? (Select all that apply.) a. The benefit of aquatic exercise b. Signs and symptoms of cataracts c. Ways to control sodium intake d. Latest technologic interventions for hearing loss e. The effects of exercise on cardiovascular health ANS: A, C, E The most common chronic problems in 2002 were heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD), Alzheimer disease, and diabetes. These exercise programs can have a positive influence on these common conditions. Cataracts and hearing loss are not included.

DIF: Understanding (Comprehension) REF: Page 125 OBJ: 7-1 TOP: Teaching-Learning MSC: Health Promotion 2. The nurse is educating an 80-year-old patient regarding a newly prescribed medication. The nurses teaching strategies include which of the following? (Select all that apply.) a. Using pictures to show how the medication should be stored b. Asking the patient to use his own words to describe the medications possible side effects c. Avoiding written instruction in favor of verbal, face-to-face communication d. Delivering the information using a slow, deliberate manner of speech e. Repeating the information at least three times during the conversation ANS: A, B, E

Strategies such as repetition, patient restating, and varied delivery methods such as pictures, written, audio, and oral discussion are all appropriate and recommended for the older adult learner.

DIF: Understanding (Comprehension) REF: Page 124 OBJ: 7-1 TOP: Teaching-Learning MSC: Health Promotion 3. The nurse who volunteers at a community center for older people refers which people to the Supplemental Security Income office? (Select all that apply.) a. Disabled persons b. Those who are visually impaired c. Deaf persons d. Those with minimal income e. Those who are cognitively impaired ANS: A, B, D Individuals who are eligible for SSI include those who are very old, disabled, visually impaired, and have minimal income or assets. Being deaf or cognitively impaired are not criteria.

DIF: Remembering (Knowledge) REF: Page 122 OBJ: 7-3 TOP: Communication and Documentation MSC: Safe Effective Care Environment 4. The nurse hears a news report about an older woman having her purse stolen. The assailant said, Give me your purse, old lady, or Ill kill you. What crimes have been committed? (Select all that apply.) a. Assault b. Battery c. Larceny

d. Robbery e. Burglary ANS: A, D Assault is the threat of harm. Robbery is taking property by force or threat of force. Battery is actually physically harming the victim. Larceny is a noncontact crime resulting in loss of property. Burglary is the taking of property while being in the victims residence, place of business, or automobile without authorization.

Chapter 5 Common Aging Changes MULTIPLE CHOICE 1. The nurse keeps the environment warmer for older adults because they are more sensitive to cold because of the age-related changes in their: a. metabolism rate. b. subcutaneous tissue. c. musculoskeletal system. d. peripheral vascular system.

ANS: B The reduction of subcutaneous tissue as an age-related change causes sensitivity to cold because it is the main insulator of the body.

DIF: Cognitive Level: Application REF: 36 OBJ: 1 TOP: Sensitivity to Cold KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse reassures the distressed 75-year-old male that the wartlike dark macules with distinct borders are not melanomas, but the skin lesions of:

a. senile lentigo. b. cutaneous papillomas. c. seborrheic keratoses. d. xerosis.

ANS: C Dark, slightly raised macules are seborrheic keratoses, which may be mistaken for melanomas.

DIF: Cognitive Level: Comprehension REF: 33 OBJ: 1 TOP: Seborrheic Keratosis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse is accompanying a group of older adults on a July 4th outing to monitor heat prostration. Older adults are intolerant of heat because of an age-related reduction of: a. melanin. b. perspiration. c. body temperature. d. capillary fragility.

ANS: B Reduction in perspiration related to reduced sweat gland function results in possible heat intolerance from an inability to cool the body by evaporation.

DIF: Cognitive Level: Analysis REF: 34 OBJ: 2 TOP: Heat Intolerance KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse cautions the CNAs to use care when transferring or handling older adults because their vascular fragility will cause: a. altered blood pressure.

b. pressure ulcers. c. pruritus. d. senile purpura.

ANS: D Increased capillary fragility results in subcutaneous hemorrhage or senile purpura from incautious handling by caregivers.

DIF: Cognitive Level: Comprehension REF: 34-35 OBJ: 7 TOP: Senile Purpura KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse assesses a stage I pressure ulcer on an older adults coccyx by the appearance of a: a. clear blister. b. nonblanchable area of erythema. c. scaly abraded area. d. painful reddened area.

ANS: B A red nonblanchable area is indicative of a stage I pressure ulcer.

DIF: Cognitive Level: Analysis REF: 35 OBJ: 5 TOP: Pressure Ulcer KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The CNA caring for an older adult asks if the yellow, waxy, crusty lesions on the patients axilla and groin are contagious. The nurses most helpful response is: a. Yes. It is cellulitis caused by bacteria. b. No. It is seborrheic dermatitis caused by excessive sebum. c. Yes. It is an indication of scabies.

d. No. It is the lesion seen with basal cell carcinoma.

ANS: B Seborrheic dermatitis is a bothersome skin condition resulting from an excess of sebum.

DIF: Cognitive Level: Application REF: 36 OBJ: 5 TOP: Seborrheic Dermatitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The nurse leads a group of postmenopausal older women on a daily 15-minute walking tour through the long-term care facility to: a. improve bone strength. b. orient them to their surroundings. c. improve their socialization. d. increase their appetite.

ANS: A Stress to long bones by weight-bearing and walking will increase bone strength.

DIF: Cognitive Level: Analysis REF: 36 OBJ: 7 TOP: Bone Strength KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. When the perplexed 70-year-old woman asks, How in the world can my bones be brittle when I eat all the right foods? the nurses most informative reply is: a. Calcium loss is expected in the older adult. b. Calcium is continuously withdrawn from bone for nerve and muscle function. c. Smoking and alcohol consumption speed calcium loss from the bones. d. Walking and standing increase calcium loss from the bone.

ANS: B Calcium is constantly withdrawn from the bone for nerve and muscle function and clotting needs.

DIF: Cognitive Level: Comprehension REF: 36-37 OBJ: 3 TOP: Calcium Loss KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. When the 70-year-old woman complains, I weigh exactly the same as I did when I wore a size 10 and now I can barely squeeze into a size 16, the nurse explains: a. Metabolism in the older adult creates increased adipose tissue. b. Postmenopausal women gain adipose tissue related to loss of calcium. c. Decrease in muscle mass is replaced with adipose tissue. d. Kyphosis causes a redistribution of weight.

ANS: C Decrease in muscle mass is replaced with adipose tissue, which frequently changes the appearance of the body, but not the weight.

DIF: Cognitive Level: Application REF: 39 OBJ: 4 TOP: Loss of Muscle Mass KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. When the 70-year-old postmenopausal woman asks whether her hormone replacement therapy (HRT) will prevent bone loss, the nurses most helpful response is: a. No. HRT is not helpful after the age of 60. b. Yes. HRT will prevent bone loss but can cause a stroke, heart attack, or breast cancer. c. No. HRT is reliant on some natural estrogen production from the ovaries. d. Yes. HRT is a widely accepted therapy for prevention of bone loss.

ANS: B HRT is helpful to prevent bone loss, but the risks of cardiovascular complications and cancer have made the choice of HRT controversial.

DIF: Cognitive Level: Analysis REF: 39 OBJ: 4 TOP: Hormone Replacement Therapy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. An 80-year-old-woman who has osteoarthritis complains of how ugly her hands have become since she has developed Heberden nodes, which are: a. yellow longitudinal lines in the nails. b. thickened discolored fingernails. c. darkened areas under the fingernail. d. bony enlargements of distal joints of the fingers.

ANS: D Heberden nodes are bony enlargements of the distal joints of the fingers associated with osteoarthritis.

DIF: Cognitive Level: Knowledge REF: 40 OBJ: 4 TOP: Heberden Nodes KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The nurse modifies the nursing care plan for a 62-year-old woman in an extended-care facility who is suffering a flare in her rheumatoid arthritis to include interventions to: a. increase fluid intake. b. schedule several rest periods to balance activity. c. reduce salt in the diet. d. assist with rigorous finger extension exercises.

ANS: B Balancing rest and activity allows the resident to remain relatively flexible. Joints may be splinted to reduce contracture.

DIF: Cognitive Level: Application REF: 40 OBJ: 5 TOP: Rheumatoid Arthritis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. The nurse explains that emphysema is a chronic obstructive pulmonary disease characterized by the pathophysiology of: a. constriction of the bronchial tree, excessive mucus, and nonproductive cough. b. calcification of the alveoli and a dry cough. c. overinflation of the alveoli, making them ineffective for gas exchange. d. inflammation of the trachea and bronchioles, excessive mucus, and productive cough.

ANS: C Emphysema causes overinflation of the nonelastic alveoli, which disallows gas exchange in the affected alveoli and results in reduced oxygenation.

DIF: Cognitive Level: Comprehension REF: 42 OBJ: 5 TOP: Emphysema KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. The nurse explains that the pathophysiology of a myocardial infarct is that: a. a portion of the myocardium necroses and scars over. b. the coronary vessels are narrowed during the attack. c. the ischemic myocardium causes pain during the attack but is able to regenerate. d. there is damage to the myocardium but no serious alteration of cardiac output.

ANS: A The myocardium necroses and scars and does not regenerate. The degree of heart damage is related to the amount of necrosis.

DIF: Cognitive Level: Comprehension REF: 46 OBJ: 6 TOP: Myocardial Infarct KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. The nurse is aware that the cardinal signs and symptoms of congestive heart failure are: a. dyspnea and edema. b. myocardial pain and hypotension. c. ventricular arrhythmias and cyanosis. d. atrial arrhythmias and polycythemia.

ANS: A Dyspnea and generalized edema are the cardinal signs and symptoms of congestive heart failure.

DIF: Cognitive Level: Application REF: 47 OBJ: 5 TOP: Congestive Heart Failure KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. The nurse explains that pernicious anemia is caused by: a. an iron deficiency. b. a deficiency of vitamin B12. c. inadequate nutrition. d. blood loss.

ANS: B Pernicious anemia results from a deficiency of vitamin B12.

DIF: Cognitive Level: Knowledge REF: 50 OBJ: 2 TOP: Pernicious Anemia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. The nurse alters the nursing care plan for a patient with a hiatal hernia and resultant gastrointestinal reflux to include interventions for: a. encouraging the patient to lie down after meals. b. drinking two full glasses of liquid after the evening meal. c. eating smaller, more frequent meals. d. using caffeine drinks to assist with digestion.

ANS: C Eating smaller and more frequent meals does not enlarge the stomach.

DIF: Cognitive Level: Analysis REF: 53 OBJ: 5 TOP: Hiatal Hernia KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 18. The nurse suspects that the pale, edematous, listless diabetic patient who has a blood urea nitrogen (BUN) level of 35 mg/dL and a creatinine level of 4 mg/dL has: a. diverticulitis. b. congestive heart failure. c. chronic renal failure. d. benign prostatic hypertrophy.

ANS: C The increased BUN and creatinine levels indicate renal failure.

DIF: Cognitive Level: Application REF: 56 OBJ: 6

TOP: Renal Failure KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. The most appropriate intervention added to the nursing care plan for a person with Parkinson disease with a nursing diagnosis of Nutrition, less than body requirements related to difficulty swallowing, would be to: a. feed the patient at each meal. b. place the patient in a semi-Fowler position for mealtime. c. offer a thick, high-nutrition shake as a snack. d. encourage the patient to drink a sip of water after each bite of solid food.

ANS: C Thick shakes are easier to swallow without aspiration and will also improve nutrition.

DIF: Cognitive Level: Application REF: 58 OBJ: 5 TOP: Parkinson Disease KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 20. The nurse would anticipate that a person with a hemorrhagic CVA to the left hemisphere would exhibit: a. language disturbances. b. poor impulse control. c. inappropriate affect. d. confabulation.

ANS: A A left hemisphere CVA would most likely cause language disturbances such as aphasia, agraphia, or alexia.

DIF: Cognitive Level: Analysis REF: 61 OBJ: 5

TOP: Cerebrovascular Accident KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 21. When giving written discharge instructions to a person with macular degeneration, the nurse should: a. write the instructions in bold print. b. adjust the table and light to assist the patient to use peripheral vision to read. c. place written document directly in front of the patient to read. d. read the document to the patient.

ANS: B Assist the patient to use peripheral vision because central vision is lost in macular degeneration.

DIF: Cognitive Level: Analysis REF: 64 OBJ: 5 TOP: Macular Degeneration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. The nurse becomes aware of inadequate insulin coverage in a patient with diabetes mellitus type 1 when the patient exhibits: a. diminished urine output. b. ketones in the urine. c. shallow and slow respirations. d. extreme diaphoresis.

ANS: B When there is inadequate insulin coverage for the type 1 diabetic, the diabetic lacks the glycogen to use as energy and attempts to use fat, which creates an acid in the form of ketones.

DIF: Cognitive Level: Application REF: 70 OBJ: 5 TOP: Diabetes Mellitus Type 1 KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. An 80-year-old extended-care resident comes to the nurse asking for a bandage for a bleeding, dark pigmented mole with irregular shape and border. The nurse documents this assessment and reports it as a suspected: a. melanoma. b. basal cell carcinoma. c. cutaneous papilloma. d. senile lentigo.

ANS: A Melanomas are dark, irregularly shaped lesions that may cause itching or bleeding. These are potentially deadly and should be reported to obtain quick treatment.

DIF: Cognitive Level: Comprehension REF: 35 OBJ: 5 TOP: Melanoma KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease MULTIPLE RESPONSE 1. The nurse takes into consideration that the factors influencing the timing and extent of agerelated changes include __________. (Select all that apply.) a. health maintenance b. ethnicity c. heredity d. attitude e. environment ANS: A, C, E Heredity, environment, and health maintenance affect the timing and magnitude of age-related changes.

DIF: Cognitive Level: Comprehension REF: 32 OBJ: 1 TOP: Influences on Age-Related Changes KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse reminds an 82-year-old man with rosacea that he should avoid __________. (Select all that apply.) a. stress b. dairy products c. sun exposure d. spicy foods e. alcohol consumption ANS: A, C, D, E The patient who has rosacea should avoid stress, sun exposure, spicy foods, and alcohol consumption.

DIF: Cognitive Level: Comprehension REF: 35 OBJ: 5 TOP: Rosacea KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 3. The nurse is aware that in order for a person to support ossification, he or she must have an adequate intake of vitamin(s) __________. (Select all that apply.) a. A b. B6 c. C d. D e. E ANS: A, C, D

Vitamins A, C, and D are necessary for bone matrix formation and replenishment.

DIF: Cognitive Level: Knowledge REF: 36 OBJ: 7 TOP: Ossification KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 4. The nurse uses a chart to outline the risk factors for osteoporosis, which include __________.

(Select all that apply.) a. menopause b. smoking c. white female d. excessive high-impact exercise e. long-term use of phenytoin (Dilantin) ANS: A, B, C, E Menopausal white women who smoke and have had long-term administration of phenytoin (Dilantin), heparin, or corticosteroids are at risk for osteoporosis.

DIF: Cognitive Level: Comprehension REF: 39 OBJ: 5 TOP: Risk Factors for Osteoporosis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse outlines age-related changes in the respiratory system that put the older adult at risk for infection, which include __________. (Select all that apply.) a. reduced ciliary movement b. decrease in alveolar elasticity c. pooling of secretions d. flattened diaphragm e. calcification of costal cartilage ANS: A, B, C

The flattening of the diaphragm and the calcification of cartilages decrease respiratory effectiveness but do not support pathogen growth as do ciliary and alveolar changes.

DIF: Cognitive Level: Comprehension REF: 42 OBJ: 1 TOP: Age-Related Changes in the Respiratory System KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation COMPLETION 1. The nurse is aware that children with __________ have the treatment and care needs of persons of advanced age.

ANS: progeria A rare condition called progeria causes severe premature aging. When they are only 8 or 9 years of age, children with progeria have the physiology and appearance of 70-year-olds.

DIF: Cognitive Level: Knowledge REF: 32 OBJ: 7 TOP: Progeria KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The 75-year-old resident in a long-term care facility complains of muscle pain while riding a stationary bicycle. The nurse explains that the discomfort is related to the buildup of __________ __________ in the muscle.

ANS: lactic acid Elevated levels of lactic acid may result in muscle fatigue and soreness.

DIF: Cognitive Level: Comprehension REF: 38 OBJ: 7 TOP: Lactic Acid Buildup KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. When a 75-year-old male resident in an extended-care facility tells the nurse he wants to build up the muscles in his arms, the nurse recommends a(n) __________ exercise program.

ANS: isotonic Isotonic exercises such as flexing and extending the arms while holding hand weights build tone and muscle mass.

DIF: Cognitive Level: Comprehension REF: 38 OBJ: 4 TOP: Isotonic Exercises KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation OTHER 1. Arrange these common diseases of the older adult in order of their mortality rate. a. Cancer b. Pneumonia c. Stroke d. Chronic obstructive pulmonary disease (COPD) e. Heart disease ANS: E, A, C, B, D The five leading causes of death in older adults are heart disease, cancer, stroke, pneumonia, and COPD.

Chapter 6 The Specialty of Gerontological Nursing

MULTIPLE CHOICE 1. Which option refers to the highest level of human functioning according to Maslow? a. Biological and physical integrity b.Safety and security c. Self-esteem d.Self-actualization ANS: D According to Maslow, persons whose basic physical needs are met, who feel safe and secure, and who possess self-esteem and self-efficacy can achieve self-actualization, reaching out beyond themselves to make their lives meaningful.

Biological and physical integrity is the lowest level in Maslows hierarchy, below safety and security. Safety and security are the second-lowest level, below self-esteem. Self-esteem is the second-highest level, below self-actualization.

PTS:1DIF:RememberREF:5-6 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 2. A man is terminally ill with end-stage prostate cancer. Which is the best statement about this mans wellness? a. Wellness is possible in the management of his medical care. b.Wellness is unfortunately not a real option for this client. c. Wellness is the same thing as faith healing, and if the client would be more receptive, then he could be back at work in a few weeks. d.Nursing interventions can help empower a client to achieve a higher level of wellness.

ANS: D Nursing interventions can help empower a client to achieve a higher level of wellness; a nurse can foster wellness at all levels of the needs hierarchy.

Wellness is possible even if the client assists in the management of his medical care; an individual must work hard to achieve wellness, similar to a job. Wellness is unfortunately not a

real option for this client; however, all persons, regardless of age or life-health situations, can be helped to achieve a higher level of wellness. Wellness is the same thing as faith healing, and if the client would be more receptive, then he could be back at work in a few weeks; biomedical approaches and other treatments and techniques are used to achieve realistic improvements in wellness.

PTS: 1 DIF: Apply REF: 4-5 TOP: Nursing Process: Diagnosis MSC:Health Promotion and Maintenance 3. In differentiating between health and wellness in health care, which of the following statements is true? a. Health is a broad term encompassing attitudes and behaviors. b.The concept of illness prevention was never considered by previous generations. c. Wellness and self-actualization develop through learning and growth. d.Wellness is impossible when ones health is compromised.

ANS: A Health is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves ones whole being.

The concept of illness prevention was never considered by previous generations; throughout history, basic self-care requirements have been recognized. Wellness and self-actualization develop through learning and growthas basic needs are met, higher-level needs can be satisfied in turn, with ever-deepening richness to life. Wellness is impossible when ones health is compromisedeven with chronic illness, with multiple disabilities, or in dying, movement toward a higher level of wellness is possible.

PTS: 1 DIF: Understand REF: 4 TOP: Nursing Process: Evaluation MSC:Health Promotion and Maintenance 4. Which cultural group is predicted to have the fastest growing older adult population in the United States between the years 2010 and 2050? a. Native Americans

b.African Americans c. Hispanic Americans d.Asian/Pacific Island Americans ANS: C As shown in Figure 1-1, the Hispanic older adult population is projected to be the most rapidly increasing population segment between 2010 and 2050.

The older adult populations of all other races, combined, do not rise as rapidly as the Hispanic older adult population between the years 2010 and 2050. The African-American older adult population is expected to have the second-fastest rise between 2010 and 2050. The non-Hispanic white older adult population is projected to decrease between 2010 and 2050.

PTS:1DIF:UnderstandREF:Figure 1-1 on page 3.

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 5. Historical influences that have shaped the lives of the majority of the middle-old population in the United States today include which of the following? a. Influenza epidemic of 1918 b.Immigration from communist Europe c. Child rearing in the Depression d.World War II ANS: D Those who are middle-old in 2005 were in their teens and 20s during World War II; in particular, the men were likely to have fought in it.

A person who survived the influenza epidemic would be at least 87 years old in 2005 and therefore would be considered old-old or a centenarian. Those who are middle-old in 2005 were born between 1920 and 1930, before communism swept Europe. Most of those who are middleold in 2005 had not reached childbearing age by the end of the Depression.

PTS:1DIF:UnderstandREF:2-3

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 6. The nurse prepares for the arrival of older adults evacuated from a hurricane to a shelter for short-term care. Which of the following is the priority nursing intervention? a. Demonstrate that the staff is prepared to meet their needs. b.Use individual medical records to develop a medication plan. c. Help older adults display family photographs and memorabilia. d.Help older adults teach one another a new skill in the shelter.

ANS: B The nurse prepares for short-term care by prioritizing the needs of the older adults, and this intervention helps maintain the therapeutic plan, thereby addressing the need for physiological integrity. Furthermore, the nurse maintains continuity of care by preparing a medication schedule to prevent missed doses of medication. Providing safety and security from the storm is Maslows second most basic need.

In emergency conditions, the nurse provides basic care relating to safety, security, and physical well-being. Maintaining a sense of belonging is important but not in emergency conditions. A state of emergency is not the time to develop self-esteem; meeting safety, security, and physical needs are more important.

PTS:1DIF:AnalyzeREF:5-6 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 7. According to researchers, which characteristic will most centenarians share in the future? a. Female b.Demented c. Malnourished d.Wheelchair bound ANS: A Researchers expect women to make up the majority of centenarians in the future.

Gerontologists expect dementia to be common among older adults, but they are not predicting most centenarians will have dementia. Malnutrition is common among older adults, but researchers have not predicted that most centenarians will be malnourished. Decreased mobility is common among older adults, but researchers have not predicted that most centenarians will be confined to a wheelchair.

PTS:1DIF:RememberREF:2 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 8. Which statement describes aging in developing countries? a. Aged dependence is likely to improve from 1:4 to 1:2. b.The biggest problem for older adults will be the lack of food. c. Most older adults are likely to reside in these countries. d.Similar to fertility, life expectancy is increasing, although at a different rate.

ANS: C Currently, developing countries already contain two thirds of the worlds older adult population.

Aged dependence is likely to deteriorate from 1:4 to 1:2. The biggest problem of the worlds oldest adults is most likely to be a lack of regular income. Life expectancy is increasing, but fertility is decreasing worldwide.

PTS:1DIF:UnderstandREF:2-5 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 9. An older woman tells the nurse that she has experienced increasing fatigue and shortness of breath over the last 2 days. Which goal is the nurses priority? a. Promote safety to prevent injury. b.Complete nutritional assessment. c. Balance exercise and rest periods. d.Explore the womans complaints.

ANS: D

Investigating the complaint is the nurses priority; fatigue and shortness of breath can indicate cardiac disease, especially in women. Women with cardiac disease often exhibit atypical symptoms, and because it tends to be treated less aggressively in women, the nurse must be careful not to miss indicators of potential cardiac disease. In addition, in investigating the older womans chief complaint, the nurse investigates all possible causes.

Promoting safety and preventing injury are reasonable goals to include for this adult but are not as important as investigating the chief complaint; breathing and circulation are two of the three most important physical needs. Completing the nutritional assessment for this adult is reasonable because the symptoms can be related to nutritional deficiencies; however, this assessment should be a part of the examination of the chief complaint. Balancing rest and exercise is a reasonable approach to a complaint of fatigue and shortness of breath if the adult is deconditioned; however, the nurse must investigate the chief complaint to determine whether deconditioning is a factor.

PTS: 1 DIF: Analyze REF: 5-6 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment 10. The nurse develops a community program to promote exercise for older adults. Which should the nurse include in the exercise program? a. Reinforce the ease of exercising every day. b.Use exercise to relax any dietary restrictions. c. Describe ways to resume exercise after lapses. d.Participate because exercise achieves wellness.

ANS: C Because the path to wellness includes progression, as well as regression, the nurse shares information to help participants anticipate these events. The nurse encourages participants by telling them to expect periods of regression; he or she emphasizes that progress made up to a point is not lost and explains how to approach resumption in progress toward wellness with exercise.

The nurse tells the participants that achieving wellness takes work and regular effort. Rather than offering false hope, the nurse shares practical advice about how to incorporate exercise into everyday life. The nurse avoids suggesting that adults can look forward to relaxing dietary or

medical restrictions by using a single method; it is unethical to offer false hope, the plan can be ineffective, and the plan can have adverse effects. The nurse avoids instructing adults to rely on one method of achieving wellness; wellness is achieved by balancing emotional, spiritual, social, cultural, and physical processes.

PTS: 1 DIF: Apply REF: 4-6 TOP: Nursing Process: Planning MSC:Health Promotion and Maintenance 11. Which describes the older man who is likely to experience the best overall health and wellbeing? a. Resides in assisted-living facility, watches television alone, uses herbal remedies, is underweight b.Resides alone, was moved to a new city recently by his family members for their convenience, has osteoarthritis c. Has prostate cancer with metastasis to the lungs, is receiving radiation therapy, is wealthy, has a large family d.Uses a wheelchair, has peripheral arterial disease, attends weekly baseball games with three friends ANS: D Despite a serious chronic illness and mobility restrictions, this older man has a social network and planned activities with friends. Further, he overcomes mobility issues to pursue personal interests; thus this person is most likely to experience the best health and well-being because of an optimal functional status.

This older adult is not thriving in an assisted-living facility, despite having other people in the facility, as evidenced by television viewing habits and weight, both potential indicators of depression. Various aspects of this persons life are unbalanced, thus inhibiting progress on the path to optimal health and wellness. In addition, the use of herbal remedies can be aggravating or precipitating the problems. After a move to a new region, an older adult, especially one who lives alone and is moved to a new area for the familys convenience, is likely to experience loneliness and isolation until a new social network is established. Although this person has a less acute health problem, the social isolation is likely to create significant disruption on the path to health and wellness. Although this older adults financial resources are plentiful, the existence of

a large family does not ensure any type of psychosocial support. Most likely, this person faces a grim prognosis because the prostate cancer has crossed the diaphragm, thus reducing the likelihood of a prolonged life.

PTS:1DIF:AnalyzeREF:4-6 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 12. Which nursing intervention is a holistic approach to an older adult? a. Performs glucose testing during the weekly worship service. b.Wheels ambulatory adults to exercise when running late. c. Assigns female nurses to older women who are Islamic. d.Allows older adults in a nursing home to eat meals alone.

ANS: C The nurse uses a holistic approach to the care of an older female adult who is Islamic because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture.

Interrupting an older adults worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older adults life by testing for glucose before the service begins. In transporting ambulatory adults to the exercise program in a wheelchair to save time, the nurse disregards the need for self-esteem and exercise, both important aspects of physical well-being. Ambulatory adults can walk with assistance, if needed, to exercise programs and can benefit from the additional activity and independence. The nurse can be tempted to allow an older adult to eat meals alone in his or her room if this will motivate the person to eat or if the older adult has dysphasia and is embarrassed. However, while focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being.

PTS: 1 DIF: Understand REF: 4 TOP: Nursing Process: Evaluation MSC:Health Promotion and Maintenance

13. An older man who resides in a nursing home has total cholesterol of 245 mg/dl. Which nursing intervention is most likely to assist this man in achieving his highest level of wellness? a. Instruct him about increasing dietary fiber. b.Ask the health care provider for a low-fat diet. c. Schedule a consultation for him with the dietitian. d.Review a menu with him to choose suitable foods.

ANS: D The nurse collaborates with the older adult to choose suitable foods, which is likely to be an effective nursing intervention to help an older adult with hyperlipidemia achieve optimal health and well-being; it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol.

Informing the older man about dietary fiber offers no control to him because he is not part of the decision. Nursing interventions developed with the older adults collaboration are most likely to help the older adult achieve health and wellness. Collaborating with the health care provider for a low-fat diet is a reasonable approach to help this man with hyperlipidemia achieve health and wellness. However, he is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has had some control. Scheduling a consultation with a dietitian is a reasonable approach to an older adult with hyperlipidemia and is a part of a multifaceted approach to optimizing his health. However, the older adult is more likely to engage in a regimen over which he has input.

PTS: 1 DIF: Analyze REF: 4-6 TOP: Nursing Process: Planning MSC:Health Promotion and Maintenance 14. Which approach requires the nurse to integrate and balance all aspects of an individuals life into the plan of care? a. Holistic nursing b.Healthy People 2020 c. Maslows Hierarchy of Human Needs d.Orems Self-Care Requirements ANS: A

Holistic nursing integrates all aspects of an individuals life into the plan of care by balancing an individuals internal and external environment with psychosocial, spiritual, cultural, and physical processes.

Healthy People 2020, an updated document from 2000 that outlines the goals for achieving health in this country, is a mandate for health care professionals to follow with 467 objectives in 28 focus areas. Maslows Hierarchy of Human Needs provides a basis for understanding individuals in context and for ranking nursing assessments, diagnoses, goals, and interventions in order of importance. Dorothea Orems Self-Care Requirements lists human needs, including the need for air, fluids, nutrition, hygiene, elimination, activity, comfort, relief from suffering, and skin integrity. The nurse helps individuals meet these needs to achieve optimal health and wellness.

PTS:1DIF:RememberREF:4 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 15. An older man living in an adult community becomes a widower 1 month after retirement.

Two months later, he has not resumed a weekly outing with his fishing club. Which should the nurse implement? a. Ask the older adult why he is not fishing. b.Have club members visit him at home. c. Meet with him to assess his interests. d.Enroll him in a weekly card game.

ANS: C The nurse meets with the older adult to determine how and when to establish new relationships and social activities in light of his wifes death. Although the older man was engaged in fishing before, the nurse respects his wishes and needs as he transitions to a different life.

The nurse avoids confronting him, even if done so in a gentle manner. Why questions can be interpreted as confrontational, and the older adult may be unable or unwilling to articulate a reason. The nurse avoids asking club members to visit him because doing so would remove the older adult from the decision making process. Although this effort can be well-meaning, it can also be interpreted as an invasion of privacy. The older adult is more likely to participate in an

activity in which he has input. In addition, the nurses action can be interpreted as disrespectful because an adult has the right to control his own life.

PTS:1DIF:ApplyREF:4-6 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 16. The nurse plans activities for older women born between 1920 and 1930 and who reside in an assisted-living facility. Which is the best intervention for the nurse to implement? a. Have them bake cookies twice a week. b.Conduct interviews for specific interests. c. Arrange dog and cat visits from volunteers. d.Take them to the library for guest speakers.

ANS: B The nurse conducts individual interviews with the women to determine their interests and to avoid generalizing; as people live longer, they become more and more unique.

Because most of these women are in their 80s, were born between 1920 and 1930, and have generally spent their lives as homemakers, the nurse presumes to know what activities they will enjoy. The nurse avoids arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older adult to a pet visit. Unless it is organized on a voluntary basis, the nurse avoids arranging visits by guest speakers. In addition, the nurse will assess each older woman before an outside visit to avoid embarrassing events including incontinence and hearing and vision problems.

PTS:1DIF:AnalyzeREF:2-3| 4-6 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 17. Which are the major factors influencing the experience of aging? a. Health, history, and sex b.Self-care needs and culture c. Self-fulfillment and self-esteem d.Society, culture, and marital status

ANS: A Health, history, and sex are major factors influencing the aging experience and interact to make each cohort distinctive.

Culture is a major influence on the experience of aging and contributes to the uniqueness of a cohort; however, self-care needs are basic human needs and contribute to the similarities between cohorts. Self-fulfillment and self-esteem are higher-level human needs on Maslows hierarchy and denote similarities between cohorts. Society and culture are major influences on the aging experience, but marital status is not.

PTS:1DIF:RememberREF:2-3 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment MULTIPLE RESPONSE 1. The nurse plans the care for an older man who has Medicare, lives on Social Security and a small pension, and has type 2 diabetes mellitus. Which aspect(s) of this man should the nurse integrate into a positive approach to his health and well-being? (Select all that apply.) a. Pays for some diabetic supplies. b.Enjoys regular physical activity. c. Practices effective glucose control. d.Lives alone in a high-rise apartment. e. Lacks low-cost, reliable transportation. f. Attends weekly dinner club for diabetics.

ANS: B, C, F The enjoyment of physical activity is a positive aspect of this man and thus can be included in the nurses plan because he already incorporates an important part of diabetic care into his life and, potentially, enjoys the health benefits of exercise. Practicing effective glucose control demonstrates this mans resilience and capacity to manage effectively the challenges associated with a chronic illness and thus is a strength the nurse can use in a positive approach toward his health and well-being. This man has a social network that helps him to live with diabetes and to

prevent the long-term complications of diabetes. This is a definite strength the nurse uses to help him achieve his optimal health and well-being.

With limited financial resources, paying for some of his diabetic supplies is a burden to overcome and cannot be used in a positive approach toward health and well-being. Living alone is not ideal for an older adult, especially one with diabetes, because of the potential for loneliness and complications from diabetes such as hypoglycemia. Living alone is a negative aspect of this mans life and one which has to be resolved for his safety and well-being. The nurse cannot include this mans transportation issues into a positive plan; the lack of reliable transportation is a problem to overcome and not a strength on which to capitalize.

Chapter 7 Holistic Assessment and Care Planning MULTIPLE CHOICE 1. The geriatric nurse recognizes that the bodys homeostatic mechanisms may be compromised in the: a. 79-year-old with moderate Alzheimer disease who requires assistance with all activities of daily living (ADLs). b. 73-year-old with a history of chronic bronchitis who lives with family. c. 86-year-old who lost a spouse and is moving into an assisted living facility. d. 69-year-old with peripheral vascular disease who is visited by home health care weekly.

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

DIF: Analyzing (Analysis) REF: N/A OBJ: 4-2 TOP: Nursing Process: Diagnosis MSC: Physiologic Integrity 2. To best minimize patient anxiety and help ensure a successful history assessment interview, the geriatric nurse first: a. asks whether the patient has any questions about the interview. b. makes sure the interview area is comfortable and private. c. explains the reason for asking the questions. d. assures the patient that all answers will be kept confidential.

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

DIF: Applying (Application) REF: N/A OBJ: 4-1 TOP: Nursing Process: Implementation MSC: Emotional Needs Related to Health Problems 3. An older patient is admitted for bacterial pneumonia. The only abnormal assessment values include a heart rate of 102 beats per minute, slight cyanosis of the nail beds, and mild confusion.

The patients daughter questions the possibility of pneumonia stating, He isnt coughing or having any difficulty breathing. The nurse responds most appropriately by saying: a. We are lucky to determine the problem in its early stage. b. Respiratory problems develop only after the infection is well established. c. People your dads age often lack the muscular strength to cough. d. Older adults frequently lack the typical signs of a respiratory infection.

ANS: D

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

DIF: Understanding (Comprehension) REF: Page 57 OBJ: 4-2 TOP: Teaching-Learning MSC: Physiologic Integrity 4. A nurse aide working in the geriatric units dining room tells the nurse that a patient who was oriented to time and place this morning is now confused about what day it is and why shes here.

The nurse appropriately directs the nurse aide to: a. take the patient back to her room and put her safely in bed. b. place a falls risk identification bracelet on the patient and add the status care plan. c. immediately take the patients vital signs and report them to her. d. reorient the patient to time and place frequently and document the patients response.

ANS: C A sudden change in an older adult patients cognitive status is likely a symptom of a physiologic stressor such as an infection. The vital signs will allow the nurse to determine the presence of a fever or other deviation from the patients baseline vitals. The patient may or may not need or wish to go to bed, but this does not provide any data for the nurse to evaluate. An ill patient may need to be on fall precautions, but again this does not provide data. Reorientation may be necessary, but if the patient has an illness, this needs to be taken care of.

DIF: Applying (Application) REF: N/A OBJ: 4-2 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 5. The nurse most effectively implements guided reminiscence during a patient interview by: a. reminding the patient to share important memories of the past.

b. scheduling several short interviews rather than one long one. c. controlling the interview by selecting the memories to be discussed. d. encouraging the patient to relive his or her memories while maintaining focus.

ANS: D This goal-directed interviewing process helps the patient share pertinent information through remembering. The tendency to reminisce may make it difficult for the patient to stay focused on the topic, so it is the nurses responsibility to refocus the interview when necessary. Reminding the patient to share memories, using several short interviews, and controlling the interview do not make best use of this technique.

DIF: Applying (Application) REF: N/A OBJ: 4-4 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 6. To establish a mutually respectful relationship with an older adult patient being admitted to a skilled nursing unit, the nurse first introduces himself and then asks: a. how the patient would like to be addressed. b. if the patient has any specific requests to make of the staff. c. the patient to share a little about his or her personal likes and dislikes. d. the patient to read the orientation materials that the facility provides.

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

DIF: Applying (Application) REF: N/A OBJ: 4-4 TOP: Integrated Process: Caring MSC: Psychosocial Integrity

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

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

DIF: Applying (Application) REF: N/A OBJ: 4-4 TOP: Nursing Process: Assessment MSC: Communication and Documentation 8. An older patient is being admitted to a long-term care facility. The nurse recognizes that the primary purpose of the initial geriatric health assessment is to: a. identify the patients physiologic baselines. b. ultimately create a plan of care that prevents disability and dependence. c. initiate the therapeutic nurse-patient relationship. d. document self-care deficiencies that the patient exhibits.

ANS: B Specifically, the purpose of older adult assessment is to identify patient strengths and limitations so that effective and appropriate interventions can be delivered to support, promote, or restore optimum function and to prevent disability and dependence. Physiologic baseline, therapeutic

nurse-patient relationship, and self-care deficits are all important aspects of the assessment but not the major purpose for it.

DIF: Remembering (Knowledge) REF: Page 55 OBJ: 4-8 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 9. A 76-year-old postsurgical diabetic patient has reported feeling dizzy and clammy. The daily serum glucose level shows the patients levels to be within normal limits. The geriatric nurse shows an understanding of established health norms for the older adult when stating: a. This patients normal may not be within the typical lab norms. b. Ill ask the lab to rerun the test so we can double-check the results. c. There must be another reason for the symptoms. d. Ill compare the patients baseline lab work with todays results.

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

DIF: Understanding (Comprehension) REF: Page 56 OBJ: 4-1 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity 10. A patient is being admitted after a fall that has caused a painful leg injury. In preparing to interview the patient for a health history, the nurse is initially concerned that: a. the family should be present to help answer questions. b. a therapeutic nurse-patient relationship should be established. c. the patient should be free of hearing and vision barriers. d. the patients pain should be effectively managed.

ANS: D

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

DIF: Application (Apply) REF: N/A OBJ: 4-5 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 11. The nurse has administered the Apgar screen tool to assess an older patients family function status. Upon determining that the family functions at a 4, the nurse: a. prepares to administer a more detailed tool. b. prepares to report reasonable suspicion of elder abuse. c. asks the patient to identify specific family members to include in care planning sessions. d. notifies social services that the family is not likely to be of much support to the patient.

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

DIF: Analysis (Analyze) REF: N/A OBJ: 4-9 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 12. The geriatric nurse admitting a patient to an assisted living facility recognizes the importance of tools such as the Katz and the Barthel indexes because of the impact they have on: a. planning the amount of help the patient will need with ADLs. b. the patients ability to be realistic about achieving independence. c. creating an appropriate, patient-specific nursing care plan. d. appropriate staffing to ensure the safety needs of the patients are met.

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

DIF: Analysis (Analyze) REF: N/A OBJ: 4-9 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 13. An older patient is reluctant to report multiple vague signs and symptoms, including lethargy, incontinence, and weight loss that have persisted for 6 weeks. The nurse recognizes that such symptoms place the patient at great risk for: a. viral infection. b. disorientation. c. malnutrition. d. physical frailty.

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

DIF: Remembering (Knowledge) REF: Page 56 OBJ: 4-7 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 14. An older patient is hospitalized after a fall that resulted in a fractured left ankle. By day 4 of the hospitalization, which includes reduction of the fracture and analgesic drug therapy, the patient has become mildly disoriented and is incontinent of urine. The nurse explains to the family that these symptoms reflect the:

a. relationship between aging and both physical and psychosocial responses to trauma. b. response exhibited by many older adults who are hospitalized. c. effects of stress-induced perceptual deficits often seen in the hospitalized older adult. d. results of the pharmacologic pain control therapy.

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

DIF: Understanding (Comprehension) REF: Page 56 OBJ: 4-2 TOP: Teaching-Learning MSC: Physiologic Integrity 15. When unsure about how to address older patients with advanced stage Alzheimer disease, the nurse recognizes that it is best to address the patient by: a. a pet name, because the patients are not likely to respond to their given names. b. the first name, to foster a friendly, relaxed atmosphere. c. the full name, to show respect for the patients as individuals. d. a childhood nickname, because long-term memory will likely still be intact.

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

DIF: Application (Apply) REF: N/A OBJ: 4-4 TOP: Caring MSC: Psychosocial Integrity

16. A nurse is working with an older patient in the gerontology clinic. The patient reports a vague decline in function and says, I guess Im just getting older. What action by the nurse is best? a. Help the patient find ways to cope with the changes. b. Assess the patient for an undetected illness. c. Ask if the patient needs any home health services. d. Find out what the patient thinks of these changes.

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

DIF: Applying (Application) REF: N/A OBJ: 4-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 17. The nurse admitting a debilitated patient to a long-term care facility initially assesses the patient using the Katz Index. The student asks why the nurse chose that tool. What answer by the nurse is best? a. It is quick and simple for a baseline. b. The Katz Index is mandated by Medicare. c. It is comprehensive in nature. d. It shows functioning in 12 areas.

ANS: A The Katz Index takes only about 5 minutes to complete and rates patients as to whether they are totally independent or dependent in six basic functions. For the debilitated patient who will tire

easily, this is the best choice. It is not mandated by Medicare, it is not as comprehensive as other tools, and it only shows functioning in 6 areas.

DIF: Understanding (Comprehension) REF: Page 71 OBJ: 4-9 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 18. A nurse assesses a patient using the Barthel Index and scores the patient as a 98. What inference does the nurse draw from this assessment? a. The patient is nearly dependent in all areas measured. b. The patient is able to live independently. c. The patient is close to independent in the areas measured. d. The patients cognitive status impaired the assessment.

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

DIF: Applying (Application) REF: N/A OBJ: 4-9 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 19. The staff members in a long-term care facility have noted a decline in cognitive function in one of the residents; however, each time the resident is given the Short Portable Mental Status Questionnaire (SPMSQ), the score does not change. What action by the nursing manager is best? a. Provide in-service education on using this tool. b. Conduct the assessment him- or herself c. Switch to a different screening tool d. Determine that no changes have occurred.

ANS: C

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

DIF: Applying (Application) REF: N/A OBJ: 4-10 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 20. The nurse has used the Yesavage Geriatric Depression Scale (short form) and scored the patient at a 1. What is the nurses best action? a. Refer the patient to a mental health practitioner. b. Assess the patient further for depression. c. Ask the patient about using antidepressant medications. d. Document findings in the patients medical record.

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

DIF: Applying (Application) REF: N/A OBJ: 4-10 TOP: Nursing Process: Assessment MSC: Psychologic Integrity 21. A nurse is conducting an admission interview with an older patient admitted to a long-term care facility. When the nurse asks about the patients former occupation, the patient states, What do you care? I am long retired! What response by the nurse is best? a. Your job may have exposed you to some health hazards. b. It helps me get to know you and your background better. c. We have several clubs here you might be interested in. d. No real reason, its just part of our admission interview.

ANS: A

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

The question does help the nurse get to know the patient and maybe offer some activities he or she would most likely be interested in, but thats not the main reason for the question. Saying there is no reason to ask the question puts the entire admission interview under suspicion for being irrelevant.

DIF: Understanding (Comprehension) REF: Page 66 OBJ: 4-6 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE 1. A nurse who cares for older adults recognizes which of the following clinical features associated with dementia? (Select all that apply.) a. Failing to remember his or her room number b. Becoming increasingly disoriented at night c. Working on jigsaw puzzles for hours at a time d. Often referring to a cup as a canyon e. Misunderstanding when told its raining cats and dogs ANS: A, D, E Clinical features of dementia are associated with cognitive deficiencies such as forgetfulness, lack of inquiry, inability to correctly associate proper words to objects, and concrete thinking.

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

(Select all that apply.) a. Sleep disorders b. Problems with eating

c. Incontinence d. Falls e. Social situations ANS: A, B, C, D SPICES stands for sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown.

Chapter 8 Legal Aspects of Gerontological Nursing MULTIPLE CHOICE 1. A nurse caring for older adult patients shows an understanding of the implementation of standards of care when: a. dialing the telephone when the patient wants to call his daughter. b. requesting the patients favorite dessert on his birthday. c. closing the patients door when he is praying. d. reminding the patient to call for assistance before getting out of bed.

ANS: D A standard of care is a guideline for nursing practice and establishes an expectation for the nurse to provide safe and appropriate care, such as reminding the patient to call for assistance before getting out of bed. Standards of care may be established on national or regional levels. Dialing the phone for the patient, closing the patients door, and requesting a special dessert are not actions that conform to standards of care.

DIF: Applying (Application) REF: N/A OBJ: 3-1 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment

2. A nurse new to geriatric nursing asks the nurse manager to clarify how to handle a patients claim that she has been physically abused. The nurse manager responds most appropriately when stating: a. Ill show you where you can find this states reporting requirements. b. As a nurse you are considered a mandated reporter of elder abuse. c. As long as you are reasonably sure abuse has occurred, report it. d. You need to report any such claims directly to me.

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

DIF: Applying (Application) REF: N/A OBJ: 3-8 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 3. The nurse recognizes that a nursing aide likely to abuse an older patient is one who has: a. ineffective verbal communication skills. b. little experience working with the older population. c. poor stress management skills. d. been a victim of abuse.

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

DIF: Remembering (Knowledge) REF: Page 32 OBJ: 3-8 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment 4. An older adult resident of a long-term care nursing facility frequently attempts to get out of bed and is at risk of sustaining an injury. The nurses planned intervention to minimize the patients risk for injury is guided by: a. the patients right to self-determination and to be free to get out of bed. b. an understanding that nondrug interventions must be tried before medications. c. the knowledge that application of a vest restraint requires a physicians order. d. the patients cognitive ability to understand and follow directions.

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

DIF: Remembering (Knowledge) REF: Page 35-6 OBJ: 3-7 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 5. During the state inspection of a skilled nursing facility, a surveyor notes suspicion that a particular nurse may not be providing the proper standard of care. The nurse manager informs the nurse to expect: a. a review of the situation by the state board of nursing. b. termination of employment from the facility. c. mandatory remediation related to the suspect care issues. d. unannounced reevaluation of performance within the next 3 months.

ANS: A In such cases, the surveyor may forward the record showing the relevant findings to the appropriate state agency or board for review of the nurses practice, requesting a determination of whether the nurse may have violated the states nurse practice act. Regulations do not specify that the nurse be terminated, have remediation, or have an unannounced reevaluation.

DIF: Understanding (Comprehension) REF: Page 37 OBJ: 3-1 TOP: Communication and Documentation MSC: Safe and Effective Care Environment 6. An 87-year-old patient is unsure of the purpose of a living will. The nurse describes its purpose best when stating: a. Its a legal document that Social Services can help you create. b. It designates a family member to make decisions if you become incompetent. c. It provides a written description of your wishes in the event you become terminally ill. d. It assures you wont be subjected to treatments you dont want.

ANS: C Living wills are intended to provide written expressions of a patients wishes regarding the use of medical treatments in the event of a terminal illness or condition.

DIF: Understanding (Comprehension) REF: Page 39 OBJ: 3-10 TOP: Teaching-Learning MSC: Safe and Effective Care Environment 7. The nurse is caring for an unresponsive patient who has terminal cancer with a Do Not Resuscitate order in effect. A family member tells the nurse, Ill sue you and every other nurse here if you dont do everything possible to keep her alive. The nurse understands that protection from legal prosecution in this situation is provided by:

a. legal immunity granted when acting according to the patients expressed wishes. b. the legal view that the duty to put into effect the patients wishes falls to the physician. c. knowledge of and compliance with facility policies and procedures regarding end-of-life care. d. implementing interventions that preserve the patients right to self-determination.

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

DIF: Understanding (Comprehension) REF: Page 42 OBJ: 3-10 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 8. The nurse is caring for a terminally ill older patient who has a living will that excludes pulmonary and cardiac resuscitation. The family expresses a concern that the patient may change her mind. The nurse best reassures the family by stating: a. The nursing staff will watch her very closely for any indication she has changed her mind. b. We will discuss her wishes with her regularly. c. She can change her mind about any provision in the document at any time. d. Your mother was very clear about her wishes when she signed the document.

ANS: A AMD provisions appropriately provide that people can change their minds at any time and by any means. Nurses need to be alert to any indications from a patient. Based on the persons medical condition, subtle signs such as a gesture or a nod of the head may be easily overlooked.

The patient may or may not be able to discuss her condition. Stating that the mother was very

clear in her wishes does not take into account the fact that patients can change their minds any time.

DIF: Applying (Application) REF: N/A OBJ: 3-7 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment 9. A patient residing in a long-term care facility has been experiencing restlessness and has often been found by nursing staff wandering in and out of other patients rooms during the night. The nurse views the patients PRN antipsychotic medication order as: a. an appropriate intervention to help assure his safety. b. an option to be used only when all other nondrug interventions prove ineffective. c. inappropriate unless the physician is notified and approves its use. d. not an option because it should not be used to manage behaviors of this type.

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

DIF: Analysis (Analyze) REF: N/A OBJ: 3-7 TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment 10. An alert but disoriented older patient lives with family members. The home health nurse, being aware of the role of patient advocate, recognizes the obligation to report possible patient abuse based on: a. a family member stating, Its hard being a caregiver. b. assessment showing bruises in the genital area. c. observation of mild changes in orientation. d. patients report of always being hungry.

ANS: B Even when a patient exhibits disorientation, any report of mistreatment or neglect is to be considered reasonably suspicious and so should be reported. Bruises in the genital area raise suspicions of abuse. The family stating caregiving is hard does not mean they dont have enough support to cope. Mild changes in orientation may be expected in a disoriented patient. The patient who is always hungry should be followed up with a nutrition assessment, and this may or may not be a sign of abuse.

DIF: Application (Apply) REF: N/A OBJ: 3-8 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment 11. An older adult patient has been approached to participate in a research study. The nurse best advocates for the patients right of self-determination by: a. evaluating the patients cognitive ability to understand the consequence of the study. b. determining what risks to the patient are involved. c. discussing the importance of the study with the patient and his family. d. encouraging the patient to discuss the decision with trusted family or friends.

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

DIF Applying (Application) REF: N/A OBJ: 3-7 TOP: Communication and Documentation MSC: Safe and Effective Care Environment

12. A nurse responsible for the care of older adult patients shows the best understanding of the nursing standards of practice when basing nursing care on the: a. physicians medical orders. b. stated requests of the individual patient. c. care that a responsible geriatric nurse would provide. d. implementation of the nursing process.

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

DIF: Remembering (Knowledge) REF: Page 30 OBJ: 3-1 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 13. The nurse caring for an older patient who resides in an assisted living facility is asked to obtain and witness the patients signature on a living will document. The nurse responds most appropriately when stating: a. I will, because such a document is so valuable to the patients plan of care. b. Ill ask the patients family if they agree that the patient should sign the document. c. First I need to discuss the purpose of this document with the patient. d. Im sorry but I cannot ethically do that.

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

DIF: Application (Apply) REF: N/A OBJ: 3-9

TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 14. A graduate nurse learns about the provisions of the Health Insurance Portability and Accountability Act (HIPAA), which include which of the following? a. Requires employers to offer health care insurance b. Regulates the amount employers can charge for insurance c. Mandates that employers provide specific benefits d. Helps maintain coverage when a person changes jobs ANS: D HIPAA has several provisions, one of which is that it helps people maintain health care insurance when they are changing jobs. The other statements are common misconceptions about HIPAA. DIF: Remembering (Knowledge) REF: Page 31 OBJ: 3-5 TOP: Teaching-Learning MSC: Safe Effective Care Environment 15. The nurse manager in a long-term care facility reviews resident care plans at what interval? a. Quarterly b. Every 60 days c. Annually d. When changes occur ANS: A The resident care plan is routinely reviewed quarterly.

DIF: Remembering (Knowledge) REF: Page 33 OBJ: 3-1 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

16. The manager of a long-term care facility is evaluating patients use of drugs. The resident on which of the following medications would be allowed to continue taking medications to control behavior? a. On anxiolytics; now able to participate in group activities b. Given a benzodiazepine at night; roommate now sleeps well c. Given sedatives; eats 100% of meals if resident is fed d. Taking an antipsychotic; no longer wanders at night ANS: A Drugs should not be used to control behavior. If used to manage health conditions, the patient should show improvement. The patient who is now able to participate in activities shows an increase in functional ability, so this medication is therapeutic for this patient. The other patients are given drugs to control behavior.

DIF: Applying (Application) REF: N/A OBJ: 3-7 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 17. To meet current guidelines regarding incontinence in a long-term care facility, what action by the director of nursing is best? a. Assess residents for the ability to participate in a bladder training program. b. Take all residents to the toilet every 2 hours and after meals. c. Ensure all residents wear incontinence briefs, which are changed routinely. d. Ask physicians and other providers to prescribe medications for bladder control.

ANS: A Urinary incontinence is a common problem that can lead to several complications. The extent to which residents participate in bladder training programs is an area of focus for facility inspectors.

