Gerontological Nursing, Eighth Edition , Charlotte Eliopoulos , Test BAnk

Type:

Test Bank

Resource:

Gerontological Nursing

Edition:

8th Edition

Author(s):

Charlotte Eliopoulos

Name: __________________________ Date: _____________ 1. A nurse who works on a subacute medical unit of a hospital is discussing the increasing population of older adults on the unit with a colleague. Which of the colleague's following statements about older adults is most accurate?

A) “Fortunately, Social Security ensures a sufficient level of income for people over 65.”

B) “It helps that older people don't have to directly incur any costs for their medical care.”

C) “Most of the older clients on the unit will have come to us from nursing homes.”

D) “It's reassuring that people are starting to show more concern for older adults than in decades past.”

2. A public health nurse who directs a homecare program that serves an area with a large population of older adults is conducting a long-term strategic plan. Which of the following phenomena should the nurse take into account when planning for the future?

A) While life expectancy will continue to rise, the percentage of older adults in the United States relative to the overall population will decrease.

B) By 2020, it is expected that over one-third of Americans will be over the age of 65.

C) Both life expectancy and the percentage of people over 65 in the population will increase in coming decades.

D) Chronic conditions, such as diabetes, are expected to bring a gradual decrease in the number of older adults by 2020.

3. A nurse who practices in a long-term care facility is providing care for a 101-yearold black female. The nurse's coworker states, “It's gratifying that black people in this country are finally reaching the same levels of health that white people are enjoying.” How can the nurse best respond?

A) “Actually, the difference in life expectancy between black people and white people is growing, not shrinking.”

B) “We've not yet arrived at a place where the life expectancies are equal between black and white people, but the gap is decreasing gradually.”

C) “Black women do tend to live longer than white women, but the overall life expectancies when men are included are not yet equal.”

D) “You're right. Since the 1980s the life expectancies of black and white Americans have remained nearly the same.”

Page 1

4. Which of the following phenomena most likely accounts for the fact that more women than men live alone later in life?

A) Women tend to both live longer than men and marry men older than themselves.

B) Men tend to have greater access to care facilities due to higher incomes and savings.

C) Men are more likely to live with younger family members following the death of a spouse.

D) Social pressures tend to stigmatize older men who live alone.

5. Which of the following statements most accurately captures the financial status of older adults in the United States?

A) The percentage of older people living below the poverty level has been increasing.

B) The financial needs of most older adults are well met by Social Security income alone.

C) The recent decline in housing prices has made many older adults “asset rich and cash poor.”

D) Women 65 years of age and older is the fastest growing group of employment.

6. A care aide employed on a geriatric medicine unit of a hospital expresses frustration that “old people get sick so much more often than young people.” What is the nurse's most appropriate response to this statement?

A) “In fact, the prevalence of obesity and accompanying chronic illnesses mean that young people actually have more chronic conditions than older adults.”

B) “It's actually a myth that older adults require more hospitalization than young people.”

C) “Actually, older adults experience fewer acute illnesses than younger people, it's just that they tend to take longer to recover from them.”

D) “With the increase in life expectancies in recent years, most older people actually live free of chronic diseases until very late in life.”

7. Which of following statements most accurately captures the role of chronic illness in the lives of older adults?

A) Chronic illnesses constitute the leading cause of death for older adults.

B) More older adults die from acute illnesses than from chronic diseases.

C) While chronic diseases used to be the leading cause of death, this is no longer the case.

D) While cancer rates have fallen, other chronic diseases remain a common cause of death.

Page 2

8. The board of a large chain of hospitals has commissioned a strategic plan in order to meet the care needs of baby boomers in coming years. Which of the following trends constitute a sound basis for understanding the baby boomer generation and conducting future planning? Select all that apply.

A) Baby boomers tend to have fewer children than members of earlier generations.

B) Adjusted for inflation, baby boomers have lower incomes than their parents had.

C) Due to technology, baby boomers have more leisure time than other adults.

D) Baby boomers perform physical exercise more frequently than other adults.

9. The family of an 85-year-old man who has been admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD) has expressed concern about their ability to pay for his present and future care. Which of the following statements most accurately conveys the reality of payment for care services by older adults?

A) The high value of assets owned by older adults makes the financial burden of care minimal for most older adults.

B) Payment for long-term care of adults is most often covered by private insurers.

C) Most older adults have their basic care needs provided in a long-term facility.

D) Overall, federal money pays for more care than do older adults themselves or private insurers.

10. Which of the following statements by the daughter of an 87-year-old resident of a nursing home would the nurse most likely want to correct or clarify?

A) “It seems like more and more people are living well into their 80s like my mom.”

B) “My mom has a house worth loads of money but little cash flow, like many older adults.”

C) “It seems like heart disease is getting more common even though people live longer than they used to.”

D) “There are more women living to my mother's age than there are men.”

11. In ancient times, the relationship between age and the value afforded to individuals was generally: A) Positive: with advanced age came increased value B) Negative: respect declined as age increased C) Variable: respect was different in different cultures D) Cyclic: respect moved back and forth between positive and negative 12. Twentieth-century laws regarding health care for the elderly trace their roots back to: A) England's 17th-century Poor Laws B) Child labor laws of the 19th century C) The Biblical commandment “Honor your father and your mother” D) The tradition of respect for the elderly passed down from ancient Roman law

Page 3

13. A new patient is not satisfied with the conditions of the nursing home, takes a highly active role in her health care, and, because of her ability to access information, has as much knowledge as her health care providers on some health issues. This new patient is most likely: A) A young-old female baby boomer who just turned age 65 B) An old woman 75 to 85 years of age C) An old-old woman over age 85 D) An elite old woman older than 100 years 14. Gerontological nursing will become an increasingly important profession, compared with in the past, because: A) More people will be presenting with the same health care challenges B) More elderly are living in increasingly squalid living conditions C) A greater number of people are surviving the previously hazardous period of infancy D) More people are spending a longer time span in old age 15. Which of the following factors should a nurse prioritize when planning the care of older adults?

A) The high prevalence of mental impairment among the elderly B) The diversity of the older adult population C) The fact that most older people live below the poverty line D) The lack of family support that is the norm among the elderly 16. From the late 1980s to the present, the gap in life expectancy between individuals in the Caucasian and African American communities has widened. Which of the following most clearly accounts for this trend?

A) Acute illness in the black population has increased B) Infant mortality and complications of childbirth in the white population have declined C) The life expectancy of African Americans has not increased at the same rate as that of the white population D) Deaths from homicide in the white population have increased 17. Two related and important trends in the elderly population are: A) The growing gap in life expectancy between males and females and the number of women living alone B) The increase in life expectancy of white and black people.

C) The continued burden of acute disease and the low levels of education among the elderly D) The increased burden of chronic illness and the shifting causes of death with advancing age

Page 4

18. It is important for the nurses to be aware of their patients' financial situations, which can affect patients' nutritional needs and access to medical care. Which of the following applies to the majority of older people?

A) Own their own homes and have sufficient monthly income B) Get more than half their income from Social Security and live above the poverty level C) Are an increasing percentage of the labor force but are “cash poor” D) Are retiring at earlier ages and so live below the poverty level 19. What is the most important factor contributing to limitations in self-care and independent living among the elderly?

A) Lack of family support B) Low financial assets C) Acute illness and injury D) Chronic illness 20. Which of the following statements best captures an aspect of illness in older adults?

A) Death from heart disease is increasing in this population.

B) Death from cancer is increasing in this population.

C) Chronic illnesses are less common than in younger people.

D) Several acute illnesses are often present that must be managed simultaneously.

21. What are the most important competing forces that influence health policy for the elderly?

A) Cost containment versus quality of care B) Acute care versus the burden of chronic disease C) Private insurance payments versus Medicare support D) Long-term care at home versus nursing home services 22. When compared with elderly populations of the past, persons entering their senior years between 2015 and 2030 will have: A) Fewer chronic diseases but more acute illnesses B) Greater support from their children and spouses C) Better education and greater wealth D) Fewer needs for hospital or nursing home care

Page 5

23. Which of the following patient histories is most likely for a person older than 65 years of age?

A) In the last year, Patient F has been treated for a skin rash, a sprained ankle, and influenza B) Patient G takes medications daily for arthritis pain relief and reduction of blood pressure levels C) Patient H complains of chronic fatigue, stress-related allergies, and acid reflux after meals D) Patient I has been to the emergency room three times in the past year for ear infections and allergy attacks 24. Hospital management is reviewing departmental statistics. Which of the following departments most likely has the highest death rate of patients over age 65, and why?

A) Oncology, because the elderly have been exposed to more carcinogens in their long lifetimes B) Cardiology, because, despite a decline in recent years, heart disease remains the number one cause of death among the elderly C) Endocrinology, because the elderly already have compromised immune systems D) Neurology, because stroke and Alzheimer's disease together cause more deaths of the elderly than any other conditions

Page 6

Answer Key 1. D 2. C 3. A 4. A 5. C 6. C 7. A 8. A, D 9. D 10. C 11. C 12. A 13. A 14. D 15. B 16. C 17. D 18. B 19. D 20. B 21. A 22. C 23. B 24. B

Page 7

Name: __________________________ Date: _____________ 1. Which of the following statements most accurately conveys an aspect of the error theory of aging?

A) Perpetuation of DNA mutations results in organ and system malfunction.

B) Age-related dysfunction of organs, tissues, and body systems results in mutation of body DNA. C) The number of cell divisions is genetically predetermined.

D) Errors in the function of various organs contribute to changes in the genetic code of various body cells.

2. The error theory of aging proposes a cause-and-effect relationship between the genetic activity of body cells and the effects of aging. Place the following steps in the error theory of aging in the correct chronological order. Use all the options.

A) Organ, tissue, and system malfunction B) Perpetuation of mutation during cell divisions C) DNA mutation D) Overall decline in body functions E) Decline in body functions 3. A nurse is explaining to an older adult client that many of the changes in his body that are currently causing him frustration may have their origins in genetic changes that may have in fact benefited him during his younger years. Which of the following theories of aging underlies the nurse's explanation?

A) Disposable soma theory B) Free radical theory C) Mutation accumulation theory D) Antagonistic pleiotropy theory 4. An 80-year-old female who enjoys good health explains to her primary care provider that she attributes her health status to her regular intake of berries, fruit juices, and green tea, which she states “help cleanse the damaging molecules out of my body.”

Which of the following theories of aging underlies the client's health behaviors?

A) Free radical theory B) Biogerontology C) Disposable soma theory D) Cross-linking theory

Page 1

5. A nurse is discussing an older adult client's apparent increased susceptibility to infection with his family. Which of the following statements by the nurse would be most congruent with current thought around the autoimmune role in the aging process?

A) “Changes that we call 'mutations' in your father's cells make his organs more vulnerable to chronic illness and germs.”

B) “Older adults often have more difficulty fighting off infections because of their weaker immune systems, and their bodies can even attack themselves.”

C) “Diseases such as arthritis, which we term 'autoimmune,' make older people more likely to catch viruses and other bugs.”

D) “Our bodies seem to have an 'expiry date,' after which we are far more likely to get infections and develop chronic illness.”

6. A hospital clinical educator is espousing the disengagement theory of aging when teaching staff how best to meet the needs of older clients. Which of the nurse's teaching points best captures the disengagement theory of aging?

A) “Older adults often benefit from a gradual and controlled withdrawal of their own interests from society's interests.”

B) “The disengagement between an older adult's abilities and desires can lead to frustration and, ultimately, to illness.”

C) “The lack of synchronicity between older adults' immune systems and their environments can be the root of many problems.”

D) “It is imperative that we ensure older adults remain engaged with interests and events beyond themselves.”

7. Which of the following directives by the head nurse at a long-term care facility is most reflective of the activity theory of aging?

A) “We need to facilitate older adults' desire to step back from the responsibilities and roles they had in earlier years.”

B) “It's hard to overestimate the importance of regular, physical exercise in maintaining health and healthy aging.”

C) “We need to remember that the psychological roles and characters of our residents change profoundly in later years of life.”

D) “We have to treat our residents like younger people and keep them engaged in meaningful acts.”

8. Which of the following tasks are components of Erikson's description of the old age tasks of reconciling ego integrity with despair? Select all that apply.

A) An 80-year-old man is struggling to determine his identity apart from his lifelong career as a business leader.

B) A 79-year-old woman has established habits that promote her financial independence in spite of a lack of savings.

C) An 80-year-old man revels in his large, happy family rather than focusing on his mobility limitations resulting from Parkinson disease.

D) A 77-year-old man is trying to determine whether his life has had deep significance and meaning.

Page 2

9. Which of the following actions by a nurse who works with older adult clients in an assisted living facility is most likely to inhibit healthy aging?

A) Discussing current events with clients who read and watch television.

B) Placing a bib on each client during meal times to ensure clients maintain a clean appearance.

C) Challenging clients to learn new skills and develop preexisting talents.

D) Facilitating introductions between new and existing clients.

10. A nurse notes that a 90-year-old male client on a geriatric medical unit of the hospital has been talking about death frequently. Given that the nurse has good rapport with client, what is the nurse's most appropriate response?

A) “Try to focus more on the positive benefits of healing rather than what might happen.”

B) “Remember that in this day and age many people can live far beyond 90 years of age.”

C) “I've noticed you've brought up the issue of dying a lot. How do you feel about that?”

D) “You'll find that aiming for health rather than thinking about death will have positive results.”

11. Nurses need to understand the aging process in order to help their patients: A) Live longer with their long-term disabilities B) Maintain youth and delay the onset of old age C) Accept the limitations imposed by genetic tendencies toward cellular degeneration D) Postpone the negative consequences of the aging process 12. Mrs. H and Mrs. J are the same age. While in the doctor's waiting room, they discuss their ailments and their beliefs about aging. Mrs. H argues that Mrs. J must be older because she has more ailments. The nurse settles the argument by stating a cornerstone of all biological theories of aging. Which of the following statements did the nurse most likely make?

A) Aging is a predictable cellular process.

B) Cells undergo a finite number of divisions.

C) No two individuals age identically.

D) Body systems decline at the same rate.

13. Which of the following statements is evidence that supports the programmed theory of aging?

A) The life spans attained by parents and their offspring are negatively correlated.

B) Mutations perpetuate themselves through each cycle of cell division.

C) In cultures, cells go through a finite number of cell divisions before dying.

D) In cultures, cells from older donors divide faster than those from younger donors.

Page 3

14. Which of the following statements form components of both the error theory of aging and the cross-linking theory of aging?

A) Free radicals cause mutations in cells.

B) Senescence is environmentally controlled at the cellular level.

C) Changes in DNA lead to organ malfunctions.

D) Genetic programming determines life expectancy.

15. Which of the following statements underlie both the error theory of aging and the free radical theory of aging?

A) Biochemical damage accumulates over time, leading to cell death.

B) The rate of cellular death is genetically programmed.

C) The aging body produces fewer growth and repair hormones.

D) Environmental agents such as radiation and heavy metals damage DNA. 16. The nursing staff at a nursing home works closely with the staff in the Endocrinology Department at a local hospital. This relationship is maintained for the welfare of the nursing home residents, because a failing immune system in the elderly might account for: A) A decline in the rate of growth hormone production B) The increased incidence of cancer among the aged C) The oxidative activity of free radicals D) Changes in brain activity and nervous system function 17. Although the immune system is affected by the aging process, the elderly are not the only individuals who have autoimmune disorders. These occur in populations of all ages because autoimmune disorders involve: A) An attack of antibodies on body cells B) An overproduction of T cells in bone marrow C) A decrease in the weight of the thymus gland D) An increase in the amount of lipofuscin in the blood 18. A magazine geared toward elderly women contains an advertisement for an antiwrinkle cream purported to remove wrinkles caused by the drying effects of years of soap use. Knowledgeable nurses can keep their elderly female clients from being duped by this advertisement by explaining that the wrinkling of facial skin in old age results primarily from: A) Changes in the endocrine glands B) Cellular mutations arising from toxic chemicals C) Repeated exposure to ultraviolet light D) A diet high in fats and refined sugars

Page 4

19. Mr. B, age 72, has a history of heart disease. He insists that his high-fat diet is permissible, however, because he takes a daily supplement of gugulipid, an herb purported to reduce blood cholesterol levels. In talking with the patient, what should Mr. B's nurse do first?

A) Suggest that Mr. B ask his doctor for a prescription medication to reduce cholesterol levels B) Review with Mr. B the benefits associated with limiting dietary fat C) Introduce Mr. B to the additional benefits associated with fish oil supplements D) Advise Mr. B to stop using gugulipid, as herbal supplements are not regulated by the FDA 20. Ms. E, an 80-year-old, is gradually withdrawing from society and wants society to gradually withdraw from her. She believes that this mutual withdrawal will free her from societal roles and give society the means for transferring power from the old to the young. Ms. E's grown children are concerned and say her belief has no scientific basis. On which of the following theories of aging can Ms. E say she bases her belief?

A) Activity theory B) Developmental tasks theory C) Disengagement theory D) Continuity theory 21. A state committee is looking to improve the lives of the state's elderly. It wants to recommend that health care facilities that cater to the elderly population be required to base their practices on the activity theory of aging. Which of the following may be one problem with implementing the activity theory of aging?

A) The assumption that older people want to maintain their middle-aged lifestyle B) The reluctance of the elderly to give up their occupational roles at retirement age C) The decline in mental acuity that accompanies physical impairment in most cases D) Declining health, loss of roles, and shrinking circle of friends of most elderly 22. Mr. D was friendly and active as a young adult. Now, as a 75-year-old, he enjoys visiting with his neighbors and attending a variety of sporting and cultural events.

Mr. D's behavior is most consistent with which theory of aging?

A) Activity theory B) Developmental tasks theory C) Disengagement theory D) Continuity theory

Page 5

23. Nurse Z takes ample time to explain all medical options to her elderly patients and to ensure they have the information they need to make informed decisions about their care. What is Nurse Z's best reason for taking these actions?

A) Full disclosure deters malpractice suits and negligence claims B) The activity theory of aging requires maintenance of lifestyle C) Information is an effective strategy for stress management D) Empowerment has a positive effect on health status

Page 6

Answer Key 1. A 2. C, B, E, A, D 3. D 4. A 5. B 6. A 7. D 8. A, C, D 9. B 10. C 11. D 12. C 13. C 14. C 15. A 16. B 17. A 18. C 19. B 20. C 21. A 22. D 23. D

Page 7

Name: __________________________ Date: _____________ 1. Which of the following projections of future demographics of older Americans is most accurate?

A) By 2020, more than 50% of older Americans will belong to a non-Hispanic white group.

B) The percentage of black older adults will decrease slightly due to lower life expectancies.

C) The number of Hispanic older adults is projected to grow dramatically.

D) Within 40 years, a minority of older Americans will be white related to immigration.

2. A nurse is providing care for an 81-year-old Hispanic woman in the context of a geriatric medicine unit of a hospital. Which of the following phenomena should the nurse anticipate?

A) The client's family is likely to advocate for her placement in a nursing home at an early stage.

B) The client is likely to prioritize the role of spirituality in the healing process.

C) She is likely to forego medical or traditional treatment due to a fatalistic view of health and illness.

D) The woman's family will most likely delegate responsibility for her care to the hospital care team.

3. A nurse who works in an inner-city clinic provides care for a large number of the older black clients. Which of the following health promotion activities best reflects the particular health needs of this population?

A) A blood sugar and blood pressure monitoring program.

B) An education session on the positive health effects of good nutrition.

C) A screening mammography campaign for older black women.

D) A program that teaches black men the importance of prostate health screening.

4. Nurse Y works in the emergency department of a large, urban hospital. When assessing the following older black adults who have recently presented to the department, which of the following assessments would the nurse want to modify for this population?

A) Assessment of the strength and gait of an 80-year-old male client with a history of failure to thrive.

B) Assessment of peripheral sensation in a 76-year-old male client with poorly controlled diabetes mellitus.

C) Assessment of cyanosis in a 78-year-old female with peripheral vascular disease and Raynaud disease.

D) Assessment of a client's chest pain who has a history of myocardial infarction.

Page 1

5. A nurse is assessing an 84-year-old female Chinese American's pain following her left hemiarthroplasty 2 days prior. Which of the following characteristics of Chinese Americans should the nurse be aware of during this assessment?

A) Chinese Americans often view pain as a virtue and tend to underreport it.

B) Chinese Americans have a fatalistic view of pain and see analgesia as inappropriate and undeserved.

C) Chinese women often overstate their pain in light of health care providers' reluctance to provide analgesia.

D) There is often a reluctance to acknowledge pain among older Chinese Americans.

6. Which of the following interventions in the care that preceded the death of a female, Jewish older American was most likely to have warranted special consideration?

A) The client required transfusions of packed red blood cells during her care.

B) Assessment by a male physician was required.

C) An autopsy was ordered due to the client's unique disease etiology.

D) A do-not-resuscitate (DNR) order was recommended by the care team when the client's disease progressed.

7. A nurse is being orientated to his new position in a community adjacent to a large Indian reservation. Which of the nurse's following statements indicates a sound understanding of the Native American population with whom he will work?

A) “I suppose that we will see a disproportionately high number of clients with lung and oral cancers.”

B) “The high prevalence of diabetes and hypertension mean that strokes are likely to be relatively frequent in the area.”

C) “It's unfortunate that many of the older Native Americans are unlikely to have family members involved their care.”

D) “The unique skin pigmentation of Native Americans means that I'll have to modify my assessment techniques.”

8. Which of the following statements by a nurse who provides care in an assisted living facility best conveys cultural sensitivity?

A) “We need to ensure that both minorities and Americans have their health needs met.”

B) “It's important to remember that minority groups do not usually express their pain explicitly.”

C) “We need to build our knowledge of residents who belong to cultural and ethnic groups that we're not familiar with.”

D) “We need to teach Hispanic and Native American residents that their health problems are necessarily the result of punishment.”

Page 2

9. Which of the following contexts would be most appropriate for a screening program for high blood pressure?

A) A seniors' group that is based at a Jewish community center in Brooklyn.

B) An Indian reservation in rural, Western Oklahoma.

C) A predominantly Chinese-American neighborhood in the San Francisco Bay area.

D) A minimum security prison serving young, rehabilitating offenders.

10. Nursing students attending City College of Nursing are scheduled for clinical experience at facilities in various sections of the city. Their experience will expose them to a wide variety of populations. Which of the following is a major reason why nurses need to understand the general characteristics of various ethnic groups?

A) To ensure that clients get the respect customary in their own ethnic group B) To provide individualized and culturally sensitive care C) To ensure that medical treatments comply with cultural expectations D) To increase compliance among minority patients 11. According to statistics, Baby J, born to a black American couple, has a life expectancy lower than that of Baby K, born to a white American couple. According to current demographic projections, by the seventh decade of life, Baby J's life expectancy will: A) Begin to equal that of similarly aged white elders B) Exceed that of similarly aged Asian elders C) Drop to less than half that of similarly aged Native American elders D) Rise above that of white elders until age 75 and then drop 12. Although only 12% of elderly black Americans experience institutional care in their lifetimes, compared with 23% of elderly white Americans, they typically possess more health problems than their white counterparts. This difference in health status is most likely due to: A) High incidence of violent crime and sexually transmitted diseases B) Reliance on family for health care advice and rejection of formal service agencies C) Cultural preference for unconventional medical treatments like spiritual and herbal remedies D) Lower standard of living and less access to health care services

Page 3

13. Riverdale has a small budget for community health programs aimed specifically toward its African American population. Nurse G advocates free blood pressure screening in supermarkets and shopping malls in this town because: A) Many causes of morbidity and mortality among black Americans cannot be effectively controlled through lifestyle modifications B) Black Americans have a higher incidence of cancer and diabetes than white Americans C) Hypertension and heart disease occur at a higher rate in the black population than in the white population D) Black persons experience a heightened nocturnal response that lowers blood pressure to dangerous lows during sleep 14. Nurse A works with Native American patients at a reservation health care center.

She advises a new staff member to be especially observant of these patients and tolerant of their health care requests because Native American patients: A) May demand special rituals during sickness and at death B) Use services from agencies as a last resort because such assistance conflicts with their belief in the Great Creator C) Link the typical nursing assessment process to evil forces or to punishment D) Show their absence of feeling, caring, or discomfort by appearing calm and controlled 15. A government study investigated the incidence of diseases and their probable causes in elderly Native Americans as compared with all elderly Americans. Study results showed that Native American seniors have twice the incidence of which of the following diseases?

A) Arthritis B) Cancer C) Heart disease D) Diabetes 16. Rehabilitation Health Facility has a high percentage of Jewish patients recovering from a variety of ailments. Which of the following is important for the facility's staff to know about medical care and the Jewish culture?

A) Pork and shellfish but not milk products are recommended as healthful foods in the diet.

B) A rabbi must be consulted before any health-related decisions can be made.

C) A skullcap and socks must be worn from sundown Friday to sundown Saturday.

D) Modern medical care is encouraged but may be opposed during the Sabbath.

Page 4

17. Mrs C brings her elderly Chinese grandmother to the health clinic. When Grandmother C finds out that all the clinic physicians on duty are males, she appears embarrassed and becomes quiet and withdrawn. All the office staff were schooled in traditional Western medicine. Of the following suggestions, which best describes what the staff can do to put Grandmother C more at ease about receiving health care?

A) Have the physician use his senses rather than machinery or invasive procedures to assess Grandmother C's medical problem B) Show Grandmother C a picture of the human body and have her point to the area of her problem C) Observe Grandmother C more closely and ask specific questions D) Tell Grandmother C that being seen for treatment by a physician of either gender will put her yin and yang back in balance 18. A statistical analysis of City Health Clinic's patient base shows that few of its patients are elderly Asian Americans. Nurse K, a second-generation Asian American, offers a probable cause for this phenomenon. She knows that Asian American groups, though different from each other: A) Value a strong family network and expect that family members will care for their elders at home B) Subscribe to traditional health practices and reject modern technology C) Do not express their feelings openly or challenge the health professional D) Have preserved many of their homeland traditions and tend to live in isolated pockets 19. When talking with elderly Native Americans and Asian Americans, it is important for gerontological nurses to recognize that: A) Both cultures are in the process of replacing traditional values with modern medicine B) These clients may be reluctant to express their thoughts and feelings openly C) Ritualistic and spiritual healing methods are preferred over modern medical services D) These clients expect to be treated and cared for by family members exclusively.

20. To receive government money, County Hospital is required to provide demographic statistics on its patient base. In checking off the Ethnic Group boxes on the obligatory forms, office workers must be able to distinguish terminology. Which of the following best defines the term Hispanic?

A) Immigrant workers who entered the United States and their descendants B) Puerto Ricans who emigrated from the United States and their descendants C) Any Spanish-speaking people living in the United States D) Illegal immigrants from Spain, Mexico, Puerto Rico, and Brazil

Page 5

21. Which of the following is the most direct way for nurses to accommodate ethnic diversity among their clients?

A) Explain how scientific research evidence supports medical treatment B) Provide standardized diets that meet patients' nutritional needs C) Listen to the life stories of elderly patients D) Take a foreign language class or travel abroad 22. Some health conditions are more prevalent in the black population than in the white population. It is important that nurses pay particular attention to identifying those health conditions. Which of the following health assessments and reasons is the most important in working with black patients?

A) Control their lifestyle changes because of a lower life expectancy B) Monitor their blood pressure because of a blunted nocturnal response C) Examine their buccal mucosa because black skin color can complicate the use of skin color for assessment of health problems D) Monitor for HIV/AIDS as this is a leading cause of death among African Americans 23. An elderly Chinese patient tells the nurse that blockage of qi in one of her meridians is causing her severe headaches. Her doctor has diagnosed migraines and has prescribed a triptan drug. The nurse's best course of action is to: A) Suggest that the prescribed medicine may stimulate the flow of qi B) Explain the vasoconstrictive and serotonin-moderating action of triptan C) Recommend acupuncture or acupressure treatments as an adjunct to the triptan D) Caution her that her headaches will grow worse if she fails to take her medication

Page 6

Answer Key 1. C 2. B 3. A 4. C 5. D 6. C 7. B 8. C 9. B 10. B 11. A 12. D 13. C 14. A 15. D 16. D 17. C 18. A 19. B 20. C 21. C 22. B 23. A

Page 7

Name: __________________________ Date: _____________ 1. A nurse manager at a long-term care facility is engaged in efforts to change many staff members' inaccurate and negative views of older adults. Which of the following statements made by staff is most clearly indicative of ageism?

A) “Older people seem to have so many more chronic health problems than younger people.”

B) “Older adults' motor skills get progressively slower as they age.”

C) “It's normal to expect a gradual loss of memory and intelligence with age.”

D) “A lot of the physical changes that accompany aging are inevitable.”

2. According to Erikson, the final stage of the life cycle is centered on achieving integrity versus despair. Which of the following situations would signal to the nurse that the client in question is at risk for disappointment and despair as characterized

by Erikson?

A) An 81-year-old woman has needed to adopt a minced diet following a recent stroke.

B) A 78-year-old man has had a pacemaker implanted to address his atrial fibrillation.

C) A 90-year-old woman is grieving the recent death of her husband to whom she was married for 66 years.

D) An 80-year-old man describes himself as “useless” since he can no longer help his adult children with their yard and garden work.

3. Which of the following clients of a nurse practitioner is demonstrative of a growing trend in the role of grandparents in contemporary American society?

A) A 70-year-old grandmother is raising her two grandchildren because their mother is in prison.

B) An 80-year-old client of the nurse is going through a divorce with her husband of several decades.

C) A 79-year-old man laments the fact that he is estranged from his son's children.

D) A married couple in their seventies who refuse to provide free child care for their grandchildren on a daily basis.

Page 1

4. A nurse who works on a palliative care unit has developed a strong partnership with the 77-year-old wife of a client who has recently died of lung cancer. The woman has expressed her fears around being a widow to the nurse. How can the nurse best respond?

A) “You will likely find that once you are remarried the grief will subside and you will move on.”

B) “It's very normal to have these fears, but antidepressant medications can help immeasurably with this difficult transition.”

C) “Though it might not feel like it now, many women eventually find joy in new friendships and freedom after the death of a spouse.”

D) “It will be important, and healthy, for you to maintain roles and routines similar to before your spouse died.”

5. A primary care nurse has a long-standing relationship with a 63-year-old male client who is poised to retire. Place the following phases of the client's likely transition in the correct chronological order. Use all the options.

A) A euphoric period involving testing of fantasies around retirement.

B) Near phase, often accompanied by fantasy regarding the retirement role.

C) Disenchantment phase D) Establishment of a stable and sustainable retirement role.

E) Establishment of realistic and alternative sources of satisfaction during retirement.

6. Nurse M is employed in an assisted living facility and is privy to many of the changes that accompany the aging process. An older female resident of the facility has expressed a fear that her decreased mobility will make her increasingly dependent on her daughter. How can the nurse best respond to the resident's concerns?

A) “There are treatments and drugs that we can explore which might prevent this from happening.”

B) “This is a normal part of the aging process and you don't necessarily need to fear it.”

C) “Many older adults have similar concerns. We can work together to keep you independent as long as possible.”

D) “I'm sure this is very stressful for you, but it's fortunate that you are not experiencing severe pain or illness.”

7. Which of the following nursing interventions by practitioner in a long-term care facility are appropriate? Select all that apply.

A) The nurse times laxative administration as to not interfere with social interaction.

B) The nurse provides diuretics after, not before, recreation sessions.

C) The client's need for and dosage of nighttime sedation is weighed in light of activities planned for the following morning.

D) Analgesia is provided prior to physical activity but held before social activities.

Page 2

8. The occupational therapist on a geriatric rehabilitation unit of a hospital has integrated a life review into a group therapy session. Which of the following statements best captures the nature of life review among older adults?

A) A life review is associated with uncovering unresolved guilt and pain.

B) A life review can help reflect on accomplishments but can also bring painful mistakes to light.

C) A life review is a valuable diagnostic insight into personal health behaviors.

D) A life review should be undertaken only with the supervision of qualified staff.

9. Which of the following teaching points around the use of self-reflection with older adults is most accurate?

A) Self-reflection is easier for older adults than for younger adults.

B) Self-reflection is less effective for male elders than for females.

C) Self-reflection often involves learning a process and is difficult for many people.

D) Self-reflection is not normally possible with individuals who have cognitive deficits.

10. Nurse S encourages older adult clients to engage in spiritual beliefs and practices that they are familiar with. How can this activity be best characterized?

A) Spiritual concerns are less relevant than immediate physical and financial issues.

B) Older adults raised in more religious times are more likely to spontaneously express their spirituality.

C) Addressing clients' expressions of spirituality is beyond the scope of appropriate nursing.

D) Spiritual expression can be useful in facilitating hope in older adults.

11. Various changes during the aging process demand multiple complex adjustments that require stamina, ability, and flexibility. In which stage of life do individuals experience the greatest number of simultaneous changes?

A) Adolescence B) Young adulthood C) Middle age D) Old age 12. Mrs S is recently widowed. She worked at home as a full-time wife and mother throughout her adult life. She is now most likely to experience: A) A desire to obtain employment outside the home B) Relief at being freed from the responsibilities of childrearing C) A sense of loss of her established social roles D) An interest in meeting men her own age and remarrying

Page 3

13. The emergence of today's nuclear family units has changed the roles and functions of family members in many ways. In counseling elders and their families, which of the following beliefs about aging should a nurse be aware as one of these ways?

A) Children are expected to provide financial support for their aging parents B) Grandparents are spending more time with their grandchildren than ever before C) Older adults enjoy freedom from responsibility for their adult children's welfare D) Older parents and their children grow apart, seldom developing satisfying adultto-adult relationships 14. A group of young student nursing assistants is getting clinical experience at a nursing home. In her introductory meeting with this group, the supervising nurse determines that the students harbor some misconceptions about the elderly. Four of the students' comments are listed below. Three of them are misconceptions about the elderly.

Which comment is true?

A) Most old people are sick or disabled B) Most seniors have a private pension plan C) Senility comes with old age D) Old people are still interested in sex 15. A young couple are looking for a new home. They want to move into a neighborhood that has no elderly neighbors. Such ageism carries several consequences. By separating themselves from the elderly, the couple: A) Are less likely to see the similarities between themselves and older adults B) Will lose their insights into aging C) Will not experience the challenges of old age D) May have an easier time minimizing their socioeconomic challenges 16. The children of an elderly resident at a nursing home are concerned that their parent is alone and lonely. A staff nurse can assure the family that the elderly should be allowed periods of solitude because such times: A) Are essential for reflecting, analyzing, and better understanding the dynamics of life B) Decrease loneliness, insecurity, and self-imposed isolation C) Help the elderly face the misfortunes of growing old D) Affect displays of anxiety, depression, and anorexia 17. Most older women become widows. Widows must adjust to the significant loss of loved ones and the new task of living alone. Studies show that most widows: A) Require short-term treatment for depression B) Adjust well, finding new friends, interests, and activities C) Turn to their still-married female friends for advice and support D) Move in with their adult children for a period of time

Page 4

18. Gerontology instructors at City College of Nursing impress upon their students that gerontological nurses should be concerned with the welfare of both the current aged population and future ones. The best way nurses can help young and middle-aged adults prepare for their retirement is to promote: A) Meaningful leisure time activities B) Freedom from family responsibilities C) Achievement in a worthwhile occupation D) Maximal use of community health resources 19. After an initial period of enthusiasm, Mr J feels disappointed with his retirement. He cannot afford to travel as much as he had dreamed, and arthritis limits his mobility.

Mr J's nurse can help him most by assisting him in entering which phase of retirement?

A) Stability, in which he accepts his limitations B) Termination, in which he resumes a productive work role C) Reorientation, in which he assesses alternative sources of satisfaction D) Disenchantment, in which his hidden depression can be openly diagnosed and treated 20. Mr B, age 73, has a terminal illness. He has entered a nursing home, where he will reside until his death. Until age 70, he worked as a successful bank president and was an active community leader. His nurse should be alert for signs that he most resents his: A) Mortality B) Unemployment C) Family D) Dependency 21. Younger individuals know that they will not live forever, but their behaviors may indicate that they deny their mortality. One major indication of this denial is their failure to: A) Establish a financial plan for retirement B) Provide adequately for their family's health care needs C) Make a will and set up a burial plan D) Form strong relationships with family and friends

Page 5

22. What is the best action a busy nurse can take to help with the desire of elderly clients to reminisce about their past lives?

A) Refer clients to senior centers, where they can share their stories with others of their own age group B) Encourage the recording of stories through diaries and scrapbooks to be shared with younger family members C) Introduce older clients to members of local historical societies who can record their stories for posterity D) Look for ways to steer discussion toward health-promoting habits such as good exercise and adequate nutrition 23. In old age, the body's efficiency declines. Which of the following is a typical response to that decline?

A) An attempt to push the body to perform physically at the same level as in the past B) A neglect of personal appearance and other hygiene practices C) A failure to restrict lifestyle choices in a health-appropriate way D) An expressed desire to enter a nursing home to receive daily care and assistance 24. The bodily changes that occur during the aging process can affect an older person's body image and self-concept. The nurse can gain insight into the emotional wellbeing and self-concept of older persons by: A) Uncovering any unresolved guilt and perceived failures B) Reviewing how they interpret and refine their past experiences C) Examining what roles they accept and what roles they reject D) Determining which work roles they forfeit 25. A state health investigator surveyed the residents of a retirement housing complex to determine how their financial resources affected their lives and influenced their choices. Which of the following did the investigator most likely find to be true of most of the retired residents?

A) Most older people depend on their life savings through their retirement years B) Inflation in the past decades increased retirement benefits for today's seniors C) Nearly three-quarters of all seniors are financially comfortable D) More than half of all seniors retire with only Social Security benefits

Page 6

Answer Key 1. C 2. D 3. A 4. C 5. B, A, C, E, D 6. C 7. A, B, C 8. B 9. C 10. D 11. D 12. C 13. C 14. D 15. A 16. A 17. B 18. A 19. C 20. D 21. C 22. B 23. A 24. C 25. D

Page 7

Name: __________________________ Date: _____________ 1. During an assessment of an 82-year-old woman, a gerontological nurse learns that the woman has lost over 4 inches in height over the last several years. Which of the following factors have likely contributed to this phenomenon? Select all that apply.

A) The woman's overall proportion of body water has decreased.

B) The client has experienced a loss of cartilage.

C) The woman's thyroid hormone levels have declined since the sixth decade.

D) The client's vertebrae have thinned.

E) Loss of stature is a consequence of the woman's diet.

F) The woman's long bones have decreased in length.

2. A 78-year-old man has received a recent diagnosis of community-acquired pneumonia. Potential pathological findings on a recent chest x-ray have prompted his physician to order a bronchoscopy and lung function tests. Which of the following findings would be most likely suggestive of pathological processes rather than normal, age-related respiratory changes?

A) The client has fewer cilia than would be found in a younger client.

B) Lung function tests reveal that both maximum breathing and vital capacity are diminished since his last test.

C) There is an accumulation of serous fluid between the lungs and the pleural membrane.

D) The lungs are smaller than younger adults' and there are fewer alveoli.

3. An 80-year-old resident of an assisted living facility is proud of the fact that he was an elite athlete during his younger years. Despite his concerted efforts to remain physically active and maintain his stamina, he is lamenting his loss of exercise tolerance in recent years. How can his nurse best respond to these concerns?

A) “It's inevitable that your heart increases in size as you age, and this is associated with a loss of cardiac efficiency.”

B) “It's normal for your heart to contract less strongly as you age, and this makes you somewhat less able to exercise vigorously.”

C) “As you age, it's common for your heart rate becomes less regular and this often results in fatigue.”

D) “The normal increase in blood pressure that accompanies aging leaves you with less cardiac reserve capacity than when you were young.”

4. Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation?

A) An 81-year-old woman's glomerular filtration rate (GFR) is low.

B) A 78-year-old male's stomach pH is increased.

C) A 71-year-old male client's echocardiogram reveals slight left ventricular hypertrophy.

D) A 78-year-old man has recently developed urinary incontinence.

Page 1

5. A 66-year-old man has undergone a digital-rectal exam (DRE) during a visit to his family physician. The exam reveals that the client's prostate has become enlarged since his last DRE. The most accurate conclusion that his care provider will draw from these findings is that they suggest: A) Prostate cancer B) A risk of malignancy that should be followed up C) A normal age-related change unlikely to have consequences D) A urinary tract infection 6. A 74-year-old woman has presented to the emergency department with a suspected hip fracture following a fall on the sidewalk outside her home. The nurse's assessment of the client would recognize which of the following factors as most likely contributed to the suspected injury?

A) Bone remodeling in long bones ceases in the seventh or eighth decade.

B) Bone minerals and mass are reduced as part of the aging process.

C) Bone marrow production of cellular components declines with age.

D) Thinning disks and shortened vertebrae are common assessment findings in older adults.

7. A hospital client, aged 82 years, is presently undergoing an endocrine diagnostic workup in an effort to diagnose his increasing fatigue of unknown etiology. Which of the following findings would his care team recognize as potentially pathological?

A) Apparent decreased thyroid gland activity.

B) Decreased somatotropic growth hormone (GH) levels.

C) Delayed and insufficient release of insulin by the -cells.

D) Decreased erythropoietin production by the kidneys.

8. A care aide at a long-term care facility has assured the family of a resident that their father's increasing forgetfulness is a normal part of the aging process. How can the nurse best respond to the care aide's statement to the family?

A) “It's actually a myth that older people experience changes to their memory.”

B) “Memory losses are a normal age-related change many people experience.”

C) “Older adults have less working memory and slower retrieval, but this still requires further assessment.”

D) “There is no reason for healthy older adults to experience changes in their memory unless they are experiencing dementia.”

Page 2

9. A nurse practitioner is teaching a 90-year-old client about her new medication regimen. Which of the following principles should the nurse integrate into the teaching session?

A) While numerous factors can interfere with learning, learning ability itself is not seriously altered with age.

B) Older adults require simplified learning objectives and slower introduction of new directions.

C) Simple association is well executed by older adults but complex analysis is normally absent.

D) Successful learning late in life requires a multisensory teaching approach.

10. Which of the following phenomena most likely accounts for the progressive loss of hearing that an 83-year-old man is experiencing?

A) Multiple changes in the structures of the inner ear.

B) The effect of cognitive changes on the interpretation of auditory stimuli.

C) Cellular atrophy of the cells in the outer and middle ear.

D) Age-related deterioration of the neural pathways associated with hearing acuity.

11. It is important to measure and record fluid input and output accurately because this information is used in evaluating a patient's fluid balance and in planning care and treatment. Dehydration is a significant risk for the elderly because: A) The number of body cells is less, and fewer cells are functioning in the body.

B) Total body fat as a proportion of the body's composition increases with age.

C) Cellular solids and bone mass decrease with age affecting the ability to balance.

D) Extracellular fluid remains constant, but intracellular fluid decreases with age.

12. With aging the skin becomes thinner and more fragile. The thinning of the skin's subcutaneous fat layer makes older adults more sensitive to: A) Cold B) Heat C) Pain D) Pressure 13. Each of the blood vessel layers is affected differently by the aging process. Which would a nurse suspect is responsible for a patient's fibrosis?

A) Tunica intima B) Tunica media C) Tunica adventitia D) Fibrosis is caused by an enlarged heart 14. The heart muscle commonly weakens with age. What is a consequence of this fact?

A) The heart beats faster but pumps with less force.

B) Fatty deposits and other substances clog narrowed coronary vessels.

C) Blood pressure lowers because of systemic vasodilation.

D) The time required for the heart's diastolic–systolic cycle decreases.

Page 3

15. Older adults in good physical condition have cardiac function comparable to younger persons in poor condition. What is the most likely cause of a rise in systolic blood pressure in the elderly?

A) Postural and postprandial hypotension B) Atherosclerosis in the innermost layer of the blood vessels C) Impaired baroreceptor function and increased peripheral resistance D) Cellular proliferation in the tunica intima 16. As a person ages, muscle tone decreases throughout the digestive system, causing a slowing movement of food through the esophagus. Delayed esophageal emptying in the elderly increases the risk of: A) Gastric irritation B) Aspiration C) Irritable bowel syndrome D) Constipation 17. Which of the following is the most common urinary problem among men aged 65 years and older?

A) High urinary volume B) Glucose in the urine C) Stress incontinence D) Frequent urination 18. Which of the following is a normal reflex profile for an elderly patient?

A) Knee: normal; arm: absent; abdomen: absent B) Knee: normal; arm: reduced; abdomen: absent C) Knee: reduced; arm: normal; abdomen: reduced D) Knee: reduced; arm: reduced; abdomen: absent 19. Bone fractures are a serious risk to the elderly. Which of the following is a contributing factor?

A) Diminished calcium absorption B) Shortening of the long bones C) Formation of points and spurs D) Deterioration of cartilage surfaces 20. A gerontological nursing course syllabus includes the topic of helping elders ambulate safely. The major factor contributing to an increased risk of falls in the elderly is: A) Decline in brain weight B) Reduction of blood flow to the brain C) Flawed response to changes in balance D) Slowed nerve conduction velocity

Page 4

21. A nurse is reviewing thyroid test results of her clients. Which of the following is the most likely thyroid test result for a healthy elderly patient?

A) T4: low; T3: low; thyroid function: low B) T4: high; T3: normal; thyroid function: high C) T4: high; T3: normal; thyroid function: low D) T4: normal; T3: low; thyroid function: normal 22. Which of the following blood chemistries may indicate diabetes among young adults but not among the elderly?

A) Low blood glucose level B) High blood glucose level C) Prolonged hypoglycemia D) Insufficient release of insulin 23. The charge nurse at a nursing home impresses on a visiting class of nursing assistants the importance of hand washing, because older adults have a depressed immune response. One contributor to this depressed immune response in older adults is: A) Decreased serum activity of the thymic hormones B) Inactivation of varicella-zoster infections C) Decreased serum concentrations of IgA and IgG D) High pain sensitivity associated with inflammation 24. Older adults may appear rigid in their attitudes because of: A) Changes in personality that accompany aging B) Diminished ability to learn new information C) Physical or mental limitations D) Decline in morale and self-esteem 25. Decreased renal mass and reduced glomerular filtration make it especially important that nurses: A) Assist elderly patients with frequent toileting B) Ensure that age-adjusted drug dosages are prescribed C) Look for signs of urinary tract infections D) Frequently check urine for glucose

Page 5

Answer Key 1. A, B, D 2. C 3. B 4. D 5. B 6. B 7. D 8. C 9. A 10. A 11. D 12. A 13. A 14. A 15. C 16. B 17. D 18. B 19. A 20. C 21. D 22. B 23. A 24. C 25. B

Page 6

Name: __________________________ Date: _____________ 1. Prior to the beginning of a gerontological nursing course, a nursing student questions why the course is not classified as geriatric nursing. How can the instructor best respond?

A) “Gerontological nursing implies health promotion activities that can accompany aging, not solely nursing care of the sick.”

B) “Gerontological nursing focuses on issues related to normal aging and excludes the direct care of acutely ill older adults.”

C) “The term 'geriatric nursing' implies that all older adults are ill, and the term is no longer in use.”

D) “There is a stigma associated with the term 'geriatric' so it has been replaced with the term 'gerontological'.”

2. Which of the following facts best accounts for the complexity of gerontological nursing?

A) Assessment of older adults is often complicated by the presence of cognitive deficits.

B) Multiple health conditions often coexist in older adults and symptoms are often atypical.

C) Older adults are expected to have poorer health outcomes than younger clients.

D) Evidence-based practice with older adults is more difficult due to the relative lack of research into their unique health needs.

3. Which of the following principles that underlie a gerontological nurse's practice is most in need of reexamination and modification?

A) Nursing older adults requires a unique data and knowledge set.

B) Aiming for wholeness in physical, social, spiritual, and psychological health is a realistic goal.

C) The aging process is a natural and unavoidable part of human life.

D) Health outcomes among older adults can be equal to those of younger populations.

4. Nurse L works on an acute care for elders (ACE) unit of a county hospital. Which of the following sources should the nurse utilize as standards for practice? Select all that apply.

A) The American Nurses Association (ANA) standards B) The Joint Commission C) Hospital-specific standards of practice D) State and federal regulations

Page 1

5. Which of the following nursing actions by a gerontological nurse best exemplifies the role of “advocate”?

A) Teaching licensed care staff to perform appropriate assessment of lower limb circulation.

B) Providing an environment in which the restoration of a client's mobility poststroke can be realized.

C) Developing new techniques for the wound care of venous ulcers.

D) Teaching an older adult how to best deal with a daughter who is attempting to gain power of attorney prematurely.

6. Which of the following sources is the most justifiable foundation for the future of gerontological nursing?

A) Systematic trial and error B) Gerontological nursing research C) Financial realities of nursing care D) Institutional policies and procedures 7. Which of the following nursing activities involving older adults best exemplifies holistic care?

A) A nurse administers a client's IV antibiotics and teaches him and his wife why he is receiving them.

B) A nurse encourages a client with chronic obstructive pulmonary disease to independently perform regular deep breathing exercises.

C) A nurse encourages a client who has received a preliminary diagnosis of liver cancer to seek a second opinion.