Some residents may need routine toileting, wearing briefs, and medications, but they should all be assessed for the ability to participate in bladder training.

DIF: Applying (Application) REF: N/A OBJ: 3-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity: Reduction of Risk Potential 18. The director of nursing at a long-term care facility is getting ready for the annual inspection.

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

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

DIF: Remembering (Knowledge) REF: Page 36 OBJ: 3-4 TOP: Communication and Documentation MSC: Safe Effective Care Environment 19. The nursing student learns about the Patient Self-Determination Act. What is a key provision of this act? a. It establishes new rights for patients in medical facilities. b. It requires facilities to educate patients on their rights. c. It allows families to be approached for organ donation. d. It spells out the procedures for creating an advance directive.

ANS: B

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

DIF: Remembering (Knowledge) REF: Page 42 OBJ: 3-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment MULTIPLE RESPONSE 1. To best address the patients right to self-determination, which of the follow questions does the nurse ask at the time the patient is admitted to a nursing facility? (Select all that apply.) a. Do you understand what a living will and durable power of attorney are? b. If you have already prepared an advance care directive, can you provide it now? c. Are you prepared to discuss your end-of-life choices with the nursing staff? d. Have you discussed your end-of-life choices with your family or designated surrogate? e. Would you like help with preparing a living will or a durable power of attorney?

ANS: A, B, D, E All the correct options address the patients right to make an informed decision regarding health care issues by using various advance directives. The patient does not need to discuss end-of-life choices with the staff in order to exercise the right to self-determination.

DIF: Application (Apply) REF: N/A OBJ: 3-7 TOP: Integrated Process: Teaching-Learning MSC: Safe and Effective Care Environment 2. What provisions for nursing service are part of the Omnibus Budget Reconciliation Act (OBRA) as it pertains to long-term care facilities? (Select all that apply.) a. Resident assessments

b. Annual screenings c. Minimum staffing d. Ensuring resident rights e. Registered nurse educational requirements ANS: A, B, C, D OBRAs service requirements include resident assessments and screenings, minimum staffing requirements, and ensuring resident rights. Educational requirements for nurses are not part of this mandate.

DIF: Remembering (Knowledge) REF: Page 33 OBJ: 3-4 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 3. The director of nursing at a certified long-term care facility overhauls the nursing assistant training program to include which features? (Select all that apply.) a. 12 hours of classroom content b. Training in infection control measures c. Instruction on resident rights d. 6 hours of quarterly in-service education e. Education on safety measures ANS: B, C, D, E Requirements for a nursing assistants education includes training in infection control and interpersonal skills, instruction on resident rights and safety procedures, and 6 hours of education through in-services quarterly. Nursing assistants must have classroom training before working with residents, but the amount of time is not specified.

DIF: Applying (Application) REF: N/A OBJ: 3-3 TOP: Teaching-Learning MSC: Safe Effective Care Environment

4. The adult child of a long-term care facility resident receives a phone call from the director of nursing stating that her parent has 30 days to move out of the home. Under what conditions can a facility require a resident to move?(Select all that apply.) a. Nonpayment for services received b. Needs exceeding what the facility can provide c. Stay is no longer required based on the residents medical condition d. Facility is going out of business e. Frequent disruptive behavior during the night ANS: A, B, C, D A facility can require a resident to leave in four situations: nonpayment for services, needs that exceed what the facility can provide, the patients medical condition no longer warrants long-term care, or the facility is going out of business. Being disruptive is not a cause for expelling a resident.

Chapter 9 Ethical Aspects of Gerontological Nursing MULTIPLE CHOICE 1. Which of the following statements is true about health care costs for older adults in the United States? a. Older adults become eligible for full Social Security benefits upon reaching the age of 65 years. b.Medicare, Part A, covers physician visits, whereas Part B covers prescription drugs. c. Health maintenance organizations (HMOs) can obtain an exemption from Medicares per capita spending limit. d.Older adults pay a fixed premium and low out-of-pocket costs in a preferred provider organization (PPO).

ANS: C If an HMO is granted a per capita waiver, it cannot refuse an applicant on the basis of a preexisting condition. The eligibility age for full Social Security benefits is 66 years of age for

persons born after 1937 and 67 years of age for those born in 1960 or later. Medicare, Part A, covers hospitalizations and other inpatient care. Medicare, Part B, which is optional insurance purchased by the beneficiary, covers outpatient services, physician visits, some therapy sessions, and some home health care. Older adults that pay a fixed premium and low out-of-pocket costs is a description of an HMO rather than a PPO. PTS:1DIF:RememberREF:10-11 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 2. Managed care systems are most effective for an older adult who does which of the following? a. Avoids using the system until it is really needed in an emergency. b.Avoids seeing generalists and seeks health care only from specialists. c. Uses high-tech treatments to reduce expenses over the long term. d.Seeks regular primary care and preventive strategies to maintain health.

ANS: D Managed care is most effective for individuals who, over a long period of enrollment, use primary care and preventive behavior to avoid the need for intensive treatment.

Avoiding using the system until it is needed in an emergency is both costly and detrimental to the clients health. Managed care systems limit access to specialists and encourage the use of primary care. Managed care systems favor ongoing subacute care and prevention to avoid the need for high-tech, acute treatments.

PTS:1DIF:UnderstandREF:10-11 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 3. When an older adult is considering long-term care insurance (LTCI), which is an important consideration? a. Carefully scrutinize all exclusions before enrolling. b.Apply at the oldest age possible for lower rates. c. Avoid purchasing LTCI through a group policy. d.Delay application until the government sponsors LTCI.

ANS: A As with everything else in life, always read the fine print. For example, many plans strictly limit benefits for those with Alzheimer disease. The rates may go up with age at application. The best LTCI packages have been obtained by large organizations with considerable negotiating power.

LTCI plans do not receive any government support; therefore the subscriber finances his or her own LTCI. PTS:1DIF:UnderstandREF:15 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 4. Which of the following statements is true about case management and care management for older adults? a. A case manager works for a health care system to save time and money. b.Care managers are usually paid from public agencies such as the Area Agency on Aging (AAA). c. One nurse can only perform care management. d.The Outcomes-Based Quality Improvement system is designed to evaluate the expected benefit of a procedure.

ANS: A A case manager works for a health care system to save time and money. Care managers are rarely paid through the AAA or similar agencies; they are usually paid privately and sometimes through Medicare or Medicaid. The nurse can perform case management and care management.

The aspects measured in an Outcomes Based Quality Improvement System are known as efficacy, effectiveness, and efficiency.

PTS:1DIF:UnderstandREF:16 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 5. Which of the following statements describes one of the standards of case management during hospitalization? a. Begin discharge planning on the first day of hospitalization.

b.Keep an older adult in the hospital as long as necessary. c. Accept the hospital discharge planners (HDP) proposal for discharge. d.Assist hospital personnel to focus on the admission complaint.

ANS: A Discharge planning begins on the first day of hospitalization. The case manager is responsible for ensuring that quality care is given accordingly in a specific time frame. The case manager facilitates discharge and contacts community-based resources to assist in the continuation of care. Keeping an older adult in the hospital as long as necessary is not required for the patient to receive the care he or she needs. Hospitalization is dangerous to older adults; therefore early discharge is encouraged. The case manager should negotiate with the HDP for the least restrictive level of care. Once the patient is in the hospital, any condition that the patient may have been neglecting should also be assessed and treated.

PTS:1DIF:UnderstandREF:16-17 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 6. An older woman is resisting her sons help to make her money last longer. He wants to have her declared incapacitated so he can manage her finances. Which nursing assessment can be used by the court to declare incapacitation? a. Prepares very few meals and avoids cleaning the house. b.Ambulates around her local community without difficulty. c. Balances her checkbook weekly and pays her bills on time. d.Resists medical advice to remove a stage I malignant tumor.

ANS: D Refusing surgery to remove a malignant tumor at an early stage after receiving medical advice to do so can indicate impaired cognitive functioning; early treatment offers the best chance for a cure.

Preparing few meals and avoiding cleaning the house may be potential evidence of not understanding the consequences of her actions and may be potential evidence of impaired capacity to make medical decisions. If the aspects of daily living are not important to her, then ambulating around her local community without difficulty does not reflect impaired capacity.

Balancing her checkbook weekly and paying her bills on time, which are indications that she is managing her finances, are evidence of intact capacity; functional status is irrelevant in a capacity hearing.

PTS:1DIF:ApplyREF:18-22 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 7. A health care provider asks the nurse about an older mans durable power of attorney (DPA) because consent is needed for a medically necessary invasive procedure. The patient has endstage disease, is intubated, and is on mechanical ventilation. Which steps should the nurse implement? a. Refer to the patients advance directive for a name. b.Assist with obtaining informed consent from the patient. c. Use the oral trail-making test to measure cognitive function. d.Apply the Confusion Assessment Method for critical care.

ANS: D The health care provider assumes the intubated older adult lacks the cognitive skill to give consent for treatment. Before the search begins for the DPA and to help determine the patients cognitive status, the nurse assesses the patient for delirium using the Confusion Assessment Method for the intensive care unit. As the patients advocate, the nurse implements this valid and reliable tool because the nurse wants to give the patient every opportunity to participate in the plan of care and make his own determinations.

If the patient has an advance directive, then the attorney-in-fact named in the power of attorney should be on that document. However, because the patient has the right to make his own decisions about care, his cognitive status should be established first. Before informed consent can be given, the patients cognitive status must be determined. The patient is unable to perform an oral test while he is intubated.

PTS:1DIF:ApplyREF:18-22 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment

8. An older woman is brain dead, and the attorney-in-fact or surrogate named in her DPA is opposed to organ donation; the law in the state allows a surrogate with a DPA to make end-oflife decisions. Although she failed to document it, her family states that she wanted to donate her organs. Given the law about a DPA, what does the nurse expect the surrogate to do? a. Deny consent. c. Refuse to decide. b.Provide consent.d.Get a second opinion.

ANS: B A DPA acts at the pleasure of the designator, can manage the designators finances, and functions as the designators health care surrogate, making judgments for the designator using substituted judgment when the designator is unable to do so. Therefore, in accordance with the law and the womans wishes according to her family, the surrogate should provide consent for organ harvesting. It is against the law and unethical for the DPA for this older adult to deny consent for organ harvesting. Because the attorney-in-fact named in the DPA is her health care surrogate, the attorney-in-fact must make a decision on behalf of the woman and cannot refuse to do so. The attorney-in-fact can get another opinion on the older adults neurological status but not as a way to avoid the decision concerning organ harvesting.

PTS: 1 DIF: Apply REF: 18-25 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment 9. The older adult wants to appoint an attorney-in-fact with DPA for a specific period around a forthcoming surgery. Which should the nurse implement? a. Help the patient find a qualified attorney. b.Explain the legal rights and responsibilities of an attorney-in-fact with a DPA. c. Suggest using a guardian for the surgical period. d.Offer to act as the patients guardian during surgery.

ANS: A The nurse provides safe, effective, and comprehensive care but should not provide legal advice to an older adult; rather, the nurse should refer the patient to experts in the law and can assist the

older adult with finding a suitable attorney. The nurse must avoid participating in the selection of the individual attorney to avoid conflict of interest.

The nurse can provide short general explanations about powers of attorney to assist the patient in finding suitable legal counsel, but the nurse should leave explanations about the law surrounding a DPA to an attorney. The nurse should avoid providing legal advice to an older adult and avoid offering to participate in an older adults legal affairs to avoid a conflict of interest.

PTS:1DIF:ApplyREF:18-25 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 10. The wife of an older man who has diabetes mellitus brings him to primary care. He has severe bilateral infections forming black rings around each ankle. He tells the nurse it is caused by tight shoes. Which intervention should the nurse implement first to investigate this individuals health care regimen? a. Examine his health insurance coverage. b.Question the man without the wife present. c. Consult with social services about neglect. d.Analyze his glycosylated hemoglobin level.

ANS: D Infected, black rings around both ankles of an individual who has diabetes is a potential clinical indicator of prolonged hyperglycemia because of nonadherence, neglect, or abuse. To begin the assessment of his health care regimen, the nurse checks his glycosylated hemoglobin to quantify his exposure to hyperglycemia. This is the best intervention because the nurse fulfills the duty owed to the patient by implementing a patient-focused action.

Although the nurse might be suspicious of potential abuse or neglect and because it is doubtful that tight shoes have caused the rings, the nurses priority is the older adult. Information about his health insurance can provide clues about nonadherence to therapy if the insurance provider denies coverage for diabetic supplies or other necessary health care services. Questioning the man without the wife present is a low priority for the nurse who is faced with a patient who has such a serious health problem. Although the nurse can gather clues concerning the origin of the patients infection by questioning him without the wife present, talking to him in privacy does not

guarantee that he will be forthcoming with information or will be a reliable source of information. Consulting with social services about neglect is secondary to his physical needs and a premature intervention because the nurse has not completed an assessment. However, when the nurse completes the patient assessment and gathers evidence supporting a claim of abuse or neglect, social services is a valuable resource for connecting the older adult to community services. The nurse should follow agency policy regarding abuse and neglect.

PTS:1DIF:AnalyzeREF:21-27 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 11. Which is the fundamental difference between Medicare Part A and Medicare Part B? a. Hospice care c. Home care services b.Health care setting d.Invasive procedures ANS: B The primary difference between Medicare Part A and Part B is the care setting. Part A covers acute, inpatient care and some specialized care. Part B covers some costs of outpatient and ambulatory services. Hospice care is not a difference; Part A and Part B coverage is no longer available for a patient in hospice care. Home care services are not included in Part B, therefore home care cannot be compared with Part A. Invasive procedures are potentially covered by both Part A and Part B. PTS:1DIF:UnderstandREF:5-8 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 12. Which of the following statements is true about conservators? a. A conservatorship entails control over property, whereas a guardianship entails control over the person. b.The most legally restricting way individuals and property can be handled are through conservatorships and guardianships. c. Conservators cannot be members of the conservatees (patients) family. d.Because a conservatorship is the least restrictive alternative, a court hearing is not required.

ANS: B A conservator can be responsible for the conservatees property, person, or both. The conservatee is a ward of the conservator or guardian and has no decision-making rights and, in many states, has no legal right to sue to terminate the conservatorship or guardianship. The conservator is the individual appointed by the court; this person can be a family member or someone who has a conflict of interest. Conservatorship is a most restrictive alternative and requires a court hearing.

PTS:1DIF:UnderstandREF:18-25 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment MULTIPLE RESPONSE 1. The nurse distrusts the male caregiver, the son of an older woman, and collaborates with social services about potential resources for abused older adults. Which characteristics of the caregiver does the nurse report to social services as indicators of potential elder abuse? (Select all that apply.) a. Collects unemployment benefits. b.Finds fault with any nursing care. c. Takes frequent breaks for smoking. d.Lives in the same house as his mother. e. Makes demands on assistive personnel. f. Sits at his mothers bedside for hours daily.

ANS: B, D, E The male caregiverand sonof this woman excessively criticizes the nursing care and demonstrates a lack of appreciation, which are common characteristics of an elder abuser.

Because the majority of caregiving occurs in the home and a majority of abuse occurs in the family, this caregiver has the characteristics of a potential abuser. Aggressive, combative, provocative, and overly demanding behavior is also characteristic of an older adult abuser. The lack of employment is not a characteristic of an elder abuser, although this problem can frustrate the individual; however, financial dependency on the abused is a predictor for abuse. Although smoking is an unhealthy habit and exposes the older adult to second-hand unhealthy air, smoking is not a characteristic of an elder abuser. Sitting at the patients bedside for hours, in itself, is not a

characteristic of an older adult abuser; concerned, caring family members often keep bedside vigils.

PTS:1DIF:UnderstandREF:21-27 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 2. The nurse understands which of the following indicator(s) describe(s) the profile of an abused older adult? (Select all that apply.) a. Resides in safe housing. b.Is from a lower socioeducational level. c. Is a woman who lives with an abuser and is socially isolated. d.Has nonwhite ethnicity.

ANS: B, C, D A profile of an abused older adult consists of one who is married and comes from a lower socioeducational level. Women who are 80 years of age or older are more often abused; the abused older adult often lives with the abuser and is socially isolated. The abused are often nonwhite, have a mental or physical disability, are dependent on the abuser, and reside in unsafe or inadequate housing.

PTS:1DIF:UnderstandREF:43 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 3. The nurse understands which of the following indicator(s) describe(s) the profile of an elder abuser? (Select all that apply.) a. Does not have a history of abuse. b.Has mental health problems. c. Has substance abuse problems. d.Is stressed with the caregiving role.

ANS: B, C, D The abuser often has mental health and substance abuse problems and is stressed or frustrated with the caregiving role. The abuser is often financially dependent on abused and has inadequate

financial resources of his or her own. The abuser has had or currently has health problems, and may have a history of abuse and being abused.

Chapter 10 Continuum of Care in Gerontological Nursing MULTIPLE CHOICE 1. When the home health nurse assists the older adult patient with rearranging furniture within the home to prevent the patient from falling, the nurse is demonstrating: a. health promotion. b. health protection. c. health prevention. d. disease prevention.

ANS: B The overarching goals are to attain high-quality, long lives free of preventable disease, disability, and injury; to eliminate disparities; create social and physical environments that promote health; and optimize quality of life across the life span. Health protection targets five areas including unintentional injury. Rearranging furniture to prevent falls is a health protection activity.

DIF: Applying (Application) REF: N/A OBJ: 8-1 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 2. The primary focus of the health belief model of health promotion is addressed when the nurse: a. accompanies the assisted living residents on a walk before dinner. b. asks a senior citizens group what health screening they want to have. c. plans a program on cooking diabetic-friendly meals in cooperation with a dietician. d. asks the patient if he believes smoking puts him at risk for lung cancer.

ANS: D

The health belief model, which was developed to determine the likelihood of an individuals participation in health promotion, health protection, and disease prevention services, includes assessing an individuals perception of his or her susceptibility to developing an illness. Asking the patient about beliefs related to tobacco use and health is an activity that falls within this model. The other activities do not.

DIF: Understanding (Comprehension) REF: Page 141 OBJ: 8-2 TOP: Nursing Process: Assessment MSC: Health Promotion 3. Financial considerations are a major barrier to the older adults participation in health promotion because: a. most older adults have accepted poor health as a part of growing older. b. Medicare often does not cover the cost of preventive services. c. many already have been diagnosed with chronic illnesses. d. they generally place more value on saving their disposable income.

ANS: B Older adults must incur the cost of many preventive services because Medicare does not cover them all. This can be hard on the fixed, limited income of many older adults. It is not true that older adults accept poor health as inevitable. Health promotion activities can occur in the presence of chronic illnesses. Some older adults do place high value on saving money, but not all older adults are influenced by this desire.

DIF: Understanding (Comprehension) REF: Page 148 OBJ: 8-4 TOP: Nursing Process: Assessment MSC: Health Promotion 4. To engage the older adults who frequently attend a senior citizens center in primary disease prevention, the nurse: a. immunizes those attending a weekly luncheon against the H1N1 virus. b. arranges for a colorectal cancer screening at the center.

c. schedules a speaker to discuss cooking for diabetic patients. d. surveys the members to identify health issues of interest to them.

ANS: A Primary prevention refers to specific action taken to optimize the health of the older individual by helping him or her to become more resistant to disease or to ensure that the environment will be less harmful. Providing immunizations would be included in this level of prevention.

Colorectal cancer screening is secondary prevention. Cooking for diabetic patients is tertiary prevention. Surveying patients does not fall into any level of prevention.

DIF: Applying (Application) REF: N/A OBJ: 8-5 TOP: Nursing Process: Implementation MSC: Health Promotion 5. The nurse has the greatest impact on a patients health promotion when: a. evaluating a diabetic patients ability to administer his insulin injections. b. encouraging an obese patient to limit both fat and carbohydrate intake. c. volunteering to take blood pressures at a community health fair. d. educating the patient about vitamin D and calcium to prevent bone loss.

ANS: D Health promotion includes interventions that help prevent disease and disability in a patient.

Education regarding health promotion issues has the greatest impact on the health of a patient.

The other patients already have established diseases.

DIF: Applying (Application) REF: N/A OBJ: 8-1 TOP: Teaching-Learning MSC: Health Promotion 6. A nurse is assessing a patients ability to manage existing health problems. What question by the nurse is most helpful?

a. Can you tell me why its important to test your blood glucose level at least daily? b. What were the results of your most recent A1C blood test? c. Which pharmacy do you use when your prescription needs to be refilled? d. Have you been experiencing pain in your feet?

ANS: B The results of a laboratory test used to monitor glucose control will show how well the patient has been managing the various aspects of his or her treatment plan. This information is collected in the health perception/health management functional health pattern. The other questions do not demonstrate the patients knowledge level.

DIF: Applying (Application) REF: N/A OBJ: 8-5 TOP: Nursing Process: Assessment MSC: Health Promotion 7. During a home visit, a nurse is assessing the nutritional awareness of an older adult patient who lives alone. The nurse is most effective in obtaining objective information when: a. asking to see what types of foods the patient keeps readily available. b. reviewing the components of a healthy diet with the patient. c. asking the patient to describe what he or she ate for all three meals yesterday. d. observing the patient eat a meal that he or she has prepared.

ANS: D Objective information is best obtained when observing general appearance and various body system indicators of nutritional status. Note height, weight, and fit of clothes. If possible, observe the older adult eating a meal. Food available in the home does not indicate the patients knowledge, as someone else may have bought the food. Asking the patient for information is requesting subjective data. Reviewing a healthy diet does not allow the patient to demonstrate knowledge.

DIF: Applying (Application) REF: N/A OBJ: 8-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity 8. The nurse is discussing an older adults past marital history during the admission assessment.

The nurse can best determine that the patient has a healthy ability to cope with emotional stressors when the patient states: a. After my husband died, I managed to raise and educate our two children by myself. b. Since my husbands death, Ive grown even closer to my sisters. c. Its been hard since my husband died, but you manage to go on somehow. d. After my husband died, I married a good man who was there for me and my children.

ANS: A This pattern encompasses the patients reserve and capacity to resist challenges to self-integrity and his or her ability to manage difficult situations. The ability to view herself as a success in fulfilling her responsibilities as a mother is evidence of healthy stress coping skills.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 8-5 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 9. An older adult patient has recently experienced some difficulty sustaining an erection as a result of medication he has been prescribed. The nurse best assesses the patients perception of his own sexuality by asking: a. How are you and your wife coping with your sexual dysfunction? b. What problems has your sexual dysfunction caused between you and your wife? c. What impact has this dysfunction had on your ability to be intimate with your wife? d. Are you and your wife prepared to deal with this dysfunction over the long term?

ANS: C

Asking about the impact of the dysfunction directly assesses the patients satisfaction or dissatisfaction with current circumstances related to sexual function and intimacy, thus providing the best evaluation of his self-perception of the issue.

DIF: Applying (Application) REF: N/A OBJ: 8-5 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 10. The nurse admitting an 89-year-old patient to an assisted living facility notes that the patient is currently taking numerous prescribed and over-the-counter medications. The nurses initial intervention is to: a. confirm with the physician that all the medications are required. b. evaluate the patients understanding of why he is taking each medication. c. explain to the patient the dangers of taking so many different medications. d. review the listed medications for possible interactions.

ANS: D The first nursing action is to determine if the patients health is at risk from possible drug interactions. The other actions might be warranted, but patient safety comes first.

DIF: Understanding (Comprehension) REF: Page 143 OBJ: 8-6 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 11. When assessing the older adult for bowel health, the nurse is most effective in obtaining subjective data when asking: a. Would you describe your bowel movements as usually normal? b. Do you have a problem with constipation? c. How often do you usually have a bowel movement? d. Have your bowel movements changed recently?

ANS: C

Subjective data can be obtained through the health history. Asking the patient to identify how often the bowels move would establish the fundamental baseline of the patients elimination patterns. Normal is a vague term that should not be used. Asking if there are problems with constipation or if bowel habits have changed are yes/no questions, which are generally avoided.

DIF: Applying (Application) REF: N/A OBJ: 8-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 12. Using social cognitive theory, which action by the nurse will have the most impact on older adults participation in health promotion behaviors? a. Creating a walking club in the community b. Offering private nutritional counseling c. Providing meals at the senior center d. Handing out educational materials ANS: A According to this theory, self-efficacy and outcome expectations are influenced by successful performance of the behavior, verbal encouragement, seeing similar people do the behavior, decreasing unpleasant aspects of the behavior, caring approaches to facilitate the behavior, and education about benefits. A local walking club with other seniors fulfills many of these criteria.

Private nutritional counseling does not allow the participant to see others engaged in this activity.

Meals may or may not be healthy or palatable. Educational materials on their own may not have great benefit.

DIF: Applying (Application) REF: N/A OBJ: 8-2 TOP: Nursing Process: Implementation MSC: Health Promotion 13. The nurse wishes to participate in a community secondary prevention activity. Which activity does the nurse choose? a. Administering blood pressure screening at a mall

b. Dispensing free flu vaccinations at a clinic c. Fitting impoverished older adults with glasses d. Teaching about the risks of sun exposure ANS: A Secondary prevention is screening and early diagnosis. It aims to find people with clinical conditions that have not yet become apparent to them. Blood pressure screening would fit this description. Flu vaccinations and teaching about sun exposure are examples of primary prevention. Fitting older adults with glasses is a tertiary prevention.

DIF: Applying (Application) REF: N/A OBJ: 8-5 TOP: Nursing Process: Implementation MSC: Health Promotion 14. A patient who is homeless has not followed through with getting an influenza vaccination.

What response by the nurse to a student is most appropriate? a. Its hard to be proactive when you are hungry. b. If the patient would just come in, we have the shot. c. These patients never follow through on directions. d. Too bad we cant take the shot to him where he is.

ANS: A Competing priorities often cause patients to seem uninterested or noncompliant with health recommendations. According to Maslow, basic needs such as food, water, shelter, and safety take priority over other matters. Perhaps it is a good idea to take shots into the community, but that is not the best response by the nurse, as it does not help the student understand the situation.

The other two statements are biased and show disregard for the patients circumstances.

DIF: Applying (Application) REF: N/A OBJ: 8-4 TOP: Communication and Documentation MSC: Health Promotion

15. The nurse is seeing a 68-year old woman for a physical exam in the family practice clinic.

The woman complains about having another pelvic exam. What response by the nurse is best? a. I know its uncomfortable, but its important to do it. b. You are past the age where this exam is recommended. c. Why dont you want to have your pelvic exam? d. This will be the last time you need this exam.

ANS: B According to the U.S. Preventative Task Force, pelvic exams and pap smears can be discontinued after age 65 if prior testing was normal and the patient is not at high risk for cervical cancer. The other statements are incorrect.

DIF: Understanding (Comprehension) REF: Page 143 OBJ: 8-5 TOP: Teaching-Learning MSC: Health Promotion 16. A male patient complains about the digital rectal prostate exam and blood work for prostatespecific antigen (PSA) and asks, How long am I expected to do this? What response by the nurse is best? a. Every year for the rest of your life. b. Until you turn 75 years of age. c. You can quit when you turn 80. d. There are no guidelines on this.

ANS: B According to the U.S. Preventative Task Force, there is no evidence that continuing routine PSA screening past the age of 75 has any benefit, so the patient can forgo the blood test after he turns 75.

DIF: Understanding (Comprehension) REF: Page 143 OBJ: 8-5

TOP: Teaching-Learning MSC: Health Promotion 17. A nurse routinely assesses patients for alcohol use. What principle guides this assessment? a. The older adult must balance risks to benefits of use. b. Alcohol causes older adults to fall and should not be consumed. c. There are no data on risks or benefits after the age of 75. d. Alcohol-related diseases are more severe in older people.

ANS: A There are both benefits and risks to drinking alcohol. The nurse must help the older patient determine which predominates when assessing and possibly counseling patients on their alcohol use.

DIF: Applying (Application) REF: N/A OBJ: 8-6 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 18. An 80-year-old woman has found a lump in her breast and is in the clinic. What question by the nurse is most appropriate? a. How long have you had this lump? b. If its cancer, are you willing to treat it? c. Do you have cancer in your family? d. Are you having any pain right now?

ANS: B All questions are appropriate; however, for a woman this age, further testing is not recommended unless the patient is willing to go through with treatment for cancer. Tumors in older women tend to be slow growing and quality of life is a bigger priority.

DIF: Applying (Application) REF: N/A OBJ: 8-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity 19. A nurse wishes to volunteer in a tertiary health care activity. What activity would the nurse choose? a. Teaching about safer sexual behaviors b. Greeting women at an emergency pregnancy clinic c. Assisting women who are having radiation therapy d. Finding home health safety resources ANS: C Tertiary prevention aims to care for established disease. Helping women having radiation therapy for cancer would fall into this realm. Teaching is primary prevention. The emergency pregnancy clinic is secondary prevention. Home safety is primary prevention.

DIF: Applying (Application) REF: N/A OBJ: 8-5 TOP: Nursing Process: Implementation MSC: Health Promotion 20. A nurse is working with a woman who has been reluctant to start a walking program for her osteoporosis. What assessment by the nurse is most important? a. Fear of falling b. Lack of time c. Lack of energy d. Pain with movement ANS: A Fear of falling is a common fear in older adults and has special significance to those with osteoporosis. The nurse should first assess for this factor. All other factors can be possible contributors, but people usually attend to safety first.

DIF: Applying (Application) REF: N/A OBJ: 8-4

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity MULTIPLE RESPONSE 1. A nurse planning primary disease prevention interventions for a 64-year-old patient includes which of the following? (Select all that apply.) a. Giving an influenza vaccination in early autumn of each year. b. Suggesting the patient attend Cooking to Manage Hypertension classes taught by a registered dietician. c. Giving a pneumococcal vaccination to celebrate the patients 65th birthday. d. Identifying several local smoking cessation support groups. e. Providing the patient with a take-home occult stool screening kit.

ANS: A, C, D Primary prevention refers to specific action taken to optimize the health of the older individual by helping him or her become more resistant to disease or to ensure that the environment will be less harmful.

DIF: Application (Apply) REF: N/A TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 2. A patient has not followed up with recommendations made by the nurse to participate in cardiac rehabilitation after a myocardial infarction. What factors are most important for the nurse to assess in determining the cause of this behavior? (Select all that apply.) a. Out-of-pocket costs b. Transportation problems c. Beliefs about the benefits d. Location of the clinic e. Ethnicity of providers ANS: A, B, C, D

Many factors affect the ability and willingness of patients to engage in health promotion behaviors, including cost, transportation, beliefs, and location of the services. Ethnicity of the providers may be a consideration for some, but that is not a high priority for assessment in most patients.

DIF: Applying (Application) REF: N/A OBJ: 8-2 TOP: Nursing Process: Assessment MSC: Health Promotion 3. The student learns the Medicare guidelines for preventive health and reimbursement policies.

Which statement follows the guidelines? (Select all that apply.) a. Medicare pays for an annual pneumococcal vaccination. b. Medicare covers annual influenza vaccinations. c. Pap smears and pelvic exams are covered once every 2 years. d. Annual fecal occult blood tests are covered for those who are from 50 to 85 years of age. e. A bone density scan is covered every 2 years (a co-payment is required).

ANS: B, D, E Medicare guidelines provide reimbursement for pneumococcal vaccination once and every 5 years as recommended, an annual flu vaccination, pap smears and pelvic exams every 3 years, an annual fecal occult blood test for those who are from 50 to 85 years of age, and a bone density scan every 2 years (however, a co-payment is required)

Chapter 11 Nutrition and Hydration MULTIPLE CHOICE 1. The nurse explains that the lowest recommended daily caloric intake to meet nutritional needs of the older adult safely is _____ calories. a. 1000 b. 1200

c. 1400 d. 1800 ANS: B The minimal caloric intake for the older adult that will meet nutritional needs of the older adult is 1200 calories.

DIF: Cognitive Level: Knowledge REF: 103 OBJ: 2 TOP: Minimal Calorie Intake KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The 65-year-old woman brags that by using the MyPyramid guidelines for nutrition, she has lost 15 lb. The nurse reminds her that in order to maintain the weight loss, she must be physically active for _____ minutes a day. a. 15 to 20 b. 20 to 30 c. 30 to 40 d. 40 to 60 ANS: D According to the guidelines of MyPyramid, an activity period of 40 to 60 minutes a day is necessary to maintain weight loss.

DIF: Cognitive Level: Comprehension REF: 104 OBJ: 4 TOP: MyPyramid KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse recommends that the older man eat chicken and fish because these are complete proteins, which have: a. some molecules of carbohydrate.

b. all the essential amino acids. c. high fat content. d. soluble fiber.

ANS: B Fish and lean chicken have all the essential amino acids and very little fat content, unlike red meat.

DIF: Cognitive Level: Analysis REF: 106 OBJ: 2 TOP: Complete Protein KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse explains that high-density lipoproteins (HDLs), the so-called healthy fats, are made up of: a. mainly proteins. b. mostly triglycerides. c. mainly cholesterol. d. a variety of minerals.

ANS: A HDLs are made up primarily of proteins, as opposed to lipids such as triglycerides, which are found in very-low-density lipoproteins (VLDLs) and cholesterol, which is found in low-density lipoproteins (LDLs).

DIF: Cognitive Level: Comprehension REF: 106 OBJ: 1 TOP: High-Density Lipoproteins KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse points out that the nonhealing pressure ulcers and decreasing visual acuity in a patient on a fat-restricted diet may be related to the patients impaired ability to metabolize vitamin: a. A. b. B6. c. B12. d. C. ANS: A Vitamin A is a fat-soluble vitamin and helps with wound healing and night vision acuity. Persons on low-fat diets may not be able to metabolize vitamin A from food sources because of the decreased fat in their diet.

DIF: Cognitive Level: Analysis REF: 106 OBJ: 6 TOP: Vitamin A Deficiency KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The home health nurse does an ongoing assessment of the patient who has had a subtotal gastrectomy for evidence of a deficiency in vitamin: a. A. b. B6. c. B12. d. C. ANS: C Vitamin B12 is generated from the digestion of protein in the stomach. If part of the stomach is gone (gastrectomy), there is less digestive potential for vitamin B 12.

DIF: Cognitive Level: Analysis REF: 106-107 OBJ: 3 TOP: Vitamin B12 Deficiency KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The nurse giving an iron preparation in capsule form will improve its absorption by giving the patient extra: a. orange juice. b. milk products. c. water. d. caffeine drinks.

ANS: A Vitamin C improves the absorption of iron.

DIF: Cognitive Level: Application REF: 109 OBJ: 8 TOP: Iron Administration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 8. The nurse caring for the older adult patient who is taking a diuretic for control of hypertension should monitor the patient closely for signs of: a. hypokalemia. b. hypocalcemia. c. hyponatremia. d. hyperkalemia.

ANS: A Diuretics deplete the body of potassium, a necessary mineral.

DIF: Cognitive Level: Application REF: 109 OBJ: 6 TOP: Hypokalemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

9. The older adult patient in an extended-care facility has a pressure ulcer. The nurse would encourage wound healing by increasing the patients intake of zinc from food sources such as: a. meat. b. citrus fruit. c. green leafy vegetables. d. complex carbohydrates.

ANS: A Meat, nuts, and shellfish are dietary sources of zinc.

DIF: Cognitive Level: Application REF: 109 OBJ: 1 TOP: Zinc KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. The nurse is aware that older adults need a minimum daily fluid intake of _____ mL. a. 1000 b. 2000 c. 3000 d. 4000 ANS: B The minimum daily fluid requirement is 2000 mL/day.

DIF: Cognitive Level: Comprehension REF: 110 OBJ: 2 TOP: Fluid Requirements KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. Older adults who consume excessive amounts of alcohol put themselves at risk for nutritional deficits because alcohol:

a. decreases blood glucose levels. b. alters the function of some minerals. c. interferes with the absorption of nutrients. d. increases the metabolism.

ANS: C Excessive intake of alcohol interferes with the absorption of nutrients because of changes in the stomach lining.

DIF: Cognitive Level: Comprehension REF: 111 OBJ: 6 TOP: Factors Affecting Nutrition KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 12. The nurse in a retirement center who is selecting a main dish from the residents menu for an Orthodox Jewish man would select: a. crab cakes with white sauce. b. lamb chops with mint jelly. c. ham steak with red gravy. d. pork chops with cranberries.

ANS: B Shellfish and pork are not permitted in the diet of Orthodox Jewish persons.

DIF: Cognitive Level: Analysis REF: 115 OBJ: 8 TOP: Cultural Factors KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 13. The nurse takes into consideration that the patient who would need higher caloric intake would be the patient with a condition such as: a. bacterial pneumonia.

b. osteoporosis. c. arthritis. d. stroke.

ANS: A Persons with infections require a higher caloric intake.

DIF: Cognitive Level: Application REF: 103 OBJ: 6 TOP: Changing Caloric Needs KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. The nurse explains that most older adults need only about 50 g of protein daily, which is equivalent to approximately _____ lb. a. 1 b. c. d.

ANS: D There are approximately 450 g in a pound, so 50 g is roughly equivalent to lb, essentially the weight of one thin hamburger patty.

DIF: Cognitive Level: Application REF: 104 OBJ: 2 TOP: Protein Intake Equivalent KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. The nurse instructing the older man in the use of MyPyramid points out that he should eat _____ cup(s) of fruit a day. a. b. 1

c. d. 2 ANS: D The MyPyramid guidelines recommend eating 2 cups of fruit daily.

DIF: Cognitive Level: Comprehension REF: 104 OBJ: 2 TOP: MyPyramid: Fruit KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. While instructing the patient who is to take oral iron supplements, the nurse indicates that: a. supplements should be taken between meals on an empty stomach. b. medication should be drunk from a nonmetal glass. c. the color of the stool will change to dark green or black. d. constipation is likely to occur.

ANS: C Iron supplements can color the stool a dark green or black. Iron should be taken with a meal to reduce gastrointestinal irritation. The preparation should be taken through a straw. The supplement might cause diarrhea.

DIF: Cognitive Level: Comprehension REF: 109 OBJ: 8 TOP: Iron Preparations KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. When the nurse weighs an edematous patient with congestive heart failure, the weight increase from yesterday is 2.2 lb. The nurse assesses that this patient has retained _____ of fluid. a. 500 mL b. 1 L c. 1500 mL

d. 2 L ANS: B The weight gain of 2.2 lb (1 kg) is equal to 1 L of fluid retention.

DIF: Cognitive Level: Application REF: 122 OBJ: 6 TOP: Fluid Retention KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 18. The nurse encourages a group of extended care residents to sit out on the sunny patio for an hour a day during the afternoon in order to help them with the synthesis of vitamin: a. A. b. B12. c. D. d. K. ANS: C Exposure to the sun allows the skin to synthesize vitamin D, which is required for calcium absorption.

DIF: Cognitive Level: Analysis REF: 107 OBJ: 8 TOP: Synthesis of Vitamin D KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. What is the caloric value (in calories per gram [cal/g]) of protein? a. 9 cal/g b. 4 cal/g c. 0 cal/g d. 7 cal/g

ANS: B Proteins yield 4 cal/g.

DIF: Cognitive Level: Comprehension REF: 103 OBJ: 1 TOP: Calorie Values KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 20. What is the caloric value of alcohol? a. 9 cal/g b. 4 cal/g c. 0 cal/g d. 7 cal/g ANS: D Alcohol yields 7 cal/g.

DIF: Cognitive Level: Comprehension REF: 103 OBJ: 1 TOP: Calorie Values KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 21. What is the caloric value of vitamins? a. 9 cal/g b. 4 cal/g c. 0 cal/g d. 7 cal/g ANS: C Vitamins yield no calories.

DIF: Cognitive Level: Comprehension REF: 103 OBJ: 1 TOP: Calorie Values KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 22. What is the caloric value of fat? a. 9 cal/g b. 4 cal/g c. 0 cal/g d. 7 cal/g ANS: A Fats, which can come from either plant sources or animal sources, yield 9 cal/g.

DIF: Cognitive Level: Comprehension REF: 103 OBJ: 1 TOP: Calorie Values KEY: Nursing Process Step: N/A MSC: NCLEX: N/A MULTIPLE RESPONSE 1. The nurse takes into consideration the factors that influence nutritional needs, which include __________. (Select all that apply.) a. bone density b. gender c. climate d. presence of illness e. body temperature ANS: B, C, D, E Bone density is not a factor, but all other options are factors that have a significant effect on nutritional needs.

DIF: Cognitive Level: Comprehension REF: 102 OBJ: 2 TOP: Influences on Nutrition KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse uses a chart to show the vital nutrients required by all persons, which are __________. (Select all that apply.) a. carbohydrates b. proteins c. vitamins and minerals d. fats e. electrolytes ANS: A, B, C, D Electrolytes are not nutrients, but all other listed options are considered essential nutrients.

DIF: Cognitive Level: Knowledge REF: 103 OBJ: 2 TOP: Essential Nutrients KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse encourages older adults to include complex carbohydrates such as vegetables and fruits in their diet because complex carbohydrates contain __________. (Select all that apply.) a. minerals b. fats c. vitamins d. soluble fiber e. polysaccharides ANS: A, C, D, E No fat is contained in complex carbohydrates.

DIF: Cognitive Level: Comprehension REF: 104 OBJ: 1 TOP: Complex Carbohydrates KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse is aware that older adults who do not take in adequate fluids are at risk for __________. (Select all that apply.) a. altered absorption of drugs b. digestive disorders c. constipation d. bleeding disorders e. reduced appetite ANS: A, B, C, E Bleeding disorders are not associated with inadequate intake. All other options are problems associated with a fluid deficit.

DIF: Cognitive Level: Application REF: 109-110 OBJ: 6 TOP: Fluid Deficit KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Older adults plagued with chronic health problems may become undernourished because they __________. (Select all that apply.) a. are too fatigued to prepare meals b. become frustrated when attempting to open packaging c. may be unable to carry groceries any distance d. have no interest in eating out due to health issues e. lack stamina to shop for groceries ANS: A, B, C, E

Having no interest in eating out is not going to cause the older adult to be malnourished. Lack of interest in eating or socialization due to a chronic health problem can cause the older adult to be malnourished. All the other options listed can result in the older adult being malnourished.

DIF: Cognitive Level: Comprehension REF: 110 OBJ: 6 TOP: Factors Affecting Nutrition KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 6. The home health nurse is painfully aware that older adults living independently have many barriers to providing themselves with adequate nutrition, which include __________. (Select all that apply.) a. difficulty chewing b. lack of transportation to shop c. use of quick frozen meals d. lack of motivation to cook e. sensory changes ANS: A, B, D, E The availability of quick frozen foods, which are easy to prepare, offer a source of better nutrition to the older adult.

DIF: Cognitive Level: Application REF: 111 OBJ: 6 TOP: Factors Affecting Nutrition KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. An older adult who is a resident in an extended-care facility is at risk for nutritional deficits related to __________. (Select all that apply.) a. repetitive nature of meals b. lack of culturally significant food c. environmental odors

d. reaction to being fed by others e. non-nutritious food choices ANS: A, B, C, D Although the food is nutritious, the repetitive nature of the menu, the lack of culturally significant food, and environmental concerns alter the motivation to have adequate intake.

DIF: Cognitive Level: Comprehension REF: 112 OBJ: 6 TOP: Factors Affecting Nutrition KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 8. The nurse suggests to the older adult that sources of protein that are less expensive than meat include __________. (Select all that apply.) a. corn b. beans c. whole-grain foods d. cheese e. nuts ANS: B, C, D, E Corn is not a source of protein.

DIF: Cognitive Level: Application REF: 106 OBJ: 1 TOP: Protein Consumption KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. The nurse cautions the older adult against taking excess vitamin supplements because some vitamins can be retained in fatty tissue and cause liver damage, including vitamin(s) __________. (Select all that apply.) a. A

b. B6 c. C d. D e. E ANS: A, D, E Excess fat-soluble vitamins A, D, and E can be retained in fatty tissue and result in hepatic damage.

Chapter 12 Sleep and Rest MULTIPLE CHOICE 1. The nurse is aware that the initial entry to deep sleep is: a. stage 1 nonrapid eye movement (NREM). b. stage 3 NREM. c. stage 5 NREM. d. rapid eye movement (REM) sleep.

ANS: B Stage 3 NREM is the initial phase of deep sleep in which there is complete muscular relaxation and vital signs begin to decline.

DIF: Cognitive Level: Comprehension REF: 329, Box 20-1 OBJ: 1 TOP: Deep Sleep KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The phenomenon of sleep walking is most likely to occur in the sleep stage of: a. stage 1 NREM. b. stage 2 NREM. c. stage 4 NREM.

d. REM sleep.

ANS: C Stage 4 NREM is the deepest stage of sleep in which sleep walking is most likely to occur.

DIF: Cognitive Level: Comprehension REF: 329, Box 20-1 OBJ: 1 TOP: Sleep Walking KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse explains that older adults often experience a disturbed sleep-wake cycle because of hormonal changes, which include a(n) _____ level. a. increase in angiotensin b. decrease in insulin c. increase in growth hormone d. decrease in melatonin ANS: D A decrease in the melatonin level causes age-related sleep disturbances.

DIF: Cognitive Level: Application REF: 329 OBJ: 1 TOP: Hormonal Changes KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The older man in a long-term care facility consistently wakes at 3 AM and does not return to sleep. The nurse records this behavior as _____ insomnia. a. sleep initiation b. sleep maintenance c. terminal

d. undifferentiated ANS: C Terminal insomnia is a sleep disturbance in which the patient consistently wakes at an early hour and cannot return to sleep.

DIF: Cognitive Level: Application REF: 330 OBJ: 2 TOP: Terminal Insomnia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The newly admitted older adult who cannot fall asleep and asks for a sedative every night is most probably experiencing a difficulty with sleep: a. initiation related to anxiety of relocation. b. maintenance related to unfamiliar environment. c. initiation related to depression associated with relocation. d. maintenance related to episodes of nocturnal movement disorders.

ANS: A Sleep initiation issues are usually associated with anxiety.

DIF: Cognitive Level: Application REF: 330 OBJ: 2 TOP: Insomnia KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 6. The home health nurse assesses that the patient is probably experiencing myoclonus when his wife says: a. His loud snoring and jerking awake wakes me up, too. b. I am black and blue from his kicking me every night. c. He wakes up at 2 AM every morning and walks around the house. d. His constant leg movements tear up the covers and keep me awake.

ANS: B Myoclonus is a periodic kicking movement of the lower extremities, which can be severe.

DIF: Cognitive Level: Application REF: 330 OBJ: 2 TOP: Myoclonus KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The nurse would question the order for lorazepam (Ativan), 5 mg at bedtime, for a patient with: a. chronic obstructive pulmonary disease (COPD). b. any form of dementia. c. hypertension. d. sleep apnea.

ANS: D Sedation may prevent the patient with sleep apnea to awaken to restore respiration.

DIF: Cognitive Level: Application REF: 330, Table 20-1 OBJ: 3 TOP: Lorazepam KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 8. In order to assist a 75-year-old male resident in a long-term care facility to decrease his problems with sleep initiation, the nurse would: a. provide a heavy snack at bedtime. b. reschedule the 8 PM albuterol inhalation treatment to 4 PM. c. coach the resident in 10 minutes of exercise before bedtime. d. provide a cola drink, strong tea, or cocoa at bedtime.

ANS: B

Albuterol is a drug that may interfere with sleep schedules.

DIF: Cognitive Level: Analysis REF: 331, Table 20-2 OBJ: 7 TOP: Insomnia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 9. The nurse cautions the patient who has just started on the antidepressant trazodone hydrochloride to help relieve insomnia to: a. increase fluids. b. avoid aged cheese and red wine. c. decrease sodium intake. d. avoid excessive exposure to the sun.

ANS: D Trazodone makes persons photosensitive.

DIF: Cognitive Level: Application REF: 330, Table 20-1 OBJ: 7 TOP: Trazodone KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 10. The 80-year-old man complains that when he goes to bed and cannot fall asleep, he tosses and turns and gets so frustrated that he gets up and drinks coffee all night. The nurse suggests that when he has not fallen asleep after 30 minutes, he should: a. take two tablets of a sedative medication. b. get up and do a mild stretching exercise for 15 minutes. c. remain in bed with his eyes closed. d. get up and read until he feels sleepy and then return to bed.

ANS: D

Getting up and reading or watching TV is more restful than experiencing the frustration of inability to fall asleep. Sleep-inducing drugs frequently have a negative effect on older adults, exercising is stimulating, and lying in bed may increase tension.

DIF: Cognitive Level: Application REF: 331 OBJ: 7 TOP: Insomnia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. The nurse clarifies that the continuous positive airway pressure (CPAP) machine decreases the incidence of episodes of sleep apnea by: a. stimulating inspiration to be deeper. b. taking over respiratory activity when the patient ceases to breathe. c. sounding an alarm if respirations have ceased. d. keeping alveoli from collapsing.

ANS: D The use of CPAP keeps alveoli from collapsing and causing periodic apnea.

DIF: Cognitive Level: Comprehension REF: 332 OBJ: 7 TOP: Continuous Positive Airway Pressure Machine KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 12. When the patient tells the home health nurse that he has flung himself out of bed three times in the course of a violent nightmare, the nurse recognizes the cardinal indicator of: a. myoclonus. b. restless legs syndrome. c. rapid eye movement (REM) sleep disorder. d. epilepsy.

ANS: C REM sleep disorders excite excessive muscle activity during a nightmare, which causes the patient to thrash about to the point that he or she falls out of bed.

DIF: Cognitive Level: Application REF: 332 OBJ: 5 TOP: REM Sleep Disorder KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. The nurse cautions that although activity and exercise during the day are an effective sleep aid, activity and exercise should be avoided within _____ before bedtime. a. 30 minutes b. 1 hour c. 2 hours d. 3 hours ANS: C Exercise should be avoided within 2 hours of bedtime because activity increases the metabolic rate and may interfere with sleep.

DIF: Cognitive Level: Knowledge REF: 334 OBJ: 7 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. The patient is encouraged to decrease fluid intake in the late evening to prevent interruption of sleep from: a. increased digestive processes in the bowel. b. episodes of nocturia. c. gastroesophageal reflux. d. changes in body temperature.

ANS: B Reduced fluid intake in the evening will prevent nocturia, which interrupts sleep.

DIF: Cognitive Level: Knowledge REF: 334-335 OBJ: 7 TOP: Nocturia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. The nurse makes arrangements to promote normal circadian rhythm in a long-term care facility by ensuring that all rooms have: a. bright lights during the daytime. b. dim lights to promote relaxation. c. appropriate environmental temperature. d. curtains for privacy.

ANS: A Bright lights during the day support normal circadian rhythm. Environmental temperature control and privacy are important but do not affect circadian rhythm.

DIF: Cognitive Level: Application REF: 333 OBJ: 7 TOP: Circadian Rhythm KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort MULTIPLE RESPONSE 1. The nurse is aware that an older adults diurnal patterns can be altered by __________. (Select all that apply.) a. shift work b. time zone changes c. altered nutrition d. illness

e. medications ANS: A, B, D, E Nutrition does not alter diurnal patterns. All other options have the potential to alter the diurnal patterns of the older adult.

DIF: Cognitive Level: Knowledge REF: 328 OBJ: 1 TOP: Factors That Disrupt Diurnal Patterns KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The long-term care facility nurse takes into consideration that most residents go to sleep early and awaken early because of __________. (Select all that apply.) a. increased blood pressure b. drop in core temperature c. diminished food intake d. diminished hormone production e. decreased exposure to light ANS: B, E Decrease in body temperature and diminished light exposure cause circadian changes, which result in going to bed early and rising early.

DIF: Cognitive Level: Analysis REF: 329 OBJ: 2 TOP: Age-Related Changes in Circadian Rhythm KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse gives the antihistamine diphenhydramine (Benadryl) as a sleep aid with caution because the older adult may experience side effects, such as __________. (Select all that apply.) a. confusion b. urinary retention c. hypotension d. depression of respiration e. diarrhea ANS: A, B, C Benadryl can cause confusion, urinary retention, and hypotension in the older adult.

DIF: Cognitive Level: Application REF: 330, Table 20-1 OBJ: 7 TOP: Antihistamines as Sedatives KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 4. When mild sedation has failed to solve the problem of insomnia in the older adult, the nurse suggests __________. (Select all that apply.) a. relaxation therapy b. taking a cool bath or shower before bedtime c. listening to relaxing music d. arranging the sleep environment to promote sleep e. going to bed at a regular time after observing routine sleep rituals ANS: A, C, D, E Taking a cool bath or shower will not promote relaxation. All other options listed would encourage sleep.

DIF: Cognitive Level: Comprehension REF: 331, Health Promotions OBJ: 7 TOP: Insomnia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse explains that factors that contribute to sleep apnea include __________. (Select all that apply.) a. obesity b. diabetes c. hypotension d. African American heritage e. use of alcohol ANS: A, B, D, E Hypotension does not contribute to sleep apnea. All other options are considered to be factors that contribute to sleep apnea.

DIF: Cognitive Level: Comprehension REF: 331-332 OBJ: 5 TOP: Sleep Apnea KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. The wife of a patient tells the home health nurse that she suspects her husband has sleep apnea because he __________. (Select all that apply.) a. snores loudly b. interrupts snoring with several seconds of silence c. complains of daytime drowsiness d. frequently is incontinent of urine e. has episodes of myoclonus ANS: A, B, C Incontinence and myoclonus are not associated with sleep apnea.

DIF: Cognitive Level: Application REF: 331-332 OBJ: 5 TOP: Sleep Apnea KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. The nursing staff helps encourage sleep in long-term care facility residents by __________.

(Select all that apply.) a. using the minimum light necessary when making rounds b. making necessary sleep interruptions at the same time every night c. keeping conversational noise at the nursing station to a minimum d. answering call lights promptly e. providing heavy blankets for warmth ANS: A, B, C, D Heavy blankets may initially feel warm to the resident but eventually make the resident uncomfortable and unable to sleep. All other options listed will help diminish sleep interruptions.