D) A nurse provides wound care to a diabetic client's new foot amputation and explores the client's feelings around the loss.

8. Which of these nursing actions is most likely to be effective in reconciling the costs of care with the need for quality care?

A) Ensuring that older adults who are hospitalized are discharged as early as possible.

B) Maximizing the role of unlicensed caregivers within their scope of practice.

C) Standardizing nursing care plans for hospital and care facility clients.

D) Enlisting the help of family, friends, and neighbors in the care of older adults.

9. Which of the following practices at a long-term care facility is most congruent with the provision of quality care at a reasonable cost?

A) Ensuring that all medications in a care facility are administered by nurses.

B) Maintaining a schedule for bathing that is standardized for all residents.

C) Beginning each day with a set of vital signs for each resident.

D) Encouraging residents' family members to assist with feeding and dressing when appropriate.

Page 2

10. Which of the following events is noted to have marked the beginning of the nursing profession's interest in the care of the aged?

A) Articles on the care of the elderly published in the American Journal of Nursing B) Passage of the Federal Old Age Insurance Law and Medicare Act C) Publication of the first specialty nursing textbook dedicated to gerontology D) Establishment of the specialty group of the American Nurses Association 11. Why did facilities that provided residential care for the elderly come to be known as nursing homes?

A) Were staffed by gerontological nurses after passage of the Social Security Act B) Were often operated by women who called themselves nurses C) Served mostly sick and disabled patients who required round-the-clock nursing D) Employed mostly elderly nurses who were themselves near retirement age 12. Why was the term geriatric nurse replaced with the preferred term gerontological nurse?

A) To avoid misinterpretation because geriatric nurse means “old nurse” B) To define the field as an academic discipline (the suffix -ology means “to study”) C) To emphasize the distinction between care of the elderly and other nursing specialties D) To reflect a scope broader than the care of the ill aged 13. As compared with a geriatric nurse, on what does the gerontological nurse place greater emphasis?

A) Promotion of wellness and quality of life throughout the life span B) Provision of services to the terminally ill clients in hospice facilities C) Caregiving in a long-term, residential facility or similar situation D) Standards of care and performance set by the American Nurses Association 14. Gerontological nursing is a complex specialty. Which of the following contributes most to this fact?

A) Elderly people are generally compromised in their health status B) Care for the elderly costs more than care for younger patients C) Numerous health conditions can overlap in the elderly D) Complications after surgery or illness result in death in most cases 15. Holistic gerontological care means helping older individuals achieve a sense of wholeness. How can gerontological nurses best help older individuals achieve this wholeness?

A) Guiding them in understanding and finding meaning and purpose in life B) Doing as much for them as possible C) Eliminating many of their chronic diseases and effects of advanced age D) Facilitating harmony of all their body systems

Page 3

16. The concept of the “wounded healer” was suggested by Henri Nouwen. How can the gerontological nurse best put this concept into practice?

A) By recognizing that ageism and prejudice can negatively affect health care for the elderly B) By emphasizing coping with disease, restoring function, and finding meaning in life C) By employing medical equipment with caution to avoid injury to self and others D) By using her or his own life experiences to assist the recovery of others 17. Which of the following is the primary role of the gerontological nurse, and for what reason?

A) Innovator, because gerontological nursing continues to be an evolving specialty B) Caregiver, because the nurse uses gerontological theory in the conscientious application of the nursing process to the care of elders C) Educator, because the nurse shares knowledge and skills related to the care of older adults with the general public D) Advocate, because the nurse aids older adults in asserting their rights and obtaining required services 18. Nurse B talks with Patient G about effective methods of managing stress incontinence. What role of the gerontological nurse is being enacted in this exchange?

A) Innovator B) Caregiver C) Educator D) Advocate 19. Which of the following statements about gerontological nursing is supported by research evidence?

A) Geriatric nurse practitioners increase the cost of care for elderly patients in hospitals.

B) Whether geriatric nurse practitioners are employed has no effect on the quality of care for older adults in ambulatory care settings.

C) Gerontological clinical nurse specialists in acute hospitals decrease the length of stay for elderly patients.

D) In acute hospitals, readmission rates post-discharge are higher when gerontological nurse specialists are employed.

Page 4

20. To effectively care for the clinical complexities of older adults, nurses need preparation in the unique principles and best practices of geriatric care. On what are the best practices built?

A) The ANA Standards of the Gerontological Nurse and the Principles of Gerontological Nursing Practice B) Evidence-based practice and the expertise of the nurse C) Scientific data regarding theories, life adjustments, and pathophysiology of aging D) A large pool of knowledgeable colleagues and advanced practice 21. Nursing standards arise from a variety of sources. Which of the following is the best source of standards for gerontological nursing?

A) Each state's nurses association and practice act B) The American Association of Retired Persons (AARP) C) The Joint Commission on Accreditation of Healthcare Organizations D) The National Committee on Vital and Health Statistics (NCVHS) 22. In a seminar, Nurse T presents a meta-analysis in support of his position that all citizens over age 50 should be screened for hypertension. Nurse T's presentation uses: A) The compiled results from several research studies B) Tables and graphs prepared using PowerPoint C) A detailed breakdown of costs and projected benefits D) A comparison of communities that provide such screening 23. The scope of nursing includes more than following a medical order or performing an isolated task. Which of the following statements best describes the scope of nursing?

A) Nursing involves the care of aging, ill people and emphasizes the promotion of their highest possible quality of life and wellness.

B) The needs of the client for self-care drive the nursing process.

C) The nursing process involves a holistic approach to individuals and the care they require.

D) The nursing role is to focus on the sick, rather than the well, who are more representative of the older population.

Page 5

Answer Key 1. A 2. B 3. D 4. A, B, C, D 5. D 6. B 7. D 8. D 9. D 10. A 11. B 12. D 13. A 14. C 15. A 16. D 17. B 18. B 19. C 20. B 21. C 22. A 23. C

Page 6

Name: __________________________ Date: _____________ 1. Mr. C., aged 82 years, has always lived independently in the house that he and his late wife purchased over 50 years ago. Mr. C. has experienced few health problems, and for that reason his recent falls in the home comes as a surprise to himself and his children. What should the nurse who is providing primary care for Mr. C. first do in this situation?

A) Arrange a family meeting to organize supervision for Mr. C. during high-risk times.

B) Perform a comprehensive musculoskeletal assessment of Mr. C. C) Investigate what community resources might be appropriate and available to Mr. C. D) Elicit from Mr. C. what he perceives to be the causes of and potential solutions to his falls.

2. A nurse who provides care on the palliative unit of a large teaching hospital has been working with an older adult client who is dying of lung cancer with liver metastases and has generated good rapport with both the client and his family. Which of the following statements best exemplifies a holistic approach to nursing care?

A) “Our goal is to keep you pain-free to the best of our ability, so don't hesitate to request additional pain medications.”

B) “I will raise the possibility of palliative radiation treatment when your oncologist is next in.”

C) “I'm wondering what feelings you have around being at this stage of your life.”

D) “I'll make sure that both the social worker and physical therapist come by in the next day or so.”

3. Mrs. D, age 77, has been recently diagnosed with type 2 diabetes mellitus. Which of the following questions by her nurse is most indicative of a holistic approach to gerontological nursing care?

A) “How do you anticipate this affecting your lifestyle and your daily routines?”

B) “Would you like me to show you a few different glucometers so that you can choose one that works for you.”

C) “Can I arrange for you to meet with a dietitian to go over some nutrition tips?”

D) “When would be a good time for me to teach you about skin care and diabetes?”

Page 1

4. A community health nurse has been invited to speak to a group of older adults in the context of the local community center. Which of the following nursing actions best reflects an approach that emphasizes the importance of health promotion in gerontological nursing care?

A) A teaching session on the signs and symptoms of stroke, along with current treatment modalities.

B) An educational presentation on the importance of prostate screening for men and mammography for women.

C) A class that presents the beneficial effects of regular exercise and practical methods for integrated exercise into daily routines.

D) A presentation on the issue of elder abuse and ways to identify and prevent it.

5. After a lifetime of good health, a 72-year-old man has been found to have severe hypertension. What can his nurse do that most clearly prioritizes the role of monitoring that nurses play in the management of health challenges?

A) Liaising between his family physician and his cardiologist to ensure that appointments do not conflict and communication is maintained.

B) Guiding the client toward the purchase of a home blood pressure cuff and keeping up to date on his regular readings.

C) Teaching the client about lifestyle changes that his condition necessitates and that will ensure his high level of function.

D) Educating the client about the basic pathophysiology that underlies his condition.

6. Nurse J provides care for numerous older adult clients in the context of her work as a community health nurse. Which of her following clients is displaying a deficit in knowledge, experience, and skills that has the potential to compromise his or her health?

A) A 79-year-old female client who has dysphagia (difficulty swallowing) following her recent stroke.

B) Mrs. H, age 78, who states that she lost all hope since her husband's death 5 months prior and no longer wants to stay active.

C) An 89-year-old man who has recently lost the ability to climb stairs due to the exacerbation of his congestive heart failure.

D) Mr. I, recently diagnosed with diabetes, who shows an inability to manipulate his glucometer and test strips.

Page 2

7. In which of the following situations would the care team be most likely justified in superseding the desires of the older adult client in question?

A) Mrs. J persists in smoking cigarettes despite her emphysema and dependence on oxygen by nasal prongs.

B) Mr. L is adamantly opposed to placement in a care facility, despite his progressing dementia and tendency to leave his stove turned on.

C) Mrs. B, though denying suicidal ideation, is depressed and has cloistered herself in her apartment for many months.

D) Mr. E, despite his family's wishes, does not want any treatment for his recently diagnosed brain tumor.

8. Which of the following statements provides the clearest justification for the performance of gerontological nursing intervention?

A) The client does not possess the requisites to meet his or her needs independently.

B) The client is deemed by health professionals, in their professional judgment, to be in a compromised health state.

C) The client expresses a desire for assistance with self-care.

D) The client engages in behaviors that are not compatible with good health.

9. While working with a client who is living with progressively worsening Parkinson disease and consequent self-care deficits, Nurse P is conscious of integrating principles of holistic gerontological nursing care. Place the following steps in the application of these principles in the correct logical and chronological order. Use all the options.

A) Implement specific nursing care plan actions B) Perform an assessment of the client C) Identify the presence of needs related to health challenges D) Evaluate how well identified health needs are being met E) Explore reasons underlying the client's health needs 10. A nurse is performing a comprehensive assessment of new male client, age 76 years.

Which of the following components of the nurse's assessment relate directly to the holistic model? Select all that apply.

A) Measuring the client's apical heart rate.

B) Asking the client about his church involvement.

C) Identifying the support systems that the client believes he possesses.

D) Eliciting the client's immunization history.

Page 3

11. Which of the following is a holistically based nursing intervention for the nursing diagnosis Impaired Gas Exchange related to immobility?

A) Teach and encourage turning B) Feed in the sitting position C) Apply oxygen as needed D) Demonstrate signs of adequate respiration 12. A gerontological nurse must seek interventions recognizing that the elderly have considerable inner resources for self-care. What are the central consequences of this approach?

A) Promotion of normalcy and individuality B) Development of feelings of dependence and powerlessness C) The ability to make their own decisions D) Clients becoming active participants of care rather than passive recipients 13. In the holistic model of gerontological care, health is best defined as: A) Absence of disease and disability B) Integration and quality of life C) Physiological balance and anatomical normalcy D) Prevention of disease and promotion of wellness 14. In a busy clinical setting, which element of the holistic model of gerontological care is most in danger of being overlooked?

A) Gratification B) Risk reduction C) Comfort D) Physiological balance 15. Older adults have the same basic health needs as others. They may also have what additional need?

A) Physiological balance B) Connection C) Monitoring D) Gratification 16. The nurse ensures that conflicting treatments are not prescribed for an elderly patient. What responsibility is he or she fulfilling for the client?

A) Education B) Coordination C) Coaching D) Counseling

Page 4

17. Which of the following is a prerequisite for self-care?

A) Instruction B) Desire C) Evaluation D) Connection 18. Mr. S is living alone at age 82. His wife of more than 50 years died recently. Visiting his home, his nurse finds that Mr. S is eating well and maintaining his mobility but neglecting his personal hygiene. His clothes are dirty, and his body odor is strong.

What should be his nurse's first action?

A) Explain to Mr. S the health benefits of keeping clean B) Probe the reasons why Mr. S is not bathing or doing laundry C) Offer time-saving bathing tips and advice on easy methods for washing clothes D) Motivate Mr. S to take the time and trouble to keep clean 19. The inability of a patient to meet self-care needs creates a need for a nursing intervention. Which of the following interventions is the preferred first priority whenever possible?

A) Assisting the individual promptly and efficiently B) Providing direct services by acting for or by doing for C) Empowering the patient by strengthening her or his self-care capacities D) Eliminating or minimizing self-care limitations 20. Which of the following is true of coaching an elder to perform a self-care task independently?

A) It requires more time and effort than letting the caregiver do the task B) It makes the patient feel demeaned and dependent C) It is not advised for patients who require multiple medications D) It is not possible when a patient lacks desire or decides against self-care 21. Mrs. J, age 79, presents with acute abdominal pain at the ER. She is found to have an ovarian cyst. Surgery is promptly and successfully performed. Because Mrs. J lives alone, she is transferred to a short-term care facility where she can recover until her daughter can travel from another state to take her home. While in the care facility, Mrs. J, who is already underweight and frail, refuses to eat. She begins to lose weight rapidly. In developing a care plan for Mrs. J, her gerontological nurse can best strengthen Mrs. J's self-care capacity by: A) Making sure her meals are attractive and seasoned well B) Planning and ordering nutritious meals for her C) Monitoring her nutritional status through observations of skin turgor and muscle strength D) Obtaining a menu from the facility's kitchen from which she can order foods she prefers

Page 5

22. Mrs. J, age 79, presents with acute abdominal pain at the ER. She is found to have an ovarian cyst. Surgery is performed promptly and successfully. Because Mrs. J lives alone, she is transferred to a short-term care facility where she can recover until her daughter can travel from another state to take her home. While in the care facility, Mrs. J, who is already underweight and frail, refuses to eat. She begins to lose weight rapidly. In developing a care plan for Mrs. J, what does the nurse most need to know before undertaking any action to strengthen Mrs. J's self-care capacity?

A) What medications the physician has ordered?

B) When Mrs. J's daughter will arrive?

C) Mrs. J's reasons for rejecting food D) Developing a care plan for “Nutrition and Hydration” 23. Which of the following best describes a nursing intervention for the nursing diagnosis Risk for Infection which is congruent with the holistic model of gerontological nursing care?

A) Assist in the selection of foods to improve nutritional status B) Prevent complications associated with immobility C) Observe for and detect respiratory problems early D) Teach the importance of cleansing the perineal region after elimination

Page 6

Answer Key 1. D 2. C 3. A 4. C 5. B 6. D 7. B 8. A 9. B, C, D, E, A 10. B, C 11. A 12. D 13. B 14. A 15. C 16. B 17. B 18. B 19. C 20. A 21. D 22. C 23. D

Page 7

Name: __________________________ Date: _____________ 1. Which of the following aspects of gerontological nursing would be most likely classified under private law?

A) The regulation of who may call himself or herself a “nurse” B) The contract between an older adult resident and the owners of the facility C) The legal criteria for declaring an individual mentally incompetent D) The criminal consequences for instances of elder abuse 2. A nurse has been providing care for a 69-year-old female client who has recently had her right foot amputated as a result of a chronic diabetic foot ulcer. The nurse undertook to perform debridement of the wound despite lacking the relevant education and experience. The client experienced permanent nerve damage as a result of the nurse's misguided efforts. Which category of legal liability is most likely relevant in this case?

A) Larceny B) Assault C) Invasion of privacy D) Negligence 3. An investigation into reports of substandard care on the subacute geriatric unit of a hospital has been undertaken. Which of the following events are representative of malpractice on the part of the nursing staff? Select all that apply.

A) A client with a documented history of seizures was left with his bed raised and with bedrails not in place, resulting in a fall and head injury.

B) A client was sent for a colonoscopy, after which it was learned that the client had never given written consent for the procedure.

C) A client with a diagnosis of vascular dementia was found wandering in the hall outside the unit.

D) An immobile client was not turned over the course of a night shift and developed a pressure ulcer on her coccyx.

E) A client admitted with a diagnosis of pneumonia contracted an antibioticresistant organism during her stay.

Page 1

4. A nurse is providing care for an older adult client who has been admitted to the hospital with liver cirrhosis. The client has expressed to the nurse his concerns that the details of his condition and treatment remain confidential, and that written documentation not “get out there.” How can the nurse best respond to the client's concerns?

A) “Anything that is discussed between us is confidential and will not be shared with anyone else.”

B) “The Health Insurance Portability and Accountability Act ensures that your medical records will not leave this hospital.”

C) “Provided you signed a directive on admission, your records will not be made public.”

D) “The law protects your right to confidentiality and health information from being released into unintended hands.”

5. An 81-year-old female client was diagnosed 1 year ago with Alzheimer's disease following a noticeable increase in confusion. She now possesses a durable power of attorney. Which of the following statements most accurately conveys an aspect of this legal arrangement?

A) The parameters of the arrangement must be revisited if the client's condition declines.

B) The arrangement was most likely initiated by court order for a government conservator.

C) The client appointed someone to take care of her affairs in the event that she becomes incompetent.

D) The family has control of logistical arrangements for the client but must gain court permission around financial affairs.

6. During a busy shift, a registered nurse directed an unlicensed care provider to change the dressing and perform wound care on an older adult client's surgical incision, an act that exists outside of the scope of the unlicensed care provider's scope of practice.

Which of the following statements best captures the legal context of this event?

A) The unlicensed care provider is solely responsible for the inappropriate practice.

B) The nurse can be held liable for the actions of the unlicensed care provider.

C) Liability rests with the company that owns the healthcare facility.

D) In the absence of documented harm to the client, the action is legally permissible.

Page 2

7. In which of the following situations would the use of physical restraints most likely be justified?

A) Mr. Y is agitated and aggressive while he is experiencing severe withdrawal from alcohol and is not responding to chemical sedation.

B) Mrs. U, who has a diagnosis of dementia, was found wandering outside the hospital and nurses have been unable to redirect her to stay on the unit.

C) Mr. I is delirious during the acute stage of his urinary tract infection and is ringing the call bell nearly continuously.

D) Mrs. T is frequently entering other patients' rooms and attempting to crawl into others' beds.

8. Nurse R works on the geriatric medicine unit of the university hospital and provides care for numerous older adult clients nearing the end of life, many of whom have Do Not Resuscitate (DNR) orders. Which of the following situations is incompatible with the legal requirements for a DNR order?

A) A client who is mentally competent has declared his wish to have a DNR order despite the availability of treatment options for his condition.

B) A client has expressed her desire to have a DNR order but her daughter is adamantly opposed to it.

C) A client clearly told the nurse her desire to have a DNR order, which the nurse documented and noted at the bedside.

D) A client has been in a coma and the family has decided to put in place a DNR order.

9. An 81-year-old female client has presented to the emergency department accompanied by her daughter with whom she lives. The daughter states that her mother has experienced a recent series of falls, which have resulted in her facial and arm bruises. The client smells of urine and is noticeably emaciated, unkempt, and is anxious while the daughter berates her during the nurse's assessment. What is the nurse's responsibility in this situation?

A) Determine the daughter's legal status with regard to her mother's financial affairs.

B) Report suspected elder abuse to the Adult Protective Services Department.

C) Establish whether the client has a durable power of attorney in place.

D) Obtain medical records regarding prior admissions for similar problems.

10. Following a recent lawsuit that implicated one of their colleagues, the nursing staff at an assisted living facility are especially aware of the need to safeguard themselves legally. Which of the following measures should the nurses take? Select all that apply.

A) Investigate whether their liability insurance is sufficient B) Ensure that work performed by unlicensed care staff under their supervision is performed adequately C) Avoid admitting residents who have living wills or advance directives.

D) Assess the competence of employees under their supervision

Page 3

11. Which of the following is a matter of public, not private, law?

A) Wrongful acts against another party B) Invasion of a patient's privacy C) Assault and battery on a patient D) Licensing of a home health agency 12. Nurse B arrives for his regular night shift at a care facility for the aged. Because of a family emergency, he has slept only 3 hours since his last shift. One of Nurse B's aides calls in sick, and there is no one to replace the aide that night. With no help available, Nurse B lifts an obese patient from a wheelchair into a bed on his own.

Short on time and help, Nurse B decides to skip the patient's evening bath. Legally, what does Nurse B most likely face?

A) Little risk of liability because he is doing his best under difficult circumstances B) Immediate discipline or dismissal for dereliction of duty C) Liability if a pattern of negligence is part of his performance evaluation D) A high risk of liability for his actions 13. Which of the following is the BEST description for a standard of care?

A) A relationship in which a nurse has assumed responsibility for the care of a patient B) A policy or procedure established by a health care agency or professional association C) The norm for what a reasonable individual would do in a similar circumstance D) A public law that, if violated, can result in liability for the nurse 14. Nurse M obtains a signature on an informed consent form from Mr. Y, who is later shown to have a fluctuating level of mental competency. In this case, what is Nurse M's most likely legal position?

A) Free from liability because Mr. Y signed the form B) May be held liable for a violation of Mr. Y's rights C) Liable unless a malpractice insurance policy is in effect D) Not liable because no family member had a durable power of attorney 15. A nurse is caring for a group of clients and will perform each of the following during the next shift. For which of the following is informed consent required?

A) Ordering a liquid diet for a post-surgical patient B) Listening to a patient reveal his or her private, personal secrets C) Giving a patient saline solution to relieve dry nasal passages D) Asking a patient to complete a questionnaire for a research study on hospital practices

Page 4

16. Which is the major reason why nurses should not act in place of a physician in obtaining informed consent from patients?

A) Nurses may be tempted to influence the patient's decision in subtle ways B) Nurses may not be able to answer some of the medical questions the patient asks C) A signature obtained by anyone other than a physician will not stand up in court D) Under the law, nurses are only allowed to act as witnesses to informed consent signatures 17. How does guardianship differ from power of attorney?

A) The court appoints a guardian. An individual grants a power of attorney to someone else to make decisions on his or her behalf B) Guardianship is legally binding whether or not an individual is competent.

Power of attorney applies only to the incompetent C) Courts monitor the actions of those executing a power of attorney, but guardians are free to act on behalf of another as long as standards of “reasonable prudence” are met D) Guardianship stays in effect for one calendar year and must be renewed annually. Power of attorney stays in effect until one or both parties choose to revoke it 18. A durable power of attorney differs from a power of attorney in what way?

A) It is granted by the court on behalf of an incompetent individual B) It stays in effect if the individual granting it becomes incompetent C) It goes into effect only after an individual becomes incompetent D) It includes responsibility for managing an individual's financial assets 19. What implications does the doctrine of respondent superior have for nurses? Nurses are held A) Liable for injury deriving from advice given to a member of a patient's family B) Responsible for double-checking the doses of medication ordered by a physician C) Responsible for the actions of the staff they supervise D) Obligated to obtain informed consent for any diagnostic procedure 20. Which of the following actions can a nurse safely take without risk of liability?

A) Questioning a doctor's written orders for medication B) Permitting a volunteer to move a patient C) Using a blood pressure cuff that is sometimes sticking D) Asking a family member to deliver routine medication to a patient's room

Page 5

21. When in doubt about using restraints on an agitated patient, it is prudent for nurses to: A) Restrain the patient for his or her own safety B) Use such minor restraints as a bedside rail or a tray on a wheelchair C) Use alternatives such as a bed alarm with increased staff supervision D) Avoid any device or procedure to limit liability 22. To minimize liability, what action should nurses take when accepting telephone orders from physicians?

A) Ask the physician to follow up with a faxed, written order B) Clearly communicate the most likely diagnosis to the physician C) Have another staff member talk with the physician and audiotape the conversation D) Accept only written orders or those communicated orally, in person 23. Which of the following is required in order for a nurse to be legally justified in not attempting to save a client's life?

A) A "Do Not Resuscitate" (DNR) statement on the patient's care plan B) A “No-Code” sign or symbol placed at the patient's bedside C) A “No-Code” order written and signed on the physician's order sheet D) The next of kin's request for DNR orally or in writing 24. What is the most important advantage of an advance directive?

A) Such a will indicates how property is to be passed on after death and avoids probate for inheritors B) It spares the family the burden of making significant decisions for a patient regarding terminal care C) It settles the issue of guardianship without the expense of going to court for each incident D) It frees health professionals from any liability derived from Do Not Resuscitate orders

Page 6

Answer Key 1. B 2. D 3. A, D 4. D 5. C 6. B 7. A 8. C 9. B 10. A, B, D 11. D 12. D 13. C 14. B 15. D 16. B 17. A 18. B 19. C 20. A 21. C 22. A 23. C 24. B

Page 7

Name: __________________________ Date: _____________ 1. A nurse manager who provides leadership in a long-term care facility prioritizes the need for residents to have current and relevant immunizations, stating, “it's inconvenient and costly, but it provides protection not only to the person getting the vaccine but to all those that they're in contact with.” Which of the following ethical philosophies most likely underlies the nurse's statement?

A) Nonmaleficence B) Absolutism C) Utilitarianism D) Relativism 2. Due to a bed shortage in the area, the head nurse on a busy geriatric medicine unit is under significant pressure to minimize client lengths of stay and speed up discharge planning. An older adult client who is convalescing after recent falls is adamant that he is not ready for discharge, and tells the nurse, “It doesn't matter who or how many people are waiting in the emergency department for this bed; I'm simply not healthy enough to go home yet.” Of which philosophy of ethics is the patient's statement most indicative?

A) Absolutism B) Relativism C) Egoism D) Beneficence 3. Despite the wishes of her family and the recommendations of the care team, a 70year-old client with a diagnosis of congestive heart failure, but who is otherwise healthy, wants to have a no-code order in place. Which of the following statements by the care team most clearly prioritizes the patient's autonomy?

A) “If this is what is best for everyone then we need to go ahead with the order.”

B) “Provided it can be demonstrated that she has a potentially poor prognosis, we should certainly consider doing this.”

C) “It's best that social work get involved at this point to reconcile the family's and the patient's wishes.”

D) “If that's what she wants, then ultimately we're obliged to respect her wishes.”

4. Nurse H is providing care in the hospital for a 71-year-old male patient who is in the late stages of cancer and who has painful bone metastases. The client is nonresponsive but groans and grimaces intermittently. Nurse H is drawing up a breakthrough dose of morphine for the patient, but Nurse R cautions that, “sure, that will address his pain, but it could depress his respiratory drive and actually kill him at this stage.” Which of the following ethical principles is Nurse R prioritizing?

A) Nonmaleficence B) Justice C) Beneficence D) Fidelity

Page 1

5. Nurse T promised an 81-year-old female client that he would liaise with the physiotherapy team and ensure that her rehabilitation would commence soon, since it was apparent that she was being overlooked. Due to a busy shift during which another patient declined rapidly, the nurse did not follow up. Which ethical principle has Nurse T most clearly violated?

A) Beneficence B) Fidelity C) Veracity D) Justice 6. Mr. L's health insurance has just expired though he is still in the recovery stages of a serious exacerbation of his chronic obstructive pulmonary disease. Backdating the paperwork by only 2 days will spare Mr. L the out-of-pocket expense of home oxygen therapy. The nurse who is organizing Mr. L's care on discharge has chosen a course of action that prioritizes the principle of veracity. Which of the following courses of action best exemplifies this principle?

A) Backdating the paperwork to ensure that Mr. L does not sustain harm from having to pay or having to go without oxygen therapy.

B) Backdating the paperwork because it will clearly maximize Mr. L's well-being at a nominal cost to the insurer.

C) Refusing to backdate the paperwork because to do so would be untruthful.

D) Refusing to backdate the paperwork because to do so would be an unjust act toward the insurance company.

7. Which of the following phenomena have contributed to recent increases in the number and complexity of ethical dilemmas for gerontological nurses? Select all that apply.

A) The scope of practice goes beyond simply following doctors' orders.

B) Nurses' levels of responsibility are higher than in past years.

C) Medical technology has made significant advances.

D) The Internet has made patients and their families more informed about health.

E) Deaths from heart disease are declining while deaths from cancer are increasing.

F) Conflicts between cost effectiveness and quality of care 8. Which of the following statements that nurses on a hospital unit made about ethical decision making is most accurate?

A) “Instead of making ethical decisions in isolation we should enlist the help of people like ethics committees and clergy.”

B) “We should ensure that contributors to our ethical decision making have direct experience with the types of hands-on care we provide.”

C) “Decisions that we make involve complex realities so we have to avoid specific philosophies of ethics.”

D) “The need for confidentiality means that we shouldn't be discussing particular ethical issues with anyone other than patients themselves.”

Page 2

9. Which of the following statements most accurately captures an aspect of the use of ethics committees in the ethical decision-making process?

A) It is important that lawyers be excluded from ethics committees.

B) Ethics committees should originate within academic and religious contexts rather than health care organizations themselves.

C) Multiple ethics committees are often necessary in order to gain a holistic and balanced perspective on issues.

D) Evaluation by ethics committees of decisions that have been made can lead to the development of policies and better decision making in the future.

10. The ethics committee of a hospital has decided that it is unethical to prioritize patients who possess more comprehensive insurance plans than those with minimal or no insurance. Which of the following principles most clearly underlies this decision?

A) Beneficence B) Justice C) Fidelity D) Veracity 11. Which of the following social changes is increasing the number and complexity of ethical dilemmas that nurses face?

A) Outdated medical technologies B) Diminished fiscal constraints C) Greater numbers of older adults D) Expansion of the hospice movement 12. Artificial organs, genetic screening, ultrasound, and other innovations today save lives that once would have been given no hope. These advances have raised ethical questions related to which of the following issues?

A) For whom and when technology should be used B) How procedures should be monitored and outcomes measured C) How judgments about patients' health status can be kept objective D) The limits of medical practice in diagnosing and treating disease 13. Which of the following factors most contributes to the fact that society is experiencing an increased burden for entitlement programs for the elderly?

A) The rights of older citizens to receive health services unavailable to other age groups B) The increasing ratio of dependent elderly to productive workers C) Growing public attention to policy and reimbursement decisions that are not in the best interest of elders D) The widening scope and increased accountability of gerontological nurses

Page 3

14. Which of the following is the best example of the ethical principle of beneficence?

A) The nurses at City Hospital answer patients' call buttons “with all deliberate speed” B) The nursing supervisor fires an incompetent part-time nursing assistant, leaving a less than full complement of staff C) At a nursing home, the staff closes residents' doors before the body of a deceased resident is wheeled out D) The charge nurse documents all reported incidents at the end of the shift 15. Which of the following actions is viewed as ethically acceptable under the philosophy of relativism?

A) An older adult's children propose that she split her life savings between them before she needs care.

B) A lottery winner donates money to a hospital only if the hospital's new wing is named after him.

C) A millionaire finds a wallet in her physician's waiting room and keeps the money inside.

D) A poor man steals medicine and diabetic supplies from a pharmacy to help his ill child.

16. When advocating the rights of patients to receive health care regardless of ability to pay, a nurse is applying which of the following ethical principles?

A) Holistics B) Justice C) Fidelity D) Autonomy 17. Patient P refuses a blood test that Nurse N believes P desperately needs. Nurse N ignores the patient's wishes and sends a blood sample to the lab without P's knowledge. The ethical conflict between Patient P and Nurse N involves: A) P: nonmaleficence; N: veracity B) P: beneficence; N: relativism C) P: egoism; N: utilitarianism D) P: autonomy; N: paternalism 18. Patient R is seriously injured in an automobile accident, and his chances of survival are slim. During his diagnostic workup, lab tests reveal that he is HIV positive. The health care professional who decides to withhold the test results from R is violating the ethical principle of: A) Veracity B) Nonmaleficence C) Beneficence D) Autonomy

Page 4

19. Which of the following is the best way for nurses to minimize their struggles in making ethical decisions?

A) Take no action unless an advance directive, will, and other legally binding documents are in effect B) Act on the recommendations of a patient's healthcare provider, friends, and family members C) Consult the guidelines of the American Nurses Association and the institution's ethics committee D) Maintain nursing's traditional focus on following physicians' orders and providing care and comfort for the patient 20. In which of the following cases is the ethical conflict between cost containment and quality care most obvious?

A) The termination of an incompetent aide who is the sole support of his family B) The conversion of a community playground into a senior citizen center C) An insurance company that denies reimbursement for dialysis of patients older than age 70 D) The decision to remove the feeding tube from a comatose patient 21. A patient with a terminal illness confides in his nurse that he plans to commit suicide. The nurse struggles with whether to report his intent. In the “Code of Ethics for Nurses” of the American Nurses Association, the nurse reads the following statement: “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” In this case, the nurse perceives the greatest ethical conflict between: A) Advocacy and protection B) Safety and patient rights C) Health and terminal illness D) The patient and the nurse 22. Nurse G is a practicing alcoholic, but continues in the job without seeking treatment.

Nurse G is most in violation of which provision of the American Nurses Association “Code of Ethics for Nurses”?

A) The nurse practices with respect for the inherent dignity of every individual B) The nurse is responsible and accountable for determining the appropriate delegation of tasks C) The nurse owes the same duties to self as to others, including the responsibility to preserve integrity D) The nurse participates in maintaining conditions of employment conducive to the provision of quality care

Page 5

23. Which of the following responsibilities is included in the “Code of Ethics for Nurses” of the American Nurses Association?

A) Advancing nursing research B) Meeting continuing education requirements C) Shaping social policy D) Defending colleagues accused of ethical violations 24. Mrs. J's insurance company reimburses for a maximum of four physical therapy sessions annually. At age 62, Mrs. J is recovering slowly from hip surgery, and her nurse believes that additional sessions would enhance Mrs. J's self-care capacity.

Mrs. J cannot afford to pay for additional sessions. Which of the following is the nurse's major ethical concern?

A) Do I increase financial risks for health care institutions by insisting that nonreimbursed therapy be provided?

B) Is the insurance company reimbursing in a manner that threatens my patient's well-being?

C) Have meta-analyses shown that additional therapy sessions are cost-effective?

D) Am I in compliance with the integrity requirement of the “Code of Ethics for Nurses” of the American Nurses Association?

Page 6

Answer Key 1. C 2. C 3. D 4. A 5. B 6. C 7. A, B, C, F 8. A 9. D 10. B 11. C 12. A 13. B 14. A 15. D 16. B 17. D 18. A 19. C 20. C 21. B 22. C 23. C 24. B

Page 7

Name: __________________________ Date: _____________ 1. Mrs. J, age 68, needs to deal with the financial and legal ramifications of her husband's recent death. To which of the following sources should the nurse first direct Mrs. J? A) Her bank or financial institution B) Her immediate family C) Veterans Affairs D) The Social Security Administration 2. The nurse is providing home care for a 69-year-old female client who is experiencing significant financial challenges in light of her high monthly costs for medication and care. The client is eager to remain in her house that she owns, but she is faced with the possibility of downsizing to an apartment to free up money for her monthly needs. Which of the following options might the nurse want to present to the client as a potential solution to her situation?

A) Consult with a bank officer regarding a reverse annuity mortgage B) An assisted living arrangement C) A life-care community D) Meals on wheels 3. A recent nursing graduate is being oriented to the public health unit in an area with a large number of residents over age 65. Which of the following statements by the nurse best demonstrates a sound understanding of the older adult population?

A) “Most hospital beds are occupied by older adults.”

B) “Older adults are often resistant to preventative health and wellness programs, which did not exist in decades past.”

C) “A large majority of older adults will spend at least some time in a nursing home.”

D) “Physical ailments become more prevalent with age but mental illnesses are less common in the elderly.”

4. A 78-year-old man who lives alone in his apartment has enjoyed good health until recently. In the last 2 months, however, he has fallen twice and required assistance, most recently having to wait several hours until his daughter found him in his bathroom. Which of the following possible solutions should the nurse who provides primary care for the client first suggest?

A) Relocation to an assisted living facility B) Use of a remote medical alarm C) A live-in home health care provider D) Spending the day at adult day care

Page 1

5. The children of a 76-year-old woman with a diagnosis of Alzheimer disease struggles to provide her increasing level of care, with the burden being especially difficult for the client's daughter with whom she now lives. The nurse who has been working with the client and her family has suggested adult day care as an option to be considered. Which of the following statements about adult day care is most accurate?

A) Older adults can go to a single location for their medical care.

B) Only clients with moderate to severe illnesses are likely to qualify for adult day care.

C) The main goal of adult day care is to provide protection for elders at risk.

D) A central focus of adult day care is providing respite for caregivers.

6. Which of the following older adults is most likely to qualify for a day hospital program?

A) A male client who is depressed and isolated following the death of his wife 3 months prior.

B) A man with sepsis secondary to a pressure ulcer on his coccyx, and who requires IV antibiotics every 4 hours.

C) A woman with bilateral venous ulcers requiring twice-daily dressing changes and who lives alone and is unable to provide her own self-care.

D) A female client who has early vascular dementia and who resides with her son and daughter-in-law, both of whom work outside the home.

7. Following a recent exacerbation of her congestive heart failure, an 80-year-old widow is investigating several assisted living facilities. Which of the following characteristics of one of the facilities she is considering would most likely be considered atypical?

A) A program is in place whereby each resident checks up on a designated neighbor once per day.

B) The organization of the bathroom is modified to accommodate physical disabilities.

C) The facility prioritizes self-care over medical treatment.

D) Twenty-four-hour, on-site nursing care is provided at the facility.

8. Following a severe hemorrhagic stroke 5 weeks prior, a 76-year-old man is experiencing a protracted decline in his health that his care team expects to end in death. The nurse manager on the acute medical unit of the hospital where he is presently receiving care has suggested the possibility of hospice care to the client's family. Which of the following interventions would the family most likely expect to give up should they choose this option?

A) Psychosocial support aimed at the family's response to their father's imminent death.

B) Surgical removal of plaques from the client's cerebral arteries to prevent future strokes.

C) A primary focus on the client's quality of life in the time until his death.

D) Spiritual care in line with the family's belief system.

Page 2

9. After an acute onset of confusion, a 90-year-old female resident of an apartment was admitted to hospital for treatment of a urinary tract infection, and the care team is suggesting that she be discharged home to complete her recovery with oral antibiotics and her urinary catheter still in place. Which of the following aspects of the woman's situation would be the nurse's priority in predischarge planning and assessment?

A) The quality and quantity of assistance that the woman has at home.

B) The woman's cognitive status and the resolution of her infection-induced delirium.

C) The woman's understanding of the function and care of her catheter.

D) The woman's fluid balance in the 24 hours prior to discharge.

10. A 70-year-old woman who experiences frequent leg pain due to sciatica tells her nurse, “I've been hearing a lot about how well acupuncture works for chronic pain and I think I might give it a try.” How can the nurse best respond to the woman's statement?

A) “That sounds like an excellent idea and I'd encourage you to go ahead with it.”

B) “Before you begin the treatment it's likely best to get your physician's permission.”

C) “A lot of these types of treatments are unproven and even dangerous, so be very careful.”

D) “Perhaps I can tell you about the risks, benefits, and limitations of acupuncture first.”

11. Which of the following represents the demographic group currently receiving the most medical treatment in the United States?

A) Infants B) Adolescents C) Middle-aged adults D) The elderly 12. Which of the following best states a true relationship between mental health status and age?

A) Mental health disorders most often arise in adolescence.

B) Mental health problems increase in prevalence with age.

C) Mental health problems are more common in the college-educated regardless of age.

D) The majority of mental health patients are young adults with schizophrenia.

Page 3

13. An elderly husband and wife still living in their own house need help with light housekeeping, minor repairs, and shopping. They ask a gerontological nurse for assistance. The nurse identifies their needs, refers them to appropriate services, and supports and coordinates the services. In this instance, the gerontological nurse is working within which category of services?

A) Preventive services B) Supportive services C) Partial care services D) Continuous care services 14. Mr. B vows that he will never set foot in a nursing home as a resident as long as he lives. Statistically, what is his chance of being right?

A) 20% B) 40% C) 60% D) 80% 15. The functions of the gerontological nurse are varied and multifaceted. Which of the following is an important goal of the gerontological nurse?

A) Achieve maximal efficiency of service delivery in the health care setting B) Help the elderly face the transition to death with comfort and dignity C) Advocate the maximal allocation of fiscal and technological resources to elderly patients D) Minimize the need for impaired and infirm patients to perform self-care tasks 16. The two extremes of the continuum of care for the elderly are defined by: A) Wellness and illness B) Health risks and safety C) Psychological and physiological challenges D) Social and economic resources 17. Which of the following distinguishes care management and case management?

A) Care management involves assessment and planning. Case management emphasizes implementation and coordination of services.

B) Care management is a means to control costs. Case management is confined to provision of health services.

C) Care management is long term. Case management focuses on a specific episode of care.

D) Care management is regulated by the National Association of Professional Geriatric Care Managers. Case management is not.

Page 4

18. Adult day-care programs are the fastest growing component of community-based long-term care. What do these programs attempt to do?

A) Maximize the existing self-care capacity of participants while preventing further limitations B) Sponsor public agencies, religious organizations, and private groups that provide volunteers for the elderly C) Lend wheelchairs, wheelchair vans, and other equipment to elders who require special transportation for day trips D) Provide a safe, pleasant environment and respite for family caregivers to attend 19. Mr. E is capable of dressing and bathing himself if given bathing supplies and clean clothes, but he forgets to perform these activities unless reminded and coached.

Which of the following would be the best form of care for Mr. E? A) Respite center B) Institutionalization C) Adult foster care D) Home monitoring 20. Which of the following outcomes do day treatment and day hospital programs facilitate?

A) Provision of social services to elderly patients B) Early discharge from hospitals and nursing homes C) Transition of the terminally ill to hospice care D) Access of gerontological nurses to the elderly population 21. Which of the following is the best description of hospice care?

A) A hospice is a place where dying individuals are cared for.

B) The focus of hospice care is on life extension.

C) Insurance companies do not reimburse for hospice care.

D) Hospice care can be either intermittent or continuous.

22. Which of the following is the best argument against same-day outpatient services for the elderly?

A) Shortened hospital stays fail to promote an elderly person's self-care capacities B) Shortening hospital stays increases a patient's risk of hospital-induced complications C) Most insurance providers reimburse only for overnight stays D) Recovery time is longer for the elderly than for younger adults

Page 5

23. What should the gerontological nurse's position be on the use of complementary and alternative therapies such as yoga and aromatherapy?

A) Patients should use such nonconventional therapies only under a physician's supervision B) Such therapies are best avoided when conventional medical therapies are prescribed C) Such nonconventional therapies are best provided by professional gerontological nurses D) Educating patients about the benefits, risks, and limitations of such therapies is a duty of the nurse 24. Mr. T has moderate levels of hearing and visual impairment. His nurse wants him to enter adult foster care, but Mr. T insists that he will continue living alone in his own home. In this situation, what is the most important variable in providing care?

A) Mr. T's preference B) Mr. T's self-care capacity C) Mr. T's physical limitations D) Mr. T's socioeconomic level

Page 6

Answer Key 1. D 2. A 3. A 4. B 5. D 6. C 7. D 8. B 9. A 10. D 11. D 12. B 13. A 14. C 15. B 16. A 17. C 18. A 19. C 20. B 21. D 22. D 23. D 24. A

Page 7

Name: __________________________ Date: _____________ 1. Which activity done by a gerontological nurse would be considered outside the normal scope of gerontological nursing practice?

A) Addressing the pain that accompanies clients' aging through various sources B) Helping older adults explore the deeper meanings of experiences they have C) Providing care that facilitates integration, restoration, and balance in clients' lives D) Intervening in clients' family relationships that have become dysfunctional or estranged 2. Which statement captures the ultimate goal of the gerontological nurse healer?

A) Facilitating change B) Preventing and treating illness C) Assisting in a return to wholeness D) Ensuring longevity and productivity 3. The nurse wants to demonstrate presence with a patient newly diagnosed with heart disease. Which actions will the nurse perform when caring for this patient? (Select all that apply.)

A) Use the senses B) Actively listen C) Refer to a to-do list D) Suggest that the patient should not worry E) Focus on what the patient says 4. An older patient recovering from a fractured hip is concerned about the ability to care for a spouse with Alzheimer's disease. Which nursing response would demonstrate availability?

A) “How have you helped your spouse in the past?”

B) “It sounds like this might be very stressful for you.”

C) “You'll likely find that your hip will heal quite a bit faster than you expect.”

D) “I'm going to look into homecare options for you both that might be available.”

5. Which statement best captures the nature of the connections that nurse healers strive for with their patients?

A) Connection entails identifying what makes a patient unique.

B) It is important that the connections be therapeutic rather than personal.

C) Connection involves being truly with patients and devoting undivided attention to them.

D) Nurses should prioritize the patient's needs and experiences and avoid sharing details of their own lives.

Page 1

6. The nurse consciously integrates activities into a daily routine that facilitates selfcare. What benefits can the nurse expect to gain from this habit? (Select all that apply.)

A) Enriched interactions with patients B) Improved ability to demonstrate integrity C) Increased knowledge base of nursing practice D) Reprioritization of his or her patients' needs over his or her own E) Higher quality relationships with his friends and family 7. Increased patient acuity at the long-term care facility and recent staff resignations have increased the nurse's workload over the last few months. Which actions would increase the nurse's self-care?

A) Resolving to work no more than one overtime shift per pay period.

B) Consciously setting limits on the amount of time spent with any given patient.

C) Documenting any lapses in care that result from the low staff ratio at the facility.

D) Asking the nurse manager to temporarily assign more unlicensed care providers to the facility.

8. The nurse who works in the intensive care unit reads the Bible and attends church every week. Which statement best captures the role of spirituality in nursing practice?

A) Spirituality nurtures strong relationships with the nurse's family.

B) Being spiritually active has been shown to increase stamina and immunity.

C) Spiritual depth allows the nurse to be immune from the stresses of high-paced work environment.

D) Being spiritually active allows the nurse to better understand and meet patients' and families' spiritual needs.

9. The nurse manager has received funding for a staff retreat and is organizing the event. Which goal should the nurse manager identify as the priority for staff participants?

A) An opportunity for staff to experience luxurious surroundings and treatments that foster their self-care B) An opportunity for staff to “be” rather than “do” and experience respite from normal responsibilities C) A chance to refocus on the professional standards of nursing and rekindle their passion for nursing practice D) A chance to reflect on challenges facing the unit and brainstorm solutions in surroundings very different from the work environment

Page 2

10. The nurse is discussing the benefits of meditation to a colleague. Which of the nurse's statements warrants correction?

A) “When you meditate, you try to 'be' rather than 'do.'”

B) “Meditation can actually lower your blood pressure and keep you healthier.”

C) “When you meditate sometimes stressful and confusing issues become clearer.”

D) “Meditation is a useful activity for people who adhere to Easter religious traditions.”

11. While listening to a patient talk about his childhood, the nurse notices broken glass from a window on the floor of the room. There is no threat of immediate harm to either the patient or the nurse. What should the nurse do?

A) Record the window problem on a notepad while the patient continues to talk B) Give the patient full attention and call in a repair request for the window later C) Use the telephone in the patient's room to report the cracked window immediately D) Interrupt the patient to leave and promise to return after reporting the cracked window 12. The nurse is reading an article that explains nursing as being a healing art. Which statement explains how nursing is a healing art?

A) Compassion and support are as important as caregiving.

B) Each individual nurse approaches it in a unique, creative style.

C) Nurses must “paint the canvas” of their own well-being before they can help others.

D) The challenges that nurses encounter are too unpredictable to be studied scientifically.

13. Which nurse risks the loss of presence when interacting with a patient?

A) The nurse with a broken arm and is working with a cast on B) The nurse who is responding to three simultaneous call bells C) The nurse who has worked 8 hours of a 10-hour shift and has missed lunch D) The nurse who has misplaced the thermometer needed to perform routine temperature checks 14. The nurse wants to ensure “wholeness” when caring for patients. Which term best defines “wholeness” as it relates to the work of the nurse healer?

A) Optimal function B) Maximal self-care C) Spiritual well-being D) Physiological integrity

Page 3

15. A patient tells the nurse about having an affair that has been kept secret from the spouse for many years. The patient is feeling remorseful. What should the nurse's response be to this patient?

A) “What your spouse doesn't know won't hurt her. Try to forget about it.”

B) “I can't help you with that, but how about we work together on your breathing exercises?”

C) “Confession is good for the soul. Why don't you tell your spouse and get it off your chest.”

D) “Everyone makes mistakes. Your feelings of remorse show how much you care for your spouse.”

16. The nurse learns that a patient is still grieving over the loss of an infant to sudden infant death syndrome (SIDS) many years earlier. The nurse recently lost a child to SIDS herself. What is the nurse's best response?

A) Listen attentively and keep her own experience to herself B) Share her own experience and relate how she feels about it C) Remind the patient that she is not alone since many people lose babies to SIDS D) Suggest that the pains of the past be laid to rest and that it is best to live in the present 17. The nurse who is feeling sluggish and gaining weight decides to take a 20-minute walk daily during the lunch break but seldom manages to do it. What is the nurse's best corrective action?

A) Find a coworker to walk with B) Write WALK! on an index card and tape it to the locker C) Buy a new pair of walking shoes and wear them to work D) Borrow an exercise video from the library and try it out at home 18. The number and quality of personal relationships increases in direct proportion to a nurse's: A) Commitment to self-care B) Number of hours worked per week C) Time and energy set aside for friends and family D) Skill in communicating with openness and compassion 19. Which is the most direct benefit for nurses who develop a spiritual connection with God or another higher power?

A) A commitment to lifestyle improvements and self-care practices B) An understanding that helps to service the spiritual needs of their patients C) An allocation of time and energy to building strong relationships with family and friends D) Early identification of signs, symptoms, and corrective actions needed to promote optimal health

Page 4

20. The nurse spends time with friends, talking about situations and events that have occurred. What is the primary benefit that the nurse will gain from sharing personal life stories?

A) Increased ability to meet patients' psychosocial needs B) Realization that others have experienced similar life difficulties C) Awareness that others can be helped after tending to self-care needs first D) Realization that changes need to be made to promote a healthful lifestyle 21. The nurse suggests that a patient start a journal. How should the nurse explain the difference between journaling and life stories?

A) Life stories are factual reports. Journals are limited to the search for insights.

B) Life stories are the reminiscences of the elderly. Journals are the diaries of the young.

C) Journaling examines activities and thoughts in the present. Life stories are accounts from the past.

D) Life stories are fictional accounts loosely based on real life. Journals are accurate, factual accounts.

22. After attending a weekend retreat the nurse decides to start meditating daily. What will be the biggest challenge for the nurse when learning to meditate?

A) Achieving deep relaxation B) Focusing on a word or prayer C) Being open to random thoughts D) Being still rather than doing something 23. The nurse who practices meditation can most likely expect an increase in which aspect of health?

A) Libido B) Strength C) Endurance D) Circulation 24. A group of nurses are planning to go on a retreat. Which phrase best describes the experience that the nurses will have on the retreat?

A) A respite from routine responsibilities and distractions B) A “get-away-from-it-all” trip to a monastery or private resort C) A time for spiritual reunions shared by members of a religious faith D) A structured, group meeting devoted to psychological re-evaluation

Page 5

25. Which analogy best reflects an action that a nurse who prioritizes self-care in daily life and nursing practice would take?

A) At a dinner party: Criticizing the food and monopolizing the conversation B) At a buffet: Passing up the salad bar and heading straight for the desserts C) On an airplane: Putting on an oxygen mask before helping another person with theirs D) On a bus: Taking a handicapped seat at the front of the bus and watching others move to the rear 26. The nurse is helping a patient work through the process of recovering from a communicable neurological disease. What actions will the nurse take to help this patient heal? (Select all that apply.)

A) Teaching ways to overcome temporary disabilities B) Guiding to make healthy life choices going forward C) Modeling healthy behaviors for the patient to emulate D) Recommending others to take care of the patient at home E) Encouraging following the treatment plan to improve health 27. The nurse is taking a few hours over the weekend to perform a self-evaluation of health practices. On what will the nurse focus during this evaluation? (Select all that apply.)

A) Corrective actions to improve rest B) Relationships with family members C) Feelings about friends and interests D) Signs of unhealthy respiratory habit E) Contributing factors to unhealthy movement 28. An older patient with end-stage renal disease is telling the nurse about the time spent in the army and how he opened up his own business as a young adult. The nurse realizes this patient is engaging in which activity?

A) Sharing life stories B) Making a connection C) Connecting with self D) Demonstrating presence 29. The nurse is having trouble correcting a health problem with a strategy that has worked in the past. What should the nurse do about the health problem?

A) Nothing since the strategy no longer works B) Avoid dwelling on the unpleasant health problem C) Identify new strategies to correct the health problem D) Continue to implement the strategy that has worked in the past

Page 6

30. The nurse, invited to a party after working an overtime shift, politely declines to attend. What does this nurse's behavior exemplify?

A) Presence B) Availability C) Models holism D) Connection with self

Page 7

Answer Key 1. D 2. C 3. A, B, E 4. B 5. A 6. A, B, E 7. A 8. D 9. B 10. D 11. B 12. A 13. B 14. A 15. D 16. B 17. A 18. C 19. B 20. B 21. C 22. D 23. D 24. A 25. C 26. A, B, C, E 27. A, D, E 28. A 29. C 30. C

Page 8

Name: __________________________ Date: _____________ 1. Which statement best captures the predominant societal view of sexuality in general and sexuality in older adults?

A) Sexuality has recently become valued and normalized in both older and younger adults.

B) There is an acknowledgment that sexual interest and activity do not necessarily decline with age.

C) There is societal recognition that the overall importance of sexuality remains high across the life span.

D) Stigma and prejudice around sexuality in older adults persists despite changes in the societal view of sexuality in general.

2. The nurse who cares for patients at an assisted living facility is planning a program to address safer sex in older adults. Why would this program be important? (Select all that apply.)

A) Susceptibility to sexually transmitted infections (STIs) increases with age.

B) HIV/AIDS is spreading more quickly among older adults than among younger adults.

C) Older adults frequently forego condom use because the risk of pregnancy does not exist.

D) Many older adults assume that STIs are problems of younger adults only.

E) Because of the hormonal changes that accompany menopause, older women are in fact more prone to sexually transmitted diseases than younger adults.

3. A female patient asks about using hormone replacement therapy (HRT) for menopausal symptoms but is concerned about the risks. How can the health care provider best guide the patient decision to begin or forego HRT? A) “The significant increases in the risk of heart disease make HRT a risky treatment that is best avoided.”

B) “You won't likely be increasing your risk of heart disease if you begin HRT, but neither will you be preventing.”

C) “The overall effectiveness of HRT in alleviating the unwanted changes that following menopause has been disproven.”

D) “HRT can best be described as a tradeoff, where menopausal symptoms decrease but there is a significantly increased risk of hip fractures and breast cancer.”

Page 1

4. The nurse wants to acknowledge and accommodate the sexual needs of older residents in a long-term care facility. Which statement provides the most accurate guide for the nurse's practice?

A) Erectile dysfunction drugs can be used to significantly enhance older adults' lack of interest in sex.

B) The nurse should gently and creatively seek to liberate older adults from the rigid gender roles of their youth.

C) The nurse should remember that the general pattern and character of sexual behavior and identity is consistent throughout the life.

D) The nurse should recognize that older adults experience an increased desire for emotional comfort and intimacy along with an accompanying decrease in desire for physical, sexual activity.

5. The nurse manager overhears health care providers make inaccurate comments about the sexuality of older patients. Which comment should the nurse correct or follow up with teaching?

A) “Overall, sex takes longer for older men than younger men.”

B) “Older people are less sexually responsive than young people.”

C) “Both men and women have orgasms less often than younger people do.”

D) “Sexual intercourse is usually not physically possible for older women because vaginal lubricant production ceases with menopause.”

6. An older male patient has disclosed to the nurse his recent inability to achieve an erection. How should the nurse respond to the patient's statement?

A) “It's not unusual for older men to have the problem occasionally, but we need to make sure that it's not the result of something we can change.”

B) “This is a very normal part of the aging process. Are there other ways of achieving sexual fulfillment that you and your wife could try?”

C) “It's a myth that older men have difficulty gaining and maintaining erections, so a thorough medical investigation is likely the best plan.”

D) “This is often an unintended result of medications. Try withholding your medications for a few days and see if the problem resolves itself.”

7. Which older adult client would the nurse identify as being susceptible to decreased libido or sexual function as a result of the medication regimen?

A) A 78-year-old woman who takes an antiplatelet aggregator for the prevention of ischemic heart disease.

B) An 80-year-old male client with osteoporosis who is taking vitamin D and calcium supplements.

C) A 77-year-old man who takes a diuretic and a -adrenergic receptor blocker for the treatment of hypertension.

D) An 81-year-old woman who takes HRT and nebulized bronchodilators for her chronic obstructive pulmonary disease.

Page 2

8. Which statements does the nurse identify as reasons for many older adults being unable to find a sex partner? (Select all that apply.)

A) Most men are married to older women.

B) There are many more men over age 65 than women.

C) Most older men are married while older women are widowed.

D) The number of older women far exceeds the number of older men.

E) Most women marry men who are significantly older than themselves.

9. The nurse identifies which patient as having the highest risk of erectile dysfunction?

A) Patient who is obese and has poorly controlled type 2 diabetes B) Patient who is 80 years old and has a colostomy following colon cancer 7 years prior C) Patient who is 71 years old and was recently diagnosed with Parkinson disease D) Patient who has a diagnosis of lung cancer following a work history that included asbestos exposure 10. Two residents of a long-term care facility have been married for over 50 years and lived in the same house until health problems caused them to be admitted to the facility. They are currently assigned to different rooms. How can the nursing staff best facilitate the couple's sexuality?

A) Facilitate a move into the same room if possible B) Locate a place in the facility where they can spend time alone C) Regularly assess and document their feelings and issues around sexuality D) Educate the couple on the ways that they can expect their situation to affect their sexuality 11. At which point should the nurse assess a senior patient's sexual health?

A) After gaining the elder's permission B) Before receiving approval from a physician C) After reviewing the results of the elder's physical exam D) Before checking the patient's prescription and over-the-counter drug use 12. What is the first thing the nurse should check when an elderly widower reports a sudden onset of erectile dysfunction?

A) His mental health history B) His heart rate and blood pressure C) What drugs he has started taking D) His attitudes toward sex outside marriage

Page 3

13. A 70-year-old male patient has erectile dysfunction, but he tells the nurse that he is no longer interested in sexual activity. What is the best advice the nurse can give to the patient?

A) Suggest that he ask his physician for Viagra in case he changes his mind B) Encourage the patient to have a medical exam to find the cause of his erectile dysfunction C) Recommend counseling, because most erectile dysfunction is psychological in origin D) Point out that erectile dysfunction affects one in four elderly men and is no reason for concern 14. The nurse recognizes that older men may decide they are too old for sex because of a cycle involving which of the following?

A) Erection and flaccidity B) Impotence and anxiety C) Masturbation and impotence D) Climax and a failure to ejaculate 15. Which statement does the nurse recognize as being a myth about sex and the elderly?

A) Sexual responsiveness diminishes in old age.

B) Most women lose interest in sex after menopause.

C) Most men in their eighties achieve erections and are capable of intercourse.

D) An individual's sexual preferences and behaviors are the same in old age as in midlife.

16. An older female patient is providing information about her sexual history with the nurse. What does the nurse realize as being true about the sexual response in older women?

A) Orgasm is more easily achieved B) Sexual interest and receptivity decline after age 60 C) Intercourse may be painful as a result of reduced lubrication D) Poor muscle tone in the vaginal wall makes penetration difficult 17. The nurse is helping an older female patient understand the difficulty of finding a sexual partner at this time in her life. What is generally true of the elderly population?

A) Most men and most women are still married B) Most men are married and most women are widowed C) Most men are widowers and most women are married D) Most men are widowers and most women are widows

Page 4

18. The nurse learns about an older male and older female resident in a long-term care facility who spend time together in a locked room. What should the nurse do about this situation?

A) Nothing. The residents have a right to privacy B) Talk to the residents' adult children about the situation C) Initiate a meeting with the residents to discuss the situation D) Institute a “no locked doors” policy and make sure all residents know about it 19. The nurse is planning a presentation for nursing staff on supporting the sexual needs of the long-term care residents. Which statement would the nurse include that best defines sexuality?

A) Any behavior involving the genital organs B) Identification with a socialized gender role C) Any physical interaction between two people D) Any behavior undertaken to attract a member of the opposite sex 20. A female patient in menopause asks why estrogen levels change during and after menopause. What should the nurse explain about estrogen in a postmenopausal woman?

A) Conversion of androstenedione to estrone occurs in the skin and fatty tissue B) Secretion of estradiol and complementary progesterone from the adrenal glands C) Synthesis by the ovarian follicles in response to gonadotropic hormone stimulation D) Coenzyme action in the parathyroid gland prompted by stimulation from the thyroid 21. A female patient believes she is experiencing menopausal symptoms but the health care provider wants to perform additional testing. What manifestations did the patient most likely demonstrate?

A) An onset of migraine headaches B) Rising to urinate several times each night C) Moodiness, depression, and forgetfulness D) Occasional weakness and numbness on her right side 22. A patient experiencing menopausal symptoms asks what dietary changes can be made to reduce the manifestations of menopause. What should the nurse instruct the patient?

A) Eat meats and dairy products rich in animal estrogens B) Eat whole grains, nuts, and soybeans rich in plant estrogens C) Eat fruits and vegetables rich in vitamin C to increase estrogen retention D) Drink coffee and caffeinated sodas to stimulate estrogen release from the adrenal glands

Page 5

23. A female patient is experiencing hot flashes and anxiety since beginning menopause.

What should the nurse teach the patient about managing these symptoms? (Select all that apply.)

A) Consider meditation B) Cut down on exercise C) Take rhapontic rhubarb D) T'ai chi can help with stress E) Reduce sleep to 6 hours a night 24. During an assessment the nurse suspects an older male patient is experiencing andropause. What did the nurse assess in this patient? (Select all that apply.)

A) Breast enlargement B) Testicular shrinking C) Dark spots on the skin D) Reduced muscle mass E) Bruising and petechiae 25. A male patient who experienced a heart attack 6 months ago tells the nurse that he did not realize that his sexual life would be over so early in life. What information would be appropriate for the nurse to share with this patient? (Select all that apply.)

A) Encourage to cultivate hobbies B) Teach about alternative positions to avoid strain C) Instruct to avoid large meals for several hours before sex D) Plan to take medications for peak effectiveness during sex E) Explain that everyone experiences an end to sexual experiences 26. While completing an assessment the nurse learns that an older female patient has many misconceptions about having sex at this time in her life. What did the patient say for the nurse to come to this conclusion?

A) Sex can refracture a broken hip.

B) Some medications can reduce the desire for sex.

C) Menopause changes the amount of estrogen in the body.

D) Different positions can be used to help with the limits of arthritis.

27. A patient explains a lack of interest in sex since her spouse passed away 3 years ago.

After completing the health history what would the nurse suspect as contributing to the patient's lack of interest in sex?

A) Prescribed antidepressants for sadness B) Change in the patient's Medicare benefits C) Participating in arthritis swimming classes D) Reduced intake of red meat and carbohydrates

Page 6

Answer Key 1. D 2. B, C, D 3. B 4. C 5. D 6. A 7. C 8. C, D, E 9. A 10. A 11. A 12. C 13. B 14. B 15. B 16. C 17. B 18. A 19. B 20. A 21. D 22. B 23. A, C, D 24. A, B, D 25. B, C, D 26. A 27. A

Page 7

Name: __________________________ Date: _____________ 1. An older female patient tells the nurse that even though she believes in a higher power she is not interested in information on the hospital's chaplaincy services since she has never been religious. What does the nurse recognize as the relationship between religion and spirituality?

A) Some people are religious, while others are spiritual.

B) Religion is a particular, structured way of expressing spirituality.

C) Religion is the essence of our being that connects us with the Divine.

D) All human beings have an innate desire for religious structure and spiritual fulfillment.

2. The nurse manager of a geriatric medicine unit learns that spiritual care services are underutilized by patients and their families. Which phenomenon explains this finding?

A) While spiritual needs are a universal part of the human condition, many people do not acknowledge these needs.

B) The high-stress environment of a hospital is incompatible with the solace and quiet necessary for addressing spiritual needs.

C) Spiritual needs are less apparent during times of immediate and tangible need, such as acute illness requiring hospital treatment.

D) Many older adults who have experienced a lifetime of self-sufficiency and practical resourcefulness do not have spiritual needs.

3. The nurse is aware of the spiritual dimension in Erikson's conceptualization of the older adult's growth and development. When applying Erikson's theory to the care of older patients, what does the nurse realize as being a spiritual component of Erikson's final development task?

A) Awareness that one is loved by others and has provided unconditional love.

B) A confidently held hope that a transcendent and positive afterlife awaits one following death.

C) A sense of contribution that one's relationships and endeavors have benefited society and one's family.

D) A sense of wholeness rooted in the knowledge that life experiences make sense and have served a purpose.

4. The nurse is caring for older patients in a long-term care facility. When ensuring for these patients' dignity, which statement reflects the role of dignity as it relates to the spiritual needs of the older adult?

A) Older adults who have lived a life of integrity and service have earned dignity.

B) An acknowledgment of spiritual needs is necessary for the presence of dignity.

C) Older adults may lack many of the attributes that are valued in society, but they can derive a sense of dignity from spirituality.

D) Older adults who have moved successfully through Erikson's stages of development can experience dignity in spite of disability.

Page 1

5. The spouse of a patient with dementia remains upbeat and is appreciative of having good health and a loving family. The nurse realizes that the spouse is demonstrating which component of spirituality?

A) Hope B) Fatalism C) Gratitude D) Transcendence 6. An older patient just learning of having a terminal illness begins to cry. Which statement or question should the nurse make to facilitate the patient's spiritual health?

A) “Remember that everything in life, even the bad things, happens for a reason.”

B) “Is there anything in your spiritual beliefs or practices that might bring you comfort at this time?”

C) “It's not appropriate for me to pray with you, but would you like me to arrange a visit from the chaplain?”

D) “It's likely best for you to try to focus on what is going right in your life, even though that's likely hard right now.”

7. What should the nurse use to help guide interventions to meet the spiritual needs of a patient?

A) The client's prognosis for recovery B) The nurse's own religious tradition C) The denominational affiliation of the chaplain D) The presence of icons and religious books at the bedside 8. An older male patient with end-stage renal disease is sad and believes that he will die within a few days. Which interventions should the nurse use to promote hope in the patient? (Select all that apply.)

A) Using humor at the bedside B) Facilitating a life review for the client C) Helping the client to find pleasure during current life activities D) Encouraging the client to focus on a time of life that was more pleasant E) Introducing the client to an individual who has a much poorer prognosis and/or health status

Page 2

9. An older female patient, experiencing cancer pain and nausea and vomiting from chemotherapy, asks the nurse to pray for her during this difficult time. How should the nurse respond to the patient's request?

A) Facilitate a visit from a chaplain to the client at the bedside.

B) First determine whether the client shares a similar religious tradition as the nurse.

C) Pray for the client, asking a higher power to intervene and provide peace and relief.

D) Explain that praying is beyond the nurse's scope of practice and explore alternative interventions.

10. An older male patient admits to doing many things in life that he is not proud of and is having a difficult time getting them out of his mind. How should the nurse respond to the patient's statement?

A) “Remember that no one has lived a perfect life.”

B) “Is there anyone that you might want to ask forgiveness from?”

C) “Is there anything I can do to help you focus on more positive things?”

D) “Do you think that you were really any worse than most other people?”

11. Two nurses are discussing the relationship between spirituality and religion. Which statement explains this relationship?

A) They are the same. Both connect individuals to the Divine and to other living things.

B) They are directly related. The more spiritual the individual, the greater his or her commitment to religion.

C) They interact inversely. Heavy involvement in organized religion diminishes spirituality and vice versa.

D) They are different. Spirituality is a sense of connection to the Divine; religion is a structure of beliefs, rituals, and rules.

12. At the conclusion of a health history the nurse conducts a spiritual assessment with the patient. Why is this assessment important?

A) Strong spiritual beliefs facilitate health and healing B) A spiritual crisis can trigger a psychosomatic disease C) It is the nurse's job to facilitate communication between the patient and the clergy D) The nurse needs to be careful that therapeutic regimens do not violate a patient's religious beliefs

Page 3

13. A patient with cancer asks the nurse to pray with him but the nurse does not feel comfortable with prayer. What should the nurse do?

A) Decline politely and ask a coworker to pray with the patient B) Arrange transportation so that the patient can attend prayer meetings at his church C) Pray with the patient after making sure he understands that the nurse would prefer not to D) Pray with the patient realizing that the patient's needs are more important than the nurse's beliefs 14. During an interview process as a staff nurse for a geriatric patient care area, the nurse is asked about her philosophy of spirituality. Why is this important when caring for older patients?

A) Spirituality becomes more unconditional as people age B) Spirituality often becomes more important to people as they age C) An individual's spirituality remains stable from youth through old age D) As people age, their spirituality becomes more quantitative than qualitative 15. Which statement should the nurse use to plan interventions to address the behavior of an older patient sitting quietly alone in a room?

A) Spending a lot of time alone is a sign that an elder is lonely or grieving.

B) Uninterrupted periods of solitude and inactivity are therapeutic for the elderly.

C) Solitude should be discouraged among elders because it leads to social isolation.

D) Occupational therapy should be arranged for an elder often observed doing nothing.

16. The nurse is preparing a list of patients who will need the annual influenza inoculation. Which older adult will most likely refuse this vaccination?

A) A 71-year-old Christian Scientist B) A 68-year-old man who attends a Unitarian church C) A 68-year-old female patient who identifies herself on admission as a Jehovah's Witness D) A 78-year-old who says that she is a member of the Church of Jesus Christ of Latter Day Saints 17. For patients from which of the religious groups would an opportunity to fast in the weeks before Easter be most important?

A) Jewish B) Eastern Orthodox C) Seventh-Day Adventist D) Episcopalian (Anglican)

Page 4

18. The nurse is caring for an older patient who is nearing death and realizes that no professional clergy needs to be contacted. This patient is most likely a member of which faith?

A) Pentecostal B) Unitarianism C) Seventh-Day Adventists D) Church of Jesus Christ of Latter Day Saints 19. An older female patient in the resident care facility insists that her hair be kept covered at all times. Of which branch of the Jewish faith is she most likely a member?

A) Reform B) Orthodox C) Rabbinical D) Conservative 20. An older patient tells the nurse that he meditates to seek enlightenment. Because of this, the nurse might inquire if he wishes to have which item eliminated from his daily dietary intake?

A) Beef B) Cereal C) Refined sugar D) Leavened bread 21. An older female patient tells the nurse that through periods of trial and tribulation, the Bible has been the source of ongoing strength and support. Which statement supports this patient's beliefs by researched evidence?

A) Patients from low socioeconomic levels tend to be more religious.

B) Religious commitment has a positive effect on health care outcomes.

C) Patients holding strong religious convictions experience great emotional stress during illness.

D) Among the elderly, high levels of religiosity correlate with greater levels of physical disability.

22. A patient is demonstrating signs of spiritual distress but refuses to be visited by clergy or to participate in religious services. What should the nurse do to help the patient?

A) Arrange for a volunteer to read inspirational essays to the patient B) Do not challenge the patient's decision or attempt to change his mind C) Pray that the patient will come to recognize his need for spiritual support D) Talk with the hospital chaplain about looking in on the patient without talking about religion

Page 5

23. During an assessment an older male patient states that he has not been happy in life because he does not deserve to be loved. The nurse realizes that this patient believes love has been withheld because of which criteria? (Select all that apply.)

A) Productivity B) Social position C) Education level D) Physical condition E) Material possessions 24. The nurse determines that a patient is experiencing spiritual distress. What did the nurse assess in this patient? (Select all that apply.)

A) Anger B) Smiling C) Complaining D) Poor appetite E) Refusing to make plans 25. A patient tells the nurse that she has practiced meditation for years since it has helped her with mental clarity. Which type of meditation should the nurse document that the patient practices?

A) Mindfulness B) Concentrative C) Transcendental D) Trans-mutational 26. The nurse is planning care to address a patient's spiritual distress. Which interventions would be appropriate to include in this plan of care? (Select all that apply.)

A) Pray with the patient upon request as needed and desired B) Find a volunteer to read the Bible to the patient upon request C) Remind the patient that spiritual needs are often addressed last D) Contact the patient's church to have the clergy visit the patient E) Help the patient identify factors contributing to spiritual distress 27. A patient is observed sitting on the side of the bed crying. When approached the patient does not say anything but continues to cry and hold the nurse's hand. What should the nurse do to communicate being present with the patient?

A) Sit down next to the patient B) Leave the patient alone to cry C) Encourage the patient to stop crying D) Ask the patient to use the call bell if he or she wants to talk

Page 6

Answer Key 1. B 2. A 3. D 4. C 5. C 6. B 7. D 8. A, B, C 9. C 10. B 11. D 12. A 13. A 14. B 15. B 16. A 17. B 18. D 19. B 20. A 21. B 22. B 23. A, B, D, E 24. A, C, D, E 25. B 26. A, B, D, E 27. A

Page 7

Name: __________________________ Date: _____________ 1. Even though a nursing assistant notices that an older patient's oral intake has been poor since being admitted to the care area, the assistant is not concerned since “older people don't need to eat much anyway.” How should the nurse respond to this assistant's comment?

A) “That's a myth actually; older adults have increased caloric and nutritional needs.”

B) “Actually, older adults who are sick require more calories than younger people do during their recovery.”

C) “You're right, but it's still important that we provide vitamin supplements especially when a patient is recovering from an illness.”

D) “Even though it is true that older people don't need quite as many calories as younger people, they need as many nutrients as you or I.” 2. A health-conscious resident of an assisted living facility is promoting the value of fiber to a fellow resident. Which statement made by the resident about the benefits of fiber is accurate?

A) Improved bowel activity and increased metabolic rate B) Improved bowel activity and decreased serum cholesterol C) Improved gastric emptying and prevention of colon cancer D) Increased nutrient absorption and decreased glucose tolerance 3. During a home visit, the nurse is asked by an older couple if vitamin and nutritional supplements can compensate for poor food intake. What should the nurse respond to this question?

A) “Supplements can be useful but avoid those that contain calcium.”

B) “The risks of excess dosages mean that supplements are best avoided entirely.”

C) “Supplements should be thought of as supplements, not replacements, so it's best not use them.”

D) “Vitamin and nutrient supplements can be a useful short-term nutritional measure, but only if they don't interact with prescribed medications.”

4. An older woman asks what she can do to reduce the risk of developing osteoporosis.

What should the nurse respond to this patient?

A) “The key to preventing osteoporosis is to remain physically active on a regular basis.”

B) “For women who have complete menopause, vitamin D supplements are the best form of prevention.”

C) “The best thing that you can do is to maximize your calcium intake by including dairy at most meals and taking supplements as well.”

D) “You need to make sure you are getting the recommended daily dose of calcium, which may involve taking supplements at each meal.”

Page 1

5. An older patient with a history of renal failure is admitted with dehydration and hyponatremia. The nurse identifies which assessment findings as being consistent with the diagnosis of dehydration? (Select all that apply.)

A) Confusion B) Shortness of breath C) Decreased skin elasticity D) Increased blood urea nitrogen (BUN) E) Adventitious lung sounds on auscultation 6. An older patient is demonstrating signs of dehydration. Which action should the nurse initiate first?

A) Minimize food intake and maximize fluid intake B) Advocate for the initiation of intravenous rehydration C) Initiate monitoring and recording of fluid intake and output D) Ask that the physician order blood work to confirm or rule out dehydration 7. After receiving new dentures the nurse provides instruction to an older patient on the use and their care. Which patient statement indicates that teaching about the dentures has been effective?

A) “I do not have to brush and floss my teeth every day.”

B) “I suppose that I'll have to get these resized and adjusted from time to time.”

C) “I'll have to change my diet to include only soft and pureed foods now I suppose.”

D) “I've had to go to the dentist so often over the last few years and it's a relief not to have to anymore.”

8. An older patient asks the nurse what he can about nausea that occurs after eating because of delayed gastric emptying. What advice should the nurse provide to the patient?

A) Changing to a vegetarian, organic diet B) Limiting food intake and taking antacids regularly C) Increasing the amount of soluble and insoluble fiber in his diet D) Eating several small meals throughout the day rather than three larger ones 9. The family of an older patient with dysphagia comes to the skilled nursing facility at mealtimes to feed the patient. Which of the family's feeding practices should the nurse follow up with teaching or correction?

A) The family makes sure that the patient does not talk while eating B) The family checks for pocketing of food prior to introducing another bite C) The family places the patient in high Fowler position during and after feeding D) The family introduces large pieces of food to prevent accidental inhalation of small food particles

Page 2

10. The nurse is planning interventions for an older patient who is prone to developing constipation. Which intervention would be appropriate for the nurse to implement with this patient?

A) Increase fluids and encourage activity B) Scheduled administration of oil-based laxatives C) Provide normal saline enemas every 2 to 3 days D) Reduce activity and provide senna each day before bed 11. The nurse is providing a seminar for a group of seniors on changing nutritional needs. What should the nurse instruct the participants about the reduced need for calories?

A) “You should consume at least three servings of fruits and vegetables daily.”

B) “You should limit your fat intake to less than 50% of total calories consumed.”

C) “The consumption of a high-carbohydrate diet prevents the release of glucose.”

D) “As you age, your basal metabolic rate declines, contributing to weight gain even when you consume the same amount of calories as when you were younger.”

12. A confused but physically healthy older patient eats a diet very high in cereals and breads, with fruit only once per week and little protein. How does the patient's diet impact her current condition?

A) A lack of vitamin A can affect her night vision.

B) A high-calcium diet can lead to problems with kidney stones.

C) The lack of fruit in her diet can contribute to complaints of constipation.

D) A high-carbohydrate diet can stimulate abnormally high release of insulin, which can add to her confusion.

13. After a nutritional assessment the nurse learns that a 70-year-old female patient routinely ingests a diet high in fat. The nurse realizes the patient is at an increased risk for developing which health problem?

A) Cancer B) Arthritis C) Osteoporosis D) Heart disease 14. An older patient reports a significant amount of cheese, milk, and calcium-fortified orange juice in her diet. She also takes a 750 mg calcium supplement at breakfast.

What should the nurse instruct the patient about her calcium intake?

A) Keep the intake of calcium to 30% of kilocalories or less B) Take calcium supplement doses totaling not more than 5,000 mg C) Limit the intake of calcium to a total of 2,000 mg or less from all sources D) Follow the RDA listed on the milk products' nutrition labels for calcium intake

Page 3

15. The nurse observes the skin of an older patient and then asks the patient questions about his nutritional status. How did inspection of the patient's skin guide the nurse to complete a nutritional assessment?

A) Purpura may indicate hyperglycemia B) Fungus infections may indicate zinc deficiency C) Poor skin turgor may be an indicator of overhydration D) Persistent “goose bumps” may indicate a vitamin deficiency 16. A 75-year-old patient and his 40-year-old daughter both have an intestinal virus with complaints of vomiting and diarrhea. Why is the nurse concerned about the patient being at risk for dehydration?

A) The patient is on a fixed income B) The virus will make changes to the patient's gastrointestinal system C) The vomiting and diarrhea will cause a reduction in intracellular fluids D) The patient does not want to bother a health care professional for a common virus 17. An 80-year-old patient who has just spent 2 days at the beach with his family is demonstrating confusion, dry skin, a dry brown tongue, sunken cheeks, and concentrated urine. What health problem do the patient's symptoms most likely indicate?

A) Dehydration B) Renal failure C) Hyperthermia D) Food poisoning 18. An 80-year-old patient is admitted to the hospital for dehydration related to flu symptoms and receives intravenous fluids. What is a major risk factor for the patient during this hospitalization?

A) Fluid restriction can lead to infection and constipation.

B) Fluid restriction can lead to serious electrolyte imbalance.

C) Dehydration can lead to decreased ability of the bladder to distend.

D) Overhydration can lead to problems when receiving intravenous fluids.

19. An older female patient will only eat oatmeal and has bad breath. A dental exam reveals that the patient has a few of her own teeth and uses a partial appliance. She also has red, swollen, painful gums, and some teeth are loose at the gumline. The nurse realizes the patient is experiencing which health problem?

A) Periodontal disease B) Endodontic disease C) Gastrointestinal disease D) Lack of adequate nutrition

Page 4

20. An older patient has dentures and tells the nurse that she has not seen the dentist for years. What is the best advice the nurse should provide the patient?

A) Visit the dentist periodically to replace the dental appliance B) Visit the dentist regularly if she wears his dentures everyday C) Make an emergency dental visit if she notices a problem with the gums D) Schedule regular visits with the dentist to monitor for lesions and fit of the dental appliance 21. During a home visit the nurse notes that an older patient has a tray of many types of vitamins, minerals, and herbal supplements on the kitchen counter. The patient was recently discharged from the hospital after having an acute myocardial infarction.

What should the nurse instruct the patient about these supplements?

A) Continue taking the supplements but only with meals B) Stop taking the vitamins and other supplements until further notice C) Take the vitamins but do not exceed the recommended daily allowances for older adults D) Check with the health care provider to identify any supplements that may produce adverse interactions with prescribed medication 22. The nurse is instructing a nursing assistant on how to feed all patients with dysphagia. What information should the nurse include in this instruction?

A) Thicken liquids and cut solids into very small pieces B) Use a spoon to transport even solid food to the patient's mouth C) Listen for bowel sounds to make sure the food has reached the stomach D) Make sure the patient is sitting upright whenever consuming food or fluid 23. The nurse is caring for an 85-year-old male patient who weighs 150 lb and is 6 feet 3 inches tall. If using the resting energy expenditure equation, how many calories must the patient consume each day to maintain his current body weight? (Be sure to round your answer to the nearest whole number.)

24. An older patient takes over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for self-treatment of arthritis. For which nutritional health problems will the nurse include when assessing this patient? (Select all that apply.)

A) Thirst B) Nausea C) Diarrhea D) Vomiting E) Constipation

Page 5

25. The nurse is concerned that an older patient with renal failure is developing malnutrition. What did the nurse assess in this patient? (Select all that apply.)

A) Hematocrit level 30% B) Hemoglobin level 7 g/dL C) Serum albumin level 2.5 g/100 mL D) Blood glucose level 110 mg/dL E) Weight loss of 6% over the last month 26. An older patient is prescribed a thiazide diuretic as treatment for mild right heart failure. Which herbal supplements should the nurse instruct the patient to avoid while taking this medication? (Select all that apply.)

A) Green tea B) Kava-kava C) White willow D) Cascara sagrada E) Aloe barbadensis

Page 6

Answer Key 1. D 2. B 3. D 4. D 5. A, C, D 6. C 7. B 8. D 9. D 10. A 11. D 12. D 13. D 14. C 15. D 16. C 17. A 18. D 19. A 20. D 21. D 22. D 23. 1,378 calories 24. B, C, D, E 25. A, B, C, E 26. D, E

Page 7

Name: __________________________ Date: _____________ 1. The nurse is identifying the different sleep patterns of assigned patients on a geriatric care unit. Which patient is demonstrating the typical sleep pattern of a patient who is older?

A) Age 82 patient sleeps a total of more than 12 hours out of 24 B) Age 90 patient describes the quality of sleep as “better than it ever was” C) Age 80 patient falls asleep early in the evening but wakes up before dawn D) Age 79 patient sleeps in until 9 o'clock each morning despite a lifetime of early rising 2. An older patient suffering from chronic exhaustion has an EEG that shows little time is spent in REM sleep. After reviewing the patient's history, what does the nurse suspect might be contributing to the patient's sleep problem?

A) Has two or three glasses of wine near bedtime B) Obese and diagnosed with type 2 diabetes 6 years ago C) Takes low-dose aspirin for the prevention of heart disease D) Stressed due to the spouse's new diagnosis of Alzheimer disease 3. An older patient hospitalized for pneumonia is having difficulty sleeping and is frustrated with the noises at night. What should the nurse do about this situation?

A) Obtain an order for a benzodiazepine to be taken at bedtime B) Change the temperature of the client's room to be more conducive to sleep C) Provide a form of white noise and plan to minimize noise during caregiving activities D) Teach the client about the normal changes in sleep quality and quantity that accompany aging 4. An older patient is experiencing restless legs that are interfering with sleep. What should the nurse respond to this patient's problem?

A) “Some people find that daily exercise helps with this problem.”

B) “Most often restless legs can be traced to a deficiency in dietary calcium.”

C) “There are prescription drugs that nearly always provide relief from this problem.”

D) “There are a number of different medications that can cause this problem or make it worse.”

5. An older patient complains of overwhelming daytime fatigue, which the spouse attributes to loud snoring and erratic breathing patterns during the night. Which health problem should the nurse suspect as causing this patient's fatigue?

A) Insomnia B) Central sleep apnea C) Nocturnal myoclonus D) Obstructive sleep apnea

Page 1

6. Which patient on a geriatric medicine unit would the nurse recognize as being most prone to sleep problems?

A) An obese female patient receiving IV antibiotics for the treatment of a urinary tract infection B) A 74-year-old female receiving transfusions of packed red blood cells for an upper GI bleed C) A 78-year-old male recovering from an ischemic stroke and has skin breakdown on the coccyx D) A male patient admitted for exacerbation of chronic obstructive pulmonary disease (COPD) with a history of angina 7. An older patient with multiple health problems asks the nurse for advice about recurrent insomnia. Which statement made by the nurse is most accurate?

A) “Caffeine obviously makes it hard for you to sleep, while a moderate amount of alcohol at bedtime is useful.”

B) “You should try over-the-counter sleep aides for several weeks before you move on to prescription options.”

C) “It's very normal for the quality of sleep to decrease with age, so this is usually a problem that requires accommodation rather than treatment.”

D) “A lot of medications have the potential to interfere with sleep, so it would be useful to review your medications with your physician or a pharmacist.”

8. An older resident of a long-term care facility has recently been prescribed a nonbarbiturate sedative. For which effect should the nurse assess in this patient?

A) Anticholinergic effects B) Daytime sedation and confusion C) Respiratory depression and sleep apnea D) Changes in blood pressure and heart rate 9. Because many residents in a long-term care facility are experiencing sleep problems, which routine should the nurse reevaluate?

A) Offering a light snack at bedtime B) Bathing residents in the evening rather than first thing in the morning C) Activities are concentrated in the morning to ensure evenings are free D) Encouraging residents to refrain from going to bed when they first feel drowsy in the evening

Page 2

10. What should the nurse keep in mind when determining the relationship between pain and sleep in an older patient?

A) Nonpharmacologic measures to control pain and enhance sleep are preferable to analgesics.

B) Analgesic drugs should be administered to older adults to prevent potential episodes of pain.

C) Older adults are more sensitive to pain than younger adults, and more at risk of having pain interfere with sleep.

D) The availability of alternative forms of pain control such as massage and diversion means that pharmacologic pain medications are inappropriate and unnecessary.

11. A healthy older patient is experiencing sleep problems. What should the nurse instruct the patient about the influence of aging as it relates to sleep?

A) As people age, most of them require fewer hours of sleep.

B) The normal aging process has minimal effect on the quantity of sleep.

C) Older adults are no longer bothered by noise and lights during the night.

D) Older people sleep more soundly but awaken more often during the night.

12. An older patient is relocating to the home of her daughter who wants to modify the home environment to suit her mother's needs. What information should the nurse provide to the daughter to address the patient's age-related sleeping needs?

A) Older people are less active during the day and require less sleep at night.

B) Older people are not affected by age-related changes but may have some individual needs.

C) Older people stay awake very late into the night and as a result usually sleep late in the morning.

D) Older people sleep less soundly and may awaken to noises that would not cause the same reaction in younger adults.

13. An older patient who spends most of the time in bed because of impaired mobility is complaining about not getting enough sleep. What would cause the nurse concern if this patient were prescribed sleep sedatives?

A) Promotion of incontinence B) Depression of some vital body functions C) Decreased body movements during sleep D) Decreased susceptibility to adverse reactions 14. An older patient asks the nurse for medication to promote sleep. What is the best alternative to sleep sedatives that the nurse can suggest?

A) Watch television before going to bed B) Drink some wine before going to bed C) Take a warm bath before going to bed D) Avoid eating carbohydrates before going to bed

Page 3

15. An older patient asks for natural methods, instead of medications, to help with falling asleep. What can the nurse suggest to this patient?

A) Avoid protein, take a walk every day, and drink a non-caffeinated herbal tea at bedtime B) Avoid carbohydrates, take a walk every day, and drink non-caffeinated herbal tea at bedtime C) Take a walk every day, get exposure to the sun daily, and drink non-caffeinated herbal tea at bedtime D) Minimize the amount of exercise, get exposure to the sun daily, and drink noncaffeinated herbal tea at bedtime 16. The nurse is identifying interventions to help older patients with insomnia. What action should the nurse perform first?

A) Educate older patients about how foods and beverages affect sleep B) Identify insomnia as a short-term problem associated with physical or mental illness C) Suggest natural methods to the older patient fall asleep sooner and sleep more soundly D) Recognize insomnia as a symptom and assess for factors that contribute to disrupted sleep 17. The nurse is preparing to document that an older patient is experiencing nocturnal myoclonus. What assessment finding is consistent with this documentation?

A) Five leg jerks or movements per hour of sleep B) Any number of leg jerks related to the use of antidepressants C) Five leg jerks brought on by an epileptic seizure during a night's sleep D) Leg jerks in combination with episodes of breathing cessation during sleep 18. The nurse notes that two obese male residents snore loudly throughout the night. The nurse recognizes that snoring usually accompanies which health problem?

A) Central sleep apnea B) Nocturnal sleep apnea C) Obstructive sleep apnea D) A combination of central and obstructive sleep apneas 19. An adult male patient who works full time complains of being tired all day even after getting 8 hours of sleep each night. Which condition is most likely the cause of this patient's complaint?

A) Sleep apnea B) Alcohol abuse C) Nocturnal myoclonus D) Age-related changes to sleep

Page 4

20. An older patient is complaining of not being able to sleep because of leg pain. What is the first thing that the nurse should identify when relieving the patient's pain?

A) Cause of the pain B) Psychological factors C) Sleeping position at night D) Medications that could interfere with sleep 21. Nonpharmacologic pain relief measures have been ineffective to reduce an older patient's pain to promote sleep. What should the nurse do next?

A) Provide a trial of opioids B) Give the strongest dosage of analgesic and gradually decrease as necessary C) Administer the lowest dosage of analgesic and gradually increase as necessary D) Offer the lowest dosage of analgesic and give only when requested by the patient 22. An older patient is demonstrating signs of dress. How does the nurse explain the body's immediate reaction to stress?

A) Formation of ulcers B) Elevation of blood pressure C) Development of heart disease D) Stimulation of the sympathetic nervous system 23. An older patient is telling the nurse about life stresses, including a chronically ill spouse and problems with grandchildren. What is the most appropriate information for the nurse to provide to the patient?

A) Pharmacological options B) Ways to prevent chronic stress C) The benefits of natural remedies D) The name and phone number of a geriatric therapist 24. The nurse determines that an older patient is in stage II of sleep. What did the nurse observe in this patient? (Select all that apply.)

A) Relaxed muscles B) Easily awakened C) Rapid respirations D) Difficult to awaken E) Minor eye movement seen

Page 5

25. An older patient is being admitted to a long-term care facility. What information will the nurse include when conducting a sleep history with this patient? (Select all that apply.)

A) Usual bedtime routine B) Characteristics of sleep C) Amount of daytime drowsiness D) Food and fluids consumed before sleep E) Number of hours doing housework each day 26. The nurse was considering melatonin supplements for an older patient with a sleep disturbance but realized this action would be contraindicated because of the patient's medications. Which medications interact with melatonin? (Select all that apply.)

A) Warfarin B) Salicylates C) Antipsychotics D) Antidepressants E) Immunosuppressants 27. An older patient has identified stress as being the cause for not receiving adequate sleep and wants to “do something” to relax. Which activities should the nurse suggest to the patient? (Select all that apply.)

A) Read B) Take a walk C) Needlework D) Listen to music E) Visit with friends

Page 6

Answer Key 1. C 2. A 3. C 4. D 5. D 6. D 7. D 8. B 9. C 10. A 11. B 12. D 13. C 14. C 15. C 16. D 17. A 18. C 19. A 20. A 21. C 22. D 23. B 24. B, E 25. A, B, C, D 26. A, C, D, E 27. A, C, D

Page 7

Name: __________________________ Date: _____________ 1. A patient with a diagnosis of lung cancer has recently developed metastases to the bone which is causing severe pain. The nurse would characterize this patient's pain as being which type?

A) Chronic B) Neuropathic C) Somatic nociceptive D) Visceral nociceptive 2. The nurse wants to ensure that assigned patients are comfortable. What will the nurse use as a measurement of comfort?

A) A state of physical, emotional, and spiritual well-being B) An absence of reports, signs, or symptoms of physical pain C) A transcendent emotional and spiritual state that exists regardless of the presence or absence of pain D) A condition of maintaining a patient's self-report of pain being below a selfreported threshold of 1 out of 10 3. The family of an older patient is concerned because the patient at times complains of pain but at other times does not. The family does not know what to believe. What can the nurse explain to the family about aging and pain perception?

A) “Older adults become progressively more sensitive to pain.”

B) “The only pain to be concerned about is pain that lasts longer than 3 months.”

C) “Older people have been shown to be less sensitive to pain than younger people.”

D) “It's actually not clear in the research what happens to people's perception of pain as they age.”

4. An older patient is experiencing nociceptive pain in the shoulder. For which potential consequences of debilitating pain should the nurse assess in the patient?

(Select all that apply.)

A) Anemia B) Dementia C) Depression D) Decreased oral intake E) Immobility resulting in skin breakdown 5. A patient who is cognitively impaired is demonstrating signs of being in pain. How should the nurse assess this patient's pain level?

A) Ask the patient to numerically rate the pain B) Observe the patient often over the next several hours C) Provide the patient with a visual analog scale to gauge pain D) Go through the McGill Pain Questionnaire with the patient

Page 1

6. The nurse is caring for an older patient with a fractured hip. Which pain control goal would be the most realistic for the patient?

A) The patient will experience relief from pain.

B) The patient will state that being in a state of comfort.

C) Scheduled and breakthrough analgesia will be administered as needed.

D) The patient's self-report of pain will remain below 5 out of 10 while hospitalized.

7. A patient experiencing chronic pain asks the nurse if there is “anything else” that can be done to help with the pain. Which response should the nurse make to address complementary therapies with the patient?

A) Complementary therapies provide added options for treating pain.

B) Complementary therapies can be explored when medication has failed to relieve pain.

C) Complementary therapies are preferable to medications in light of their more holistic nature.

D) Complementary therapies often have unproven effectiveness but bring emotional comfort to patients.

8. What dietary advice should the nurse provide to an older patient who is experiencing pain and inflammation due to rheumatoid arthritis?

A) “Eating fewer calories will minimize inflammation in your joints.”

B) “A high protein, low-carbohydrate diet has been shown to benefit many arthritis sufferers.”

C) “A low-cholesterol diet and drinking lots of fluids might help with the pain you're experiencing.”

D) “Cutting back on your consumption of meat, fatty dairy products and oils might have a positive effect on your pain.”

9. Which approach should the nurse use when considering pain management of an older patient recovering from injuries from a motor vehicle crash?

A) Try non-opioids and adjuvant drugs before providing opioid analgesia.

B) Implement opioids if complementary therapies have proven to be ineffective.

C) Begin with a moderate dose of opioid analgesia and taper down to the lowest effective dose.

D) Restrict analgesia options to NSAIDs and adjuvant medications due to the risk of unwanted effects.

10. The nurse observes an older patient crying, tensed, and lying rigidly in bed. What action should the nurse take first?

A) Reposition the patient in bed B) Perform a systematic pain assessment C) Ask the patient if she is experiencing a problem D) Prepare a dose of breakthrough medication for the patient.

Page 2

11. The daughter of an older patient is concerned because the patient continues to experience lower back pain even though all exams, labs, and radiology studies have been negative. What should the nurse discuss with the patient's daughter?

A) Pain is a normal part of being old.

B) The pain is phantom pain, and nothing else can be done.

C) The patient's complaint does not fall into the true definition of pain.

D) The patient's team needs to explore all possible valid reasons for her mother's pain, including physical causes.

12. An older patient with type 2 diabetes mellitus is complaining of burning feet. The nurse determines that the patient is most likely experiencing which type of pain?

A) Somatic pain B) Visceral pain C) Nociceptive pain D) Neuropathic pain 13. The nurse is planning to assess the pain level of an older patient who is hearing impaired. Which assessment technique would be the most appropriate for the nurse to use?

A) Withhold analgesia until the patient requests it.

B) Ask the patient to rate pain on a scale of 1 to 10.

C) Show the patient a scale with 0 being a smile and 6 being a crying grimace.

D) Show the patient a picture of the body with a pain intensity scale, and use keywords to ask about her pain.

14. An older patient being treated for intermittent pain is complaining of increased pain despite being started on a new pain management plan. What should the nurse do to help this patient?

A) Discussing alternative methods of pain management B) Identifying underlying factors that could be interfering with the current plan C) Reevaluating and setting realistic, specific goals for the pain management plan D) Discussing with the pain management team about increasing the dosage of the medication 15. An older patient has been treated with acetaminophen for chronic pain, and it is no longer effective. What would be the next drug of choice for this patient?

A) Codeine B) Ibuprofen C) Oxycodone D) Morphine patch

Page 3

16. The nurse finds a patient sitting in bed, crying. What should the nurse do when the patient says that nothing is wrong?

A) Ignore the problem because the patient obviously does not wish to talk.

B) Document the patient crying and go back to see the patient later in the shift.

C) Sit in the chair beside the patient's bed, and maintaining eye contact, ask a few questions about the day.