DIF: Cognitive Level: Comprehension REF: 332-333 OBJ: 7 TOP: Sleep Support KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 8. The nurse knows that the older adult experiences changes in patterns of sleep, which typically include __________. (Select all that apply.) a. inability to sleep throughout the night b. sleeping soundly all night c. increase in the number of hours asleep at night d. difficulty in arousing from deep sleep e. waking up early ANS: A, E The older adult has a decreased number of hours of sleep, wakes early, and rarely sleeps soundly.

DIF: Cognitive Level: Knowledge REF: 329 OBJ: 3 TOP: Effects of Disease Processes on Sleep KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. The nurse assesses that the resident may be experiencing changes in sleep and rest patterns when she states__________. (Select all that apply.) a. I dont know why everything seems to bother me lately. b. Ive been so clumsy. c. Im having trouble concentrating. d. My daughter says I talk in my sleep. e. I cry for no reason at all.

ANS: A, B, C, E Sleep talking occurs within the sleep cycle. Irritability, increased accidents, difficulty paying attention, and altered emotional stability are symptoms of an altered sleep and rest pattern.

Chapter 13 Comfort and Pain Management MULTIPLE CHOICE 1. When planning care for the older adult experiencing pain, the nurse bases interventions on the realization that: a. generally pain control is less effective than it is for younger adults. b. this cohort is less pain sensitive than younger adults. c. older adults are more likely to verbally express pain than younger adults. d. pain is undertreated in this cohort compared to younger adults.

ANS: D Pain is underrecognized, highly prevalent, and undertreated among older adults.

DIF: Remembering (Knowledge) REF: Page 256 OBJ: 14-4 TOP: Nursing Process: Analysis MSC: Physiologic Integrity

2. An older patient is observed grimacing whenever walking and getting in and out of bed. When assessed, the patient regularly denies having any pain. To best provide the patient with effective pain control, the nurse initially: a. discusses the effects of untreated pain on the patients general wellness. b. offers the patient a prescribed prn analgesic. c. asks the patient why he is denying the presence of pain. d. documents the symptoms that the patient is exhibiting.

ANS: A Older adult patients actually underreport pain and are therefore at risk for undertreatment of pain, which may cause unnecessary suffering, exacerbation of the underlying disease, and reduction in activities of daily living (ADLs) and quality of life. Without this information the patient is unlikely to take the prn medication. Why questions are not therapeutic, as they place people on the defensive. The symptoms should be documented, but this should not be the only action.

DIF: Applying (Application) REF: N/A OBJ: 14-2 TOP: Teaching-Learning MSC: Physiologic Integrity 3. The nurse caring for an older adult patient experiencing carpal tunnel syndrome anticipates the patient will best achieve pain control when prescribed a(n): a. narcotic (e.g., fentanyl). b. opioid (e.g., oxycodone). c. tricyclic antidepressant (e.g., amitriptyline [Elavil]). d. nonpharmacologic strategy (e.g., wrist bracing).

ANS: C Neuropathic pain results from a pathophysiologic process involving the peripheral or central nervous system. These types of pain respond to unconventional analgesic drugs, such as tricyclic antidepressants. Carpal tunnel syndrome is caused by nerve injury.

DIF: Analyzing (Analysis) REF: N/A OBJ: 14-8 4. When planning care for the older adult patient with a history of persistent pain, the nurse acknowledges the effects of the mind-body connection by including: a. regular pain assessments. b. prompt response to reports of pain. c. pain consults. d. relaxation techniques.

ANS: D Some mind-body therapies include meditation, relaxation, guided imagery, and cognitive behavioral counseling. The other actions are appropriate but not related to mind-body therapies.

DIF: Remembering (Knowledge) REF: Page 266 OBJ: 14-8 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 5. An older adult patient has been prescribed an opioid to manage chronic pain resulting from a shoulder injury. To eliminate a common barrier to opioid drug compliance, the nurse: a. encourages the patient to use the opioid only as prescribed. b. educates the patient about the appropriate management of constipation. c. assures the patient that dizziness will decrease as therapeutic levels are reached. d. suggests the patient take the medication with meals or a snack.

ANS: B Older adults have a high rate of discontinuation of opiates because of the resulting constipation.

The treatment for constipation, especially that which is opioid induced, is readily available and should be provided as a preventive measure before starting narcotic pain medication. The other actions do not address this issue.

DIF: Understanding (Comprehension) REF: Page 263 OBJ: 14-4

TOP: Teaching-Learning MSC: Physiologic Integrity 6. The nurse is discussing pain control with an older patient who has been prescribed an opiate.

When the patient expresses concerns about the diminishing effect that the medication has had on the pain, the nurse responds: a. It appears that the dosage you take needs to be adjusted upward. b. We need to be concerned about you developing a drug tolerance. c. This drug category is well known for its low ceiling effect. d. Opiate addiction is a concern when tolerance occurs.

ANS: A Tolerance is defined as the diminished effect of a drug while maintaining the same dosage over time. It is a characteristic of opiates when given over time. With opiates, some individuals might need higher and higher doses of a drug to maintain effectiveness. This should not be confused with addiction.

DIF: Understanding (Comprehension) REF: Page 263 OBJ: 14-8 TOP: Teaching-Learning MSC: Physiologic Integrity 7. An older patient is being treated for arthritic pain with a nonsteroidal anti-inflammatory drug (NSAID). Which question best assesses for side effects of this medication class? a. Have you noticed your heart skipping beats since you began taking this drug? b. Did you know you should not to stand up too quickly? c. Are you aware that you should take your pain medication with food? d. Have you had any episodes of shortness of breath since starting this medicine?

ANS: C The most common complaint associated with NSAIDs is indigestion. Indigestion may be reduced with antacid use or food consumption timed to coincide with analgesic intake.

DIF: Understanding (Comprehension) REF: Page 263 OBJ: 14-8 TOP: Teaching-Learning MSC: Physiologic Integrity 8. The nurse is caring for an older adult patient with terminal cancer who is receiving medication via patient-controlled analgesic (PCA) pump. The nurse shows an understanding of primary endof-life concerns when asking the patient: a. Do you have any concerns about receiving your medication intravenously? b. Are you satisfied with the way your pain is being managed? c. Are you worried about becoming addicted to the narcotic analgesics? d. Do you have any questions concerning how to use the PCA properly?

ANS: B Terminally ill patients generally identify their main concern as pain control. The other questions do not address this issue.

DIF: Applying (Application) REF: N/A OBJ: 14-8 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 9. The nurse is performing a pain assessment when the older adult patient reports pain in his left shoulder that radiates down into the forearm. The nurse immediately: a. recognizes that the patient is experiencing cardiac distress. b. alerts the rapid response team to provide emergency care. c. asks whether he has ever experienced this pain before. d. questions the patient about additional related symptoms.

ANS: C Assessment is essential in differentiating acute life-threatening pain from longstanding chronic pain. Otherwise, disease progression and acute injury may go unrecognized and be attributed to preexisting disease or illness. The patient may or may not be experiencing cardiac ischemia, the

rapid response team does not need to be called, and the nurse can assess for other symptoms after determining if this pain is new or not.

DIF: Applying (Application) REF: N/A OBJ: 14-6 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 10. An older adult who injured her knee several years ago tells the nurse that she has been managing the resulting intermittent pain with a prescription for propoxyphene (Darvon). The nurse is concerned with this treatment plan, primarily because: a. less expensive alternative analgesics are available. b. this long-term need for a narcotic warrants investigation. c. aspirin would likely be as effective in managing the pain. d. the knee should not still be causing pain for the patient.

ANS: B The nurse needs to complete a full assessment to determine what type of pain the patient is experiencing and if a narcotic is the best alternative for the patient. Other medications may be more beneficial.

DIF: Applying (Application) REF: N/A OBJ: 14-8 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 11. The nurse is caring for a 78-year-old with a history of chronic depression. The patient currently reports persistent left shoulder pain since having a fall a year ago. To best address the patients pain, the nurse initially determines: a. if the patient is still at risk for falls. b. the severity of the shoulder injury. c. how effectively depression is being managed. d. the patients ability to effectively cope with pain.

ANS: C Persistent depression affects a persons ability to cope with the pain, so it must be treated. The nurse should also assess fall risk but that is secondary to determining why the pain has lasted so long and if the patient is able to cope.

DIF: Applying (Application) REF: N/A OBJ: 14-4 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 12. Acetaminophen (Tylenol) is prescribed for a 70-year-old with chronic pain. When the patient reports to the nurse that the maximum daily dose of medication does not control the pain, the nurse responds: a. Breakthrough pain can be managed with the addition of another analgesic. b. Transcutaneous electrical nerve stimulation (TENS) is often helpful. c. It sounds as though you have developed a tolerance for acetaminophen. d. We will need to get your physician to prescribe another analgesic for you.

ANS: D The patient needs a comprehensive review of pain strategies, which will probably include changing pain medication. Using the maximum dose of acetaminophen long term can cause liver damage, which is another reason the patient should switch medications if it is not working.

DIF: Applying (Application) REF: N/A OBJ: 14-8 TOP: Communication and Documentation MSC: Physiologic Integrity 13. An older adult patient is prescribed an analgesic to manage the joint pain resulting from stiffness in his right shoulder. When the patient asks about alternative therapy techniques that might be helpful, the nurse suggests: a. applying ice packs to the area three to four times a day. b. placing a moderately warm heating pad to the shoulder.

c. arranging for a professional massage on a weekly basis. d. discussing electrical nerve stimulation with the physician.

ANS: B Heat is useful in decreasing pain and discomfort resulting from joint stiffness by increasing the elasticity of muscles. Ice is better for acute exacerbations. Massage may or may not help but would be more expensive. Electrical nerve stimulation is not warranted.

DIF: Understanding (Comprehension) REF: Page 266 OBJ: 14-8 TOP: Teaching-Learning MSC: Physiologic Integrity 14. The nurse caring for an older cognitively impaired patient with osteoarthritis in both hands assesses the patient for hand pain by: a. observing for facial grimacing when the patient uses a fork to eat. b. being alert for signs of agitation when washing the patients hands. c. listening to detect moaning when patient makes a fist. d. watching for signs that the patient is reluctant to shake hands.

ANS: B Cognitively impaired patients in pain may not portray any visible signs of pain or distress or may be unable to communicate their pain. Pain may result in agitation, as well as increased pulse, respiration, blood pressure, and confusion. The other options are not as indicative of pain in the cognitively impaired older adult.

DIF: Remembering (Knowledge) REF: Page 258 OBJ: 14-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 15. A director of nursing in a long-term care facility was concerned after reading that as many as 80% of residents have untreated pain. What action by the director is best?

a. Establish protocols for routine assessment. b. Make a pain plan for every resident. c. Involve family members in treating pain. d. Educate the staff on how to assess pain.

ANS: A Nursing begins with assessment. The director should implement a protocol for routine assessments of pain in both cognitively impaired and intact residents. A pain plan cannot be created without this assessment data. Family members should be encouraged to provide input.

The staff may or may not need to have education on assessment.

DIF: Applying (Application) REF: N/A OBJ: 14-7 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 16. An older patient who lives alone is brought to the clinic by an adult child who reports the patient has become depressed and no longer wants to go out of the home. What action by the nurse is best? a. Assess the patient for depression. b. Ask the patient why activities are avoided. c. Assess the patient for pain. d. Assess the patient for elder abuse.

ANS: C Many older adults have pain that goes untreated. Consequences of untreated pain are numerous and include depression and withdrawal. The nurse should first assess for pain. Assessing for depression or elder abuse may be warranted as well. Asking why questions is not therapeutic, as patients tend to become defensive.

DIF: Applying (Application) REF: N/A OBJ: 14-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

17. A confused patient is admitted to the hospital after suffering a fall. When asked about pain, the patient does not respond. What action by the nurse is best? a. Ask the patient again using different words. b. Pantomime what you are asking the patient. c. Observe the patients nonverbal behaviors. d. Ask the family members if they think the patient has pain.

ANS: C In some situations, the nurse cannot rely on the patients report of pain, so as a second method of assessment, the nurse looks to the patients nonverbal behaviors. The nurse should be aware, however, that the lack of specific pain behaviors does not indicate a lack of pain. The other options may be helpful for individual patients.

DIF: Applying (Application) REF: N/A OBJ: 14-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 18. A patient has just had surgery. What pain control strategy is best? a. Administer prn medications when requested. b. Give pain medications around the clock at first. c. Start with nonopioids then progress to opioids. d. Ask the patient his or her preference for medication.

ANS: B After surgery the patient is expected to have pain. The best way to control acute pain is through round-the-clock dosing (at least at first) to keep the patients pain from getting out of control. The nurse should assess the patients preferences, but should assess preferences for pain levels, because the patient may not be experienced in receiving pain medications. Opioids are expected for acute pain from surgery.

DIF: Applying (Application) REF: N/A OBJ: 14-8

TOP: Nursing Process: Implementation MSC: Physiologic Integrity 19. An older patient is hospitalized for the first time. After giving a dose of hydromorphone (Dilaudid), what assessment takes priority? a. Pain level b. Nausea c. Urinary retention d. Respiratory rate ANS: D Respiratory depression is common with opioid analgesics. All assessments are appropriate; however, respiratory assessment takes priority.

DIF: Applying (Application) REF: N/A OBJ: 14-8 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 20. An older adult lives alone at home and is being treated for chronic pain. The home health care nurse notes the adult is disheveled and has dirty dishes piled up in the sink. What action by the nurse is best? a. Notify adult protective services. b. Arrange for hospitalization. c. Assess the patients pain. d. Assess the patients cognitive status.

ANS: C Although all actions might be appropriate depending on circumstances, because the patient is being treated for pain and has a functional decline, the nurse should assess first for unrelieved pain.

DIF: Applying (Application) REF: N/A OBJ: 14-8

TOP: Nursing Process: Assessment MSC: Physiologic Integrity 21. A patient has constipation as a side effect of opioid analgesics. What menu choice indicates the patient understands nutritional therapy for this problem? a. Scrambled eggs b. White bread c. Canned fruit d. Oatmeal ANS: D Constipation can be managed with high fiber and increased water. Oatmeal has the highest fiber content of the four foods listed.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 14-1 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity 22. The nurse is caring for four frail patients with pain. Which patients pain medication prescription does the nurse question? a. The patient taking pentazocine (Talwin) b. The patient taking acetaminophen (Tylenol) c. The patient taking ibuprofen (Motrin) d. The patient taking hydromorphone (Dilaudid) ANS: A Talwin should not be used in frail older people because it leads to central nervous system excitement, confusion, and agitation. The other drugs are appropriate choices.

DIF: Applying (Application) REF: N/A OBJ: 14-8 TOP: Nursing Process: Implementation MSC: Physiologic Integrity

MULTIPLE RESPONSE 1. When planning nursing care for an older adult who is experiencing chronic pain, the nurse includes which of the following interventions? (Select all that apply.) a. Maintain mobility. b. Promote autonomy. c. Manage any chronically painful condition. d. Provide economical sensitive pain relief. e. Support the patients right to be pain-free.

ANS: A, B, C Goals for pain management in older adults include control of chronic disease conditions that cause pain, maintenance of mobility and functional status, promotion of maximum independence, and improvement of quality of life.

Chapter 14 Safety MULTIPLE CHOICE 1. Which nursing intervention best demonstrates the understanding that older adults are at increased risk for falls because of normal age-related changes? a. Speaking in a loud voice when warning the patient about safety hazards b. Turning on bright lights so the patient can see objects such as furniture c. Encouraging the patient to rise from a supine position slowly d. Advising the patient to avoid exercising painful joints ANS: C Older adults who lie supine and then get up quickly are likely to experience the effects of lack of tissue elasticity when the blood pressure drops and a feeling of lightheadedness develops. It is important to educate older individuals to change position slowly.

DIF: Understanding (Comprehension) REF: Page 220 OBJ: 12-4 TOP: Teaching-Learning MSC: Safe Effective Care Environment 2. An older adults risk for a fall-related injury is directly correlated to his or her ability to regain balance. To evaluate this ability, the nurse assesses the patients: a. inner ear for possible fluid buildup. b. musculoskeletal hip, ankle, and shoulder strength. c. large muscle strength in thighs and upper arms. d. gait for steadiness.

ANS: B Older adults who lose their balance are able to right themselves to an upright position when the musculoskeletal strength of the hips, ankles, and shoulders is adequate. The inability to regain balance because of insufficient strength can result in a fall. The other options are also possibilities, but they are not as significant as hip, ankle, and shoulder strength.

DIF: Understanding (Comprehension) REF: Page 221 OBJ: 12-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 3. The geriatric nurses decision to identify a specific patient as a falls risk is primarily based on the: a. presence of visual deficiencies and musculoskeletal weakness. b. results determined by cognitive and physiologic assessment tools. c. degree of frailty and functional limitation observed. d. inability to follow instructions and communicate effectively.

ANS: C Research has shown that the individual with frailty and physical functional limitations is at greatest risk for falling.

DIF: Remembering (Knowledge) REF: Page 222 OBJ: 12-4 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 4. An older adult has been diagnosed with presbyopia. To minimize the patients risk for falls, the nurse suggests: a. that the edges of steps be painted a contrasting color. b. the patient wear sunglasses when driving. c. the patient wear a wide-brimmed hat when spending time outdoors. d. hanging blinds over sunny windows.

ANS: A If older individuals are experiencing presbyopia, a reduction in the eyes accommodation for changes in depth, such as when ascending or descending the stairs, instruction must be given for them to carefully watch door edges, curbs, and landing steps, which signal a change in height.

Painting the edges of steps a contrasting color will make these depth changes more visible. The other suggestions are not related to this disorder.

DIF: Applying (Application) REF: N/A OBJ: 12-1 TOP: Teaching-Learning MSC: Safe Effective Care Environment 5. An older adult has been diagnosed with a sinus infection. To minimize the risk for a fallrelated injury, the nurse teaches the patient: a. that there is a possibility of prodromal falls. b. to take her antibiotic medication with food. c. to recognize symptoms of fluid buildup in the middle ear. d. about the increased risks of falls related to normal aging.

ANS: A

Prodromal falling refers to the onset of frequent falling heralding an acute medical problem; an infectious disease typically causes this type of fall. Educating the patient regarding the most common sources of potential falls is the cornerstone of fall prevention and management. The other options do not relate directly to this condition.

DIF: Understanding (Comprehension) REF: Page 224 OBJ: 12-4 TOP: Teaching-Learning MSC: Safe Effective Care Environment 6. The nurse identifies the older adult patient at the greatest risk for a fall-related injury as the: a. male with a history of a vitamin deficiency. b. female with a diagnosis of osteoporosis. c. male with a cognitive deficient. d. female with a history of depression.

ANS: B Serious injury from falling is more likely to occur among those with osteoporosis.

DIF: Remembering (Knowledge) REF: Page 223 OBJ: 12-4 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 7. An older patient diagnosed with dementia has begun behaviors that increase the risk of falling.

The patients son tells the nurse that physical restraints may be used. The nurse responds: a. Ill document that, so that the staff can use them when necessary. b. Physical restraints are seldom effective on patients with dementia. c. The staff will use physical restraints only as a last resort. d. There are more effective methods to use to help ensure her safety.

ANS: D

Physical restraint use does not prevent falls and therefore should never be employed for safety precautions. This is the best explanation because the nurse will then need to explain the other measures that will be taken to keep the patient safe.

DIF: Understanding (Comprehension) REF: Page 223 OBJ: 12-3 TOP: Teaching-Learning MSC: Safe Effective Care Environment 8. A patient is being discharged after hip replacement surgery. The geriatric nurse recognizes that the most effective intervention to minimize the potential of a fall injury is to: a. identify the most common causes of falls that the patient is likely to encounter. b. discuss what kind of in-home assistance the patient will need. c. impress the patient with the importance of being careful not to fall. d. educate the patient that falling is not a normal part of aging.

ANS: A Educating the patient regarding the most common sources of potential falls is the cornerstone of fall prevention and management. The patient may or may not need home care assistance, telling the patient how important it is not to fall does not provide the patient with a plan to avoid falling, and educating the patient on normal age-related changes also does not give the patient any information on how to avoid falling.

DIF: Understanding (Comprehension) REF: Page 219 OBJ: 12-4 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 9. A patient is diagnosed with bilateral osteoarthritis of the knees. To best address the long-term risk for falls, the nurse encourages the patient to: a. use assistive mobility devises when necessary. b. report exacerbation of symptoms promptly. c. add a daily walk to exercise the knees appropriately. d. take analgesic medication as prescribed to manage joint pain.

ANS: D If joint pain develops and remains untreated, it can cause older adults to become sedentary or immobile. This phenomenon of disuse and muscle atrophy contributes to muscle weakness and can lead to an increase in falls. The other statements are also appropriate, but the patients pain needs to first be managed before determining if assistive devices are needed. Walking will help build strength, but the patient wont do it if it hurts too much. Reporting symptoms does not directly affect falling.

DIF: Applying (Application) REF: N/A OBJ: 12-5 TOP: Teaching-Learning MSC: Safe Effective Care Environment 10. A cognitively impaired older adult patient is a resident at a skilled nursing facility. The nurse acting as the patients advocate will consistently address the patients risk for injury issues based on: a. preferences generally expressed by cognitive patients. b. professional nursing knowledge. c. implementation of the less restrictive intervention. d. established facility policies and procedures.

ANS: D If patients are unable to make informed choices and no family members are available, the nurse must use nursing judgment and follow an acceptable standard of care to promote safety and security that are defined and described in official policies and procedure manuals. The preferences of other patients do not indicate this patients preferences. Professional nursing knowledge can be used but must remain within the policies. Less restrictive interventions are preferable, but again actions need to conform to policy.

DIF: Understanding (Comprehension) REF: Page 228 OBJ: 12-6 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

11. When appropriately addressing safety issues, the geriatric nurse plans the patients care plan directed by the standard of care that requires: a. promoting both health and wellness by assuring safety. b. minimizing the patients risk for physical injury while preserving autonomy. c. identifying safety from injury as a patient right. d. emphasizing beneficence as a an ethical standard of nursing care.

ANS: B When working with older adults, the gerontologic nurse must provide a standard of care that promotes safety and prevents foreseeable accidents or injuries while also respecting individuals autonomy to make decisions. This requires a delicate balance. The other options do not address standards.

DIF: Remembering (Knowledge) REF: Page 228 OBJ: 12-6 TOP: Nursing Process: Analysis MSC: Safe Effective Care Environment 12. Which action is best to reduce burns in the home? a. Instruct patients to install smoke detectors, b. Tell patients to have their water heaters checked, c. Encourage patients to switch from gas to electric stoves, d. Teach patients not to smoke in their houses, ANS: B The most common cause of burns in the home for older patients is scalding from water that is too hot. Patients should either check and reset the temperature themselves or have someone do it for them. The other actions are all helpful, but scalding remains the top cause of burns in the home for this population.

DIF: Understanding (Comprehension) REF: Page 229 OBJ: 12-7

TOP: Teaching-Learning MSC: Safe Effective Care Environment 13. A patient smokes. What advice does the nurse give this patient for safety? a. Do not smoke inside the house. b. Install working smoke detectors. c. Only smoke during the daytime. d. Install carbon monoxide detectors.

ANS: A Smoking has been related to house fires for many years. The nurse can provide many suggestions, but not smoking inside at all is the safest option. Smoke detectors work after a fire has started. Smoking during the daytime does not eliminate the possibility of falling asleep while smoking. Carbon monoxide detectors are important but not related to fire.

DIF: Applying (Application) REF: N/A OBJ: 12-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment 14. The nurse assesses which patient as being at the highest risk for poisoning related to mixing garden chemicals? a. The patient who has Parkinson disease with hand tremors b. The patient who has low vision or uses magnifying glasses c. The patient who has hearing impairment or wears hearing aid d. The patient who has osteoarthritis or using a wheeled walker ANS: A The patient with hand tremors is at greatest risk because of the potential for inaccurate mixing and spillage.

DIF: Applying (Application) REF: N/A OBJ: 12-7

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 15. The student asks the nurse why ground beef and other ground meat products are more likely to be contaminated and cause food-borne illness. What response by the nurse is best? a. Its because they are handled more. b. They are from cheaper cuts of meat. c. They are not kept cold during shipping. d. They are made from leftover meats.

ANS: A Ground meat products are handled more during processing, increasing the risk of being contaminated with microbes that cause food-borne illnesses.

DIF: Understanding (Comprehension) REF: Page 231 OBJ: 12-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment 16. The nurse working with older patients would assess which patient as being at highest risk for developing secondary hypothermia? a. The patient who has osteoarthritis and limited mobility b. The patient who has a raised rash on both arms c. The patient who drinks four alcoholic drinks a day d. The patient who takes furosemide (Lasix) ANS: C Alcohol and substance abuse increase the risk of hypothermia because of decreased awareness and impaired judgment. Four drinks a day is excessive. Skin conditions can lead to hypothermia, but the rash is confined to the arms. The other two conditions are not risk factors.

DIF: Applying (Application) REF: N/A OBJ: 12-8

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 17.

A patient is brought to the emergency department after falling while shoveling snow. The patients core temperature is 92?0F (33.3?0C). What rewarming measures does the nurse prepare to initiate? a. Warm blankets b. Warm heating lamps c. Peritoneal dialysis d. Warmed intravenous (IV) solutions ANS: D A core temperature this low requires active internal rewarming. Warmed IV solutions are appropriate. Blankets and a heating lamp are appropriate for mild hypothermia. Peritoneal dialysis is reserved for severe cases with cardiac instability.

DIF: Applying (Application) REF: N/A OBJ: 12-8 TOP: Nursing Process: Analysis MSC: Physiologic Integrity 18. A nurse is watching a parade during the summer and notices an older adult looking faint and acting somewhat confused. The patient has hot dry skin. While waiting for the rescue squad, what action by the nurse is most effective? a. Spraying the person with a water mist b. Giving the person iced tea to drink c. Having the person sit down on the grass d. Pouring cold water over the persons head ANS: A

Spraying the person with a cold-water mist will help dissipate heat, especially if the nurse then fans the person. Iced tea is a diuretic and will increase fluid loss. Having the person sit down is a good idea, as long as the person sits in the shade. Pouring cold water over the persons head is not as effective as a water spray mist.

DIF: Applying (Application) REF: N/A OBJ: 12-8 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 19. The nurse teaches that which of the following is the best place to store medications? a. Bathroom medicine cabinet b. Near the kitchen sink c. In the laundry room d. In a drawer in the bedroom ANS: D Medications should be kept away from heat, direct sunlight, and humidity. The drawer in the bedroom is the best of the options given.

DIF: Understanding (Comprehension) REF: Page 235 OBJ: 12-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment 20. The nurse working with older adults understands that which age-related condition contributes to driving safety concerns? a. Wearing glasses b. Hearing impairment c. Confusion d. Slower reflexes ANS: D

Slower reflexes and reaction times are a normal age-related change. Wearing glasses and hearing aids should correct the underlying problem and not be a cause for concern in themselves.

Confusion is not a normal age-related change.

DIF: Understanding (Comprehension) REF: Page 235 OBJ: 12-11 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 21. A patient has had several falls ascribed to numb feet. What action by the nurse is best? a. Assess patient for undiagnosed diabetes. b. Instruct the patient on using a cane. c. Ensure the patient has sturdy footwear. d. Tell the patient to lift the feet when walking.

ANS: A Numbness in the feet is caused by peripheral neuropathy, which is a complication of diabetes mellitus. The nurse plans to assess the patient for this condition. The other options do not address the lack of sensation to the feet.

DIF: Applying (Application) REF: N/A OBJ: 12-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE 1. When assessing an older adult for intrinsic risk factors for falls, the nurse is particularly interested in which of the following? (Select all that apply.) a. An unsteady gait when asked to walk without assistance b. The presence of throw rugs in the living room of the home c. The patients report that he wears corrective lenses d. An inability to see changes in height because of poor lighting e. Evidence of short-term memory deficiency

ANS: A, C, E The most salient observations for intrinsic risk factors for falls relate to gait, balance, stability, and cognition. Intrinsic risk factors are a combination of age-related changes and concurrent disease. The other two options are extrinsic factors, which relate to the environment.

DIF: Remembering (Knowledge) REF: Page 220-1 OBJ: 12-4 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 2. A patient is brought to the emergency department after an unexplained fall. What actions by the nurse are most appropriate? (Select all that apply.) a. Placing the patient on a cardiac monitor b. Obtaining a urine sample for cultures c. Checking a quick bedside blood glucose d. Assessing the patient for asthma e. Performing tests for orthostatic vital signs ANS: A, B, C, D Common causes of falls include cardiac dysrhythmias, urinary tract infection, hypoglycemia, and dehydration, so the nurse assesses for these conditions. Asthma most likely is not an issue.

Chapter 15 Spirituality MULTIPLE CHOICE 1. Which of the following is a true statement about the theories of aging? a. Research data support the disengagement theory, activity theory, and continuity theory. b.Everyone should be able to achieve the three tasks of Pecks model of integrity. c. The exercise of rights is not a task of aging in Kellys model. d.A person may choose to avoid pursuing inner discovery in older age.

ANS: D

Some persons do not value inner psychological exploration and remain action oriented even in an older age, and others are still subject to the same demands of daily living as they were in middle age. None of these theories is clearly supported by data. Pecks tasks of ego differentiation, body transcendence, and ego transcendence demand a great deal of courage and energy that not everyone possesses. Tasks of aging in Kellys model are accepting reality, fulfilling responsibility, and exercising rights.

PTS:1DIF:UnderstandREF:4-12 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. Which of the following is a true statement about neuropsychiatric function in older adults? a. Overall cognitive abilities are progressively degraded by neuron loss in the cerebral cortex with aging. b.Improving cognitive functions in an older person calls for sporadic mental activity around ideas the person finds significant and interesting. c. Nerve cells regenerate in the hippocampus. d.Mood does not influence an older person ability to remember verbal instructions.

ANS: C Nerve cells regenerate in the hippocampus; this is a true statement. Although neurons can regenerate in the hippocampus, regeneration is impeded by stress. Overall cognitive abilities are progressively degraded by neuron loss in the cerebral cortex with aging; this statement is not true. Neuron loss does not harm overall cognitive ability, although it makes neural processes run more slowly. Improving cognitive functions in an older person calls for sporadic mental activity around ideas the person finds significant and interesting; this is not a true statement. Neural functions can be retrained, but exercising the brain on a regular basis is necessary. Older adults learn best when new information is relevant to what is already familiar. Mood does not influence whether an older person remembers verbal instructions; this is a not a true statement. Recalling events, including communication, is impaired by a crisis situation or anxiety.

PTS:1DIF:RememberREF:16 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

3. Which of the following statements is true about social and emotional health of older adults? a. Contemporary society has strong norms for the behavior of adults older than 80 years. b.The transition to old age entails a declining level of contribution to others as one becomes increasingly dependent on them. c. Computers and the Internet have little to contribute to older adults in their need for social support. d.Nurses are often significant sources of social and emotional support for older adults.

ANS: D Nurses are often important confidants and providers of social support in the lives of older adults.

The diversity of cultures and individuals in a society such as the United States means that norms are almost nonexistent for those older than 80 years. Older adults have a great deal to contribute in wisdom and by example. E-mail and online chat rooms are a means of contact and social support for many older adults.

PTS: 1 DIF: Understand REF: 12-20| 29 Box 6-1| 33 Box 6-5| 34 Box 6-6 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 4. Which role is most likely to have a significant effect on the type of aging process experienced by the older adult? a. Grandparentc. Friend b.Spouse d.Parent ANS: B The loss of a spouse is likely to be devastating for an older adult for economic and biopsychosocial reasons. When an older adult loses a spouse, the loss can include economic security, especially for a woman, and societal roles. Alterations in these roles are not usually as challenging as the loss of a spouse. Grandparenting can offer the potential for enhanced social experiences for an older adult; however, adults can age well without them when more basic needs are met. Alterations in these roles are not always as acutely demanding as the loss of a spouse. Alterations in these roles usually call for little or a gradual adjustment.

PTS:1DIF:UnderstandREF:12-13

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 5. The children in an African-American family attended college because their mother worked two jobs as they were growing up. She never finished high school, the children are grown, and she lives alone in retirement. Which noted weakness of sociological theories on aging explains why the social exchange theory is not applicable to this older adult? a. Gender c. Ethnicity b.Cultured.Opportunity ANS: D Social exchange theory ignores the effect that opportunity can have on aging because, according to this theory, the mother should be living with one of the children. They had the opportunities that she never had. Gender is not as relevant to this theory of the value of youth as being a period where social credits are earned for old age. Culture is not as relevant to this theory as the value of youth. Ethnicity is not as relevant to this theory as the value of youth.

PTS:1DIF:AnalyzeREF:7 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 6. In which context are members of a cohort described when using the age-stratification theory to explain the effect of similar events, conditions, and circumstances? a. Historical c. Sociological b.Biologicald.Chronological ANS: A In the age-stratification model, historical context is used to understand members of a cohort in terms of similar events, conditions, and circumstances and the effect these have on the group as a whole. A good example of such a cohort is older adults who lived through World War II. Biological context is not important in considering the age-stratification theory. The agestratification theory is a sociological theory of aging that uses historical context to describe cohorts. Chronological context of a cohort will span a range, but historical context is what describes the cohort.

PTS:1DIF:KnowledgeREF:6 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 7. An older patient who was just diagnosed with a terminal disease states, All my life I attended church, but I am still worried about what will happen after death. The nurses best response is which of the following? a. The unknown may be frightening. Do you want to talk about this? b.Religious people know that God is a good God. c. People that have had near death experiences say it is peaceful. d.You must feel good about attending church most of your life.

ANS: A Often the unknown is very frightening, uses the reflective technique to identify the patients feelings regarding the fear of the unknown. Religious people know that God is a good God, denies the patients feelings. People that have had near death experiences say it is peaceful, focuses on the experience of others. You must feel good about attending church most of your life, ignores the patients concern about death.

PTS: 1 DIF: Apply REF: 12-16| 32 Box 6-4| 33 Box 6-5| 34 Box 6-6 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 8. An older man 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 Social Security. Using Jungs theory, what in this individuals life is the most pivotal in his personality development? a. Living alone c. Severe knee pain b.Meager incomed.Job and home loss ANS: D Jungs theorizes that the personality forms, in part, after a crisis, as an individual moves from extroversion to introversion in aging. Living alone is a situation that is the result of many factors coalescing in an individuals life. A meager income can be a result of the individuals life work

and other individual choices and events. His personality can affect how an individual deals with pain, and the pain can affect an individuals personality. However, whether the pain is old or new is not known; thus a determination cannot be made.

PTS:1DIF:AnalyzeREF:9-10 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 9. The nurse plans care for older adults who are in good health but isolated from their families. If the nurses goal is to move the adults toward gerotranscendence, which intervention should the nurse use in the plan of care? a. Give a daily tea party for the group. b.Call each family to encourage visiting. c. Assist them to resume midlife patterns. d.Help each person with individual activities.

ANS: D In Tornstams theory, aging offers the potential for gerotranscendence, a culmination of an individuals life, wisdom, and spiritual growth that allows the older adult to live contentedly with and without social activities. An older adult spends more time on meditation and solitude, and less time on materialism and self-consciousness about body image. Individual activities or selfselected activities are satisfactory. Solitude is satisfactory. Midlife patterns are no longer relevant to contentment.

PTS: 1 DIF: Apply REF: 12 TOP: Nursing Process: Planning MSC: Psychosocial Integrity 10. The nurse observes older female adults learning advanced knitting techniques. The nurse concludes that this learning activity is suitable for these women because it accomplishes which of the following? a. Helps maintain joint flexibility b.Improves the groups cohesiveness c. Provides a needed social opportunity d.Adds to their existing knowledge base

ANS: D Learning advanced techniques is a suitable activity for older adults because it builds on knowledge they already have; further, this activity is suitable because it is concrete and practical for experienced knitters to develop advanced skills. Joint flexibility is a physical activity and not necessarily a learning activity. The members share enjoyment of knitting; other than being women and older, the group has no special bond on which to build. The need for socializing is not evident.

PTS: 1 DIF: Apply REF: 19-20 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 11. The nurse at a nursing home wants to help decrease the risk of Alzheimer disease in the residents. Which should the nurse do to implement this goal? a. Keep the curtains open in their rooms. b.Offer beads for them to string on yarn. c. Show movies that the residents choose. d.Assist residents with ambulation to meals.

ANS: D Engaging in physical activity and social interaction are associated with a lower risk for Alzheimer disease. Keeping the curtains open can make a residents room more pleasant but is likely to be counterproductive in lowering the risk; brightening the room can entice the resident to stay in the room and decrease social interaction. Stringing beads is a passive and sedentary activity and therefore unlikely to decrease the risk for Alzheimer disease; physical activity is associated with a lower risk for Alzheimer disease. Watching movies is a sedentary but not a mentally stimulating activity for an adult with a normal intelligence.

PTS: 1 DIF: Apply REF: 15-18 TOP: Nursing Process: Planning MSC:Health Promotion and Maintenance 12. Which physiological change in the brain is the reason the nurse allows more time for answering questions with older adults?

a. Increased secretion of cholinesterase b.Decreased secretion of neurotransmitters c. Loss of spinal cord and brainstem neurons d.Atrophy of dendrites in the cerebral cortex ANS: D Dendrites are the receiving end of neurons (receiving electrochemical signals) and the branched ends extending from the cell body. The atrophy of dendrites contributes to slower thought processes with aging because the synapses are impaired; this changes the transmission of neurotransmitters that are vital in the transmission of an electrical impulse from neuron to neuron. The secretion of cholinesterase, the enzyme that inactivates acetylcholine in the synapse, does not increase with aging. Changes in the transmission of neurotransmitters are associated with the atrophy of dendrites. The spinal cord and the cerebral cortex lose neurons with age, the cerebral cortex more than the spinal cord.

PTS:1DIF:UnderstandREF:16 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 13. The nurse provides opportunities for nursing home residents to read aloud to others. Which cognitive skill is this nursing intervention most likely to improve? a. Verbal fluency c. Object naming b.Logical analysisd.Visuospatial skills ANS: A Allowing residents to read aloud helps improve and maintain verbal fluency because it provides an opportunity to practice these skills. Reading aloud does not usually require analysis. Reading is unlikely to improve object recall unless displaying objects is part of the reading. Visuospatial skills require the ability to perceive the relationship of objects in terms of the space each object occupies; reading is unlikely to improve this skill.

PTS: 1 DIF: Understand REF: 16 TOP: Nursing Process: Evaluation MSC:Health Promotion and Maintenance

MULTIPLE RESPONSE 1. Which statements are true about aging and the brain? (Select all that apply.) a. Most areas of the brain do not lose brain cells. b.Memory decline is inevitable as people age. c. Basic intelligence remains unchanged with age. d.The brain does not continue to make new brain cells.

ANS: A, C Most areas of the brain do not lose brain cells. Although older adults may lose some nerve connections, it can be part of the reshaping of the brain that comes with experience. Basic intelligence remains unchanged with age, and older adults should be provided with opportunities for continued learning. Many people reach older age and have no memory problems.

Participation in physical exercise, stimulating mental activity, socialization, health diet, and stress management help brain health.

PTS:1DIF:UnderstandREF:12-Apr TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. The nurse is admitting a patient to a long-term care facility. During the admission, the patient verbalizes a concern about getting dementia now that he is in a nursing home. In what activity(ies) should the nurse encourage the patient to participate to maintain brain health?

(Select all that apply.) a. Physical exercise c. Socialization b.Stimulating mental activityd.Increasing dietary intake ANS: A, B, C Many people reach older age and have no memory problems. Participation in physical exercise, stimulating mental activity, socialization, health diet, and stress management help brain health.

An increase in dietary intake has not been shown to influence brain health.

Chapter 16 Sexuality and Intimacy

MULTIPLE CHOICE 1. The nurse is aware that sexuality: a. becomes absent with age. b. remains part of life until death. c. as expressed through intercourse is not possible after the age of 65 years. d. must be expressed in sexual intercourse.

ANS: B Sexuality is an integral part of the makeup of each person. Although sexual expression may change, the need for sexual affection does not diminish. Intercourse is only one method of sexual expression.

DIF: Cognitive Level: Knowledge REF: 259 OBJ: 1 TOP: Sexuality KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse counsels the 70year-old female who has remained on hormone replacement therapy (HRT) that she needs to have a: a. semiweekly douche to wash out cervical debris. b. liver function assessment annually. c. mammogram biannually. d. Pap smear annually.

ANS: D Persons on HRT should have an annual Pap smear and mammogram.

DIF: Cognitive Level: Application REF: 259 OBJ: 1 TOP: Hormone Replacement Therapy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. The nurse evaluates a need for further instruction to reduce the symptoms of vaginal dryness when the 70year-old patient says: a. Vaseline was good enough for my mother. Its good enough for me. b. I use a water-soluble lubricant to aid intercourse. c. Im trying an estrogen cream to see if it works. d. Ill let you know how wild yams work for vaginal dryness.

ANS: A Vaseline and petroleum products should be avoided because they do nothing for long-term dryness.

DIF: Cognitive Level: Application REF: 260 OBJ: 4 TOP: Vaginal Dryness KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 4. The nurse identifies the person most likely to experience erectile dysfunction as the 65year-old who has _____ sexually active in earlier years. a. diabetes and was very b. irritable bowel syndrome and was minimally c. chronic pancreatitis and was very d. osteoarthritis and was moderately ANS: A Diabetic men are at risk for erectile dysfunction even at young ages.

DIF: Cognitive Level: Analysis REF: 260 OBJ: 4 TOP: Erectile Dysfunction KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The 65-year-old male who, although he is having painful symptoms related to a benign enlargement of the prostate, refuses to consider a prostatectomy because he fears that the surgery will make him impotent. The nurse reassures him that: a. a prostatectomy will enhance sexual function. b. new techniques for a prostatectomy do not damage nerves. c. the prostate has nothing to do with erection or seminal fluid production. d. impotence following a prostatectomy is entirely psychological.

ANS: B Newer techniques do not damage nerves as was once the case when impotence following surgery was a real risk.

DIF: Cognitive Level: Application REF: 260 OBJ: 1 TOP: Erectile Dysfunction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The 70-year-old woman who is considering coming off of hormone replacement therapy (HRT) for the reduction of postmenopausal discomfort asks the nurse what advantage is offered by tamoxifen, also called a designer estrogen. The nurses best response is that tamoxifen: a. provides estrogen to some tissues while acting as an antiestrogen to others. b. has no side effects. c. needs to be taken only once a week. d. improves the skin turgor and complexion.

ANS: A Designer estrogens selectively act as an estrogen on some tissues and an antiestrogen on others.

There are side effects, and the drug is usually taken twice a day.

DIF: Cognitive Level: Analysis REF: 260 OBJ: 1 TOP: Tamoxifen KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 7. The nurse teaches that some persons have found relief from postmenopausal discomfort by using phytoestrogens, which act as estrogens on some tissue and antiestrogens on others.

Phytoestrogens are found in: a. mangos. b. soybeans. c. broccoli. d. lima beans.

ANS: B Soybeans are rich in phytoestrogens.

DIF: Cognitive Level: Comprehension REF: 260, Complementary and Alternative Therapies OBJ: 1 TOP: Phytoestrogens KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 8. The nurse recognizes a need for further instruction about sexual activity when the 65year-old man who had a myocardial infarction 6 months ago says: a. Im enjoying the same sexual activities now as I did before my heart attack. b. Im still pretty cautious, but our sex lives are very satisfactory. c. Ive been told that Im at risk for another heart attack if we have sex. d. My heart medications have made me impotent, but weve found other methods of sexual expression.

ANS: C Fear, rather than an actual threat, can cause cessation of sexual relations following a heart attack.

DIF: Cognitive Level: Application REF: 260 OBJ: 2

TOP: Illness and Sexual Function KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. The nurse makes it clear to older adults in a long-term care facility that condoms are available from the medicine cart on request to: a. guarantee safe sex practices. b. reduce the incidence of sexually transmitted diseases (STDs). c. show acceptance of sexual expression. d. prevent soiling bed linens or furniture.

ANS: B STDs can still be transmitted in the older adult. Studies have shown that 10% of persons older than 50 years have been exposed to the human immunodeficiency virus (HIV). Nothing can guarantee safe sex practices.

DIF: Cognitive Level: Application REF: 261-262 OBJ: 6 TOP: STDs and the Older Adult KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 10. The home health nurse stresses to the 70-year-old gay man who has been in a monogamous relationship for 20 years that it is especially important to name his partner as his medical power of attorney (POA) and file advance directives because: a. all persons older than 60 years should have a medical POA and advance directives. b. gay and lesbian couples are estranged from their families. c. life partners frequently abandon unions when terminal illness occurs. d. life partners have no legal standing and can be prohibited from medical decisions by family.

ANS: D Life partners have no legal standing for medical decisions unless named as medical POA.

DIF: Cognitive Level: Application REF: 262 OBJ: 5 TOP: Sexual Orientation KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 11. The horrified CNA runs to the nursing station and blurts out, Do you know what Mr. and Mrs. Smith are doing? Theyre having sex right there in room 210! The nurses best response would be to: a. knock discreetly on the door and enter the room. b. call the charge nurse to report inappropriate sexual activity. c. request an order from the physician to allow intercourse. d. give the CNA a Do Not Disturb sign to put on the door of room 210.

ANS: D Privacy should be protected for appropriate sexual expression. Orders and notifying the charge nurse are not necessary, but recording the event in the nursing notes as a conjugal visit is suggested.

DIF: Cognitive Level: Application REF: 262-263 OBJ: 7 TOP: Privacy KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 12. When the cognitively impaired man is openly masturbating in the dayroom of a long-term care facility, the nurses best response would be to say: a. This is inappropriate behavior in public areas. b. Oh my God! Dont you know that will make you go blind? c. I think you may need some privacy and take him to his room. d. Heres a blanket for your legs and cover his lap with it.

ANS: C A person who is masturbating in public should be conducted to the privacy of his or her room.

DIF: Cognitive Level: Application REF: 263 OBJ: 7 TOP: Masturbation KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 13. When a married couple is admitted to the long-term care facility, the admitting nurse should show willingness to discuss sexual matters by asking: a. How often do you have intercourse? b. Do you have any sexual concerns related to your admission here? c. What can we do to keep your sex life active? d. Any sexual activity should be done in private.

ANS: B Asking about sexuality in broad terms communicates a willingness to discuss the issue.

DIF: Cognitive Level: Application REF: 261 OBJ: 7 TOP: Sexual Concerns KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 14. When the CNA tearfully reports that a resident deliberately exposes himself to her and makes lewd suggestions, the nurse could best deal with this behavior by modifying the nursing care plan to: a. assign only males to care for the resident. b. chastise the resident for lewd behavior. c. restrain the hands of the resident during routine care. d. modify clothing choices to one-piece garments or elastic waist trousers.

ANS: D Modification of the clothing to make exposure more difficult is the best initial approach to the problem.

DIF: Cognitive Level: Application REF: 263 OBJ: 7 TOP: Inappropriate Genital Exposure KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation MULTIPLE RESPONSE 1. The nurse discusses factors that alter the sexual practice of older adults, which are __________. (Select all that apply.) a. altered health status b. inability to achieve orgasm c. erectile dysfunction d. loss of sexual partner e. slowed sexual response time ANS: A, C, D, E Although the response is slowed, the ability to achieve orgasm remains throughout life.

DIF: Cognitive Level: Comprehension REF: 259 OBJ: 1 TOP: Age-Related Sexual Impairment KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse lists the age-related changes in the female reproductive system that affect sexual intercourse, which are __________. (Select all that apply.) a. pruritus vulvae b. atrophic vaginitis c. frequent yeast infections d. dyspareunia e. decreased response time ANS: A, B, C, D

The response time is not decreased. All of the other options are age-related changes in the female that affect satisfactory intercourse.

DIF: Cognitive Level: Application REF: 259 OBJ: 1 TOP: Age-Related Impediments to Intercourse KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse is aware that many women have abandoned hormone replacement therapy (HRT) because of the risk of __________. (Select all that apply.) a. stroke b. myocardial infarction c. liver disorders d. cancer e. bone demineralization ANS: A, B, C, D Bone demineralization is not a risk associated with HRT, which is prescribed to prevent bone demineralization.

DIF: Cognitive Level: Application REF: 259 OBJ: 1 TOP: Hormone Replacement Therapy Risks KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 4. The nurse lists the sexual changes experienced by the older man, which are impairments to intercourse, such as __________. (Select all that apply.) a. erections take longer to achieve and are less firm than in younger years b. orgasm takes longer to achieve

c. orgasm occurs at each intercourse d. erection loss occurs immediately after orgasm e. an increase in time between orgasms ANS: A, B, D, E Orgasms are not always achieved with each intercourse.

DIF: Cognitive Level: Application REF: 260 OBJ: 1 TOP: Sexual Impairment KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse screening patients who complain of erectile dysfunction is aware that many drugs cause this problem, such as __________. (Select all that apply.) a. digitalis b. pancreatic enzyme replacement c. antihistamines d. antiparkinson drugs e. antidepressants ANS: A, C, E Digitalis, antihistamines, and antidepressants all have a negative effect on sexual function.

DIF: Cognitive Level: Application REF: 261, Table 16-1 OBJ: 2 TOP: Medication and Sexual Function KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 6. The nurse is aware that many constraints prevent an older widow from engaging in sexual activity, which are that __________. (Select all that apply.)

a. older women outnumber older adult men by 4:1 b. there is an expectation that men should initiate contact c. display of sexual interest is considered improper d. older women do not desire sexual expression e. older women associate sexual activity with marriage ANS: A, B, C, E Older women do retain a sexual appetite.

DIF: Cognitive Level: Application REF: 261 OBJ: 4 TOP: Loss of Sexual Partner KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 7. Marriage between older adults is frequently impeded by __________. (Select all that apply.) a. disapproval of children b. financial loss in case of remarriage c. concerns about chronic illness with either partner d. the lack of opportunity for sexual expression outside of marriage e. religious and personal values that inhibit cohabitation ANS: A, B, C Lack of opportunity for sexual expression outside of marriage and distaste for cohabitation are factors that might encourage marriage rather than impede it.

DIF: Cognitive Level: Analysis REF: 261 OBJ: 1 TOP: Marriage and the Older Adult KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 8. The home health nurse takes into consideration the concerns of aging gay and lesbian couples, which include __________. (Select all that apply.)

a. health care providers being willing to discuss a homosexual union b. the health care systems focus on heterosexuality as the norm c. difficulty finding senior housing as a homosexual couple d. fear of discrimination based on sexual orientation, resulting in substandard health care e. delay of entry to a long-term care facility because of the possibility of not being able to share a room ANS: B, C, D, E Health care providers are reluctant to discuss homosexual unions. All other options are possible problems related to the health care of older gay and lesbian couples.

DIF: Cognitive Level: Comprehension REF: 262 OBJ: 5 TOP: Sexual Orientation and Health Care KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 9. While asking questions about the patients reproductive system, the nurse is aware that sexual function can be affected by __________. (Select all that apply.) a. increasing age b. grief c. illness d. religion e. physical changes ANS: A, B, C, E Religion does not affect sexual function. All other options can affect the individual physically and result in sexual dysfunction.

DIF: Cognitive Level: Comprehension REF: 259 OBJ: 1 TOP: Age-Related Sexual Impairment KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. Questions that the nurse might ask to assess sexual function include __________. (Select all that apply.) a. How many alcoholic beverages do you drink a day? b. What over-the-counter and prescription medications do you take? c. How often do you engage in sexual activity? d. Have you had any recent health problems? e. When do you see your significant other?

ANS: A, B, C, D Asking when the individual sees the significant other does not necessarily indicate that the individual is sexually active. Sexual function can be affected by excessive alcohol intake, medications, availability of sexual partners, and illness.

Chapter 17 Safe Medication Use MULTIPLE CHOICE 1. The nurse is aware that information derived from a pharmaceutical companys drug testing to establish therapeutic dose ranges may not be appropriate for the older adult because testing: a. is not done long enough. b. does not require adequate follow-up. c. is not well regulated by the U.S. Food and Drug Administration. d. is usually tested on healthy young persons.

ANS: D Long and rigorously regulated drug testing procedures most often use healthy young adults as drug testers.

DIF: Cognitive Level: Comprehension REF: 131 OBJ: 1 TOP: Drug Testing KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 2. The nurse assesses the older adult patient for evidence of the onset of the effectiveness of an oral preparation because age-related changes in the concentration of gastric acid can: a. change the chemical composition of the drug. b. increase the distribution. c. decrease the strength of the drug. d. retard absorption.

ANS: D Decreased gastric acid can decrease the speed of absorption.

DIF: Cognitive Level: Analysis REF: 132 OBJ: 3 TOP: Drug Absorption KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 3. The nurse is aware that age-related changes in the stomach that can cause increased drug absorption and possibly toxicity include: a. decreased gastric motility. b. gastric reflux disease. c. inability of gastric cells to transport the drug. d. decreased peristalsis.

ANS: A Decreased motility leaves the drug in contact with the gastric mucosa for a longer period of time, which leads to increased absorption. Peristalsis is rhythmic movements of the bowels.

DIF: Cognitive Level: Application REF: 132 OBJ: 3 TOP: Increased Absorption KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. To help prevent lithium toxicity in the older adult, the nurse modifies the nursing care plan to include interventions to: a. increase fluid intake to 3500 mL daily. b. have the patient ambulate for 10 minutes after the drug is administered. c. prohibit citrus fruit in the diet. d. administer a prescribed stool softener to ensure a daily bowel movement.

ANS: A Increase of fluids will help allow water-soluble drugs such as lithium to be diluted in the bloodstream more effectively and excreted more rapidly.

DIF: Cognitive Level: Application REF: 132 OBJ: 8 TOP: Distribution KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 5. The nurse takes into consideration that as adipose tissue replaces muscle mass in the older adult, a person taking a fat-soluble drug such as diazepam (Valium) several times a day would exhibit: a. tachycardia. b. a hangover effect. c. agitation. d. hypertension.

ANS: B Fat-soluble drugs become trapped in the adipose tissue and are slowly released into the bloodstream, increasing the drugs concentration.

DIF: Cognitive Level: Application REF: 132 OBJ: 3 TOP: Distribution KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. The nurse cautions the older adult who is taking the protein-bound drug warfarin (Coumadin) that, with age-related reduced plasma protein levels, the risk of an adverse reaction is high because: a. unbound active drug molecules continue to circulate in the bloodstream. b. the bleeding and clotting times will decrease, as evidenced by the PT and INR. c. the drug becomes ineffective and does not deliver its intended therapeutic action. d. renal damage can occur from the altered drug molecules.

ANS: A Unbound drug molecules will still be circulating, leading to excess drug in the bloodstream. In this situation the bleeding and clotting times will be decreased.

DIF: Cognitive Level: Application REF: 132 OBJ: 3 TOP: Distribution KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 7. The nurse frequently assesses the older adult who is on a psychotropic drug for an overdose because: a. older adults are less active. b. the older adult has fewer cognitive capabilities. c. brain receptors have become hypersensitive. d. receptor sites have lower perfusion.

ANS: C Brain receptors in the older adult become hypersensitive as age increases, resulting in an exaggerated response to pharmacologic therapy.

DIF: Cognitive Level: Analysis REF: 133 OBJ: 8 TOP: Pharmacodynamics KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

8. The major risk of polypharmacy for the older adult is: a. ignorance about his or her prescriptions. b. taking over-the-counter preparations. c. being treated by more than one physician. d. taking old prescriptions rather than consulting a physician.

ANS: C Although all the options may offer an opportunity for polypharmacy, the major risk is that of the patient being treated by more than one physician at the same time.

DIF: Cognitive Level: Application REF: 134 OBJ: 4 TOP: Polypharmacy KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 9. The home health nurse would be most concerned about self-medicating errors for the older adult living alone who is a type 1 diabetic and is: a. afflicted with early Parkinson disease. b. visually impaired. c. a rheumatoid arthritic with stiffened hands. d. paralyzed from the waist down.

ANS: B The visually impaired diabetic is at the greatest risk for a medication error by incorrectly preparing an insulin injection.

DIF: Cognitive Level: Analysis REF: 134 OBJ: 11 TOP: Sensory Changes KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. The medication nurse is aware that the most reliable method of patient identification for administration of medications is: a. a photograph of the patient. b. an identification bracelet. c. asking the patient to repeat his or her name. d. use of the patients room number.

ANS: B The use of an identification bracelet is the most accurate and reliable method to identify the patient.

DIF: Cognitive Level: Comprehension REF: 142 OBJ: 9 TOP: Patient Identification KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 11. The physician has written an order to convert an enteric-coated medication from the pill form to the liquid form. The nurse should: a. transcribe the order and change the medication administration record to show the liquid form. b. use up the rest of the tablets by crushing them and giving them dissolved in water. c. order the liquid form from the pharmacy as ordered. d. inquire if the physician wants the dose to be the same as the pill.

ANS: D Because liquids are absorbed more rapidly, the dose might need to be lowered or the schedule of administration changed to avoid an overdose. Enteric-coated medications should not be crushed.

DIF: Cognitive Level: Analysis REF: 143 OBJ: 9 TOP: Liquid Medication KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. When the patient complains that the several pills at the 8 AM dose stick in her throat, the nurse could facilitate administration by: a. suggesting that she take all the pills at one time with a mouthful of water. b. offering the patient one pill at a time. c. crushing all the pills and mixing them in the patients breakfast cereal. d. offering a sip of water before and after each pill.

ANS: D Offering water before and after administration counteracts the dry mouth that causes the pills to stick. Offering one pill at a time without water does not address the problem of sticking.

DIF: Cognitive Level: Application REF: 144 OBJ: 9 TOP: Pill Administration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 13. The nurse is aware that medicating with transdermal patches requires that the nurse should: a. apply the patch at the same site every day and carry out documentation. b. fold and dispose of the used patch in the sharps container. c. warm the patch in his or her hands before application. d. cover the patch with a light gauze dressing to prevent dislodgement.

ANS: B The used patch should be folded with the sticky sides together and disposed of in the sharps container for environmental safety.

DIF: Cognitive Level: Application REF: 145, Box 7 OBJ: 6 TOP: Transdermal Patches KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. When the medication nurse offers a pill to the older adult patient, the patient asks, What is this and what is it for? The nurses best response would be: a. Im not at liberty to discuss your medication. You need to talk to your doctor. b. Thats a feel good pill that will make you feel better. c. Its a cephalosporin that has been ordered to treat your URI. d. Its an antibiotic for the infection in your urine.

ANS: D Patients have the right to know what they are taking and given a reasonable rationale for its use that they can understand.

DIF: Cognitive Level: Application REF: 146 OBJ: 10 TOP: Right to Know KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 15. When the 80-year-old female patient refuses to take a medication because it burns her stomach, the medication nurse should: a. crush the pill and mix it with the dessert on her meal tray. b. insist that she take it for her own good. c. circle and initial the dose time to show nonadministration. d. document the reason for refusal and report the refusal to the charge nurse.

ANS: D The nurse should carry out documentation of the reason for refusal and report the refusal.

DIF: Cognitive Level: Application REF: 146 OBJ: 10 TOP: Refusal of Treatment KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

16. For the older adult patient receiving the bronchodilator theophylline, the nurse would assess for __________ as evidence of an overdose. a. tachycardia b. confusion c. hypotension d. lethargy ANS: A Tachycardia is a significant side effect of theophylline.

DIF: Cognitive Level: Application REF: 141 OBJ: 7 TOP: Drug Overdose KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 17. When the 75-year-old man who has been on a protocol of chlorpromazine (Thorazine) begins to _______ and complain of difficulty swallowing, the nurse notifies the physician. a. cough b. wheeze c. drool d. gag ANS: C Drooling and difficulty swallowing are signs of drug toxicity to chlorpromazine (Thorazine).

DIF: Cognitive Level: Application REF: 141 OBJ: 7 TOP: Drug Toxicity KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 18. The nurse preparing to administer 1 mL of vitamin B12 intramuscularly to an emaciated 82year-old patient would choose a _____-inch needle to inject into the _____ site.

a. 1.5; upper outer quadrant of the gluteus maximus b. 1.5; ventral gluteal c. 1; deltoid d. 1; ventral gluteal ANS: D The 1-inch needle to be injected into the ventral gluteal site is the safest choice for the emaciated patient. The location is easily accessible and free from major nerves of vessels. The deltoid is a poor site except for very small dosages.

DIF: Cognitive Level: Application REF: 145-146 OBJ: 9 TOP: Intramuscular Injection KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 19. The nurse explains that the Beers criteria provide guidelines for: a. medications best avoided by the elderly independent of diagnosis. b. diagnostic procedures that are considered inappropriate for a diagnosis. c. penalties for extended care facilities that allow administration of particular drugs. d. assessments necessary before the prescription of particular drugs.

ANS: A The Beers criteria lists medications best not prescribed for the elderly. The lists are updated regularly, most recently in 2010.

DIF: Cognitive Level: Comprehension REF: 134 OBJ: 5 TOP: Beers Criteria KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 20. The nurse preparing to crush a patients oral medications can crush the: a. plain antihypertensive medication tablet.

b. sublingual tablet of nitroglycerin. c. timed-release capsule for gastric reflux. d. enteric-coated aspirin.

ANS: A Only the plain tablet can be crushed. Timed-release, sublingual medications, and enteric-coated medications should not be crushed.

DIF: Cognitive Level: Application REF: 144, Box 7 OBJ: 9 TOP: Crushing Medication KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies MULTIPLE RESPONSE 1. The nurse planning to set up a self-medication program for a 70-year-old resident in an extended-care facility will ensure the provision of __________. (Select all that apply.) a. delivery of adequate supply of medication b. payment for medication c. locked medication storage at bedside d. medication administration record e. assessment of effectiveness of medication ANS: A, C, D, E For self-medication in an extended-care facility, the nurse should make provisions for adequate medication supply, locked storage, medication administration record, and an assessment of the effectiveness of the medication. Payment is not in the purview of the nurse.

DIF: Cognitive Level: Comprehension REF: 146-147 OBJ: 4 TOP: Medication Administration KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk

2. The nurse includes information in the nursing care plan pertinent to the patients needs as they relate to drug administration, which include __________. (Select all that apply.) a. schedule for drawing blood values b. patients need for crushing medication c. patients preference as to the use of medium in which to give crushed medicines d. schedule of medication and dose times e. parameters of pulse or blood pressure, if significant to administration ANS: A, B, C, E Schedule and dose information are not considered part of the nursing care plan.

DIF: Cognitive Level: Application REF: 142 OBJ: 8 TOP: Medication Information in the Nursing Care Plan KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 3. The home health nurse reviews all medications of a patient because the nurse is aware that with the high cost of prescription drugs, older adults will __________. (Select all that apply.) a. simply not fill a new prescription b. take less than prescribed to preserve their supply c. fill all prescriptions at once to get a discount d. save old prescription drugs for later use e. share medications ANS: A, B, D, E Filling prescriptions at one time can be costly even with a discount; therefore the older adult may pick and choose which ones to fill. All the other behaviors listed are methods whereby persons on a limited budget will attempt to preserve their supply of medications and contain costs.

DIF: Cognitive Level: Application REF: 140 OBJ: 12

TOP: Risks Related to Financial Factors KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 4. The nurse is aware that the older adult is more at risk for medication-related problems related to __________. (Select all that apply.) a. drug-testing methodology b. age-related changes c. polypharmacy d. cognitive and sensory changes e. lack of adequate medical follow-up ANS: A, B, C, D Lack of follow-up is not identified as a factor in medication-related problems.

DIF: Cognitive Level: Comprehension REF: 132 OBJ: 1 TOP: Factors in Medication-Related Problems KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 5. The nurse reminds the older adult that self-medication with OTC drugs can be hazardous because OTC drugs can __________. (Select all that apply.) a. increase the effect of a prescribed drug b. interfere with the efficacy of a prescribed drug c. mask significant symptoms of primary disease d. create symptomatology of their own e. cause overdose because they are not considered to be real drugs ANS: A, B, C, D, E The overuse of OTC drugs can cause all these medication-related problems.

Chapter 18 Respiration

MULTIPLE CHOICE 1. The nurse best maximizes an older adults potential to avoid developing a postsurgical respiratory infection by: a. walking the patient to the bathroom instead of using the bedside commode. b. encouraging compliance with prescribed antibiotic therapy. c. evaluating the patients ability to effectively cough and deep breathe. d. offering fluids every hour while the patient is awake.

ANS: C Older adults have a decrease in the number and effectiveness of cilia in the tracheobronchial tree, which results in increasing difficulty clearing secretions. The other activities also help avoid atelectasis and infection, but evaluating the patients ability to cough and deep breathe can indicate that other treatment measures may be needed postoperatively.

DIF: Remembering (Knowledge) REF: Page 423 OBJ: 22-1 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 2. An older adults pulmonary function studies indicate that his vital capacity is reduced and his residual volume is increased. The nurse recognizes that these test results are observed in the patients: a. ineffective cough reflex. b. shallow breathing. c. slow respiratory rate. d. frequent respiratory infections.

ANS: B Normal aging results in the progressive loss of elastic recoil of the lung parenchyma and conducting airways as well as reduced elastic recoil of the lung and the opposing forces of the chest wall. The lung becomes less elastic as collagenic substances surrounding the alveoli and

alveolar ducts stiffen and form cross-linkages that interfere with the elastic properties of the lungs. Any and all of these structural changes make it more difficult for the older person to ventilate.

DIF: Remembering (Knowledge) REF: Page 422 OBJ: 22-1 TOP: Nursing Process: Assessment MSC: Health Promotion 3. The nurse is concerned about an older adult patient developing toxic levels of the prescribed theophylline when it is determined that the patient has a(n): a. one pack a day smoking habit. b. elevated serum potassium level. c. history of chronic bronchitis. d. chronic, nonproductive cough.

ANS: A Theophylline is a medication that is affected by smoking, which increases serum drug levels. The other factors do not affect the pharmacokinetics of this drug.

DIF: Remembering REF: Page 425 OBJ: 22-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 4. The nurse is aware of the typical occurrence of comorbidities in the older adult. Motivated by this knowledge, the nurse assesses a patient with diagnosed respiratory dysfunction for possible: a. poor wound healing of the legs and feet. b. ineffective absorption of vitamins and minerals. c. abnormal urine protein levels. d. visual problems including retinal detachment.

ANS: A

In addition, older patients are more likely to have comorbidities involving the cardiovascular and respiratory systems. Peripheral circulation is a possible cardiovascular problem that would result in poor wound healing. The other options are not related to having a respiratory dysfunction.

DIF: Remembering (Knowledge) REF: Page 425 OBJ: 22-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 5. Because the older adult is not as likely to exhibit the typical signs of ineffective gas exchange, the nurse is particularly suspicious of: a. a nonproductive cough in an afebrile patient. b. irritability in a usually pleasant patient. c. pale nail beds in a patient of color. d. an elevated white blood cell (WBC) count in an 82-year-old patient.

ANS: B An early sign of respiratory problems is a change in mental status. Because the physiologic responses to hypoxemia and hypercapnia are blunted in older patients, compensatory changes in heart rate, respiratory rate, and blood pressure may be delayed and cerebral perfusion may suffer.

Mental status changes may include subtle increases in forgetfulness and irritability.

DIF: Applying (Application) REF: N/A OBJ: 22-1 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 6. The nurse is preparing information for the caregivers of a patient with chronic respiratory issues. The nurse will make the greatest impact on their ability to provide quality care while maintaining the patients emotional well-being by including: a. suggestions regarding proper nutrition and exercise for the caregiver. b. an explanation on how to preserve the patients sense of autonomy. c. encouragement for the primary caregiver to set aside time for his or her own interests.

d. recommendations of periodic self-reflection regarding the stressors the patient experiences.

ANS: B Many patients with respiratory illness feel a loss of control over their lives because of their symptoms. They may become demanding and controlling in dealing with their families and friends. Well-being is enhanced by having some control over ones life. The other options relate to the caregivers.

DIF: Applying (Application) REF: N/A OBJ: 22-3 TOP: Teaching-Learning MSC: Psychosocial Integrity 7. An older patient admitted to the hospital with symptoms strongly suggestive of tuberculosis (TB) has a negative Mantoux test. The nurse correctly anticipates that: a. the purified protein derivative (PPD) test will be administered. b. a chest x-ray will be ordered to detect possible infiltration. c. therapy consisting of a combination of bactericidal drugs will be initiated. d. the skin test will be repeated to achieve a booster effect.

ANS: D Tuberculin skin testing in older patients is an unreliable indicator of TB because they are more likely to have false-negative results because of reduced immune system activity. If skin testing is used, it is recommended that the standard 5 tuberculin unit (TU) Mantoux test be given and then repeated to create a booster effect. The PPD is not recommended. The skin test is followed up with a chest x-ray. Drug therapy should not begin until the patient has a diagnosis.

DIF: Remembering (Knowledge) REF: Page 440 OBJ: 22-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

8. An older adult patient who has tuberculosis is being treated with the drugs isoniazid 300 mg daily, rifampin 600 mg daily, and pyrazinamide 1500 mg daily. The nurse stresses the importance that the patient: a. wear tinted glasses when out in the sun. b. minimize contact with children younger than 3 years old. c. avoid alcohol while on the drug therapy. d. eat and drink dairy sparingly.

ANS: C Patients should not drink alcohol while taking isoniazid. The other recommendations are incorrect.

DIF: Understanding (Comprehension) REF: Page 442 OBJ: 22-5 TOP: Teaching-Learning MSC: Physiologic Integrity 9. An 80-year-old patient is concerned about contracting pneumonia. The nurse educates her that the key to prevention is: a. early recognition of the symptoms. b. being vaccinated per government guidelines c. minimizing contact with the public during the winter months. d. supplementing ones daily diet with various vitamin C sources.

ANS: B The key to pneumonia prevention is being appropriately vaccinated. All individuals should be vaccinated at age 65 unless they have conditions that lead them to earlier vaccination.

Revaccination is indicated in certain circumstances. Signs and symptoms are subtle in the aging population. Minimizing contact during winter months is an appropriate suggestion, just not the best one. Vitamin C may have immune system benefits.

DIF: Remembering (Knowledge) REF: Page 446 OBJ: 22-3

TOP: Teaching-Learning MSC: Health Promotion 10. The nurse gives priority to assessing an older patient who presents with symptoms of acute respiratory distress for which other condition? a. Substernal chest pain b. A history of panic attacks c. Any known allergies d. Bruising on the chest ANS: A The symptoms of asthma and respiratory distress mimic other conditions such as myocardial ischemia. The nurse assesses for this condition as the priority over the others.

DIF: Applying (Application) REF: N/A OBJ: 22-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 11. The nurse is caring for an older adult who has been prescribed inhaled corticosteroids for asthma. What does the nurse teach about this medication? a. Taken just before retiring for the night b. Reserved for acute attacks only c. Used in increasing doses as needed d. How to use and rinse the inhaler ANS: C Corticosteroids are an effective long-term control medication that can be used in increasing doses as needed for asthma and related disorders. It is given by the inhalation method, so the nurse teaches the patient how to use and maintain the inhaler. The other teaching tips are incorrect.

DIF: Applying (Application) REF: N/A OBJ: 22-3

TOP: Teaching-Learning MSC: Physiologic Integrity 12. An older patient with severe peripheral arterial disease wishes to quit smoking. The nurse provide education to this patient on which of the following? a. Cold turkey method b. Gradual reduction c. Nicotine patches d. Bupropion hydrochloride (Zyban) ANS: D Older patients should be offered assistance to quit smoking. The cold turkey and gradual reduction methods may not work if the patient is a long-term smoker. The patient with peripheral arterial disease should not use nicotine in any form as it causes vasoconstriction. Zyban is an appropriate choice.

DIF: Applying (Application) REF: N/A OBJ: 22-4 TOP: Teaching-Learning MSC: Health Promotion 13. An older adult with chronic obstructive pulmonary disease (COPD) asks why he should quit smoking now. What response by the nurse is best? a. It will keep your disease from getting worse. b. There are many benefits to quitting even now. c. It will decrease the risk of getting cancer too. d. Youre right; there really isnt a reason to quit.

ANS: B There are many benefits to smoking cessation including reduction in the number of respiratory infections, improvement in the function of the mucociliary clearance of the lungs, decreased coughing and dyspnea, increased appetite, and decreased sputum production. This is a more

comprehensive answer than keeping the disease from worsening and lowering the chance of getting cancer.

DIF: Understanding (Comprehension) REF: Page 432 OBJ: 22-4 TOP: Teaching-Learning MSC: Health Promotion 14. A patient has been taught about nutrition related to COPD. Which menu selection may indicate a need for further teaching? a. Bagel and cream cheese b. Broiled chicken breast c. Beans and peas d. Tofu stir-fry ANS: A Carbohydrates should not make up more than 50% of the daily intake of calories because they break down into carbon dioxide, worsening breathing. The other selections show good understanding. Of course, the nurse needs to take into consideration the amount of carbohydrates in the entire day and not just one selection.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 22-3 TOP: Nursing Process: Evaluation MSC: Health Promotion 15. An older patient is hospitalized with influenza and is prescribed amantadine (Symmetrel).

What assessment finding would indicate this drug is not appropriate for the patient? a. BUN 22 mg/dL b. Creatinine 3.2 mg/dL c. Sodium 132 mEq/L d. Potassium 4.2 mEq/L ANS: B

Amantadine can cause behavioral changes, delirium, hallucinations, agitation, and seizures, mostly in patients with impaired renal function. The creatinine is high, indicating renal disease.

The other lab values are normal.

DIF: Analyzing (Analysis) REF: N/A OBJ: 22-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 16. A frail, older patient is in the emergency room in severe respiratory distress. The patient has had repeated hospitalizations for the same thing. After stabilizing the patient, which action by the nurse is most appropriate? a. Determine what the patients end-of-life wishes are. b. Assess the family caregiver for compliance with treatment. c. Administer intravenous (IV) fluids at a rapid rate. d. Prepare to vaccinate the patient against pneumonia.

ANS: A Because of the lifesaving modalities needed to care for such a patient, the nurse and physician work together to determine what the patients end-of-life wishes are. In the emergency department, patient stabilization comes first, but once this has been accomplished a discussion should occur with the patient and family about further treatment desires. The family caregiver may or may not be adherent, or the patient may assume all self-care. IV fluids should not be given at a rapid rate because of the risk of heart failure. The patient should receive an immunization against pneumonia per guidelines.

DIF: Applying (Application) REF: N/A OBJ: 22-3 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 17. A patient has a pulmonary embolism and asks the nurse to explain the purpose of the heparin infusion. What response by the nurse is best? a. It helps dissolve the clot in your lungs.

b. It keeps you from getting septic. c. It prevents the clot from getting bigger. d. It prevents clots from forming in your heart.

ANS: C Heparin keeps the clot from getting bigger and hopefully prevents further clots from forming. It does not dissolve the clot. It does not specifically target the heart. It does not prevent sepsis.

DIF: Understanding (Comprehension) REF: Page 450 OBJ: 22-3 TOP: Teaching-Learning MSC: Physiologic Integrity 18. The nurse caring for patients using continuous positive airway pressure (CPAP) knows what about treatment effectiveness? a. Effectiveness depends on compliance. b. Its too expensive for many older adults. c. It is rarely effective for sleep apnea. d. Complicated settings make it hard to use.

ANS: A Effectiveness is determined by compliance for nearly any regime, and unfortunately compliance with CPAP is less than 50%. The other statements are incorrect.

DIF: Remembering (Knowledge) REF: Page 451 OBJ: 22-7 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE 1. To minimize an older adults risk for developing postsurgical atelectasis, the nurse does which of the following? (Select all that apply.) a. Regularly assesses and medicates for pain

b. Teaches effective deep-breathing techniques c. Provides oxygen via nasal cannula d. Encourages the patient to drink all fluids on meal trays e. Assesses lung sounds frequently ANS: A, B, D Promotion of deep breathing, effective pain management, adequate hydration, frequent position changes, and early mobility will decrease the risk of developing atelectasis. Providing oxygen and assessing lung sounds will not prevent atelectasis from occurring.

DIF: Applying (Application) REF: N/A OBJ: 22-3 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 2. When teaching older adult asthmatic patients, the nurse stresses the importance of which of the following? (Select all that apply.) a. Being alert for the early signs of breathing problems b. Fostering an effective relationship with your health care provider c. Identifying and avoid personal triggers d. Incorporating regular rest periods into your daily routine e. Increasing vitamin C consumption, especially during winter months ANS: A, B, C The prognosis for an older adult with asthma is relatively good. Success is based on a partnership between the patient and the health care provider to properly use prescribed medications, avoid asthma triggers, identify early signs of exacerbation, and maintain a healthy lifestyle. Rest may or may not be an issue if the patient has mild asthma. Vitamin C may have immune system benefits.

DIF: Understanding (Comprehension) REF: Page 428 OBJ: 22-3 TOP: Teaching-Learning MSC: Health Promotion

3. The nurse is coordinating care for a newly admitted older adult. The patient is diagnosed with hypertension, asthma, atrial fibrillation, mild osteoarthritis, and glaucoma. Before administering the patients corticosteroid medication, the nurse is especially interested in which of the following? (Select all that apply.) a. The name of the patients hypertension medication b. What the patient uses to manage arthritic pain c. Whether the patient feels the asthma is well controlled d. Whether the patient takes low-dose aspirin regularly e. Whether the patient has ever had glaucoma-related surgery ANS: A, B, D Asthma may be exacerbated by the use of nonsteroidal antiinflammatory agents for arthritis, aspirin for circulation, nonselective beta-blockers for hypertension, or glaucoma eye drops that contain beta-blockers. Feeling that the asthma is under control and previous surgery are not directly related.

DIF: Application (Applying) REF: N/A OBJ: 22-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 4. The nurse is evaluating the effectiveness of an older patients self-management of asthma.

What does the nurse assess as the priority? (Select all that apply.) a. How many times a week a rescue inhaler treatment is needed b. How well the patient is able to avoid the known triggers c. Whether the patient experience frequent respiratory infections d. Whether the patient requires rest periods during the day e. Whether the patient believes he or she has the support of family and friends ANS: A, B

The evaluation of self-management is based on the patients success in following through with the plan. Determine the frequency of rescue inhaler use, success at avoiding triggers, and the patients ability to monitor and address lifestyle changes.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 22-3 TOP: Nursing Process: Evaluation MSC: Health Promotion 5. The nurse encouraging an older patient to start pulmonary rehabilitation shares the benefits of the program, including which of the following? (Select all that apply.) a. Socialization b. Decreased cardiac risks c. Nutrition counseling d. Weight management e. Sports participation ANS: A, B, C, D There are many aspects to pulmonary rehabilitation, including socialization, decreased cardiac risks, nutrition counseling, and weight management Sports are not included, although exercise is.

Chapter 19 Circulations MULTIPLE CHOICE 1. The nurse is teaching cardiovascular risk factors to a group of older adults. The nurse stresses that cigarette smokers are four times more likely to die of sudden cardiac death than nonsmokers because smoking: a. interferes with the development of collateral coronary vessels. b. produces coronary artery stricture. c. results in carbon monoxide poisoning. d. increases platelet aggregation.

ANS: D Smoking increases platelet aggregation and causes coronary artery spasms. Nicotine increases blood pressure and cardiac demands. Carbon monoxide in tobacco smoke decreases the oxygencarrying capacity of the blood. Smoking does not interfere with collateral circulation or produce strictures, but it may contribute to higher levels of carbon monoxide in the blood.

DIF: Understanding (Comprehension) REF: Page 390 OBJ: 21-2 TOP: Teaching-Learning MSC: Health Promotion 2. When assessing an older, female, African American adult, the nurse notes that she has been a type 2 insulin-dependent diabetic 10 years. The nurse notes that the patients greatest risk for developing secondary hypertension is her: a. gender. b. ethnic origin. c. vascular system status. d. insulin therapy.

ANS: C Secondary hypertension identified in the vascular system refers to elevated blood pressure caused by underlying disease such as renal artery disease, renal parenchymal disorders, endocrine and metabolic disorders, central nervous system (CNS) disorders, coarctation of the aorta, and increased intravascular volume. Gender, ethnic origin, and insulin are not diseases that cause hypertension.

DIF: Remembering (Knowledge) REF: Page 392 OBJ: 21-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 3. When administering Lopressor to an older adult patient with hypertension, the nurse is careful to have the patients care plan include

a. frequent assessment for dizziness or syncope. b. education of the signs and symptoms of thromboembolism. c. regular evaluation of the patients muscle strength. d. regularly scheduled serum potassium levels.

ANS: A Dizziness is an adverse reaction to beta-blockers such as Lopressor.

DIF: Remembering (Knowledge) REF: Page 398 OBJ: 21-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 4. The nurse educates the obese older adult patient that the single most important outcome that will affect cardiac health is: a. compliance with drug therapy. b. adherence to the DASH diet. c. 20 minutes of exercise daily. d. a 10% reduction in weight.

ANS: D A 10% reduction of total weight will decrease blood pressure in many overweight individuals.

This factor has significance because it underscores the importance of weight reduction in the older adult population. The other factors are important but not as significant to overall cardiac health as is weight loss.

DIF: Understanding (Comprehension) REF: Page 392 OBJ: 21-2 TOP: Teaching-Learning MSC: Health Promotion 5. To evaluate an older patient for possible renal failure as a result of chronic untreated hypertension, nurse prepares to:

a. schedule an ultrasound. b. collect a urine sample. c. monitor intake and output. d. transport the patient to radiology.

ANS: B A urinalysis will investigate for proteinuria or other signs of renal failure.

DIF: Remembering (Knowledge) REF: Page 393 OBJ: 21-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 6. The nurse should assess which patient first? a. The patient with acute shortness of breath b. The patient with epigastric pain c. The patient with right arm pain d. The patient with persistent indigestion ANS: A Older patients often have atypical signs and symptoms of cardiac ischemia, including shortness of breath, fatigue, syncope, confusion, and abdominal or back pain. Shortness of breath requires the most immediate assessment.

DIF: Applying (Application) REF: N/A OBJ: 21-4 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 7. It is suspected that an older adult patient is experiencing severe hypertension. The nurse documents symptoms that support this diagnosis when the patient reports: a. difficulty reading the newspapers print. b. being fatigued after walking around the block.

c. noticing that his heart skips a beat frequently. d. getting up from a chair too quickly makes him dizzy.

ANS: A The patient with severe hypertension may experience throbbing occipital headaches, confusion, visual loss, focal deficits, epistaxis, and coma. The other manifestations are not associated with hypertension.

DIF: Remembering (Knowledge) REF: Page 392 OBJ: 21-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 8. A novice nurse requires additional education on arterial vascular deficiency when suggesting the conditions symptoms include: a. 2+ edema in calf and foot of left leg. b. a 2-cm ulcer between the great and second toe on the left foot. c. skin on the left leg is cool to the touch. d. toenails on the left foot are thick and brittle.

ANS: A Edema is not generally observed in cases of arterial deficiency, but rather in venous insufficiency. The other options are manifestations of arterial vascular deficiency.

DIF: Remembering (Knowledge) REF: Page 415 OBJ: 21-5 TOP: Teaching-Learning MSC: Physiologic Integrity 9. The nurse shows an understanding of how anemia symptoms present in the older population when: a. questioning the patient about dizziness when turning from side to side in bed. b. assessing the patient for pale oral mucous membranes.

c. asking whether the patient takes supplementary iron tablets. d. assessing the patients weekly intake of red meat.

ANS: B Skin color is not a good indicator of pallor because of varying pigmentation. Oral mucous membranes, as well as conjunctivae and nail beds, are better indicators. The other options are not related to symptoms.

DIF: Remembering (Knowledge) REF: Page 417 OBJ: 21-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 10. A nurse has provided discharge teaching for an older adult patient who had a pacemaker implanted. Which statement by the patient indicates appropriate understanding of the device? a. The battery will need charging every 2 years or so. b. Im supposed to call my doctor if my pulse is within 10 beats of my preset rate. c. My wife will have to be the one who makes the microwave popcorn. d. Ill take my pulse each morning before my first cup of coffee.

ANS: D The radial pulse should be taken at the same time daily and recorded. The patient should notify the provider if the pulse is lower than the preset lower limit on the pacemaker. Battery life is longer than 2 years. Microwaves are safe to use.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 21-4 TOP: Nursing Process: Evaluation MSC: Health Promotion 11. A 76-year-old patient has been recently diagnosed with cardiac valvular disease. The nurse assesses the patient and recognizes that the medical diagnosis is supported by: a. cyanotic fingertips.

b. weight loss of 10 pounds in 3 months. c. angina pain. d. shortness of breath with activity.

ANS: D Individuals with valvular disease may be asymptomatic for many years, but with the deterioration of the valves and hypertrophic changes in the atria or ventricles, symptoms become evident. Exertional dyspnea is frequently the initial symptom. Other symptoms include dizziness, fatigue, weakness, and palpitations. The other signs are not manifestations of valve disease.

DIF: Remembering (Knowledge) REF: Page 406 OBJ: 21-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 12. An older patient is upset with a blood pressure reading of 180/78 mmHg. What response by the nurse is best? a. It looks like you need blood pressure medicine now. b. Most people get hypertension when they get older. c. With age, blood vessels stiffen, raising blood pressure. d. Dont worry, there are lots of good medications for this.

ANS: C With age, elastin in vessel walls decreases, making them stiffer. Systolic blood pressure (SBP) is increased in older adults because of a loss of arterial distensibility resulting from arterial stiffening. The other responses do not offer any useful information on the cause of the patients condition.

DIF: Understanding (Comprehension) REF: Page 389 OBJ: 21-1 TOP: Teaching-Learning MSC: Health Promotion

13. An older patient is overwhelmed at the number of lifestyle changes needed to manage newly diagnosed cardiovascular disease. What action by the nurse will reduce this barrier to teaching? a. Tell the patient even tiny changes over time make a big difference. b. Tell the patient that smoking is the biggest risk factor and needs to stop. c. Help the patient choose a change and incorporate it into daily life. d. Educate the patient on the consequences of not making changes.

ANS: C Although it is true that small changes over time have a great impact, the nurse needs to do more by helping the patient choose a small change to implement. The nurse should help the patient work on the risk factor he or she is most willing to change. Education is important, but it will not enable the patient to make changes.

DIF: Applying (Application) REF: N/A OBJ: 21-5 TOP: Teaching-Learning MSC: Health Promotion 14. A nurse is caring for a patient taking furosemide (Lasix). What assessment finding needs to be reported to the provider immediately? a. Weight gain of 1/2 pound (1.1 kg) in 24 hours b. 2+/4+ pedal and pretibial edema c. Potassium level: 2.6 mEq/L d. Sodium level: 138 mEq/L ANS: C Furosemide is a potassium-wasting diuretic and the patients potassium is low. This finding should be reported. The weight gain should be charted but does not need immediate reporting.

Without knowing what the patients baseline edema is, there is no indication this needs to be reported. The sodium level is normal DIF: Applying (Application) REF: N/A OBJ: 21-5

TOP: Communication and Documentation MSC: Physiologic Integrity 15. An older patient is prescribed nifedipine (Procardia). What teaching topic is most important to discuss with this patient? a. Need to monitor blood pressure b. Need to follow low-salt diet c. Need to change positions slowly d. Need to add exercise to daily routine ANS: C Calcium channel blockers such as Procardia can cause orthostatic hypotension in older adults.

The nurse educates the patient on preventing this by slow position changes. The other topics are appropriate for all patients on this medication.

DIF: Applying (Application) REF: N/A OBJ: 21-4 TOP: Teaching-Learning MSC: Physiologic Integrity 16. A patient had a heart attack and the nurse identifies the diagnosis as activity intolerance.

What assessment finding indicates a priority goal for this diagnosis is being met? a. Mild chest pain getting into the chair b. Feels unsteady when getting out of bed c. O2 saturation 98% after using the commode d. Less dyspnea when changing positions ANS: C Activity intolerance is measured by changes in vital signs, electrocardiogram (ECG), and symptoms such as chest pain or shortness of breath. The oxygen saturation indicates physiologic tolerance to activity. The other options do not show physiologic tolerance.

DIF: Analyzing (Analysis) REF: N/A OBJ: 21-5

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity 17. An older patient in the internal medicine clinic reports usually being able to walk 1 mile without complaint. However, in the past 2 weeks, after walking just mile, the patients legs begin to ache. The pain goes away with rest. What action by the nurse is most appropriate? a. Elevate the patients legs b. Assess the pedal pulses c. Take the patients blood pressure d. Measure the patient for TED hose ANS: B This patient has intermittent claudication, a sign of peripheral arterial disease. The nurse assesses the patients pedal pulses. Elevation will further compromise circulation and should be avoided.

A blood pressure reading is taken during all health care visits. The patient does not need TED hose at this point.

DIF: Applying (Application) REF: N/A OBJ: 21-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 18. A patient has peripheral vascular disease. What statement by the patient indicates a need for further teaching? a. I will have the podiatrist cut my toenails. b. I will be sure to wear sturdy shoes. c. I can only walk limited distances now. d. I will report any injury to my foot or leg.

ANS: C Patients with venous insufficiency are encouraged to begin a graduated exercise program. The other statements show good understanding.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 21-5 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity MULTIPLE RESPONSE 1. The effect of aging on the cardiovascular system is evidenced by which symptoms in an older adult performing a stress test? (Select all that apply.) a. Chest pain during exercise b. Slow increase of heart rate in response to stress c. Exercise induce dyspnea d. Slow decrease of heart rate post exercise e. Stress-induced arrhythmias ANS: B, D During stress or stimulation, the heart rate increases more slowly; however, once elevated, it takes longer to return to the resting rate. The other manifestations are not related to age-induced physiologic changes.

DIF: Remembering (Knowledge) REF: Page 389 OBJ: 21-1 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 2. A novice nurse is aware that normal aging can result in changes in the ECG of a 73-year-old patient. The experienced geriatric nurse explains that these changes may include which of the following? (Select all that apply.) a. An inverted T wave b. A notched P wave c. A prolonged PR interval d. Decreased amplitude of the QRS complex e. A slurred T wave

ANS: B, C, D, E The number of pacemaker cells located in the sinoatrial node decreases with age, which results in less responsiveness of the cells to adrenergic stimulation. Common aging changes that are reflected by the electrocardiogram (ECG) include a notched P wave, a prolonged PR interval, decreased amplitude of the QRS complex, and a notched or slurred T wave.

DIF: Remembering (Knowledge) REF: Page 389 OBJ: 21-1 TOP: Teaching-Learning MSC: Health Promotion 3. A nurse is planning to teach a senior citizens group heart-healthy lifestyle choices. Which should be included? (Select all that apply.) a. Smoking cessation tips b. Low-carbohydrate food choices c. Stress management techniques d. Regular blood pressure monitoring e. Strategies to include exercise into daily routine ANS: A, C, D, E Heart-healthy lifestyle changes concern smoking cessation, stress management, blood pressure control, exercise, weight loss, and a low-fat, low-sodium diet. Low-carbohydrate foods are not considered part of heart-healthy lifestyles.

DIF: Understanding (Comprehension) REF: Page 389 OBJ: 21-4 TOP: Teaching-Learning MSC: Health Promotion 4. An older adult recovering from a myorcardial infarction (MI) has been taking subcutaneous heparin but is now to receive oral warfarin (Coumadin). The nurse prepares to teach the patient which topics? (Select all that apply.) a. Administration of both medications for up to 5 days

b. Need to use a soft bristle toothbrush c. Use of atropine as an antidote for excessive bleeding d. Need to continue drawing partial thromboplastin times e. Need to drink at least eight cups of fluids daily ANS: A, B, D Heparin and warfarin (Coumadin) are anticoagulants used to prevent the enlargement of existing thrombi and new clot formation after an MI. Therapeutic effects of heparin are monitored by partial thromboplastin times; the antidote is protamine sulfate. Warfarin is monitored by the international normalized ratio (INR); the antidote is vitamin K. Patients who initially receive heparin for anticoagulation and who need oral anticoagulation for maintenance usually take both forms of medication for 3 to 5 days to develop therapeutic blood levels. Bleeding is a complication. Patients need to be taught bleeding precautions.

DIF: Understanding (Comprehension) REF: Page 398 OBJ: 21-3 TOP: Teaching-Learning MSC: Physiologic Integrity 5. A 77-year-old patient is being treated for cardiac arrhythmia. The nurse determines that the patients cardiac output is adequate with which assessments? (Select all that apply.) a. Urine output of 140 cc over 4 hours b. Systolic blood pressure that remains within 20 mm of baseline c. Denial of substernal pain d. Recollection of the birthdays of all of her grandchildren e. Absence of rales and crackles ANS: A, B, D, E The patient will maintain an adequate cardiac output, as evidenced by heart rate and rhythm within normal range, stable blood pressure, adequate peripheral pulses, mental alertness, urine output of 30 mL/hr, and clear breath sounds. Normal mentation also denotes good cardiac output,

but the patient may have too many birthdays to remember, so this is not the best indicator of cognitive status.

Chapter 20 Digestion and Bowel Elimination MULTIPLE CHOICE 1. An 80-year-old patient has nausea and vomiting related to a gastrointestinal disorder. The nursing intervention most likely to help the patient is to: a. offer sips of soda every 15 minutes until more is tolerated. b. encourage the patient to lie in a prone position while nauseated. c. encourage the intake of high-calorie foods such as milkshakes. d. keep the patient on a nothing-by-mouth (NPO) order until the nausea subsides.

ANS: A Nursing interventions for nausea and vomiting include many self-help measures, including drinking clear liquids, progressing from eating bland foods to solid foods, and small frequent feedings. If vomiting occurs, fluid replacement should be a priority. Sips of fluids every 15 minutes until more can be tolerated may decrease episodes of dehydration. The position of the patient is unimportant. The patient should avoid nonclear liquids such as milkshakes. If the patient cannot keep even sips down, he or she may be prescribed NPO status.

DIF: Understanding (Comprehension) REF: Page 480 OBJ: 24-6 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 2. When preparing to discharge an older patient with mild dysphagia, the nurse suggests that the patient can minimize symptoms by: a. eating small meals every 2 to 3 hours b. cutting a sandwich into bite-sized peicees. c. eating less but choosing nutrient-dense foods.

d. drinking thin liquids instead of eating solids.

ANS: A Instruction regarding eating habits and maintaining weight and nutrition is important. For example, small, frequent meals, pureed or soft foods, and high-protein, high-calorie foods are helpful. Thin liquids are often harder to swallow than thickened ones. Nutrient-dense foods are important, but so is maintaining calorie requirements.

DIF: Understanding (Comprehension) REF: Page 488 OBJ: 24-6 TOP: Teaching-Learning MSC: Health Promotion 3. An older patient is being taught about oral gingivitis. The nurse has included instruction about maintaining an oral hygiene program, signs and symptoms of oral infection, and the importance of maintaining regular professional dental care. What important teaching has been missed? a. Information about when to have teeth removed and dentures made b. The necessity of using a hard-bristled toothbrush to maintain cleanliness c. The importance of avoiding meat and caffeine-containing products d. The importance of adequate nutrition for maintaining oral health ANS: D Nursing management of an older patient with gingivitis or periodontitis includes promotion of regular oral hygiene, regular preventive dental care, and maintenance of nutritional status. In addition, instructing the patient on the signs and symptoms of oral infections is also an important component of patient education. The other topics are not warranted.

DIF: Understanding (Comprehension) REF: Page 487 OBJ: 24-6 TOP: Teaching-Learning MSC: Health Promotion 4. An older adult patient has recently diagnosed gastritis. What statement made by this patient indicates the need for further teaching?

a. The abdominal pain is caused by acidity. b. I should avoid taking aspirin. c. Smoking has little effect on my stomach problem. d. I could develop pernicious anemia.

ANS: C Acute gastritis causes transient inflammation, hemorrhages, and erosion into the gastric mucosal lining. Although the cause may be undetermined, it is frequently associated with alcoholism, aspirin or nonsteroidal antiinflammatory drug (NSAID) ingestion, smoking, and severely stressful conditions such as burns, trauma, central nervous system damage, chemotherapy, and radiotherapy. It can cause abdominal pain. Smoking is a risk factor. The patient could develop pernicious anemia.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 24-6 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity 5. The nurse is planning to teach an older patient about diverticulitis. What topic does the nurse include? a. Dietary fiber and fluids will reduce the symptoms. b. It is unusual to see diverticula in older persons. c. Abdominal cramping and severe diarrhea should be reported. d. Diverticulosis rarely reoccurs once it has been treated.

ANS: A Teaching should include the need to eat high-fiber foods and the importance of achieving and maintaining adequate fluid status. Patients should be encouraged to consume up to 2000 mL of fluids each day, unless contraindicated by cardiac status. Older people have diverticulitis commonly. Abdominal cramping and diarrhea are expected findings. Diverticulitis usually reoccurs.

DIF: Understanding (Comprehension) REF: Page 497 OBJ: 24-5 TOP: Teaching-Learning MSC: Physiologic Integrity 6. The nurse caring for an older adult diagnosed with hyperplastic polyps instructs him that: a. this type of polyp is rarely malignant and usually does not require treatment. b. follow-up colonoscopies should be performed every 3 to 4 years after diagnosis. c. stool should be guaiac tested every week for 1 year after diagnosis. d. the presence of blood in the stool requires a repeat sigmoidoscopy examination.

ANS: D This type of polyp is rarely cancerous and rarely causes symptoms; however, they occasionally bleed, leaving bright red blood in the stool. A colonoscopy every 3 to 4 years is not indicated nor is testing the stool for blood for 1 year.

DIF: Applying (Application) REF: N/A OBJ: 24-6 TOP: Teaching-Learning MSC: Physiologic Integrity 7. An older adult reports chronic constipation. When asked why this problem has gotten worse with age, the nurse responds: a. As we age, our bodies require more fiber to bring about healthy bowel function. b. We need to discuss the proper use of laxatives to minimize constipation. c. Its possible that you have lost the ability to feel when you need to move your bowels. d. Aging brings about decreased gastric motility that often results in constipation.

ANS: A The most widespread cause of constipation in older adults is diet. Diets need to include 20 to 30 mg of fiber a day and plenty of water. Some changes in nerve function and gastric motility are also possible causes, but the major cause is diet. Laxatives should only be used as a last resort.

DIF: Understanding (Comprehension) REF: Page 482 OBJ: 24-6 TOP: Teaching-Learning MSC: Health Promotion 8. An older adult patient reports episodes of fecal incontinence. The nurse provides appropriate emotional support when assuring the patient that: a. it is a common problem that occurs in response to normal aging. b. the incontinence is rarely a result of a serious problem. c. disposable absorbent underwear will help manage the problem. d. the problem generally responds well to bowel control programs.

ANS: D It is important to reassure older patients that control and retraining are achievable because many older adults believe that fecal incontinence is the first step on the road to permanent institutionalization. Disposable garments may be used temporarily or long term if the patient cannot complete bowel retraining. It is not a normal response to aging.

DIF: Understanding (Comprehension) REF: Page 483 OBJ: 24-6 TOP: Teaching-Learning MSC: Physiologic Integrity 9. The daughter of a dependent older patient reports to the nurse that the patient requires regular soapsud enemas to manage chronic constipation. The nurse responds that: a. an alternative management technique should be discussed. b. enemas are generally the most effective interventions for the older adult. c. chronic constipation is best managed with oral medications. d. her mothers diet is the most likely cause of the constipation.

ANS: A Soapsud enemas lead to mucosal irritation and should not be used. Alternative methods to managing constipation include dietary changes and medications when needed.

DIF: Understanding (Comprehension) REF: Page 482 OBJ: 24-6 TOP: Teaching-Learning MSC: Physiologic Integrity 10. A 74-year-old adult is experiencing dumping syndrome after gastric resection surgery. The nurse caring for the patient instructs the patient to: a. stop smoking. b. abstain from beverages that contain caffeine. c. eat three low-carbohydrate meals daily. d. drink only between meals.

ANS: D The institution of small, frequent meals that are low in carbohydrates will diminish the incidence of these symptoms. Resting after eating and drinking fluids between (rather than during) meals will also help alleviate these symptoms. Smoking and caffeine are not related, and eating only three meals a day is not warranted.

DIF: Understanding (Comprehension) REF: Page 492 OBJ: 24-6 TOP: Teaching-Learning MSC: Physiologic Integrity 11. A 68-year-old patient is reporting symptoms that suggest a peptic ulcer. The nurse asks the patient if: a. the pain exacerbates when he eats fatty food. b. there is a family history of peptic ulcers. c. he smokes either cigars or cigarettes. d. he uses acetaminophen (Tylenol) for minor pain.

ANS: B Both genetic and environmental factors have been proposed as the cause of peptic ulcers because both gastric ulcers and duodenal ulcers tend to occur in families. At present, no direct evidence

exists that indicates dietary or occupational factors as causes of ulcer disease. Acetaminophen generally does not cause gastric ulcers.

DIF: Understanding (Comprehension) REF: Page 491 OBJ: 24-6 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 12. What dietary suggestion does the nurse give the older patient to manage age-related changes in taste? a. Add more salt to foods. b. Use a salt substitute. c. Add sugar when possible. d. Use a variety of herbs.

ANS: D Older adults experience a decrease in taste discrimination. Various herbs can be used to spice up foods. More salt should not be added, as older adults generally should eat low-salt diets. Salt substitutes often contain potassium, a problem for older adults who have an age-related decrease in kidney function and the ability to excrete potassium. Adding sugar is not healthy.

DIF: Applying (Application) REF: N/A OBJ: 24-1 TOP: Teaching-Learning MSC: Health Promotion 13. An older patient has been admitted with nausea and vomiting. What assessment takes priority? a. Respiratory system b. Urine output c. Blood pressure and pulse d. Skin integrity ANS: C

All assessments are appropriate; however, the concern in this older patient is dehydration, so assessment of cardiovascular status comes first. Urine output reflects cardiac output but it does not reflect as up-to-date information as do vital signs. Respiratory system and skin integrity are lower priorities for this patient.

DIF: Applying (Application) REF: N/A OBJ: 24-6 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 14. A patient is admitted with copious diarrhea. The patient is dizzy when standing, and skin assessment reveals abrasions around the perianal area. What assessment finding demonstrates that goals for the priority nursing diagnosis have been met? a. Perianal skin abrasions are smaller in size. b. Patient does not fall while hospitalized. c. Patient sits up without dizziness. d. Patient is able to tolerate oral fluids.

ANS: D The priority diagnosis for this patient is decreased cardiac output or fluid volume deficit, either of which is evaluated with the lack of dizziness. Falling indicates dehydration or weakness, both brought about by the cardiac output situation. Skin integrity is important but not the priority.

Being able to tolerate fluids indicates treatment is going well. However, the priority diagnosis relates to cardiac output and fluid volume.

DIF: Analyzing (Analysis) REF: N/A OBJ: 24-7 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity 15. A patient has pernicious anemia. What action by the patient and family indicates teaching for this condition has been effective? a. Proper administration of oral vitamin B12 b. Correct technique for intramuscular (IM) injections

c. Choosing aspirin over ibuprofen (Motrin) for pain d. Preparing a low-carbohydrate meal ANS: B Pernicious anemia is typically treated with IM injections of vitamin B 12. Oral preparations are not absorbed in the gastrointestinal tract. Aspirin or ibuprofen are not related, nor is a low carbohydrate diet.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 24-7 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity 16. A patient is admitted with infectious diarrhea. What action by the nurse is best? a. Place the patient in contact precautions. b. Place the patient on droplet precautions. c. Use standard precautions to care for the patient. d. Prepare staff to take prophylactic antibiotics.

ANS: A Contact precautions should be used when caring for a patient with infectious diarrhea. The other options are not warranted.

DIF: Applying (Application) REF: N/A OBJ: 24-7 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 17. An older patient with hepatitis has pruritus. What advise does the nurse provide this patient? a. Keep your fingernails cut short. b. Use diphenhydramine (Benadryl). c. Hot soapy showers will help. d. Butter is a good home remedy for itching.

ANS: A Pruritus is intense itching. The patients nails should be kept short to avoid injury to the skin and possible infection. Diphenhydramine is not recommended in older patients. Tepid water with little soap is best. Butter is not a home remedy for itching.

DIF: Applying (Application) REF: N/A OBJ: 24-7 TOP: Teaching-Learning MSC: Physiologic Integrity 18. An older patient had a stroke several months ago. The patient begins to exhibit dysphagia.

What action by the nurse is best? a. Consult with a speech-language therapist. b. Discuss the need for enteral feedings. c. Provide the patient swallowing exercises. d. Arrange for a physical exam.

ANS: D This patient has started exhibiting difficulty swallowing months after a stroke, so the stroke is probably not the cause. Difficulty swallowing is a sign of esophageal cancer, however, so the nurse should arrange for the patient to have a physical exam. The patient may still need speech language therapy and swallowing exercises, but this is not the priority.

DIF: Applying (Application) REF: N/A OBJ: 24-4 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 19. An older patient is having a colostomy as part of surgery for colon cancer. What assessment by the nurse is most important in this patient? a. Manual dexterity b. Body image c. Fear of dying

d. Fluid volume status ANS: A The older adult with diminished manual dexterity may need assistance with ostomy care. The other assessments are appropriate for patients of all ages.

DIF: Applying (Application) REF: N/A OBJ: 24-7 TOP: Nursing Process: Assessment MSC: Health Promotion MULTIPLE RESPONSE 1. A 70-year-old patient has lost 25 pounds since being diagnosed with hepatitis A. To best manage the patients anorexia, what does the nurse suggest? (Select all that apply.) a. A protein powder supplement added to liquids b. Several meals eaten during the day c. Megavitamins that include iron and folic acid d. A dietary assessment to identify favorite foods e. A high-carbohydrate, low-fat diet ANS: B, E A patient with hepatitis best tolerates a high-carbohydrate, low-fat diet. Several small feedings throughout the day will help alleviate the effect of anorexia. Favorite foods can be assessed but should not be encouraged unless they meet the dietary restrictions. Protein powder may be useful but is not necessary. Megavitamins are also not warranted.

DIF: Understanding (Comprehension) REF: Page 501 OBJ: 24-6 TOP: Teaching-Learning MSC: Physiologic Integrity 2. Because of a knowledge of age-related changes in the gastrointestinal system, the nurse encourages regular screenings for which of the following? (Select all that apply.)

a. Osteoporosis b. Vitamin B deficiency c. Pernicious anemia d. Enlarged liver e. Iron deficiency anemia ANS: A, B, C, E By the age of 60, a persons gastric secretions decrease to 70% to 80% of those of the average adult. A decrease in pepsin may hinder protein digestion, whereas a decrease in hydrochloric acid and intrinsic factor may lead to malabsorption of iron, vitamin B 12, calcium, and folic acid.

This, combined with atrophy of the mucosa and a decrease in gastric secretions, increases the incidence of pernicious anemia, osteoporosis, vitamin B deficiency, and iron deficiency anemia.

DIF: Applying (Application) REF: N/A OBJ: 24-2 TOP: Nursing process: Assessment MSC: Physiologic Integrity 3. An older adult patient is being evaluated for a possible duodenal ulcer (DU). Which of the following assessments supports the diagnoses? (Select all that apply.) a. Passing a moderate amount of dark reddish-brown stool b. Reporting a stabbing pain in the epigastric region c. Asking for some crackers to stop my stomach cramps d. Reporting the need to take antacid tablets most days e. Having a rigid abdomen about 2 hours after eating ANS: A, C, D Typically the symptoms of DU are patterned by periods of exacerbation and remission and follow a pain-food-relief pattern. The pain begins 2 to 4 hours after meals, is immediately relieved by food or antacids, is located in the mid epigastrium, and may be described as a burning or cramplike pain. On physical examination, the only abnormality is possibly a tender

epigastrium. A rigid abdomen could indicate a perforation of the ulcer. Stabbing epigastric pain is not a manifestation.