D) Fill the patient's water pitcher and move around the room, doing some small things to make the patient more comfortable.

17. An older patient with a diagnosis of osteoarthritis complains of stiffness in the joints, tenderness, and pain. Which type of pain is this patient most likely experiencing?

A) Somatic pain B) Visceral pain C) Nociceptive pain D) Neuropathic pain 18. An older resident with dementia has been pacing and holding his right arm up against his chest. What should the nurse do first to help this patient?

A) Notify the physician and get an order for an x-ray B) Document the behavior and report it to the next shift C) Check the resident's record for the history of this resident's behavior D) Medicate the resident with acetaminophen that is available PRN in his record 19. An older patient who resides in an assisted living facility is experiencing chronic pain. The physical exam reveals joint swelling and a medical history of osteoarthritis. Which approach should be used to ensure effective pain management?

A) Observation of gait B) Radiological studies to pinpoint pain C) Qualitative and quantitative assessment of symptoms D) Documentation of the body language indicative of pain 20. Which foods should the nurse recommend to a patient who appears to be deficient in the B-complex vitamins?

A) Limes B) Prunes C) Yellow vegetables D) Leafy green vegetables 21. An older patient recovering from a stomach virus is experiencing pain and nausea.

Since the patient does not have any other complicating illnesses, which herb could the nurse suggest for the symptoms?

A) Ginger B) Valerian C) Devil's claw D) White willow

Page 4

22. An older patient is receiving oxycodone for cancer pain. For which side effect should the nurse assess the patient?

A) Thirst B) Delirium C) Addiction D) Muscle weakness 23. A female patient is anxious after having a mastectomy for breast cancer. As part of her pain management program, what alternative therapy should the nurse recommend as the most beneficial?

A) Naturopathy B) Biofeedback C) Nutritional therapy D) Meditation and prayer 24. The nurse is planning care for several older patients in a long-term care facility. At which points in time will the nurse assess the patients for pain? (Select all that apply.)

A) After helping with morning care B) When the patients complain of pain C) Prior to providing a patient with a meal D) When assessing the patients' vital signs E) When a patient asks for pain medication 25. The gerontological nurse enrolls in a program to learn healing touch. How does this technique differ from therapeutic touch? (Select all that apply.)

A) Seals energy leaks B) Manipulates soft tissues C) Rebalances energy fields D) Applies pressure to body areas E) Incorporates opening energy blockages 26. During an assessment the nurse learns that an older patient uses flavonoids to help reduce joint inflammation caused by osteoarthritis. Which dietary items should the nurse ensure the patient receives to maintain this patient's practice? (Select all that apply.)

A) Green tea B) Chocolate C) Grapefruit D) Blueberries E) Raspberries

Page 5

27. An older patient consistently rates pain as being a 6 on a scale from 0 to 10 even after receiving pain medication every 6 hours. What should the nurse realize the patient is at risk for developing? (Select all that apply.)

A) Depression B) Heart disease C) Hopelessness D) Kidney stones E) Spiritual distress 28. While providing care the nurse suspects an older patient recovering from a stroke is experiencing pain. What did the nurse assess in the patient? (Select all that apply.)

A) Agitation B) Perspiration C) Poor appetite D) Increased focus E) Increased blood pressure

Page 6

Answer Key 1. C 2. A 3. D 4. C, D, E 5. C 6. D 7. A 8. D 9. A 10. C 11. D 12. D 13. C 14. B 15. B 16. C 17. A 18. C 19. C 20. D 21. A 22. B 23. D 24. B, D, E 25. A, C, E 26. A, B, D, E 27. A, C, E 28. A, B, C, E

Page 7

Name: __________________________ Date: _____________ 1. The nurse, planning care for older patients on a geriatric unit, realizes which of the following health problems as occurring more frequently among older adults than in younger adults? (Select all that apply.)

A) Cellulitis B) Pneumonia C) HIV/AIDS D) Diverticulitis E) Endocarditis 2. Which aspect of the microenvironment is a 79-year-old widow most likely to focus on first?

A) The decor of the house is several decades out of date.

B) The home was recently burglarized and the television stolen.

C) The front steps of the house are decaying and pose a safety risk.

D) The home is unbearably hot in the summer and has cockroaches.

3. Which of the following lighting schemes should the nurse manager integrate into the plan for a new long-term care facility?

A) Placement of multiple diffuse lighting sources B) The use of large banks of windows to maximize direct sunlight C) Placement of large fluorescent lighting panels centered in each room D) Low levels of lighting to reduce glare and accommodate residents with light sensitivity 4. An older individual is touring an assisted living facility with his family in order to find a place to live after the death of his spouse and issues with mobility. Which characteristic of the facility is most in need of modification?

A) The temperature of common areas is kept between 75°F and 77°F B) Aromatherapy is used in the facility to provide a pleasant scent environment C) Area rugs are placed in front of each sink in residents' washrooms to ensure warmth D) There is more tile than carpet throughout the facility and carpets are glued to the floor 5. A design firm is contracted to remodel a care facility. Which bathroom design component is most conducive to safety and quality of life for the older adult residents who will use them?

A) Throw rugs will be placed on the tile floors B) Bathrooms will include bathtubs rather than showers C) A small independent light to remain lit in the bathroom at all times D) A single, rotating faucet installed at the sink to control water flow and temperature

Page 1

6. The nurse is on a task force to reduce the incidence of falls among residents of a long-term care facility. Which measure should the nurse recommend to prevent the most falls?

A) The use of diffuse, natural lighting on the unit B) A fall history and fall risk assessment of each patient on admission C) Psychosocial interventions aimed at reducing individuals' fear of falling D) Use of physical restraints on new patients who have delirium or dementia.

7. Which statement should be incorporated into the restraint policy for residents of a long-term care facility?

A) Restraints should never be used.

B) Physical restraints should only be used with verifiably agitated patients.

C) Restraints should only be used when one-to-one staff supervision is not possible.

D) Alternatives should be explored before chemical and physical restraints are utilized.

8. During a morning assessment the nurse notes that the oral temperature of an older patient is 96°F (35.6°C). What guide will the nurse use to make decisions about this assessment finding?

A) Older adults are at increased risk for hyperthermia B) Low temperature constitutes a risk to cardiac health C) Older adults often lose body heat in response to infection D) The normal body temperature of older adults is often lower than that of younger people 9. While conducting a home visit the nurse learns that the older patient has developed cataracts. Which statement should the nurse make about this patient's ability to drive?

A) “You might want to consider planning to avoid nighttime driving.”

B) “This is likely a good time for you to consider giving up your license.”

C) “The myth of older drivers being more dangerous is exactly that: a myth.”

D) “It's probably best to consider asking your children to drive you around from now on.”

10. Which self-care activity should the nurse instruct an older patient with a history of congestive heart failure, type 2 diabetes, and hypertension?

A) Monitoring of radial heart rate and lung sounds B) Starting a course of antibiotics with temperature increases C) Accurate measurement of total daily fluid intake and output D) Adjustment of blood pressure medication dosage based on home blood pressure readings

Page 2

11. An older patient who lives at home has had several admissions to the hospital for infections and drug reactions over the last 18 months. Which nursing diagnosis would the nurse identify as being appropriate for this patient?

A) Risk for Injury B) Risk for Infection C) Risk for Impaired Mobility D) Risk for Violence: Self-Directed 12. Maslow's hierarchy of six basic human needs includes love. Which characteristic of an older person's home environment demonstrates that the need for love has been fulfilled?

A) Large airy windows B) New, stylish furniture C) Adjustable track lighting D) Furniture acquired as a newlywed 13. Which characteristic of a resident's room in a nursing home demonstrates Maslow's need of security?

A) Large airy windows B) Personal drawers and closets C) Consistent placement of the furniture D) Comfortable couches and rocking chairs 14. The staff on a unit that provides care to patients with dementia wants to make changes to the patients' environment. What would be the recommended change to lighting?

A) Remove all incidental lamps from the rooms B) Keep a bedside light on in the rooms all night C) Avoid using the fluorescent light over the beds at night D) Close the curtains during the day to minimize the effect of sunlight 15. The daughter of an older patient believes that fresh air kills germs and keeps her father's bedroom window open at night. Because her father wears pajamas, she insists that he is comfortable. What recommendation should the nurse make?

A) The patient should wear flannel pajamas.

B) Place one quilt and two blankets on the patient's bed C) Keep the temperature in the patient's room not lower than 75°F D) Ensure that the window in the patient's room has permanent screening

Page 3

16. A group of residents in a skilled nursing facility are sitting outside in the garden enjoying a hot summer day. What primary concern does the nurse recognize for these residents?

A) Lack of thirst perception B) Lack of energy and related depression C) Lack of motivation to get out of the sun D) Effects of certain medications on body temperature 17. The nursing home staff is working on a renovation project for the special care unit.

What should be a key element of the plan?

A) Paint the bedrooms green B) Paint the dining room violet C) Use wavy-patterned rugs in the hallways D) Use contrasting colors for the doors of the storage closets 18. A nurse recommends to an older patient's family to place a seat alongside the bathtub to enable the older adult bather to rest while drying off. What is the best explanation for the nurse's recommendation?

A) A drop in blood pressure may follow bathing.

B) Nonslip surfaces are essential for tubs and shower floors.

C) The elderly use the bathroom often and can benefit from the rest.

D) Most elderly have an age-related problem discriminating hazards.

19. In planning the budget for next year, the nurse manager in a special care unit includes line items for a toaster, flowering plants, and a birdfeeder. How should the manager justify these costs to administration?

A) Personal items for patients B) Items for residents' sensory stimulation C) Suggested requirements to meet labor contract D) Important tools for maintaining staff satisfaction 20. During a home visit the nurse learns that an older patient with macular degeneration restricts the intake of fluids after 6 pm. What would the nurse suspect as a reason for the patient to limit fluids after this time?

A) A fear of falling at night B) A lack of thirst perception C) Lack of non-skid footwear D) Problems differentiating shades of the same color 21. The nurse visiting a patient living in the daughter's home finds the patient in an old hospital bed that has bilateral full-length side rails. What should the nurse do?

A) Present alternatives to the family B) Recommend frequent repositioning C) Discuss additional preventive measures D) Commend the family on the use of this type of bed

Page 4

22. The staff nurses are discussing ways to reduce safety risks for patients with Alzheimer's disease. Which impairments could cause safety risks for these patients?

(Select all that apply.)

A) Diabetes B) Dementia C) Depression D) Disorientation E) Memory deficits 23. The home care nurse is concerned that an older patient is at risk for a kitchen fire.

What actions can the nurse recommend to reduce the risk of this occurring? (Select all that apply.)

A) Avoid placing electrical items near a water source B) Instruct the patient to stay in the kitchen while cooking C) Encourage the use of meal delivery services to reduce cooking D) Recommend the use of a timer to check the food on the stove E) Suggest a microwave be used to heat liquids and not the stove 24. An older male patient is upset by having to be admitted to a skilled nursing facility for extended care and renal dialysis treatments. What can the staff do to minimize this patient's anger? (Select all that apply.)

A) Recommend counseling for anger issues B) Respect the patient's private possessions C) Offer to assist with basic needs and desires D) Ask the patient to explain preferences for activities E) Provide the patient with areas for privacy or solitude 25. The nurse is visiting the home of an older patient with changes in peripheral vision and depth perception. What should the nurse instruct the family to ensure safety for the patient? (Select all that apply.)

A) Use contrasting colors on the stairs B) Avoid the use of bright colors on walls C) Arrange furniture so that it is in full view D) Ensure good lighting throughout the home E) Approach the patient directly and not from the side 26. The home care nurse is conducting a home environment assessment for an older patient with peripheral vascular disease and foot wounds. Which findings should the nurse identify as safety issues for the patient? (Select all that apply.)

A) Hot water temperature 124°F B) Fire extinguisher present in the hall closet C) Functioning smoke detector in the kitchen D) Refrigerator stocked with food that is not outdated E) Medication labels absent from prescription containers

Page 5

27. The nurse identifies the diagnosis of risk for injury as being appropriate for an older patient. What health problems would increase this patient's risk for injury? (Select all that apply.)

A) Hard of hearing B) Weak gag reflex C) Chronic renal failure D) Fatigue and weakness E) Macular degeneration

Page 6

Answer Key 1. B, D, E 2. D 3. A 4. C 5. C 6. B 7. D 8. D 9. A 10. A 11. A 12. D 13. B 14. C 15. C 16. A 17. A 18. A 19. B 20. A 21. A 22. B, C, D, E 23. B, D, E 24. B, C, D, E 25. A, C, D, E 26. A, E 27. A, C, D, E

Page 7

Name: __________________________ Date: _____________ 1. The nurse caring for older patients in an acute care facility is aware of the changes in drug metabolism that can occur in older adults. Which statement explains the most important factor that affects pharmacokinetics in older patients?

A) Changes in gastrointestinal (GI) motility increase the absorption time for many drugs.

B) Drug distribution is unpredictable due to metabolic and body-composition factors.

C) Preexisting chronic conditions complicate the distribution and metabolism of drugs.

D) Decreased renal and liver function contributes to an increased half-life for many drugs.

2. The nurse at a long-term care facility is teaching unlicensed care providers about some of the factors that characterize adverse drug reactions in the elderly residents.

Which teaching points are valid? (Select all that apply.)

A) “Even when a resident stops taking a drug, a reaction can take place after the fact.”

B) “Even when a resident has been taking a drug for a long time, a drug reaction can still occur.”

C) “Most 'drug reactions' are in fact age-related changes that are mistakenly attributed to medications.”

D) “Older adults often have signs and symptoms of adverse reactions that are very different from those of younger adults.”

E) “While older adults are prone to adverse reactions, these reactions tend to resolve more quickly than in younger people.”

3. While reviewing a newly admitted older patient's medication history the nurse notes that the patient has been taking a -blocker for many years despite no apparent history of hypertension or cardiac disease. What action should the nurse first take?

A) Hold the drug in the short term until an indication is determined B) Monitor the patient's blood pressure and apical heart rate closely C) Request that the physician providing care reconsider the use of the drug D) Investigate and provide non-pharmacologic measures to replace the drug 4. When administering a proton pump inhibitor to a patient with gastroesophageal reflux disease (GERD), the nurse notes that the patient has great difficulty swallowing the enteric-coated pill. What should the nurse do when administering this medication to the patient in the future?

A) Crush the pill and mix with applesauce B) Split the pill in two parts and give each separately C) Reposition the patient and provide more fluid when giving the pill D) Provide an herbal alternative that also reduces stomach acid production

Page 1

5. The nurse is performing a home visit to an older female patient who has a history of obesity and poorly controlled hypertension. Which assessment finding would be of concern to the nurse?

A) The patient has increased the intake of green tea to obtain more antioxidants.

B) The patient has begun taking low-dose ASA for the prevention of cardiac disease.

C) The patient takes insulin injections three times daily for the treatment of type 1 diabetes.

D) The patient has started taking ginseng and St. John's wort for stamina and concentration.

6. An older patient with a history of arthritis has fallen after an episode of dizziness.

Laboratory data reveal anemia and stool positive for occult blood. Which assessment question is the most appropriate for the patient's health situation?

A) “Do you take any medication for high blood pressure?”

B) “What herbal remedies or supplements do you use regularly?”

C) “Do you take aspirin for the treatment of pain or inflammation?”

D) “Does your family doctor ask you to get regularly scheduled blood work?”

7. A resident of a long-term care facility has been experiencing pain associated with sciatica, a health problem that has not previously been present. Which intervention should the nurse implement first to help control this patient's pain?

A) Provide morphine or codeine B) Prepare a dose of acetaminophen C) Implement nonpharmacologic measures D) Administer fentanyl or sustained-release oxycodone 8. An older patient with Alzheimer's disease is experiencing increasing episodes of agitation and wandering. The patient has been prescribed risperidone (Risperdal), an atypical antipsychotic. Why should the nurse question this medication order?

A) Physical restraints should be trialed before using an antipsychotic medication B) It is inappropriate to use antipsychotics to manage the behavior of patients with dementia C) The sensory changes that accompany antipsychotic use exacerbate the symptoms of dementia D) Atypical antipsychotics are preferable to traditional sedatives for the treatment of agitation and delirium 9. An older patient is prescribed a diuretic for the treatment of hypertension. For which health problem should the nurse assess this patient?

A) Constipation B) Cognitive changes C) Decreased gastric emptying and nausea D) Manifestations of fluid and electrolyte imbalances

Page 2

10. During the admission interview, the nurse learns that an older patient frequently experiences constipation. What should the nurse respond to the patient?

A) “I'll make sure that a laxative is ordered for you while you're here in the hospital.”

B) “Many older adults find that increasing their activity level and taking a mild laxative daily provides relief.”

C) “Constipation is usually a sign of a more serious health problem, so I'll pass that information on to your physician.”

D) “There are measures that I can teach you such as changing your diet and increasing the amount of fluids you drink.”

11. An older female patient believes taking high doses of vitamin A will help preserve her eyesight. What information about vitamin A should the nurse include when responding to the patient?

A) The vitamin can build up too high in the blood.

B) Taking too much vitamin A can lead to dehydration.

C) The vitamin can be displaced at protein-binding sites.

D) The vitamin can build up too high in the adipose tissues.

12. Barbiturates were given to an older man with reduced kidney function, and he nearly died as a result. What was the most likely reason for this near-fatality?

A) Increased drug dosage B) Increased kidney filtration C) Increased biological half-life of the drug D) Increased reabsorption of the drugs into the blood 13. Which action should the emergency department staff take first for an older patient who is demonstrating extreme confusion?

A) Order an ECG B) Administer a stimulant C) Review the drugs being taken D) Check serum electrolyte levels 14. An older patient is prescribed a large calcium tablet every day but objects because it is difficult to swallow it without choking. What action should the nurse take in this situation?

A) Substitute a glass of milk for the tablet B) Ask the physician if it can be discontinued C) Find the most concentrated form of the same dose D) Ask the patient to swallow the tablet along with food or drink

Page 3

15. An older patient has difficulty swallowing oral medicines and sometimes spits them out after the nurse leaves the hospital room. Which action should the nurse take to ensure the patient swallows the medications?

A) Crushing any large or enteric-coated tablets B) Prescribing liquid or suppository forms of the medicines C) Giving the patient ample fluids to make swallowing easier D) Having the patient hold the medicine in the mouth until being able to swallow 16. Why does the nurse take special precautions when administering a rectal suppository to an older patient?

A) Circulation to the bowel is increased B) The time for melting may be prolonged C) Fecal impaction is likely and will interfere D) The patient may try to expel it before it melts 17. The nurse learns that an older patient uses antacids after every meal to treat chronic “indigestion.” For which health problems should the nurse assess in this patient?

A) Urinary incontinence or retention B) Coagulation disorders and anemia C) Hyperlipidemia and arteriosclerosis D) Electrolyte imbalances and cardiac problems 18. For many years, an older female patient has taken 1 mg of the benzodiazepine lorazepam at bedtime and with episodes of anxiety. What should the nurse respond to learning of this information?

A) “Have you been diagnosed with generalized anxiety disorder?”

B) “Have you considered other methods beyond medication to help you sleep and relieve your anxiety?”

C) “This drug can lead to problems with coordination that mimic Parkinson disease, so it's best to minimize its use.”

D) “Drugs like this have been shown to be inappropriate and ineffective; it would be useful for you to discuss this fact with your doctor.”

19. Which statement about antibiotic use will the nurse use as a guide when assessing an older patient's use of this type of medication?

A) Antibiotics are best delivered intravenously rather than orally for older adults.

B) Excessive antibiotic use contributes to the spread of antibiotic-resistant bacteria.

C) Older adults need higher antibiotic doses to compensate for decreased immune function.

D) Long-term use of low-dose antibiotics provides protection against infections for older adults.

Page 4

20. An older female patient with a history of deep vein thrombosis is prescribed daily anticoagulant therapy. Which foods should the nurse instruct the patient to monitor to ensure the effectiveness of the medication regimen?

A) Foods high in saturated fat such as bacon and butter B) Foods high in salt and nitrates such as processed meat C) Foods high in complex carbohydrates such as bread and rice D) Foods high in vitamin K such as asparagus and green leafy vegetables 21. The nurse caring for residents in a long-term care facility administers numerous antidepressant medications each day. For which residents should the nurse investigate a possible change in treatment?

A) A 90-year-old resident prescribed a monoamine oxidase inhibitor (MAOI) since the death of his wife B) An 81-year-old resident who is responding to cognitive therapy for the treatment of her grief and depression C) An 89-year-old resident who takes citalopram, a selective serotonin reuptake inhibitor, for the treatment of depression D) A 91-year-old resident who has been taking a tricyclic antidepressant since the onset of his physical decline several years prior 22. An older patient has been prescribed a potassium-sparing diuretic and a -blocker for hypertension. Which action should be a priority for the nurse?

A) Monitor the patient for constipation B) Closely monitor the patient's electrolyte levels C) Ensure the patient does not change position quickly to prevent a fall D) Assess the patient for changes in level of consciousness and cognition 23. An older patient with a history of atrial fibrillation is prescribed digoxin 62.5 g daily. For which assessment finding should the nurse hold the medication and reassess the patient later?

A) Blood pressure is 98/55 mm Hg B) Heart rate is 60 beats per minute C) Demonstrating agitation and delirium D) Oxygen saturation level is 90% by pulse oximeter 24. The nurse is caring for an older patient with a history of chronic obstructive pulmonary disease (COPD). Which medications could cause adverse reactions in this patient? (Select all that apply.)

A) Aspirin B) NSAIDs C) Bupropion D) -Blockers E) Long-acting benzodiazepines

Page 5

25. After completing an assessment the nurse determines that an older patient is at risk for medication errors. What did the nurse most likely assess in this patient? (Select all that apply.)

A) Weak hands B) Hearing deficit C) Use of laxatives D) Limited finances E) Walks with a cane 26. After completing a medication history the nurse is concerned that an older patient is at risk for drug toxicity. What did the nurse most likely assess in this patient? (Select all that apply.)

A) Takes medication for glaucoma B) Experiences transient dizziness after taking anticonvulsant medication C) Has blood work done every 3 months to check anticonvulsant drug levels D) Takes digoxin for a cardiac dysrhythmia and carbamazepine for seizures once a day E) Takes prescribed gabapentin for peripheral neuropathy with grapefruit juice every day 27. An older patient is prescribed nicotinic acid to correct cholesterol imbalances. For which side effects of this medication should the nurse instruct the patient? (Select all that apply.)

A) Gas B) Itching C) Tingling D) Flushing E) Muscle pain 28. An older patient admitted to the hospital with renal failure is overheard asking his family to bring in the bag of red licorice from the kitchen. The nurse is concerned because licorice can cause which adverse effects? (Select all that apply.)

A) Edema B) Bradycardia C) Hypokalemia D) Hypertension E) Hypernatremia

Page 6

Answer Key 1. D 2. A, B, D 3. C 4. C 5. D 6. C 7. C 8. B 9. D 10. D 11. D 12. C 13. C 14. C 15. C 16. B 17. D 18. B 19. B 20. D 21. D 22. C 23. C 24. D, E 25. A, B, D 26. D, E 27. B, C, D 28. A, C, D, E

Page 7

Name: __________________________ Date: _____________ 1. After completing an assessment of an older patient, which finding should the nurse attribute to a pathological process rather than age-related respiratory changes?

A) Posture is slightly kyphotic B) Slight wheeze on exhalation C) Uses accessory muscles on expiration D) Mucous membranes drier than younger clients' 2. The nurse is facilitating a health promotion class at a senior center. Which statement made by a participant should be corrected by the nurse?

A) “My wife and I both get our flu shots each fall.”

B) “I'm vigilant about staying away from anyone who has a cold or flu.”

C) “I use a puffer regularly to prevent any problems with my breathing in the future.”

D) “I've found that doing deep breathing exercises helps relax me and expand my lungs.”

3. An older patient who smokes half a pack of cigarettes daily and is diagnosed with COPD expresses regret about starting smoking over 50 years ago at a time when it was considered both fashionable and harmless. What can the nurse respond to this patient?

A) “Even though you have smoked for a long time, there are still benefits to quitting smoking.”

B) “If you continue to smoke, any medical treatment for your COPD is likely to be ineffective.”

C) “Unfortunately the damage is now done and quitting smoking will likely have little effect on your future health.”

D) “Even though it won't affect the course of your COPD, quitting smoking would probably make you feel better about yourself.”

4. Which older patient would the nurse suspect is displaying the effects associated with overusing bronchodilating nebulizers?

A) A patient with acute delirium B) A patient with complaints of chest pain C) A patient with shortness of breath on exertion D) A patient with a new onset of a cardiac arrhythmia

Page 1

5. What should the nurse instruct an older patient with a history of chronic bronchitis to help reduce the manifestations of the disease? (Select all that apply.)

A) Maintain high fluid intake B) Maintain a healthy body weight C) Encourage to consciously expectorate secretions D) Teach the importance of avoiding respiratory infections E) Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) regularly 6. The nurse educator is instructing new graduate nurses on the differences in presentation and course of pneumonia in older adults. What differences should the educator include in this teaching?

A) Older adults often do not experience chest pain or exhibit a high fever B) Older adults often develop sepsis before symptoms of pneumonia are evident C) Older adults more often develop lung consolidation rather than production of secretions D) Pneumonia in older adults is most often linked to exposure to environmental toxins over the course of a lifetime 7. Which clinical guideline should the nurse follow when providing oxygen therapy to older adults?

A) Oxygen therapy should be utilized with older adults only as a last resort B) Oxygen therapy should be used with caution to prevent CO2 retention and narcosis C) Inhaled or nebulized medications are contraindicated with ongoing oxygen therapy D) Oxygen therapy can safely be used with patients experiencing or at risk for developing lung disease 8. The nurse is preparing to implement a new postural drainage order for an older patient with copious secretions caused by community-acquired pneumonia. What action will the nurse take when implementing this order?

A) Teach the patient to expect some dyspnea and distress during postural drainage B) Ask the physician to reconsider the order for postural drainage due to the patient's age C) Perform postural drainage allowing adequate periods of rest between position changes D) Suggest the physician to consider the use of bronchodilators rather than postural drainage

Page 2

9. Which should the nurse recommend to an older patient with chronic obstructive pulmonary disease (COPD) and no specific dietary restrictions or limitations?

A) Dairy products B) Spicy foods and garlic C) Green leafy vegetables D) Low-carbohydrate and high-protein foods 10. The nurse is preparing discharge instructions for an older patient with chronic obstructive pulmonary disease. What should the nurse teach the patient about the use of inhaled bronchodilators?

A) “Usually, one or two puffs should bring you relief for around four hours.”

B) “It's important to take these medications only when you experience serious symptoms.”

C) “These medications can make your shortness of breath worse if you take them too often.”

D) “If you develop any sort of heart disease or circulatory problems in the future, these inhalers will have to be discontinued.”

11. During a home visit, the nurse notes that an older patient has increased joint pain and shortness of breath since moving in with her daughter 6 months ago. What could be contributing to this patient's complaints?

A) Age-related changes B) Increase in pulmonary disease C) Family assistance limiting her mobility D) Increase in arthritic changes to the joints 12. The nurse is caring for an older patient with right-sided paralysis who is confined to a wheelchair. Which health promotion intervention should the nurse include in this patient's care plan?

A) Monitor intake and output B) Measure vital signs every 8 hours C) Perform range-of-motion exercises to the right arm D) Encourage deep-breathing exercises three times per day 13. The nurse is visiting a patient who has been widowed and continues to live in the same home. The nurse notes the home is stuffy and the patient is experiencing a significant amount of wheezing. What should the nurse include when instructing this patient?

A) Maintaining an exercise schedule B) Performing deep-breathing exercises C) Increasing the temperature in the house D) Maintaining the air quality in the house

Page 3

14. An older patient has been treated for three incidents of respiratory infection within 6 months. The patient complains of shortness of breath when walking outside in the cold weather. What should the nurse recommend to this patient?

A) Drink plenty of water B) Avoid going outdoors C) Call the physician for antibiotics D) Increase the use of bronchial medications 15. The nurse is visiting an older patient who has smoked for 50 years and has emphysema that severely affects the patient's quality of life. The patient has had multiple hospital admissions this past year. What is the nurse's priority when caring for this patient?

A) Discussing the use of inhalers B) Assessing ability to perform activities of daily living C) Reviewing deep-breathing exercises D) Assessing the air quality in the home 16. The nurse is teaching a patient with emphysema to progressively increase activity. At which point in time should the nurse instruct the client to stop activity?

A) A decrease in respiratory rate and pulse B) An increase in respiratory rate and pulse C) An increase in respiratory rate and a decrease in pulse D) A decrease in respiratory rate and an increase in pulse 17. A patient with dementia has difficulty swallowing, and frequently coughs when eating. Recently, the patient has developed a nonproductive cough with a temperature of 99°F. The nurse is concerned that this patient is at risk for developing which health problem?

A) Lung cancer B) Chronic bronchitis C) Aspiration and lung abscess D) Chronic obstructive lung disease 18. The nurse is preparing to perform postural drainage with an older patient. Which action would the nurse perform first?

A) Rest period B) Oral hygiene C) Position for postural drainage D) Administer aerosol medications

Page 4

19. A patient who is prescribed deep breathing and coughing every hour has a nonproductive cough and is easily fatigued. What can the nurse do to increase the patient's secretions?

A) Have the patient blow the nose.

B) Encourage the patient to rest for 30 minutes.

C) Provide the patient with aerosol medication.

D) Give the patient a piece of hard candy to eat.

20. An older patient with asthma is prescribed an inhaler. What health problem will the nurse suspect impacts the patient's ability to comply with this prescribed treatment?

A) Severe arthritis B) Type 2 diabetes C) Macular degeneration D) Ventricular tachycardia 21. An older patient with a terminal illness is extremely thin and is prescribed to use oxygen via a face mask at home. Which is the priority nursing consideration to ensure the patient's oxygenation needs are met?

A) Ensure a tight seal around the face mask.

B) Maintain the patency of the nasal passages.

C) Observe the patient for signs of pneumonia.

D) Educate the family about risks of oxygen use.

22. An older patient develops rapid, shallow respirations, with retraction of the respiratory muscles. What will the nurse do first to improve this patient's ineffective breathing pattern?

A) Administer oxygen B) Prevent a respiratory infection C) Keep the nasal passages patent D) Raise the bed at least 30° 23. An older patient with a history of environmental exposure to chemicals complains of shortness of breath. Which symptom most likely indicates the patient has chronic obstructive pulmonary disease (COPD)?

A) Red, frothy sputum B) Greenish, thick sputum C) Purulent and foul-smelling sputum D) Sticky, translucent, grayish white sputum

Page 5

24. Most of the older patients on a geriatric care area have some degree of pulmonary disease and ineffective respirations. Which intervention should the nurse include on these patients' care plans?

A) Enroll in yoga classes.

B) Keep the nasal passages patent.

C) Perform daily deep-breathing exercises.

D) Avoid exposure to people with infections.

25. For which health problems would the nurse identify the diagnosis Risk of Infection as being appropriate for an older patient? (Select all that apply.)

A) Reduced vital capacity B) Reduced ciliary activity C) Increase in residual capacity D) Underinflation of lung bases E) Less efficient cough response 26. During an assessment the nurse notes that an older patient has a gray discoloration of the skin. Which health problem does the nurse suspect the patient is experiencing?

A) Emphysema B) Lung abscess C) Chronic bronchitis D) Peripheral vascular disease 27. While making a home visit, the nurse determines that the quality of a patient's indoor air environment needs to be improved. What should the nurse instruct the patient?

(Select all that apply.)

A) Damp dust furniture B) Keep windows closed C) Avoid smoking inside the home D) Vacuum the floor coverings regularly E) Install air filters in heating and air conditioning units 28. The nurse assesses a change in the respiratory status of an older patient. Which findings should be reported to the health care provider immediately? (Select all that apply.)

A) Infrequent cough B) Neck vein distention C) Elevated blood pressure D) Change in mental status E) Clear drainage from the nose

Page 6

29. An older patient with chronic bronchitis is having difficulty managing periods of dyspnea and anxiety. What can the nurse do to help the patient at this time? (Select all that apply.)

A) Instruct on the disease process.

B) Discuss reducing environmental irritants.

C) Explain how to use transportable oxygen.

D) Encourage to avoid temperature extremes.

E) Recommend spending most time out of the home.

Page 7

Answer Key 1. B 2. C 3. A 4. D 5. A, C, D 6. A 7. B 8. C 9. B 10. A 11. C 12. D 13. D 14. A 15. B 16. A 17. C 18. D 19. D 20. A 21. A 22. D 23. D 24. C 25. A, B, E 26. C 27. A, C, D, E 28. B, C, D 29. A, B, C, D

Page 8

Name: __________________________ Date: _____________ 1. An older patient who enjoys good health is experiencing a decline in stamina despite being physically active over the years. The nurse recognizes which age-related change as likely affecting the patient's stamina?

A) Increased resting heart rate and blood pressure B) Reduced heart contractility and a prolonged cardiac cycle C) Stenosis of the aorta and decreased muscle tissue perfusion D) Hypotension with consequent inadequate peripheral blood supply 2. An older patient asks the nurse practitioner what measures can be taken to maintain a healthy heart. Which regimen should the nurse recommend to the patient?

A) “A low-salt diet and an aspirin tablet with each meal can promote a healthy heart.”

B) “Abstaining from alcohol and limiting your use of painkillers have a protective effect on your heart.”

C) “One Tylenol tablet and a glass of red wine each day have been shown to help prevent heart attacks.”

D) “A low-dose aspirin each day and moderate use of alcohol can help prevent cardiovascular disease.”

3. An older male patient taking medication for hypertension asks what else can be done to reduce the blood pressure. What measures should the nurse recommend to the patient?

A) A low-fat, low-cholesterol diet B) Deep breathing and Buerger-Allen exercises C) Weight loss and a reduction in sodium intake D) Daily low-dose aspirin and one alcoholic drink daily 4. An older patient who resides in an assisted living facility experiences dizziness and lightheadedness when getting out of bed in the morning and when standing up quickly from a chair. Which intervention would be appropriate at this time?

A) Assess the patient's dietary and activity habits B) Plan a weight-loss and exercise regimen together with the patient C) Review the medication regimen and teach appropriate safety measures D) Recommend the use of garlic and hawthorn berries to address hypotension 5. Which assessment finding indicates that an older patient is experiencing congestive heart failure?

A) Sharp chest pain with exertion B) Tortuous calf veins and a history of venous ulcers C) History of myocardial infarction and peripheral edema D) Moist lung crackles are audible on auscultation with shortness of breath on exertion

Page 1

6. When reviewing the medical record the nurse notes that a newly admitted older patient has a history of angina. Which assumption can the nurse make about this patient?

A) The patient will take anticoagulants and have calf and foot edema B) The patient will be obese and have a history of venous insufficiency C) The patient will have an order for nitroglycerine as needed and will be intolerant of vigorous activity D) The patient will be prone to dizziness when changing positions quickly and will be prescribed ACE inhibitors 7. An older patient recovering from surgery is experiencing left calf edema and the area is red and painful to touch. Which actions should the nurse anticipate to be prescribed for this patient?

A) Bed rest and administration of nitroglycerine as ordered B) Massaging the affected leg and providing analgesia as ordered C) Mobilizing the client and providing an ice pack for the affected leg D) Application of elastic stockings and administration of anticoagulants as ordered 8. Which interventions would be appropriate for the nurse to use to improve the tissue perfusion of an older patient? (Select all that apply.)

A) Reminding about frequent position changes B) Ensuring an adequate body temperature C) Encouraging physical activity when possible D) Assessing for and preventing sources of pressure on the body E) Limiting exercise and ensuring adequate rest between periods of exertion 9. An older male patient recovering from a myocardial infarction (MI) asks the nurse if future sexual activity is now contraindicated. Which statement should the nurse use to respond to the patient?

A) Sexual activity after MI is usually contraindicated.

B) Medications can be used to enhance sexual function.

C) There are positions that produce the least strain on the heart during sexual activity.

D) Current research suggests that sexual activity does not require modification following MI. 10. An older patient wants to use complementary therapies to help treat hypertension that has not responded to medication therapy. Which recommendation is the most appropriate for the nurse to make?

A) Ginseng and ginger B) Acupuncture and ginger C) Yoga and hawthorn berry D) Vitamins A and D supplements

Page 2

11. A newly admitted older patient has severe edema in the lower extremities and no hair on the legs. What do these manifestations most likely indicate to the nurse?

A) A diet low in protein B) Exposure to the cold from a lack of heat C) Frequent falls and injuries because of unsteady gain D) Circulatory problems related to age and a chronic illness 12. The nurse is admitting an older patient to the care area. What is the first step the nurse should take when evaluating the patient's circulation in the extremities?

A) Health history and then inspect the legs B) Exercise history for periods of immobility C) Identify medications for side effects of hypotension D) Vital signs to verify that blood pressure is within an acceptable range 13. An older patient is recovering from hip replacement surgery. Which risk factor would most likely affect tissue perfusion in this older patient?

A) History of hypotension B) Prolonged immobility after surgery C) The effects of anesthesia after a surgical procedure D) A history of anemia affected by additional blood loss from the surgery 14. An older patient has been diagnosed with a venous thromboembolism. Which agerelated change most likely contributed to this diagnosis?

A) Decreased coronary blood flow B) Less efficient cardiac oxygen usage C) Decreased elasticity of blood vessels D) Increased resistance of peripheral vessels 15. An older patient with hypertension has been admitted to a nursing home to recover from minor orthopedic surgery. What should the nurse include in this patient's nursing care plan to improve tissue perfusion?

A) Educating the patient about the importance of diet B) Encouraging the patient to ambulate several times each day C) Inspecting the patient's extremities daily for signs of altered tissue circulation D) Maintaining an adequate blood pressure level by monitoring vital signs and medications 16. After measuring an 80-year-old patient's blood pressure, the nurse realizes that it is within acceptable range. Which is an acceptable blood pressure range for this patient?

A) Usually under 130 mm Hg systolic and 90 mm Hg diastolic B) Usually under 140 mm Hg systolic and 90 mm Hg diastolic C) Usually under 140 mm Hg systolic and 80 mm Hg diastolic D) Usually under 130 mm Hg systolic and 80 mm Hg diastolic

Page 3

17. The nurse is planning care for an older patient with class 3 congestive heart failure (CHF) being admitted to a skilled nursing facility. Which action would be appropriate for this patient during the first week of hospitalization?

A) Bed rest B) Digitalis as needed C) Passive range-of-motion exercises every shift D) Assist to a chair on day 1 and progressively increase ambulation each day 18. A 60-year-old patient who participates in outdoor activities is diagnosed with angina.

Which activity should the nurse instruct the patient to avoid to decrease the risk of anginal syndrome?

A) Golfing B) Gardening C) Sitting in a spa D) Cross-country skiing 19. An older patient with a history of anginal syndrome and congestive heart failure is admitted to the Cardiac Care Unit with a myocardial infarction. Which assessment finding should the nurse report to the health care provider?

A) Early morning fatigue B) Increase in respiratory rate C) Dyspnea when getting out of bed to sit in a chair D) Decrease in blood pressure and increase in temperature 20. An older patient who has been treated for diabetes mellitus for 10 years continues to have difficulty controlling the blood glucose level. Which potential complication of diabetes should the diabetes educator include when instructing this patient?

A) Signs of congestive heart failure B) Signs of a myocardial infarction C) Complications of arteriosclerosis D) Complications of cardiac arrhythmias 21. An older patient who recently retired from working as a waitress for 40 years complains of leg cramps that interfere with sleeping. The patient also experiences dizziness when getting out of bed first thing in the morning. What problem should the nurse suspect is occurring with this patient?

A) Varicose veins B) Arteriosclerosis C) Thrombophlebitis D) Peripheral aneurysms

Page 4

22. An older patient complains of aching and swelling in the right leg. The nurse notes cyanosis of the extremity and suspects a possible venous thromboembolism. What is the most likely site of the patient's thromboembolism?

A) Aorta B) Inferior vena cava C) Superior vena cava D) Iliofemoral segment 23. The nurse notes excessive swelling of the ankles and legs in a patient with a history of congestive heart failure. What would be a recommended change to this patient's care plan?

A) Reduce oxygen B) Reduce ambulation C) Encourage deep breathing D) Implement dietary changes 24. The daughter of an older patient with diabetes and peripheral vascular disease wants to soak the patient's feet. What teaching should the nurse provide to the daughter regarding soaking the patient's feet?

A) Foot soaking can lead to fungal infections B) Foot soaking is noted to improve circulation C) Foot soaking offers a viable alternative to tub bathing D) Foot soaking is likely to increase the patient's foot problems 25. An older patient with heart disease asks the nurse what foods can be eaten to help reduce any further problems with the disease. What should the nurse instruct this patient? (Select all that apply.)

A) Use cold-pressed olive oil B) Increase the intake of fiber C) Reduce the intake of fried foods D) Avoid fish rich in omega-3 fatty acids E) Avoid all caffeine and other stimulants 26. A patient with cardiovascular disease wants to know why magnesium supplements are prescribed. What should the nurse respond to this patient? (Select all that apply.)

A) Lowers blood pressure B) Lowers total cholesterol C) Decreases homocysteine levels D) Dilates arteries and facilitates circulation E) Raises high-density lipoprotein cholesterol

Page 5

27. An older patient has a triglyceride level of 300 mg/dL. Which dietary changes would be indicated for this patient? (Select all that apply.)

A) Restrict the intake of soluble fiber B) Substitute vegetable oil for olive oil C) Increase the intake of fish and chicken D) Use skim milk and nonfat cottage cheese E) Add fresh fruit and vegetables to meals each day 28. After an assessment the nurse is concerned that an older patient is at risk for the development of an abdominal aortic aneurysm. What did the nurse assess in this patient? (Select all that apply.)

A) Diagnosis of angina B) History of hypertension C) History of arteriosclerosis D) Treatment for diabetes mellitus E) Experienced a myocardial infarction 29. An older patient with cardiovascular disease is losing weight because of a poor appetite. Which interventions should the nurse use to help support this patient's nutritional needs? (Select all that apply.)

A) Provide foods that are high in glucose B) Serve favorite foods in an attractive manner C) Explain that ethnic foods should be never eaten D) Provide several small meals throughout the day E) Explain that occasional foods can be eaten weekly

Page 6

Answer Key 1. B 2. D 3. C 4. C 5. D 6. C 7. D 8. A, B, C, D 9. C 10. C 11. D 12. A 13. B 14. C 15. B 16. B 17. D 18. D 19. D 20. C 21. A 22. D 23. B 24. D 25. A, B, C 26. B, D, E 27. C, D, E 28. A, C, E 29. A, B, D

Page 7

Name: __________________________ Date: _____________ 1. The nurse teaches an 87-year-old inactive client about avoiding constipation. Which of the following fluid and diet choices should the nurse include in the teaching?

A) Avoid beverages with caffeine B) Drink iced liquids C) Encourage low-residue foods D) Increase intake of fruit juices 2. Which of the following statements by older adult clients should the nurse interpret as a potential pathological process rather than a normal age-related change?

A) “Food just doesn't seem to have as much taste as it did when I was younger.”

B) “I feel like it takes so much longer to digest my meals than it used to.”

C) “Even when I have a bowel movement it often doesn't feel like it's complete.”

D) “I tend to regurgitate a lot of my food after a meal these days.”

3. The nurse discusses nutritional health with an 89-year-old client whose total protein level is 5 (abnormally low). Which of the following physiological changes should the nurse interpret as a potential pathological process rather than a normal age-related change?

A) Decreased amounts of pepsinogen released in the stomach B) Decreased peristalsis of the esophagus and stomach C) Decreased taste sensations, decreasing food intake D) Decreased teeth and chewing ability 4. The nurse discusses dental health with an 81-year-old client. Which of the following statements, when made by the client is identified as true?

A) “Everyone loses their teeth, it's natural.”

B) “I can't get any cavities any more, only young people get them.”

C) “Fluoride treatments might help strengthen the enamel on my teeth.”

D) “There is no treatment for my bad teeth and poor appetite.”

5. The nurse assists the aging client to create a menu. Which of the following foods, if requested by the client will require further teaching as it should not be included on this list?

A) 2% milk B) Canned tuna C) Fried chicken D) Squash

Page 1

6. The nurse teaches a group of older adults about diet. Which of following recommendations made by the nurse is most likely to result in the promotion of gastrointestinal (GI) health?

A) “If possible, eat organic, whole foods.”

B) “It's important to emphasize fiber and fluid intake.”

C) “Try to maximize the amount of unsaturated fats you eat every day.”

D) “You should try to limit your food and fluid intake.”

7. The nurse develops a plan of care for a 75-year-old male patient who has had a myocardial infarction (MI). Which of following characteristics of the man's history and present conditions predispose him to constipation? (Select all that apply.)

A) The man has a history of GERD. B) The man takes a -blocker for the treatment of hypertension.

C) The man's activity level is significantly reduced as a result of his MI. D) The man has received several doses of morphine since admission.

E) The man's fluid intake has been minimal since admission.

8. The nurse discusses dental health with an aging client. Which of the following physiological changes should the nurse interpret as a potential pathological process rather than a normal age-related change?

A) Retraction of the gum's pulp B) Diminished saliva C) Hardened brittle tooth enamel D) Periodontal disease causing tooth loss 9. Which of the following statements most accurately captures an aspect of dental health among older adults?

A) Clients who wear dentures do not normally require visits to the dentist.

B) The incidence of dental caries increases significantly with age.

C) Periodontal disease is less common in older adults than in younger clients.

D) The presence of dental problems can be indicative of a variety of other diseases.

10. A 76-year-old client has been diagnosed with an axial hiatal hernia following several months of belching and heartburn. What should the nurse teach the client about the management of this health problem?

A) “Even though you would expect them to help, it's important to avoid over-thecounter antacids as much as possible.”

B) “Losing weight and trying a bland diet might help alleviate some of the symptoms you're experiencing.”

C) “This problem can be easily corrected with day surgery, which your physician will likely suggest.”

D) “Try to limit yourself to two larger meals daily in order to minimize the amount of time in a day that food is in your stomach.”

Page 2

11. Which of the following older adults is likely at the highest risk for developing esophageal cancer?

A) A 74-year-old with alcoholism who has chewed tobacco for many decades.

B) A 66-year-old who has experienced significant dysphagia since her CVA 3 years prior.

C) An 80-year-old who has a history of sepsis that was attributed to periodontal disease.

D) An obese, 72-year-old who has a history of a hiatal hernia.

12. At a health promotion class at a senior's center, a 67-year-old client asks the nurse, “What can be done to help manage my spouse's diverticular disease?” What is the nurse's most appropriate response to this client's query?

A) “Try to encourage your spouse to drink at least 8 glasses of water each day.”

B) “You and your spouse might want to try eating 4 or 5 small meals rather than 3 larger ones each day.”

C) “I'd encourage you and your spouse to integrate more exercise into your daily routine.”

D) “Try to increase the amount of fiber that you include in the meals you cook.”

13. A 77-year-old post-surgical patient has been complaining of abdominal pain throughout the nurse's shift. In addition, the patient has a temperature of 101.5°F (38.5°C) and has had small, frequent, loose bowel movements four times since the morning. Which of the following health problems would the nurse suspect?

A) Fecal impaction B) Colon cancer C) Appendicitis D) Biliary tract disease 14. An 84-year-old man who resides in a long-term care facility has recently become incontinent of bowel, a situation that is without precedent. What is the nurse's priority for assessment?

A) Review of the man's medication regimen B) Assessment for the presence of fecal impaction C) Assessment for changes to the man's cognitive status D) Examination of the man's stool for frank and occult blood 15. As part of the treatment regimen for the diagnosis of colon cancer, a 73-year-old client has recently received a colostomy. What should the nurse prioritize during discussions in the early stages of patient teaching?

A) Modifications in food and fluid intake that the device necessitates B) The lifestyle adjustments and effect on self-concept that often accompany colostomies C) Further treatment options that exist for colon cancer D) The importance of monitoring for signs of infection at the colostomy site

Page 3

16. The nurse prepares to give a presentation on the pathology of caries to a group of seniors. Which of the following rationales is correct when understanding why today's elders had a greater risk of caries when they were young than today's children and young adults?

A) Poor diet B) Age-related changes C) Lack of fluoride in the water D) Lack of knowledge regarding oral hygiene 17. A 70-year-old patient with lung cancer is receiving transdermal doses of a narcotic analgesic. Which of the following nursing interventions can minimize any gastrointestinal (GI) issues?

A) Monitor the patient's respirations B) Monitor the drug's sedative effects C) Start at the lowest dosage of medication D) Start the patient on a bowel regimen 18. The nurse in the office advises a client with ongoing issues with constipation to keep a food journal. During a typical 24-hour period, the client has a bagel and coffee for breakfast, macaroni and cheese for lunch, and soup and salad for supper. What dietary changes should the nurse recommend to this client?