DIF: Remembering (Knowledge) REF: Page 491-2 OBJ: 24-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 4. An 82-year-old patient with a history of chronic heart and respiratory problems asks the nurse, What can I do to keep my hemorrhoids from acting up? Which of the following responses made by the nurse are appropriate?(Select all that apply.) a. Ask if he experiences constipation with any regularity. b. Encourage him to increase his fluid intake to 2000 mL daily. c. Suggest he eat more whole grains and fresh fruits. d. Discuss how he should include a walk into his daily routine. e. Ask if he has a history of rectal bleeding.

ANS: A, C, D, E Nursing management of an older patient with hemorrhoids includes the prevention and elimination of constipation. This includes a review of high-fiber, high-roughage foods, including indigestible fiber like whole grains, legumes, and fresh fruits and vegetables. An adequate intake of fluids is also important. Older patients should be encouraged to consume up to 2000 mL of fluids each day unless contraindicated. This patient has heart disease and possibly should not take in that much fluid. The nurse should encourage light exercise on a regular basis and review the importance of a regular toileting routine. Rectal bleeding should be investigated.

Chapter 21 Urinary Elimination MULTIPLE CHOICE 1. To encourage a normal daily bowel movement, the nurse can aid the older adult by: a. decreasing fluid intake. b. providing a warm beverage at breakfast.

c. medicating with a mild laxative at bedtime. d. providing a warm shower each morning.

ANS: B Warm beverages at breakfast frequently stimulate the urge to defecate.

DIF: Cognitive Level: Comprehension REF: 286 OBJ: 6 TOP: Promoting Normal Elimination KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse assesses constipation in the patient who passes: a. firm stool without difficulty every 3 days. b. hard stool without difficulty every 2 days. c. soft brown stool with difficulty every 2 days. d. hard dry stool with difficulty every 3 days.

ANS: D Constipation is defined as a hard, dry stool that is difficult to pass.

DIF: Cognitive Level: Analysis REF: 287 OBJ: 1 TOP: Constipation KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse recognizes a need for instruction about prevention of constipation when the patient says: a. I eat bran flakes or oatmeal every day to add bulk to my diet. b. Since I started eating three servings of fruit a day, I havent been constipated. c. Im never constipated. I take a gentle laxative every night. d. My daily walks have kept my bowels working regularly.

ANS: C Long-term laxative use may cause the body to become so dependent on laxatives that the patient is unable to have a normal elimination pattern without medication.

DIF: Cognitive Level: Application REF: 287 OBJ: 1 TOP: Constipation Prevention KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse explains that a diet low in dietary fiber results in a small stool that: a. moves rapidly through the intestines. b. becomes excessively dry. c. overstimulates the defecation reflex. d. contributes to frequent bowel movements.

ANS: B Small stools move slowly because of the understimulation of peristalsis. The stool becomes dry and leads to infrequent defecation and constipation.

DIF: Cognitive Level: Application REF: 287 OBJ: 1 TOP: Dietary Fiber KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse would be especially observant for the indication of constipation in the patient who is taking: a. antibiotics for an upper respiratory infection. b. hormones for postmenopausal symptoms. c. iron supplements for anemia. d. nonsteroidal inhalants for chronic obstructive pulmonary disease (COPD).

ANS: C

Iron supplements increase the risk of constipation.

DIF: Cognitive Level: Analysis REF: 287 OBJ: 4 TOP: Medications Causing Constipation KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The nurse explains that the urge to defecate (defecation reflex) can be destroyed by: a. frequent episodes of diarrhea. b. long-term use of vitamin A and vitamin B complex. c. repeatedly ignoring the urge. d. excessive fiber and bulk in the diet.

ANS: C Ignoring the urge to defecate repeatedly suppresses the urge and may destroy it completely.

DIF: Cognitive Level: Comprehension REF: 288 OBJ: 4 TOP: Defecation Reflex KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The nurse recognizes a need to make a focused bowel assessment when the 80-year-old resident complains of: a. the inability to have a bowel movement every day. b. feeling pressure and fullness in the rectum but is unable to defecate. c. having had one loose stool after breakfast. d. ingestion and flatulence.

ANS: B Feelings of pressure and fullness without being able to defecate may indicate a fecal impaction or rectal cancer. One loose stool does not represent diarrhea. Indigestion and flatulence are common in the older adult.

DIF: Cognitive Level: Application REF: 288, Patient Teaching OBJ: 4 TOP: Assessing Bowel Problems KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 8. The nurse uses special caution when performing a rectal digital examination on a patient with: a. chronic obstructive pulmonary disease (COPD). b. diabetes. c. Parkinson disease. d. congestive heart failure.

ANS: D Persons with a cardiac history may experience vagal stimulation and have a sudden drop in heart rate, resulting in syncope.

DIF: Cognitive Level: Application REF: 288 OBJ: 6 TOP: Vagal Response KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. To assist an 85-year-old older adult with weak abdominal muscles to defecate, the nurse would: a. encourage the use of a bedpan before getting up in the morning. b. place a footstool under the feet of the patient when seated on the toilet. c. insert a finger in the patients rectum to stimulate the urge to defecate. d. instruct the patient to do isometric exercises to strengthen the abdominal muscles.

ANS: B Placement of a stool under the patients feet increases intra-abdominal pressure and encourages bearing down (Valsalva maneuver) to accomplish defecation.

DIF: Cognitive Level: Application REF: 289 OBJ: 6 TOP: Weak Abdominal Muscles KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. The nurse tells the older adult that a food with the double action of providing fiber and being a natural laxative is: a. oatmeal. b. pineapple. c. prunes. d. raw apple.

ANS: C Although all the options add fiber and bulk to the diet, only prunes provide a laxative effect.

DIF: Cognitive Level: Application REF: 289 OBJ: 6 TOP: Nonconstipating Foods KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. When the patient tells the home health nurse that he has begun to take psyllium (Metamucil), the nurse cautions him that to avoid fecal impaction with this drug, he should: a. eat several servings of fresh fruit and vegetables a day. b. avoid citrus fruit juices. c. reduce intake of carbonated drinks. d. increase his fluid intake to 3000 mL a day.

ANS: D Increased fluid intake is essential to dissolve the fiber in this drug completely; otherwise, fecal impaction can occur.

DIF: Cognitive Level: Application REF: 289 OBJ: 6

TOP: Psyllium KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 12. The nurse recognizes the patient who is exhibiting signs of diarrhea and will need enhanced skin care precautions as the patient who has: a. one unformed stool after a bolus of tube feeding. b. an unformed stool followed by a formed stool 3 hours later. c. cramping and nausea followed by an unformed stool. d. no abdominal discomfort but has had three unformed stools in 8 hours.

ANS: D Frequent passage of unformed stool with or without other symptoms should call for a heightened level of skin care.

DIF: Cognitive Level: Application REF: 292 OBJ: 2 TOP: Diarrhea KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 13. The nurse plans to help reduce episodes of bowel incontinence by a proactive program of: a. encouraging intake of foods that cause mild constipation. b. using appropriate disposable garments, pads, and bed covering. c. establishing a toileting schedule. d. coaching the patient in Kegel exercises.

ANS: C Establishing a toileting schedule that follows the preincontinent state can train the patients bowel and caregivers so that incontinence is reduced.

DIF: Cognitive Level: Application REF: 293 OBJ: 6 TOP: Bowel Incontinence KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 14. The patient complains of feeling the need to urinate and fullness and tenderness in the bladder area. The patient is restless and diaphoretic. The initial nursing intervention would be to: a. help the patient into a warm tub bath to stimulate voiding. b. catheterize the patient. c. palpate the bladder fundus. d. place heated towels over the bladder area.

ANS: C Palpation to assess distention would be the initial intervention before trying to remedy the urinary retention.

DIF: Cognitive Level: Application REF: 294 OBJ: 3 TOP: Urinary Distention KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 15. The nurse recognizes the cardinal sign of stress incontinence when the patient says: a. Lifting my grandchild makes me wet my pants. b. I frequently wet myself because I just cant get to the bathroom in time. c. My arthritis makes me so clumsy that I cant get my pants down in time. d. Every time I have a urinary infection, I experience incontinence.

ANS: A Stress incontinence occurs when intra-abdominal pressure increases and forces urine through a weakened urinary sphincter. Lifting, sneezing, coughing, and laughing can cause stress incontinence.

DIF: Cognitive Level: Application REF: 294 OBJ: 3 TOP: Stress Incontinence KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. The home health nurse suggests that the patient perform a frequent series of Kegel exercises to reduce incontinence by: a. increasing the tone of the bladder. b. reducing urinary retention. c. strengthening the urinary sphincter. d. sensitizing biofeedback.

ANS: C Kegel exercises, if done correctly and regularly, will strengthen the pelvic floor and will help hold back the flow of urine.

DIF: Cognitive Level: Comprehension REF: 296 OBJ: 6 TOP: Kegel Exercises KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. An alert, independent, 89-year-old male resident with congestive heart failure has been on Lasix for a week. Over the past 2 days he has been frequently incontinent and does not make it to the bathroom in time. His urine is now dark amber with a strong ammonia smell. He tells the nurse that he is having spasms in his lower abdomen. The nursing diagnosis that most applies to this resident is: a. impaired urinary elimination. b. functional urinary incontinence. c. stress urinary incontinence d. urge urinary incontinence.

ANS: D Urge urinary incontinence occurs with the physiologic changes of aging. The use of diuretics, increased bladder stimulation from urinary tract infections, and involuntary bladder spasms cause the older adult to have a feeling of urgency and result in incontinence.

DIF: Cognitive Level: Comprehension REF: 295 OBJ: 5 TOP: Urge Incontinence KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies MULTIPLE RESPONSE 1. The nurse explains that normal bowel stimulation patterns for elimination of each person are influenced by __________. (Select all that apply.) a. level of activity b. diet c. medication d. fluid intake e. lifestyle ANS: A, B, D, E Medications frequently disrupt normal bowel elimination patterns.

DIF: Cognitive Level: Knowledge REF: 286 OBJ: 1 TOP: Normal Bowel Elimination Patterns KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse outlines age-related changes that promote constipation in the older adult, which include __________. (Select all that apply.) a. diminished abdominal muscle tone b. reduced activity level c. inadequate fluid intake d. increased dietary fiber e. dependence on laxatives

ANS: A, B, C, E Increased dietary fiber and bulk help prevent constipation.

DIF: Cognitive Level: Application REF: 287 OBJ: 1 TOP: Factors Supporting Constipation KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse encourages fluid intake for the older adult to prevent constipation. If fluid intake is inadequate, constipation occurs because __________. (Select all that apply.) a. fluid will be withdrawn from the stool b. the stool becomes hard and dry c. less mucus is formed in the colon d. lumen of bowel constricts because of smaller bulk e. peristalsis slows ANS: A, B, C Inadequate fluid intake causes fluid to be withdrawn from the stool for the bodys fluid needs, making the stool dry and hard. There is less mucus in the bowel from age-related changes and diminished mucus production because of decreased fluid. Slowed peristalsis is not related to fluid intake. Lumen of the bowel does not constrict because of smaller bulk.

DIF: Cognitive Level: Application REF: 287 OBJ: 6 TOP: Fluid Intake KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse assesses a risk for constipation related to pain because of the presence of conditions such as __________. (Select all that apply.) a. hemorrhoids b. anal fissures c. reduction of bowel mucus

d. diminished abdominal muscle tone e. slowed peristalsis ANS: A, B, C Diminished tone and slowed peristalsis do not contribute to pain.

DIF: Cognitive Level: Application REF: 288 OBJ: 4 TOP: Pain-Related Constipation KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse is alerted to the possibility of a fecal impaction when the older adult patient complains of __________. (Select all that apply.) a. cramping b. rectal pain c. abdominal distention d. anorexia e. passing large amounts of liquid stool ANS: A, B, C, D Passing large amounts of liquid stools is not a sign of a fecal impaction. All other options are indications of fecal impaction.

DIF: Cognitive Level: Application REF: 288 OBJ: 4 TOP: Fecal Impaction KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The skin care for an older adult with diarrhea should include __________. (Select all that apply.) a. perineal care immediately after the diarrhea episode b. application of lotion to the buttocks

c. maintenance of dry linens d. patting the anal area dry rather than wiping e. leaving excoriated areas open to the air ANS: A, C, D, E Lotion will not protect the skin from urine and stool. Barrier cream must be used. All other interventions listed are part of special skin care for persons with diarrhea.

DIF: Cognitive Level: Comprehension REF: 292 OBJ: 6 TOP: Diarrhea Skin Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 7. The nurse is aware that the broad general causes of bowel incontinence are __________.

(Select all that apply.) a. inability to recognize defecation urge related to mental impairment b. inability to respond to defecation urge related to immobility c. inflammatory bowel disease d. increased fiber in the diet e. unexpected defecation when passing gas ANS: A, B, C, E Fiber provides bulk to waste. All other options are causes of incontinence.

DIF: Cognitive Level: Comprehension REF: 293 OBJ: 4 TOP: Causes of Bowel Incontinence KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. The nurse knows difficulty in bowel and bladder elimination occur in the older adult as a result of __________. (Select all that apply.) a. daily use of senna for defecation

b. inability to get to adequate water c. fear of pain with defecation d. total privacy during elimination e. use of a bedpan for elimination ANS: A, B, C, E A lack of privacy may be a hindrance to elimination.

DIF: Cognitive Level: Application REF: 287-288 OBJ: 2 TOP: Age-Related Changes That Affect Elimination KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation COMPLETION 1. The nurse is aware that an adult has the urge to urinate when the bladder has approximately _____ mL of urine in it.

ANS: 300

Chapter 22 Reproductive System Health Question 1 Type: MCSA An older patient describes having to go to the bathroom more frequently at night. What manifestation is this patient experiencing?

1. Fluid overload 2. Increased glycosuria 3. Normal changes of aging

4. Impairment of drug excretion Correct Answer: 3 Rationale 1: Older adults have a decreased response to fluid overload by not increasing urine output.

Reference: Page 446 Rationale 2: Older adults also excrete less glucose in the urine, making increased glycosuria not possible.

Reference: Page 446 Rationale 3: The kidneys of older adults excrete more fluid and electrolytes at night than in the daytime. More urine is formed at night, frequently interrupting sleep patterns.

Reference: Page 446 Rationale 4: Although drug excretion may be impaired in the elderly, it would not result in increased urine output.

Reference: Page 446 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1. Describe the normal changes of aging in the physiology of the genitourinary and renal systems.

Question 2 Type: MCSA

An older patient who has been experiencing a fever, nausea, and vomiting has a urine specific gravity below normal. The patient denies being thirsty. What should the nurse suspect the patient is experiencing?

1. Dehydration 2. Fluid overload 3. Congestive heart failure 4. Normal changes of aging Correct Answer: 1 Rationale 1: The elderly are less able to concentrate their urine, making them susceptible to dehydration. In addition, there is a deficit of the thirst response. The patients symptoms of nausea and vomiting suggest decreased intake and increased output through vomiting, placing the patient at risk for dehydration.

Reference: Page 447 Rationale 2: The patient with fluid overload would have respiratory manifestations.

Reference: Page 447 Rationale 3: The patient with heart failure would have respiratory manifestations.

Reference: Page 447 Rationale 4: Fever, nausea, vomiting and a low urine specific gravity are not normal changes of aging.

Reference: Page 447 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 3 Type: MCSA The nurse is having difficulty inserting a urinary catheter in an older female patient. Which position should the nurse use to help facilitate the insertion of the catheter?

1. Side-lying lifting up the buttock 2. Supine with the bed flat, legs bent and apart 3. Supine with the HOB elevated at 30 degrees 4. Supine with the head of bed (HOB) elevated at 90 degrees Correct Answer: 1 Rationale 1: Because of estrogen-mediated changes in the perineal area of postmenopausal women, the urinary meatus may be very difficult to visualize. The side-lying position lifting up the buttock is an alternative that provides better visualization of the urinary meatus.

Reference: Page 449 Rationale 2: The supine position, regardless of the leg position or height of the bed, would not increase the visualization of the urinary meatus because it is more distal from the changes in the perineal area.

Reference: Page 449 Rationale 3: The supine position, regardless of the leg position or height of the bed, would not increase the visualization of the urinary meatus because it is more distal from the changes in the perineal area.

Reference: Page 449

Rationale 4: The supine position, regardless of the leg position or height of the bed, would not increase the visualization of the urinary meatus because it is more distal from the changes in the perineal area.

Reference: Page 449 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 4 Type: MCMA An older female patient asks the home care nurse what can be done to help with painful intercourse. What recommendations should the nurse make to the patient?

Standard Text: Select all that apply.

1. Avoid intercourse.

2. Decrease the frequency of intercourse.

3. Use vaginal lubricants during intercourse.

4. Use the hand to guide the penis into the vagina.

5. Tolerate the problem because it is a normal part of aging.

Correct Answer: 3,4

Rationale 1: Avoiding intercourse does not resolve the problem for the patient.

Reference: Page 466 Rationale 2: Decreasing the frequency of intercourse does not resolve the problem for the patient.

Reference: Page 466 Rationale 3: It is not uncommon for an elderly female to report painful intercourse, which is related to a decrease in vaginal lubrication as well as the lack of elevation of the labia during sexual arousal. Vaginal lubricants can be very effective in reducing the pain experienced during intercourse.

Reference: Page 466 Rationale 4: The older female might be advised to use her hand to guide her partners penis into the vagina.

Reference: Page 466 Rationale 5: Although this is a normal change of aging, patients do not have to tolerate the discomfort.

Reference: Page 466 Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 5 Type: MCSA

An older patient with chronic renal failure has not had a bowel movement for two days. What does the nurse realize this patient is at risk for developing?

1. Hypokalemia 2. Hyperkalemia 3. Metabolic acidosis 4. Increased serum creatinine levels Correct Answer: 2 Rationale 1: Constipation exacerbates hyperkalemia and it is important to monitor patients with chronic renal failure for daily bowel movements since the potassium levels are already impaired.

Reference: Page 453 Rationale 2: Constipation exacerbates hyperkalemia and it is important to monitor patients with chronic renal failure for daily bowel movements since the potassium levels are already impaired.

Reference: Page 453 Rationale 3: Metabolic acidosis is not directly affected by constipation.

Reference: Page 453 Rationale 4: Serum creatinine levels are not directly affected by constipation.

Reference: Page 453 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 6 Type: MCMA Which assessment findings does the nurse recognize as being a normal part of aging for an older patient?

Standard Text: Select all that apply.

1. Nocturia 2. Delayed urination 3. Less frequent voiding 4. New onset urinary incontinence 5. Decreased urine specific gravity Correct Answer: 1,2,3,5 Rationale 1: Nocturia is a normal urinary change found in older people.

Reference: Page 446 Rationale 2: Delayed urination is a normal urinary change found in older people.

Reference: Page 446 Rationale 3: Less frequent voiding is a normal urinary change found in older people.

Reference: Page 446 Rationale 4: Urinary incontinence, although it occurs frequently in the elderly for a variety of reasons, is not a normal part of aging and requires priority assessment of associated factors to determine the cause.

Reference: Page 446

Rationale 5: Decreased urine specific gravity is a normal urinary change found in older people.

Reference: Page 446 Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1. Describe the normal changes of aging in the physiology of the genitourinary and renal systems.

Question 7 Type: MCSA An older male patient with benign prostatic hypertrophy (BPH) is experiencing an increase in symptoms. Which finding would explain the reason for this patients change in symptoms?

1. Recent vasectomy 2. Decreased oral intake at night 3. Use of over-the-counter saw palmetto 4. Use of over-the-counter cold medication Correct Answer: 4 Rationale 1: A vasectomy does not affect the symptoms of BPH. Reference: Page 460 Rationale 2: A decreased oral intake at night may resolve the symptoms.

Reference: Page 460

Rationale 3: Use of saw palmetto might help resolve the symptoms.

Reference: Page 460 Rationale 4: Urinary retention in men with BPH can be precipitated by several classes of medications, such as over-the-counter medications for the common cold.

Reference: Page 460 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 8 Type: MCMA An older male patient reports having blood in the urine. For which health problems does the nurse expect the patient will be evaluated?

Standard Text: Select all that apply.

1. Pyuria 2. Renal failure 3. Bladder cancer 4. Prostate cancer 5. Urinary tract infection

Correct Answer: 3,5 Rationale 1: Pyuria is pus in the urine and may be a symptom of bladder cancer or a urinary tract infection but is not related to the pathological process of hematuria.

Reference: Pages 461, 460 Rationale 2: Blood in the urine is not a symptom of renal failure.

Reference: Pages 461, 460 Rationale 3: Blood in the urine is associated with bladder cancer.

Reference: Pages 461, 460 Rationale 4: Blood in the urine is not associated with prostate cancer.

Reference: Pages 461, 460 Rationale 5: Blood in the urine can be a symptom of a urinary tract infection.

Reference: Pages 461, 460 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 9 Type: MCSA An older patient who is postmenopausal is experiencing uterine bleeding. Which action would be appropriate for the nurse to take at this time?

1. Provide hygienic care.

2. Collect a urine specimen.

3. Direct the patient for evaluation for endometrial cancer.

4. Instruct the patient on normal changes of the reproductive system in the elderly.

Correct Answer: 3 Rationale 1: Hygienic care is important but it is not a priority at this time.

Reference: Page 462 Rationale 2: Collecting a urine specimen may be part of the further assessment but is not a priority.

Reference: Page 462 Rationale 3: Any older woman who reports postmenopausal uterine bleeding should be assumed to have endometrial cancer until proved otherwise. The patient should be directed to seek healthcare to evaluate for the presence of endometrial cancer.

Reference: Page 462 Rationale 4: Uterine bleeding is not a normal change in the older female patient.

Reference: Page 462 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 10 Type: MCSA The nurse is instructing an older female patient on reproductive cancer screenings. Which information would the nurse include in this teaching?

1. Eliminate Pap smears if high risk factors are absent.

2. Obtain mammography every other year after the age of 40.

3. Avoid hormone replacement therapy for vasomotor symptoms.

4. Eliminate self-examination of the breasts if the patient finds this socially unacceptable.

Correct Answer: 1 Rationale 1: Current recommendations are that women who are over age 65, who have had a regular history of normal Pap smears, and who are not at high risk because of other factors should not receive routine Pap smears.

Reference: Page 462 Rationale 2: Mammography is recommended yearly for women over the age of 40.

Reference: Page 462 Rationale 3: The treatment of vasomotor symptoms is the only recommended use for hormone replacement therapy in menopausal women.

Reference: Page 462 Rationale 4: Regardless of the patients feelings, self-examination of the breasts is an important breast cancer screening tool.

Reference: Page 462 Global Rationale: Cognitive Level: Applying

Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 11 Type: MCMA The nurse is reviewing the list of medications prescribed for an older patient. Which medications could lead to toxicity because of renal excretion changes in this patient?

Standard Text: Select all that apply.

1. Aspirin 2. Digoxin 3. Antibiotic 4. Vitamin C 5. ACE inhibitor Correct Answer: 2,3,5 Rationale 1: Because of renal excretion changes the older patient is prone to toxicity. Aspirin does not cause toxicity.

Reference: Page 448 Rationale 2: Because of renal excretion changes the older patient is prone to toxicity. Digoxin can cause toxicity.

Reference: Page 448

Rationale 3: Because of renal excretion changes the older patient is prone to toxicity. Antibiotics can cause toxicity.

Reference: Page 448 Rationale 4: Because of renal excretion changes the older patient is prone to toxicity. Vitamin C is a water-soluble vitamin and will not cause toxicity.

Reference: Page 448 Rationale 5: Because of renal excretion changes the older patient is prone to toxicity. ACE inhibitors can cause toxicity.

Reference: Page 448 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 12 Type: MCMA An older patient is diagnosed with chronic renal failure. Which manifestations will the nurse most likely assess in this patient?

Standard Text: Select all that apply.

1. Pruritis 2. Anorexia

3. Generalized edema 4. Postural hypotension 5. Elevated blood pressure Correct Answer: 1,2,3,5 Rationale 1: Pruritis is a manifestation of chronic renal failure.

Reference: Page 453 Rationale 2: Anorexia is a manifestation of chronic renal failure.

Reference: Page 453 Rationale 3: Generalized edema is a manifestation of chronic renal failure.

Reference: Page 453 Rationale 4: Postural hypotension is a manifestation of acute renal failure and not chronic renal failure.

Reference: Page 453 Rationale 5: Elevated blood pressure is a manifestation of chronic renal failure.

Reference: Page 453 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 13 Type: MCSA An older patient who is a widower explains that routine sexual encounters remain an important part of his life. What teaching should the nurse provide to this patient?

1. Actions to ensure safe sex 2. Importance of an adequate fluid intake 3. Reasons to abstain from sexual activity 4. Interventions to prevent erectile dysfunction Correct Answer: 1 Rationale 1: Sexually active older adults are at risk for the same sexually transmitted infections that affect younger adults. They should be offered the same education about safer sex, including the use of condoms.

Reference: Page 467 Rationale 2: An adequate fluid intake is important but this has nothing to do with the patients routine sexual encounters.

Reference: Page 467 Rationale 3: The nurse should not expect an older patient to abstain from sexual activity if this is desired.

Reference: Page 467 Rationale 4: There are no specific interventions to prevent erectile dysfunction. This topic has nothing to do with the patients routine sexual encounters.

Reference: Page 467 Global Rationale: Cognitive Level: Applying

Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4. Recognize his or her own biases related to sexuality and aging.

Question 14 Type: MCSA A 60-year-old male patient is planning to marry a woman in her 30s and is concerned about the need for contraception. How should the nurse respond to this patient?

1. After age 50, you are considered virtually infertile.

2. It is still possible at this time of life to father a child.

3. You should have a vasectomy to avoid fathering a child.

4. You will only need to be concerned about fertility for another few years.

Correct Answer: 2 Rationale 1: Approximately half of all men continue to produce viable sperm up to the age of 90 years. Older men can father children.

Reference: Page 449 Rationale 2: Approximately half of all men continue to produce viable sperm up to the age of 90 years. Older men can father children.

Reference: Page 449 Rationale 3: Discussion about a vasectomy is premature at this stage. A vasectomy may not be the best option for this patient.

Reference: Page 449

Rationale 4: Approximately half of all men continue to produce viable sperm up to the age of 90 years. Older men can father children.

Reference: Page 449 Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4. Recognize his or her own biases related to sexuality and aging.

Question 15 Type: MCMA When reviewing the hormone levels of a menopausal patient, which findings should the nurse recognize as being expected for the patient?

Standard Text: Select all that apply.

1. Reduced estrogen level 2. Reduced testosterone level 3. Elevated thyroid hormone level 4. Elevated luteinizing hormone level 5. Elevated follicle stimulating hormone level Correct Answer: 1,2,4,5

Rationale 1: Estrogen levels fall off dramatically and remain at very low levels for the rest of the womans life.

Reference: Page 450 Rationale 2: Because women also produce small amounts of testosterone, loss of libido in an older woman may be related to a decrease in testosterone.

Reference: Page 450 Rationale 3: Thyroid hormone is not affected by menopause.

Reference: Page 450 Rationale 4: Once menopause has occurred, luteinizing hormone stabilizes at levels much higher than in younger women.

Reference: Page 450 Rationale 5: Once menopause has occurred, follicle stimulating hormone stabilizes at levels much higher than in younger women.

Reference: Page 450 Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 16 Type: MCSA

The nurse is assessing an older male patient. Which finding indicates the need for further investigation?

1. The absence of libido 2. Orgasms of reduced intensity 3. Difficulty delaying ejaculation 4. An erection that is less firm than in earlier years Correct Answer: 1 Rationale 1: Although the libido of a man may diminish with aging, the loss of sexual drive should be viewed with concern.

Reference: Page 450 Rationale 2: The characteristics of the orgasm change with age as they are reduced in intensity and force.

Reference: Page 450 Rationale 3: Difficulty anticipating or delaying ejaculation is a normal finding in an older male patient.

Reference: Page 450 Rationale 4: The erection is often less firm but capable of penetration.

Reference: Page 450 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 17 Type: MCMA An older patient is experiencing overflow incontinence. What should the nurse identify as causes for this change in urinary functioning?

Standard Text: Select all that apply.

1. History of dementia 2. Enlarged prostate gland 3. Treatment for gastric ulcers 4. Diagnosis of diabetes mellitus 5. Prescribed a calcium channel blocker Correct Answer: 2,4,5 Rationale 1: Functional incontinence is associated with a history of dementia.

Reference: Page 455 Rationale 2: An enlarged prostate gland is associated with overflow incontinence.

Reference: Page 455 Rationale 3: Treatment for gastric ulcers is not associated with any type of urinary incontinence.

Reference: Page 455 Rationale 4: Diagnosis of diabetes mellitus is associated with overflow incontinence.

Reference: Page 455

Rationale 5: Calcium channel blockers are associated with overflow incontinence.

Reference: Page 455 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2. Differentiate among normal and disease-related changes in genitourinary and renal function in the older adult.

Question 18 Type: MCMA The nurse is planning care for an older patient with stress incontinence. Which interventions would be appropriate for the nurse to suggest to the patient?

Standard Text: Select all that apply.

1. Timed voiding 2. Kegel exercises 3. Bladder training 4. Restricting fluids 5. Increasing citrus juices Correct Answer: 1,2,3

Rationale 1: Timed voiding has been demonstrated to be effective for older women with stress incontinence.

Reference: Page 458 Rationale 2: Kegel exercises are another intervention that works well for stress incontinence.

Reference: Page 458 Rationale 3: Bladder training is similar to timed voiding, but the intervals between trips to the toilet are gradually lengthened, training the bladder to hold slightly increased amounts of urine.

Reference: Page 458 Rationale 4: Restricting fluids is not an effective method to improve stress incontinence.

Reference: Page 458 Rationale 5: Citrus juices are considered bladder irritants and can aggravate stress incontinence.

Reference: Page 458 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

Question 19 Type: MCSA The nurse is planning an inservice for a group of nursing assistants about urinary infections.

What information should be included in the presentation?

1. Men are most likely to experience descending urinary tract infections.

2. The rate of urinary tract infections is similar between men and women.

3. Men need a longer course of antibiotics to manage a urinary tract infection than women.

4. Catheterization is the only way to get a urine specimen to check for a urinary tract infection.

Correct Answer: 3 Rationale 1: Descending infections are less common than ascending infections of the urinary tract.

Reference: Page 454 and 455 Rationale 2: Women have a higher rate of urinary tract infection than men.

Reference: Page 454 and 455 Rationale 3: Men will usually be prescribed a longer course of therapy to manage a urinary tract infection. They have a longer urethra. When they are infected with an infection to the system, it is typically more complicated than in a woman.

Reference: Page 454 and 455 Rationale 4: A clean catch mid-stream is a reliable means to obtain a urine specimen to check for the presence of infection.

Reference: Page 454 and 455 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

Question 20 Type: MCSA An older patient tells the nurse about leaking urine when sneezing. To what does the nurse realize that is type of urinary incontinence is attributed?

1. Result of a system blockage 2. Result of bladder overstretching 3. Damage of the urinary apparatus 4. Increase in intra-abdominal pressure Correct Answer: 4 Rationale 1: A system blockage would result in urinary retention.

Reference: Page 455 Rationale 2: Bladder overstretching would not result in the incontinence being experienced by this patient.

Reference: Page 455 Rationale 3: There is inadequate information to determine the presence of urinary structural damage.

Reference: Page 455 Rationale 4: Incontinence is most often caused by an increase in intra-abdominal pressure combined with an inability to retain the urine in the bladder.

Reference: Page 455 Global Rationale:

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3. Identify the impact of changes in urinary function on the quality of life of older adults.

Question 21 Type: MCSA The results of an older patients urinalysis reveal bacteria in the urine. What action should the nurse perform next?

1. Notify the physician.

2. Order a repeat urinalysis to confirm the initial test.

3. Order a culture and sensitivity to identify the exact type of bacteria.

4. Review the nursing assessment for reports consistent with a urinary tract infection.

Correct Answer: 4 Rationale 1: Notification of the physician at this time is premature.

Reference: Page 454 Rationale 2: There is no indication that the initial urinalysis is not correct. A repeated test would not be cost effective.

Reference: Page 454

Rationale 3: Ordering a culture and sensitivity is not required at this time. The infection may not be treated if the patient is not bothered by symptoms.

Reference: Page 454 Rationale 4: Many elders with urinary tract infections may be asymptomatic. The nurse should review the data collected to determine if the patient has reported any supportive data.

Reference: Page 454 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3. Identify the impact of changes in urinary function on the quality of life of older adults.

Question 22 Type: MCSA The nurse is teaching bladder retraining to an older patient recovering from bladder surgery.

Which patient statement indicates understanding of the teaching provided?

1. I will gradually space my voiding times to longer periods.

2. I should force fluids to promote my bladder to hold more urine.

3. I should try to see how long I can hold my urine before voiding.

4. Research has not supported theories linking dietary intake to bladder irritation.

Correct Answer: 1

Rationale 1: Bladder training is an ongoing process in which the bladder is gradually trained to lengthen times between voiding.

Reference: Page 458 Rationale 2: Forcing fluids will result in a sudden overfilling of the bladder.

Reference: Page 458 Rationale 3: Holding urine for an extended time can result in bladder overfilling.

Reference: Page 458 Rationale 4: Some research has linked certain foods to bladder irritation, and so they should be avoided when possible.

Reference: Page 458 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

Question 23 Type: MCSA The nurse instructs an older patient with benign prostatic hyperplasia (BPH) on the pathophysiology of the health problem. Which patient statement indicates further teaching is needed?

1. There are nonsurgical treatment options available.

2. This condition may lead to cancer of the prostate.

3. As my condition progresses, I may need to consider surgical management.

4. Alpha blockers can be used to control my symptoms.

Correct Answer: 2 Rationale 1: There are nonsurgical treatment options for BPH. Reference: Page 460 Rationale 2: BPH is a benign condition and does not lead to cancer of the prostate.

Reference: Page 460 Rationale 3: BPH can be managed surgically.

Reference: Page 460 Rationale 4: Alpha blockers can be prescribed to help control the symptoms.

Reference: Page 460 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

Question 24 Type: MCSA

An older male patient diagnosed with prostate cancer is not prescribed any treatment. What does the nurse realize as the reason for this treatment approach?

1. The cancer is slow growing.

2. The patient will not survive treatment.

3. The patient has less than 10 years to live.

4. The cancer is growing quickly and no treatment will be helpful.

Correct Answer: 1 Rationale 1: Prostate cancer in older men is slow growing, and watchful waiting is a realistic option for older men.

Reference: Page 462 Rationale 2: Treatment for prostate cancer includes surgery, external beam radiation, and radioactive seeds implanted into the prostate. All have similar success rates. If the cancer is more advanced, external radiation or hormonal treatment may be recommended. The older patient should be offered a thorough discussion of all options with an urologist.

Reference: Page 462 Rationale 3: A time period of 10 years is used to decide if the older patient should have a prostate specific antigen level analyzed.

Reference: Page 462 Rationale 4: Treatment for prostate cancer includes surgery, external beam radiation, and radioactive seeds implanted into the prostate. All have similar success rates. If the cancer is more advanced, external radiation or hormonal treatment may be recommended. The older patient should be offered a thorough discussion of all options with an urologist.

Reference: Page 462 Global Rationale: Cognitive Level: Analyzing

Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6. Define appropriate nursing interventions for ameliorating the effect of genitourinary status on quality of life of older adults.

Question 25 Type: MCMA The nurse is planning a seminar on ways to ensure healthy genitourinary functioning when aging. What information should the nurse include in this presentation?

Standard Text: Select all that apply.

1. Drink plenty of water.

2. Expect to develop urinary incontinence.

3. Be aware of responses to new medications.

4. It is normal to continue to desire sexual activity.

5. Take steps to prevent sexual transmitted infections.

Correct Answer: 1,3,4,5 Rationale 1: Drinking plenty of water is one way to ensure healthy genitourinary functioning.

Reference: Pages 450-451 Rationale 2: Urinary incontinence is not normal, should not be expected, and should be evaluated by a healthcare provider.

Reference: Pages 450-451

Rationale 3: Be aware of responses to new medications because age-related changes in the kidney may lead to over- or under-dosing.

Reference: Pages 450-451 Rationale 4: It is normal to continue to desire sexual activity. It is also normal to have little interest in sex, particularly if that has been a long-term pattern.

Reference: Pages 450-451 Rationale 5: If going to engage in sexual activity, take appropriate precautions to prevent sexually transmitted infections.

Chapter 23 Mobility MULTIPLE CHOICE 1. The nurse explains that the slowed speed of nerve impulses will cause the older adult to: a. get a scrambled message in the brain. b. take longer to complete an activity. c. become confused. d. forget how to complete the activity.

ANS: B Slowed transmission causes the older adult to take more time to complete an activity because the message must travel from the source to the brain and then from the brain to the parts of the body involved in completing the activity.

DIF: Cognitive Level: Application REF: 303 OBJ: 2 TOP: Slowed Transmission KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse takes into consideration that the arthritic patient may be less likely to exercise because:

a. fragility of the bones puts the patient at risk for fractures. b. numbness in the feet and legs puts the patient at risk for a fall. c. stiffened ligaments and tendons put the patient at risk for reduced flexibility. d. moving heavy edematous limbs puts the patient at risk for fatigue.

ANS: C Arthritis limits joint movement; in turn, this reduces tendon and ligament flexibility, making them stiff and limiting mobility.

DIF: Cognitive Level: Analysis REF: 303 OBJ: 5 TOP: Arthritis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The home health nurse recognizes that the 75-year-old male patient has made an adjustment to reduced stamina when he: a. moved his home office to a downstairs location. b. used public transportation rather than driving his own car. c. tilled the garden plot with a motor-driven tiller. d. went to a senior center twice in 1 week to play dominoes.

ANS: A Moving the office to avoid climbing stairs is related to reduced stamina.

DIF: Cognitive Level: Application REF: 303 OBJ: 2 TOP: Stamina KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse explains that the focus of aerobic exercises such as walking and biking is to: a. improve cardiovascular function. b. build muscle mass.

c. improve dexterity. d. enhance balance.

ANS: A Aerobic exercises such as walking and biking are focused on improving cardiovascular function.

DIF: Cognitive Level: Application REF: 304 OBJ: 2 TOP: Aerobic Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 5. The nurse suggests to the 70-year-old woman who has painful arthritic joints that a beneficial exercise for her because of disability would be: a. training with hand weights. b. walking on a treadmill. c. low-impact aerobics. d. swimming.

ANS: D Swimming is a pleasurable aerobic exercise for many seniors, and water exercises can help individuals with sore joints because the water provides support and eases movement.

DIF: Cognitive Level: Application REF: 304 OBJ: 2 TOP: Exercise for Arthritics KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. When the older adult confides to the home health nurse that he wants to build muscle mass so that he can look good at the apartment pool, the nurse recommends _____ exercise. a. aerobic b. stretching c. resistance

d. tai chi ANS: C Resistance exercises using weights, elastic bands, and exercise balls can build muscle mass.

DIF: Cognitive Level: Application REF: 304 OBJ: 2 TOP: Resistance Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 7. When the 65-year-old patient who is a type 1 diabetic informs the home health nurse that he now exercises for 1 hour a day at a club, the nurse cautions him to be sure to: a. drink plenty of fluids. b. wear clothing that allows ventilation. c. take hard candy to the gym when he exercises. d. give himself less insulin than is prescribed.

ANS: C Exercise lowers the blood sugar level. A type 1 diabetic could become hypoglycemic and need a ready source of glucose, such as in hard candy.

DIF: Cognitive Level: Analysis REF: 304 OBJ: 3 TOP: Diabetic Patients KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. The nurse directs an 80-year-old recovering from a fractured pelvis to participate in several isometric exercises to maintain muscle strength, such as: a. alternately tightening and relaxing the abdominal muscles. b. lifting the body up off the bed using an overhead trapeze. c. pushing against the bed to lift the buttocks off the bed a few inches. d. pressing the sole of the foot against a footboard.

ANS: A Alternately tightening and relaxing muscles maintains strength in muscles, such as the abdominals, gluteal muscles, and quadriceps. Other options are isotonic exercises that involve joint movement.

DIF: Cognitive Level: Application REF: 307 OBJ: 5 TOP: Isometric Exercises KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 9. Because isometric and isotonic exercises can cause the patient to perform an accidental Valsalva maneuver, the nurse coaches the patient to: a. hold the breath during an exercise cycle. b. breathe through the mouth. c. breathe deeply and rhythmically during an exercise cycle. d. breathe in through the nose and out through the mouth.

ANS: B Breathing through the mouth makes it impossible to hold the breath, and bearing down cannot be performed. The Valsalva maneuver increases blood pressure and may cause cardiac overload.

DIF: Cognitive Level: Application REF: 307 OBJ: 5 TOP: Valsalva Maneuver KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 10. Balance training will help the older adult recovering from a prolonged period of immobility related to a broken hip to: a. increase peripheral circulation. b. increase strength. c. decrease the incidence of falls. d. eliminate the need for ambulatory assistive devices.

ANS: C Balance training has been shown to decrease the incidence of falls by 17%.

DIF: Cognitive Level: Application REF: 304 OBJ: 5 TOP: Balance Exercises KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 11. The fiercely independent 90-year-old woman who is recovering from a stroke frequently ambulates without the use of her walker because she says it is ugly and cumbersome. The nurses most effective intervention would be to: a. allow her to ambulate independently. b. place a gait belt around her and ambulate when she does. c. bring her walker to her and remind her that the walker is for her safety. d. instruct her to use a wheelchair for mobility.

ANS: C Bringing a device and reminding the patient of its purpose is an effective way to protect the patient and re-educate her about assistive devices. Use of a gait belt to assist her with every ambulation or allowing her to ambulate without an assistive device is not practical. Use of a wheelchair diminishes her mobility.

DIF: Cognitive Level: Analysis REF: 310 OBJ: 7 TOP: Rejection of Assistive Devices KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 12. The nurse cancels the outing to the park for a group of older adults in a long-term care facility on a(n): a. 75-degree sunny day in Texas. b. 70-degree cloudy day in Oregon.

c. 80-degree sunny day in Florida. d. 75-degree ozone alert day in California.

ANS: D Ozone alerts are given to warn of excessive air pollution and to limit exposure to the outside environment.

DIF: Cognitive Level: Analysis REF: 312 OBJ: 5 TOP: Environmental Concerns Affecting Mobility KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 13. The care plan that is custodial in its focus is characterized by: a. attention to high-level wellness. b. plans for physiologic and safety concerns. c. aggressive rehabilitation goals. d. patient participation in his or her own care.

ANS: B Low expectations and little focus for improvement, a rather negative outlook, represent the character of the custodial care plan. The goals will be those of physiologic care and safety.

DIF: Cognitive Level: Comprehension REF: 325 OBJ: 8 TOP: Custodial Focus KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 14. The older woman who has diminished dexterity would find the activity of _____ the most frustrating and difficult. a. working a crossword puzzle

b. playing a round of golf c. playing the piano d. painting with watercolors ANS: D Fine motor skills are lost, which make painting with watercolors very difficult for a person with diminished dexterity.

DIF: Cognitive Level: Analysis REF: 303 OBJ: 5 TOP: Loss of Dexterity KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. The home health nurse instructs the 75-year-old woman that daily exercise of a minimum of ____ minutes daily is as beneficial as a longer period of extreme exercise on an irregular basis. a. 15 b. 20 c. 30 d. 45 ANS: C Moderate exercise for a period of 30 minutes daily is enough to keep joints mobile and maintain strength.

DIF: Cognitive Level: Comprehension REF: 304 OBJ: 2 TOP: Regular Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease MULTIPLE RESPONSE 1. The home health nurse points out the benefits of regular exercise, which include __________.

(Select all that apply.)

a. maintenance of joint mobility b. enhancement of muscle tone c. promotion of sense of general well-being d. guarantee of weight loss e. promotion of regular elimination ANS: A, B, C, E Regular exercise does not guarantee weight loss. All other listed options are benefits of regular exercise.

DIF: Cognitive Level: Knowledge REF: 303 OBJ: 1 TOP: Benefits of Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse takes into consideration that the lessened stamina of the older adult is related to an altered oxygen exchange resulting from __________. (Select all that apply.) a. flattened diaphragm b. loss of elasticity in the lung c. nutritional deficiencies d. decrease in size of chest cavity e. fragility of capillaries ANS: A, B, C, D Fragility of capillaries does not interfere with gas exchange.

DIF: Cognitive Level: Comprehension REF: 303 OBJ: 5 TOP: Reduction of Air Exchange KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse lists factors that the patient should consider when planning an exercise program, which are __________. (Select all that apply.)

a. purchasing weights b. wearing clothing appropriate to the type of exercise c. considering membership in a health club d. establishing realistic goals e. committing time for consistent regular exercise ANS: B, C, D, E The purchase of weights is not necessary for all exercise programs. All other options listed promote the success of the exercise program.

DIF: Cognitive Level: Comprehension REF: 304 OBJ: 2 TOP: Planning an Exercise Program KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 4. The overall goals in caring for a patient with impaired physical mobility are __________.

(Select all that apply.) a. increasing the patients participation in physical activities b. preserving the patients anatomical position and function of joints c. increasing the patients former level of mobility d. avoiding unnecessary restraints e. using assistive devices to maintain mobility ANS: A, B, D, E Increasing the former level of mobility is unrealistic. All other options are goals that are appropriate for improving physical mobility.

DIF: Cognitive Level: Comprehension REF: 306 OBJ: 5 TOP: Impaired Physical Mobility KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5. When planning an exercise program for a person with activity intolerance, the nurse would consider __________. (Select all that apply.) a. identification of factors that contribute to activity intolerance b. arranging activities that progress from mild to more demanding c. rapid pacing activities to build up stamina d. individualizing the plan to include activities that the patient particularly likes e. including the patient in the planning phase ANS: A, B, D, E Rapid pacing of activities will only result in continued activity intolerance. Pacing should be slowly increased to build stamina.

DIF: Cognitive Level: Comprehension REF: 312-314 OBJ: 6 TOP: Activity Intolerance KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. The long-term goals for rehabilitation are __________. (Select all that apply.) a. prevention of further disability b. modifying the impact of the disability on lifestyle c. supporting adaptation to a changed lifestyle d. focusing on a complete return to the former level of activity e. reestablishing the patients control of her or his life ANS: A, B, C, E Rehabilitation is focused on attaining the best possible recovery with adjustment to a change in lifestyle.

DIF: Cognitive Level: Comprehension REF: 325 OBJ: 10 TOP: Rehabilitation Goals KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

7. The rehabilitation nurse demonstrates a positive attitude toward care planning by __________.

(Select all that apply.) a. acknowledging the impact of a traumatic amputation on therapy b. encouraging the residents input on the care plan c. inviting the resident and family member to attend the care plan meetings d. making a list of questions for the resident to ask at the care plan meeting e. helping the resident to perform all activities of daily living (ADLs) ANS: A, B, C Making a list of questions for the resident and performing all the ADLs does not promote a positive attitude or allow the patient to pose his or her own questions.

DIF: Cognitive Level: Comprehension REF: 325 OBJ: 9 TOP: Attitude Toward Care Planning KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 8. The nurse knows the goals of rehabilitative nursing include helping the patient to __________.

(Select all that apply.) a. minimize the impact of disability b. return to maximum level of function c. increase level of independence d. adjust to change in lifestyle e. increase control of their life ANS: A, C, D, E The goals of rehabilitative nursing do not include the return to maximum level of function, but to the most optimal level obtainable.

Chapter 24 Neurologic Function MULTIPLE CHOICE

1. An older adult patient reports burning and itching eyes. On assessment, the nurse notes swelling of the eyelid margins bilaterally. What additional data are necessary to confirm the nurses suspicion of blepharitis? a. The patient reports visual disturbances such as rainbow halos. b. The eyelids are reddened from seborrhea. c. The patient is being treated with anticoagulants. d. Small corneal hemorrhages are present.

ANS: B Blepharitis is a chronic inflammation of the eyelid margins that is commonly found in older adults. It can be caused by seborrheic dermatitis or infection. The symptoms include red, swollen eyelids, matting and crusting along the base of the eyelash at the margins, small ulcerations along the lid margins, and complaints of irritation, itching, burning, tearing, and photophobia.

DIF: Remembering (Knowledge) REF: Page 642 OBJ: 29-10 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 2. The morning of her scheduled cataract extraction and intraocular lens placement of the right eye, an older adult patient expresses concern that she will not remember her instructions for home care. Which statement is the best response to the patients concern? a. Is your family going to be here while youre in surgery? b. Are you anxious about the surgery? c. Ill reinforce the important points. d. We will provide you with written instructions.

ANS: D Postoperative care requires teaching the patient and family home care procedures for the period after cataract surgery and should be given orally as well in written form. The patient may or may

not have family present. Asking about anxiety could be important, but yes/no questions are not therapeutic. The nurses idea of what are the important points may differ from the patients.

DIF: Understanding (Comprehension) REF: Page 655 OBJ: 29-2 TOP: Teaching-Learning MSC: Physiologic Integrity 3. Your 88-year-old patient is hospitalized for a retinal detachment. He is on bed rest, and both eyes are covered with patches. Which nursing diagnosis takes priority at this time? a. Self-esteem disturbance related to decreased independence b. High risk for altered thought processes related to visual impairment c. High risk for injury related to altered sensory perception d. Impaired social interaction related to visual deficit ANS: C If the eyes are patched, safety precautions, such as keeping call lights, side rails, and necessary items within reach, must be instituted. Finally, assistance must be provided with activities of daily living (ADLs) and walking as needed to promote comfort and safety. The other diagnoses may be appropriate for selected patients.

DIF: Applying (Application) REF: N/A OBJ: 29-2 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 4. A 66-year-old patient has been diagnosed with type 2 diabetes mellitus and related vision loss.

Which statement demonstrates the ability to manage her condition? a. I schedule my yearly eye examination for the week of my birthday. b. When I notice haloes around lights, Ill know Im developing a problem with retinopathy. c. My sister had diabetic retinopathy, and the vessels in her eyes were scarred. d. I understand that the eye problems need to be diagnosed with an ophthalmoscopic exam.

ANS: A Patients with diabetes should have a yearly examination by an ophthalmologist. Scheduling the exam for the week of her birthday will keep the patient from forgetting to do so. The other statements are not related to management.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 29-3 TOP: Nursing Process: Evaluation MSC: Health Promotion 5. A 77-year-old patient who is quiet and withdrawn may have a hearing deficit related to impacted cerumen. During the nursing assessment, the nurse confirms supporting evidence of the condition when noting: a. frothy drainage from the patients ears. b. patient reports of dizziness. c. patient reports of a feeling of fullness in the ears. d. gray, metallic-appearing tympanic membrane.

ANS: C Patients with cerumen buildup may complain of ear fullness, itching, and difficulty hearing. The patient will not have frothy drainage, dizziness, or metallic-appearing tympanic membrane from cerumen.

DIF: Remembering (Knowledge) REF: Page 650 OBJ: 29-10 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 6. An older adult patient reports ringing in the ears. What additional data should the nurse gather to help determine the cause of the patients problem? a. History of ear surgery b. Use of prescription medications c. Exercise and sleep patterns

d. Nutritional status, especially protein intake ANS: B Tinnitus can be a result of damage to inner structures caused by the toxic effect of certain drugs.

The other assessment findings are not as important for this problem.

DIF: Applying (Application) REF: N/A OBJ: 29-10 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 7. An older patient with presbycusis has been advised to purchase a hearing aid and asks about its function and use. Which information is most accurate to give the patient about the function of hearing aids? a. Hearing aids amplify sound but do not improve the ability to hear. b. Hearing aids improve the ability to hear by intensifying the duration of sound waves. c. Hearing aids control the input of sound waves to eliminate extraneous noise. d. Hearing aids intensify sound waves and improve the ability to hear.

ANS: A Hearing aids amplify sound but do not improve the ability to hear. The other statements are not accurate regarding hearing aids.

DIF: Understanding (Comprehension) REF: Page 654 OBJ: 29-11 TOP: Teaching-Learning MSC: Physiologic Integrity 8. An older adults chart documents that she has been diagnosed with macular dysequilibrium.

Based on an understanding of this condition and the resulting vertigo, the nurse suggests that the patient: a. turn her head very slowly when looking from right to left. b. dangle her legs at the bedside before getting out of bed.

c. use the wall for stabilization when ambulating in the hallway. d. be careful to be seated when flexing or hyperextending her neck.

ANS: B Macular disequilibrium is vertigo precipitated by a change of head position in relation to the direction of gravitational force (e.g., severe dizziness when rising from bed). Dangling at the bedside and changing positions slowly will decrease the chance of injury. The other interventions do not relate to this disorder.

DIF: Understanding (Comprehension) REF: Page 655 OBJ: 29-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment 9. A 96-year-old patient reports symptoms of xerostomia. The nurse attempts to minimize the effects of the condition by: a. providing appropriate fluids with the patients meals. b. cutting the patients meat into small bite-sized pieces. c. elevating the head of the patients bed at mealtimes. d. assisting the patient with oral care before each meal.

ANS: A Xerostomia, commonly referred to as dry mouth, is a subjective sensation of abnormal oral dryness. Reduced salivary flow is a common complaint of older adults. Dry mouth in the older adult can lead to an increased risk of serious respiratory infection, impaired nutritional status, and reduced ability to communicate. Offering appropriate fluids with meals will assist with proper nutrition. The other options will not provide relief for this condition.