A) Gradually increase the amount of fiber in the daily diet B) Eat several small meals each day C) Immediately increase the amount of fiber in the diet to 7 to 10 servings per day D) Increase the amount of soups and cheeses in the menu 19. After complaining about severe depression following the death of a daughter, a 77year-old client is prescribed an antidepressant. Recently, the client was diagnosed with an oral fungal infection. What should the nurse suggest to the client?

A) Sip water to promote saliva B) Stop taking the antidepressant C) Explore complementary therapies D) Eat yogurt to combat the risk of fungus 20. A dentist examines an 80-year-old man with a history of pipe smoking. The dentist notes white patches in the patient's mouth. What action should be the dentist's priority?

A) Biopsy the lesion B) Refer the patient for periodontal care C) Refer or treat the patient for moniliasis D) Discuss with the man the reasons why he should quit smoking

Page 4

21. The nurse plans the care of the older adult with dysphagia. Which of the following is the priority initial nursing intervention?

A) Thicken the liquids B) Weigh the patient daily C) Observe the patient's food intake D) Offer the patient verbal cues when eating 22. During a physical exam, the nurse notes that the patient has a smooth red tongue.

Which of the following diagnostic tests is an expected follow-up?

A) Biopsy any lesions.

B) Scrape the tongue for syphilis.

C) Screen for lead poisoning.

D) Complete a nutrition screening.

23. The nurse teaches the client who recently had hiatal hernia diagnosed. To keep the patient free from pain, what should the nurse recommend?

A) Increased fiber intake B) Taking a nap after each meal C) Ensuring not to skip meals D) Remain upright for 1 hour after eating 24. An 81-year-old client has developed a fecal impaction while convalescing at home after hip surgery. Which of the following corrective actions should the nurse undertake?

A) Manually remove the feces with a gloved finger.

B) Assist the client to sit on the commode to facilitate stool passage.

C) Break up the impaction with external abdominal massage.

D) Insert a flatus bag to prevent entrance of air into the rectum 25. The nurse assesses a client with abdominal and rectal discomfort, diarrhea, and fever.

What initial data source should the nurse use to determine a possible cause of his symptoms?

A) Medical history, for prostatic hypertrophy B) Nutritional record, for the amount of dietary fiber C) Defecation record, for frequency and character of bowel movements D) Medication record, for use of anticholinergic medications 26. The nurse teaches a 65-year-old client with a chronic constipation problem. In reviewing her dietary habits, the nurse finds that the client's diet is low in fiber.

Which of the following points should the nurse prioritize when teaching about increasing fiber intake?

A) Add 20 g of fiber to other foods (such as wheat bran to ground beef or muffins).

B) Attempt a bowel movement following breakfast.

C) Use a suppository to stimulate elimination.

D) Add fiber gradually to minimize symptoms of gas or bloating.

Page 5

27. The history of a 70-year-old female indicates that she has been taking laxatives daily for years. Which of her following complaints may be a result of this laxative abuse?

A) Nausea B) Peptic ulcers C) Anorexia D) Dehydration 28. The client is a healthy, active 85-year-old with constipation. Which of the following age-related changes may contribute to this complaint?

A) Inactivity B) Reduced food and fluid intake C) Slower peristalsis D) Decreased sensory perception 29. The nurse discusses gallbladder disease with a client diagnosed with cholelithiasis.

The client indicates understanding of the pathological process when the client states: A) “I never had any GI infections before this one.”

B) “I will be undergoing laparoscopic surgery to remove the stones.”

C) “I hear that the gallbladder gets weak with old age.”

D) “I'm glad that this issue can be dealt with medication.”

Page 6

Answer Key 1. D 2. D 3. D 4. C 5. C 6. B 7. C, D, E 8. D 9. D 10. B 11. A 12. D 13. A 14. B 15. B 16. C 17. D 18. A 19. A 20. A 21. C 22. D 23. D 24. A 25. C 26. D 27. D 28. C 29. B

Page 7

Name: __________________________ Date: _____________ 1. The nurse assists the client to clean up after an incontinence episode. The client says “I'm sorry that you have to do this....” Which response, if made by the nurse, is most appropriate?

A) “Everything is just fine.”

B) “I'm happy to help you.”

C) “It's no big deal.”

D) “You shouldn't worry.”

2. The 75-year-old client states that when she senses the need to urinate, she is unable to inhibit voiding before she reaches the toilet. What advice would help her incontinence?

A) “Don't drink any liquids after 6 pm. This will decrease your urine volume.”

B) “Make a urination schedule as to when you are incontinent during the day.”

C) “Remind yourself to urinate every two hours during the day.”

D) “You need to tell your doctor because this is very unusual.”

3. The nurse instructs a class of older adult women about Kegel exercises. In which of the following urinary conditions would Kegel exercises be ineffective?

A) Stress incontinence B) Urge incontinence C) Urinary frequency D) Urinary retention 4. The nurse determines that the 75-year-old female client is not fully emptying her bladder with each void, contributing to urinary incontinence. Which of the following interventions will enhance the client's ability to void?

A) Increase coffee and tea intake B) Massage bladder area with each void C) Run warm water over hands prior to voiding D) Stand upright to void 5. The nurse practitioner assesses a 65-year-old client with anemia and intermittent bloody urine. The client denies pain, cloudy urine, and dysurea. Which of the following conditions does the nurse practitioner suspect?

A) Glomerulonephritis B) Renal calculi C) Bladder cancer D) Prostatic hypertrophy

Page 1

6. During the assessment of an 80-year-old female who has recently been admitted to the long-term care facility, the resident mentions to the nurse about her ongoing problems with urinary frequency. The nurse would recognize which of the following age-related changes as contributing to the resident's health problem?

A) Neurogenic deterioration of bladder control B) Cognitive changes inhibiting the micturition urge C) Hypertrophy of the bladder muscle and thickening of the bladder D) Decreased tone of the urethral sphincters 7. A nurse is providing care for a 75-year-old man, whom she has noted has not voided urine since the beginning of the shift. The man states that this has happened to him before and that while he presently has the urge to void, he is unable to do so. An ultrasound bladder scan indicates that there is 780 cc of urine in the man's bladder.

What is the most likely cause of the man's urinary retention?

A) Fecal impaction B) Prostatic hypertrophy C) Neurogenic reflex D) Muscle weakness 8. The nurse educator who directs care at an assisted living facility is conducting a health promotion session with residents. Which of the following pieces of advice about maintaining and promoting bladder health is most accurate?

A) “Making your urine more acidic through your diet can reduce the incidence of infections.”

B) “Resisting the urge to void for a while can increase the volume of each void and prevent frequency.”

C) “Limiting or avoiding fluids drank after 5:00 p.m. can help you void less frequently.”

D) “If you do experience frequent voiding at night, requesting a urinary catheter can help in the short term.”

9. The nurse visits an 81-year-old man with a recent diagnosis of Alzheimer's disease who lives at home with his wife (his primary caregiver). Recently, the man has begun to be incontinent of urine, a development that his wife states accompanied a decline in his cognition. How would the nurse most likely categorize this incontinence?

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

Page 2

10. Which of the following older adults would be most likely to benefit from Kegel exercises?

A) A 60-year-old female who has a diagnosis of multiple sclerosis.

B) A 73-year-old man who has been diagnosed with benign prostatic hypertrophy C) A 70-year-old woman who has been experiencing urgency incontinence since she developed a urinary tract infection D) A 67-year-old female client who has lived with stress incontinence since having her children.

11. Which of the following findings of a nurse who is assessing a 71-year-old female client's urinary function would be most likely considered abnormal and potentially pathological?

A) A test for stress incontinence yields a few drops of urine on gauze on the client's perineum.

B) The color of the client's urine is pale yellow.

C) The pH of urine sample is 9.0 D) The urine has a faint, aromatic odor 12. A 77-year-old client has presented to the primary care provider with a complaint of recent hematuria. Which of the following aspects of the client's history would most clearly signal to the care provider a risk of bladder cancer?

A) The client has been a heavy drinker as an adult.

B) The client has poor nutritional status and eats a high-salt diet emphasizing processed foods.

C) The client has been a smoker since the age of 15.

D) The client has a history of recurrent urinary tract infections.

13. A 75-year-old client has presented to the emergency department with complaints of recent fatigue, nausea, and vomiting. The patient's temperature is 101.8°F orally and urinalysis indicates proteinuria and slight hematuria. Which of the following diagnoses is the care team most likely to suspect?

A) Glomerulonephritis B) Renal calculi C) Bladder cancer D) Prostatic hypertrophy 14. A 74-year-old woman who is in hospital for rehabilitation following hip replacement has been experiencing incontinence since admission. Which of the following interventions are likely to facilitate the restoration of the patient's bladder function?

(Select all that apply.)

A) Determine and assess the woman's recent voiding pattern.

B) Request an order for an indwelling catheter from the patient's physician.

C) Teach the patient how to meet hydration needs while still limiting fluid intake.

D) Offer to assist to the commode every 2 hours while awake.

E) Assess the client for contributing factors such as constipation.

Page 3

15. On admission to the hospital, an 81-year-old woman is recognized to be at risk for polypharmacy since she is under the care of multiple care providers in the community. Which of the following components of her extensive medication regimen would constitute the greatest threat to the woman's continence?

A) The woman takes a diuretic for treatment of hypertension and over-the-counter antihistamines during allergy season.

B) The woman takes an ACE inhibitor and a -blocker for the treatment of her hypertension.

C) The woman takes prednisone and uses a topical corticosteroid for the treatment of dermatitis.

D) The woman is currently taking a broad-spectrum antibiotic for the treatment of a venous ulcer.

16. An elderly male patient complains of urinary frequency and the feeling that he cannot completely empty his bladder. Which of the following is most often associated with these symptoms?

A) Enlargement of the prostate B) Urinary incontinence C) Diverticular disease D) Constipation 17. The nurse teaches a 90-year-old male patient these steps he can take to minimize urinary retention: ensure good fluid intake, massage the bladder area, and run water while he is voiding. The primary reason for this teaching is prevention of which of the following?

A) Urinary incontinence B) Urinary tract infections C) Constipation D) Prostatic hypertrophy 18. The nurse interviews a 65-year-old client with the onset of nocturia. The client gets up two times and sometimes three times a night to void. Which of the following physical changes most likely contributes to this phenomenon?

A) Hypertrophy of the bladder muscle interferes when the client is standing for long periods.

B) Improved kidney circulation occurs when the client is lying down for a few hours.

C) Decreased ability for the bladder to expand reduces its capacity.

D) The nocturia is related to the client's development of dementia.

Page 4

19. The nurse assesses a client who has recently developed nausea and vomiting, blurred vision, and palpitations.The history reveals that the client recently increased the dosage of digoxin. Which of the following age-related changes are most likely related to these symptoms?

A) Cerebral cortex changes causing flu-like symptoms B) Heart changes that are affecting the ability to ingest the digoxin C) Age-related changes in cortical control of micturition D) Kidney changes that affect elimination of the digoxin 20. The nurse completes discharge teaching for a client admitted to the hospital with renal calculi. Which of the following interventions should the discharge teaching emphasize?

A) Close observation for toxic kidney output.

B) Fluid intake of approximately 2 L each day.

C) Interventions for the expected transient incontinence.

D) Use of a dipstick to monitor for proteinuria.

21. Which of the following individuals is at greatest risk for bladder cancer?

A) Male aged 70 years who retired as a manager for a dye factory B) Female aged 70 years who retired as a manager for a dye factory C) Male aged 70 years with a history of hypertension and diuretics treatment D) Female aged 70 years with a history of hypertension and diuretics treatment 22. An 85-year-old client with limited mobility is incontinent of urine. An expected outcome of the plan of care is to maintain skin integrity. Which of the following interventions most appropriate?

A) Assess the patient for wetness every 2 hours B) Complete ultrasound bladder scans after each void to measure residual volume of urine C) Ensure the client remains free of urine odor D) Obtain an order for the insertion of an indwelling catheter 23. A nurse conducts a class for family caregivers of elderly relatives. A woman in the audience asks about her mother's frequent urinary tract infection. What changes should the nurse suggest to the family?

A) Make changes to the mother's diet to include eggs, cheese, and fish B) Direct the mother to perform Kegel exercise at least 10 times per day C) Establish a regular toileting schedule at least every 4 hours during the day D) Ensure that the mother has an annual Pap smear to maintain good genitourinary health

Page 5

24. The nurse in the emergency department assesses a 76-year-old female. The woman's bladder is visibly distended and the woman has not voided since the previous evening. Which of the following assessment questions made by the nurse is most relevant to the source of the woman's condition?

A) “When was your last bowel movement?”

B) “Have you been receiving hormone replacement therapy?”

C) “What did you have to eat yesterday?”

D) “Do you have a history of kidney disease?”

25. The nurse observes that the client voided four times during the night. The client is a 72-year-old man who is in the hospital for treatment of a myocardial infarction. In addition, he has a history of hypertension and congestive heart failure. Which of the following components of his medication regimen is most likely implicated in his nocturia?

A) Nitroglycerine patch B) A thiazide diuretic C) An ACE inhibitor D) Morphine sulfate 26. An old-old male patient with type 2 diabetes and negative diabetic urine testing has elevated blood sugar levels. Which of the following age-related changes could cause his elevated blood sugar without any evidence of glycosuria?

A) Decreased reabsorption from the filtrate B) Reduced tubular function C) High blood urea nitrogen levels D) Increase in the renal threshold for glucose 27. A 71-year-old man has presented to his nurse practitioner's clinic complaining of abdominal and flank pain and blood in his urine for the past 48 hours. Assessment reveals the man's temperature is 102°F orally. Which of the following health problems should the nurse first suspect?

A) Bladder cancer B) Benign prostatic hyperplasia (BPH) C) Renal calculi D) Testicular cancer

Page 6

Answer Key 1. B 2. C 3. D 4. B 5. C 6. C 7. B 8. A 9. B 10. D 11. C 12. C 13. A 14. A, D, E 15. A 16. A 17. B 18. B 19. D 20. B 21. A 22. A 23. A 24. A 25. B 26. D 27. C

Page 7

Name: __________________________ Date: _____________ 1. The nurse in an OB-GYN clinic takes a complete history from the 68-year-old before the physician sees the client. Which of the following is appropriate when taking a sexual history from the client?

A) Ask questions that the client will not be embarrassed to answer.

B) Ask open-ended questions specific to sexual functioning.

C) Write down everything the client says during the interview.

D) When possible include the sex partner in the interview.

2. A menopausal woman tells her nurse that she experiences discomfort from vaginal dryness during intercourse and asks, “What should I use as a lubricant?” Which of the following should the nurse recommend?

A) Petroleum jelly B) Water-soluble lubricant C) Body cream or body lotion D) Saliva 3. The nurse assesses the reproductive system of an older adult. Which of the following questions should the nurse consider including in the interview?

A) “Do you ever have secretions, blood, or other discharge from your genitals?”

B) “Does your partner have satisfying orgasms?”

C) “When was the last time you had sexual intercourse?”

D) “With whom do you have sexual intercourse?”

4. The nurse practitioner discusses breast self-exam with a 78-year-old woman. Which of the following statements if made by the patient indicate understanding of the material?

A) “I need to get a mammogram every 5 years.”

B) “I will call you if I find any lump in my armpit.”

C) “I won't be concerned if my nipple leaks.”

D) “My home health nurse will check me.”

Page 1

5. A nurse is discussing sexual health with a 74-year-old female resident of an assisted living facility. Which of the nurse's following teaching points should be included in the discussion?

A) “Because the vagina becomes drier and its lining thinner with age, sexual experiences are normally not possible.”

B) “A lot of changes occur with age, but most of these are chemical and hormonal rather than changes to body parts and structures.”

C) “There are many changes to your reproductive system that accompany normal aging, but none of them rules out the possibility of still having satisfying experiences sexually.”

D) “It's certainly possible for you to maintain a satisfying sexual relationship even though the hormones that affected you when you were younger no longer have an effect.”

6. As part of health promotion initiative, a nurse is conducting a teaching session to a group of older adults at their church. What teaching point should the nurse include in the area of sexual health?

A) “Pap smears are usually no longer required for women over the age of 70.”

B) “It's important for men to have either a prostate-specific antigen (PSA) test or to perform a testicular self-exam each year.”

C) “Breast self-examination can be done, but it has been shown to have little value in identifying breast disease.”

D) “Women should have a gynecological exam done annually and it should include a Pap smear.”

7. The nurse is assessing and reviewing the chart of a 78-year-old male patient who is newly admitted to the hospital unit. Which of the following diagnostic and assessment findings should the nurse interpret as potentially pathological?

A) The patient's testes appear to be atrophied.

B) Slight enlargement of prostate was noted during his last visit to his primary care provider.

C) The client states he has difficulty achieving and maintaining an erection.

D) Serum testosterone levels are a small fraction of those in younger men.

8. During morning care of a 91-year-old female patient with vascular dementia, the nurse and the unlicensed care provider note that the woman's vulva is inflamed and reddened. Which of the following age-related changes has most likely contributed to the woman's health problem?

A) Decreased cognition B) Changes to normal vaginal flora C) Decreased immune function D) Fragility of the woman's vulva

Page 2

9. Which of the following measures should a nurse recommend to a 68-year-old woman who has been experiencing recurrent vaginitis?

A) Douche with hypertonic saline occasionally.

B) Avoid perineal contact with heavily perfumed soaps and sprays.

C) Begin low-dose, broad-spectrum antibiotics.

D) Avoid both Pap smears and vaginal examinations.

10. A 66-year-old patient is suspected of having cervical cancer. Which of the following signs and symptoms would be considered indicative of the disease? (Select all that apply.)

A) Vaginal bleeding B) White vaginal discharge C) Perineal herniation D) Pain E) Fever 11. A 71-year-old woman who has been experiencing several weeks of lower back pain and pelvic heaviness has been diagnosed with a cystocele. Which of the following teaching points about the woman's bladder herniation is most accurate?

A) “Incontinence of urine is a common consequence of this problem.”

B) “This problem is unlikely to worsen with time.”

C) “An infection was likely a cause of your cystocele.”

D) “Fortunately, this probably won't cause pain with intercourse.”

12. A 66-year-old male client has had a diagnosis of benign prostatic hyperplasia (BPH) for several months and is now slated for transurethral prostate resection (TURP) surgery. The man states to the nurse, “Finally I'll be able to get my sex life back in order.” How can the nurse best respond?

A) Tell the client that the surgery is likely to result in erectile dysfunction B) Explain that the surgery is unlikely to bring a rejuvenation of sexual performance C) Explain that while sexual performance is likely to improve, incontinence is often a consequence of the surgery.

D) Tell the client that there will probably be no effect on sexual performance.

13. A nurse who provides care on a postoperative unit of the hospital has recently admitted a 65-year-old male patient who has just had prostate surgery. Which of the following post-surgical teaching points is most accurate?

A) “Perform the Valsalva maneuver at least twice daily.”

B) “Avoid sexual activity for at least one week.”

C) “It's important for you to avoid becoming constipated.”

D) “Expect to have quite a bit of bright red blood in your urine for the next several days.”

Page 3

14. Which of the following men is most likely to experience a loss of sexual function?

A) Mr. E, age 70, who has recently been diagnosed with benign prostatic hyperplasia (BPH).

B) Mr. J, age 70, who had a transurethral prostate resection (TURP) 6 weeks prior.

C) Mr. Y, age 65, who has had a radical prostatectomy.

D) Mr. U, age 73, who is undergoing radiation treatment for his prostate cancer.

15. The nursing staff notes that an 85-year-old woman with dementia is incontinent every evening and is particularly restless. What health problem would this behavior lead the staff to suspect?

A) Senile vulvitis B) Atrophic vaginitis C) Perineal herniation D) Uterine cancer 16. The clinic nurse assesses a 70-year-old newlywed client who has had slight vaginal bleeding. Which of the following assessment data should the nurse prioritize?

A) Date of last Pap smear B) History of cervical cancer C) History of urinary tract infections D) Bleeding or other symptoms after intercourse 17. A 70-year-old male recently had prostate surgery. Which of the following interventions should the nurse include in the patient's nursing care plan?

A) Maintain the patient's skin integrity.

B) Restore the patient's desired roles and functions.

C) Achieve partial or complete restoration of bladder control.

D) Allow the patient to resume sexual relations.

18. A nurse educator is presenting a lecture on women's health to the nursing staff at a nursing home. A staff member asks about the most common site for vulvar malignancy. How should the nurse educator respond?

A) Clitoris B) Vagina wall C) Labia majora D) Labia minora 19. Which of the following age-related issues can contribute to vaginitis?

A) Alkaline vaginal pH B) Muscle weakness of the perineum C) Atrophy of the endocervical epithelium D) Shortening and atrophy of the fallopian tubes

Page 4

20. Which of the following elderly women would be predisposed to vaginal cancer?

A) A 65-year-old woman with a history of leukorrhea B) A 70-year-old woman with a history of pessary use C) A 70-year-old woman with a history of hysterectomy D) A 65-year-old woman with a history of nabothian cysts 21. Which of the following women exhibits signs of cervical cancer?

A) A 65-year-old woman with leukorrhea B) A 65-year-old woman with nabothian cysts C) A 70-year-old woman with history of pessary use D) A 70-year-old woman with history of hypertension 22. A 75-year-old woman complains of a feeling of heaviness in the pelvic area and a feeling of a mass in her vagina. What health problem would the health care team most likely suspect?

A) Vaginal cancer B) Cervical cancer C) Perineal herniation D) Endometrial cancer 23. Prostatic cancer has recently been diagnosed in a 75-year-old man, and he has begun estrogen treatment. He tells his spouse “These pills are going to make me a woman.”

What should the nurse tell the man about the intention of this treatment?

A) Reduce surgical risks B) Treat prostatic hypertrophy C) Support sexual performance D) Prevent tumor dissemination 24. The client has new onset of benign prostatic hyperplasia (BPH) with related urinary symptoms. What factor most likely underlies the client's urinary symptoms?

A) Loss of bladder elasticity B) Compression of the urethra C) History of use of diuretics D) Excessive use of urinary antiseptics 25. Recognizing the fact that dyspareunia is a common problem among older women, the nurse has integrated relevant assessments into her practice. Which of the following older adult women is less likely to experience painful sexual intercourse?

A) A 78-year-old woman who gave birth to 7 children in her twenties and thirties B) A 70-year-old woman with a history of vulvitis C) A woman, age 66, who has a suspected diagnosis of vaginitis D) A woman, age 70, who has been married for 48 years but never had any children

Page 5

26. As part of a health promotion initiative, a nurse is teaching a group of older men the importance of screening and prevention. Regular self-examination is promoted in order to identify which of the following health problems at an early stage?

A) Prostate cancer B) Benign prostatic hyperplasia (BPH) C) Penile cancer D) Testicular tumors 27. Which of the following health problems would a nurse be most likely to attribute to age-related changes?

A) Atrophic vaginitis B) Cancer of the vagina C) Cervical cancer D) Breast cancer

Page 6

Answer Key 1. B 2. B 3. A 4. B 5. C 6. D 7. D 8. D 9. B 10. A, B 11. A 12. B 13. C 14. C 15. A 16. D 17. D 18. A 19. A 20. B 21. A 22. C 23. D 24. B 25. A 26. D 27. A

Page 7

Name: __________________________ Date: _____________ 1. The nurse is assisting an aging client with osteoarthritis to ambulate. Which of the following instructions is most appropriate for the nurse to give the client?

A) “Bend slightly at the waist.”

B) “Close your eyes and relax.”

C) “Stand straight and tall.”

D) “Watch your feet.”

2. The nurse includes interventions to improve impaired physical activity in the plan of care for the older resident. Which of the following interventions should the nurse include? (Select all that apply.)

A) Develop an exercise program that promotes maximum heart rate.

B) Encourage family to assist in efforts to increase the patient's mobility.

C) Include passive range of motion (PROM) in plan.

D) Promote a nutritional intake of calcium and protein.

E) Provide diversional activities based on the patient's interests and level of function.

3. The nurse teaches the caregiver to assist the elderly patient with exercises. Which of the following points, if made by the caregiver, indicate that the caregiver needs more guidance?

A) Exercise all body joints through their normal range of motion (ROM).

B) Support the joint and distal limb during the exercise.

C) Force the joint past the point of resistance.

D) Complete exercise of joints at least three times daily.

4. The nurse motivates residents to move and be active. Which of the following rationales is useful in stimulating opportunities for activity?

A) Persons of the same generation enjoy the same activities.

B) Musculoskeletal problems are hereditary.

C) Immobile residents do not benefit from exercise routines.

D) Those engaged in social events are more likely to perform self-cares.

5. The nurse at the wellness center promotes activity by leading exercise programs.

Which of the following is a benefit of such exercise?

A) Cardiovascular stress B) Painful and stiff joints C) Urinary incontinence D) Improvement of mood

Page 1

6. The client has been confined to bed for 3 months. Which of the following occurrences should the nurse anticipate secondary to this prolonged immobility?

A) Bone demineralization B) Chronic muscle strengthening C) Improved cardiovascular endurance D) Increased joint flexibility 7. The nurse incorporates exercise in daily interactions with the residents in the Alzheimer's wing of the care facility. Which of the following interventions is appropriate to meet this goal?

A) Encouraging the residents to wave their arms in greeting B) Setting up a weekly t'ai chi class C) Playing music in the exercise room D) Having games and therapy equipment available for use 8. Which of the following statements best conveys the relationship between advanced age and musculoskeletal function?

A) Diminished musculoskeletal function is a result of decreased physical activity and increased bone resorption.

B) Decreased muscle mass in older adults is a pathological rather than age-related change.

C) A combination of age-related reduction in muscle mass and inactivity decreases musculoskeletal function.

D) Levels of musculoskeletal function can be maintained throughout the life span by activity and diet.

9. Which of the following active older adults who implements an exercise regimen is likely to have the most beneficial effect on musculoskeletal function?

A) A 70-year-old who runs 1 mile most mornings and cycles 5 miles once or twice a week.

B) A 76-year-old who swims laps four times weekly and does light weight training on the other 3 days.

C) A 72-year-old who has been a competitive body builder for many years and lifts weights 6 to 7 days per week.

D) A 78-year-old who has recently begun attending yoga classes three times a week.

Page 2

10. The nurse is teaching a moderately obese, older adult client who is otherwise healthy about the benefits of exercise. Which of the following teaching points is most accurate?

A) “You'll need to monitor your heart rate when you're working out to make sure it doesn't go more than 10 beats over your target rate.”

B) “Since your resting heart rate is over 75 beats per minute, an exercise program might not be appropriate.”

C) “You'll need to choose at the outset whether you want an exercise program that addresses cardiovascular function, one aimed at flexibility, or one addressing strength.”

D) “For older adults, a workout that is slightly shorter but slightly more intense is ideal.”

11. An 82-year-old resident of a long-term care facility has experienced a gradual decline in physical activity as dementia has progressed. How can the nurse who provides care for the resident best address activity the needs of this resident?

A) Teach the resident new activities that are likely to capture the resident's interest and match the resident's abilities.

B) Identify the resident's existing interests and integrate these into an activity regimen.

C) Focus on PROM in order to prevent the deleterious effects of inactivity.

D) Teach the resident about the potential risks of inactivity and how to seek out physical activity.

12. A nurse would recommend a balanced diet emphasizing which of the following foods to an older adult client who is eager to prevent musculoskeletal problems?

A) Whole grains B) Organic foods C) Fruits and leafy green vegetables D) Dairy products and lean meat 13. Following several months of joint pain in her hands and knees, a 73 year-old client has been diagnosed with osteoarthritis. Which of the nurse's following teaching points is likely to be of the most use to the client?

A) “Nonsteroidal anti-inflammatory drugs are your best choice for the pain that accompanies osteoarthritis.”

B) “This health problem is usually a result of wear and tear, so keeping your joints immobilized as much as possible can slow the progression.”

C) “Even though it might cause some discomfort, it's important for you to now exercise more, not less, than before.”

D) “There are changes you can make in your diet to help control your osteoarthritis, and surgical options now exist if it worsens.”

Page 3

14. A nurse has admitted a 79-year-old female patient to the unit from the emergency department following a fall. The nurse notes that the patient displays kyphosis. A diagnosis of osteoporosis is confirmed in the patient's medical history. Which of the following medications should the nurse anticipate administering to the patient?

(Select all that apply.)

A) Calcium supplements B) Calcitonin C) Vitamin D supplements D) Antibiotics E) Estrogen F) Thyroid hormone 15. Which of the following older adults is most likely to require surgery to correct his or her podiatric health problem?

A) A 71-year-old who has corns that he has unsuccessfully treated on his own.

B) A 73-year-old patient of a podogeriatrician who experiences pain from plantar fasciitis.

C) A 66-year-old who developed bunions following many years of wearing highheeled shoes at work.

D) A 73-year-old whose onychomycosis fungal infection has proven resistant to treatment.

16. An 81-year-old resident of an assisted living facility has mentioned to the nurse about her problems with nighttime muscle cramping, a problem that causes her significant pain. Which of the following measures should the nurse suggest?

A) Transdermal medication to provide overnight relief from the cramps.

B) Use of a cane or walker to reduce demand on muscles during the day.

C) Scheduling exercise and activity during the early evening.

D) Passive stretching of the limbs; keeping the extremities warm at night.

17. The nurse is aware of the role that heat can play in the treatment of pain and often recommends the use of heating pads or warm water soaks. For which of the following patients are these treatments most likely contraindicated?

A) An 80-year-old patient with painful bunions and a history of peripheral vascular disease.

B) A 77-year-old patient who experiences nighttime cramping and has a history of congestive heart failure.

C) A 90-year-old who has a diagnosis of rheumatoid arthritis and consequently inflamed joints.

D) An 82-year-old who has osteoporosis and a pressure ulcer on the bony prominence over her thoracic spine.

Page 4

18. An exercise physiologist approaches the nursing staff about beginning a program at the senior center. Which of the following characteristics of the program should the nursing staff require?

A) Emphasis on low weights and high repetitions B) Including both resistance exercises and isometric exercises C) Promoting yogic breathing and t'ai chi movements D) Addressing cardiovascular endurance, flexibility, and strength training 19. An attentive nursing staff should provide for range-of-motion exercises with elderly patients. What is the most direct benefit of improving range of motion in the older adult?

A) Allows the person to continue walking up and down stairs.

B) Allows the person to be involved in social activities such as dancing.

C) Minimizes the person's use of adaptive devices.

D) Reduces the person's risk of household accidents.

20. One basic measure that nurses can take in elder health care is to educate caregivers about the importance of physical activity for older adults. Which of the following suggestions would be most likely to help families increase the physical activity of their older relatives?

A) Be creative in suggesting pastimes that can stimulate movement B) Suggest isometric exercises that can be done while sitting down C) Limit expectations for older persons with arthritic limbs D) Assist older relatives by “doing for” them 21. Which of the following arrays are important health changes that can result from physical activity in older adults?

A) Lowers blood pressure, maintains muscle strength, and sharpens mental acuity.

B) Allows participation in activities, increases ability to dress themselves, and maintains muscle strength.

C) Allows participation in activities, lowers blood pressure, and sharpens mental acuity.

D) Lowers blood pressure, minimizes peristalsis, and sharpens mental acuity.

22. A 75-year-old is starting an exercise program. After calculating the adjusted training heart rate for the client, the nurse should recommend reducing the intensity of the exercises as soon as the heart rate is greater than which of the following?

A) 124 beats per minute B) 118 beats per minute C) 110 beats per minute D) 95 beats per minute

Page 5

23. Aging has a great effect on the ability to exercise. Which of the following is most important for gerontological nurses to remember in recommending individual exercise routines for older clients?

A) Sweat gland activity is decreased, so older persons require less water during exercise.

B) The stroke volume is reduced, but is usually adequate during mild exercise.

C) The body surface area is reduced, so older persons are less susceptible to heat stroke.

D) Grip strength is decreased, so the number and size of muscle fibers consequently decline.

24. A 75-year-old man has been a runner all his adult life and has just participated in another 5K road race. He does not have a history of hypertension, but his blood pressure at the finish line was 200/110 mm Hg. What is the most likely reason for the systolic blood pressure (SBP) over 200 mm Hg? A) A sign of impending cardiovascular accident B) A consequence of an age-related change C) A sign of impending myocardial infarction D) A precursor to hypertension 25. A 75-year-old is a new attendee at strength training class. Which of the following schedules is most appropriate for this client?

A) Eight repetitions for each muscle group at least twice weekly on the weight machines.

B) Eight repetitions of both push-ups and pull-ups at least twice weekly.

C) Twelve repetitions with low-weight free weights at least twice weekly.

D) Strength training once a week, and resistance and isometric training twice weekly.

26. At 65 years of age, a client is starting to exercise again after 10 years of inactivity.

Which of the following is most appropriate for this client to include in starting the program?

A) Strength training rather than aerobic activity, and periodic monitoring of vital signs and symptoms.

B) A physical exam and a focus on walking at least three times a week.

C) A physical exam, physical activities that match the client's mental abilities, and monitoring of vital signs after each workout.

D) A physical exam, physical activities that match the client's interest and ability, and monitoring of vital signs and symptoms at various activity levels.

Page 6

27. The nurse teaches exercises to a client who has had surgical repair of a fractured hip.

Because the client's ability to exercise is limited, which of the following activities is most appropriate?

A) Scissorlike crossing of the legs B) Circle arms and flex and extend feet C) As little exercise as possible for now D) Rolling from side to side in bed 28. Which of the following older adults is most likely to benefit from the administration of anti-inflammatory drugs?

A) A 72-year-old person with osteoarthritis B) A 78-year-old client with gout C) A 71-year-old client with rheumatoid arthritis D) An 80-year-old person with osteoporosis 29. A 71-year-old man has been diagnosed with gout. Which of the nurse's following dietary recommendations is most likely to help control the man's symptoms?

A) “You would benefit from changing to a vegetarian diet.”

B) “You need to integrate as many leafy, green vegetables as possible into your diet.”

C) “It's important that you avoid saturated fats like butter and tropical oils.”

D) “You should avoid alcohol as well as many kinds of meat and seafood.”

30. The 80-year-old patient has fallen. The fall impacted the right arm and hip. The patient describes the fall as painful, the skin is intact, and neither edema nor redness is noted. What is the emergency department care team's best course of action?

A) Discharge the patient home with instructions to follow up with the family doctor if further pain is noted.

B) Assess the patient for fractures in spite of the absence of obvious signs or symptoms.

C) Refer the patent to physiotherapy for rehabilitation.

D) Design an exercise program to increase the patient's stamina to prevent future falls.

31. The nurse develops measures to facilitate independence in the resident who requires a wheelchair for mobility. Which of the following interventions should the nurse choose to promote independence?

A) Assure that the call light is in reach.

B) Obtain a reacher-grabber tool.

C) Offer assistive feeding devices.

D) Provide a walker for transfers.

Page 7

Answer Key 1. C 2. B, D, E 3. C 4. D 5. D 6. A 7. A 8. C 9. B 10. A 11. B 12. D 13. D 14. A, B, C, E 15. C 16. D 17. A 18. D 19. D 20. A 21. A 22. B 23. B 24. B 25. C 26. D 27. B 28. C 29. D 30. B 31. B

Page 8

Name: __________________________ Date: _____________ 1. The nurse assesses a client with Parkinson's disease. Which of the following symptoms are unexpected, requiring immediate follow-up?

A) Drooling B) Hallucinations C) Hypoglycemia D) Tremors 2. The nurse plans the care for the hospice client with end-stage Parkinson's disease.

Which of the following symptoms should the nurse expect to incorporate into the nursing care plan?

A) Bradykinesia B) Hemiparesis C) Hemiplegia D) Visual impairment 3. The home care nurse plans the environment of the client with Parkinson's disease.

Which of the following should the environment include?

A) Brightly colored throw rugs B) Electric adjustable bed with side rails C) Weight training bench and weights D) Shower with nonslip surface and rails 4. The nurse monitors a group of older adults exercising at the wellness center. For which of the following new assessment findings should the nurse immediately call first responders?

A) Inability to speak and imbalance B) Muscle spasms and pain C) Nausea and lethargy D) Tremor in the hands 5. The nurse assesses the members of a senior center. For which of the following new findings should the nurse require immediate follow-up by the primary care provider?

A) Blood pressure of 96/62 mm Hg B) Numbness of hands C) Urinary incontinence D) Opaque sclera

Page 1

6. The nurse presents at a seminar on neurologic health issues in older adults. Which of the following data should the nurse include in the presentation?

A) Neurological health is in the hands of God. B) Older adults are not at risk for sexually transmitted infections (STIs) that impact the neurologic system.

C) Head and neck injuries can be avoided with the use of protective gear like seat belts.

D) A low body mass index reduces the risk of neurovascular disease.

7. The nurse provides for the care of the client after a cerebrovascular accident with expressive aphasia. Which of the following interventions should be the priority intervention?

A) Listen for the intent of the message and do not concentrate on the words.

B) Devise a picture chart for the patient to point for requests.

C) Encourage the client to speak when no one is around.

D) Remind the patient that no improvement is expected.

8. During a health promotion seminar, a nurse is teaching a group of older adults at a senior center about some of the normal changes that accompany the aging process.

Which of the following statements about the effects of aging on the nervous system is most accurate?

A) “It's actually a myth that intellectual performance and verbal skills deteriorate in older adults.”

B) “Your brain actually becomes smaller as you age and this affects how quickly older adults react.”

C) “The brain's ability to assimilate new information decreases greatly after age 65.”

D) “While blood flow through the brain remains consistent across the life span, the electrical activity of the brain declines somewhat later in life.”

9. An 83-year-old resident of a nursing facility worked as a chef until retirement. The resident told the nurse “I am greatly disappointed that food just doesn't taste as good as it used to.” Which of the following facts should underlie the response that then nurse chooses?

A) The function of the cranial nerves mediating taste declines with age.

B) Decreased taste sensitivity is indicative of periodontal disease or thrush.

C) While hearing, sight, and smell diminish with the aging process, taste is normally unaffected.

D) The neurological components of the sense of taste normally disappear by the ninth decade.

Page 2

10. During a neurologic evaluation, the nurse practitioner has asked an 83-year-old client to draw the face of the clock and then tell the nurse what time the clock reads. Which of the following assessment findings would be most indicative of expressive aphasia?

A) The client appears unable to understand and follow the instruction.

B) The client draws a person's face rather than the face of a clock.

C) The client draws a clock but is unable to state the time.

D) The client draws a clock with four hands rather than two.

11. During a health promotion class, a group of older adults ask the nurse to teach them measures that they can take to foster neurologic health. What should the nurse tell the group?

A) “Neurological illnesses are generally the result of factors beyond your control.”

B) “Quitting smoking and maintaining a healthy body weight can cut your risk of neurological diseases.”

C) “The best protective measure for your neurological health is to avoid environmental toxins and eat a healthy diet.”

D) “The more mentally active you stay by continually reading and learning, the less your chance of developing neurological disease.”

12. A 79-year-old male patient has a number of health problems, including Parkinson's disease. Which of the following signs and symptoms would the nurse attribute to the client's diagnosis of Parkinson's disease? (Select all that apply.)

A) The patient's vision is gradually deteriorating.

B) The patient experiences frequent, severe headaches.

C) The patient moves slowly and has poor balance.

D) The client shuffles when walking.

E) The patient's face is less expressive than when healthy.

F) The patient is emotionally unstable.

13. A nurse who provides care in a long-term facility is working with a 78-year-old resident who has a diagnosis of Parkinson's disease. Which of the following aspects of the care the nurse provides should be reconsidered or modified?

A) The nurse encourages the resident to continue to participate in the regular exercise programs at the facility.

B) The nurse provides assistance with activities of daily living when necessary but encourages the resident to do what can be done independently.

C) The nurse phrases questions and directions in a simple and understandable manner applicable to the client's decreased cognition.

D) The nurse facilitates active and passive range of motion exercises on a regular basis.

Page 3

14. A 77-year-old patient has been brought to the emergency department by the daughter due to recent visual disturbances and unilateral weakness. The diagnostic workup has led the diagnosis of transient ischemic attacks (TIAs). Which of the following patient history most likely contributed to the patient's current health problem?

A) The patient was treated for anemia 3 months ago.

B) The woman is a smoker and takes antihypertensive medications.

C) The woman has a history of recurrent deep vein thromboses.

D) The woman was diagnosed with Parkinson's disease early this year.

15. A nurse is providing care for an 80-year-old patient who experienced an ischemic cerebrovascular accident (CVA) 3 weeks prior. Which of the following nursing actions is most likely to appropriately address the cognitive changes that have accompanied the patient's stroke?

A) Discuss distant past events while avoiding discussions of recent events.

B) Emphasize written rather than spoken communication on the part of both the patient and the nurse.

C) Increase the volume of spoken communication as much as possible.

D) Talk to the patient and give explanations while performing routine care tasks.

16. Which of the following patients on a subacute geriatric medicine unit is likely at the highest risk for experiencing a cerebrovascular accident (CVA)?

A) Mr. L, age 79, who has poorly controlled hypertension and smokes half a pack of cigarettes daily.

B) Mrs. H, a 90-year-old woman, who has a diagnosis of vascular dementia.

C) Mr. J, a 77-year-old man, who has experienced an upper GI bleed and required a transfusion of packed red blood cells.

D) Mrs. N, age 83, who has had a recent fall resulting in a broken left wrist and hip.

17. The son and daughter of an 80-year-old woman have expressed concern to the nurse that their mother has become impatient and irritable since her stroke earlier in the year. How should the nurse best respond to the children's concerns?

A) “There is a new generation of medications that can help control outbursts with very few side effects.”

B) “This could be a sign that your mother is still experiencing transient ischemic attacks, so I will make sure to let her physician know.”

C) “This is not an uncommon consequence of a stroke that must be difficult for you to see, since it is uncharacteristic of her personality.”

D) “This is likely a temporarily response to the difficult changes that a stroke causes, and these behaviors will likely diminish with time.”

Page 4

18. A nurse is evaluating an elderly client's lifestyle to determine the level of risk for neurovascular problems. Which of the following should the nurse identify to the client as the most significant lifestyle risk factor for neurovascular problems such as Parkinson's disease and stroke?

A) Cigarette smoking B) Failure to use seat belts C) Sexually transmitted disease D) Alcohol and drug abuse 19. An autopsy shows that Lewy bodies were present in a patient's brain. Which of the following characteristics did the living patient probably exhibit?

A) Hemiparesis B) Tremor C) Diplopia D) Aphasia 20. The nurse initiates teaching for the client who takes levodopa (Larodopa). Which of the following should the nurse caution the patient to avoid?

A) Foods high in vitamin A B) Anticholinergic drugs C) Foods high in vitamin B6 D) Passion flower herbs 21. Relatives brought an elderly relative to the health center because they noticed a new behavior in the elderly person. The nurse practitioner explained that the behavior they noticed was characteristic of Parkinson's disease. Which of the following symptoms was most likely noticed in their relative?

A) Forced eyelid closure B) Faint tremor in the hands or feet C) Depression D) Difficulty in swallowing 22. The nurse prepares the patient for a test to determine the cause of the cerebrovascular accident (CVA). For which test should the nurse teach the client and family?

A) Carotid Doppler studies B) Visual acuity testing C) Arterial blood flow to weakened extremity D) Speech therapy evaluation

Page 5

23. The nurse initiates teaching for the patient and family with newly diagnosed Parkinson's disease. In communicating with the patient and his family, which of the following should the nurse emphasize?

A) Speech problems may affect the patient's expressive abilities.

B) Emotional stability is maintained as the disease progresses.

C) The disease progresses slowly, and therapy can minimize disability.

D) Intellectual functioning is eventually impaired by this disease.

24. The nurse advises the 80-year-old patient not to sleep slumped in the recliner. The nurse explains that proper positioning of the head and neck can help prevent transient ischemic attacks (TIAs) in which of the following ways?

A) Preventing impairment of cerebral blood flow B) Increasing neck muscle strength C) Maintaining blood pressure in a normal range D) Decreasing muscle tension 25. Good nursing care of a patient who has had a cerebrovascular accident (CVA) can improve the patient's chance of survival and minimize the limitations that impair a full recovery. In the acute phase, nursing efforts should prioritize which of the following aims?

A) Teach compensatory techniques for impaired communication.

B) Talk to the patient during routine activities.

C) Initiation of rehabilitation.

D) Maintain a patent airway.

26. A patient recovering from a stroke at home seems to have a pleasant environment.

Family members come in to talk with him, and he has his own familiar clothing and books in his room. A calendar shows the current date. A television and a radio are near his bed. No one disturbs him with the details of his condition. However, he seems depressed and anxious. A visiting nurse would most likely recommend which of the following?

A) Encouraging reminiscence.

B) Giving him antidepressant drugs.

C) Redecorating his room.

D) Giving him more information.

27. Nurses should promote activities that reduce patients' risk of cerebrovascular accident (CVA). Which of the following is the most helpful activity to promote for reducing that risk?

A) Maintaining physical activity B) Managing hypertension C) Maintaining adequate hydration D) Getting sufficient nutrition

Page 6

28. Promoting independence in an older patient with neurologic problems may take many forms. What advice to a patient's family would most help the patient achieve maximum levels of independence?

A) Attend lectures on self-improvement.

B) Prepare for personality changes in the patient.

C) Complete tasks for the patient.

D) Install self-help devices in the home.

29. A nurse is communicating with a family that includes an elder who has neurologic problems. What should the nurse suggest the family include in the home to lessen the likelihood of injury to the elder?

A) Scatter rugs rather than wall-to-wall carpeting B) Soft, restful lighting in all areas C) Kitchen chairs with wheels for easy movement D) Smoke alarms with batteries that are replaced often

Page 7

Answer Key 1. C 2. A 3. D 4. A 5. B 6. D 7. B 8. B 9. A 10. C 11. B 12. C, D, E, F 13. C 14. B 15. D 16. A 17. C 18. A 19. B 20. C 21. B 22. A 23. C 24. A 25. D 26. D 27. B 28. D 29. D

Page 8

Name: __________________________ Date: _____________ 1. The nurse teaches the caregivers to care for the clients' hearing aids. The nurse knows that the caregiver needs further teaching when the nurse notes the caregiver: A) Changing the battery after 82 hours of use B) Purchasing several new batteries when a few remain C) Removing the battery before turning the aid off D) Removing the battery when the aid is not being worn 2. The nurse helps the older adult to remove cerumen from the ears. Which of the following interventions should be included in this plan?

A) Gently irrigate the external auditory canal with warm water.

B) Push the cerumen out with cotton-tipped applicators.

C) Use a hairclip to clean out the ear.

D) Use forceful stream of solution.

3. The nurse understands the impact of sensory deficits on older adults. Which of the following nursing diagnoses are associated with sensory deficits? (Select all that apply.)

A) Constipation B) Diversional activity deficit C) Impaired social interactions D) Risk of injury E) Stress overload 4. The nurse gives a presentation to the members of the senior center about visual changes in the older adult. Which of the following pieces of information should the nurse include in the presentation? The most common cause of blindness in people over 65 is: A) Accidental injury B) Detached retina C) Glaucoma D) Macular degeneration 5. The nurse plans care for a client who has had gradual vision loss. Which of the following should the nurse include in the care plan?

A) Brightly colored throw rugs to lighten up the client's room.

B) Fluorescent overhead lights on at night.

C) A clock that chimes the hour in the client's living room.

D) Radio playing music in the client's room around the clock.

Page 1

6. Which of a gerontological nurse's following teaching points about the role of sensory function in older adults are accurate? (Select all that apply.)

A) “Sensory deficits are a threat not only to quality of life but to safety as well.”

B) “A healthy lifestyle can prevent the sensory losses that many people assume to be inevitable.”

C) “Sensory deficits have a negative effect on older adults' social integration and relationships.”

D) “Impaired communication is a common result of sensory losses.”

E) “Older adults may have difficulty correctly perceiving their physical environment when sensory deficits exist.”

7. Which of the following phenomena would a nurse be most likely to attribute to a pathological process rather than an age-related change?

A) A gradual loss in the number of photoreceptor cells in the retina.

B) Difficulty transitioning between areas of bright light and low light.

C) An increased sensitivity to glare.

D) Increased pressure within the eye that inhibits visual acuity.

8. Which of the following measures should the nurse teach to older adults in order to promote healthy sensory function?

A) “To help your hearing, you should remove your ear wax gently but regularly using a cotton-tipped applicator.”

B) “Although they may not appear connected, regular physical activity is key to preventing loss of vision.”

C) “Even if you have good vision, it's important to get an annual eye examination.”

D) “High cholesterol levels and diabetes can have a negative effect on hearing, so it's important to keep these health problems well-managed.”

9. The nurse assesses a 77-year-old client. Which of the following signs and symptoms should the nurse associate with the development of cataracts?

A) The client has eye pain that is described as “a constant dull ache.”

B) The client states “I often sees double, especially early in the morning.”

C) The client's most recent eye exam indicated increased intraocular pressure.

D) The client states “my vision is becoming more and more blurry.”

10. Which of the following older adult clients faces the most immediate threat to his or her vision?

A) A 67-year-old man who has been diagnosed with angle-closure (narrow angle) glaucoma.

B) An 80-year-old woman whose annual eye examination has just revealed the presence of cataracts.

C) An 80-year-old man with chronic (open-angle) glaucoma.