DIF: Applying (Application) REF: N/A OBJ: 29-8 TOP: Nursing Process: Implementation MSC: Physiologic Integrity

10. The preferred way for the nurse to communicate with a 72-year-old hearing-impaired patient is to: a. speak loudly into the patients unaffected ear. b. exaggerate the form of each word. c. provide all communication in written form. d. speak clearly and directly, facing the person.

ANS: D Interventions for the patient with a hearing impairment focus on aural rehabilitation and facilitation of communication. Patients should be spoken to using a clear voice and face to face, which gives the patient an unobstructed view of the speakers face and lips. The other techniques are not as helpful.

DIF: Remembering (Knowledge) REF: Page 653 OBJ: 29-11 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 11. A patient in a nursing home is confused, nonverbal, but pleasant. The nurse notes the patient has suddenly become agitated and is screaming and scratching at the eyes. While the nurse is examining the patient, the patient vomits. What action by the nurse is best? a. Consult the provider about an ophthalmologic exam. b. Sedate the patient so she wont injure herself. c. Place mitts on the patients hands to avoid scratches. d. Give the patient a prn medication for pain.

ANS: A The patient could be having an episode of acute angle closure glaucoma, manifested by severe pain, nausea and vomiting, and visual disturbances. Because the patient is nonverbal, the nurse must assess for pain with behavioral changes. The nurse should contact the provider about obtaining an ophthalmologic exam to determine if the patient has glaucoma. The other

interventions will not help determine the cause of the problem. The nurse should attempt to discover the source of the behavior, not just try to control it.

DIF: Analyzing (Analysis) REF: N/A OBJ: 29-2 TOP: Communication and Documentation MSC: Physiologic Integrity 12. A patient has been admitted to the postanesthesia care unit after a trabeculectomy. What assessment takes priority? a. Airway b. Pain c. Eye patch d. Blood pressure ANS: A Airway always comes first when prioritizing care.

DIF: Applying (Application) REF: N/A OBJ: 29-2 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 13. A patient had cataract surgery without a lens implant. What teaching point is most important? a. Keep your follow-up appointment with the surgeon. b. Instill your eyedrops just like we have practiced. c. Do not drive and be careful going up or down stairs. d. Take acetaminophen (Tylenol) for pain.

ANS: C If cataract surgery was performed without a lens implant, the patient will wear glasses or contact lenses but will have a decrease in depth perception. The patient should not drive and should use

extra caution negotiating stairs. The other instructions are appropriate for any patient having cataract surgery.

DIF: Applying (Application) REF: N/A OBJ: 29-2 TOP: Teaching-Learning MSC: Safe Effective Care Environment 14. A patient has Mnire disease. What statement by the patient indicates a good ability to manage the condition? a. Because its from dehydration, I can increase salt in my food. b. There are no medications, so I just have to learn to live with it. c. If I get dizzy I should lie down immediately and hold my head still. d. Because I have asthma, I cannot take any medications for Mnire disease.

ANS: C If the patient gets dizzy, he or she should lie down and hold the head still. A low-salt diet may help with fluid retention in the ear. There are several medications for Menire disease, but because of the anticholinergic properties of some of them, people with asthma, glaucoma, or BPH should be monitored closely.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 29-7 TOP: Nursing Process: Evaluation MSC: Health Promotion 15. A patient had a chemical splash into the eye at work. What action by the occupational health nurse takes priority? a. Begin flushing the patients eye with cool water. b. Call emergency medical services. c. Ask about the patients tetanus status. d. Tape the eye closed to prevent injury.

ANS: A

The nurse should begin flushing the eye immediately. While the eye is being irrigated, the nurse can call 9-1-1 and inquire about the patients last tetanus shot. The eye should not be taped shut.

DIF: Applying (Application) REF: N/A OBJ: 29-8 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 16. A patient with glaucoma is on timolol (Timoptic). The patient also takes metoprolol (Toprol) for hypertension. The patient reports to the clinic nurse that the eyedrops Make me dizzy. What assessment by the nurse is most appropriate? a. Assess the patients eyedrop instillation technique. b. Determine how long the patient has been on the drops. c. Assess the patients gait and balance while walking. d. Ask the patient if breakfast is eaten prior to applying the eyedrops.

ANS: A The patient should be using punctal occlusion (closing the lacrimal duct) when instilling these eyedrops to avoid a cumulative, systemic effect from the combination of both beta-blockers. The nurse can assess the other factors as well, but this is the most likely cause of the dizziness.

DIF: Analyzing (Analysis) REF: N/A OBJ: 29-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE 1. When assessing the patients vision, the nurse should understand that older adults may report common aging changes, including which of the following? (Select all that apply.) a. My eyelids droop so unattractively. b. The whites on my eyes seem a bit yellow. c. The vision in my right eye seems blurry. d. Ive started to use over-the-counter eye moisturizing drops.

e. I have noticed the night driving has become more difficult.

ANS: A, B, D, E The eyelids lose tone and become lax, which may result in ptosis of the eyelids, redundancy of the skin of the eyelids, and malposition of the eyelids. The conjunctiva thins and yellows in appearance. In addition, this membrane may become dry because of the diminished quantity and quality of tear production. Peripheral vision decreases, night vision diminishes, and sensitivity to glare increases.

DIF: Analysis (Analyze) REF: N/A TOP: Nursing Process: Assessment| Neuromuscular MSC: Physiologic Integrity 2. An older adult diagnosed with Mnire disease is prescribed meclizine (Antivert) and hydrochlorothiazide (HCTZ). The nurses educational instructions include which of the following? (Select all that apply.) a. The need to avoid alcoholic beverages b. Instructions to take the medication with food c. Symptoms of electrolyte imbalances d. That drowsiness is a common side effect e. Stopping the medication if chest pain occurs ANS: A, C, D Meclizine may cause drowsiness; patients should be instructed to avoid alcoholic beverages while taking this drug. A patient on a diuretic such as hydrochlorothiazide (HCTZ) needs to be monitored for evidence of fluid or electrolyte imbalances.

DIF: Application (Apply) REF: N/A TOP: Nursing Process: Implementation| Drug-Related Responses MSC: Safe and Effective Care Environment

3. Which of the following are appropriate steps to take when removing cerumen from an older persons ear? (Select all that apply.) a. Instill a softening agent first. b. Use hot water and hydrogen peroxide. c. Use a Waterpik inserted just inside the meatus. d. Have the patient lean backward. e. Drain water by having the patient lean forward toward the affected side.

ANS: A, C, E The nurse instills a softening agent and uses warm (not hot) water mixed with hydrogen peroxide or saline to irrigate the ear. A Waterpik or other irrigating equipment is used and is inserted just inside the meatus so the tip is still visible. Tip the patients head toward the side being irrigated.

When draining, the patient can lean forward and toward the affected side.

DIF: Remembering (Knowledge) REF: Page 650-1 OBJ: 29-6 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 4. A nurse is assessing a patient who reports moderate tinnitus. The nurse should assess the patient for which of the following? (Select all that apply.) a. Use of ibuprofen (Motrin) b. History of excessive cerumen c. Drinking carbonated beverages d. History of frequent headaches e. Presence of hypertension ANS: A, B, D, E Beverages with caffeine are assessed; the patient may be drinking decaffeinated cola products.

The other assessments are appropriate.

Chapter 25 Vision and Hearing MULTIPLE CHOICE 1. Which of the following diseases affects the eyesight of an older adult by damaging the central part of the retina? a. Glaucoma b.Presbyopia c. Cataract d.Macular degeneration ANS: D Macular degeneration is a disease characterized by damage to the central part of the retina that leaves the outer edges of the visual field intact. Presbyopia, a gradual decline in the flexibility of the lens, makes close-up focusing more difficult and is a common age-related change but not a disease. Glaucoma, a disease marked by increased pressure within the eye that potentially leads to optic nerve damage, is the most common cause of blindness in those 65 years of age and older.

A cataract is a disease marked by clouding and blurring of the lens.

PTS:1DIF:RememberREF:7-8 TOP: Nursing Process: Assessment MSC: Physiological Integrity 2. Which of the following is used to treat the most common cause of impairment to an older persons hearing? a. Hearing aids b.Cochlear implants c. Ear canal irrigation d.Sign language ANS: C Irrigation is used to dissolve and remove impacted cerumen, the most common cause of impaired hearing in older adults. Hearing aids are useful for sensorineural hearing loss, but the most common cause impairing the hearing of older persons is cerumen impaction. Cochlear implants

are useful for profound sensorineural deafness, but the most common cause impairing the hearing of older persons is cerumen impaction. Sign language has been used primarily by those who become deaf in childhood or at birth, but it is not considered a treatment.

PTS: 1 DIF: Understand REF: 12 TOP: Nursing Process: Planning MSC: Physiological Integrity 3. A medical illustration shows a man with the blunt end of a tuning fork pressed to the center of his forehead. The man is being tested for which of the following? a. Sensorineural hearing loss b.Presbycusis c. Tinnitus d.Unilateral conductive hearing loss ANS: D Webers test, in which a vibrating tuning fork is placed on the center of the forehead, detects the differences in hearing between one ear and the other caused by poor sound conduction. During testing, the patient is asked to describe the sensation felt when the tuning fork is activated and then placed on the forehead. If the patients hearing by conduction is intact, then he or she will feel vibrations conducted through the bones of the skull from the tuning fork. Webers test with the tuning fork is used to detect conductive hearing loss.

Presbycusis affects both ears and has a sensorineural origin. The tuning fork test is used to detect conductive hearing loss in one ear. Tinnitus is a hearing sensation not caused by an actual sound.

The tuning fork test is used to detect hearing loss caused by poor sound conduction.

PTS:1DIF:RememberREF:11-13 TOP: Nursing Process: Assessment MSC: Physiological Integrity 4. Persons with normal age-related sensory changes are likely to have the most difficulty distinguishing which of the following? a. Spoken pairs of phrases like shes praised and fees raised b.Orange towel hanging on a beige wall

c. Go and to in lowercase letters in fine print d.Spoken word pairs like cupful and capful ANS: A A person with presbycusis has trouble hearing the higher frequencies, where most of the differences between consonant sounds occur. The contrast between a vivid color such as orange and a pale color such as beige can help an older person distinguish objects. The details of the letters may be poorly focused, but their overall shape, relative to the line around them, helps distinguish them. Age-related hearing impairments affect the hearing of consonants more than vowels. A person would have more trouble distinguishing cupful and couple.

PTS:1DIF:UnderstandREF:11 TOP: Nursing Process: Assessment MSC: Physiological Integrity 5. Which of the following interventions should the nurse use when communicating with a hearing impaired older patient. a. Stand beside the patients chair when speaking. b.Always clearly identify yourself and others with you. c. Exaggerate your voice, depending on the cause of the hearing loss. d.Select colors for paint, furniture, and pictures with rich intensity.

ANS: B Always speak promptly, and clearly identify yourself and others who are with you. State when you are leaving to ensure that the person is aware of your departure. Get down to the persons level, and face him or her when speaking. Speak normally but not from a distance; do not raise or lower your voice, and continue to use gestures if doing so is natural to your communication.

Selecting colors for paint, furniture, and pictures with rich intensity is for the visually impaired, not those with a hearing impairment.

PTS: 1 DIF: Apply REF: 22 Box 16-1 TOP: Nursing Process: Planning MSC: Physiological Integrity

6. The nurse plans the care of an older female resident of a nursing home who has experienced a sudden deterioration in visual acuity. Which intervention should the nurse complete first? a. Prevent behavioral and social decline. b.Tell her to hold onto the rails during ambulation. c. Examine her mood and functional status. d.Use problem solving involving the resident.

ANS: C The most important intervention for the nurse to complete first is to assess the impact of the visual impairment on the residents quality of life, mood, and functional ability. The resulting assessment data will provide the basis for solving new problems caused by the loss of vision and finding compensatory mechanisms for the resident. Preventing decline can be a goal in the overall plan of care for this resident, but that cannot be determined until the assessment is complete. Telling her to hold onto rails during ambulation is a potential nursing intervention for patient teaching; however, in problem solving, a different compensatory solution can be developed, based on the assessment. Problem solving takes place after a complete assessment.

PTS:1DIF:AnalyzeREF:2-10| 22 Box 16-1 TOP: Nursing Process: Planning MSC: Physiological Integrity 7. The most detrimental illness or condition that an older adult with deafness that occurred at birth can experience is which one of the following? a. Aphasia b.Cataracts c. Glaucoma d.Osteoarthritis ANS: B Cataracts can have a potentially devastating impact on the life of an individual with prelingual deafness because sign language is the primary source for communication. Without the ability to read signing or lips accurately, the older adult who has a cloudy lens is unable to receive communication except by Braille. Aphasia has the potential to affect the individuals life; however, with adequate vision, some means of communication can remain viable. Glaucoma

would not devastate the individuals ability to read sign language unless blindness occurred.

Effective treatment should help maintain the individuals baseline visual acuity. Osteoarthritis can make signing more difficult for an individual with prelingual deafness, but it is not nearly as devastating to the ability to communicate as a cloudy lens from cataracts.

PTS:1DIF:AnalyzeREF:2-16 TOP: Nursing Process: Assessment MSC: Physiological Integrity 8. An older man who has tinnitus complains to the nurse that it is very annoying. Which should the nurse implement to alleviate the stress he is experiencing from tinnitus? a. Irrigate the bilateral Eustachian tubes. b.Assess for modifiable risk factors. c. Propose a hearing aid and a masker. d.Use white noise to override the tinnitus.

ANS: B The nurse assesses the patient for risk factors potentially contributing to tinnitus that can be altered such as smoking cigarettes, consuming caffeine, drinking alcohol, experiencing fatigue, and taking medications that carry a high risk of causing tinnitus. Removing these potential offenders can help give the patient a sense of control, as well as provide potential relief from tinnitus. The nurse irrigates the external auditory canal for impacted cerumen to decrease the risk of tinnitus.. Although a hearing aid and a masker have the potential to alleviate tinnitus, introducing them can also serve as a potential source of additional stress, depending on the financial and functional status of the individual. Although white noise has the potential to alleviate tinnitus, it can be ineffective or serve as a potential source of additional stress.

PTS: 1 DIF: Apply REF: 12-14 TOP: Nursing Process: Planning MSC: Psychosocial Integrity 9. An older adult complains about experiencing dry eyes daily. Which of the following should the nurse assess to help determine the cause of the patients complaint? a. Vitamin B deficiency b.Use of humidifier at home

c. History of diabetes mellitus d.Prescription antihistamine use ANS: D Medications can cause dry eye, especially antihistamines, diuretic agents, beta-blockers, and some sleeping pills. Vitamin A deficiency is a risk factor, not Vitamin B deficiency. The use of a humidifier should help with dry eyes, not cause it. Diabetes mellitus is an endocrine disorder, and dry eyes are an exocrine disorder.

PTS:1DIF:AnalyzeREF:8-9 TOP: Nursing Process: Assessment MSC: Physiological Integrity 10. The nurse is teaching older adults about maintaining health and wellness. Which recommendation should the nurse include in the teaching to maintain optimal vision? a. Take 50,000 units of vitamin A daily. b.Wear sunglasses that block sun rays. c. Read in good light to avoid eye strain. d.Visit the ophthalmologist every 5 years.

ANS: B The nurse helps older adults preserve their vision by recommending sunglasses that block harmful ultraviolet rays. Although vitamin A intake is encouraged to promote visual health and to relieve dry eyes, 50,000 units is a huge dose with the potential to cause liver damage; this dose is used to treat acne but only for limited periods. Reading in good light is usually easier for older adults; however, reading in poor light does not cause eye damage. An ophthalmologist should check the vision of an older adult every year.

PTS: 1 DIF: Apply REF: 10 TOP: Teaching/Learning MSC:Health Promotion and Maintenance MULTIPLE RESPONSE

1. The children of an older man believe he is too old to drive a car. Which assessment information about the man warrants further investigation by the nurse to determine his fitness to drive a car safely? (Select all that apply.) a. Increased rate of tripping on curbs b.Increased frequency of getting lost c. Multiple bruises on lower extremities d.Restricts reading to a well-lit sunroom e. Socializes with a partners bridge group f. Cooks gourmet meals for entertainment ANS: A, B, C, D Tripping on curbs can potentially indicate a vision impairment, but it can also be caused by other problems. Getting lost frequently can potentially indicate a vision impairment, but it can also be caused by other problems. Bruising from bumping into objects can potentially indicate a vision impairment, but it can also be caused by other problems. Reading in a well-lit sunroom exclusively can potentially indicate vision impairment, especially if the patient requires additional lighting for reading. Socializing with a bridge group is likely to indicate adequate visual acuity for reading the cards and keeping score. Gourmet cooking is likely to indicate adequate visual acuity to measure and prepare food.

PTS:1DIF:ApplyREF:2-10| 22 Box 16-1 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment 2. Which population groups are most at risk for developing macular degeneration? (Select all that apply.) a. African American b.Asian American c. Caucasian d.Hispanic ANS: B, C Individuals who are Caucasian or Asian American are most at risk for developing macular degeneration than are African Americans or Hispanics.

PTS: 1 DIF: Understand REF: 7 TOP: Nursing Process: Planning MSC:Health Promotion and Maintenance 3. When preparing a patient teaching session on retinopathy, the nurse should include which intervention(s) when discussing treatments for slowing the progression of the disease? (Select all that apply.) a. Glucose control b.Blood pressure control c. Laser therapy d.Cornea transplant ANS: A, B, C Better control of glucose, blood pressure, and cholesterol can assist in halting the progression of retinopathy. Laser therapy is also a treatment. Cornea transplant is not an option.

PTS: 1 DIF: Understand REF: 7-8 TOP: Nursing Process: Planning MSC:Health Promotion and Maintenance 4. The nurse recognized which of the following as symptoms of wet age-related macular degeneration (AMD)? (Select all that apply.) a. Rarely causes severe visual impairment b.Yellow deposits under the retina c. Decrease in central vision d.Visual distortion ANS: C, D Patients suffering from wet AMD experience a decrease in central vision and visual distortion.

Wet AMD leads to blindness. With distortion, edges or lines become wavy. Dry AMD rarely causes severe visual impairment, and yellow deposits under retina are a classic sign.

PTS:1DIF:UnderstandREF:7-8 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

OTHER 1. On the following illustration, mark the area of the eye where glaucoma causes fluid to accumulate.

ANS: The X marks the area of the eye where glaucoma causes fluid to accumulate. Acute angle-closure and open-angle glaucoma are caused when the balance between intraocular fluid production and drainage is disrupted, resulting in increased intraocular pressure.

Chapter 26 Endocrine Function MULTIPLE CHOICE 1. The nurse caring for an older adult with type 2 diabetes mellitus places importance on assessing the patient for: a. painful nodules on the fingers and toes. b. reddened rash and brittle nails on the hands. c. heartburn and flatus after meals. d. skin temperature and hair growth pattern on the legs.

ANS: D Insulin resistance causes increased production of inflammatory cytokines correlating with the development of type 2 diabetes mellitus and atherosclerotic vascular disease, therefore skin temperature and hair growth pattern on the legs should be assessed.

DIF: Remembering (Knowledge) REF: Page 458 OBJ: 23-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 2. The nurse recognizes that an older adult on both antihypertensive and antidepressant drug therapies has a specific need for:

a. regular blood pressure monitoring. b. an effective history focusing on sexual function. c. an increase in daily fluid intake. d. frequent assessment of emotional stability.

ANS: B Drugs such as oral contraceptives, hormone replacement, antihypertensives, antidepressants, or sedatives can cause a sexual arousal disorder as a side effect. In women this can manifest as female sexual dysfunction (FSD), and in men it can manifest as erectile dysfunction (ED).

DIF: Remembering (Understanding) REF: Page 471-2 OBJ: 23-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 3. Aware that older adult patients often present with nonclassic symptoms of type 2 diabetes mellitus, the nurse is particularly suspicious of a patient reporting: a. bouts of diarrhea alternating with periods of constipation. b. recent problems reading and an infected sore on the toe that will not heal. c. periods of depression and severe indigestion after eating. d. dizziness when getting up too quickly and a red rash on the hands.

ANS: B Often a newly diagnosed older individual will describe symptoms of fatigue, blurred vision, weight change (gain or loss), and infections. The other symptoms are not related.

DIF: Remembering (Knowledge) REF: Page 460 OBJ: 23-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 4. The nurse observes signs that a patient being assessed may have an underactive thyroid. The data supporting this suspicion includes:

a. heat intolerance, low-grade fever, and patchy hair loss. b. polycythemia, tachycardia, and oral candidiasis. c. muscle cramps, fatigue, and cold intolerance. d. increased blood pressure, postural hypotension, and blurred vision.

ANS: C Older patients are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion, which are symptoms of hypothyroidism that are often attributed to old age. Heat intolerance is often associated with hyperthyroidism. The other options are not related to thyroid dysfunction.

DIF: Remembering (Knowledge) REF: Page 470 OBJ: 23-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 5. The nurse is preparing to provide an older, newly diagnosed diabetic patient with information regarding type 2 diabetes. The nurse initially: a. asks if the patient prefers a video or a pamphlet. b. invites the patients spouse to be present during the instruction. c. selects a quiet, well-lighted space for the class. d. ensures that the patient is pain-free and comfortably seated.

ANS: A Cognitive function and learning styles vary, so knowing the patients preferred learning style facilitates education. Some individuals prefer to learn by visual methods, others by listening, and still others by experiencing contact in a hands-on approach. Controlling pain and ensuring the patient is comfortable will also facilitate learning, but it is more important to meet the patients preferred learning style. The other options are helpful but not as vital.

DIF: Understanding (Comprehension) REF: Page 462 OBJ: 23-2 TOP: Teaching-Learning MSC: Health Promotion

6. Which documentation demonstrates that the nurse effectively assessed an older adult diabetic patients cardiac status? a. radial pulse: 88 and regular b. carotid pulses equal and strong c. BP 126/78 recumbent and 122/78 sitting d. nail beds pale in color ANS: C To assess circulation, the nurse should take an apical pulse, noting rate and rhythm; check pedal pulses bilaterally; and note the presence of hair on the lower extremities. The nurse should take blood pressure measurements with the patient in both recumbent and sitting positions, note any dizziness associated with a change of position, and assess the respiratory rate, depth, and chest sounds.

DIF: Understanding (Comprehension) REF: Page 462 OBJ: 23-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 7. The nurse teaching a 79-year-old with type 2 diabetes about the importance of regular exercise suggests that the patient: a. swim 10 laps in the community center pool three times a week. b. enroll in a daily lunch time aerobics class at the senior center. c. lift 5 pound weights in a routine of 10 repetitions in each arm. d. walk on the treadmill each morning for 30 minutes.

ANS: D Older adults may derive the greatest benefit from morning exercise because that is the time of greatest insulin resistance. However, any exercise is better than no exercise at all. Aerobic exercise should be balanced with weight training.

DIF: Remembering (Knowledge) REF: Page 465 OBJ: 23-2

TOP: Teaching-Learning MSC: Health Promotion 8. What assessment findings support an older patients diagnosis of hypothyroidism? a. A 2-cm wound noted on medial aspect of left foot b. An apical rate: 98/min c. A patient report that I always wear a sweater d. A weight loss of 10 pounds over 6 weeks ANS: C Older patients are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion. The other assessments are not related.

DIF: Remembering (Knowledge) REF: Page 470 OBJ: 23-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 9. Which assessment findings support the suspicion that an older patient has osteoporosis? a. The patients reports an allergy to dairy products. b. A lactase enzyme is a part of the patients drug regime. c. Bones in one of the patients lower legs are shorter than in the other. d. The patient is inch shorter than at his or her previous physical.

ANS: D Dorsal kyphosis, chronic back pain, and loss of height are common signs of primary osteoporosis in older persons. The other signs do not relate to this disorder.

DIF: Remembering (Knowledge) REF: Page 471-2 OBJ: 23-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 10. An older patient has been diagnosed with metabolic syndrome. What action by the nurse takes priority?

a. Educate the patient on medications. b. Teach lifestyle changes the patient can manage. c. Encourage 60 minutes of aerobic activity daily. d. Instruct the patient on a low-fat diet.

ANS: B Lifestyle changes are the mainstay of treatment for this disorder. Nurses have the primary responsibility for teaching. The patient should be included in planning so that lifestyle changes are reasonable and doable for the older patient. Activity and diet are part of the changes needed, but activity does not need to be so extensive and diet should not be the only topic taught.

Medications are not generally used.

DIF: Applying (Application) REF: N/A OBJ: 23-2 TOP: Teaching-Learning MSC: Health Promotion 11. A patient has type 2 diabetes. The family reports the patient has become very forgetful. What response by the nurse is best? a. We should assess her for Alzheimer disease. b. Forgetfulness is a common sign in diabetes. c. Have her blood sugars been under good control? d. Does she recognize you and know your names?

ANS: B Many diabetics report depression and memory problems, so the nurse explains this fact.

Forgetfulness does not necessarily indicate dementia. Asking about blood glucose is appropriate, but not related. Not recognizing family is not the same as forgetfulness.

DIF: Understanding (Comprehension) REF: Page 462 OBJ: 23-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

12. The family of a patient who has type 2 diabetes calls the clinic to report a very small sore on the patients foot. What action by the nurse is best? a. Have the patient come to the clinic today. b. Have the family wash and bandage it. c. Tell the patient to check for a fever. d. Have the patient go to the emergency room.

ANS: A Any ulcer or sore on a foot requires medical attention because on superficial inspection, the true degree of injury can be hidden. The patient should come to the clinic today. The family should not attempt to care for the wound and the patient does not need to take a temperature before coming in. The patient does not need to go to the emergency department at this time.

DIF: Applying (Application) REF: N/A OBJ: 23-2 TOP: Communication and Documentation MSC: Physiologic Integrity 13. A patient has been admitted with new atrial fibrillation. What additional diagnostic testing does the nurse anticipate? a. Thyroid hormones b. Platelet count c. Urinalysis d. Blood glucose ANS: A Hyperthyroidism is often seen with atrial fibrillation. Platelet count, urinalysis, and glucose are often done as part of admission, but they are not directly related to atrial fibrillation as is hyperthyroidism.

DIF: Remembering (Knowledge) REF: Page 468 OBJ: 23-2

TOP: Nursing Process: Assessment MSC: Physiologic Integrity 14. An older patient has osteoporosis and is reluctant to exercise because I already have a bone problem, so how will it help? What response by the nurse is best? a. It can improve posture, balance, and reduce falls. b. It will give you heart-healthy benefits. c. Exercise will make you feel younger. d. If you join a gym, you can socialize with new people.

ANS: A Exercise not only improves bone health but improves posture, balance, and reduces falls. The nurse should educate the patient on these benefits.

DIF: Understanding (Comprehension) REF: Page 471-2 OBJ: 23-2 TOP: Teaching-Learning MSC: Health Promotion 15. A nurse is preparing to administer metoprolol (Toprol) to an older male patient. What action by the nurse is best regarding endocrine disorders? a. Administer the medication as ordered. b. Check the patients ID using two sources. c. Say, Many men experience ED with this drug. d. Tell the patient to discuss the side effects with his provider.

ANS: C The nurse should instruct patients on side effects of medications. The nurse can assess if the patient wants to discuss this issue by opening the conversation with a normalizing statement, such as many men have ED on this drug. Is this something you would like to discuss? Although side effects do need to be brought up to the provider, the wording of this statement does not indicate a willingness of the nurse to engage in conversation. The other two options are correct but not related to endocrine dysfunction.

DIF: Applying (Application) REF: N/A OBJ: 23-2 TOP: Teaching-Learning MSC: Psychosocial Integrity 16. A type 2 diabetic patient is admitted to the hospital with a gastrointestinal illness and a blood glucose of 480 mg/dL. After stabilizing the patient, what action by the nurse is best? a. Educate the patient on safe food handling. b. Ask if the patient took the diabetic medication. c. Teach the patient ways to avoid dehydration d. Delegate frequent blood sugars to the aide.

ANS: B A frequent cause of hyperglycemia requiring hospitalization in diabetics is poor sick day management. The type 2 diabetic still makes insulin and so needs antihyperglycemic drugs even when ill. The nurse assesses the diabetics knowledge of sick day management. The other options are appropriate but not the priority. Better sick day management can possibly keep the patient from further, similar, hospitalizations.

DIF: Applying (Application) REF: N/A OBJ: 23-3 TOP: Nursing Process: Assessment MSC: Health Promotion 17. A nurse is reviewing possible first-line medications for a new, older type 2 diabetic. What contraindication does the nurse identify for metformin (Glucophage)? a. Patient drinks three to four alcoholic drinks/day b. Patients parents both took insulin c. Creatinine 0.9 mg/dL d. Potassium 3.8 mEq/dL ANS: A

Patients with hepatic or renal dysfunction should not take metformin. A patient who drinks as much as three to four alcoholic drinks a day has a real risk of liver disease. The use of insulin by the parents is not related. Both kidney lab values are normal.

DIF: Analyzing (Analysis) REF: N/A OBJ: 23-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE 1. The nurse is assessing an older patient with elevated plasma triglyceride levels. What other assessment finding leads the nurse to suspect metabolic syndrome? (Select all that apply.) a. Blood pressure of 148/90 mm Hg b. A fasting blood glucose of 109 mg/dL c. Reports of frequent urination d. Weight measurement of 50 inches e. HDL level of 52 mg/dL ANS: A, B, D, E The clinical criteria for metabolic syndrome includes increased waist circumference (population specific) plus any two of the following: (1) blood pressure greater than 129/84 mm Hg or taking hypertension medication, (2) plasma triglyceride levels over 149 mg/dL or taking triglyceride medication, (3) high-density lipid levels less than 40 mg/dL in men or less than 50 mg/dL in women or taking HDL-C medication, (4) fasting glucose greater than 99 mg/dL (including patients with diabetes).

DIF: Remembering (Knowledge) REF: Page 458 OBJ: 23-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 2. The nurse is teaching a newly diagnosed diabetic patient about metformin. What information does the nurse include? (Select all that apply.)

a. Alcohol intake should be limited and taken with food. b. Overweight patients sometimes poorly tolerate metformin. c. Oral hypoglycemic agents can increase the risk of hyperglycemia. d. Metformin has been the cause of anorexia in older patients. e. Oral hypoglycemic agents affect vitamin D absorption.

ANS: A, D Studies indicate that metformin, classified as a biguanide, may be the drug of choice for overweight patients. Side effects such as anorexia, nausea, and abdominal discomfort may, however, limit its use in older adults. Alcohol can decrease hypoglycemic awareness, so metformin should only be ingested with food. Alcohol use should also be limited.

DIF: Understanding (Comprehension) REF: Page 465 OBJ: 23-3 TOP: Teaching-Learning MSC: Physiologic Integrity 3. What assessment findings support a diagnosis of hyperthyroidism in the older adult? (Select all that apply.) a. Tremors b. Heat intolerance c. Tachycardia d. Palpable goiter e. Atrial fibrillation ANS: A, D, E The classic geriatric presentation of hyperthyroidism includes tachycardia, fatigue, tremors, and nervousness in contrast to tachycardia, heat intolerance, and fatigue in younger patients. An enlarged, palpable goiter is present in 60% of older adults with hyperthyroidism. The most common complication, occurring in 27% of geriatric hyperthyroid patients, is atrial fibrillation that does not convert back to sinus rhythm when a euthyroid state has been achieved.

DIF: Remembering (Knowledge) REF: Page 468 OBJ: 23-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 4. The nurse assessing patients for diabetes looks for the classic signs, including which of the following? (Select all that apply.) a. Polyuria b. Polycythemia c. Polydipsia d. Polyphagia e. Polyandrony ANS: A, C, D The classic signs of diabetes are polyuria, polydipsia, and polyphagia.

DIF: Remembering (Knowledge) REF: Page 460 OBJ: 23-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 5. When teaching an older patient about diet therapy, the nurse plans to assess for barriers to adherence, including which factors? (Select all that apply.) a. Lifelong habits b. Cultural influences c. Finances d. Dependency e. Inability to learn ANS: A, B, C, D Diet therapy can be problematic for older adults who have a lifetime of food habits, cultural influences on food, finances that may be limited, and dependency on others to buy or prepare food. Older adults are not unable to learn.

DIF: Applying (Application) REF: N/A OBJ: 23-2 TOP: Nursing Process: Assessment MSC: Health Promotion 6. The nurse teaches an older patient safety rules for exercising. What do these rules include?

(Select all that apply.) a. Carry medical identification. b. Check blood glucose before exercising. c. Drink plenty of water. d. Have quick-acting glucose. e. Knowing signs of hyperglycemia.

ANS: A, B, C, D Rules for safe exercise include all the above except the patient is more likely to experience hypoglycemia, so those signs and symptoms are important related to exercise.

Chapter 27 Skin Health MULTIPLE CHOICE 1. When the older adult complains of the multiple raspberry-colored bruises on his extremities (senile purpura), the nurse explains that these colorful marks of increasing age are the result of: a. arteriosclerotic changes in the vessels. b. prolonged clotting time. c. fragility of capillary walls. d. reduction of subcutaneous fat.

ANS: C Age-related fragility of the capillary walls allows bright raspberry-colored bruises to develop with the mildest injury.

DIF: Cognitive Level: Comprehension REF: 266 OBJ: 3

TOP: Senile Purpura KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse assesses an area of skin on the patients upper thigh that is different in appearance than the surrounding skin. The documentation that is most informative is: a. red area on upper right thigh. Patient denies discomfort. b. erythematous scaly patch 2 2 cm on lateral aspect of right thigh. Patient denies pain. c. painless red patch on right thigh 2 2 cm. d. medium-size red scaly patch on right thigh. 0 drainage. 0 pain.

ANS: B The second option describes color and texture alterations, location, size, and subjective and objective data related to the lesion.

DIF: Cognitive Level: Analysis REF: 267 OBJ: 1 TOP: Skin Assessment KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse is aware that progressively graying hair is caused by: a. reduced melanocytes. b. altered blood circulation to the scalp. c. decreased density of hair. d. environmental factors.

ANS: A Decreasing melanocytes in the hair cause the hair to lose color and turn gray.

DIF: Cognitive Level: Comprehension REF: 267, Table 17-1 OBJ: 1 TOP: Gray Hair KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. When the assessment of a patients toenails reveals brittle thick nails with longitudinal lines in the nail, the nurse should assess for: a. fungal infection of the toenails. b. pedal pulses. c. history of gout. d. intake of dietary calcium.

ANS: B The nail changes are the result of decreased peripheral circulation. Checking for the strength of pedal pulses can add extra information related to circulation.

DIF: Cognitive Level: Analysis REF: 267, Table 17-1 OBJ: 2 TOP: Age-Related Nail Changes KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The 80-year-old woman newly admitted to a long-term care facility complains of intense itching in her axillae and antecubital fossa. There are small red lesions in linear patterns. These are all signs of: a. rosacea. b. keratosis. c. pruritus. d. scabies.

ANS: D Scabies is common in older adults, causing intense itching and small red lesions in a linear pattern. The condition is communicable and, unless treated, can spread to the entire facility.

DIF: Cognitive Level: Comprehension REF: 268 OBJ: 1

TOP: Scabies KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 6. The nurse reminds the CNAs that to prevent skin trauma from shearing force, the patients must: a. be slid across the bed linens to change position. b. have generous amounts of lotion applied to the skin. c. be lifted on draw sheets when being pulled up in bed. d. have frequent tub baths to soften the skin.

ANS: C Lifting patients up clear of the bed linens to move or change position will reduce the risk of shear force injury.

DIF: Cognitive Level: Comprehension REF: 268 OBJ: 2 TOP: Prevention of Shear Force Injury KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. To prevent pressure ulcers in the bedridden patient, the most effective intervention would be to: a. perform skin assessment every day. b. use a drawsheet to move the patient. c. change the patients position every 2 hours. d. remove wet bed linen promptly.

ANS: C Repositioning is the most effective intervention. Long periods of pressure over bony prominences are the primary cause of pressure ulcers, not wet linens, frequent assessments, or not using a drawsheet.

DIF: Cognitive Level: Analysis REF: 270 OBJ: 3

TOP: Prevention of Pressure Ulcers KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 8. The admitting nurse gives the new long-term care facility resident a score of 20 on both the Norton Risk Assessment Scale and the Braden Scale for Predicting Pressure Sore Risk. These scores indicate that the resident has: a. a high probability of developing a pressure ulcer. b. a moderate risk of developing a pressure ulcer. c. a low risk of developing a pressure ulcer. d. at least one pressure ulcer at the time of admission.

ANS: C Scores of 20 on the Norton and Braden Scales indicate a very low probability of developing a pressure ulcer.

DIF: Cognitive Level: Application REF: 271-272, Tables 17-3 and 17-4 OBJ: 3 TOP: Braden and Norton Skin Assessment Tools KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 9. On the admission assessment of an 80-year-old to a long-term care facility, the nurse notes that the residents toenails are dark, thick, and brittle; extremely misshapen; and growing at an angle from the toe. The nurse recognizes these as signs of _____ nails. a. fungal infection of the b. rams horn c. ingrown d. expected age-related changes in the ANS: A

Fungal nail infections cause nails to be dark, brittle, and misshapen. The nails grow at odd angles from the toes because they are lifted from the nail bed by the infection.

DIF: Cognitive Level: Application REF: 273 OBJ: 2 TOP: Fungal Infection of Toenails KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. The home health nurse suggests to the 80-year-old woman that to reduce the pruritus from dry skin, the patient should change her bathing schedule to: a. a hot shower every night before going to bed. b. a cool shower every morning using a detergent soap. c. a soak in a warm sudsy bath, leaving a film of soap on the skin. d. one shower a week, with sponge baths in between.

ANS: D A weekly shower with sponge baths in between provides adequate cleanliness and decreases dryness. Soap should be completely rinsed off. Hot showers and detergent soaps dry the skin.

DIF: Cognitive Level: Application REF: 274 OBJ: 3 TOP: Bathing KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 11. To reduce pressure ulcers in a bedridden patient, the nurse places the patient _____ bearing the weight. a. directly on his side, with the trochanter b. supine, with the sacrum and iliac crest c. in a semi-Fowler position, with the sacrum and ischium d. in a lateral position, with body rotated 30 degrees with gluteus ANS: D

The 30-degree lateral position places weight on the gluteus muscle, avoiding weight-bearing on bony prominences such as the trochanter, sacrum, and ischium.

DIF: Cognitive Level: Application REF: 275 OBJ: 3 TOP: Positioning KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 12. The long-term care facility nurse requests a dental consult to treat gingivitis in a resident. The nurse is aware that gingivitis, if not treated, can ultimately cause: a. receding gums. b. tooth loss. c. bleeding. d. halitosis.

ANS: B The bleeding, swelling, and receding gums of gingivitis ultimately lead to tooth loss.

DIF: Cognitive Level: Comprehension REF: 279 OBJ: 3 TOP: Gingivitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 13. The long-term care facility resident who has not worn his dentures for several months complains that the dentures no longer fit. The nurse explains that the dentures do not fit now because although he was not using them, his: a. gums have hypertrophied. b. gums have receded. c. jaw shape has altered. d. dentures have warped from disuse.

ANS: C

The arch of the jaw changes to compensate for the absence of teeth.

DIF: Cognitive Level: Comprehension REF: 280 OBJ: 1 TOP: Dentures KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. When the patient complains of dry mouth, the nurse should inquire about and assess for: a. difficulty in chewing and swallowing. b. mouth ulcerations. c. adequate intake of vitamin B. d. inflammation of the tongue.

ANS: A Xerostomia causes difficulty in chewing and swallowing because food sticks to the mucous membranes and tooth surfaces.

DIF: Cognitive Level: Application REF: 280 OBJ: 1 TOP: Xerostomia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. When the older man complains of a hard white patch that has developed on the side of his tongue, the nurse should: a. request a dental consult to evaluate his dentures for adequate fit. b. examine his teeth to assess for a lost filling, which has left sharp edges on his teeth. c. request a medical consult for evaluation of a precancerous lesion. d. provide frequent, warm, salt water rinses for his mouth.

ANS: C Leukoplakia is a precancerous condition that requires a medical consultation.

DIF: Cognitive Level: Application REF: 280 OBJ: 3 TOP: Leukoplakia KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 16. When the male patient who has been on long-term antibiotic therapy inquires what may have caused his thrush, the nurses most informative response would be that the yeast infection occurred because: a. of a vitamin A deficiency. b. long-term antibiotic therapy has destroyed the normal flora of his mouth. c. he has developed an allergy to the antibiotic. d. oral hygiene has been inadequate.

ANS: B Long-term antibiotic therapy destroys the normal flora of the oral cavity, allowing opportunistic infections to occur. Thrush is a common yeast infection.

DIF: Cognitive Level: Application REF: 280 OBJ: 2 TOP: Superinfection KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation MULTIPLE RESPONSE 1. The nurse explains that the purpose of the hydrocolloid dressing applied to a clean stage II pressure ulcer is to __________. (Select all that apply.) a. dbride the ulcer b. prevent shear force trauma c. absorb the exudate d. harden eschar e. make an air-occlusive seal ANS: A, B, C, E

The hydrocolloid dressing prevents shear force trauma to the ulcer while granulation tissue and reepithelialization are occurring during healing. It also forms an air-occlusive seal, protects the ulcer from infection, and absorbs exudate. If there were eschar present, it would soften it.

DIF: Cognitive Level: Application REF: 278, Table 17-6 OBJ: 3 TOP: Hydrocolloid Dressing KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 2. The nurse is diligent in skin care to prevent pressure ulcers. Older adults are at risk because __________. (Select all that apply.) a. the epidermal layer has thickened b. subcutaneous fat has diminished c. bruising is prevalent d. skin receptor cells have reduced in sensitivity e. the skin is dry and scaly ANS: B, D Lack of subcutaneous fat to pad the bony prominences and reduced sensitivity to touch and pressure put older adults at risk for pressure ulcers.

DIF: Cognitive Level: Analysis REF: 266 OBJ: 1 TOP: Pressure Ulcers KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse is aware that the common symptom of pruritus in the older adult is the result of __________. (Select all that apply.) a. a reduction of sebaceous gland function b. a reduction in the amount of perspiration c. excessive bathing

d. use of emollients e. environmental conditions ANS: A, B, C, E Emollients keep the skin moist and reduce dryness. All other options listed contribute to pruritus.

DIF: Cognitive Level: Comprehension REF: 267 OBJ: 1 TOP: Pruritus KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. When performing a skin assessment for pressure ulcers on an older man who is bedridden and prefers to lie on his right side, the nurse will pay special attention to the __________. (Select all that apply.) a. right ear b. lateral edge of the right foot c. sacrum d. medial edge of the left foot e. right scapula ANS: A, B, D For this right sidelying patient, the right ear, lateral edge of the right foot, and medial edge of the left foot are probable areas for pressure ulcers.

DIF: Cognitive Level: Comprehension REF: 269, Figure 17-5 OBJ: 2 TOP: Pressure Ulcers KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. To fully assess a suspected skin breakdown over the trochanter of a dark-complexioned African American, the nurse would __________. (Select all that apply.)

a. use a halogen light to examine the area b. palpate for local edema in the area c. touch the area to feel for changes in tissue temperature d. assess for localized pain e. press the area to test for blanching ANS: A, B, C Halogen lights make a stage I area appear blue in a dark-skinned person. There is usually a local area of heat and edema. Stages I and II pressure ulcers are painless. Testing for blanching when erythema cannot be assessed is useless.

DIF: Cognitive Level: Application REF: 267, Cultural Considerations OBJ: 3 TOP: Pressure Ulcer Assessment KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. The long-term care facility nurse making a list of residents whose foot care must be referred to the podiatrist would include the __________. (Select all that apply.) a. 90-year-old poststroke patient with right hemiparesis b. 85-year-old diabetic patient who is 100 lb overweight c. 80-year-old resident with phlebitis and a stasis ulcer on the left ankle d. 75-year-old resident with congestive heart failure (CHF) e. 70-year-old resident with chronic obstructive pulmonary disease (COPD) ANS: B, C Persons with diabetes or circulatory disorders should have foot care performed by a specialist.

DIF: Cognitive Level: Application REF: 273 OBJ: 2 TOP: Nail and Foot Care KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

7. The nurse explains that xerostomia (dry mouth) in the older adult may be caused by __________. (Select all that apply.) a. age-related reduction in saliva b. allergy c. eating highly seasoned foods d. inadequate fluid intake e. use of diuretic medications ANS: A, D, E Reduction of saliva, inadequate fluid intake, and fluid loss through the use of diuretics can cause xerostomia.

DIF: Cognitive Level: Application REF: 280 OBJ: 1 TOP: Xerostomia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. The nurse recognizes the signs and symptoms of Vincent angina in a newly admitted patient, which include __________. (Select all that apply.) a. an advanced state of malnutrition b. enlargement of the cervical lymph nodes c. epistaxis d. dysphagia e. a discolored tongue ANS: A, B, D Enlargement of the cervical lymph nodes, difficulty swallowing, and mouth ulcers in a malnourished person are indications of Vincent angina.

DIF: Cognitive Level: Application REF: 280 OBJ: 2 TOP: Vincent Angina KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. While giving a report to the CNAs, the nurse reviews interventions that will aid in maintaining the skin integrity of the residents. Appropriate interventions would include __________. (Select all that apply.) a. changing the briefs and bed linens when damp b. maintaining the temperature in the room at 80 degrees c. rinsing excess soap off the skin during a shower d. administering frequent pericare on the continent resident e. laying residents down after lunch ANS: A, C, E Waste products and soap are irritating to the skin and must be removed promptly. Rest periods during the day will relieve pressure. Exposure to a hot, dry environment and frequent pericare to a resident who is not incontinent is going to make the skin more prone to breakdown.

DIF: Cognitive Level: Application REF: 274 OBJ: 3 TOP: Skin Integrity KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 10. The nurse instructs a group of older adults on how to maintain intact skin by __________.

(Select all that apply.) a. altering their body position every 30 minutes while sitting in the chair b. changing incontinent products when they become soiled c. using a pressure-relieving device like the donut to sit on d. routinely checking their feet for redness and indentations e. patting the skin dry after a shower or bath ANS: A, B, E Frequent changes in body position, changing damp pads and briefs, and patting the skin dry will promote skin integrity. The donut causes pressure to surrounding area when used. Checking the

feet routinely will alert the older adult to a potential problem but will not maintain skin integrity.

Changing socks daily or applying lotion to the feet will aid in maintaining skin integrity.

Chapter 28 Cancer MULTIPLE CHOICE 1. When planning an educational program on cancer for a group of older adults, the nurse incorporates information regarding racial and ethnic patterns of cancer in the United States that includes evidence that: a. the incidence of cancer is highest among African Americans. b. Native Americans have the highest overall incident rates of cancer. c. incidence rates for lung cancer are lowest for white women. d. Hispanic women have the lowest incidence rates of cervical cancer.

ANS: A Cancer affects Americans of all racial and ethnic groups; however, the incidence of cancer does demonstrate patterns according to racial and ethnic origins. African Americans have higher overall incidence rates than whites, whereas Hispanic Americans and Native Americans have lower incidence rates overall.

DIF: Remembering (Knowledge) REF: Page 297 OBJ: 17-2 TOP: Teaching-Learning MSC: Physiologic Integrity 2. An older adult patient asks the nurse why so many of her friends are developing cancers. The nurse responds best when answering: a. Cancer cells generally develop as a result of prolonged exposure to external agents. b. The longer we live the more exposure we have to environmental toxins. c. Aberrant growth seems to be the risk factor in the older adult that is not well understood.

d. As we age, our cells are less able to regulate replication appropriately.

ANS: D The aging cell has a tendency toward aberration or abnormalcy as it replicates. Aberrant cell growth is related to failure of growth control mechanisms, which leads to less cell regulation during replication. Cancer occurs more commonly in replicating than in nonreplicating cell groups, which suggests that changes in internal cellular control mechanisms give rise to cancer.

DIF: Understanding (Comprehension) REF: Page 299 OBJ: 17-1 TOP: Teaching-Learning MSC: Physiologic Integrity 3. An older adult patient expresses concern about developing cancer in the future and asks the nurse advice about cancer prevention. The nurse shares that: a. Eating foods high in protein, such as chicken and fish, promote cell growth and repair, thus minimizing the risk. b. Although there are some behaviors that can help minimize your risk, the possibility of developing cancer is usually determined by age 65. c. Most cancers that develop after age 65 generally respond well to cancer treatment modalities. d. Cancers that develop late in life are generally slow growing, so they generally do not contribute to this groups mortality.

ANS: B Most cancers are the result of a lifelong exposure, so the risk of developing malignant disease after age 65 is probably already determined by the time one reaches that age. If exposure to promoters can be avoided or reduced and antipromoters can be used, then cancerous transformation may not take place or may be delayed. The other statements are not accurate.

DIF: Understanding (Comprehension) REF: Page 300 OBJ: 17-1 TOP: Teaching-Learning MSC: Physiologic Integrity

4. An older adult patient has rheumatoid arthritis, which limits her manual dexterity and ability to perform breast self-examinations. To address the patients need for breast health promotion, the nurse teaches the patient to: a. use the palm of her hand to perform monthly breast examinations. b. schedule a mammogram every 12 months. c. check each breast while in the shower if possible. d. visit her physician yearly for a breast examination.

ANS: A Older women, while having the highest incidence of breast cancer, have been shown to have the least knowledge about the importance of breast examination. Modifying and encouraging selfbreast examination would be the most effective intervention to promote breast health. The other actions are good but not as helpful as adapting the technique of self-exam so the woman can accomplish it.

DIF: Applying (Application) REF: N/A OBJ: 17-3 TOP: Teaching-Learning MSC: Health Promotion 5. Which statement, if made by an older Caucasian adult man, indicates the need for further teaching about prostate cancer and its prevention? a. Digital rectal examinations arent needed for screening. b. I should discuss having a yearly PSA test. c. Prostate cancer can look a lot like an enlarged prostate. d. I am not in a high-risk category for prostate cancer.

ANS: A The digital rectal exam and prostate-specific antigen (PSA) blood test are the two main screening methods for prostate cancer. Men should begin discussions about screening for this cancer when

they are 50. The digital rectal exam is less costly than a blood test. The other statements show understanding.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 17-3 TOP: Nursing Process: Evaluation MSC: Health Promotion 6. When obtaining a health history, the nurse recognizes that an older adult patient has a risk factor for colorectal cancer when he reports: a. that he is a vegetarian who eats soy products. b. that he often needs laxatives for constipation. c. a history of inflammatory bowel disease. d. that diarrhea occurs at least monthly.

ANS: C A personal or family history of colorectal cancer, polyps, or inflammatory bowel disease has been associated with increased colorectal cancer risk. The other options do not increase this patients risk.

DIF: Remembering (Knowledge) REF: Page 305 OBJ: 17-1 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 7. While awaiting the results of testing to determine a diagnosis of cancer, an older adult patient asks a nurse to explain what happens when cancer metastasizes. The nurse responds: a. It is the result of prolonged exposure to an external agent. b. Cancer cells convert from transformed cells into small clusters of clonal cells. c. Cell control mechanisms fail, giving rise to aberrant cell growth. d. Cancer cells move from one location to another unconnected location.

ANS: D

Metastasis involves a change in location of the cancer cells from one organ or part of the body to another that is not directly connected. The other statements are not correct.

DIF: Understanding (Comprehension) REF: Page 299 OBJ: 17-1 TOP: Teaching-Learning MSC: Physiologic Integrity 8. The family of an older adult diagnosed with cancer asks the nurse to explain how gene therapy might be beneficial. The nurse responds: a. The treatment decreases blood flow to the tumor and it dies. b. A virus is injected into the tumor and then it cant grow. c. The cancer cells nucleus is destroyed and the cell shrivels. d. Photosensitizers are introduced into the cells so lasers can kill them.

ANS: B Gene therapy involves the injection of a virus that makes the cancer cells incapable of reproducing.

DIF: Understanding (Comprehension) REF: Page 308 OBJ: 17-1 TOP: Teaching-Learning MSC: Physiologic Integrity 9. The nurse observes a suspicious mole on the back of an older adult who is undergoing palliative radiotherapy for brain metastasis. The nurse suspects that the mole: a. is a result of the radiation. b. is a secondary cancer. c. will not be screened. d. was the primary cancer.

ANS: C

Screening should not be conducted if there is no intent or ability to pursue findings with more complete evaluation and treatment. The goal of screening is to detect early cancer that is amenable to treatment; this patient is undergoing palliation, which means he or she is not expected to live but is getting the radiation for symptom control.

DIF: Analyzing (Analysis) REF: N/A OBJ: 17-3 TOP: Nursing Process: Analysis MSC: Physiologic Integrity 10. An older adult patient with breast cancer is reluctant to agree to the suggested treatment plan because I have heard such horrible things about radiation therapy. The nurse responds: a. Radiation therapy no longer causes such terrible side effects. b. Your chances of recovery are best when radiation is included. c. Ask the oncologist if there are alternative treatments. d. Actually there is very effective symptom control now.

ANS: A Cancer care has changed dramatically over the years; however, many older adults remember friends or relatives who were treated with now outdated therapies that had devastating side effects. The other statements do not address the primary concern, which is side effects of the treatment.

DIF: Understanding (Comprehension) REF: Page 309 OBJ: 17-4 TOP: Communication and Documentation MSC: Physiologic Integrity 11. After a course of chemotherapy for cancer of the throat, an older adult patient is admitted to the hospital with persistent nausea and vomiting. The nurse should initially assess the patient for: a. weight loss and weak gag reflex. b. anemia and poor muscle tone. c. oral inflammation and ulceration. d. dehydration and infection.

ANS: D Drug-induced nausea and vomiting can result in dehydration, decreased caloric intake, and weight loss. Chemotherapy in general will impact the immune systems ability to combat infections. All assessments are important, but dehydration and infection (or sepsis) need to be treated immediately.