D) A 78-year-old man whose cornea is inflamed and appears to have a corneal ulcer.

Page 2

11. A 76-year-old resident of an assisted living facility has just been diagnosed with chronic glaucoma. What should the nurse tell the resident about expectations for treatment?

A) “It's imperative that this be resolved within 24 hours either by surgery or medication.”

B) “You'll likely be prescribed eye drops that you will need to instill regularly.”

C) “In the past this meant you would need surgery, but laser therapy is most commonly used these days.”

D) “Your physician will probably talk to you about the need for lens replacement surgery.”

12. The nurse teaches a 78-year-old about treatment for the management of recently diagnosed glaucoma. Which of the following self-cares should the nurse include in the prevention of complications?

A) Avoid reading or watching television in low-light conditions or for long periods of time.

B) Remain in a lying position as much as possible throughout the day.

C) Avoid stress, coughing, sneezing, or the Valsalva maneuver.

D) Use antihypertensive medications and diuretics with great caution.

13. Which of the following factors common in older adults are most closely associated with the development of corneal ulcers?

A) Infections and stroke B) Constipation and straining during defecation C) Diabetes mellitus and peripheral vascular disease D) Decreased percentage of water versus body weight and decreased renal function 14. An otologist has recommended the use of a hearing aid for a 74-year-old client who has experienced a progressive loss of hearing acuity in recent years. Which of the following should be included in the nurse's teaching plan?

A) “With the right hearing aid, you can expect your hearing to be back to normal.”

B) “You can save money by purchasing hearing aids online or by mail order after you get the prescription.”

C) “Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise.”

D) “Many people find that hearing aids only help with certain types of hearing loss that are caused by previous noise exposure.”

15. The nurse notes that the client has a sudden change in vision. Which of the following conditions should the nurse suspect as a possible cause?

A) Chronic glaucoma.

B) Dermatoses C) Diabetes D) Furunculosis

Page 3

16. The nurse at the ophthalmology office teaches the client who was newly diagnosed with cataracts. Which of the following should the nurse counsel the client to avoid now?

A) Reading B) Strenuous exercise C) Bright sunlight D) Contact lenses 17. The client's symptoms include seeing halos around lights, having headaches, and experiencing misty vision. The symptoms are especially pronounced in the morning.

How would an ophthalmologist most likely treat this patient?

A) Eye exercises B) Iridectomy or other surgery C) Mydriatics D) Medications to increase blood pressure 18. The nurse receives medication orders for an 84-year-old patient with glaucoma.

Which of the following medications should the nurse expect?

A) Miotic: pilocarpine nitrate (Carpo-Miotic) B) Anticholinergic: hyoscyamine (Levsin) C) Mydriatic: mitomycin (Mitosol) D) Stimulant: epinephrine (EpiPen) 19. An unconscious 84-year-old patient in the emergency room is wearing a medical bracelet that states diabetes and glaucoma. Lab tests indicate the patient has a low blood sugar level. Which of the following is most likely to help her?

A) Mydriatics B) Anticholinergic agents C) Intravenous glucose D) Epinephrine 20. An older adult exhibits symptoms that include seeing spots moving across one eye, blurred vision, and flashes of light. The client says “I feel as if something is starting to coat my eye.” What treatment should the nurse anticipate occurring as soon as possible?

A) Laser therapy B) Antibiotics C) Cryosurgery D) Bilateral eye patches

Page 4

21. A nurse conducted a comparative study of two nursing homes, Home 1 and Home 2, in different parts of the same city. Results of the study showed that the two homes had different kinds of residents: Residents in Home 1 had held blue-collar jobs, and those in Home 2 were better educated and had had higher incomes. Residents in Home 1 also were more likely than those in Home 2 to have hearing deficits. The most likely reason for the difference in residents is that those in Home 1: A) Had been exposed to more ototoxic drugs B) Were receiving poorer care C) Had smoked cigarettes for a longer time D) Had been exposed to more noise 22. The nurse plans care for older adults living with hearing deficits. Which of the following serious threats to the emotional health should be included in the plan of care?

A) Suspicion of those around them brought on by the inability to lip-read conversations.

B) Social isolation brought on by the difficulty in communication.

C) Confusion brought on by having to depend on written communication.

D) Anger and frustration brought on by ill-fitting hearing aids.

23. The family of a person with a severe hearing loss may find it difficult to deal with that family member. What is the best advice a nurse can teach the family that will help the situation?

A) Speak as loudly as possible and face the person.

B) Make no frustrating efforts to communicate.

C) Buy the person the best hearing aid available immediately.

D) Speak in a low-frequency voice, and use sign language.

24. What can hospital planners and nurses do to provide an environment for elderly patients that takes these patients' changing senses into account?

A) Brew coffee and bake cookies in patient areas.

B) Use similar colors and textures in adjoining areas.

C) Keep sounds to a minimum.

D) Avoid irritating patients by touching them.

25. How can a home or hospital room be made more comfortable and helpful for elderly persons with visual deficits?

A) Each person's belongings should be labeled with the same number or letter.

B) Windows should be uncovered to allow maximum natural light.

C) Furnishings should be in assorted bright colors.

D) The overhead lighting should be bright.

Page 5

26. Which of the following observations by a nurse calls for immediate action?

A) Patient's inability to read fine print B) Foul odor related to incontinence C) Cigarette burns on a patient's fingers D) Patient's report of having difficulty seeing objects to the side 27. The nurse discusses medication use with the older adult who has arthritis, asthma, and glaucoma. Which of the following information should be included in the teaching?

A) Use over-the-counter cold medications as needed.

B) Apply the dorzolamide (Trusopt) drops 1 minute after the pilocarpine.

C) Avoid stool softeners and laxatives.

D) Take ibuprofen as directed for the arthritis pain.

28. A significant number of older people have some degree of hearing loss. The nurse is in a key position to educate these individuals about hearing aids. How can the initial period of adjustment to a hearing aid be minimized and the long-term success maximized?

A) Wear the hearing aid at all times.

B) Sit in the back rows of churches and meeting halls.

C) Lower the amplification in noisy environments.

D) Let batteries wear out completely before replacing them.

29. An African-American woman in her early fifties experiences sudden and severe eye pain, headache, nausea, and vomiting. Her intraocular pressure (IOP) is 24 mm Hg. After she rests for 12 hours, the IOP falls to 18 mm Hg. What treatment will she most likely need?

A) Iridectomy B) Carbonic anhydrase inhibitors C) Magnifying glasses and high-intensity reading lamps D) Cycloplegics and antibiotics

Page 6

Answer Key 1. C 2. A 3. B, C, D 4. D 5. C 6. A, C, D, E 7. D 8. C 9. D 10. A 11. B 12. C 13. A 14. C 15. C 16. C 17. B 18. A 19. C 20. D 21. D 22. B 23. D 24. A 25. C 26. C 27. D 28. C 29. B

Page 7

Name: __________________________ Date: _____________ 1. The nurse assesses a group of older adults at a senior center for conditions related to an aging endocrine system. Which of the following assessment findings should the nurse prioritize and address first?

A) Blood glucose of 300 in an 88-year-old person B) Metabolic syndrome in a 67-year-old person C) New onset of peripheral edema and constipation in a 72-year-old adult D) The presence of a Dupuytren contracture in a 78-year-old adult 2. The nurse educates the older adult regarding a new diagnosis of diabetes mellitus.

Which of the following educational materials should the nurse consider as appropriate?

A) A commercial pamphlet with pictures and font size 12 B) An audio recording.

C) Online interactive presentation D) Printed handouts on white paper with font size 16 3. The nurse educated the patient with newly diagnosed diabetes. Which of the learning outcomes would be appropriate? (Select all that apply.)

A) To demonstrate the correct method of blood glucose testing B) To demonstrate the proper technique for administration of antidiabetic medication C) To lose 5 lb a week for the next 52 weeks D) To remain with heart rate within normal limits E) To verbalize understanding of diabetes and its management 4. The nurse admits a patient to the skilled care unit with symptoms of fatigue, weakness, and lethargy. Before the primary care provider completes a diagnosis of depression, which of the following laboratory tests should be completed?

A) Estrogen and testosterone B) Random blood glucose C) T4 and TSH D) Triglyceride 5. The nurse interviews the client at a yearly office visit. The client states “I don't really eat that much, I'm not that hungry, but I keep gaining weight. Just look at my fat face!” Which of the following conditions should the nurse suspect?

A) Hyperlipidemia B) Hypothyroidism C) Diabetes D) Peripheral vascular disease

Page 1

6. The nurse administers the initial dose of levothyroxine sodium (Synthroid) to a 76year-old. Which of the following signs would indicate a complication?

A) Anorexia B) Cold intolerance C) Constipation D) Tachycardia 7. The nurse instructs the patient receiving treatment for hypothyroidism. Which of the following statements, if made by the patient, indicate the need for further teaching?

A) “I will continue to take the stool softener until my constipation is better.”

B) “I will call the office if I have any chest palpitations.”

C) “I will not need to refill this prescription.”

D) “I will take one pill today, two tomorrow, and then three pills a day.”

8. The nurse presents at a seminar on “Aging of the Endocrine Glands” at a senior center. Which of the following should the nurse include in the presentation?

A) Blood tests are necessary for initial assessment of endocrine system decline.

B) Endocrine function decline can be prevented with exercise and vitamins.

C) Glands that secrete hormones decline at a predetermined prescribed rate.

D) The thyroid, pancreas, and adrenal glands are at risk for dysfunction in the older adult.

9. Which of the following older adults is most likely experiencing the effects of agerelated changes to endocrine function?

A) A 71-year-old whose circadian rhythms are disrupted due to decreased melatonin production by the pineal gland.

B) A 78-year-old whose pancreas is releasing insufficient amounts of insulin, resulting in hyperglycemia.

C) A 67-year-old who is experiencing hyperthermia and insomnia due to increased thyroid activity.

D) A 69-year-old who has experienced decreased sexual responsiveness due to a large decline in testosterone production.

10. A diabetes nurse is providing an educational in-service to nurses who provide care on a geriatric, subacute medical unit of hospital. Which of the following teaching points related to diagnosing diabetes in older adults should be included in the teaching?

A) “Older adults with a new onset of diabetes will be hungry and thirsty with copious urine output.”

B) “Because of an absence of signs and symptoms in older adults with diabetes, diagnosis can be very difficult.”

C) “Older persons can often display signs and symptoms of diabetes that are more subtle than those in younger adults.”

D) “Pancreatic biopsy is often required in order to determine a definitive diagnosis of diabetes in the elderly.”

Page 2

11. A 74-year-old has been diagnosed with type 2 diabetes based on the results of glucose tolerance test during a current hospital stay. The care team has prescribed oral glimepiride. Which of the following guidelines should the patient's nurse use in the administration of the new drug?

A) Administer the drug 30 minutes before each meal, beginning the drug with a low dose.

B) Give the glimepiride only if blood glucose exceeds 200 mg/dL (11.1 mmol/L).

C) Drug levels will be required to determine the therapeutic serum concentration of the drug.

D) Hold the drug if the patient exhibits signs and symptoms of hyperglycemia.

12. Which of the following statements best conveys the relationship between hyperglycemia and glycosuria in older adults?

A) Older adults' kidneys tolerate higher glucose levels, so hyperglycemia does not necessarily result in glycosuria.

B) Because older adults often display atypical signs and symptoms of diabetes, glycosuria coupled with hyperglycemia is considered the most accurate source of a definitive diagnosis.

C) Decreased renal filtration capacity in older individuals causes their urine to normally contain more glucose than younger adults'.

D) Glycosuria is considered a pathological finding in younger adults but a normal finding in older adults.

13. During patient education of a 71-year-old who has a recent diagnosis of diabetes, the nurse has emphasized the importance of consistently maintaining blood glucose levels within the normal range rather than simply reacting to high or low levels.

Which of the following tests is most likely to gauge the consistency of the patient's blood sugar control over time?

A) Random blood glucose B) Triglyceride monitoring C) Hemoglobin A1c D) Glucose tolerance test (GTT) 14. The home care nurse regularly performs visits to a client's apartment. This client asks about ways that exercise might be able to control his type 2 diabetes. How should the nurse respond to the client's query?

A) “Exercise is very beneficial for diabetes control, but if it's too vigorous it can lead to rebound hyperglycemia that is dangerous.”

B) “Confirm with your doctor, but it's likely best to maintain a low activity levels to keep your glucose levels within normal range.”

C) “Exercise can be an excellent substitute for oral antihyperglycemic medications.”

D) “It's important to have an exercise plan that is appropriate specifically for you, because you don't want to bring on hypoglycemia by exercising too hard.”

Page 3

15. Which of the following statements by patients on a geriatric medicine unit would be considered suggestive of hypothyroidism? (Select all that apply.)

A) “I've never been prone to constipation in the past, but lately I'm only having a bowel movement every 3 or 4 days.”

B) “I'm having a terrible time getting to sleep at night and I keep waking up early.”

C) “Lately I just can't manage to stay warm no matter how high I keep the thermostat.”

D) “I've always been a cheerful person but now I can't shake this blue feeling.”

E) “I feel like I just don't have the energy that I normally do.”

16. Based on a 77-year-old client's signs and symptoms, the care team suspects an overactive thyroid gland. Which of the following components of assessment is most likely to yield information that is central to the diagnosis?

A) A review of the client's medications, specifically the use of cardiac medications.

B) Measurement of the patient's respiration rate, breath sounds, and oxygen saturation.

C) Blood work that focuses on liver function.

D) Assessment of renal function including a 24-hour urine.

17. With aging, the endocrine system experiences changes that can be diverse and interrelated. Which of the following statements accurately describes an effect of aging on the endocrine system and its hormones?

A) The action of water-soluble hormones on body cells increases.

B) The endocrine system's ability to regulate body activities decreases.

C) The response of body cells to hormones increases.

D) Hormones become more concentrated.

18. Early diagnosis of diabetes in the elderly is often difficult because the classic symptoms of diabetes may be absent. What is the most reliable indicator of diabetes in the elderly?

A) High blood glucose level B) Glaucoma C) High urinary glucose level D) Kidney failure 19. Before having a blood sugar test, a patient must avoid drugs that affect blood glucose level. In analyzing a patient's blood glucose level, the nurse should be aware of any drugs the patient is taking. Which of the following drugs may lower a patient's blood sugar level?

A) Nicotinic acid B) Estrogen C) Diuretics D) Monoamine oxidase inhibitors

Page 4

20. Patients with newly diagnosed diabetes are often fearful and nervous about coping with the disease. Only some of their fears are unfounded. Which of these concerns is undeniably true?

A) “I will have to make lifestyle changes.”

B) “I can't learn to inject myself with insulin.”

C) “I will eventually have to enter a nursing home.”

D) “I can't afford a special diet.”

21. The nurse plans care for residents of a nursing home with diabetes. Which of the following symptoms of hypoglycemia are characteristic of the elderly that the nurse should be attentive to?

A) Tachycardia and restlessness B) Poor sleep patterns and slurred speech C) Perspiration and anxiety D) Anxiety and restlessness 22. The nurse practitioner assesses an 84-year-old client, who talks about feeling tired and chilly, and having dry skin and coarse hair. Which of the following conditions should the nurse practitioner first consider?

A) Hyperlipidemia B) Hypothyroidism C) Diabetes D) Peripheral vascular disease 23. A 79-year-old in very good health has a lipid screening during a visit to the nurse practitioner. Which of the following values should the nurse interpret as desirable for him?

A) Triglycerides 299 mg/dL B) Triglycerides 199 mg/dL C) Triglycerides 149 mg/dL D) Triglycerides 19 mg/dL 24. The elderly population has a high incidence of hyperglycemia. Compared with younger adults, what makes the elderly more vulnerable to this disorder?

A) Glucose intolerance B) Improved diagnostic tests C) Diabetes prevalence D) Obesity prevalence

Page 5

25. The nurse at the wellness center plans exercise treatment for the client with diabetes.

Why should the nurse advise this patient who is being treated for diabetes to exercise with caution?

A) The resting heart rate is lowered.

B) Hypoglycemia may occur.

C) The heart rate is temporarily increased.

D) The absorption of insulin is lowered.

26. Older people are subject to a long list of complications from diabetes, so the disease must be strictly managed. Which of the following statements is true about diabetes and its complications?

A) Hyperglycemia is associated with anxiety and insomnia.

B) Unmanaged hyperglycemia can cause tachycardia and heart arrhythmias.

C) Ketoacidosis can cause gangrene in the limbs and lead to eventual amputation.

D) Diabetes can eventually damage nearly every body system.

27. The nurse practitioner interviews an 80-year-old client who reports that the longterm issue with constipation has stopped and the client now has normal bowel movements. Which of the following conditions should the nurse practitioner suspect that this patient has developed?

A) Atrophy of the adrenal gland B) Diabetes C) Hyperthyroidism.

D) Hyperlipidemia 28. The nurse assesses a 94-year-old resident of a nursing home who has diabetes mellitus. For which of the following signs and symptoms should the nurse perform a blood glucose test?

A) Restlessness and postural hypotension B) Somnolence and slurred speech C) Perspiration and incontinence D) Numbness and weak pulses

Page 6

Answer Key 1. A 2. D 3. A, B, E 4. C 5. B 6. D 7. C 8. D 9. B 10. C 11. A 12. A 13. C 14. D 15. A, C, D, E 16. A 17. B 18. A 19. D 20. A 21. B 22. B 23. C 24. A 25. B 26. D 27. C 28. B

Page 7

Name: __________________________ Date: _____________ 1. The nurse prevents and treats pressure ulcers in the at-risk population of immobile elders. Which of the following interventions will best treat a stage 1 pressure ulcer?

A) Clean with normal saline three times a day.

B) Cover with a hydrogel sheet like Vigilon.

C) Off-load the area under pressure.

D) Thoroughly clean and irrigate the lesion.

2. The nurse assists in the surgical removal of eschar from a trochanter pressure ulcer revealing the bone and tendons. The nurse correctly stages this ulcer as what stage?

A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4 3. The nurse teaches a 65-year-old obese client who works as a greeter in a store regarding care of the client's varicose veins. Which of the following statements, if made by the client, indicates the need for further teaching?

A) I can sit with my legs crossed at the knees.

B) I elevate my legs on breaks and in the evening.

C) I have joined weight watchers to help me lose my excess weight.

D) I will get some support stockings from the medical supply company.

4. The nurse describes various integumentary conditions to a group of older adults.

Which of the following descriptions best defines actinic keratoses?

A) Gray or brown raised lesions located on sun exposed areas of the skin.

B) Irregular shaped, irregular colored lesions found in the scalp of older adults.

C) These lesions are dark, wartlike projections on various parts of their bodies.

D) When located on the leg or abdomen, the lesions are dry and the size of a penny.

5. The nurse assesses a group of older adults for various integumentary conditions.

Which of the following descriptions correctly identifies a seborrheic keratosis?

A) Gray or brown and located on sun exposed areas of the skin.

B) Irregular shaped, irregular colored lesion.

C) Redness and edema around the base of a lesion.

D) When located in the armpit, the lesion is dark and oily.

6. Which of the following aspects of the integumentary system would a gerontological nurse expect to increase, rather than decrease, with the age of clients?

A) Pigmentation B) Dermal thickness C) Coarseness of collagen D) Size of hair bulbs

Page 1

7. The nurse teaches a group of older adults about the benefits of health promotion activities specific to the integumentary system. Which of the following statements by a participant best reflects a sound understanding of health promotion of the skin?

A) “I make sure that I take a bath each evening to keep my skin good and clean.”

B) “I have the best face cream, it removes wrinkles and lines.”

C) “I know that any mole that is brown or raised can be sign of skin cancer.”

D) “I learned that moles that are irregular in shape can be associated with melanoma.”

8. The nurse observes an 83-year-old resident of a nursing home scratching repeatedly over the last several days. The resident states, “I'm so itchy these days it drives me crazy.” Which of the following measures should the nurse prioritize?

A) Referral to the resident's physician for oral corticosteroids.

B) Increasing the frequency of the residents bathing schedule.

C) Closer monitoring for a better control of the resident's blood pressure.

D) Dietary changes and application of zinc oxide.

9. During a nurse's home visit, a 74-year-old woman has expressed her frustration with the number and size of seborrheic keratoses on her neck and trunk. How can the nurse most appropriately respond to the woman's concern?

A) “Even though these usually don't pose a danger to your health, we can still investigate getting them removed.”

B) “Your physician will likely want to biopsy each of these because they are usually indicative of skin cancer.”

C) “These lesions are normally benign, so there is likely no need for follow-up.”

D) “These are quite rare so it's important that you visit your primary care provider as soon as possible.”

10. The nurse assesses clients to determine the risk factors to integumentary health.

Which of the following older adults faces the most acute threat to his or her health?

A) A 66-year-old retired farmer who has been diagnosed with melanoma following a lifetime of sun exposure.

B) An 80-year-old client whose most recent physical examination has revealed the presence of numerous seborrheic keratoses.

C) A 78-year-old former factory worker whose basal cell carcinoma has been attributed to occupational exposures in decades past.

D) A 67-year-old client who has developed squamous cell carcinoma after many years of sun tanning without sunscreen.

Page 2

11. The homecare nurse performs visits to a 74-year-old client with numerous health problems. The nurse has noted the presence of an irregular-shaped, growing lesion of irregular color on the client's scalp but the client is resistant to visiting the primary health care provider. Which of the nurse's statements is most accurate?

A) “Even if this does turn out to be skin cancer, the treatment is usually topical creams and you wouldn't have to undergo surgery.

B) “If this is skin cancer, the sooner you have it diagnosed, the better the chance of a favorable outcome.”

C) “Cancerous regions of the skin usually have to be removed, but they are almost never fatal and you won't have any lasting consequences.”

D) “Even though this is probably just a minor growth called a keratosis, it should still be checked out by your doctor.”

12. The wound care nurse in a hospital has been asked to consult in the care of a 79year-old patient with numerous vascular lesions on lower legs. Place the following events involved in the development of the health problem in the chronological order in which they most likely occurred. Use all the options.

A) Poor venous return B) Development of edema C) Obesity D) Emergence of stasis ulcers E) Stasis dermatitis 13. The nurse manager of a subacute geriatric unit of a hospital recognizes the need to reduce the incidence of pressure ulcers in patients on the unit. Which of the following protocols and procedures are associated with a decreased risk of pressure ulcers? (Select all that apply.)

A) All patients are turned every 2 hours both during the day and during the night.

B) Care providers are encouraged to lift rather than slide patients during transfers.

C) Staff is discouraged from turning patients who are using a pressure-reducing mattress.

D) Records of food and fluid intake are kept for each patient.

E) Oils are added to patient baths and lotions applied thereafter.

14. A 78-year-old resident with a diagnosis of melanoma is experiencing anxiety related to the appearance of the large and highly visible lesion on the right cheek. Which of the following nursing actions is most likely to decrease the resident's anxiety?

A) Forewarn visitors and staff that the resident's appearance is likely to be disturbing.

B) Facilitate psychological counseling to help the resident cope with an altered appearance.

C) Resolve to interact with and touch the resident no differently than other residents.

D) Avoid touching the resident's face in order to preclude embarrassment.

Page 3

15. An 84-year-old client has dry skin and accompanying pruritus. Which of the following complementary therapies is most likely to address the low moisture content of the client's skin?

A) Thyme oil B) Rosewood oil C) Aloe vera D) Chamomile extract 16. Some of the elderly patients in an assisted living facility bathe too seldom, and a nurse wants to encourage more cleanliness without insulting them. What aids for promoting healthy skin is the best for a nurse to recommend to them?

A) Clean, starched linens B) Daily baths or showers C) Alcohol-based skin preparations D) Bath oils and lotions 17. A dark-skinned client who tans easily and never burns asks for advice about sun exposure. Which of the following bits of advice is best for this client?

A) “Always use a sunscreen with an SPF of 15 or more.”

B) “Stay out of the sun entirely when possible.”

C) “Enjoy the sun without taking precautions.”

D) “Be cautious, even on overcast days.”

18. The nurse counsels two different older adults who are considering cosmetic surgery.

Which of the following teaching points is the most appropriate?

A) Encourage both patients to do whatever it takes to look their best.

B) Tell them their efforts to avoid the aging process will be frustrating and fruitless.

C) Explore their reasons for seeking cosmetic surgery to ensure it is a rational decision.

D) Advise them that not all surgeons are skilled in cosmetic surgery.

19. The nurse identifies common skin problems among older adults. In which of the following patients is pruritus most likely to occur?

A) A diabetic patient who has a diet rich in nutrients and vitamins.

B) A patient with liver disease who takes sponge baths most of the time.

C) A psychiatric patient who uses bath oils and lotions.

D) A cancer patient who lives in a desert environment.

20. The nurse records observations of patients' melanomas. Which of the following melanomas would indicate poorest prognosis?

A) Deep, darkly pigmented papule on the back B) Thin, red-pigmented, flat lesion on the arm C) Thin, irregularly pigmented lesion on the leg D) Thin, variably pigmented plaque on the chest

Page 4

21. Older adults are at high risk for pressure ulcers because such individuals are more frequently affected by immobile and edematous conditions. Which of the following intervention best minimizes the occurrence of pressure ulcers?

A) Elevate the head of the bed 45 degrees, and turn the patient every hour.

B) Make sure the patient cannot feel pressure, and turn the patient every 2 hours.

C) Advise using pillows on a water bed, and turn the patient every hour.

D) Provide a high-carbohydrate diet, and turn the patient every 2 hours.

22. The child of a nursing home resident complains to the nurse that his mother is required to get out of bed and do simple morning exercises when she would rather sleep. Which of the following rationales is the most appropriate for the nurse to state to the relative?

A) The exercise is needed for promoting circulation.

B) The exercise is needed for preventing pressure ulcers.

C) The nurse's aide can make the bed more easily.

D) The exercise is needed for psychological health.

23. The nurse chooses herbal remedies and essential oils to treat the client's skin. Which of the following can be helpful both as an emollient and for treating minor burns and cuts?

A) Chamomile extract B) Aloe vera C) Witch hazel D) Peppermint oil 24. The nurse works with cancer patients and their families to deal with difficult issues.

Which of the following reasons supports why a diagnosis of malignant melanoma may be extremely difficult for patients to accept?

A) It cannot be detected early enough to improve the prognosis.

B) It is a high risk in fair-skinned individuals, and incidence increases with age.

C) It has been rising in the United States, probably due to sun exposure.

D) It causes a small percentage of total deaths from cancer but is metastatic and fatal.

25. The nurse plans care for stasis ulcers to control infection and facilitate healing.

Which of the following recommendations should the nurse give a patient who has had stasis ulcers?

A) Eat lower calorie, balanced meals.

B) Wear no elastic stockings.

C) When possible, stand rather than sit.

D) Have varicose veins stripped.

Page 5

26. Wound care is not a single process, but requires attending to different symptoms with different measures. Which of the following is needed for dermal ischemia?

A) Protection with DuoDerm or similar product and adhesive foam.

B) Treatment with topical antibiotics.

C) Protection with Vigilon or similar product.

D) Debridement.

27. The nurse presents at a seminar for older adults with integumentary problems. Which of the following information should the nurse give regarding the use of alternative therapies?

A) Alternative therapies are often the treatment of choice those with problems.

B) Alternative therapies are dangerous and should be avoided.

C) Discuss the use of any alternative therapy with your family.

D) Inform your health care team of alternative therapies in use.

28. An elderly patient with many health problems wants to save money to have a facelift.

Which of the following is the most tactful and helpful comment a nurse can make?

A) Cosmetic surgery is fine at any age if a patient can afford it, and will do much more for the appearance than any cosmetic.

B) Cosmetic surgery is a waste of money for the elderly, but good cosmetics can be healthful and make you look much better.

C) Cosmetic surgery may be fine, but good cosmetics can be a less expensive and effective option.

D) Cosmetic surgery is inadvisable, and elderly patients should concentrate on inner beauty.

Page 6

Answer Key 1. C 2. D 3. A 4. A 5. D 6. C 7. D 8. D 9. A 10. A 11. B 12. C, A, B, E, D 13. B, D, E 14. C 15. C 16. D 17. D 18. C 19. D 20. A 21. C 22. A 23. B 24. D 25. A 26. C 27. D 28. C

Page 7

Name: __________________________ Date: _____________ 1. The clinic nurse teaches the older adult who is receiving the influenza vaccination.

Which of the following statements, if made by the client, indicate the need for further teaching?

A) “I will call my health care provider if I develop a cough and fever.”

B) “I will increase my intake of vegetables this flu season.”

C) “I want the live attenuated nasal spray vaccine, not the shot.”

D) “I will wash my hands before and after I urinate.”

2. The clinic nurse teaches the older adult who has been diagnosed with viral rhinitis (the common cold). Which of the following statements, if made by the client, indicate the need for further teaching?

A) “I will finish the antibiotics that I have left in my cupboard.”

B) “I will increase my intake of zinc.”

C) “I will use my hanky to cover my nose when sneezing.”

D) “I will wash my hands before and after I eat.”

3. The nurse educates the staff of a residential home about an upcoming influenza season. Which of the following should the nurse include in the presentation?

A) Antibiotics are an effective treatment for influenza.

B) Hand hygiene is one of the most important ways to prevent the spread of infections.

C) Infection control practices increase the risks of transmission of influenza.

D) The influenza vaccination is not recommended for persons over the age of 64.

4. The nurse prioritizes completion of home visits during an outbreak of the flu. Which of the following persons is at greatest risk for contracting influenza?

A) A 67-year-old recovering from a knee replacement received 3 weeks ago.

B) An 89-year-old with asthma living in a public housing facility.

C) An obese 82-year-old living with family.

D) A 74-year-old who fell at yoga class 10 days ago and has an open wound.

5. A nurse hears a colleague state, “It's actually a myth that older people get sick more often and have a weaker immune response than young people.” How can the nurse best respond?

A) “Even though there are things that older people can do to strengthen their immune system, it naturally does get weaker over time.”

B) “It's true; while older adults do suffer from more chronic conditions, they don't become more susceptible to infections as they age.”

C) “Actually, function of the immune system becomes weaker with each decade and this decline is not modifiable.”

D) “You're right. Characterizing older adults as sickly is an inaccurate stereotype based on ageist ideas.”

Page 1

6. A 77-year-old retiree who has long enjoyed good health has become sick with a number of infections over the past several years. Which of the following age-related changes to the person's immune system may have contributed to increased susceptibility?

A) A decrease in the total number of immunoglobulins B) A decline in her number of T and B cells C) Hypersensitivity to cutaneous introduction of pathogens D) A deficiency in the cell-mediated immune response 7. A resident of an assisted living facility has ingested Clostridium difficile bacteria that was acquired from a chair in a common area of the facility. However, the resident did not become ill with the gastritis associated with the bacteria. Place the following steps in the woman's defense against the pathogen in the order in which they most likely occurred. (Use all the options.)

A) Antibodies attack the antigen.

B) A macrophage attacks the antigen and retains some of the antigen's protein on its surface.

C) The antigen enters the resident's body.

D) A macrophage carries the antigen's protein markers to lymphoid tissue.

E) T lymphocytes interpret the antigen as foreign.

8. Which of the following dietary modifications is most likely to foster an older adult's immune function?

A) Emphasizing organic fruits, vegetables, and meats.

B) Limiting intake of caffeine, alcohol, fat, and refined carbohydrates.

C) Avoiding animal products that may contain growth hormones and residual drugs.

D) Cutting out sugar and tropical oils.

9. A 72-year-old client who is diligent in maintaining good health has told the nurse of the plan to begin a 2-day cleansing fast. What teaching point should the nurse prioritize?

A) “Fasting has a significant cleansing effect, but is unlikely to influence your immune system.”

B) “Fasting has a lot of benefits, but it's best to get an assessment from your doctor before you begin.”

C) “This is a great idea; just make sure that you reintroduce food and fluids very slowly once you're finished.”

D) “It's okay to skip up to two meals, but anything beyond that is usually not recommended for older adults.”

Page 2

10. During a visit to her nurse practitioner, a 68-year-old client is surprised at the nurse's recommendation of immunizations, stating, “I thought those were only for children and teenagers.” Which of the following statements provides the most accurate rationale for the nurse's recommendation?

A) Persons over 65 should receive vaccinations against measles, mumps, rubella, and hepatitis.

B) Older adults should receive annual influenza vaccinations and tetanus and diphtheria boosters every 10 years.

C) The childhood immunization schedule be replicated in beginning at age 65 to ensure adequate antibody titers.

D) Older adults should receive vaccinations if they live in close contact with others who may be or may become infected with infectious diseases.

11. Which of the following activities are known to have a positive effect on the immune function of older adults? (Select all that apply.)

A) Careful control of chronic conditions such as diabetes and hypertension.

B) Adherence to a healthy diet that emphasizes fruits and vegetables.

C) Annual pneumococcal and hepatitis vaccinations.

D) Use of relaxation techniques such as yoga and meditation.

E) Performance of physical exercise to stimulate the release of cortisol.

12. During an impromptu speech at her 100th birthday party, a client attributes her longevity to an outlook that has always emphasized optimism, faith, and the ability to laugh at herself. A nurse would recognize which of the following phenomena as most accurately underlying the client's statement?

A) Older adults tend to recall positive events more clearly than negative events.

B) A healthy immune system results in a positive and balanced psychological state.

C) Persons of faith are often able to view life more positively.

D) Humor and a positive psychological state are associated with improved immune function.

13. The nurse assesses the health actions of a group of clients. Which of the following practices best demonstrates appropriate use of antibiotics?

A) An 80-year-old client takes a low dose of a broad-spectrum antibiotic once daily to prevent infection.

B) A 77-year-old client makes sure to stop taking the antibiotics once signs and symptoms of infection are no longer present.

C) An 81-year client does not take synthetic antibiotics but rather limits self to natural substitutes.

D) A 72-year-old client discards leftover antibiotics once the prescribed course is complete.

Page 3

14. A 73-year-old client with a diagnosis of upper respiratory infection has been prescribed antibiotics. The client has inquired about natural remedies to supplement antibiotic therapy and reduce future infections. Which of the following substances might the nurse encourage the client to explore?

A) Echinacea and garlic B) Aloe vera and rosemary oil C) Ginger and witch hazel D) Glucosamine and vitamin D 15. The nurse discusses the immune response with a group of older adults. Which of the following is one of the factors that contributes to the severity of infectious diseases in the older adult population?

A) Loss of collagen leading to thin skin B) Inability to tolerate antibiotic therapy C) Localized reduction in T lymphocytes D) Increased incidence of hospitalizations 16. A staff member notices an abrasion and small laceration on the forearm of an 85year-old resident. Which of the following immune system factors contributes to the resident's risk of a localized infection?

A) Loss of macrophages B) Reduced antibody response to vaccines C) Increased risk of a chronic health condition D) Altered concentration of immunoglobulins in the blood 17. One step in the functioning of a healthy immune system involves the T cells correctly interpreting that the antigen's protein is foreign. In an elderly adult, this response is affected by which age-related change?

A) The increased thickness and circulation to the skin.

B) An increase in the delayed cutaneous hypersensitivity response.

C) The thymus progressively declining in size.

D) A decrease in the number of immature T cells.

18. Certain foods are known to have a positive effect on the immune system. Which of the following meals would a nurse recommend as ideal for the older adult?

A) Roast beef sandwich on a roll with cheese; fruit salad; and tea.

B) Broiled fish with potatoes; a salad; and a glass of tomato juice.

C) Fish sandwich on wheat bread with lettuce and tomato; fruit compote with honey; and a glass of skim milk.

D) Yankee pot roast with whole-grain rice; green beans; blueberry pie with low-fat ice cream; and a glass of skim milk.

Page 4

19. A gerontological nurse is presenting a nutritional seminar to a group of women at a local health food store. One of the students in her sixties tells the group that she fasts for 1 or 2 days a few times a year as part of a regular regimen. Which of the following statements is the first thing the nurse is most likely to say in this setting about fasting?

A) “Fasting can increase macrophage activity.”

B) “Fasting is recommended only for people under the age of 65.”

C) “Fasting has a positive impact on the immune system and can promote healing.”

D) “Fasting may be safe but requires a prior comprehensive history and physical exam.”

20. The nurse prepares a 70-year-old client to begin hemodialysis. Before beginning treatment, which of the following immunizations is required?

A) Influenza B) Hepatitis A C) Hepatitis B D) Tetanus and diphtheria 21. Which is the most appropriate guideline for a nurse who makes decisions about vaccines in the elderly?

A) Immunizations should be given until the person does not seem to respond to them anymore.

B) Vaccines are more successful if the elderly person takes additional measures to improve their effectiveness.

C) Vaccines can be less effective in the elderly because of age-related changes in the immune system in response to foreign antibodies.

D) Immunizations should be continued although they may cause T-cell function to decline and result in a weaken response to their effectiveness.

22. In reviewing nursing home residents' tuberculin tests, a nurse should keep in mind that, in older adults, the results of such skin tests may be altered by which of the following?

A) Patients' increased exposure to antigens in an institutional setting.

B) The delayed cutaneous hypersensitivity response.

C) Improvement in the ability of monocytes to kill bacteria.

D) Increased neutrophil antibacterial activity.

23. A 75-year-old man who is largely bedridden is admitted to the dementia unit in a nursing home. One primary nursing care goal is to keep this resident free from infection. Which of the following actions is most likely to reduce his risk of infection?

A) Maintaining his skin integrity.

B) Assisting him with exercise.

C) Counseling him against overuse of antibiotics.

D) Monitoring him for atypical signs of infection.

Page 5

24. Psychoneuroimmunologic studies have identified a specific set of traits associated with persons who generally have sound immune systems. Which of the following individuals has at least two of these traits?

A) A retired Catholic nun undergoing chemotherapy.

B) A former stand-up comedian residing in a supportive living program.

C) A volunteer involved with a religious community group working to improve housing.

D) A secretary to a group that builds homes for mixed-use housing developments.

25. The director of nurses has asked the nurse to collaborate with the activity director on a stress management program for the assisted living facility. Which of the following activities should the nurse prioritize?

A) Bingo B) Yoga or t'ai chi C) Lectures on nutrition D) Monthly birthday parties 26. In examining a client with several diseases diagnosed, including hypertension and depression, the nurse examines the physiology of the effect of stress on the immune system. Which of the following physiologic responses affects this client the most strongly?

A) A reduction in the level of virus-fighting interferon.

B) An increase in the level of serum cortisol.

C) An increase the number of immature T cells.

D) A reduction in the antibody response to vaccines.

27. The nurse assesses a client with new-onset hearing loss. The client tells the nurse, “I had had a cold so I took the antibiotic in the cupboard.” Which of the following medication should the nurse suspect?

A) Isoniazid B) Tetracycline C) Tobramycin, an aminoglycoside D) Ciprofloxacin, a fluoroquinolone

Page 6

Answer Key 1. C 2. A 3. B 4. B 5. A 6. D 7. C, B, D, E, A 8. B 9. B 10. B 11. A, B, D 12. D 13. D 14. A 15. D 16. A 17. C 18. C 19. D 20. C 21. C 22. B 23. A 24. C 25. B 26. B 27. C

Page 7

Name: __________________________ Date: _____________ 1. Which assessment finding is most important in determining nursing care for a client with pneumonia?

A) A slight cough and fatigue B) Confusion and restlessness C) Mild pleuritic chest pain D) Fever 2. The nurse discusses hand hygiene with the staff specifically regarding Clostridium difficile. Which of the following should the nurse include in teaching plan?

A) Avoid the use of bleach and bleach cleaners in C. difficile isolation rooms, as the bleach does not kill the spores.

B) Hand washing is required with running water and soap to remove the spores from the caregivers' hands.

C) The spores are transmitted only from direct contact, so wear gloves when touching the patient.

D) Use of alcohol-based hand cleansers is appropriate for use before and after each patient contact.

3. The nurse at the assisted living facility inspects the skin of a resident with intense pruritus. Which of the following symptoms would support the need for treatment of scabies?

A) The itching is worse during the day.

B) The lesions are concentrated on the abdomen.

C) The lesions are linear with a vesicle on one end.

D) The vesicles follow a nerve route.

4. The nurse instructs an older adult who has developed shingles regarding risk for future occurrences of the disease. Which of the following should then nurse include in this discussion?

A) “Chronic diarrhea and thrush are symptoms that can develop years after herpes zoster has invaded the body.”

B) “Herpes zoster is a sexually transmitted disease.”

C) “You should receive the vaccination to prevent future occurrences.”

D) “Your family is now at risk for developing shingles.”

5. The nurse plans care for the clients with C. difficile infection. Which of the following interventions should be included in this plan? (Select all that apply.)

A) Accurate intake and output B) Contact isolation precautions C) Monitor electrolyte levels D) Restricting fluids E) Strict hand washing procedures

Page 1

6. The nurse conducts a session entitled “Physical Changes after Menopause” at a women's health fair. Which of the following conditions are at a significantly higher risk than before menopause based on these physical changes?

A) C. difficile–associated disease B) Herpes zoster (shingles) of the vagina C) HIV transmission with unprotected vaginal intercourse D) Vancomycin-resistant Enterococcus from toilet seats 7. In which of the following hospital patients would a nurse be most confident in ruling out the presence of an infection?

A) A 78-year-old man, post hip replacement, who has a temperature of 99.5°F and a loss of appetite.

B) A 70-year-old female patient who is newly incontinent of urine and confused.

C) A 90-year-old male patient, normally mobile, who is insisting on remaining in bed and has an unsteady gait when walking to the bathroom.

D) A 73-year-old woman whose blood pressure is increased and oxygen saturation levels are decreased.

8. A nurse is providing care for a 79-year-old female patient who has been admitted for treatment of a urinary tract infection. Which of the nurse's following actions is most in need of modification?

A) The nurse is maintaining a 24-hour fluid balance record.

B) The nurse is maintaining a fluid restriction for the patient to prevent incontinence.

C) The nurse has encouraged the patient's family to bring in unsweetened cranberry juice for the patient.

D) The nurse is advocating for the removal of the patient's urinary catheter that was inserted in the emergency department.

9. A gerontological nurse teaches a new nurse about older adults and pneumonia.

Which of the following teaching points for the new nurse is most accurate?

A) “The presence or absence of pleuritic pain can help differentiate between pneumonia and cardiac problems.”

B) “Pneumococcal vaccine can significantly reduce the length and severity of pneumonia if given shortly after diagnosis.”

C) “The cardinal signs of a new onset of pneumonia are chest pain, fever above 100°F, and a productive cough.”

D) “Pneumonia can often be prevented, but numerous age-related factors conspire to make older adults susceptible to it.”

Page 2

10. Which of the following measures that are regularly undertaken in a long-term care facility are likely to reduce the incidence of influenza in the facility's residents over the winter?

A) Pneumococcal vaccinations are given annually.

B) Vitamin D supplements are provided for all residents.

C) Surfaces in common areas are cleaned regularly and contact with sick residents is minimized.

D) Fluid intake is encouraged among all residents.

11. A 75-year-old male resident of an assisted living facility has had an 8-week history of weight loss, weakness, and fever. Recently, his symptoms have been determined by a Mantoux test to be caused by tuberculosis (TB), a diagnosis that has left the man distraught. What should the nurse tell the resident?

A) “Recent advances in medicine mean that a brief course of antibiotics will nearly always cure TB.” B) “This will likely mean that you will have to move to a specific institution, but your prognosis is actually very positive.”

C) “This doesn't mean that you have been neglecting yourself; rather, it's a reflection of the fact that TB is much more common in recent years.”

D) “This will require a long course of medications, but if you're vigilant about taking them as scheduled, you'll likely have no long-term effects.”

12. A nurse is administering analgesia to a 77-year-old female patient who has been diagnosed with herpes zoster (shingles). Which of the following statements about the patient's diagnosis is most accurate?

A) The disease was most likely contracted sexually, earlier in life.

B) Antibiotics, coupled with pain control, will be the most likely course of treatment.

C) Age-related changes to the immune system likely made the woman particularly susceptible.

D) The infectious process exists in the brain even though symptoms are most often felt peripherally.

13. A long-term care facility has experienced an outbreak of scabies among the residents. Which of the following actions are likely to control the spread of the outbreak? (Select all that apply.)

A) Antibiotic treatment for those residents who have tested positive B) An emphasis on vigilant hand hygiene C) Disinfection of mattresses and common areas D) Quarantine of the facility until the outbreak subsides E) Isolation of all the laundry in the facility

Page 3

14. The subacute geriatric medicine unit of a hospital is experiencing an outbreak of diarrhea that has been attributed to C. difficile. Which of the following should be the focus of the infection control department's investigation of the outbreak?

A) The logistics of the hospital's food production and meal delivery systems.

B) The hand hygiene habits of staff and their adherence to infection control measures.

C) The housekeeping practices of the cleaning contractors.

D) The individual medication regimens of affected patients.

15. The nurse admits a 78-year-old patient to the intensive care unit and swabs the patient's nares for methicillin-resistant Staphylococcus aureus (MRSA). What is the best rationale for the nurse's action?

A) If the patient is positive for MRSA, her risk of mortality is extremely high.

B) The presence of MRSA on the patient's skin may pose a potential threat to other patients.

C) The absence of available drug treatments for MRSA means that early identification is crucial.

D) The diarrhea and gastritis associated with MRSA is highly communicable in a hospital setting.

16. Which of the following factors contributes to the high incidence and prevalence of HIV/AIDS among older adults?

A) Health care providers often overlook the possibility of HIV/AIDS in older adults.

B) Older adults have an atypical presentation of HIV/AIDS. C) Treatment options for HIV/AIDS are often not feasible in older adults due to their impact on the immune system.

D) A low CD4+ is a common age-related finding, making diagnosis of HIV/AIDS difficult in older adults.

17. The clinic nurse completes discharge teaching for an 80-year-old client with a urinary tract infection. What should the discharge plan for this patient include to minimize the reoccurrence of the condition?

A) Teach the client how to test her blood glucose levels.

B) Discuss age-related bladder changes with the patient.

C) Assess the primary factors contributing to the patient's condition.

D) Instruct the patient about proper hydration.

18. During nursing rounds, a team member notices that an elderly patient has a temperature of 99°F and has been asking to void at least once per hour with minimal results. The team should: A) Offer the patient cranberry juice hourly.

B) Notify the primary health care provider immediately.

C) Tally the patient's fluid intake and output for the last 24 hours.

D) Run water in the bathroom to promote urinary drainage.

Page 4

19. An 85-year-old male patient complains of lower back pain, painful urination, and nocturia. His temperature is within his normal range, 97.6°F. Which of the following pairs of tests and diagnoses is most likely related to these urinary symptoms?

A) Simple urinalysis, acute bacterial prostatitis B) Ultrasound of the prostate, chronic bacterial prostatitis C) Fluid intake and output (I&O), acute bacterial prostatitis D) Special clean-catch with prostatic secretions, chronic bacterial prostatitis 20. The nurse develops a plan of care for an 88-year-old new resident of a care facility who arrived from the hospital after a cardiac event brought on by heat stroke. The resident was diagnosed with pneumonia this morning. Which of the following would be the most likely explanation for the pneumonia?

A) Cardiac events often precede respiratory infections.

B) Pneumonia is directly related to the heat stroke.

C) Flu season and an increase in the number of cases.

D) Elderly predisposition to nosocomial pneumonia.

21. A nurse notes that an 80-year-old nursing home resident has a dry cough, rapid respirations, and a slightly elevated temperature of 99.1°F. After a comprehensive assessment, a diagnosis of pneumonia is made. The patient also appears confused and agitated, which is probably a result of which of the following phenomena?

A) Reaction to the fever B) Decreased oxygen to the brain C) Adverse reaction to medication D) Lowered resistance to infection 22. A 64-year-old requests an injection of flu vaccine because her 90-year-old mother died last year from the flu. What is the influenza-related respiratory complication that could have contributed to the mother's death?

A) Complications of COPD B) Complications related to asthma C) Inability to clear mucus from the lungs D) Lack of obvious symptoms leading to complications

Page 5

23. The nurse discusses the influenza vaccination with a group of older adults. An 87year-old speaks up and says “I had the flu vaccine last October, and I still got the flu.” Which of the following statements if made by the nurse most accurately relates to the person's situation?

A) “You should receive the live attenuated influenza vaccine (LAIV) nasal spray instead.”

B) “The recommendation would be for you to not get the vaccine this year, because it did not prove effective in you last year.”

C) “I would advise you to get the vaccine earlier in the fall to improve its effectiveness.”

D) “Although the vaccine did not prevent influenza, it probably reduced the severity of the infection.”

24. The infectious disease nurse leads a discussion about tuberculosis (TB) in the elderly. Which of the following pieces of information should the nurse include in the discussion?

A) New infections of TB are more common in the elderly.

B) Symptoms of TB in the elderly mirror other conditions.

C) The key symptom of TB for the elderly is night sweats.

D) The key symptoms of TB for the elderly are fever and anorexia.

25. The nursing home staff screens an elderly resident for TB. Results are positive.

Streptomycin is ordered by the physician, so a critical part of the nursing care plan for this resident includes which of the following?

A) Monitoring for diarrhea B) Observing for signs of anorexia C) Increasing safety precautions D) Closely monitoring food intake 26. A healthy 70-year-old woman confides to the nurse that she has vaginal soreness with some bleeding and white discharge. She is embarrassed and confused because she has not been sexually active for more than a year. The nurse should explain that older women are predisposed to vaginitis for what reason?

A) Limited sexual activity B) Lack of proper hygiene C) Reduced response of the immune system D) Age-related changes to vaginal tissue

Page 6

27. The nurse creates a plan of care for a 70-year-old patient with Herpes zoster (shingles). The treatment plan includes analgesics, corticosteroids, and a topical cream for the pain. In addition to treating the viral infection and pain, which of the following final objectives should this plan include?

A) Preventing recurrence B) Preventing postherpetic neuralgia C) Evaluating underlying lymphoma D) Evaluating possible immune deficiency 28. The nurse admits a 79-year-old to the nursing home with differential diagnosis of dementia. Recently, the client has exhibited symptoms that include persistent elevation of his temperature, chronic diarrhea, and some palsy. Which of the following assessments should the health care team pursue?

A) HIV testing B) An x-ray to test for a fecal impaction C) Testing for Parkinson's disease D) A complete nutritional assessment 29. A patient in the skilled care unit has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA). The treatment plan for this patient includes infection control because MRSA is a threat to which of the following groups?

A) The general population B) The skilled care staff C) Other debilitated patients D) Patient's family members 30. The nurse conducts a session entitled “Vaginitis in Older Women” at a women's health day. Which of the following should the nurse suggest limiting?

A) Sexual activity B) Use of condoms C) Yogurt consumption D) Intake of wine, cheese, and sugar

Page 7

Answer Key 1. B 2. B 3. C 4. C 5. A, B, C, E 6. C 7. D 8. B 9. D 10. C 11. D 12. C 13. B, C, E 14. B 15. B 16. A 17. C 18. B 19. D 20. D 21. B 22. C 23. D 24. B 25. C 26. D 27. B 28. A 29. C 30. D

Page 8

Name: __________________________ Date: _____________ 1. Which of the following statements most accurately captures an aspect of the relationship between cancer and aging?

A) The incidence and prevalence of cancer in older adults is approximately equal to that of younger adults.

B) Cancer is the leading cause of death among persons age 65 and older.

C) Age is the most significant risk factor for cancer.

D) The prevalence of cancer in older adults is expected to decrease in coming decades.

2. A nurse is conducting a workshop for a group at a senior center. Which member of the group has the highest statistical risk of developing cancer within the next year?

A) An obese 75-year-old woman B) An 85-year-old Swedish woman C) An 85-year-old Italian man D) A 75-year-old man with a poor diet 3. The diagnosis and treatment of cancer in older adults is accompanied by complexities that do not exist in younger populations. Which of the following phenomena contribute to the additional complexity of cancer diagnosis and treatment among the elderly? (Select all that apply.)

A) Detection often occurs at later stage in the course of the disease.

B) Older adults tend to have atypical presentations of many types of cancer.

C) The presence of other chronic health problems makes detection more difficult.

D) The potentially harmful effects of many treatment options make treatment more challenging.

E) Decreased survival rates in older adults mean that treatment is often not costeffective.

4. Mammograms (at various intervals) for detecting breast cancer are generally recommended for all women. Which group is least likely to take advantage of having them?

A) Elderly women of all ethnicities B) Middle-aged black women C) Middle-aged Latinas D) Young Latinas

Page 1

5. The family of a 78-year-old male patient is shocked by his recent diagnosis of pancreatic cancer, citing his lifelong commitment to a healthy diet, consistent exercise, and avoidance of environmental risk factors. Which of the following factors most likely contributed to the man's diagnosis?

A) Age-related changes to his immune system may have compromised his body's ability to recognize cancerous cells.

B) The interplay of existing chronic conditions may have contributed to the etiology of his cancer.

C) His cancer may have been a consequence of a bacterial or viral infection earlier in life.

D) Autoimmune processes associated with the aging process may have initiated abnormal cell division.

6. Recognizing the high incidence of breast cancer among older adult women, a public health nurse has included the topic in a health promotion teaching session at a senior's center. What should the nurse tell the assembled women about their risk of developing breast cancer?

A) “Stopping your hormone replacement therapy can greatly reduce your chance of developing breast cancer.”

B) “The substances that you were exposed to during your childbearing years will largely determine your future risks of breast cancer.”

C) “Breast cancer appears to be heavily influenced by heredity.”

D) “Women who had their children very early in life appear to have an increased risk of breast cancer.”

7. When counseling patients, which strategy should a nurse identify as most likely to help elderly men avoid prostate cancer?

A) Cooking meat at high temperatures B) Avoiding food additives C) Maintaining weight within an ideal range D) Avoiding tobacco smoke 8. Cancer is not a disease of only the elderly. Some cancers, however, are more prevalent in old age. What factor may explain one of the relationships between cancer and age?

A) Prolonged exposure to carcinogens B) Age-related weight differences C) Increased T-cell activity with age D) Alterations in BRCA1 and BRCA2 genes

Page 2

9. When the nursing student identifies which of the following as a risk factor for developing breast cancer does the nurse educator know that the student will need additional instruction?

A) Women who had their first menstrual period before age 12.

B) Women who experienced menopause after age 55.

C) Women who have a first-degree relative with breast cancer.

D) Women who do not use hormonal replacement therapy with menopause.

10. The incidence of cancer in a remote rural area was found to be higher than expected.

Of the following possible reasons for the finding, which is the most likely?

A) Fluoridated drinking water B) Industrial waste in the drinking water C) Nitrate-contaminated drinking water D) Nitrate-contaminated vegetables such as spinach and beets 11. A nurse is taking the medical history of an elderly patient who has thyroid cancer.

What is an especially important question the nurse should ask?

A) Have you ever smoked cigarettes?

B) Did you have acne as a teenager?

C) Have you ever experienced stress?

D) Have you ever used artificial sweeteners?

12. Which of the following are interventions that gerontological nurses can implement to prevent and diagnose cancer in older adults? (Select all that apply.)

A) Encouraging healthy lifestyles B) Educating patients about cancer screening C) Facilitating patient efforts to obtain appropriate screening tests D) Providing creative, holistic, and skillful nursing interventions to patients diagnosed with cancer E) Supporting the physical, emotional, and spiritual health of individuals 13. Which of the following would reduce the risk of lung cancer? (Select all that apply.)

A) Avoiding the use of and exposure to tobacco products B) Limiting exposure to the sun C) Eating a diet rich in fiber, fruits, and vegetables D) Ensuring that there is adequate ventilation in the home E) Maintaining weight within an ideal range 14. A 77-year-old male patient who has been diagnosed with lung cancer is discussing treatment options with his oncologist. Which of the following factors is most likely to make the patient's treatment more complicated than that of a younger patient?

A) Radiation treatment is not an option for most patients over age 70.

B) Age-related decline in kidney function can affect drug therapy.

C) The client is unlikely to be a candidate for surgery.

D) Fewer pharmacologic treatment options exist for older adult clients.

Page 3

15. Older adults undergoing radiation and chemotherapy require close monitoring for which of the following reasons?

A) They are more vulnerable than younger patients to dehydration and infections.

B) Older adults are more likely than younger patients to suffer pain.

C) They are more sensitive to radiation than are younger patients.

D) They are more likely to become suicidal than are younger patients.

16. An elderly patient scheduled for cancer treatments may require age-related adjustments in dosages for some procedures. Which kind of treatment can be administered without any age-related adjustment?

A) Surgery B) Radiation C) Chemotherapy D) Biologic therapy 17. Which one of the following statements about conventional treatment for cancer and the elderly is most accurate?

A) The risk of mortality and complications after surgery is no greater for older adults than it is for younger adults.

B) Advanced age can affect the pharmacokinetic process of excretion with cytotoxic drugs because of decreased glomerular filtration rate.

C) Older adults are usually not able to tolerate radiation therapy.

D) Older adults require more basic care when undergoing conventional treatment for cancer.

18. Which one of the following statements about the patients' choice to use complementary and alternative medicine (CAM) is most accurate?

A) CAM therapies are used by 80% of all Americans.

B) CAM therapies are not popular in the United States.

C) CAM practitioners tend to focus mostly on treating the disease.

D) CAM practitioners usually focus on the whole person.

19. A 72-year-old woman who has been diagnosed with breast cancer has declared her intention to seek an alternative treatment abroad that is claimed to eradicate cancer in nearly all cases. How can the nurse best respond to the woman's statement?

A) “Alternative and complementary therapies have been shown to have a valuable role in the holistic treatment of cancer.”

B) “It would be a good idea to investigate whether your American insurer will reimburse for treatment in another country.”

C) “It's likely in your best interests to limit your treatment to what your oncologist performs.”

D) “You might want to investigate why this treatment is not available in the United States.”

Page 4

20. A nurse who works in an oncologist's office is talking with a patient with cancer who has exhausted all conventional treatments. The patient says she has heard that she can be cured by a healer who uses massage therapy. What is the most helpful response the nurse can give?

A) “Let's consult the National Cancer Institute website to find out if there are any risks in this treatment and whether the benefits will outweigh them.”

B) “It won't work, and you will waste your money.”

C) “Massage isn't useful for cancer.”

D) “This will give you something else to think about other than your illness.”

21. Which of the following patient signs and symptoms should the nurse recognize as a warning sign of cancer?

A) Dyspnea on exertion B) Joint pain C) A sore that does not heal D) Increasing forgetfulness 22. A 71-year-old man has been diagnosed with colon cancer after a recent colonoscopy.

How can the nurse best address the man's anxiety surrounding his diagnosis?

A) “Try to remember that nearly everyone who is diagnosed with cancer these days survives.”

B) “I don't think you will have a great deal of trouble with pain.”

C) “This must be very stressful for you. Who are the people that you can rely on for support at this time?”

D) “I'd encourage you to explore alternative and complementary therapies.”

23. A nurse is conducting a class in recognizing the danger signals for cancer and lowering risks. Which of the following is a possible danger signal, as publicized by the American Cancer Society?

A) Abdominal or chest pain B) Indigestion or difficulty in swallowing C) Unusual vision problems D) Reddening or blanching of the skin 24. Elderly patients may need more support when facing a diagnosis of cancer than younger patients, because elders: A) Have a more pessimistic outlook on life.

B) Have less faith in medicine.

C) May only know about persons who were diagnosed with cancer years ago when treatment options were more limited.

D) May not realize that a cancer diagnosis is often mistaken.

Page 5

25. Which one of the following statements about providing support to patients and families is most accurate?

A) It is selfish of family members to have additional concerns of their own.

B) An example of a worry of a family member might be that the cost of treatment may impoverish them.

C) It is not useful for the patient to express his or her feelings.

D) It is best to keep the patient and family from knowing of the cancer diagnosis and prognosis.

Page 6

Answer Key 1. C 2. B 3. A, C, D 4. A 5. A 6. C 7. C 8. A 9. D 10. C 11. B 12. A, B, C 13. A, D 14. B 15. A 16. B 17. B 18. D 19. D 20. A 21. C 22. C 23. B 24. C 25. B

Page 7

Name: __________________________ Date: _____________ 1. Which of the following statements most accurately conveys an aspect of mental health among older adults?

A) As a result of their life experiences, older adults have a lower incidence of depression.

B) Older adults are less likely than younger people to use alcohol inappropriately as a coping tool.

C) The overall incidence of mental illness is higher in young people than in older adults.

D) The elderly are more likely than young adults to choose suicide.

2. Which of the following are strengths that older people have which are advantages that many younger adults do not? (Select all that apply.)

A) They probably have had more experience with coping, problem solving, and managing crises because they have lived longer.

B) Most older persons do not have concerns about what they are going to be when they “grow up” because they have already grown up.

C) Most elderly people have not learned who they really are.

D) They have faced and overcome numerous stresses.

3. What factors may be reasons that older people may have mental illness despite the advantages of experience? (Select all that apply.)

A) Mental illness is to be expected in older adults as they become demented.

B) More people survive to old age and may bring problems that they have had throughout their lifetime.

C) Mental health is generally increased as a person ages.

D) The many losses and challenges of late life may exceed the physical, emotional, and social resources of some persons and promote mental illness.

4. Which of the following are problems that older adults may confront that challenge their emotional homeostasis? (Select all that apply.)

A) Altered function or body image B) Increased vulnerability to crime and abuse C) Independence from others D) Sensory deficits E) Greater awareness of own mortality

Page 1

5. A nurse who works in a long-term care facility recognizes the challenge of fostering and maintaining the mental health of residents. Which of the following suggestions for new residents is most appropriate?

A) “It's helpful to maximize the amount of time that you spend with your family and peers.”

B) “Try to stay involved in activities that you find satisfying and interesting.”

C) “Don't hesitate to ask your physician about antidepressants whenever you feel your mood worsening.”

D) “To maintain health and balance it's best to avoid spending too much time alone.”

6. Mr. J, age 81, has been admitted to hospital for the treatment of diverticulitis. It is noted in his history that Mr. J has a history of depression. Which of the following nursing actions is most likely to foster his mental health?

A) Performing as many of Mr. J's ADLs as possible to minimize his perceived burden of responsibility.

B) Organizing a life review to remind Mr. J of the positives that exist in his life.

C) Encouraging Mr. J to make decisions regarding his routine and care.

D) Selecting a roommate for Mr. J who is social and optimistic.

7. Which one of the following is an appropriate principle that the nurse may use in guiding the care of mental health problems in elders?

A) Strengthening the individual's capacity to manage the condition by promoting health.

B) Eliminating the limitations imposed by the condition by doing everything possible for the individual.

C) Challenging elderly persons by immersing them in new and unfamiliar situations that will stimulate their mental functioning.

D) Insisting that elder persons do not spend time by themselves.

8. Which one of the following residents of a long-term care facility is most likely exhibiting signs and symptoms of depression?

A) Mrs. L, age 79, who has withdrawn from her regular bridge games and no longer returns calls to her friends.

B) Mr. U, age 76, whose neighbors have stated that he has become progressively more forgetful in the last several weeks.

C) Ms. K, age 73, who has visited her primary care physician with complaints of palpitations and labored breathing accompanied by feelings of doom.

D) Mrs. D, age 82, who is frequently tearful following the death of her husband 4 days prior.

Page 2

9. Which of the following would be symptoms of depression in an elderly person?

(Select all that apply.)

A) Inability to discriminate current reality from the past B) Inattention to hygiene C) Changes in sleep patterns D) Physical complaints such as anorexia, constipation, headache, and indigestion 10. Mrs. L has experienced a progressive loss of mobility over the last several years as a consequence of multiple sclerosis. Combined with a narrowing social circle, Mrs. L has characterized her life as “not worth living” and expressed to her nurse a desire to “end it all.” How should the nurse best respond to Mrs. L's statement?

A) Assure Mrs. L that such challenges are not uncommon in older adults.

B) Implement measures to ensure Mrs. L's safety.

C) Inform Mrs. L's family about her statements.

D) Add “risk for depression” to Mrs. L's nursing care plan.

11. Mr. O is a patient on an acute medical unit of a hospital who is receiving treatment for a chronic pressure ulcer on his coccyx that has necessitated a temporary colostomy. The accompanying disturbance in his body image and activities of daily living has caused Mr. O to become depressed. During a visit by his daughter and son-in-law, the nurse brings Mr. O his scheduled medications, to which Mr. O states, “why not bring them all at once so I can end this mess.” The daughter dismisses her father's statement as simply an expression of his pessimistic demeanor. Which of the following statements most accurately underlies the response that the nurse will choose?

A) Older people attempt suicide frequently but rarely succeed.

B) While older adults do sometimes commit suicide, the problem is mostly an issue of younger adults.

C) The patient's statement requires appropriate follow-up and should be taken seriously.

D) Suicidal ideation in older adults is often a consequence of polypharmacy.

12. Mr. G is called “Gloomy Gus” by his family, as he always sees the dark side of things. He has even threatened several times to kill himself, although he has not followed through on the threats. Lately, he seems preoccupied and has accidentally taken an overdose of a medication. He has just threatened suicide again. What should the nurse be sure that the family understand is important?

A) Encourage him to find a psychoanalyst.

B) Make sure he gets immediate attention by a psychiatrist.

C) Ignore his “crying wolf” again.

D) Remind him of his many blessings.

Page 3

13. An 80-year-old male patient who is receiving treatment for COPD in the geriatric medicine unit of a hospital has been displaying frequent signs of anxiety since admission. Which of the following nursing actions should the nurse prioritize?

A) Implementing a predictable routine and providing explanations prior to nursing interventions.

B) Ensuring that the patient has appropriate benzodiazepines prescribed.

C) Explaining to the patient that his prognosis is good and that discharge will take place shortly.

D) Working with the occupational therapist to provide the patient with meaningful activity.

14. Some elderly patients may exhibit a pattern of behaviors that include insomnia, chain smoking, increased blood pressure, and frequency of voiding. What is one way a nurse can help them?

A) Prepare them for all expected activities.

B) Encourage them to enroll in stimulating classes.

C) Have barriers installed to prevent their wandering.

D) Encourage them to drink wine with dinner.

15. Which of the following statements about the nursing care of older persons with anxiety is most accurate?

A) Older adults should be encouraged to have daily coffee chats with their peers.

B) The nurse should encourage the older persons to avoid thinking about or discussing the source of their anxiety.

C) Medication is the most appropriate treatment for anxiety in older adults.

D) Nurses should plan interventions specific to the underlying cause.

16. Which one of the following statements about alcohol abuse/dependency or addiction in older populations is most accurate?

A) It is easy to determine if an older adult suffers from alcohol abuse.

B) Older adults who abuse alcohol have always used it very heavily throughout their lives.

C) The incidence of alcohol and illegal drug abuse in elderly persons is declining.

D) Alcohol abuse can seriously threaten the physical, emotional, and social health of older persons.

17. Which of the following are possible indications of alcohol abuse? (Select all that apply.)

A) Drinking one alcoholic beverage daily over a prolonged period of time B) Frequent injuries or falls due to clumsiness C) Keeping to oneself and being irritable around others D) Experiencing blackouts E) Using alcohol to calm nerves or improve mood

Page 4

18. The children of a 78-year-old frail woman are exasperated at what they perceive to be her obsession with her ailing health. The children state that their mother rarely talks about anything other than her health problems and is constantly scheduling appointments with her physician that they believe are frivolous. How should the woman's nurse direct the family to deal with their mother's problem?

A) Focus on fostering their mother's health in the knowledge that the problem will diminish if her health improves.

B) Bar their mother from making appointments that they deem unnecessary and reassure her that her health is stable.

C) Resolve to accept their mother's priorities and engage with her prioritization of her health problems.

D) Focus on engaging their mother in conversations that include a discussion of topics other than her health.

19. Mr. Y visits his elderly mother weekly at an assisted living facility 70 miles from his home. Mr. Y has noted that in recent months his mother frequently fixates their conversations on the treatment and prognosis of her various health challenges. Mr. Y admits to his mother's nurse that as an only child he now feels an overwhelming guilt around the infrequency of his visits, a fact that his mother constantly emphasizes.

How can the nurse best respond to Mr. Y's concerns?

A) “It's not uncommon for some older people to emphasize their ailments in order to manipulate others' behavior in some way.”

B) “If your mother's health has become such a priority to her, it may be time to consider placing her in long-term care rather than assisted living.”

C) “Your best strategy is to ignore anything that your mother says about her failing health and her physical challenges.”

D) “This is often a sign of an underlying cognitive deficit that remains undiagnosed; I'll be sure to mention this to your mother's physician.”

20. A group of women at a senior center spend a great deal of time talking together about their physical problems, comparing symptoms and remedies. They seem to have no interests outside their own health. What might a counselor do for them?

A) Encourage them to join a book club or discussion group.

B) Sit down with them and listen to their complaints.

C) Tell them to talk about something else.

D) Break up the group to ensure they talk to new people.

21. Hypochondriasis may be commonly associated with which one of the following problems in older adults?

A) Anxiety B) Depression C) Paranoia D) Dementia

Page 5

22. Which of the following statements about hypochondriasis in older adults is most accurate?

A) Symptoms are never an indication of an underlying physical problem.

B) Symptoms are always an indication of an underlying physical problem.

C) Hypochondriasis may be a means of controlling a spouse or children.

D) Hypochondriasis is often caused by failure of health care providers to reinforce physical complaints.

23. A 76-year-old woman has been prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of her depression. What assessments should the nurse prioritize during the initial days of the patient's drug therapy?

A) Monitoring for changes in the patient's cognitive status and nutrition.

B) Regular assessment of the patient's vital signs.

C) Monitoring the patient's blood work for fluid and electrolyte imbalances.

D) Assessment of the patient's integument for signs of skin breakdown of inadequate circulation.

24. Which of the following statements about monitoring the use of psychotropic medications in older adults is most accurate?

A) Any side effects are likely to be mild.

B) Medications are the best method of dealing with psychiatric problems in older adults.

C) Side effects in older persons may be profound.

D) The highest dosage of medications should be used in older adults.

25. A recreational therapist has proposed an organized program to the nurse manager of a long-term care facility that the therapist claims can significantly improve the selfconcept of residents. Which of the following components of the therapist's program is most likely to achieve the stated goal?

A) Bringing in a staff member's dog to regularly interact with residents.

B) Organizing a series of health promotion classes for residents that will be conducted by staff nurses.

C) Holding reminiscence sessions where residents are encouraged to write autobiographical life reviews.

D) Beginning a chair aerobics class to increase physical activity by frail residents.

26. To the embarrassment of his family, an 81-year-old male patient on the subacute unit of a hospital has made repeated, sexually inappropriate statements to female staff members. The patient's family is adamant that such behavior is uncharacteristic.

What should be the nurse's initial action?

A) Attempt to identify the underlying cause of the patient's behavior.

B) Explore pharmacologic treatment options with the patient's physician.

C) Emphasize to the patient that such behavior is not permissible.

D) Liaise with the nurse manager to ensure the patient receives care from male staff whenever possible.

Page 6

27. Which of the following is the most effective nursing action for an elderly person who becomes violent/physically abusive?

A) Understanding that elderly persons have weakened physical conditions and are unlikely to cause harm to themselves or others.

B) Scheduling time for supervised walking.

C) Putting persons in situations that trigger the behavior to desensitize the person.

D) Getting help to protect self and others.

28. Which of the following would be appropriate nursing actions for an elderly person with night-wandering? (Select all that apply.)

A) Ensure that the client is engaged in daytime activities, particularly late day exercise.

B) Keep the light on at all times.

C) Lock the door so that the elderly person cannot leave their room.

D) Assist the elderly person to toilet before bedtime.

E) Encourage the elderly person to sleep in the daytime.

Page 7

Answer Key 1. D 2. A, B, D 3. B, D 4. A, B, D, E 5. B 6. C 7. A 8. A 9. B, C, D 10. B 11. C 12. B 13. A 14. A 15. D 16. D 17. B, C, D, E 18. D 19. A 20. A 21. B 22. C 23. A 24. C 25. C 26. A 27. D 28. A, D

Page 8

Name: __________________________ Date: _____________ 1. Which of the following older adults is most likely to have his or her health problem characterized as delirium rather than dementia?

A) Mr. L, whose wife has brought him to the emergency department because of the forgetfulness and confusion that he has exhibited over the last 48 hours.

B) Mrs. O, whose children state that her personality has changed markedly and who has difficulty finding words lately.

C) Mr. J, who has developed an unsteady and awkward gait coupled with uncoordinated motor skills in recent months.

D) Mrs. Y, who was diagnosed with a brain tumor and who has experienced consequent changes in behavior and cognition.

2. An elderly man is admitted to the hospital for surgery. A day later, he seems confused and disoriented. He imagines there is a trapdoor in the ceiling above his bed. His wife panics, telling a nurse that several of her husband's relatives have had Alzheimer's disease but that until now he has seemed “sharp as a tack.” What should the nurse do first?

A) Control environmental temperatures and noises.

B) Check the patient's chart for medications that can cause delirium.

C) Have the patient evaluated for Alzheimer's disease.

D) Tell the wife there is nothing to worry about.

3. As per her routine, the daughter of an 82-year-old patient recovering from a prostate resection has come to the hospital in the morning to be with her father at the bedside.

The daughter has approached her father's nurse and stated that he is uncharacteristically difficult to rouse this morning, with his only verbal response being occasional nonsensical muttering. What is the care team's most appropriate response?

A) Diagnostic imaging to determine the location of any organic brain changes.

B) Assessment of the patient's mood and current stressors.

C) Assessment to determine the cause of his delirium.

D) Screening for risk factors that would suggest Alzheimer's disease.

Page 1

4. A 79-year-old female patient, admitted for hip replacement surgery, complained of insomnia the night before and was administered lorazepam, a benzodiazepine. She began displaying signs of delirium shortly thereafter, a situation that has persisted until the morning change of shift. Which of the following guidelines should the night nurse provide to the nurse coming on shift to care for the patient?

A) “Make sure you get a sedative order from her doctor this morning.”

B) “Try to keep her level of stimulation as low as you can when you are working with her.”

C) “Make sure you let the family know that there are effective drug treatments that will resolve her delirium.”

D) “Work with the discharge-planning nurse to help the family reassess her living arrangement after discharge.”

5. Which one of the following statements about delirium and dementia is most accurate?

A) A person who has dementia can suffer from delirium.

B) Dementia and delirium are the same.

C) Delirium causes a progressive, irreversible decline in cognition.

D) Dementia occurs in all elderly persons.

6. Which of the following would most likely be associated with delirium in older adults? (Select all that apply.)

A) Urinary tract infection B) Dehydration secondary to gastroenteritis C) Low zinc levels D) A new medication that causes confusion E) Neurofibrillary tangles 7. Which of the following is most likely to be a cause of dementia in an older adult rather than a cause of delirium in an older adult?

A) Genetic predisposition B) Hyperlipidemia C) Creutzfeldt-Jakob disease D) Hypertension 8. A 78-year-old man has been diagnosed by his geriatrician as being in the third stage of Alzheimer's disease. Which of the following manifestations would be most congruent with the staging of the man's disease?

A) The man displays an uncharacteristically flat affect and denies that he is experiencing any cognitive deficits.

B) The man's wife and children have recently noticed a change in his memory and judgment and he gets easily flustered in social situations.

C) The man is commonly oriented to person but disoriented to time and place.

D) The man no longer remembers his wife's name and requires assistance with most of his activities of daily living.

Page 2

9. The husband of a 74-year-old female patient is distraught at her recent diagnosis of Alzheimer's disease. In an effort to identify a cure, the husband is conducting extensive online research as well as speaking with each member of the care team about possible treatments. How can the nurse best respond to the husband's inquiry?

A) “There is presently no cure for Alzheimer's disease but highly promising treatments are expected.”

B) “Eliminating any exposure to aluminum or mercury has been shown to have a positive impact on people in the early stages of Alzheimer's.”

C) “There isn't any cure currently available for Alzheimer's but some drugs have been shown to slow the progression of the disease.”

D) “Drugs that affect the neurotransmitters in the brain are now available that can cure many early cases of Alzheimer's.”

10. An autopsy is performed to determine the cause of death in an elderly man who may have been poisoned. His brain tissue shows neuritic plaques and neurofibrillary tangles in the cortex, but no other abnormalities. What would the future have held for him if he had lived?

A) Neuronal degeneration in the neocortex and hippocampus B) Dementia associated with smoking and hypertension C) Neuronal atrophy in the frontal lobes D) Lewy body dementia 11. The husband of an elderly woman notices that she is posting reminder notes to herself throughout the house and making many lists. He thinks these behaviors might be early signs of Alzheimer's disease. What should he do?

A) Be alert for signs of depression.

B) Ignore the signs he has noticed.

C) Provide his wife with zinc and antioxidant supplements.

D) Ask his wife's physician to order blood work.

12. Which of the following therapies may be most helpful in slowing the progression of symptoms in Alzheimer's disease?

A) Medications that stop or slow the enzyme that breaks down acetylcholine B) Avoiding exposure to aluminum C) Prophylactic use of antibiotics D) Avoiding exposure to zinc

Page 3

13. A nurse is facilitating a group for family members of recently diagnosed Alzheimer's patients. Which of the nurse's following teaching points about the etiology of Alzheimer's disease is most accurate?

A) “There are a number of factors that cause Alzheimer's disease, and modification or removal of many of these can cause a significant improvement in your loved one's condition.”

B) “Unfortunately we still do not really know anything about what exactly causes Alzheimer's.”

C) “Science has recently discovered the direct link between diet and the development of Alzheimer's disease.”

D) “Alzheimer's appears to result from a combination of genetic and environmental factors and no one theory can explain it.”

14. Which of the following individuals is most likely to possess an increased risk of developing Alzheimer's disease in the future?

A) A man with a family history of Down syndrome B) A woman with a diagnosis of autism C) A man whose admission assessment reveals polypharmacy D) A woman with poorly controlled type 1 diabetes` 15. A 71-year-old man is obese and has poorly controlled hypertension. The man states that while he has been a smoker since his teens, many of his peers have done likewise and still enjoy good health. Over the last 2 to 3 days, his wife has noted that he has become uncharacteristically forgetful and suspicious and he was found wandering outside his house last night. Which of the following health problems is his care team most likely to suspect?

A) Creutzfeldt-Jakob disease B) Alzheimer's disease C) Wernicke encephalopathy D) Vascular dementia 16. The family of a patient with Alzheimer's disease wants to know more about the implications of the disease for the entire family. What might a nurse tell the patient's childless 35-year-old daughter?

A) “Have a brain scan and other testing for Alzheimer's disease.”

B) “If you become pregnant, undergo fetal testing for Down syndrome.”

C) “Avoid having any children.”

D) “Alzheimer's disease is not hereditary, and you do not need to worry.”

Page 4

17. Which of the following are common causes of dementia in older adults other than Alzheimer's disease? (Select all that apply.)

A) It is a normal consequence of aging.

B) Trauma.

C) Creutzfeldt-Jakob disease.

D) Parkinson's disease.

E) Vascular dementia.

18. A 70-year-old male resident of a long-term care facility is in the advanced stages of Alzheimer's disease. Consequently, the resident frequently wanders throughout and, on more than one occasion, outside the facility. Due to his cognitive deficits, he is not responsive to patient teaching and redirection. What is the nurse manager's best response to the resident's behavior?

A) Provide a controlled and safe place for the patient to wander.

B) Work with the resident's family to establish a supervision schedule.

C) Administer the minimum effective dose of a sedative when the resident is most restless.

D) Begin placing the resident in a wheelchair with a tray when he shows signs of restlessness.

19. The nursing staff on a subacute, geriatric medicine unit of a hospital have noted that Mr. R, an 80-year-old patient with a diagnosis of Alzheimer's disease, tends to become agitated in the evening and early in the night. Which of the following nursing actions is most likely to effectively address Mr. R's sundowner syndrome?

A) Ensure that Mr. R's room is kept as dark as possible during the times in question.

B) Limit Mr. R's fluid intake after 17:00 to prevent nocturia.

C) Minimize the amount of touch used in nursing care to avoid stimulating Mr. R. D) Schedule physical therapy and exercise in the afternoon hours to help Mr. R expend energy.

20. Nurse Y is providing care for a male patient who is in the late stages of vascular dementia. The nurse is in the habit of reminding the patient who he is, where he is, and what month and year it is when interacting with him. How is nurse Y's action best understood?

A) Reorientation is ineffective with patients diagnosed with dementias.

B) Reorientation serves only to remind patients with dementia of their cognitive losses, so it is best avoided.

C) Reorientation can be a useful intervention when used appropriately.

D) Reorientation does not slow the progression of cognitive losses and is thus unwarranted.

Page 5

21. The nursing staff at a long-term care facility are providing care for a male resident who requires total assistance owing to his severe Alzheimer's disease. Which of the following nursing actions are likely to foster the resident's dignity, personal worth, and individuality? (Select all that apply.)

A) Ensuring that nursing actions are performed in privacy as much as possible.

B) Using the resident's name when interacting with him, despite the fact that he is disoriented to person.

C) Giving the resident choices and options even though he has difficulty making decisions.

D) Attempting to engage the resident in conversation despite his cognitive losses.

E) Minimizing stressors by performing as many of his ADLs as possible.

22. The husband of a 77-year-old woman is her sole care provider, a responsibility that has become onerous since she was diagnosed with Alzheimer's disease 3 months prior. When working with the husband, which of the following actions is most appropriate?

A) Encouraging the husband to independently develop techniques for basic care that he feels work best for him and his wife.

B) Emphasizing to the husband the importance of remaining optimistic and enthusiastic when interacting with his wife.

C) Encouraging the husband not to feel guilty for needing respite on occasion.

D) Organizing outside help to minimize the amount of direct care that the husband provides.

23. Mrs. V is an elderly woman in the final stages of Alzheimer's disease; she is unlikely to live more than a year longer. Breast cancer has been diagnosed, and her surgeon wants to operate. Mrs. V cannot grasp the situation, however, and is becoming agitated about it. Her children think surgery would be painful and not worth the potential benefit. What might a nurse advise Mrs. V's family?

A) The patient herself should make the decision.

B) The need for surgery is of secondary importance.

C) Surgery is definitely indicated.

D) The insurer should be involved in the decision.

24. The environment of a patient with dementia includes photographs of her family, soft music, and low lighting. She wears her own jewelry—necklaces and rings she had received as gifts. Unused electrical outlets are covered. Once a day, she exercises with a group. What might a nurse suggest is missing from this picture?

A) Nutritional supplements B) A walker C) An ID bracelet D) A commode chair

Page 6

25. A daughter complains that her mother, who has Alzheimer's disease, thinks and acts so slowly that everything must be done for her. What can a nurse advise the daughter that might be helpful for both the patient and herself?

A) “Encourage your mother's self-care, but under supervision.”

B) “Continue doing things for your mother to save time.”

C) “Investigate respite care for yourself.”

D) “Allow your mother to self-care, and let her do it independently.”

26. Determine which of the following nursing considerations has the highest priority for an elderly adult with dementia.

A) Promoting therapy and activity B) Ensuring patient safety C) Providing physical care D) Respecting the individual

Page 7

Answer Key 1. A 2. B 3. C 4. B 5. A 6. A 7. A 8. B 9. C 10. A 11. A 12. A 13. D 14. A 15. D 16. B 17. B, E 18. A 19. D 20. C 21. A, B, C, D 22. C 23. B 24. C 25. A 26. B

Page 8

Name: __________________________ Date: _____________ 1. A nurse is well aware of the high incidence and prevalence of chronic conditions among older adults. The nurse would recognize which of the following phenomena as currently contributing to this high rate of incidence? (Select all that apply.)

A) Longevity is increasing.

B) Many previously fatal diseases are now treatable.

C) Increasing numbers of older adults can afford medical care.

D) Older adults have increased expectations for treatment.

E) New chronic conditions are being identified by medical researchers.

2. A nurse planning a health workshop for senior citizens wants to provide discussion topics that will interest everyone. In a typical group of seniors, which disorder will afflict the greatest number?

A) Hypertension B) Hearing impairment C) Heart condition D) Arthritis 3. Mr. W has recently been diagnosed with rheumatoid arthritis, a chronic condition that is having a significant impact on his daily routines and his quality of life. Which one of the nurse's following statements best reflects recognition of the importance of healing rather than curing Mr. W's condition?

A) “A combination of physical therapy and corticosteroid treatment holds a strong chance of mitigating the effects of your arthritis.”

B) “The best way for us to foster your overall well-being is to eliminate the symptoms that are most affecting your daily routines.”

C) “There are changes that I can help you make that can help you live a full life in spite of this health problem.”

D) “There are lifestyle changes, coupled with promising new therapies, that hold out hope for being free from this problem.”

4. Which of the following statements about the goals for persons with chronic illnesses are appropriate? (Select all that apply.)

A) Chronic illnesses can be cured with proper and persistent treatment.

B) Healing requires the mobilization of the body, mind, and spirit.

C) Appropriate care measures focus on helping patients live in harmony with chronic disease.

D) Controlling symptoms, promoting a sense of well-being, and enhancing the quality of life are appropriate goals for persons with chronic illnesses.

Page 1

5. A homecare nurse has begun providing care for an older adult male in the community who has recently been diagnosed with type 2 diabetes. The nurse is responsible for creating a care plan for the client and has consequently identified a number of goals for his care. Which of the following goals of care is most in need of reexamination or modification?

A) “The client will gain the knowledge and skills necessary to manage his diabetes independently and effectively within 3 months.”

B) “The client will remain free of common complications of diabetes.”

C) “The client will maintain a high quality of life despite his diabetes.”

D) “The client will no longer require blood sugar monitoring or oral antihyperglycemic medications within 12 months.”

6. Despite the fact that the patient is now receiving palliative care because of the progression of her congestive heart failure (CHF), a nurse views the care that was provided for the patient as a success. Which of the following aspects of the patient's situation would most likely lead the nurse to this conclusion?

A) The client was able to live independently and care for herself until very late in the progression of her disease.

B) The client maintained an acceptable cardiac output for the majority of the time that she lived with CHF. C) The client was able to teach other older adults about the experience of living with CHF and the way it affected her life.

D) The client remained largely pain-free from the time of diagnosis until the present.

7. A nurse is providing care for an 82-year-old woman on the palliative care unit of a hospital. The woman has a long-standing diagnosis of diabetes that has manifested in serious cardiac problems and she is not expected to survive the weekend. How can the nurse best understand this course of events in light of the chronic care that the patient has long received?

A) Death represents the ultimate failure of the provision of care.

B) Dying in comfort and dignity is the final component of high-quality chronic care.

C) The period of death represents the transition from chronic care to acute care.

D) Holistic, chronic care requires that the nurse limit care to psychosocial interventions.

Page 2

8. Mr. E, an elderly man who lives alone, has hypertension and diabetes but seems to manage both conditions quite well. Three times a week he drives to a dialysis center for dialysis. He injects himself with insulin and is in charge of his medications and meals. Because Mr. E is lonely, he often has lunch or dinner in restaurants where he may eat and drink unwisely, but he takes his medicines with him. What could a nurse at the dialysis center suggest that would most help Mr. E in managing his conditions?

A) Eat at home most of the time B) Take a list of approved foods to the restaurants C) Find some social activities that do not involve eating D) Test your blood pressure and blood sugar after returning home 9. An elderly woman had a series of lab tests that indicate she is healthy, but she has had several colds lately and often feels fatigued (although she is not depressed). She eats lightly but has a healthful diet. Which is the best advice a nurse could give her for improving her health?

A) Increase total food intake.

B) Take mega-doses of vitamins.

C) Exercise more.

D) Have psychotherapy.

10. Mr. P, a 70-year-old retired engineer, has diabetes and is on dialysis. He is a gourmet who takes pride in cooking delicious meals. His physical condition is quite good, but he is unhappy and bored with the restricted life he must lead. An old friend has invited him to travel across the country to San Francisco and spend a week there.

Dialysis treatments can be arranged through a network of dialysis providers. How should Mr. P's charge nurse respond to this situation?

A) Discourage the idea, as he is likely to eat and drink too much on vacation B) Discourage the idea, but provide as much helpful information as possible C) Encourage him to go, and provide as much helpful information as possible D) Encourage him to go, and advise him to relax regarding his condition for a week 11. A nurse in a cardiac fitness unit is helping an elderly man set health goals for the coming year. The patient has had one heart attack and two coronary artery bypass operations, and can now walk only one city block (1/8 mile) before tiring. Which goal seems most reasonable for him?

A) Walk 10 blocks every day B) Jog 4 blocks every day C) Walk 24 blocks every day D) Continue to walk 1 block every day

Page 3

12. Which of the following older adults with chronic conditions is most likely to have the greatest care needs?

A) An 80-year-old woman with varicose veins who has just been diagnosed with osteoarthritis.

B) A 74-year-old man with macular degeneration and type 1 diabetes.

C) A 77-year-old man who has long-standing hypertension and is displaying early signs of chronic renal failure.

D) An 84-year-old woman who lives with severe hearing loss and recurrent hemorrhoids.

13. How can a visiting nurse best ensure proper care for a patient when she is not present but can be reached by a telephone or pager?

A) Instruct that all the family's questions should be filtered through the primary caregiver.

B) Provide detailed written instructions for all procedures.

C) Train the patient carefully in all procedures.

D) Train all caregivers carefully in all procedures.

14. Mr. Q has heart disease, and his wife needs to learn about the cooking methods and recipes she can use to help his condition. Which of the following sources is probably her best source of information?

A) Cardiologist B) General practitioner C) Nurse D) Support group 15. A 77-year-old woman has recently been diagnosed with type 2 diabetes. The gerontological nurse who is working with the woman has emphasized the need for the woman to make smart lifestyle choices in the management of her chronic condition. The woman has retorted, “Choices! I didn't choose to get diabetes and there's not much that I can do about it!” Which of the following statements best underlies the response that the nurse will provide?

A) Many of the factors that contribute to increased quality of life are within the woman's direct control.

B) The woman has the ability to adopt or reject behaviors that have the potential to cure her disease.

C) The woman can identify treatment options in consultation with the physician who is providing her care.

D) Lifestyle choices exist only in older adults with strong support networks and sufficient resources.

Page 4

16. Mrs. S has a serious chronic condition that requires her seeing a physician several times a year (or more, if she is hospitalized). She is considering four physicians, all of whom are well qualified. Which physician is likely to be her best choice?

A) Dr. A is the top expert in his field and is highly respected at the local hospital.

B) Dr. B is a woman with an office in Mrs. S's neighborhood.

C) Dr. C is a woman who makes Mrs. S feel comfortable and allows plenty of time for talking.

D) Dr. D communicates well with her and is in high demand.

17. A 76-year-old man has had his quality of life significantly affected by chronic obstructive pulmonary disease (COPD), a condition that has brought a steady decline in his activity tolerance, his mobility, and ultimately his independence. In light of the apparent ineffectiveness of conventional treatment, the man is eager to forego conventional treatments and explore alternative and complementary treatment options. How can the man's nurse best direct him?

A) “This is a wise decision, since conventional treatments are motivated by profit and the interests of pharmaceutical companies, not patients.”

B) “These are good options to explore, but you will need to set aside your physician's advice in the short term in order to get accurate information.”

C) “Try not to think of your options as choosing either conventional treatment or alternative therapies, but rather choosing the best of both.”

D) “Your care team is probably ignorant of alternative therapies, so you'll have to go elsewhere for any information you need.”

18. Mr. Y, who lives with his wife in their home of 50 years, has a diagnosis of osteoarthritis. Which of the following factors is most likely to have the largest impact on Mr. Y's ability to manage his illness?

A) The availability of new treatment options for his condition B) The financial resources available to Mr. Y and his wife C) The course and progression of his condition D) The openness of Mr Y to complementary and alternative medicine (CAM) 19. The daughter of an 80-year-old female patient with a diagnosis of severe ischemic heart disease has been her mother's sole care provider for over a year. The daughter is tearfully telling the homecare nurse about the onerous burden that she bears by struggling to meet her mother's ever-increasing needs. How can the nurse best respond to the daughter?

A) “There are promising new treatments for heart disease that hold a great potential for your mother.”

B) “It's very normal for you to feel this way, given how much you do for your mother; perhaps we can explore other living options together.”

C) “It sound like it is probably time to place your mother into long term care.”

D) “This must be difficult for you; many others in a circumstance similar to yours find it useful to remind themselves of how much their parents did for them when they were young.”

Page 5

20. Mrs. D, a resident in a nursing home, is considered noncompliant by many of the staff because she refuses to eat some of the food, which is nourishing and has been carefully planned by a dietitian. Most other residents have no objection to the meals.

In addition, Mrs. D sometimes skips exercise classes. On the other hand, she takes all her medicines, and she gets along well with the other residents, to whom she tells risqué jokes. In what area is Mrs. D coping successfully?

A) Diet B) Assertiveness C) Exercise D) Compliance 21. Mr. A says that he does not need his medicine for hypertension. He also claims that it makes him feel weak and he suspects that it sometimes makes him impotent.

When his wife tries to remind him to take the drug, he becomes enraged. How can a nurse best help in this situation?

A) Suggest that Mr. A vent his frustrations B) Insist that Mr. A force himself to take the medicine C) Advise Mr. A's wife to supervise him D) Exhort Mr. A repeatedly that a chronic condition like hypertension requires selfcare 22. An elderly woman has lived with her son and his family for about 10 years. When she came to live with them, she was independent and healthy, but now she has rheumatoid arthritis and is nearly blind. To take care of her, her daughter-in-law took early retirement from a job she enjoyed. Although the daughter-in-law did so voluntarily, she now feels resentful about staying home, and the family's income has lessened. Recently, the family hired a part-time home care worker to help out. This gives the daughter-in-law more freedom but adds to the financial burden. The marriage is beginning to suffer. What might a marriage counselor tell the couple?

A) Set firmer boundaries with the mother B) Arrange for additional in-home care C) Consider finding an assisted-living facility for the mother D) Make their own decisions without outside input 23. What is one of the steps in the COACHING acronym?

A) Assist B) Help C) Caution D) Instill

Page 6

24. An elderly man is dying of cancer, and a hospice nurse comes to his home every day to oversee his care and comfort. What is the most important thing the nurse can provide?

A) Stress management B) Help with tasks that may sap the patient's energy C) Assurance of support D) Help with basic needs such as eating and bathing

Page 7

Answer Key 1. A, B 2. D 3. C 4. B, C, D 5. D 6. A 7. B 8. C 9. C 10. C 11. A 12. B 13. B 14. D 15. A 16. C 17. C 18. C 19. B 20. B 21. A 22. C 23. B 24. C

Page 8

Name: __________________________ Date: _____________ 1. A nurse is well aware of the high incidence and prevalence of chronic conditions among older adults. The nurse would recognize which of the following phenomena as currently contributing to this high rate of incidence? (Select all that apply.)

A) Longevity is increasing.

B) Many previously fatal diseases are now treatable.

C) Increasing numbers of older adults can afford medical care.

D) Older adults have increased expectations for treatment.

E) New chronic conditions are being identified by medical researchers.

2. A nurse planning a health workshop for senior citizens wants to provide discussion topics that will interest everyone. In a typical group of seniors, which disorder will afflict the greatest number?

A) Hypertension B) Hearing impairment C) Heart condition D) Arthritis 3. Mr. W has recently been diagnosed with rheumatoid arthritis, a chronic condition that is having a significant impact on his daily routines and his quality of life. Which one of the nurse's following statements best reflects recognition of the importance of healing rather than curing Mr. W's condition?

A) “A combination of physical therapy and corticosteroid treatment holds a strong chance of mitigating the effects of your arthritis.”

B) “The best way for us to foster your overall well-being is to eliminate the symptoms that are most affecting your daily routines.”

C) “There are changes that I can help you make that can help you live a full life in spite of this health problem.”

D) “There are lifestyle changes, coupled with promising new therapies, that hold out hope for being free from this problem.”

4. Which of the following statements about the goals for persons with chronic illnesses are appropriate? (Select all that apply.)

A) Chronic illnesses can be cured with proper and persistent treatment.

B) Healing requires the mobilization of the body, mind, and spirit.

C) Appropriate care measures focus on helping patients live in harmony with chronic disease.

D) Controlling symptoms, promoting a sense of well-being, and enhancing the quality of life are appropriate goals for persons with chronic illnesses.

Page 1

5. A homecare nurse has begun providing care for an older adult male in the community who has recently been diagnosed with type 2 diabetes. The nurse is responsible for creating a care plan for the client and has consequently identified a number of goals for his care. Which of the following goals of care is most in need of reexamination or modification?

A) “The client will gain the knowledge and skills necessary to manage his diabetes independently and effectively within 3 months.”

B) “The client will remain free of common complications of diabetes.”

C) “The client will maintain a high quality of life despite his diabetes.”

D) “The client will no longer require blood sugar monitoring or oral antihyperglycemic medications within 12 months.”

6. Despite the fact that the patient is now receiving palliative care because of the progression of her congestive heart failure (CHF), a nurse views the care that was provided for the patient as a success. Which of the following aspects of the patient's situation would most likely lead the nurse to this conclusion?

A) The client was able to live independently and care for herself until very late in the progression of her disease.

B) The client maintained an acceptable cardiac output for the majority of the time that she lived with CHF. C) The client was able to teach other older adults about the experience of living with CHF and the way it affected her life.

D) The client remained largely pain-free from the time of diagnosis until the present.

7. A nurse is providing care for an 82-year-old woman on the palliative care unit of a hospital. The woman has a long-standing diagnosis of diabetes that has manifested in serious cardiac problems and she is not expected to survive the weekend. How can the nurse best understand this course of events in light of the chronic care that the patient has long received?

A) Death represents the ultimate failure of the provision of care.

B) Dying in comfort and dignity is the final component of high-quality chronic care.

C) The period of death represents the transition from chronic care to acute care.

D) Holistic, chronic care requires that the nurse limit care to psychosocial interventions.

Page 2

8. Mr. E, an elderly man who lives alone, has hypertension and diabetes but seems to manage both conditions quite well. Three times a week he drives to a dialysis center for dialysis. He injects himself with insulin and is in charge of his medications and meals. Because Mr. E is lonely, he often has lunch or dinner in restaurants where he may eat and drink unwisely, but he takes his medicines with him. What could a nurse at the dialysis center suggest that would most help Mr. E in managing his conditions?