DIF: Applying (Application) REF: N/A OBJ: 17-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 12. The daughter of an older adult woman who had a colostomy as a result of colon cancer tells the nurse, Mom seems to be so withdrawn; she has stopped going out with her friends and Im really concerned. The most relevant nursing diagnosis for the patients reaction is: a. Ineffective individual coping. b. Dysfunctional grieving. c. Social isolation. d. Hopelessness.

ANS: C Voluntary social isolation may result when an older adult with cancer no longer feels comfortable in social settings because of his or her situation, including, for example, changes in body image, energy levels, or interests. Older persons with cancer may withdraw because they perceive that others are uncomfortable in their presence and because they believe, rightly or wrongly, that others are avoiding them because of the cancer diagnosis. Coping may be disturbed in this patient as well. The patient may be grieving loss of her former healthy self, and she may feel hopeless. But social isolation fits the daughters data.

DIF: Applying (Application) REF: N/A OBJ: 17-6 TOP: Nursing Process: Diagnosis MSC: Psychosocial Integrity

13. An older adult patient diagnosed with colon cancer is being evaluated for surgical removal of the tumor. The nurse explains that the primary consideration is the: a. absence of any chronic disorders. b. absence of metastasis. c. tumors staging status. d. patients presurgical health status.

ANS: D The curability of cancer in older adults is largely predicted by an individuals ability to tolerate major surgery. The absence of metastasis and the tumor stage will impact additional treatments.

Absence of chronic illness is not a factor in and of itself.

DIF: Understanding (Comprehension) REF: Page 309 OBJ: 17-4 TOP: Teaching-Learning MSC: Physiologic Integrity 14. An older adult patient is undergoing palliative surgery for colon cancer metastasis. The nurse explains to the family that this intervention is intended to: a. prolong the patients life by several months. b. improve the effectiveness of the chemotherapy. c. relieve the pain associated with spread of the tumor. d. prevent further tumor growth.

ANS: C Surgery may be indicated for palliative care in cases in which large primary or metastatic tumors can be reduced; the size or location of the tumor can create problems such as compression of surrounding tissues and organs, leading to pain, necrosis, or organ failure. Palliative procedures are designed to manage symptoms.

DIF: Understanding (Comprehension) REF: Page 309 OBJ: 17-4

TOP: Teaching-Learning MSC: Physiologic Integrity 15. The nurse is admitting a patient to the hospital who has cancer and a neutrophil count of 430/mm3. What action by the nurse is best? a. Place the patient in a private room. b. Use good handwashing with all contact. c. Place the patient in protective precautions. d. Initiate contact precautions.

ANS: C A patient whose neutrophil count is below 500/mm3 is at extreme risk of infection and should be placed on protective isolation. A private room and good handwashing are also necessary, but the best intervention is isolation.

DIF: Applying (Application) REF: N/A OBJ: 17-5 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 16. A patient is admitted to the hospital for chemotherapy and has severe mucositis. What action by the nurse is best? a. Provide frequent oral care with saline. b. Have the family bring the favorite mouthwash. c. Document the patients oral assessment. d. Ensure teeth are brushed with a firm toothbrush.

ANS: A Frequent oral care is a must for patients with mucositis. However, commercial products contain alcohol, and the patient needs gentle products that do not contain alcohol. Saline is a good option. Documentation should occur, but the nurse should act to address the problem. A soft toothbrush or swab is preferred for comfort.

DIF: Applying (Application) REF: N/A OBJ: 17-5 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 17. A patient has severe watery diarrhea from chemotherapy and is embarrassed having to be cleaned up frequently. The nurse notes several open areas on the patients rectal area that cause pain. What nursing diagnosis takes priority? a. Acute pain b. Impaired skin integrity c. Ineffective coping d. Decreased cardiac output ANS: B Physical needs take priority over psychosocial ones. The patient has open areas and impaired skin integrity, but no information shows decreased cardiac output. The pain is related to the impaired skin, so treating that will diminish the pain.

DIF: Analyzing (Analysis) REF: N/A OBJ: 17-5 TOP: Nursing Process: Diagnosis MSC: Physiologic Integrity 18. An older patient getting cisplatin (Platinol) asks the nurse how it works. What is the best response? a. Prevents RNA transcription and DNA replication b. Interferes with synthesis of chromosomal nucleic acid c. Formed from soil fungi; prevents RNA and DNA synthesis d. Binds to cell proteins and inhibit mitosis ANS: A

Cisplatin is an alkylating agent, which prevents RNA transcription and DNA replication.

Antimetabolites interfere with synthesis of chromosomal nucleic acid. Antitumor antibiotics prevent RNA and DNA synthesis. Plant alkaloids bind to cell proteins and inhibit mitosis.

DIF: Remembering (Knowledge) REF: Page 311 OBJ: 17-4 TOP: Teaching-Learning MSC: Physiologic Integrity 19. An older patient on chemotherapy is in the oncology clinic for follow-up. The nurse notes the patient appears depressed. What action by the nurse should occur first? a. Assess the patient for depression. b. Review the patients chemotherapy. c. Ask the patient about suicidal ideation. d. Inquire how the patient has been feeling.

ANS: B The nurse should assess the patient for depression; however, prior to doing so, the nurse should review the patients chemotherapy. Some chemotherapy drugs can cause depression, and it may be a confusing picture. Depending on the results of the screening, asking about self-harm may be appropriate. Inquiring how the patient is feeling is appropriate, but it is not the most important action.

DIF: Applying (Application) REF: N/A OBJ: 17-6 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 20. The family of an older patient recently diagnosed with cancer reports that the patient seems to be in denial, refusing to choose treatments and planning an extended vacation. What response by the nurse is best? a. Ask the patient how he or she feels about the diagnosis. b. Tell the patient treatment started early has the best results. c. Refer the patient to a licensed mental health professional.

d. Tell the family that the patient will get over it in his own time.

ANS: A This patient may be experiencing a compensatory form of grief and not allowing him- or herself to ponder the enormity of the situation at one time. Rather, the patient may be allowing bits of information to seep into his or her existence slowly in order to make sense of it. This is adaptive and the nurse should ask the patient how he or she feels about the cancer. Telling the patient that treatment must start early may be too harsh and the patient may not be ready to make decisions.

The patient probably does not need a mental health professional; rather the patient should be left to come to terms with this diagnosis on her or his own terms. Using phrases like get over it are judgmental and imply the patient is doing something wrong.

DIF: Applying (Application) REF: N/A OBJ: 17-5 TOP: Caring MSC: Psychosocial Integrity MULTIPLE RESPONSE 1. The nurse is using a tool to assess the quality of life of a hospice patient. The nurse addresses the appropriate areas of concern when asking which of the following questions? (Select all that apply.) a. Are you able to bathe yourself? b. Did your grandson get the grass cut like he planned? c. How would you rate your pain on a scale of 1 to 10? d. Do you still have concerns about your will? e. Can we talk about why you never remarried?

ANS: A, B, C, D Quality of life was measured by the Missoula-Vitas Quality of Life Index (MVQOLI), an instrument designed specifically for use with terminally ill patients. The MVQOLI determines levels of symptom distress, patient ability to function, social support, affairs in order, and

religious comfort or support. Asking about why the patient never married is not appropriate at this time.

DIF: Understanding (Comprehension) REF: Page 317 OBJ: 17-6 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. The nurse suspects the older adult patient will require diagnostic testing for possible lung cancer when the patient does which of the following? (Select all that apply.) a. Reports smoking two packs of cigarettes daily b. Reports severe chest pain c. Loses 10 pounds in 1 month d. Takes several naps daily e. Locates a palpable lump on the left lateral chest ANS: A, C, D The classic clinical presentation of lung cancer is a persistent cough, sputum streaked with blood, chest pain, and recurring pneumonia or bronchitis. This constellation of symptoms is also associated with cigarette smoking, and their significance as indicators of cancer may be overlooked. Other symptoms include more systemic complaints such as anorexia, weight loss, and fatigue. Older persons more often experience dyspnea and weight loss, whereas pain is less frequent.

DIF: Remembering (Knowledge) REF: Page 301 OBJ: 17-3 TOP: Nursing Process: Assessment MSC: Health Promotion 3. The nurse is preparing discharge education for an older patient and his family. The patients hemoglobin is currently 8.2 mg/dL as a result of cancer treatment therapy. To best address the patients hematology status, the nurse includes instructions to do what? (Select all that apply.) a. Include eggs or an egg substitute into the daily diet. b. Avoid strenuous exercise until hemoglobin improves.

c. Regularly take both a mid-morning and mid-afternoon nap. d. Have a green leafy salad with vegetables at meals. e. Check for bruising to the extremities and the gums.

ANS: A, B, C, D Instruct the patient and family to increase rest and sleep periods as well as to incorporate foods into the diet that are high in iron, such as eggs, lean meat, green leafy vegetables, carrots, and raisins. These interventions are directed toward conserving energy and providing iron. Avoiding strenuous activity will decrease the chance of injury. Bleeding and bruising would indicate low platelet count.

Chapter 29 Mental Health Disorders MULTIPLE CHOICE 1. An older adult is experiencing age-related postural hypotension and he fears something is really wrong because he is the only one in his social group experiencing the problems. The nurse responds: a. Dont be concerned; just be very careful about your risk for falling. b. You have had very thorough testing, so dont worry about it being serious. c. Its just a matter of time before they too have to watch not to get up too quickly. d. You just dont have the compensating mechanisms of your friends.

ANS: D The age-related symptoms of postural hypotension are dizziness or lightheadedness when changing positions rapidly. However, compensatory processes in the cortex and subcortical areas of the brain help aging individuals maintain relatively normal motor performance.

DIF: Understanding (Comprehension) REF: Page 565 OBJ: 27-2 TOP: Teaching-Learning MSC: Physiologic Integrity

2. What education by the nurse is most important to address age-related changes to the senses? a. Installing auditory smoke alarms b. Having regular eye checkups c. Being aware that hearing acuity decreases with age d. Checking the expiration dates on foods such as dairy ANS: A An age-related reduction in the senses makes it less likely that an older person will smell smoke from a fire. Loud fire alarms are important for home safety. The other factors are not as directly related to safety.

DIF: Understanding (Comprehension) REF: Page 566 OBJ: 27-2 TOP: Teaching-Learning MSC: Safe Effective Care Environment 3. The nurse is conducting an admission assessment on a mildly confused older patient. The nurse best assures an accurate history by first: a. scoring the clients cognitive responses. b. focusing on the client to respond. c. directing the questions to both patient and family. d. arranging a Mini-Mental State Examination (MMSE).

ANS: C An interview with the friend or family member is an appropriate method to first implement when a patient is exhibiting confused behavior. The other options will not get accurate information for the assessment.

DIF: Understanding (Comprehension) REF: Page 566 OBJ: 27-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

4. A nurse is caring for an older patient diagnosed with acute depression. What action by the nurse is most important to help prevent delirium in this patient? a. Reorienting the patient to the day, time and place frequently b. Being physically present to help the patient with eating meals c. Providing the patient with opportunities to discuss depression d. Administering antidepressive medication as prescribed ANS: B Depressed older adults may neglect eating or caring for a chronic medical condition, predisposing them to the development of delirium resulting from hypoalbuminemia and possibly electrolyte imbalances. The other actions will not prevent delirium.

DIF: Applying (Application) REF: N/A OBJ: 27-4 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 5. When assessing an older patient displaying symptoms of delirium, the nurse focuses the assessment on: a. the degree and duration of the symptoms. b. the amount of self-care deficiency the symptoms cause. c. identifying processes that commonly result in the symptoms. d. physiologic dysfunction resulting from the symptoms.

ANS: C The treatment of delirium entails the identification and treatment of the underlying cause. The nurse should assess this factor as the priority. The other assessments are of lesser priority.

DIF: Applying (Application) REF: N/A OBJ: 27-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

6. An 80-year-old patient is exhibiting signs of dementia representative of Alzheimer disease (AD). The nurse supports that possibility when determining that the patient: a. experienced a gastric resection several years ago. b. traveled often to third world countries. c. was employed as a steelworker for 40 years. d. has a history of viral encephalitis.

ANS: D Viral illness such as herpes zoster, herpes simplex, or viral encephalitis is believed to be a possible risk factor for AD. However, advancing age is the primary risk factor. The other options are not related.

DIF: Remembering (Knowledge) REF: Page 571 OBJ: 27-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 7. When planning care for the older adult with advanced dementia, the nurse recognizes that the best way to implement reality orientation is to: a. place printed labels on important items, such as the telephone. b. place a clock and calendar in the patients immediate environment. c. use hand gestures instead of verbal communications to demonstrate meaning. d. show the patient a picture of a toothbrush when it is time for oral hygiene.

ANS: D Reality orientation supports failing memory in early stages of dementia and preserves independent functioning for a longer duration. Although written messages and signs may become meaningless to individuals with advancing dementia, pictures often evoke a response. The other options are not part of this strategy.

DIF: Remembering (Knowledge) REF: Page 579 OBJ: 27-4

TOP: Nursing Process: Implementation MSC: Physiologic Integrity 8. A 73-year-old patient diagnosed with vascular dementia is admitted for exacerbation of asthma. The patient has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior. The nurses initial response is to: a. identify the patient as being at high risk for falls. b. monitor the patient for signs of benzodiazepine withdrawal. c. notify the admitting physician immediately. d. place the patient on strict intake and output.

ANS: C Benzodiazepines should be reserved for acute situations and not used for the long-term management of troubling behaviors. Long-term use can precipitate withdrawal if use is stopped and can possibly cause seizures. The nurse should notify the physician immediately so that plans for safely discontinuing the drug can be made.

DIF: Applying (Application) REF: N/A OBJ: 27-6 TOP: Communication and Documentation MSC: Physiologic Integrity 9. Which of the following statements, when made by family members caring for an older patient with dementia, indicates peaceful acceptance of the situation? a. Im so pleased that Mother had a good day today. Im really very hopeful. b. The hospice nurses are so helpful when I need time for myself. c. I promised Mother I would take care of her and Ill never leave her. d. Its the least I can do for Mother since she cared for us all these years.

ANS: B Adjusting to the fact that dementia is irreversible and prolonged places families in situations of dealing with grief over a long period. Nurses need to encourage caregivers to take time out from

their task and participate in self-care and health promotion activities. The other statements do not show this acceptance as clearly.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 27-6 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 10. The son of a patient with possible Alzheimer disease (AD) asks the nurse if there is a diagnostic test that can confirm the diagnosis. The nurse responds that: a. an electroencephalogram is often very useful in diagnosing AD. b. a positron emission tomography (PET) scan is a cheap but dependable tool. c. magnetic resonance imaging (MRI) is often ordered for that purpose. d. postmortem autopsy is the only definitive diagnostic tool.

ANS: D Autopsy remains the gold standard and only definitive method for the diagnosis of AD. DIF: Understanding (Comprehension) REF: Page 572 OBJ: 27-5 TOP: Teaching-Learning MSC: Physiologic Integrity 11. An 89-year-old diagnosed with dementia was until recently responding well to cognitive cueing techniques. The nurse shows an understanding of dementia when sharing with staff that: a. We will implement new interventions that address the diseases progression. b. Its important that we frequently recue the patient to improve her quality of life. c. The patients family needs to be made aware of this decline. d. This poor response to cueing is likely a result of advanced aging.

ANS: A Positive responses to selected interventions may continue for a time but may decline as the disease progresses, which results in the need to reevaluate strategies. The nursing staff cannot

evaluate the patients quality of life; only the patient can, and this patient is not capable. The family should be informed but that is not related to understanding dementia. The change in response is the result of advancing disease, not age.

DIF: Applying (Application) REF: N/A OBJ: 27-6 TOP: Teaching-Learning MSC: Physiologic Integrity 12. An 80-year-old patient who is experiencing symptoms of depression and anxiety is reluctant to comply with the prescribed treatment plan. The nurse initially addresses the issue with the patient by asking: a. How do you feel about how others view your mental health problem? b. Are you concerned about paying for your psychiatric medications? c. Did you know that depression is common among people your age? d. Do you have any questions about your the mental health treatment plan?

ANS: A Older adults are often reluctant to seek care from a mental health professional because they grew up during a period when a strong stigma was attached to mental illness, mental hospitals, and mental treatment. The other questions do not open a discussion.

DIF: Applying (Application) REF: N/A OBJ: 27-8 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 13. An older adult patient being treated for chronic obstructive pulmonary disease (COPD) is exhibiting signs of memory loss and confusion. In planning his care, the nurse should give priority to: a. obtaining an order for a pulmonary function test (PFT). b. determining the potential of a possible adverse drug reaction. c. reorienting the patient to time, place, and person frequently. d. assessing for a family history of dementia.

ANS: B Two of the most common side effects of many medications taken by older adults are mental confusion and disorientation. The initial action should be to determine the possible cause of the symptoms. If a cause can be found, a change might be possible. There is no indication the patient needs a PFT. Reorienting the patient is a good intervention, but it would be better to identify and eliminate the causative factor. Assessing a family history is a potential intervention as well.

DIF: Applying (Application) REF: N/A OBJ: 27-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 14. The nurse caring for an older adult patient recovering from cardiac surgery recognizes that it is most appropriate to assess this patient for mental health problems because: a. cardiac surgery often results in anxiety-related issues. b. untreated depression can contribute to the patients morbidity risks. c. many in this age cohort have undiagnosed depression. d. hospitalization is both anxiety and depression inducing.

ANS: B Depression can and should be treated when it occurs with other illnesses because untreated depression can delay recovery from or worsen the outcome of the other illnesses. Cardiac illness is associated with depression, but not necessarily with anxiety issues. It is true that depression in the older population is underdiagnosed. Hospitalization can lead to depression. But the main reason to assess for depression is because of its effects on other health conditions.

DIF: Applying (Application) REF: N/A OBJ: 27-8 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 15. When planning care for the older adult being treated for depression, the nurse addresses the patients tertiary intervention needs best by:

a. helping the patient to identify the early symptoms of depression. b. helping the patient deal with the physical symptoms of depression. c. discussing with the patient how to implement new coping skills. d. educating the patient about the importance of being drug compliant.

ANS: C Tertiary intervention refers to the restorative or rehabilitative functions that the nurse performs to assist patients in the recovery process. An important aspect of tertiary intervention involving patients with depression is teaching new coping skills to lessen the likelihood of recurring depression. Identifying early symptoms is a secondary prevention. Treating the depression will limit the physical symptoms. Education is generally considered primary prevention. However, in this case it is education on part of treatment. This is not the best answer because the nurse is not teaching about the drugs, only about the importance of being compliant.

DIF: Applying (Application) REF: N/A OBJ: 27-8 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 16. To best advocate for an older adult patient being prescribed medication to control newly observed signs of confusion and aggressive behavior, the nurse: a. initiates an assessment to determine possible underlying causes of the behavior. b. contacts family to inform them of the new medication therapy being planned. c. discusses possible nonpharmaceutical treatments with the physician. d. documents a detailed description of the behaviors before administering the drugs.

ANS: A In this population, such symptoms may be mistakenly assumed to be a result of normal aging, so prescription medications may be ordered for anxiety, depression, aggressive and disruptive behavior, or paranoid-type behavior, without assessing the reasons for the behavior. If an underlying cause of the behavior is found, it can be treated, thereby eliminating the problem. The other actions do not demonstrate advocacy.

DIF: Applying (Application) REF: N/A OBJ: 27-9 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 17. An older adult has been recently diagnosed with type 2 diabetes and mild retinal deterioration. To best address the patients potential for developing situation depression, the nurse: a. assesses the patients coping skills. b. Encourages the patient to participate in a depression support group. c. assesses the patients ability to manage the symptoms. d. educates the family on early signs of depression.

ANS: A One of the keys to successful aging is adjusting to or, perhaps more accurately, adapting to, although not necessarily accepting, changes that occur in ones life. The nurse assesses the patients coping skills and methods. The patient does not need a support group before developing depression. Managing symptoms is part of coping. Educating the family is an appropriate intervention but is not the priority.

DIF: Applying (Application) REF: N/A OBJ: 27-8 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 18. An older adult has a medical condition that has required hospitalization at a facility far from home and family. To best minimize the patients risk for depression, the nurse: a. keeps the patient informed of the expected discharge date. b. offers to help the patient telephone family members each evening. c. reassures the patient that early discharge is a nursing goal. d. encourages the patient to place family photographs around the room.

ANS: B

The family continues to be the first source of support for older adults. This support is best achieved by regular contact through visiting or telephoning. The other options may be helpful, but they are not the best choice.

DIF: Understanding (Comprehension) REF: Page 599 OBJ: 27-8 TOP: Caring MSC: Psychosocial Integrity 19. An older patient is anxious about an upcoming diagnostic test and requests something to calm the nerves. To best address the patients need, the nurse prepares to administer a PRN dose of: a. clonazepam (Klonopin). b. diazepam (Valium). c. chlordiazepoxide (Librium). d. lorazepam (Ativan).

ANS: D There are two broad categories of benzodiazepines: short-acting (e.g., alprazolam [Xanax], lorazepam [Ativan], and oxazepam [Serax]) and long-acting (e.g., diazepam [Valium], chlordiazepoxide [Librium], and clonazepam [Klonopin]). The short-acting agents are preferred for older adults because of their lower potential for buildup leading to sedation and depression.

DIF: Applying (Application) REF: N/A OBJ: 27-9 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 20. While collecting a health history for an older adult patient, the nurse learns that the patient had been prescribed Elavil 3 weeks ago and wants to stop taking it because It didnt make me feel any better. In response to this information, the nurse shares with the patient that: a. sudden withdrawal is likely to cause a hypertensive crisis. b. depression seldom improves without medication. c. realistically it will take longer for the patient to feel an improvement.

d. in time, people adjust to the side effects.

ANS: C Older patients may need up to 12 weeks of this medication for evaluation of a full response.

Psychotropic medications need to be started low and increases should be done slowly. The other options are not correct.

DIF: Understanding (Comprehension) REF: Page 597 OBJ: 27-9 TOP: Teaching-Learning MSC: Physiologic Integrity 21. The nurse familiar with the old adult population recognizes that the patient who has the greatest potential for successfully committing suicide is the: a. 63-year-old Asian female. b. 86-year-old Caucasian male. c. 76-year-old Hispanic female. d. 67-year-old African-American male.

ANS: B The highest rates of suicide are among men over the age of 85.

DIF: Remembering (Knowledge) REF: Page 567 OBJ: 27-9 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 22. A 65-year-old adult who recently lost his spouse is admitted to the hospital after a failed suicide attempt. He presents with a sad affect and is reluctant to interact within the milieu. The nursing diagnosis with priority is: a. ineffective coping related to recent loss. b. hopelessness related to death of spouse. c. risk for loneliness related to loss of spouse.

d. risk for self-directed violence related to depression.

ANS: D This patient is at risk for another attempt at suicide, so safety is the primary concern.

DIF: Applying (Application) REF: N/A OBJ: 27-8 TOP: Nursing Process: Analysis MSC: Psychosocial Integrity 23. The nurse is caring for a severely depressed older patient. To best effect change in the patients emotional state, the nurses initial goal is to: a. plan interventions that will enhance the patients self-esteem. b. introduce the patient to new coping skills. c. assess the patients potential to self-harm. d. develop a therapeutic nurse-patient relationship.

ANS: D The nurses ability to positively effect change in older adults responses to depression lies in the development of therapeutic relationships. Assessing risk for harm is an important safety issue but does not help the patients emotional state. The other two options come later after the relationship has entered its working phase.

DIF: Applying (Application) REF: N/A OBJ: 27-8 TOP: Caring MSC: Psychosocial Integrity 24. An older adult is hospitalized for treatment of a mental health disorder and is prescribed clomipramine (Anafranil). The nurse documents that the medication is having the desired effect when the patient: a. begins sleeping 8 hours per night. b. engages in fewer ritualistic behaviors.

c. reports fewer episodes of nervousness. d. exhibits no delusionary thinking.

ANS: B This medication is a tricyclic antidepressant that is specifically helpful for obsessive-compulsive disorder (OCD). The other assessments are not specific indicators of the effectiveness of this medication.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 27-8 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity 25. To help manage the potential side effects of prescribed antipsychotic medications, amantadine (Symmetrel) may be prescribed. Which statement best indicates that the nurse understands the appropriateness of this medication for the older adult patient? a. This medication produces few anticholinergic effects. b. Symmetrel is an effective dopamine agonist. c. Extrapyramidal symptoms are best controlled by Symmetrel. d. Older patients seem to have the fewest side effects on this medication.

ANS: A Amantadine (Symmetrel), a dopamine agonist prescribed to manage EPS, may be used, especially in older patients and in those with cardiovascular dysfunction, because of its reduced anticholinergic effects. The other statements are not accurate.

DIF: Remembering (Knowledge) REF: Page 598 OBJ: 27-8 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE 1. A 72-year-old is prescribed lithium. The nurse educates the patient on the importance of biannual evaluation of which of the following? (Select all that apply.)

a. Renal function b. Serum glucose level c. Liver function d. Thyroid function e. Red blood cell count ANS: A, C, D Renal, liver, and thyroid studies should be evaluated every 6 months because of the drugs potential toxicity. Glucose and red blood cell count are not affected.

DIF: Remembering (Knowledge) REF: Page 597 OBJ: 27-8 TOP: Teaching-Learning MSC: Physiologic Integrity 2. A 78-year-old patient was admitted with dehydration. The nurse assesses and documents observations that support a finding of dementia. Which of the following observations are related to dementia? (Select all that apply.) a. Forgetting what she ate for lunch today b. Crying frequently when alone c. Inability to find her way back to her room from the dayroom d. Being impatient with the nursing staff for not closing her door e. Repeatedly asking to call her son ANS: A, C, D, E Common manifestations of dementia include repeated questions and statements, forgetting to pay bills or take medications, increasing problems with orientation, and geographic disorientation.

Other symptoms of AD include pervasive forgetfulness and memory loss, language deterioration, impaired ability to mentally manipulate visual information, poor judgment, confusion, restlessness, and mood swings. Personality changes may include apathy or loss of interest in previously enjoyed activities. Crying is not a classic sign of dementia, although depression often accompanies dementia and this could be a sign of depression.

DIF: Remembering (Knowledge) REF: Page 569 OBJ: 27-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 3. The nurse is caring for an older adult patient admitted to the hospital. What assessment findings place the patient at risk for developing delirium during the hospitalization? (Select all that apply.) a. The patent takes medications to manage several chronic illnesses. b. The patent has a history of urinary tract infections. c. The patent is in cancer remission. d. The patent has recently been eating poorly. e. The patent experienced a mild heart attack 2 years ago.

ANS: A, B, D The risk factors for delirium include advanced age, central nervous system diseases, infection, polypharmacy, hypoalbuminemia, electrolyte imbalances, trauma history, gastrointestinal or genitourinary disorders, cardiopulmonary disorders, and sensory changes. These factors can lead to physiologic imbalances increasing the risk for confusion. Cancer remission and a heart attack 2 years prior do not increase the patients risk.

DIF: Remembering (Knowledge) REF: Page 569 OBJ: 27-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 4. A home care nurse is visiting a patient with moderate cognitive impairment from Alzheimer disease. The patients partner expresses concern about difficulty getting the patient to eat properly. The nurse suggests which of the following? (Select all that apply.) a. Serving meals at the same time each day b. Offering liquids in place of solid foods when possible c. Offering a calorie-dense snack at bedtime d. Cutting food into bite-sized pieces that will fit into the patients hand

e. Asking the patent to identify favorite foods ANS: A, C, D It is important to support the ongoing nutrition of individuals with dementia because they may experience decreased hunger and ability to taste food. People who demonstrate symptoms of moderate to severe cognitive impairment may benefit from having meals in the same place at the same time each day. Small, frequent, nutritionally dense meals and snacks should be provided.

During later stages of dementia, individuals may need to be reminded to open the mouth and chew. Food should be soft and cut in small pieces. Liquids do not need to be substituted for solid food. The patient may not be able to identify favorite foods, and asking may cause frustration.

Chapter 30 Delirium and Dementia MULTIPLE CHOICE 1. The nurse clarifies that perception differs from cognition in that perception refers mainly to: a. intellect. b. memory. c. judgment. d. interpretation.

ANS: D Perception refers mainly to the ability to interpret situations in the environment.

DIF: Cognitive Level: Comprehension REF: 180 OBJ: 1 TOP: Perception vs. Cognition KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 2. The nurse suspects the presence of cataracts in the older adult when the patient: a. holds the newspaper a good distance away while attempting to read small print. b. seeks an area in a room that is free from glare in order to read the newspaper.

c. holds a hand over one eye while attempting to read small print. d. uses only peripheral vision while attempting to read a newspaper.

ANS: B Cataracts blur the vision and increase the sensitivity to glare.

DIF: Cognitive Level: Analysis REF: 181 OBJ: 2 TOP: Cataracts KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse approaching a patient who has profound hearing loss should: a. knock on the door before entering. b. touch the patient on the hand to gain attention. c. give the patient a list of interventions that the nurse plans to perform. d. speak in a higher tone of voice.

ANS: B Touching on the hand to gain attention before giving care is thoughtful. Giving a lengthy list is not necessary. Knocking on the door may be futile, and speaking in higher tones is not helpful because the hearing-impaired lose the ability to hear high tones first.

DIF: Cognitive Level: Comprehension REF: 183 OBJ: 7 TOP: Hearing Impairment KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. When attempting to communicate with a patient who is hearing-impaired, the nurse should remember to: a. keep the message simple. b. provide lengthy explanations and information. c. assume understanding if the patient does not ask for clarification.

d. use many hand gestures.

ANS: A Keeping the message simple will assist the hard of hearing to understand. Long explanations and the use of many hand gestures may be confusing. It is the responsibility of the nurse to check to confirm understanding.

DIF: Cognitive Level: Comprehension REF: 183 OBJ: 7 TOP: Communication with the Hearing-Impaired KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. In adapting the environment for a person with right-sided hemianopsia, the nurse should: a. approach the patient from the right side. b. arrange personal articles on the left side of the bed. c. remind the patient to avoid turning his or her head to reduce added perceptual problems. d. touch the patient on the right side to get his or her attention.

ANS: B Arrangement of personal items on the good left side is supportive to independence.

DIF: Cognitive Level: Application REF: 184 OBJ: 7 TOP: Hemianopsia KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The night nurse hears a high whistling noise coming from the hearing aids that are lying on the bedside table of the sleeping patient. The nurse should: a. replace the hearing aids in the patients ears.

b. turn off the hearing aids. c. place the hearing aids in a drawer to prevent loss. d. ask that an audiologist be notified of the problem.

ANS: B The noise is feedback between the two active hearing aids. They should be turned off to preserve the batteries.

DIF: Cognitive Level: Application REF: 185 OBJ: 7 TOP: Hearing Aids KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 7. The nurse interprets a patients behavior changes as being characteristic of delirium because: a. the onset of the behavior was rapid. b. there is no change in the level of consciousness. c. of the absence of disorientation. d. of the absence of hallucinations.

ANS: A Delirium comes on suddenly and is accompanied by a change in the level of consciousness, disorientation, and hallucinations.

DIF: Cognitive Level: Application REF: 186, Table 10-1 OBJ: 4 TOP: Delirium KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. The nurse is aware that conditions that can cause delirium in the older adult include: a. uncontrolled pain. b. death of a loved one. c. relocation to a long-term care facility.

d. altered sleep patterns.

ANS: A Delirium results from physiological influences such as uncontrolled pain, metabolic disturbances, or drug toxicity.

DIF: Cognitive Level: Analysis REF: 186 OBJ: 3 TOP: Delirium KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. The nurse recognizes a cardinal indicator that the patient with stage 1 dementia has deteriorated to stage 2 by the presence of: a. inability to communicate. b. incontinent episodes. c. total dependency. d. forgetfulness.

ANS: B Incontinent episodes are indicative of stage 2 dementia.

DIF: Cognitive Level: Application REF: 188 OBJ: 4 TOP: Stages of Dementia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. The nurse can provide continuity for the demented patient in a general hospital by: a. keeping the patient in the room. b. reducing environmental stimuli such as the TV or radio. c. assigning the same personnel every day for care. d. attaching a bed alarm to the patient.

ANS: C Assigning the same personnel helps the demented patient have continuity of care.

DIF: Cognitive Level: Application REF: 189 OBJ: 7 TOP: Dementia KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 11. When the demented resident in a long-term care facility becomes combative when being prepared for a bath in the shower, the nurse should: a. call for assistance to complete the shower. b. say, I understand you dont want a shower, so Ill give you a sponge bath. c. medicate the patient with a sedative and complete the bath when the patient is more cooperative. d. say, Okay. Its your right to remain dirty.

ANS: B Focusing on feelings or offering an alternative is helpful with a combative demented patient.

Arguing serves no purpose other than to make the resident more upset.

DIF: Cognitive Level: Application REF: 189 OBJ: 7 TOP: Combative Patient KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 12. The nurse explains to a family that current Omnibus Budget Reconciliation Act (OBRA) guidelines allow the use of antipsychotic medication as a chemical restraint to control: a. disruptive verbal behavior. b. constant yelling and screaming. c. hallucinations. d. disorientation.

ANS: B The current OBRA prohibits the use of antipsychotic drugs to control nonaggressive behavior.

However, antipsychotic drugs may be prescribed for the control of constant screaming and yelling.

DIF: Cognitive Level: Application REF: 190 OBJ: 7 TOP: Use of Antipsychotic Drugs KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 13. When the patient with a cognitive disorder acts out because of excessive stimulation, the nurses most effective intervention would be to: a. medicate with a psychoactive drug such as lorazepam or diazepam. b. send the patient to his or her room for time out. c. remind the patient that acting out behavior will not be tolerated. d. distract the patient with a quiet activity.

ANS: D Distraction with a quiet activity and with interpersonal contact frequently interrupts acting out.

DIF: Cognitive Level: Application REF: 191 OBJ: 7 TOP: Acting Out Behavior KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 14. When the home health nurse is helping a family accept the diagnosis and prepare for the patient with a cognitive disorder, the nurse should: a. leave them literature about the disorder. b. instruct them about the physiological changes that cause the disorder. c. allow them time for expression of their feelings and grief. d. discuss options for placement in a long-term care facility.

ANS: C Allowing time for expression of their feelings will help the family cope and begin planning how best to care for their loved one.

DIF: Cognitive Level: Application REF: 191 OBJ: 3 TOP: Impact of Cognitive Disorder on Family KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 15. To help a male patient with expressive aphasia communicate, the nurses most effective intervention would be to: a. provide flash cards with text and pictures. b. be patient and ask him to repeat himself. c. encourage him to practice slow speech. d. arrange with him to blink the eyes once for yes and twice for no.

ANS: A Flash cards or pen and paper help the patient with expressive aphasia communicate. Blinking only allows the patient to answer, not communicate needs.

DIF: Cognitive Level: Comprehension REF: 194 OBJ: 7 TOP: Expressive Aphasia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 16. The nurse in an extended care facility finds an 86-year-old female resident in tears and her hearing aids on the floor. The resident says, Ill just be deaf! I cant stand those things in my ears!

All I can hear is static, hums, and whistles! The nurses most helpful response is: a. Everybody says that. Im going to put these back in the box in your bedside table.

b. Those are very expensive pieces of equipment. Because you paid for them, it seems to me to just be good sense to use them. c. Lets put them back in. Youll get used to them in a few days. d. Its frustrating to have something not work. Let me help you replace them and after 10 minutes, Ill help you take them out.

ANS: D Many people who have new hearing aids report that the sounds are tinny and noisy. When first fitted, the person may be able to tolerate the hearing aids for only a few minutes a day.

DIF: Cognitive Level: Comprehension REF: 184 OBJ: 7 TOP: Hearing Aid Adjustment KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. The nurse reading the history of a newly admitted 88-year-old man with dementia sees that this resident is prone to catastrophic reactions. The nurse understands that this person will: a. demonstrate excessive emotional reactions. b. become combative with little stimulus. c. suddenly display self-destructive behaviors. d. openly expose himself or make sexual advances.

ANS: A Catastrophic reactions are reactions that are excessively emotional.

DIF: Cognitive Level: Comprehension REF: 188 OBJ: 3 TOP: Catastrophic Reactions KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 18. An 84-year-old female resident with dementia in an extended care facility rapidly paces the halls and the common areas from right after breakfast to bedtime. The nurse should include in the plan of care to:

a. restrain the resident from pacing. b. apply a bracelet that sounds an alarm if the resident leaves the building. c. encourage rest by asking her to sit and have a glass of juice or a snack. d. pace with her and engage her in conversations.

ANS: C Encourage rest periods during the day by offering a snack or juice. Pacers should not be restrained from pacing. An alarm bracelet is not necessary if no attempt to leave the building is made. Pacing with her does not result in rest periods.

DIF: Cognitive Level: Application REF: 189 OBJ: 7 TOP: Pacing KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation MULTIPLE RESPONSE 1. The nurse lists indicators of hearing loss, which include __________. (Select all that apply.) a. understanding the female voice better than the male voice b. reluctance to have telephone conversations c. becoming irritable with background noise d. turning the TV up to the loudest volume e. responding with off-the-wall answers to a question ANS: B, C, D, E Because of the higher register of the female voice and that of children, the person with a hearing impairment does not understand them well. All other options are valid indicators of hearing loss.

DIF: Cognitive Level: Comprehension REF: 182 OBJ: 4 TOP: Sensory Deficit KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The nurse is aware that memory loss in the older adult __________. (Select all that apply.) a. increases with age b. decreases in a person with more education c. increases with the use of antihistamines d. decreases with the use of vitamin A e. decreases in persons who have many varied memories ANS: A, B, E The use of vitamin A has no memory enhancement capability. Antihistamines do not have a history of being a cause of memory loss.

DIF: Cognitive Level: Comprehension REF: 182 OBJ: 2 TOP: Memory Loss KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse instructs a hearing-impaired patient on some methods to improve communication, which include __________. (Select all that apply.) a. informing others of the hearing deficit b. focusing on the speaker c. facing the speaker d. requesting the speaker to shout if necessary e. asking the speaker to repeat what is not clear ANS: A, B, C, E Shouting does not help a hearing-impaired patient to understand. All other options improve communication for a hearing-impaired person.

DIF: Cognitive Level: Comprehension REF: 185 OBJ: 7 TOP: Hearing Impairment KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

4. The nurse explains that confusion is divided into three different types, which are __________.

(Select the three that apply.) a. acute confusion b. mixed confusion c. idiopathic confusion d. generic confusion e. dementia ANS: A, C, E The three types of confusion are acute confusion or delirium, idiopathic confusion, and dementia.

DIF: Cognitive Level: Comprehension REF: 186 OBJ: 3 TOP: Types of Confusion KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse can help a demented person maintain orientation by __________. (Select all that apply.) a. consistently calling the patient by name, usually the first name b. referring the patient to a calendar to note special events c. reminding the patient about the time of day by pointing to the clock d. calmly taking the patient to an appointment without explanation e. reminding the patient of her or his whereabouts frequently ANS: A, B, C, E Demented persons need a simple explanation of all procedures involved in their care. All other options are helpful in maintaining orientation for a demented patient.

DIF: Cognitive Level: Application REF: 189 OBJ: 7 TOP: Orientation Methods KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

6. The nurse should include which factor(s) in a pain assessment? (Select all that apply.) a. What provokes it b. Location c. Radiation d. Severity e. Frequency ANS: A, B, C, D, E All options are significant parts of a pain assessment.

DIF: Cognitive Level: Knowledge REF: 197 OBJ: 8 TOP: Pain Assessment KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 7. The nurse designing a teaching plan for a family caring for an older adult who is experiencing pain would stress __________. (Select all that apply.) a. giving medication before the pain becomes severe b. distracting the patient instead of medicating c. that pain reported by the older adult may be exaggerated d. delaying administration to reduce the risk of addiction e. observing the effectiveness of the medication ANS: A, E Giving medication before pain is severe alleviates pain better and results in the patient requiring less medication. Assessment of the drugs effectiveness is important to relay to the physician in the event the drug needs to be changed or the dose increased.

Chapter 31 Living in Harmony With Chronic Conditions MULTIPLE CHOICE

1. The nurse is preparing an older widowed patient with several chronic illnesses for discharge to home. The nurse addresses the primary nursing outcome for this patient when: a. assuring the patient that social services will arrange for help with medical expenses. b. arranging for in-home assistance in areas of activities of daily living (ADLs) and nursing care as needed. c. educating the patient regarding the safety risks caused by these conditions. d. identifying barriers to ensure adherence to the prescribed drug therapies.

ANS: D A key role for the nurse caring for an older adult with a chronic condition is to help the patient achieve optimal physical and psychosocial health. Staying adherent with drug therapy can help achieve this outcome. Payment through a third party is not guaranteed. In-home assistance may or may not be needed. Education is always needed but is not the priority for achieving optimal wellness.

DIF: Applying (Application) REF: N/A OBJ: 16-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 2. The nurse is assessing patients diagnosed with chronic disease processes for the probability of hospitalization because of the exacerbation of related symptoms. The nurse recognizes that the patient with the highest probability is a(n): a. 72-year-old male with congestive heart failure (CHF). b. 82-year-old male with type 2 diabetes. c. 72-year-old female with chronic bronchitis. d. 82-year-old female with osteoporosis.

ANS: A

Individuals with chronic conditions typically have repeated hospitalizations to treat exacerbations of their illness. The most common reasons for hospitalization in older patients are heart disease, cancer, pneumonia, and stroke. The 72-year-old with CHF is at highest risk.

DIF: Remembering (Knowledge) REF: N/A OBJ: 16-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 3. An older patient has developed moderate muscle weakness on the left side as a result of a cerebral vascular accident (CVA, stroke). The nurse determines the patient possesses the healthiest view of self-wellness when heard stating: a. Ill certainly miss hiking, but I guess Ill find something else to do outdoors. b. I was getting too old to safely practice karate. c. Ive decided to take up oil painting because its difficult for me to knit. d. It was getting difficult to work in the garden anyway.

ANS: C After learning and mastering the requirements imposed by the condition, older adults often view themselves as well. With a wellness-in the-foreground perspective, the disease is only one component of their life and is not their identity, so they substitute lost abilities and resulting pleasures with others.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 16-2 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 4. A 73-year-old patient has been diagnosed with congested heart failure (CHF). The nurse provides the greatest support for this patients positive view of self-wellness by presenting information regarding: a. how to minimize the exacerbation of symptoms. b. locally available supportive services. c. the importance of adherence to medical treatment.

d. the need to report symptoms promptly.

ANS: A Many older adults now seek education about health promotion and management of their illness.

The nurse can support older adults by teaching self-care management in these areas. The other actions are also valued, but learning how to control symptoms gives patients the feeling of accomplishment.

DIF: Applying (Application) REF: N/A OBJ: 16-5 TOP: Teaching-Learning MSC: Physiologic Integrity 5. The nurse is caring for an older patient who recently immigrated to the United States from Asia. To best address the patients apparent resistance to the medical and nursing plan of care, the nurse: a. discusses the patients behavior with Asian staff members. b. researches the patients cultural views on health care. c. requests a cultural consultation from social services. d. asks family members to discuss the patients views on health care.

ANS: D Concepts of health and illness are deeply rooted in culture, race, and ethnicity and influence an individuals (and familys) illness perceptions and health and illness behavior. The patients family should have the best insight into the patients culturally biased beliefs. Discussing behavior with other staff members might be a privacy violation. Researching culture may be helpful, but each patient is an individual and should not be stereotyped. Social services may or may not be able to provide cultural services.

DIF: Applying (Application) REF: N/A OBJ: 16-5 TOP: Communication and Documentation MSC: Psychosocial Integrity

6. The nurse feels most confident that an older patient is prepared to assume self-management of new type 2 insulin-dependent diabetes when the patient: a. is heard asking her son to check the insulins expiration date. b. is able to identify the symptoms of hypoglycemia. c. asks why she needs to test her glucose levels so frequently. d. inquires why she needs to have an A1C test every 3 months.

ANS: A Adherence is greatly improved when the patient is in agreement with the treatment plan and shows a willingness to follow it. The patient is requesting help ensuring that the insulin is not expired. Knowledge about symptoms does not equate with adherence. Asking questions does not indicate adherence or not.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 16-2 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity 7. The nurse impacts the trajectory of a patients type 2 insulin-dependent diabetes best by: a. evaluating the patients ability to administer insulin appropriately. b. providing the patient with a written copy of the treatment plan. c. explaining to the patient the importance of serum glucose control. d. providing the patient with research-based nursing care.

ANS: A The illness trajectory can be modified by actions taken by the health care provider that directly affect the patients ability/interest to adhere to the treatment plan prescribed. The other actions are important but do not directly affect the illness trajectory.

DIF: Applying (Application) REF: N/A OBJ: 16-3 TOP: Nursing Process: Evaluation MSC: Health Promotion

8. An older patient diagnosed with severe osteoarthritis has recently moved in with his son ecause of a history of falls. The son describes how he and his family have eagerly assumed responsibility for meeting all Dads needs. The nurse is most concerned that this environment will result in the patient: a. developing a sense of powerlessness and possibly a loss of hope. b. becoming unnecessarily physically and emotionally dependent. c. losing his will to get better and become independent again. d. becoming resentful and argumentative with his sons family.

ANS: A With no control over the meeting of his own needs, the patient may develop a sense of powerlessness, which can result in a loss of hope. The other concerns might be a problem for some patients, but powerlessness and loss of hope remain the priority.

DIF: Understanding (Comprehension) REF: Page 286 OBJ: 16-3 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 9. To best assist an older adult patient to cope with a new diagnosis of chronic renal failure, the nurse: a. asks the patient to describe her usual coping strategies. b. provides the patient with descriptions of new coping strategies. c. initiates discussions with the patient to explain the disease. d. offers to arrange a meeting with another patient with the diagnosis.

ANS: C Understanding the illness and what to expect is directly related to the ability to cope. After the patient has information, the nurse can then assess psychosocial systems.

DIF: Applying (Application) REF: N/A OBJ: 16-3

TOP: Teaching-Learning MSC: Physiologic Integrity 10. To best help manage health care costs in older adults, the nurse entrepreneur would do which of the following? a. Create a telehealth system where nurses could check on patients daily. b. Provide local transportation services for older people to keep appointments. c. Create educational videos in multiple languages seen in the community. d. Build a nurse-run clinic to serve the homeless and underinsured population.

ANS: A The majority of health care expenditure is spent on chronic illness. Patients with chronic illnesses have multiple hospitalizations for exacerbations of their conditions. Keeping chronic conditions under control would make a difference in health care cost. A telehealth service in which nurses could assess and counsel patients daily could help accomplish that goal. The other ideas are good too, but tight control of chronic conditions is a priority.

DIF: Applying (Application) REF: N/A OBJ: 16-5 TOP: Nursing Process: Implementation MSC: Health Promotion 11. A nurse is working with a patient who was diagnosed with type 2 diabetes 4 months ago. The patients blood sugars have stayed under control. What action by the nurse is best? a. Ask the patient what barriers to wellness still exist. b. Remind the patient about the A1C in 2 months. c. Review side effects of medications with the patient. d. Ask the patient how she or he feels about diabetes.

ANS: A Older patients typically see chronic illness as one part of their lives. The nurse can support older adults by working with them to identify areas that may hinder progress along the wellness

continuum and by teaching self-care management in these areas. The nurse should assess the patients needs from his or her point of view.

DIF: Applying (Application) REF: N/A OBJ: 16-5 TOP: Nursing Process: Assessment MSC: Health Promotion 12. A nurse is assessing quality of life (QOL) in older individuals with chronic illnesses who attend a community center. What information is most important to assess? a. How many days were lost to exacerbations in the last year b. How good each individual perceives his or her QOL to be c. How burdensome the patients treatment regime is daily d. How often the patient needs to see a health care provider ANS: B QOL is individualized for each patient, and each person is the only one who can rate his or her quality of life. It is not dependent on objective measures such as number of health care visits or how many days were spent sick.

DIF: Application (Applying) REF: N/A OBJ: 16-1 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 13. Nurses should evaluate health programs based on what data? a. Effect on quality of life b. Cost-benefit ratio of service c. Adherence statistics d. Ease of following through ANS: A

Quality of life should drive treatment decisions. The patient and health care provider should set goals that are mutually acceptable and promote independence and quality of life. The other factors are considerations, but quality of life is most important.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 16-5 TOP: Nursing Process: Evaluation MSC: Health Promotion 14. A student learning about the early AIDS epidemic wonders why the patients were stigmatized. What response by the nurse was best? a. Fear of the unknown etiology b. Expense required government assistance c. Patients being ashamed of their illness d. Younger patients not having accomplishments ANS: A Stigma arises out of specific characteristics of a disease or an unknown etiology, which causes fear. In the early days of the AIDS epidemic, not much was known about transmission, which generated fear in health care workers and the general population.

DIF: Understanding (Comprehension) REF: Page 286 OBJ: 16-3 TOP: Teaching-Learning MSC: Psychosocial Integrity 15. When working with older adults with chronic illness and exacerbations, what action by the nurse is most appropriate? a. Continually assess the patients for adherence to the regime. b. Assess the patients for ways they can remain in control. c. Teach the patients about the illness trajectory. d. Routinely review all medications the patients are taking.

ANS: B

With exacerbations, the patient loses some control over an acute phase of the illness. The patient can be helped to maintain independence, control, and dignity by reassessing what is still within the patients ability and desire to control. The patient may or may not be adherent, but the nurse should not assume he or she is not. Teaching about the illness trajectory is one tool for giving control to patients. Medication reviews should be done but are not the best action.

DIF: Applying (Application) REF: N/A OBJ: 16-3 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 16. An older patient has moved into an adult childs home after an extended stay at a rehabilitation facility. The patient complains the child is now the boss and the child complains about caregiving duties. What action by the nurse is best? a. Help the older patient find another place to live. b. Suggest that it is time for assisted living. c. Mediate a family meeting to discuss roles. d. Listen empathetically but let them work it out.

ANS: C Role reversals and role changes are common in families where an older adult has chronic illnesses. These lost roles need to be mourned by all involved. The nurse helps most in this situation by mediating a family meeting where roles, coping, and feelings can be discussed. The nurse can help problem solve by assisting the individuals to identify ways in which they can keep their traditional roles, if even only for a short time.

DIF: Applying (Application) REF: N/A OBJ: 16-3 TOP: Communication and Documentation MSC: Psychosocial Integrity 17. An older adult has chronic fatigue from several illnesses. The patient is frustrated at this symptom. What action by the nurse is best? a. Ask the patient to prioritize activities.

b. Have the patient keep a fatigue diary. c. Encourage the patient to rest in the day. d. Instruct the patient on good sleep hygiene.

ANS: A Helping the patient cope with fatigue is an important nursing intervention. The nurse should first ask the patient to prioritize the activities she or he most wants to do. Then the nurse and patient can plan strategies that will allow the patient to participate in these activities. Keeping a diary is helpful, but knowing what interests the patient most is more important. Rest and sleep are important, but they are not the priorities.

DIF: Applying (Application) REF: N/A OBJ: 16-3 TOP: Nursing process: Assessment MSC: Psychosocial Integrity 18. An older patient has been admitted to the nursing unit after a car crash and surgery. When does the nurse begin planning for rehabilitation? a. On admission b. When the patient is awake c. When the patient is stable d. When the family requests it ANS: A Planning for rehabilitation, like discharge planning, begins on admission.

DIF: Remembering (Knowledge) REF: Page 289 OBJ: 16-3 TOP: Nursing Process: Analysis MSC: Physiologic Integrity 19. A home health care nurse is conducting a functional assessment on an older woman who lives alone. What assessment question is likely to get the best information?

a. How do you manage all your medications? b. Who shops and cleans your house for you? c. Can you show me how you prepare a meal? d. What parts of your body cant you wash?

ANS: C Older patients may downplay or deny functional limitations, so the nurse gets more accurate data asking what the patient is able to do, rather than what she or he is not able to do.

DIF: Understanding (Comprehension) REF: Page 290 OBJ: 16-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 20. A nurse assesses a newly admitted patient to a nursing home using the Functional Independence Measure (FIM) and rates the patient at 20. What action by the nurse is best? a. Arrange admission to a rehabilitation center. b. Plan care for a nearly dependent person. c. Plan care for a nearly independent person. d. Tells the family the patient is cognitively impaired.

ANS: B Eighteen measures are accounted for in the FIM with scores ranging from 1 (dependent) to 7 (independent). A score of 20 indicates near total dependence. The FIM does not measure cognitive status.

DIF: Applying (Application) REF: N/A OBJ: 16-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE

1. Adherence to prescribed health care treatments by a patient with a chronic disease is best facilitated when the nurse does which of the following? (Select all that apply.) a. Provides the patient with information regarding his disease b. Assesses the patients ability to understand his disease c. Defines health and wellness for the patient d. Helps the patient identify barriers to his personal wellness e. Coordinates support services to facilitate the patients discharge ANS: A, B, D, E The five As of a patients self-management of care includes assess, advise, agree, assist, and arrange.

DIF: Remembering (Knowledge) REF: Page 284 OBJ: 16-3 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 2. The student learning about chronic disease and illness in the older population learns which facts about this situation? (Select all that apply.) a. One in two adults, or more than 133,000 Americans, has a chronic condition. b. Chronic disease is the leading cause of death in those over 65. c. About 75% of medical costs each year are spent on managing chronic disease. d. Formerly acute conditions are now manageable chronic diseases.. e. The focus of Americas health care services is now on chronic illness ANS: A, B, C, D One in two adults has a chronic illness, and these problems are the leading cause of death in those over 65 and the largest cost to our health care system. One reason for this is that formerly acute, possibly fatal, conditions are now manageable as chronic conditions. Americas health care system continues to be focused on acute care.

DIF: Remembering (Knowledge) REF: Page 282 OBJ: 16-1 TOP: Teaching-Learning MSC: Physiologic Integrity 3. The nurse understands what about the Americans with Disabilities Act? (Select all that apply.) a. It outlaws discrimination on the job because of disabilities. b. It requires state governments to fund disability services. c. It prohibits discrimination in government services to the disabled. d. It requires all buildings to be retrofitted to allow access. e. It provides funding for barrier-free buildings and parks.

ANS: A, C The ADA outlawed discrimination on the basis of disability in employment, in programs and services provided by state and local governments, and in the provision of goods and services provided by private companies and commercial facilities. It does not mandate government payment for disability services, require buildings to be retrofitted, or provide funding for barrierfree facilities.

Chapter 32 Rehabilitative and Restorative Care Cha MULTIPLE CHOICE 1. What action by the nurse is most important for preventing hospital-acquired infections in the older population? a. Appropriate hand hygiene b. Rapid isolation for infection c. Strict sterile procedures d. Ensuring patient nutrition ANS: A Hand hygiene is the most effective infection control action the nursing staff can take.

DIF: Applying (Application) REF: N/A OBJ: 9-3 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 2. The nurse on a medical acute care unit is preparing for the admission of an 84-year-old patient with several diagnosed chronic illnesses. The nurse begins the plan of care for this patient based on the understanding that the older adult is likely to: a. develop hospital-induced delirium. b. require special attention related to sensory deficits. c. need a social services consult before discharge. d. present with a need for a high level of nursing care.

ANS: D The older adult is not likely to be admitted to the hospital until a high level of acuity or complications exists. The other options may be possible, but the majority of older patients are admitted at a high level of acuity.

DIF: Remembering (Understanding) REF: Page 154 OBJ: 9-1 TOP: Teaching-Learning MSC: Physiologic Integrity 3. The nurse is planning the discharge of a 70-year-old patient who lives alone and is recovering from a fractured ankle. What action by the nurse shows an understanding of factors affecting the patients ultimate return to preinjury function? a. Encourages the patient to comply with recommendations made by the physical therapist b. Arranges for the patients meals to be delivered daily for several weeks after discharge c. Assesses the barriers to self-ambulation that exist in the patients home d. Educates the patient on the importance of a diet that promotes both bone and muscle healing ANS: C

In the hospital setting, health care professionals can become so involved in addressing the acute condition that they fail to appreciate the underlying problems and how these too influence the patients health and recovery. Assessing for ambulation barriers in the patients home has a longterm effect on the patients ability to regain independence.

DIF: Understanding (Comprehension) REF: Page 154 OBJ: 9-1 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 4. The nurse in an acute care facility is caring for a patient recovering from a cerebral vascular accident that has resulted in a mild loss of muscle function in his right arm and leg. The nurse is best addressing the patients need via the functional model of care when: a. assessing the patients right-sided muscle strength daily. b. reaffirming to the patient that physical therapy will improve his muscle strength. c. instructing the patients family on how to properly assist the patient in walking. d. placing the telephone where the patient can reach it with his left hand.

ANS: D The functional models main goal may not be curing the disease but managing the disease, with a focus on self-care and symptom management strategies. Placing the telephone where the patient can reach it for himself is an example of a symptom management strategy. The other actions do not increase the patients functional abilities.

DIF: Applying (Application) REF: N/A OBJ: 9-2 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 5. The nurse is caring for an older adult patient who was admitted with a stage 3 pressure ulcer on the left heel and who also has a history of Parkinson disease and chronic renal failure. To minimize the patients risk of developing an iatrogenic illness, the nurse: a. uses sterile technique when changing the heels dressings. b. reviews all the patients medications for possible adverse reactions.

c. instructs the patient to call for assistance when needing to go to the bathroom. d. assists the patient in choosing the appropriate foods from the daily menu.

ANS: B Adverse drug reactions frequently precipitate hospitalizations and, although often unreported, are among the most common iatrogenic events in the acute care setting. The hospital staff needs to get an accurate drug history of a patient, be aware of pharmacokinetic and pharmacodynamic changes related to aging, and have a working understanding of drug-disease, drug-drug, and drug-food interactions in older adults. Nurses should be particularly aware of drugs that may be high risk when used in older adults. The other actions are important for patient safety, but the more frequent cause of iatrogenic problems is related to medication use.

DIF: Understanding (Comprehension) REF: Page 154 OBJ: 9-3 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 6. The nurse best addresses the possible intrinsic factors that contribute to falls experienced by older adult patients in an acute care setting by: a. encouraging patients to wear their glasses. b. keeping a low-level light on in the room at night. c. keeping the patients bed low to the floor. d. assessing the room for clutter on the floor.

ANS: A Risk factors for hospital falls include both intrinsic and extrinsic factors. Intrinsic factors include age-related physiologic changes and diseases, as well as medications that affect cognition and balance. The other actions are important safety measures that are helpful to some patients as well, but good vision is critical for safety.

DIF: Understanding (Comprehension) REF: Page 154 OBJ: 9-6 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

7. The nurse caring for an older patient is concerned when the patient begins experiencing mild confusion. The nurse notes that the vital signs are all within normal limits for this patient. To best assess related symptoms, the nurse initially: a. asks the patient to Squeeze my hand as hard as you can. b. reviews documentation about how the patient has been eating. c. reviews the patients medication for possible adverse reactions. d. asks the patients daughter if her mother has been confused before.

ANS: B Anorexia is a symptom of urinary tract infection, which occurs frequently in older adults.

Subclinical infection and inflammation can occur with presenting symptoms such as acute confusion, functional capacity deterioration, anorexia, or nausea rather than the classic symptoms of fever and dysuria. Although all actions are appropriate, the nurse suspecting a urinary tract infection (UTI) will assess eating patterns.

DIF: Applying (Application) REF: N/A OBJ: 9-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 8. The nurse is caring for a confused patient. Which action by the nurse shows the best understanding of managing the cascading effects of iatrogenic illnesses in this population cohort? a. Reorienting the patient to person, place, and time frequently b. Offering the patient liquids each time there is patient-nurse contact c. Repositioning the patient every 2 hours d. Using restraints to ensure patient safety only as a last resort ANS: D Once older adults are hospitalized, immobilization through enforced bed rest or restraint often results in functional disability, and the subsequent occurrence of iatrogenic illnesses often represents a vicious circle, referred to as the cascade effect, in which one problem increases the

persons vulnerability to another one. Gerontologic nurses must be leaders in advocating more appropriate care and treatment of hospitalized older adults to prevent or at least reduce the occurrence of iatrogenic illness. The other actions are good nursing care but do not relate to the cascade effect.

DIF: Applying (Application) REF: N/A OBJ: 9-3 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 9. An 80-year-old patient with visual and hearing deficits is admitted for hip replacement surgery. The patient has begun to show mild confusion and has become resistant to care and treatment. To minimize this problem, the nurse initially edits the patients care plan to include: a. frequent reorientation to people in the patients environment. b. putting on the patients glasses and hearing aid as a part of activities of daily living (ADLs). c. assigning the same staff to provide patient care whenever possible. d. minimizing the number of off-unit trips for the patient.

ANS: B Older adults have a decreased ability to negotiate within and adapt to an unfamiliar environment, which can be initially minimized by the use of hearing aids and eyeglasses, for example. The other actions may be appropriate, but until the sensory deficit is corrected, the patient will most likely remain confused.

DIF: Applying (Application) REF: N/A OBJ: 9-3 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 10. What action by the nurse best shows an understanding of the effects of acute hospitalization on the functional abilities of the older patient? a. Setting goals that support a short hospitalization. b. Attempting to adapt nursing care to individual needs

c. Administering a systematic functional assessment d. Assessing for a decline from original baseline function ANS: D The nurse should assess for new onset signs or symptoms of a decline from baseline function and then implement appropriate interventions before they trigger a downward spiral of dependency and permanent impairment.

DIF: Understanding (Comprehension) REF: Page 156 OBJ: 9-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 11. Which statement by a resident best indicates that the residents psychosocial needs are being met? a. Im really enjoying the opportunity to select my own mealtimes. b. I miss being at home, but I understand why I must live here. c. I appreciate being placed on the waiting list for a private room because I prefer living alone. d. Im an independent person who has always made my own decisions, and I will for as long as I can.

ANS: A Psychosocial needs are best met when a patient is encouraged to be independent both physically and mentally. Making choices is a good example psychosocial needs being prioritized.

DIF: Understanding (Comprehension) REF: Page 169 OBJ: 9-4 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 12. A 70-year-old patient covered by Medicare is being admitted for stabilization of type 2 diabetes. When asked by the family why their parents care is being co-managed by a geriatric nurse practitioner and a physician, the best explanation is that:

a. the geriatric nurse practitioner is specially trained to work with older patients. b. research has shown that this care model often results in shorter hospital stays. c. the physician and nurse practitioner will focus on different needs. d. Medicare encourages this team concept of patient care.

ANS: B Some studies demonstrate a significant decrease in the length of stay when patients are comanaged by a nurse practitioner and an attending physician.

DIF: Understanding (Comprehension) REF: Page 177 OBJ: 9-4 TOP: Teaching-Learning MSC: Safe Effective Care Environment 13. The nurse is going to educate an older patient newly diagnosed with type 2 diabetes on how to test serum glucose levels appropriately. The nurse shows an understanding of the adaptation of teaching techniques for this age group by: a. providing both written and verbal instructions on the skill. b. asking the patient if he has any hearing or vision deficits. c. restating the important points several times. d. asking the patient to describe the proper technique in his own words.

ANS: B This population often experiences sensory deficits that can affect their learning capacity. The other actions are also appropriate, but if the patient has sensory deficits, they must be addressed before teaching begins.

DIF: Understanding (Comprehension) REF: Page 169 OBJ: 9-7 TOP: Teaching-Learning MSC: Physiologic Integrity

14. The nurse at an assisted living facility is caring for a 73-year-old cognitively impaired patient who has recently been admitted. The nurse creates a care plan that strives to help maintain the patients independence by including: a. sufficient time for the patient to complete self-care. b. encouraging the patient to make decisions regarding self-care. c. regular assessment of the patients ability to provide self-care. d. regular cueing by staff to direct patient self-care.

ANS: D Cognitively impaired individuals often need supervision and cueing rather than physical assistance to perform ADLs and instrumental activities of daily living (IADLs).

DIF: Understanding (Comprehension) REF: Page 158 OBJ: 9-4 TOP: Communication and Documentation MSC: Health Promotion 15. An older patient has fallen twice in the hospital in the last 2 days. What action by the nurse is best? a. Request restraint orders from the provider. b. Assess the patient for undiagnosed illness. c. Remind the patient to call for help getting up. d. Have a family member stay with the patient.

ANS: B Falls are commonly associated with a new onset of illness in the older patient. The nurse assesses for this possibility. Restraints are a last resort. The patient may be too confused or forgetful to remember to call for help, plus this places the responsibility for safety on the patient. Family members may not be present or able to stay with the patient continuously.

DIF: Applying (Application) REF: N/A OBJ: 9-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity 16. A nurse is caring for an older patient in the intensive care unit. The patient has a sudden onset of confusion. What action by the nurse is best? a. Request a sedative from the provider. b. Attempt to reorient the patient. c. Perform a sepsis screening. d. Review lab work for today.

ANS: C The most common presenting sign of sepsis in the older adult is confusion. The nurse assesses the patient for this condition. Sedatives and restraints are a last resort. The nurse should attempt to reorient the patient, but this is not the most important action. The nurse should also review lab work, but current assessments are more important.

DIF: Applying (Application) REF: N/A OBJ: 9-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 17. Which individual would the nurse refer to the local Area Agency on Aging? a. One who needs housekeeping services b. One who needs help with preparing taxes c. One who needs nutritious meals d. One who needs long-term care placement ANS: C The AAA provides resources for community members on information and referral for medical and legal advice; psychologic counseling; preretirement and postretirement planning; programs to prevent abuse, neglect, and exploitation; programs to enrich life through educational and social activities; health screening and wellness promotion services; and nutrition services. The patient needing nutritious meals would most benefit from this agency.

DIF: Understanding (Comprehension) REF: Page 160 OBJ: 9-4 TOP: Communication and Documentation MSC: Safe Effective Care Environment 18. The nursing faculty explains to students the definition of homebound. Which is the best explanation of this situation? a. A person uses a wheelchair for all mobility. b. A person desires services provided at home. c. Leaving home requires great effort. d. No local agency is available to provide service.

ANS: C Homebound implies that a person could leave the home for a legitimate medical reason, but he or she must exert a great deal of effort to do so. Being in a wheelchair does not in itself cause a person to be homebound, nor does requesting home services or not having another agency to provide services elsewhere.

DIF: Understanding (Comprehension) REF: Page 162 OBJ: 9-9 TOP: Teaching-Learning MSC: Health Promotion 19. A patient is on hospice care. Which situation would result in an acute hospitalization? a. Progression of disease b. Intractable pain c. New pressure ulcer d. Bladder infection ANS: B

Inpatient care is available when the patient experiences acute or severe pain or symptom management problems. The other conditions are managed without acute hospitalization.

DIF: Remembering (Knowledge) REF: Page 167 OBJ: 9-12 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 20. Which action does the nurse delegate to the unlicensed assistive personnel (UAP) pertaining to pressure ulcer prevention? a. Assessing the patients skin daily b. Keeping the patients skin clean and dry c. Obtaining a special overlay mattress d. Monitoring the patients nutritional status ANS: B The nurse can delegate keeping a patients skin clean and dry to the UAP. The other actions are within the nurses scope of practice.

DIF: Applying (Application) REF: N/A OBJ: 9-17 TOP: Communication and Documentation MSC: Safe Effective Care Environment MULTIPLE RESPONSE 1. A nurse is caring for a confused and frail patient. Which interventions will best minimize the patients risk of injury related to the geriatric triad? (Select all that apply.) a. Respond to the patients call bell promptly. b. Ensure the bed alarm is on at all times. c. Remain with the patient when eating. d. Assess elimination needs every 2 hours while the patient is awake.

e. Offer the patient fluids during each visit.

ANS: A, B, D The geriatric triad includes falls, changes in cognitive status, and incontinence. Responding promptly to call lights, assessing for elimination needs, and having bed alarms limits falling.

DIF: Applying (Application) REF: N/A OBJ: 9-6 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 2. The nurse explains to the student the benefits of home health care. Which are benefits typically associated with this care? (Select all that apply.) a. Less exposure to iatrogenic risks b. Less chance of becoming confused c. Better management of chronic conditions d. Better reimbursement from Medicare e. Patient remains in control of environment ANS: A, B, C, E Many benefits exist for home health care including less risk of iatrogenic illness/injury, less chance the patient will be acutely confused by the change of environment, better long-term management of chronic conditions, and control of the environment by the patient.

DIF: Understanding (Comprehension) REF: Page 162 OBJ: 9-9 TOP: Teaching-Learning MSC: Physiologic Integrity 3. What actions by the nursing staff in a long-term care facility display an awareness of resident rights? (Select all that apply.) a. Getting informed consent for the use of an antipsychotic medication b. Reminding the unhappy resident and family about grievance processes

c. Ensuring that all residents are asked if they wish to vote in an election d. Giving residents information on the ombudsmans name and address e. Assessing residents for their ability to safely administer their medications ANS: A, B, C, E Long-term care facilities are responsible for honoring the many rights of their residents, including setting up informed consent processes for side rails and chemical restraints, having a posted grievance policy and process, pursuing the residents right to vote, assessing residents for the ability to safely administer their own medications, and posting information about the ombudsman program. pter 33 Acute Care

Chapter 34 Long-Term Care MULTIPLE CHOICE 1.The home health nurse is assisting a family to select a long-term care facility for an 80-yearold widow in good health who no longer drives, loves to play cards, can ambulate with a walker, and is oriented. Which facility would be the best selection for this patient? a. Subacute unit setting b.Long-term care facility (nursing home) c. Assisted living center d.Continuing care retirement center (CCRC) ANS: C The assisted living center provides meals, transportation, social interaction, and a home-like quality without the intrusion of the medical model. The patients age does not make her a reasonable candidate for a CCRC. The patient does not require acute skilled nursing care.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1184 OBJ:2TOP:Long-term care

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 2.The home health nurse helps an older adult couple plan changes in their home that will facilitate care in their home as they age. What percentage of people over 65 live in a home setting? a. 42% b.48% c. 55% d.67% ANS: D The majority (67%) of people over the age of 65 live in a home or family setting.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1181 OBJ:2TOP:Long-term care KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 3.The nurse confirms that the cost of caring for a relatively unimpaired older adult in a private home is approximately what fraction of the cost of placing the older adult in a long-term care facility? a. b.1/3 c. d.2/3 ANS: C It costs approximately half as much to care for an older adult at home as it would cost in a longterm care facility.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1182 OBJ:4TOP:Long-term care

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 4.What is the goal for services provided by home health care agencies? a. Self-care b.Assisted living c. Rehabilitation d.Improved function ANS: C Services provided by home health care agencies are aimed at rehabilitation.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1182 OBJ: 8 TOP: Home health KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 5.The nurse clarifies to the family of a patient that one of the roles of the LPN/LVN in the home care setting is to evaluate the care provided to the patient by which provider? a. The family b.Other licensed care providers c. Nonlicensed staff d.The physician ANS: C One of the roles of the LPN/LVN in the home care setting may be to evaluate the care provided

by CNAs, HHAs, homemakers, and personal care attendants.

PTS: 1 DIF: Cognitive Level: Application | Cognitive Level: Comprehension REFage 1183OBJ:7TOP:Home health KEY:Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

6.The family caring for an older adult in their home feels that they need assistance from a hospice service. What is necessary for hospice service to be initiated? a. A family request b.A patient request c. Medical certification d.A referral by a hospice nurse ANS: C Hospice agencies provide care at the end of life. Medical certification is required for terminal care.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1183 OBJ: 8 TOP: Hospice KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 7.The nurse suggests to a family caring for a member with early Alzheimer disease in their home that they investigate the services of an adult day care center. What is a major benefit of adult day care centers? a. It takes the patient out on recreational outings. b.It can provide daily hygiene. c. It expands social interaction. d.It is free to the public.

ANS: C Adult day care centers are open a large part of the day and offer several modalities to enhance social interaction and also give the family respite.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1183 OBJ:8TOP:Adult day care KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance 8.What differentiates the services of a long-term care facility from that of an assisted living facility? a. Skilled nursing care b.Personal care services c. Weekly visits by the staff physician d.Intensive rehabilitation services ANS: B Assisted living is a type of residential care setting where the resident receives personal care services.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1184 OBJ:8TOP:Long-term care KEY:Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 9.What would be the most appropriate guidance the nurse could provide an older adult couple that is considering a continuing care retirement community (CCRC)? a. Admittance is limited to people who are relatively unimpaired. b.A contract is usually a lifetime commitment. c. A contract is an acceptable tax shelter. d.Contracts can be signed on a month-to-month basis.

ANS: B CCRCs offer a complete range of health care services, from independent living to 24-hour skilled nursing. In most cases, signing a contract with a CCRC is a lifetime commitment.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1185 OBJ:8TOP:Long-term care

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 10.An 82-year-old patient recovering from a hip replacement could be expected to move from the acute care hospital to which setting for rehabilitation? a. A subacute care unit b.An assisted living center c. An adult day care center d.A continuing care retirement community ANS: A Subacute units have a strong rehabilitative focus and a shorter length of stay than a long-term care center.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1185 OBJ: 1 TOP: Subacute KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 11.What is the correct term for people who live in long-term care facilities? a. Patients, because they will be receiving acute care b.Residents, because the facility has become their home c. Patients, because they seek professional medical services d.Customers, because they are purchasing care service ANS: B The older adult in a long-term care facility is referred to as a resident to reinforce the home-like environment.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1186 OBJ:2TOP:Long-term care KEY:Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

12.Which statement is true concerning a 50-year-old patient recovering from a stroke who is going to a long-term care facility for a short stay? a. Her regular hospitalization insurance will pay for the care. b.She will still have daily physician visits. c. She will need to contract outside physical therapy services. d.She will probably be discharged within 6 months.

ANS: D A short-stay resident in a long-term care facility for rehabilitation will have residential physical therapy services and will usually be discharged within 6 months. Regular hospitalization insurance does not cover long-term care. Daily physician visits do not occur in the long-term care facility.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1186 OBJ:2TOP:Long-term care KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 13.In the long-term care facility, health care professionals work together to meet the needs of older adults and to go over the care plan with the resident and family members. What is this approach called? a. Team approach b.Individualized approach c. Interdisciplinary approach d.Outgoing approach ANS: C The long-term care facility is an interdisciplinary setting.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1186 OBJ: 7 TOP: Long-term care KEY: Nursing Process Step: N/A MSC:NCLEX: N/A

14.What is the time limit for the legal administration of medications? a. 30 minutes b.1 hour c. 90 minutes d.2 hours ANS: D In long-term care, there is a 2-hour window for legal administration of medications, 1 hour before and 1 hour after the official administration time.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1187 OBJ:3TOP:Long-term care KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 15.The Omnibus Budget Reconciliation Act (OBRA) defines the requirements for which aspect of care as it relates to long-term care? a. Nursing care b.Nutritional support c. Quality of care d.Staffing requirements ANS: C OBRA defines requirements for the quality of care given to residents of long-term care facilities.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1188 OBJ:3TOP:Long-term care KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 16.The Health Care Financing Administration (HCFA) conducts unannounced institutional surveys annually to assess the quality of life for the patients. The findings of the surveys are reported to:

a. various licensing boards. b.facility administrators. c. the public. d.the U.S. Department of Health and Human Services.

ANS: C Surveyors are required by law to visit the long-term care facility unannounced, on an annual basis and as needed, and the report is made public.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1188 OBJ:3TOP:Long-term care KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 17.A 48-year-old long-term care facility resident expresses concern that the cost of his care has used up his assets. For what program should the nurse suggest that the resident apply to cover the continued cost of living in a long-term facility? a. Medicare b.Hospitalization insurance c. Medicaid d.Public health funds ANS: C When adults have used all of their assets, they may then qualify for Medicaid. Medicaid is a federally funded, state-operated program of medical assistance for people with low incomes.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1188 OBJ:3TOP:Long-term care KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 18.Although the Occupational Safety and Health Act (OSHA) increases the cost of care, what is a benefit that it provides for long-term care? a. It ensures a safe environment for personnel.

b.It ensures that medications are administered safely. c. It ensures that food is prepared safely. d.It ensures safe ambulation and transportation of patients.

ANS: A The OSHA guidelines significantly increase costs, but they also ensure a safe environment for personnel, which is mandatory today.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1188 OBJ: 3 TOP: Long-term care KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 19.A nurse helps a family understand that once hospice service is initiated, the focus of care changes from rehabilitation and restoration to what type of care? a. Maintaining the patient at the optimal level b.Assisting with funeral planning c. Relieving the family of care d.Maintaining comfort as death approaches ANS: D Hospice care is focused on the provision of comfort to the person who is approaching death.

While hospice will assist with funeral planning as needed, it is not the focus of care. Hospice provides respite for the family, but hospice does not relieve the family of care duties.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1183 OBJ: 8 TOP: Hospice KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 20.What is included when the LVN/LPN completes the Resident Assessment Instrument (RAI)? a. Minimum Data Set (MDS) and the signature of the physician b.Resident Assessment Protocols (RAPs) and the drug list c. Minimum Data Set, Resident Assessment Protocols, and the RNs signature

d.Resident Assessment Protocols and the signature of the administrator ANS: C The RAI must be signed by the RN and contain the RAPs and MDS. PTS: 1 DIF: Cognitive Level: Application REF: Page 1189 OBJ:3TOP:Long-term care KEY:Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 21.The nurse assesses a patients ability to perform self-care activities, as well as more complex social and household activities. What is provided from this assessment? a. Physical status b.Emotional status c. Health status d.Functional status ANS: D The functional status is related to activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

PTS: 1 DIF: Cognitive Level: Application REF: Page 1189 OBJ:2TOP:Long-term care KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 22.How often does the Omnibus Budget Reconciliation Act (OBRA) require that a summary (including vital signs and weight) be obtained in the long-term care setting? a. Daily b.Weekly c. Monthly d.Yearly

ANS: C A summary, including vital signs and weight, is only required on a monthly basis.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1189 OBJ:3TOP:Long-term care KEY:Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 23.In a long-term care facility, the nurse takes an active part in formulating the residents plan of care. How often is the plan of care revised? a. Weekly b.Every 90 days c. Monthly d.Every six months ANS: B In long-term care, the residents plan of care is reviewed by the interdisciplinary team every 90 days for resolution of problems or revision of goals and interventions.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1190 OBJ:3TOP:Nursing process KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 24.The nurse recognizes that an ongoing assessment will help set priorities in the nursing care plan of a long-term care resident. What does this allow the planning process to become? a. Timely b.Patient-centered c. Preferential d.Categorized ANS: B

The planning process must be patient-centered.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1191 OBJ:6TOP:Nursing process KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 25.The long-term care facility nurse recognizes that visiting the resident, changing his or her position, assessing for incontinence, providing skin care, and offering fluids are part of the nurses responsibility. What does the initiation of these interventions provide? a. Continuity b.Safety c. Prevention d.Reassurance ANS: B Nursing interventions basic to long-term care include monitoring such safety measures as changing the residents position every two hours, assessing for incontinence, providing skin care when needed, and offering fluids.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1190 OBJ:6TOP:Nursing process KEY:Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 26.How often should the long-term care facility nurse make rounds and monitor residents for safety? a. Every 2 hours b.Every 4 hours c. Every 6 hours d.Once per shift

ANS: A Nursing interventions related to long-term care include making rounds and monitoring for resident safety every 2 hours.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1190 OBJ:7TOP:Nursing process KEY:Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 27.When a patient asks why he must be transferred to a subacute unit from the hospital, what would be an appropriate response by the nurse? a. Reimbursement guidelines limit adults stays in an acute setting. b.The physician can oversee care more closely in a subacute setting. c. Financial restrictions of insurance limit time spent in an acute care setting. d.Cost and services at the acute care setting are the same as at the hospital.

ANS: A In the acute care setting, strict rules about length of stay and limitations in cost reimbursement limit the amount of time adults can be hospitalized. These strict reimbursement rules for acute care do not apply, however, to subacute care provided in a skilled nursing facility setting.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1185 OBJ:3TOP:Nursing process KEY:Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE

28.The LPN/LVN performs which function(s) when working as a staffing coordinator of a home health agency? (Select all that apply.) a. Scheduling appropriate care providers b.Reviewing documentation c. Verifying financial coverage d.Making referrals e. Performing comprehensive assessments ANS: A, C Reviewing documentation may be done by an LPN/LVN but not in the role of staffing coordinator but as a medical chart auditor or reviewer. Scheduling care providers and verifying financial coverage are among the duties of the staffing coordinator. Making referrals and performing comprehensive assessments are duties of the RN. PTS: 1 DIF: Cognitive Level: Application REF: Page 1183 OBJ:8TOP:Staffing coordinator KEY:Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 29.The LPN/LVN suggests to the RN that the nursing care plan be modified to include referral to an adult day care center. What benefits should the client expect to receive? (Select all that apply.) a. Overnight care b.Respite care for the family c. Social interaction for the patient d.Mental stimulation for the patient e. Supporting maintenance of the ADLs ANS: B, C, D, E Overnight care is usually not offered from a day care center.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1183 OBJ:8TOP:Adult day care

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 30.A daughter is assessing a nursing home before placing her mother there for what she feels will be a long-term stay. Which of the following are important aspects of quality to consider when selecting a nursing home? (Select all that apply.) a. Privacy is respected b.Staff members are task-focused c. The staff welcomes family visits d.There is a homelike environment e. Rooms are maintained like a hospital ANS: A, C, D It is important that privacy is respected, family members are welcomed, and a homelike environment is maintained. Staff members should be resident-focused, not task-focused. Rooms should be maintained like a home instead of like a hospital.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1187, Box 37-4 OBJ: 7 TOP: Quality Indicators KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 31.What impact will the Affordable Care Act have on nursing homes and long-term care centers when fully implemented? (Select all that apply.) a. A weaker consumer complaint system b.Better training for state inspectors c. Program to support national criminal background checks d.Public disclosure of nursing home owners and operators e. Training of nursing assistants in the care of people with dementia ANS: B, C, D, E The Affordable Care Act will result in a stronger consumer complaint system, better training for state inspectors, a program to support national criminal background checks, public disclosure of nursing home owners and operators, and training for nursing assistants in the care of people with dementia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1188, Box 37-5 OBJ: 3 TOP: Federal Regulations KEY: Nursing Process Step: N/A MSC:NCLEX: N/A COMPLETION 32.The nurse explains to a patient that shopping, using a phone, and administering his own medications are classified as ____________ activities of daily living.

ANS: instrumental IADLs are more complex skills than ADLs and indicate a higher level of independent functioning.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1184 OBJ: 8 TOP: Instrumental activities of daily living (IADLs) KEY:Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 33.When a resident who is a Muslim becomes concerned about his religiously dictated dietary requirements, the nurse may refer this concern to the long-term care ____________ department.

ANS: dietary Long-term facilities take into consideration the patients individual needs, including diet preferences. The dietary department is usually able to meet most requests.

Chapter 35 Family Caregiving

MULTIPLE CHOICE 1. While children voice concern about their father living alone after having a mild stroke that resulted in only minimal disability, the patient angrily disagrees, stating that hes always managed on his own and can do so now. The nurse can be most helpful to this family by: a. assuring them that their fathers physical limitations should not cause a safety issue. b. assisting them in identifying how they can help their father to live independently. c. offering to arrange a social service consult to arbitrate the conflict. d. suggesting that the patient accept the services of a home care aide on a short-term trial basis.

ANS: B Preserving a patients autonomy through independent living is vital to a patients sense of wellbeing and can often be preserved through cooperation between family members to provide the required support. If the nurse can help the family find internal or external resources to support the patients desire to live independently, that is a win-win for all involved. Assuring the family that safety is not an issue does not help resolve their anxiety. The nurse can arrange a referral but can do more to help with this situation. A short-term trial of home health services is often accepted, but it does not address the entirety of the situation.

DIF: Applying (Application) REF: N/A OBJ: 6-6 TOP: Communication and Documentation MSC: Safe Effective Care Environment 2. The physical changes that occur naturally as a result of the aging process often create an autonomy versus safety issue and is most problematic when: a. protracted reaction time increases the risk for driving accidents. b. arthritic knee and hip joints make falls more prevalent. c. eyesight diminishes, making following written instruction more difficult.

d. responding to warning alarms is affected because of impaired hearing acuity.

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

DIF: Remembering (Knowledge) REF: Page 103 OBJ: 6-2 TOP: Teaching-Learning MSC: Safe Effective Care Environment 3. When discussing stressors with the primary caregiver of an 83-year-old patient, the nurse explores the issue of dissolving familiar social boundaries when asking: a. Has it been a problem taking over the role of head of the family? b. What do you do to help relax and revitalize yourself? c. Do you find it difficult to ask for help when you need it? d. Are there any physical care tasks that you find difficult to complete?

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

DIF: Applying (Application) REF: N/A OBJ: 6-5 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 4. The family of an 80-year-old patient shares with the nurse that they are concerned that the patient is too frail to be living alone. The nurses initial intervention is to: a. help the patient express the importance of living independently to the family members.

b. assess the patients functional abilities related to being able to safely live independently. c. have the family provide specific examples of behaviors that cause them concern. d. identify ways the family can help assure the patients safety while living independently.

ANS: B The first nursing intervention is to determine through a health assessment and history the patients ability to perform activities of daily living (ADLs) safely while living independently. All actions are appropriate, but assessment is the first step of the nursing process.

DIF: Applying (Application) REF: N/A OBJ: 6-6 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 5. An older patient with cognitive impairment is being cared for by family members. They have expressed concerns about providing appropriate care as his functional level declines. The nurse responds: a. Im glad that you are interested enough in his care that youve expressed this concern. b. His abilities will certainly decline. This is the time to discuss other care options. c. You are right to be concerned. Lets talk about issues that may come up in the future. d. The condition will get worse, so think about what will happen if you cant meet his needs.

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

DIF: Applying (Application) REF: N/A OBJ: 6-6 TOP: Caring MSC: Safe Effective Care Environment 6. An older patient who lives with family has a history of chronic alcohol abuse and poor compliance with the medical plan. The patient has begun to experience a marked decline. His family tells the nurse that these problems are a result of their inability to care for the patient properly. The nurse best responds by: a. evaluating the care the family has been providing. b. suggesting that care should be assumed by a professional caregiver. c. helping the family recognize that the decline is a result of the patients condition and personal choices. d. assuring them they are providing the patient with care motivated by love.

ANS: C Family members often feel they have failed. They may need help to recognize when failures are the result of a challenging situation and not their performance. Giving objective information about the patients medical condition and the consequences of not following the medical regime can help alleviate guilt. The nurse may need to evaluate the care the patient gets, but that puts the entire responsibility back on the family, which is counterproductive. Care may need to be assumed by a professional, but the nurse should first help the family with their feelings.

Suggesting this prematurely can lead to increased guilt. Telling the family their care is motivated by love dismisses their concerns.

DIF: Understanding (Comprehension) REF: Page 107 OBJ: 6-2 TOP: Communication and Documentation MSC: Psychosocial Integrity 7. An adult child is finalizing arrangements to provide in-home care for a dependent parent. In order to best foster the long-term wellness for both the patient and the caregiver, the nurse: a. explains the patients plan of care in detail with both the patient and the caregiver. b. discusses the importance and availability of respite care.

c. encourages the patient and caregiver to seek assistance with problems as they arise. d. provides written information regarding available in-home services.

ANS: B The nurse should help caregivers recognize that caregiving is a job. Just as employees benefit from regular breaks and vacations, caregivers benefit from a break in the job. The nurse should emphasize that the need for respite care begins with the onset of caregiving. Explaining the plan of care, encouraging the family to seek assistance, and providing written information are all appropriate, but home caregivers face multiple stressors and need to care for themselves too.

DIF: Applying (Application) REF: N/A OBJ: 6-7 TOP: Communication and Documentation MSC: Psychosocial Integrity 8. An 80-year-old patient with diminishing cognitive function is being discharged into the care of his 72-year-old spouse. The nurse recognizes that besides the spouses physical ability to provide appropriate care, there is a need to evaluate the: a. couples financial resources. b. couples social support system. c. spouses cognitive level of function. d. patients long-term health prognosis.

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

DIF: Applying (Application) REF: N/A OBJ: 6-6 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

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

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

DIF: Application (Apply) REF: N/A TOP: Nursing Process: Assessment| Emotional Needs Related to Health Problems MSC: Safe and Effective Care Environment 10. The adult child of a patient diagnosed with Alzheimer disease has shared that he feels so sad that he is not able to carry on a social conversation with the patient anymore because of her loss of memory. The nurse suggests: a. keeping conversations short while focusing on things that happened in the past. b. concentrating on doing things his mother enjoys rather than focusing on talking. c. participating in support groups that offer suggestions for communication. d. allowing his mother to pick the topic and then simply being with her in her world.

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

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

DIF: Understanding (Comprehension) REF: Page 107 OBJ: 6-4 TOP: Communication and Documentation MSC: Psychosocial Integrity 11. Adult children of a patient beginning to show early signs of cognitive decline share with the nurse that they are reluctant to discuss financial issues because the patient was always private about money matters. The nurse responds most therapeutically when suggesting: a. Maybe it would less threatening to your father if a lawyer spoke to him about the matter. b. Assure your dad you are only interested in making the financial arrangements he wants. c. A social worker can discuss the financial aspects of long-term care with your dad. d. This is a conversation that has to occur in order for your father to receive appropriate care.

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

DIF: Understanding (Comprehension) REF: Page 101 OBJ: 6-7 TOP: Communication and Documentation MSC: Psychosocial Integrity 12. The nurse works with older adults to help plan for possible in-home care needs knowing that what percentage of older adults will need this type of care during their lifetimes? a. 50%

b. 60% c. 75% d. 85% ANS: D About 85% of older adults will need some type of in-home assistance during their lifetimes.

DIF: Remembering (Knowledge) REF: Page 97 OBJ: 6-1 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 13. The nurse working with older adults wonders why fewer of the aging patients seen in the clinic live with their adult children than in the past. What trend most likely explains this? a. declining birth rate b. mobility of families c. rise of assisted living d. healthier older adults ANS: A The birth rate has declined from 30.1 in 1910 to 13.8 in 2009. This trend explains why so few adult children are available to help support their aging parents. Mobility is another factor, but it is not as important as the birth rate.

DIF: Remembering (Knowledge) REF: Page 98 OBJ: 6-1 TOP: Teaching-Learning MSC: Psychosocial Integrity 14. A nurse has worked with an older adult who has mild dementia and the patients family to ensure the financial status of the older person is sound and well managed on a day-to-day basis.

The nurse knows planning was successful by assessing that: a. the parent and children are happy with the arrangements.

b. the children have the older persons checkbook themselves. c. one adult child pays all the bills and sends reports each month. d. the children were granted conservatorship and manage the money.

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

DIF: Evaluating (Evaluation) REF: N/A OBJ: 6-4 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 15. The nurse is helping an adult child transition into the role of full-time caregiver for an older parent with dementia. What action by the nurse is best? a. Ensure the child has information on long-term care. b. Help the child negotiate care issues with siblings. c. Teach the child about the parents illness. d. Offer the child information on support groups.

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

DIF: Applying (Application) REF: N/A OBJ: 6-7 TOP: Communication and Documentation MSC: Psychosocial Integrity 16. A nurse is mediating a family meeting with an older adult and four grown children. One daughter, who has three small children of her own, keeps volunteering to do tasks until she has agreed to do about 90% of what is needed for the older adult. What action by the nurse is best?

a. Praise the daughter for being so willing to do so much for her father. b. Ask the other children why they are so unwilling to help out. c. Ask the daughter if she can realistically accomplish all these items. d. Tell the daughter that she is unable to do all these things and to delegate.

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

DIF: Applying (Application) REF: N/A OBJ: 6-7 TOP: Communication and Documentation MSC: Psychosocial Integrity 17. A nurse is working with a family that is conflicted about care arrangements for an older parent who continues to live at home in less than safe conditions. What action by the nurse is best? a. Identify and enlist the help of the prime mover b. Tell the family you are calling social services c. Give the family a deadline for making decisions d. Offer to give the family tours of different facilities ANS: A Families often have a prime mover, the person who gets things done. The nurse can enlist this person to move on the decisions needing to be made. Threatening to call social services or giving deadlines will most likely result in entrenchment by the family. Offering to give tours will not help this family make decisions.

Chapter 36 End-of-Life Care

Test Bank MULTIPLE CHOICE 1. The home health nurse encourages the older adult to file an advance directive to indicate: a. the degree of intervention desired for life support. b. who is to manage medical decisions in case of debilitating illness. c. who will manage finances in case of debilitating illness. d. the mortuary to be used in the case of death.

ANS: A Advance directives indicate the degree of interventions desired for life support in the case of a terminal illness.

DIF: Cognitive Level: Analysis REF: 244 OBJ: 1 TOP: Advance Directives KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 2. The patient is attempting to make an informed decision about whether to have a life-extending treatment done. The essential piece of information that is significant in the decision is: a. whether the quality of life will improve after the procedure is done. b. the cost of the treatment. c. the amount of time treatment will take. d. whether insurance will cover the cost of treatment.

ANS: A Whether the quality of life will be improved by treatment is the most significant piece of information for making the decision. The consideration about the cost and time involved with the treatment can be addressed after the decision about the treatment has been made.

DIF: Cognitive Level: Analysis REF: 245 OBJ: 2

TOP: Life-Extending Treatments KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 3. The totally competent 76year-old female with terminal cancer is fatigued and tearful about the ineffectiveness of her treatment. She tells the nurse that she wishes she had never started it but now feels obligated to continue. The nurse explains that: a. once treatment has begun, the doctor should decide about any changes. b. she may change her mind about treatment at any time. c. decisions about treatment should be made by the person who is her medical power of attorney. d. cessation of treatment will shorten her life.

ANS: B Competent patients can change their minds about treatment options or advance directive options at any time.

DIF: Cognitive Level: Application REF: 245 OBJ: 2 TOP: Treatment Cessation KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 4. Professional health care providers may neglect to educate patients about end-of-life care because they: a. fear that patients will perceive that they are giving up. b. do not want to influence the patient in any decision. c. want to keep up the patients morale. d. believe that death is a personal failure on their part.

ANS: D Professional health care providers frequently neglect mentioning end-of-life provisions because they believe that death is a personal failure.

DIF: Cognitive Level: Application REF: 245 OBJ: 3 TOP: Caregiver Attitudes KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 5. The home health nurse is firm with an 86year-old man with terminal illness that he needs to file an advance directive to: a. demonstrate understanding of his imminent death. b. comply with most hospital policies. c. clarify treatment protocols. d. spare his family the burden of making end-of-life decisions.

ANS: D The filing of advance directives relieves the family of making those decisions at a more stressful time. It also gives back control over terminal care to the terminally ill person.

DIF: Cognitive Level: Application REF: 244 OBJ: 1 TOP: Advance Directives KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 6. The nurse is aware that hospice care can be made available to terminal patients who: a. have a life expectancy of only 12 months. b. are Medicaid-qualified. c. agree to palliative measures. d. are hospitalized.

ANS: C Hospice is a Medicare-funded program for the provision of palliative care for persons who have 6 months or less life expectancy. The service is extended to qualified persons at home, in a longterm care facility, or in the hospital.

DIF: Cognitive Level: Application REF: 246 OBJ: 5 TOP: Hospice Care KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 7. The dying patient with terminal liver cancer says to the nurse, Im going to take a long time to die, arent I? Im going to get sicker and weaker every day. The nurses best response would be: a. Your type of cancer is usually fatal in 4 to 6 months. b. I dont want to hear this kind of negative talk. Make use of the time you have. c. We have many medications that can make you feel better. d. What concerns you the most about dying?

ANS: D Using an open-ended question but being honest about terminal illness creates an interpersonal environment for effective communication.

DIF: Cognitive Level: Analysis REF: 248 OBJ: 4 TOP: Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 8. The distraught wife of a terminally ill patient complains to the nurse, My husband has not been shaved, and he has that miserable gown on instead of his own pajamas. Dont you people care about things like that? The nurses best response would be: a. I delayed his morning care because he was sleeping comfortably. Ill complete his care now that hes awake. b. Were running late today and I have six other patients to care for. What do you want? c. Of course we care! Someone will come to do his care before lunch. d. Im sorry you feel were doing such a poor job. Im doing my best.

ANS: A

Listening to criticism without defensiveness and giving a prompt response to requests with an explanation shows the nurses concern for meeting the needs of the dying person and of the distressed family members.

DIF: Cognitive Level: Application REF: 247 OBJ: 4 TOP: Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 9. When the nurse becomes tearful at the death of a patient, the nurse should: a. leave the room so that the family will not witness the unprofessional behavior. b. touch the hand of the daughter and say, Well miss your dad. c. become occupied with rearranging a floral bouquet until emotions are under control. d. discontinue the oxygen, turn off the IV, and say, Im sorry for your loss.

ANS: B Showing that the nurse is experiencing a loss also helps the family deal with their grief. Showing empathetic emotion is not unprofessional. Automatic phrases such as sorry for your loss seem insincere.

DIF: Cognitive Level: Application REF: 248 OBJ: 4 TOP: Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 10. The nurse notes that a cardiovascular sign of impending death is: a. Cheyne-Stokes respiration. b. bounding pulse. c. bluish mottling of extremities. d. widening pulse pressure.

ANS: C

As death approaches, there is vasoconstriction to the extremities to keep blood going to the heart and brain. This causes mottling of the extremities. Bounding pulse and widening pulse pressure are not seen in the dying person. Cheyne-Stokes respirations are changes seen in the respiratory system, not the cardiovascular system.

DIF: Cognitive Level: Application REF: 252 OBJ: 6 TOP: Cardiovascular Changes of Approaching Death KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. The nurse emphasizes that the objective of pain control for the dying patient is to: a. keep the patient unconscious and relaxed to avoid the perception of pain. b. delay medication until the patient reports that the pain is intense. c. find a control level that reduces pain but allows the patient to interact. d. eradicate pain completely.

ANS: C Finding a level of pain control that allows the patient to participate in care and communicate with family is the goal of pain control. Analgesics given before pain becomes intense can keep pain at a moderate level. Completely eradicating pain is usually not realistic.

DIF: Cognitive Level: Comprehension REF: 251 OBJ: 6 TOP: Pain Control KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The daughter of a dying patient is distressed about oversedation related to her mothers receiving 2 mg of morphine sulfate every hour. The nurse clarifies that this small dose of morphine is helpful in controlling the end-of-life symptom of: a. dyspnea.

b. pain. c. hallucinations. d. fatigue.

ANS: A Administering frequent, small doses of morphine sulfate is standard protocol to reduce end-oflife air hunger. One dose is not enough for euthanasia.

DIF: Cognitive Level: Application REF: 253 OBJ: 6 TOP: Dyspnea KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. To reduce the threat of aspiration in the unconscious patient who is near death, the nurse should: a. perform deep tracheal suctioning of the patient every hour. b. place the patient in a side-lying position, with the head turned to the side. c. slightly elevate the foot of the bed, with the patient in a supine position. d. give the patient only thickened fluids.

ANS: B Side-lying is a safe position for reducing the threat of aspiration. The supine position is not appropriate for aspiration reduction. Frequent suctioning is stressful to the patient, and fluids are never attempted for an unconscious patient.

DIF: Cognitive Level: Application REF: 254 OBJ: 6 TOP: Aspiration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 14. The nurse questions the order for a bulk-forming laxative for the person who is near death because the patient would need a minimum fluid intake of _____ mL to tolerate this type of drug.

a. 1000 b. 1500 c. 2000 d. 2500 ANS: C To prevent a bowel obstruction from bulk-forming laxatives, the patient must have a fluid intake of at least 2000 mL a day.

DIF: Cognitive Level: Knowledge REF: 254 OBJ: 6 TOP: Bulk-Forming Laxative KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmaceutical Therapies 15. When the dying patient becomes delirious, the nurse encourages the family to: a. leave the room and wait outside until the delirium clears. b. hold the patients hand, but say nothing, because hearing stays intact until death. c. remain near the bed and speak to the patient in loud tones to stimulate the patient. d. touch the patient, call the patient by name, and speak in reassuring tones.

ANS: D Touching, calling by name, and speaking in a calm and reassuring manner frequently cause the symptoms of delirium to abate and are beneficial to the delirious patient.

DIF: Cognitive Level: Comprehension REF: 255 OBJ: 6 TOP: Delirium KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 16. Because of diminished vision in the person who is dying, caregivers should: a. keep lights bright to increase visual acuity. b. stand slightly away from the bed and identify themselves before speaking.

c. keep all lights on in the room, day and night. d. come close to the bed and stand directly in front of the patient.

ANS: D Putting oneself directly in front of the patient, as close as possible, helps the patient with diminished vision identify the speaker.

DIF: Cognitive Level: Application REF: 255 OBJ: 6 TOP: Diminished Vision KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation MULTIPLE RESPONSE 1. The nurse is aware that end-of-life planning is often neglected because __________. (Select all that apply.) a. there is a clear procedure to follow b. people are uncomfortable talking about death c. young people do not see the need for end-of-life planning d. end-of-life planning is a relative new concept e. many persons are not really sure what they want to do ANS: B, C, D, E The options are so numerous that there is not any one clear line of action to follow. End-of-life planning is a relatively new concept that the older generation did not experience in their youth.

Persons are reluctant to talk about death issues, especially young persons, who do not see the need.

DIF: Cognitive Level: Analysis REF: 243-244 OBJ: 1 TOP: End-of-Life Planning KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

2. The holistic caregiver will bring to end-of-life care the ability to __________. (Select all that apply.) a. communicate and respond to the patients concerns about death b. embrace the value of palliative care rather than curative care c. help the patient and family face loss and grieve in anticipation of loss d. encourage the patient to focus on wellness and recovery e. collaborate with other professionals for patient support ANS: A, B, C, E The focus of palliative care is not recovery.

DIF: Cognitive Level: Application REF: 247 OBJ: 3 TOP: Palliative Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 3. The nurse reminds the 70-year-old male patient who has signed an advance directive that copies of the form should be __________. (Select all that apply.) a. given to the person who has been named as his power of attorney for medical decisions b. posted in his home for emergency personnel c. placed in his file in his physicians office d. filed with the hospital of his choice e. given to his spiritual advisor ANS: A, B, C, D The spiritual advisor is not usually considered an appropriate recipient for a copy of the advance directive. It should only be given to those who will be directly involved with health choices and require this information.

DIF: Cognitive Level: Application REF: 244-245 OBJ: 3 TOP: Advance Directives KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 4. The nurse lists the benefits of filing an advance directive, which are that this document __________. (Select all that apply.) a. is legally binding b. remains in effect until the family changes it c. prevents last-minute confusion about the wishes of the patient d. prevents violation of end-of-life choices e. clarifies end-of-life issues for the family ANS: A, C, D, E The family cannot alter an advance directive made by a patient. It is a legally binding document that clarifies and prevents violation of end-of-life choices of the patient and can only be altered by the patient.

DIF: Cognitive Level: Application REF: 244 OBJ: 2 TOP: Advance Directives KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 5. The nurse is sensitive to the fact that a persons perceptions about end-of-life care are dependent on __________. (Select all that apply.) a. age b. gender c. cultural background d. caregivers e. life experiences ANS: A, B, C, E The caregivers are there to be supportive. A persons attitude about end-of-life care is affected by his or her age, gender, cultural background, religious affiliations, and life experiences.

DIF: Cognitive Level: Comprehension REF: 245 OBJ: 1 TOP: End-of-Life Attitudes KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 6. The charge nurse on an oncology unit encourages the staff to complete a values clarification exercise to identify __________. (Select all that apply.) a. their own values b. values that influence care decisions c. values that must be abandoned or changed d. values that may cause an ethical dilemma e. negative values ANS: A, B, D A value clarification exercise neither designates any value as negative nor suggests that any value be abandoned. The exercise is to help persons gain insight into their own value system.

DIF: Cognitive Level: Comprehension REF: 245 OBJ: 3 TOP: Values Clarification KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 7. The nurse considers the provisions of palliative care, which are to __________. (Select all that apply.) a. treat symptoms of pain, dyspnea, and nausea b. promote acceptance of death c. provide CPR d. monitor mechanical ventilation machines e. enable the patient to have a better quality of life ANS: A, B, E

Providing mechanical ventilation equipment and performing CPR are not aspects of palliative care.

DIF: Cognitive Level: Comprehension REF: 247 OBJ: 3 TOP: Palliative Care KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 8. To meet the changing needs of the dying person, interservice collaboration is necessary among __________. (Select all that apply.) a. medical professionals b. social workers c. clergy d. transportation services e. dieticians ANS: A, B, C, E The dying persons needs change as their physical processes decline. Communication and collaboration among specialty services are necessary. Transportation services are not in the basic care collaboration.

DIF: Cognitive Level: Comprehension REF: 247 OBJ: 6 TOP: Collaboration KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 9. To show willingness to spend time with a dying patient and encourage communication, the nurse should __________. (Select all that apply.) a. address the patient by name at every opportunity b. use direct questions to inquire about the patients concerns relative to health and endof-life issues c. complete care with a minimum of conversation to encourage questions from the patient

d. provide empathetic touching during care to show concern e. sit down in the room to converse with patient ANS: A, D, E Use of direct questions, which only allow a yes or no answer from the patient, does not generate communication, nor does limited conversation from the caregiver.

DIF: Cognitive Level: Application REF: 247 OBJ: 4 TOP: Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 10. The nurse shares the information that the benefits of dehydration for persons near death are __________. (Select all that apply.) a. better gas exchange because of reduction of fluid in the lungs b. decreased need to suction because of reduction of respiratory secretions c. improved bowel elimination because of reduced bulk in the stool d. decreased pain related to release of endorphins e. improved drug distribution via the circulating volume ANS: A, B, D Bowel elimination and drug distribution are both reduced when the patient is dehydrated.

DIF: Cognitive Level: Analysis REF: 253-254 OBJ: 6 TOP: Dehydration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. A resident in the long-term care facility has just expired at 2 AM, and the family is on the way to say their last goodbyes. Before the arrival of the family, the nurse should __________.

(Select all that apply.) a. remove equipment (e.g., IV poles and tubing, feeding tubes, oxygen equipment)

b. dress the resident in a clean gown and cover him or her with a clean sheet c. remove dentures d. apply a diaper to catch draining body fluids e. provide privacy by drawing the curtain or moving the other resident to an unoccupied room ANS: A, B, D, E Removing the dentures give the face an unnatural appearance. All the other activities are appropriate to prepare the resident and environment after death.

DIF: Cognitive Level: Application REF: 255-256 OBJ: 6 TOP: After-Death Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 12. While working with the bereaved at the time of death, the nurse should __________. (Select all that apply.) a. review the stages of dying with them b. ensure privacy c. observe cultural and spiritual preferences d. legally pronounce the death e. allow the bereaved to express their feelings ANS: B, C, E Reviewing the stages of dying should have been addressed before the death. The physician is the individual who legally pronounces the death. Assuring privacy will allow the bereaved to say final farewells and grieve. Observing cultural and spiritual preferences will prevent the bereaved from being offended.

DIF: Cognitive Level: Application REF: 255 OBJ: 7 TOP: Bereavement KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. The role(s) of the nurse while working with the bereaved include __________. (Select all that apply.) a. guidance b. resource c. advocacy d. support e. spiritual counseling ANS: A, B, C, D Individuals are brought in as requested to meet the spiritual needs of the bereaved. The role of the nurse includes guiding the bereaved as to what needs to be done, serving as a resource for information related to death and dying, being an advocate for the deceased and their family to make requests known related to cultural and spiritual preferences, and supporting the need for privacy and emotional release at the time of death.