A) Eat at home most of the time B) Take a list of approved foods to the restaurants C) Find some social activities that do not involve eating D) Test your blood pressure and blood sugar after returning home 9. An elderly woman had a series of lab tests that indicate she is healthy, but she has had several colds lately and often feels fatigued (although she is not depressed). She eats lightly but has a healthful diet. Which is the best advice a nurse could give her for improving her health?

A) Increase total food intake.

B) Take mega-doses of vitamins.

C) Exercise more.

D) Have psychotherapy.

10. Mr. P, a 70-year-old retired engineer, has diabetes and is on dialysis. He is a gourmet who takes pride in cooking delicious meals. His physical condition is quite good, but he is unhappy and bored with the restricted life he must lead. An old friend has invited him to travel across the country to San Francisco and spend a week there.

Dialysis treatments can be arranged through a network of dialysis providers. How should Mr. P's charge nurse respond to this situation?

A) Discourage the idea, as he is likely to eat and drink too much on vacation B) Discourage the idea, but provide as much helpful information as possible C) Encourage him to go, and provide as much helpful information as possible D) Encourage him to go, and advise him to relax regarding his condition for a week 11. A nurse in a cardiac fitness unit is helping an elderly man set health goals for the coming year. The patient has had one heart attack and two coronary artery bypass operations, and can now walk only one city block (1/8 mile) before tiring. Which goal seems most reasonable for him?

A) Walk 10 blocks every day B) Jog 4 blocks every day C) Walk 24 blocks every day D) Continue to walk 1 block every day

Page 3

12. Which of the following older adults with chronic conditions is most likely to have the greatest care needs?

A) An 80-year-old woman with varicose veins who has just been diagnosed with osteoarthritis.

B) A 74-year-old man with macular degeneration and type 1 diabetes.

C) A 77-year-old man who has long-standing hypertension and is displaying early signs of chronic renal failure.

D) An 84-year-old woman who lives with severe hearing loss and recurrent hemorrhoids.

13. How can a visiting nurse best ensure proper care for a patient when she is not present but can be reached by a telephone or pager?

A) Instruct that all the family's questions should be filtered through the primary caregiver.

B) Provide detailed written instructions for all procedures.

C) Train the patient carefully in all procedures.

D) Train all caregivers carefully in all procedures.

14. Mr. Q has heart disease, and his wife needs to learn about the cooking methods and recipes she can use to help his condition. Which of the following sources is probably her best source of information?

A) Cardiologist B) General practitioner C) Nurse D) Support group 15. A 77-year-old woman has recently been diagnosed with type 2 diabetes. The gerontological nurse who is working with the woman has emphasized the need for the woman to make smart lifestyle choices in the management of her chronic condition. The woman has retorted, “Choices! I didn't choose to get diabetes and there's not much that I can do about it!” Which of the following statements best underlies the response that the nurse will provide?

A) Many of the factors that contribute to increased quality of life are within the woman's direct control.

B) The woman has the ability to adopt or reject behaviors that have the potential to cure her disease.

C) The woman can identify treatment options in consultation with the physician who is providing her care.

D) Lifestyle choices exist only in older adults with strong support networks and sufficient resources.

Page 4

16. Mrs. S has a serious chronic condition that requires her seeing a physician several times a year (or more, if she is hospitalized). She is considering four physicians, all of whom are well qualified. Which physician is likely to be her best choice?

A) Dr. A is the top expert in his field and is highly respected at the local hospital.

B) Dr. B is a woman with an office in Mrs. S's neighborhood.

C) Dr. C is a woman who makes Mrs. S feel comfortable and allows plenty of time for talking.

D) Dr. D communicates well with her and is in high demand.

17. A 76-year-old man has had his quality of life significantly affected by chronic obstructive pulmonary disease (COPD), a condition that has brought a steady decline in his activity tolerance, his mobility, and ultimately his independence. In light of the apparent ineffectiveness of conventional treatment, the man is eager to forego conventional treatments and explore alternative and complementary treatment options. How can the man's nurse best direct him?

A) “This is a wise decision, since conventional treatments are motivated by profit and the interests of pharmaceutical companies, not patients.”

B) “These are good options to explore, but you will need to set aside your physician's advice in the short term in order to get accurate information.”

C) “Try not to think of your options as choosing either conventional treatment or alternative therapies, but rather choosing the best of both.”

D) “Your care team is probably ignorant of alternative therapies, so you'll have to go elsewhere for any information you need.”

18. Mr. Y, who lives with his wife in their home of 50 years, has a diagnosis of osteoarthritis. Which of the following factors is most likely to have the largest impact on Mr. Y's ability to manage his illness?

A) The availability of new treatment options for his condition B) The financial resources available to Mr. Y and his wife C) The course and progression of his condition D) The openness of Mr Y to complementary and alternative medicine (CAM) 19. The daughter of an 80-year-old female patient with a diagnosis of severe ischemic heart disease has been her mother's sole care provider for over a year. The daughter is tearfully telling the homecare nurse about the onerous burden that she bears by struggling to meet her mother's ever-increasing needs. How can the nurse best respond to the daughter?

A) “There are promising new treatments for heart disease that hold a great potential for your mother.”

B) “It's very normal for you to feel this way, given how much you do for your mother; perhaps we can explore other living options together.”

C) “It sound like it is probably time to place your mother into long term care.”

D) “This must be difficult for you; many others in a circumstance similar to yours find it useful to remind themselves of how much their parents did for them when they were young.”

Page 5

20. Mrs. D, a resident in a nursing home, is considered noncompliant by many of the staff because she refuses to eat some of the food, which is nourishing and has been carefully planned by a dietitian. Most other residents have no objection to the meals.

In addition, Mrs. D sometimes skips exercise classes. On the other hand, she takes all her medicines, and she gets along well with the other residents, to whom she tells risqué jokes. In what area is Mrs. D coping successfully?

A) Diet B) Assertiveness C) Exercise D) Compliance 21. Mr. A says that he does not need his medicine for hypertension. He also claims that it makes him feel weak and he suspects that it sometimes makes him impotent.

When his wife tries to remind him to take the drug, he becomes enraged. How can a nurse best help in this situation?

A) Suggest that Mr. A vent his frustrations B) Insist that Mr. A force himself to take the medicine C) Advise Mr. A's wife to supervise him D) Exhort Mr. A repeatedly that a chronic condition like hypertension requires selfcare 22. An elderly woman has lived with her son and his family for about 10 years. When she came to live with them, she was independent and healthy, but now she has rheumatoid arthritis and is nearly blind. To take care of her, her daughter-in-law took early retirement from a job she enjoyed. Although the daughter-in-law did so voluntarily, she now feels resentful about staying home, and the family's income has lessened. Recently, the family hired a part-time home care worker to help out. This gives the daughter-in-law more freedom but adds to the financial burden. The marriage is beginning to suffer. What might a marriage counselor tell the couple?

A) Set firmer boundaries with the mother B) Arrange for additional in-home care C) Consider finding an assisted-living facility for the mother D) Make their own decisions without outside input 23. What is one of the steps in the COACHING acronym?

A) Assist B) Help C) Caution D) Instill

Page 6

24. An elderly man is dying of cancer, and a hospice nurse comes to his home every day to oversee his care and comfort. What is the most important thing the nurse can provide?

A) Stress management B) Help with tasks that may sap the patient's energy C) Assurance of support D) Help with basic needs such as eating and bathing 25. The mobility, activity tolerance, and overall quality of life of a 79-year-old woman are severely diminished by her angina. The woman now lives with her daughter and son-in-law, both of whom are unsure how best to foster her well-being. Which of the following teaching points of the nurse is most appropriate?

A) “Doing as much as you and your husband can for your mother will allow her to dedicate her energies to recovery.”

B) “The most beneficial approach for your mother is to treat her exactly as you did before she developed this disability.”

C) “It will be helpful for you both to occasionally remind your mother about the areas of her health and abilities that remain intact.”

D) “Try to maximize the amount of self-care that your mother performs and still treat her like a responsible person.”

26. Part of the job responsibility of a nurse who works for a team of physicians is to provide documentation about elderly patients who may need nursing home care.

Which of the following patients meets the criteria for being classified as frail?

A) Mrs. A is inactive, walks slowly, and has many colds.

B) Mrs. B has many colds, tires easily, and has lost 15 pounds in the past year.

C) Mr. C has lost 20 pounds in the past year, cannot grip utensils, and is inactive.

D) Mr. D has lost 20 pounds in the past year, is inactive, and has many colds.

27. Elderly people are at risk for becoming frail, which can lead to serious disabilities.

Which of the following is the most likely to prevent or postpone frailty?

A) Exercises for strengthening muscles B) Reminiscing activities C) A weight-loss diet D) Puzzles and board games

Page 7

28. Albert, Bob, Charlie, and David have all had below-the-knee amputations and are leaving the hospital. Albert's family members are excited about having him come home and have had the house completely remodeled with grab bars, a wheelchair ramp, and every other aid they know of. Someone will always be available to help him. Bob's family members mean well, but they are not reliable. They have made some preparations for his homecoming, but others have not been finished. He will have willing help at times. Charlie's family members have finished some essential preparations, such as a wheelchair ramp; others have not been finished but have been planned. Other family members work and will be able to help him only occasionally; however, he can always rely on their showing up at scheduled times. David's family members have done nothing, saying they will rehab the house when he comes home and then see what is needed. Other family members work and can make no promises about helping him. Whose family situation seems most promising?

A) Albert's B) Bob's C) Charlie's D) David's 29. Which of the following are reactions that accompany disability for most people?

(Select all that apply.)

A) Mourning losses B) Denial of disabilities by making unrealistic plans and not complying with their care plans C) Angry outbursts and impatience with those who are trying to help them D) Fluctuations in reactions E) Acceptance of the disability with an absence of periods of regret or resentment 30. After a fall in the supermarket near his home, Mr. G has experienced a slow recovery in hospital from hip replacement surgery 9 weeks prior, enduring a postoperative infection and a slow resumption of mobility. Consequently, the care team has recommended that Mr. G be moved to a facility better able to meet his rehabilitative needs. Which of the following goals should be prioritized during his rehabilitation?

A) Effective pain management B) A return to pre-fall levels of mobility C) Improvement in functional capacity D) Freedom from infection

Page 8

31. Mrs. Y lives with hemiplegia following an ischemic stroke 8 weeks ago, a disability that has impaired her ability to independently check her blood sugars using a glucometer. What action should the nurse choose to address Mrs. Y's challenge?

A) Reevaluate Mrs. Y's goals for diabetes treatment and the need for random blood glucose monitoring.

B) Enlist the help of Mrs. Y's family and friends in performing the glucose monitoring.

C) Teach Mrs. Y a method of using a glucometer that can be performed using her unaffected hand.

D) Substitute scheduled hemoglobin A1c testing at a medical lab for random blood glucose testing.

32. Which of the following are principles of rehabilitative nursing in gerontological nursing care? (Select all that apply.)

A) Increase self-care capacity.

B) If the patient is not returned to his or her pre-illness state, rehabilitative nursing was unsuccessful.

C) Eliminate or minimize self-care limitations.

D) Act for or do for when the person is unable to take action for himself or herself.

33. When the rehabilitative nurse is working with a gerontologic client and focuses on the many obstacles that the client has already successfully overcome, the nurse is exhibiting which of the following guidelines for rehabilitative care?

A) Provide time and flexibility.

B) Recognize and praise accomplishments.

C) Prevent complications.

D) Emphasize function rather than dysfunction.

34. If a nurse infantilizes the client, the nurse is not adhering to which of the following guidelines for rehabilitative nursing?

A) Prevent complications.

B) Do not equate physical disability with mental disability.

C) Provide time and flexibility.

D) Recognize and praise accomplishments.

35. Which of the following residents of an extended care facility is most likely to be characterized as dependent in terms of his or her capacity to perform activities of daily living?

A) Ms. Q, who needs to ring the call bell and then be accompanied to the toilet by a care aide.

B) Mr. H, a man who needs the assistance of care staff to get off the bedpan after he voids.

C) Mr. N, who requires regular prompts to toilet himself.

D) Mrs. R, who has a long term, indwelling urinary catheter and needs help in performing the relevant care.

Page 9

36. Which is most likely to keep a person from functioning independently and living alone?

A) Inability to prepare meals B) Difficulty in eating C) Illiteracy D) Inability to use a telephone 37. Which of the following are typical activities of daily living? (Select all that apply.)

A) Eating B) Dressing C) Toileting D) Moving E) Cooking 38. Which of the following are instrumental activities of daily living related to nutritional status? (Select all that apply.)

A) Eating B) Shopping C) Cooking D) Cleaning kitchen after cooking 39. Recognizing the high incidence of pressure ulcers in the hospitalized elderly patients, a nurse is in the habit of prompting patients to maintain proper positioning when they are seated in a chair or in a wheelchair that lacks foot pedals. Which of the nurse's following directions is most accurate?

A) “Make sure that you place your arms flat on your lap with your palms down.”

B) “Try to keep your back straight and your head aligned with your spine.”

C) “Keep your legs uncrossed and your feet directly under your chair.”

D) “Make sure that your feet are raised so that your thighs are not bearing any weight.”

40. Which of the following are reasons that correct body alignment for the elderly rehabilitation client is so important? Correct body alignment: (Select all that apply.)

A) Facilitates optimal function of major systems.

B) Makes the nurse feel more comfortable.

C) Promotes comfort for the patient.

D) Prevents complications such as contractures and pressure ulcers.

Page 10

41. A nurse who provides care on a rehabilitative medicine unit of a hospital works with numerous geriatric patients. Which of the following principles most accurately guides the nurse's efforts to integrate range-of-motion exercises into patient care?

A) Passive range-of-motion exercises should be delegated to physiotherapists in order to reduce the chance of injury.

B) Patients should be encouraged to put all of their joints through a range of motion at least once daily.

C) Performing range-of-motion exercises as slowly as possible maximizes their benefit.

D) Range-of-motion exercises are contraindicated in patients with existing cardiac conditions.

42. Residents in an assisted-living facility attend a daily exercise class. Their blood pressures and heart rates are monitored before, during, and after exercising. While they are riding stationary bicycles, a nurse notices the signs listed below. Which patient should stop exercising?

A) Mr. A's systolic blood pressure has increased by 25 mm Hg. B) Mr. B's heart rate has increased to 90 beats per minute.

C) Ms. C's face is flushed.

D) Ms. D is breathing rapidly.

43. A nurse is helping a patient with range-of-motion exercises. Which of the following actions by the nurse is correct? The nurse: A) Offers support above and below the knee being exercised.

B) Documents any increase in heart rate or respirations.

C) Moves each joint slowly and smoothly past the point of resistance.

D) Moves each joint back and forth once.

44. The nurse is providing range-of-motion exercises to a patient who is comatose.

Which type of range-of-motion is the nurse providing?

A) Active range of motion B) Active assistive range of motion C) Resistive range of motion D) Passive range of motion 45. Which of the following older adults is using his or her mobility device most appropriately?

A) Mr. B, who says that his cane helps him stay more balanced and stable when he walks.

B) Mrs. A, who has begun using a walker in order to prevent further deterioration of her mobility.

C) Mrs. D, who uses a wheelchair to get around her care facility because she is unable to walk quickly.

D) Mrs. L. who uses an adjustable cane to help support her weaker side during transfers.

Page 11

46. A nursing home resident can walk only with difficulty and has trouble reaching the dining room by mealtime. In walking down the hall, she must frequently use the wall railings for supporting her weight, although her sense of balance is good. The entire nursing home has smooth tiled floors. Which of the following is likely the best mobility aid for the resident?

A) Walker with four wheels B) Walker with two or no wheels C) Cane with a broad claw foot D) Wheelchair 47. The nurse should keep abreast of current assistive technology for which of the following reasons? (Select all that apply.)

A) So that the nurse can become an entrepreneur in marketing these devices.

B) These devices will enable older adults to care for themselves.

C) These devices will enable older adults to function within the community.

D) These devices will also afford older adults the opportunity to remain in the workforce as long as possible, despite having a disability.

48. Which of the nurse's following questions is most appropriate for providing reality orientation for a patient with stage 5 Alzheimer's disease?

A) “Are you looking forward to Thanksgiving next week Mr. Hall?”

B) “Could you tell me the month and the year this morning, Mr. Hall?”

C) “Do you know what holiday is coming up soon, Mr. Hall?”

D) “Will your son and daughter-in-law be coming to visit on Thanksgiving, Mr. Hall?”

49. The director of a nursing home tries to provide stimulating activities for the residents. Every Friday evening, there are Bingo games for the residents. Most residents enjoy playing Bingo, but a few object that it is a “waste of time” and they refuse to play. How should the director handle the situation?

A) Continue the games but offer an alternative activity that provides more mental stimulation.

B) Continue the games and insist that all the residents should continue participation.

C) Find a new, more stimulating activity for all the residents.

D) Continue the games but allow the residents to read or watch television instead of playing.

50. Which aid to reality orientation can most help elderly patients?

A) Conversations B) Calendars and clocks C) Holiday decorations D) Newspapers and television and radio news programs

Page 12

51. What are the therapeutic effects of reminiscence? (Select all that apply.)

A) It is entertaining.

B) It is a means of validating existence.

C) It is a means of resolving past conflicts.

D) It is a means of finding meaning in remaining life.

52. What is the most important skill for nurses to use in reminiscing activities?

A) Encouraging B) Listening C) Guiding D) Redirecting 53. During the homecare nurse's visit, the wife of a 74-year-old post-stroke patient is teary and clearly overwhelmed with the fact that she is the sole caregiver for her husband. To what resource(s) should the nurse direct the wife in order to aid in her husband's functional recovery?

A) A social worker and rehabilitation counselor B) The couple's family physician C) A family therapist or psychological counselor D) A public health nurse 54. Which of the following are professionals who can offer guidance in locating appropriate resources? (Select all that apply.)

A) Social workers B) Physical therapists C) Occupational therapists D) Speech and hearing therapists E) Local libraries

Page 13

Answer Key 1. A, B 2. D 3. C 4. B, C, D 5. D 6. A 7. B 8. C 9. C 10. C 11. A 12. B 13. B 14. D 15. A 16. C 17. C 18. C 19. B 20. B 21. A 22. C 23. B 24. C 25. D 26. C 27. A 28. C 29. A, B, C, D 30. C 31. C 32. A, C, D 33. D 34. B 35. B 36. B 37. A, B, C, D 38. B, C, D 39. B 40. A, C, D 41. B 42. A 43. A 44. D 45. A 46. B 47. B, C, D 48. A

Page 14

49. A 50. A 51. B, C, D 52. B 53. A 54. A, B, C, D

Page 15

Name: __________________________ Date: _____________ 1. The husband of a 78-year-old postsurgical patient has approached the nurse, upset that his wife has become incontinent of urine during her hospital stay. The husband states that this is without precedent and he is adamant that the matter be looked into further. The nurse would recognize that which of the following factors may have contributed to this course of events?

A) Age-related changes to genitourinary function B) Sensory deprivation C) Changes in diet since admission to the hospital D) Sedative effects of medications 2. Which of the following nursing practices commonly performed in the geriatric medical unit of a hospital is most in need of modification or correction?

A) Patients are regularly prompted to practice deep-breathing and coughing exercises in order to mobilize secretions and prevent atelectasis.

B) Patients at risk for urinary incontinence are catheterized in order to reduce the risk of urinary tract infections.

C) Reality orientation is provided to patients who exhibit cognitive deficits.

D) The discharge planning process is begun immediately following admission.

3. Elderly hospital patients need special care in some respects. What is one thing a nurse can do to ensure that they leave the hospital in good condition and can return to a normal life?

A) Keep the patients in bed as much as possible to help them rest.

B) Keep the room temperature between 65°F and 70°F. C) Wash hands between patients and use other infection control practices.

D) Use a urinary catheter on a patient who has stress incontinence.

4. Nurse R is providing care for a 71-year-old woman who has been admitted to the surgical unit following her post-anesthetic recovery from a bilateral mastectomy. The patient has been physically stable but disoriented to place and time since admission, but the nurse knows that a history of dementia is noted in the patient's chart. The patient's daughter is distraught, however, because “mom was always just a bit forgetful, but nothing at all like this.” What would be the most appropriate response by the nurse?

A) “If your mother already has dementia, her confusion is to be expected.”

B) “It is nothing for you to worry about, most elderly persons are forgetful.”

C) “Delirium can also cause an alteration in mental status and can be caused from a new environment, altered level of consciousness, excess stimuli, adverse drug reactions, and physiologic disturbance, all which your mother has likely experienced as a result of her hospitalization and surgery.”

D) “Are you blaming us for your mother's confusion?”

Page 1

5. An operating room nurse is assisting with the positioning of a 78-year-old female patient on the operating table prior to the patient's abdominal surgery. Which of the following actions should the nurse prioritize?

A) Keeping the patient cool to prevent operative hyperthermia B) Supporting the neck and head to prevent postoperative neck pain C) Placing the patient supine to maximize respiratory status D) Protecting the patient's skin integrity by padding bony prominences 6. A nurse is conducting a preoperative assessment of a 76-year-old patient who will be having a transurethral prostatic resection later that day. The patient's wife is concerned about maintaining the patient's medication regimen, stating, “He takes a lot of pills and it's important that he gets them while he's in the hospital.” How can the nurse best respond to the wife's concern?

A) “The care team will look at his medications and only hold those that can safely be stopped.”

B) “You're right that it's important, and they'll be continued throughout his stay in the hospital.”

C) “His medications will have to stop while he's being held without food, but we will restart them as soon as possible.”

D) “In light of his surgery, your husband probably will not need any of the medications that he used to require.”

7. Upon further questioning, an elderly man who expressed apprehension about his upcoming coronary artery bypass surgery admitted that he had a friend who had coronary artery bypass surgery a few years ago and had many complications postoperatively. Which of the responses by a nurse would be the best?

A) “You will feel better immediately.”

B) “This surgery is always successful at our hospital.”

C) “Bypass surgery has improved over the past 20 years.”

D) “You can recover as easily as a young person can.”

8. An obese elderly patient is scheduled for surgery. The following diagnostic tests were performed: a chest X-ray, an ECG, a complete analysis of blood samples, a nutritional assessment, and a mental assessment. What test is missing?

A) Cardiac enzymes test B) Pulmonary function test C) Transferrin test D) Hemoglobin test 9. What is one way of improving the chances for successful anesthesia of an elderly patient?

A) Long, careful surgery B) Frequent turning of tissue during surgery C) Particularly close monitoring during surgery D) Use of inhaled agents during surgery

Page 2

10. As she began to wake after surgery, Mrs. P became extremely restless. Which of the following should the recovery room nurse likely administer first?

A) A narcotic to ease the pain B) Antibiotics to prevent an infection C) Electrolytes to correct an imbalance D) Oxygen to correct hypoxia 11. Older patients are particularly subject to several postoperative complications. Which of the following arrays of symptoms is indicative of respiratory complications?

A) Reduced activity and lowered resistance B) Fever and dehydration C) Negative chest X-ray thoracic distention D) Decreased lung sounds and a low-grade fever 12. An elderly woman had cardiac surgery that was completed quickly and seemed successful, but she developed an infection and was given cephalosporins and ampicillin. After that, she developed paralytic ileus with a low-grade fever. A chest X-ray appeared normal. Next, her kidneys failed. How might the kidney failure have been prevented in this patient?

A) She should have been on a low-protein diet.

B) She should have been given different antibiotics.

C) Her ileus should have been treated.

D) The surgery should have taken longer.

13. What factors are most likely to contribute to the problem of hypothermia that older adults may face intraoperatively and postoperatively? (Select all that apply.)

A) The normal body temperature of older adults that is often lower B) The cool temperature of the operating rooms C) The use of medications that slow metabolism D) Fever from infection 14. Nurse R has just entered the hospital room of an 84-year-old female patient after hearing a crash and has found the patient lying on the floor of the room beside her overturned commode. How should the nurse best respond to this situation?

A) Initiate a code.

B) Assist the patient to a sitting position for an assessment.

C) Leave the patient on the floor until her status is determined.

D) Position a sling for a mechanical lift under the patient.

Page 3

15. Mr. A, aged 89, is displaying a furrowed tongue, dry lips, and a thready pulse of 105, causing the care team to strongly suspect that he is dehydrated. Which of the following principles provides the best guide for managing Mr. A's immediate care?

A) Older adults cannot tolerate a rapid intake of oral fluids.

B) Older adults are more able to tolerate dehydration than younger people, owing to their lower volume of intracellular fluid.

C) Fluids should be replaced intravenously rather than orally in older adults.

D) Most older adults require between 2 and 3 L of fluid daily.

16. An elderly woman falls in her home. Paramedics are called to help her get up and take her to a nearby hospital. What action is the paramedics' priority?

A) Assess her vital signs B) Teach the woman how to fall safely C) Assess the factors that led to her fall D) Request that an X-ray be done at the hospital 17. Mr. S, a 92-year-old patient in a geriatric medicine unit, has become acutely confused. The development is of great concern to the care team since Mr. S has no history of cognitive deficits. What action should the nurse prioritize?

A) Contacting Mr. S's family B) Assessing Mr. S's vital signs and obtaining blood samples C) Moving Mr. S to a bed that is visible from the nursing station D) Supervising Mr. S during transfers 18. Which of the following are goals that a nurse may have in the case of a myocardial infarction in an elderly person? (Select all that apply.)

A) To aid in prompt diagnosis B) To reduce cardiovascular stress C) To minimize or eliminate causative factors D) To prevent and promptly identify complications 19. For which of the following reasons are emergencies in older persons particularly problematic? (Select all that apply.)

A) They occur frequently because of the age-related changes that lower resistance and make the body more susceptible to injury and illness.

B) They are not as urgent as it is expected that elderly people will die.

C) They often present an atypical picture that complicates diagnosis.

D) They can be more difficult to treat or stabilize because of older persons' altered response to treatment.

E) They carry a greater risk of causing serious complications and death.

Page 4

20. Despite the nurses' high-quality care and conscientious application of the principles of asepsis, a 78-year-old post-coronary bypass patient has developed an infection in his leg incision. Which of the following factors may have contributed to the man's infection?

A) Altered antigen–antibody response B) Decreased intracellular fluid volume C) Decreased cardiac output D) An adverse drug reaction 21. Infections are common acute conditions that demand prompt attention. A variety of factors can be responsible for the high risk of infection in the elderly. Gerontological nurses should suspect an infection when which of the following phenomena occurs?

A) The patient displays reduced activity and lowered resistance.

B) Embolus and thrombus are diagnosed.

C) A lower body temperature causes atypical fever.

D) Any abrupt, unexplained change in physical or mental function is detected.

22. Albert, Bob, Charlie, and David wandered into a health food store when they were mall-walking one morning. They decided to try various remedies that might boost their resistance to infection. According to claims made about the following remedies, which man is most likely to increase his immunity?

A) Albert, who substituted soy for dairy foods.

B) Bob, who began taking vitamins C and A everyday.

C) Charlie, who began eating large quantities of onions.

D) David, who increased his intake of sugar and began taking Siberian ginseng.

23. An elderly woman suffering from abdominal pain, nausea, urinary incontinence, fever, and vomiting is brought to the emergency department. What is the most likely preliminary diagnosis?

A) Appendicitis B) Aneurysm C) Urinary tract infection D) Colon cancer 24. Which of the following measures would be particularly important for preventing infections of elderly persons who are being cared for in a health-care institution?

(Select all that apply.)

A) Ensuring that the older adult has had all childhood immunizations.

B) Ensuring that pneumococcal and influenza immunizations have been administered (unless contraindicated).

C) Adhering to infection-control practices.

D) Restricting contact with persons who have infections or suspected infections.

Page 5

25. An 81-year-old female patient has just been admitted to the hospital following a stroke. The patient's daughter is upset that nurses are trying to carry out discharge planning early in the admission, characterizing their efforts as evidence that they “just want to get her out the door as soon as possible.” How can a nurse best respond to the daughter's concern?

A) “Actually, it's been found that patients who leave the hospital as soon as possible recover better and more quickly than those who stay hospitalized longer.”

B) “Our goal is not to rush your mother's discharge but rather to have as many supports in place as possible when it does come time for her to go home.”

C) “Unfortunately, one of the realities of hospital care today is that patients do get discharged earlier than they did in years past.”

D) “Discharge can often happen with little notice, so we are trying to get as much organized early in her admission as we can.”

26. Which of the following are reasons that hospitalized older adults require early and competent discharge planning? (Select all that apply.)

A) To prevent complications B) To reduce the risk of rehospitalization C) To minimize stress to themselves and their caregivers D) So that they can leave the hospital in a sicker, more debilitated state 27. The family of a 90-year-old female hospital patient is worried about her chances of making a full recovery from her recent fall once she returns home. Which of the following factors are likely to have a positive effect on the woman's post-discharge health outcomes? (Select all that apply.)

A) The presence of a reliable and an adequate social support network.

B) The patient's understanding of her health and her prognosis.

C) The presence or absence of other health problems.

D) The self-care habits that the woman had prior to her fall.

E) Beginning the discharge planning at the time that the woman is being discharged.

Page 6

Answer Key 1. D 2. B 3. C 4. C 5. D 6. A 7. C 8. B 9. C 10. D 11. D 12. B 13. A, B, C 14. C 15. D 16. A 17. B 18. A, B, D 19. A, C, D, E 20. A 21. D 22. B 23. C 24. B, C, D 25. B 26. A, B, C 27. A, B, C, D

Page 7

Name: __________________________ Date: _____________ 1. Which of the following statements most accurately captures an aspect of long-term care in the United States?

A) The acuity of long-term care facilities is decreasing as the acuity of older hospital patients increases.

B) Both the number of long-term care facilities and the number of residents they house are rapidly increasing.

C) Most older adults of the current generation will require some form of long-term care at some point in their lives.

D) Interventions that were formerly available in long-term care facilities are now often restricted to hospital settings.

2. The family of an 84-year-old female resident of a long-term care facility is profoundly dissatisfied with the environment and the quality of care that the woman is receiving. Which of the following aspects of the facility can be considered a throwback to the pre-20th century history of long-term care?

A) The facility has copious rules and rigidly enforced schedules.

B) The facility emphasizes psychiatric care over physical care.

C) Volunteers provide the majority of direct patient care.

D) The facility is entirely dependent on government money for its operation.

3. The colleague of a nurse who provides care in a long-term care facility consistently refers to their workplace as a “nursing home.” Which of the following historical facts may underlie the colleague's choice of words?

A) Early care facilities did not provide care for the long term, but rather provided temporary respite by nurses.

B) Residential care providers early in the 20th century began to call themselves nurses.

C) Government funding for care facilities was tied to their designation as a home staffed by credentialed nurses.

D) Long-term care facilities were differentiated from hospitals by the absence of physician-led care.

4. As life expectancy and demographics in the United States have changed, the number of residents in long-term care facilities has increased. In a typical group of older men and women, what is the likelihood of their needing long-term care at some time?

A) Nearly 50% for women and 33% for men B) Nearly 33% for women and 50% for men C) Nearly 67% for women and 50% for men D) Nearly 50% for women and 67% for men

Page 1

5. During the 19th century, early long-term care facilities emerged. What was one of their important characteristics?

A) Unscheduled activities B) Activities suited to patients' needs C) Integration into mainstream society D) Similar treatment of all patients 6. In the mid-20th century, the number of nursing homes grew quickly. What was most responsible for this increase?

A) Institute of Medicine B) Social Security C) Hill-Burton Act D) Medicare and Medicaid 7. Which of the following were regulations that were developed under legislation known as the Omnibus Budget Reconciliation Act of 1987 (OBRA)?

A) Use of a standardized assessment tool—the Minimum Data Set B) Timely development of a written care plan C) Reduction in the use of restraints and psychotropic drugs D) Decrease in staffing to cut costs E) Protection of resident's rights 8. In 19th century Europe, institutions emerged for the care of various disadvantaged groups. How were the groups usually categorized?

A) Mentally and physically ill people were separated.

B) All groups were housed and cared for together.

C) Ill and impoverished people were separated.

D) Orphaned children were housed separately from other groups.

9. Which of the following are factors that have contributed to an uncomplimentary image of long-term care? (Select all that apply.)

A) A history of scandals involving a small minority.

B) The media's readiness to highlight the abuses and substandard conditions of a small minority.

C) Reimbursement policies that significantly limit the ability to provide highquality care.

D) The dedication and professionalism of many nurses who work in the field.

Page 2

10. The daughter of an 86-year-old man with stage 3 Alzheimer's disease has suggested exploring long-term care facilities as a way of meeting his increasing daily needs.

The man is strongly opposed to entertaining the possibility, stating, “We put my granddad in one of those 45 years ago and it was a horror for him.” Which of the following historical phenomena may explain the man's reaction and his grandfather's negative experience in long-term care?

A) Nursing homes in the 20th century often attracted care providers who were unable to meet the standards required for working in a hospital context.

B) Philosophies of care in the mid-20th century emphasized minimal assistance with activities of daily living.

C) Evidence-based gerontological nursing did not exist during the era in question.

D) Nursing homes in the 1960s proliferated in number but standards of care were low and enforcement was lacking.

11. Which of the following factors provided the most significant impetus for the improvement in the quality of nursing homes that occurred in the 1980s?

A) Nursing research demonstrating the harmful effects of substandard care B) The risks of losing federal funding faced by deficient nursing homes C) Public relations efforts by families of long-term care residents and nursing organizations D) Unflattering media reports of long-term care practices 12. Recently, Haven Nursing Home was found deficient in some respects. How can the Omnibus Budget Reconciliation Act of 1987 (OBRA) rules be enforced against the nursing home?

A) Haven may no longer receive subsidized foods from the U.S. Department of Agriculture (USDA).

B) Haven's administrators may go to jail.

C) Haven may be fined a large amount of money.

D) Haven may lose the certification that entitles them to reimbursement from Medicare.

13. How did geriatric nurses respond to the poor conditions in early nursing homes?

A) They defined nursing facility care.

B) They lobbied for improvements.

C) They failed to help conditions.

D) They provided a clear model of long-term care.

Page 3

14. Which one of the following statements most well describes why nurses must define nursing facility care?

A) To change the perception that nurses are not bright or hardworking enough to be entrepreneurs.

B) Nurses have historically taken an active role dictating nursing home practices.

C) For nurses to reap considerable financial gains for themselves.

D) When nursing fails to exercise leadership, non-nurses will determine nursing practice.

15. In the wake of an inspection and audit that revealed serious lapses in care, the recently hired nurse manager of a long-term care facility has been commissioned with bringing the facility in accordance with standards. Which of the following sources should the nurse use to determine the scope of improvements?

A) Federally mandated standards and state standards if the state specifies its own higher standards B) Standards determined by the Joint Commission C) Standards identified by the federal government D) State standards and standards dictated by the American Nurses Association (ANA) 16. Mrs. W is a nursing home resident who is bitter about her family's placing her there, and she feels that they do not love her. If her family is typical, why did they place her there?

A) They can't afford to keep her at home.

B) They need more freedom.

C) A crisis made it necessary.

D) The family home is too small.

17. Three gerontological nurses have announced their intention to open a long-term care facility in their community, something that a colleague has disparaged as “making money from older adults' frailty.” How can the nurses best respond to their colleague's criticism?

A) “It can actually be in the best interests of residents for experts in care, like nurses, to be in charge of directing care.”

B) “One of the freedoms we enjoy in a free-market system is the opportunity to make a profit from a variety of enterprises.”

C) “If nurses don't control long-term care then it will be controlled by corporate interests that lack any form of conscience.”

D) “Actually, nursing homes run by nurses can qualify for increased federal and state funding, a situation that ultimately benefits residents.”

Page 4

18. The wife and daughter of Mr. B, an 80-year-old man, are experiencing guilt and doubt about their recent decision to place him in a long-term care facility, despite the fact that his declining functional level justifies the move. Which of the following actions by the nurses at the facility is likely to ease the women's anxiety about admitting Mr. B? (Select all that apply.)

A) The nurse manager of the facility has placed the women in contact with another resident's family who have recently gone through the same experience.

B) The designated visiting hours are made clear to both Mr. B and his family so that Mr. B does not await their visits when prohibited.

C) Staff encourage the family to use an activity room or the outdoors during their visits.

D) The nurses explain the rationale for barring the family from bringing food from home to Mr. B. E) The wife and daughter are encouraged to participate in Mr. B's care.

19. A small long-term care facility employs several unlicensed caregivers and one registered nurse. The nurse consequently holds the responsibility for numerous aspects of residents' care. Which of the following pressing responsibilities should the nurse prioritize and perform as soon as possible?

A) Administering the Minimum Data Set (MDS) on a newly admitted patient.

B) Increasing the dosage of a resident's beta-blocker in light of his high blood pressure today.

C) Ambulating a resident who has multiple sclerosis.

D) Choosing the standards that the facility will adopt for the provision of care.

20. Which of the following is a specialized role that a gerontological nurse can fill?

(Select all that apply.)

A) Director of nursing B) Geropsychiatric nurse specialist C) Direct care provider D) Infection control coordinator E) Supervisor 21. As part of an internal quality review, the nurse directors of a long-term care facility have identified specific goals for the care that residents of the facility will achieve.

Which of the following goals represents the highest level in the hierarchy of residents' needs?

A) “Residents will be encouraged to exercise their individual rights despite the presence of health challenges that may limit their independence.”

B) “Residents will be assured of timely, caring, evidence-based treatment for their medical conditions.”

C) “Residents will maintain a high level of self-care in as many aspects of their lives as their abilities permit.”

D) “Residents will experience a growth in meaning and purpose of life despite the presence of health challenges.”

Page 5

22. The medical model of long-term care has limitations. Which of the following is the underlying theme of the new model of long-term care?

A) Medical supervision and treatment B) Patients' and caregivers' rights C) Holism and healing D) Social and spiritual growth 23. Mr. R will have to enter a long-term care facility soon, and he and his family are visiting various local facilities. They have a long list of questions to ask the administrators at each location. Which of these questions is the most important?

A) “What types of health insurance are accepted?”

B) “What types of medications are given?”

C) “What special therapies are prohibited?”

D) “What is the organizational structure of the facility?”

24. Oakside Care Center appears very attractive to visiting families. Nutritious and appealing meals are served in an attractive dining room with a view of the lake.

Plenty of caregivers are in evidence, some of them dispensing medicines from a large cart, others changing bed linens, still others talking and joking with residents. In the large lobby, a group of neat, clean residents is sitting in front of a large television set after lunch. There are no unpleasant odors in hallways or patients' rooms. A special van is at the curb, waiting to take residents to medical appointments at a nearby medical center. Which of the following is the most likely reason that some residents are unhappy here?

A) They need more attention from the staff B) They need better surroundings C) They need to be more active D) They need better medical care 25. Haven Care Center tries to provide meals that take residents' medical conditions into account. Some residents have diabetes. How can the dietitian help them?

A) Provide lessons in eating correctly for diabetes control.

B) Have some no-sugar treats available occasionally.

C) Provide meals for everyone that are safe for diabetic residents.

D) Tell the diabetics which foods on the menu they should avoid.

Page 6

26. Which of the following are assumptions that are woven within the model of holism and healing? (Select all that apply.)

A) Physical well-being is more important that psychological, social, and spiritual well-being.

B) Clients only need medical supervision and treatment.

C) The physical environment can be used as a therapeutic tool.

D) Alternative and complementary therapies cannot effectively or safely meet the needs resulting from chronic conditions.

E) Caregivers' presence and interactions affect health, healing, and the quality of nursing facility life.

Page 7

Answer Key 1. C 2. A 3. B 4. A 5. D 6. B 7. A, B, C, E 8. B 9. A, B, C 10. D 11. B 12. D 13. C 14. D 15. A 16. C 17. A 18. A, C, E 19. A 20. B, D 21. D 22. C 23. A 24. C 25. B 26. C, E

Page 8

Name: __________________________ Date: _____________ 1. Mrs. W, age 82, resides with her son and daughter-in-law who are finding it challenging to provide adequate care while maintaining their careers and home life.

During a home care visit, Mrs. W tells the nurse that, “My children's generation doesn't know how good they've got it; when I was younger we all had to take care of our parents, and for a lot longer than most people do now.” Which of the following statements most accurately underlies the response that the nurse will provide to Mrs. W? A) The increasing prevalence of chronic illnesses means that there are indeed fewer old-old adults than there were in earlier generations.

B) The increasing acceptance of long-term care means that the caregiving burden of the son and daughter-in-law's generation is lighter than that of Mrs. W's generation.

C) More older people are living longer and receiving care in the community than when Mrs. W was in her middle-adult years.

D) The increase in women in the workforce, mobility of families, and complexity of family structures resulting from divorce and remarriage complicate family relationships and caregiving now.

2. A discharge planning nurse works with a wide variety of families when organizing care for older adults after their discharge from the hospital. Which of the following relationship structures would the nurse consider to be a family? (Select all that apply.)

A) Mr. E and his partner, Mr. S, who live together in an apartment B) Mr. R and his new “lady friend,” who began cohabitating 2 months ago C) Mrs. B and her daughter, son-in-law, and widowed sister, all of whom share a house.

D) Mr. R, who is estranged from his children and has lived with his brother, a bachelor, for several years E) Mrs. U, who lives by herself and has no close friends or relatives 3. A nurse at a rehabilitation center is preparing a care plan for a 71-year-old poststroke patient who has shown significant improvement in function and who is ready to return to the community. In the nurse's efforts to mobilize family caregiving, which of the following statements provides the most accurate criterion for inclusion in the category of “family?”

A) The patient's spouse, biological children, and closest friends.

B) Any unpaid person who has expressed sincere interest in the patient's condition and provided hands-on care since his admission to the facility.

C) Anyone who self-identifies as being a member of the patient's family.

D) Any individual who fulfills the patient's family functions.

Page 1

4. Which of the following statements most accurately captures an aspect of contemporary family caregiving in the United States?

A) Women typically spend more time caring for aging parents than they did for their own children.

B) The most common pattern of care involves an older man providing in-home care for his wife.

C) The majority of care is now provided by public and private agencies rather than family members.

D) A residential or institutional environment is now the most common venue for caregiving.

5. Mrs. J is 80 years old. Until recently, she lived alone, but after having a stroke she moved into an in-law apartment in the home of her 55-year-old widowed daughter, Mary. Mary loves her mother and wants to be a good caregiver, but she also wants to resume a normal social life and perhaps to remarry. Mrs. J's other daughter, 53-yearold Cynthia, is married and lives in another city. She has a large home and would be happy to have Mrs. J live with her, but she is also a busy teacher. Mrs. J and Mary tend to call Cynthia for financial and legal advice. Mrs. J's son, 45-year-old Frank, is something of a black sheep; he can't keep a job and often asks family members for financial help. Although no one in the family is poor, no one is wealthy either. An energetic 70-year-old neighbor, Mrs. N, is very helpful; she often shops for Mrs. J. In taking notes about the family, a visiting nurse needs to determine who would be the best primary caregiver and who would be a good backup. What would be her best choice?

A) Mary as primary caregiver, Cynthia as backup B) Mary as primary caregiver, Mrs. N as backup C) Mary as primary caregiver, Frank as backup D) Cynthia as primary caregiver, Mary as backup 6. The children of a 77-year-old man who has recently moved to an assisted living facility are adamant that their father's common law partner of 2 years be barred from participating in his care. The children state that the partner is manipulative and solely interested in their father's money, while the father disagrees and states that they have a healthy and mutually beneficial relationship. How can the nurse best respond to this situation?

A) The nurse should accept that the relationship plays a positive role for the man.

B) The nurse should organize a family meeting that includes both the children and the man's partner in an effort to facilitate reconciliation.

C) The nurse should document the children's concerns and investigate the truth of their claims.

D) The nurse should ask the partner to demonstrate that she is not a negative influence on the resident.

Page 2

7. Mrs. J is 80 years old. Until recently, she lived alone, but after having a stroke she moved into an in-law apartment in the home of her 55-year-old widowed daughter, Mary. Mary loves her mother and wants to be a good caregiver, but she also wants to resume a normal social life and perhaps to remarry. Mrs. J's other daughter, 53-yearold Cynthia, is married and lives in another city. She has a large home and would be happy to have Mrs. J live with her, but she is also a busy teacher. Mrs. J and Mary tend to call Cynthia for financial and legal advice. Mrs. J's son, 45-year-old Frank, is something of a black sheep; he can't keep a job and often asks family members for financial help. Although no one in the family is poor, no one is wealthy either.

Which family member is fulfilling the role of a decision-maker?

A) Mary B) Mrs. J C) Cynthia D) Frank 8. A woman who is in her forties has young children and is also the primary caregiver for her elderly widowed mother. Which one of the following phrases would best describe this woman?

A) Victim B) Member of a skipped-generation household C) Dependent D) Member of the sandwich generation 9. Mr. and Mrs. D have been married for 55 years. Mrs. D is terminally ill with lung cancer. Mr. D has taken over all of the functions of housekeeping and caregiving.

Which of the following roles are Mr. and Mrs. D assuming?

A) Caregiver and dependent B) Decision-maker and victim C) Caregiver and victim D) Decision-maker and dependent

Page 3

10. Mrs. J is 80 years old. Until recently, she lived alone, but after having a stroke she moved into an in-law apartment in the home of her 55-year-old widowed daughter, Mary. Mary loves her mother and wants to be a good caregiver, but she also wants to resume a normal social life and perhaps to remarry. Mrs. J's other daughter, 53-yearold Cynthia, is married and lives in another city. She has a large home and would be happy to have Mrs. J live with her, but she is also a busy teacher. Mrs. J and Mary tend to call Cynthia for financial and legal advice. Mrs. J's 45-year-old son, Frank, is something of a black sheep; he can't keep a job and often asks family members for financial help. Although no one in the family is poor, no one is wealthy either. As children, the three siblings did not get along well at all. When Mrs. J had her stroke, they met in her hospital room. The next day, they got together in Mary's home to discuss the family situation. If this family is typical, how did the siblings' relationships develop from that point on?

A) All three temporarily became much closer, but only for a short time.

B) All three became much closer for the rest of their lives.

C) Mary and Cynthia became much closer for the rest of their lives, but Frank remained distant from them.

D) They argued about Mrs. J and remained distant from each other.

11. Both members of an elderly couple have some health problems. As a young married couple, they fought often and almost were divorced at one point. They stayed together at first because they had children, and later because they seemed better able to tolerate each other's behavior. A nurse working with them wants to assess their current feelings for each other so that she will know how much help they will give each other. Which assessment is most likely?

A) They have grown apart and stay together only because of inertia.

B) They feel secure with each other and support each other willingly.

C) They have grown to care for each other deeply.

D) They tolerate and somewhat unwillingly support each other.

12. An elderly couple's son and daughter were pawns in their parents' early battles and became resentful of both their father and their mother. They left home after finishing high school and have seldom visited since then. The daughter has visited more often than the son. If the parents need care, how are the siblings likely to respond?

A) Probably both children will help.

B) Probably neither of the children will help.

C) Probably the daughter will help, but the son will not.

D) Probably the son will help, but the daughter will not.

13. Which one of the following represents a skipped-generation household?

A) Miss H, who raised her only sister's children after her sister's death.

B) Mrs. D, who raised her granddaughter until she left for college.

C) Mrs. B, who is cared for by her adult granddaughter.

D) Mrs. S, who lives with her single parent daughter and her daughter's children.

Page 4

14. Which of the following family interactions would the nurse most likely interpret as being atypical?

A) Mr. R states that he and his brother always had a cordial, though somewhat distant, relationship but that they are now quite close.

B) Mrs. D describes being a grandparent as “having all the benefits of having children without the headaches and responsibilities.”

C) Mr. and Mrs. N had a tumultuous relationship for decades but now appear more at ease with one another.

D) Mr. A states that his ideal living situation would be himself and his adult son and daughter all under the same roof.

15. A 52-year-old woman is preparing to have her father move into her home after his discharge from hospital. Which of the following subjects should the discharge planning nurse prioritize when preparing the woman for her new caregiving role?

A) The availability and scope of community resources B) The importance of her own self-care and techniques to maximize it.

C) Assertiveness training to ensure she can set limits.

D) Management of finances 16. An elderly couple want very much to maintain their independence and avoid asking their children for help. What can a counselor suggest that will most help the couple maintain independence?

A) They can have grab bars, a wheelchair ramp, or other needed modifications made to their home.

B) They can hire a part-time worker to do chores and run errands.

C) They can have someone telephone every day to make sure they are all right.

D) They can order meals on wheels or other prepared foods.

17. A 92-year-old woman lives with her 70-year-old daughter, Emily. The daughter has been a sole caregiver for several years, has some health problems of her own, and is becoming depressed by her restricted life. She has no financial worries but believes she is wasting her life. What help is most needed in this situation?

A) Emily needs more training in caregiving.

B) Emily needs to temporarily leave the situation.

C) Emily needs more financial help.

D) Emily needs a social life.

18. A daughter and mother are extremely close emotionally. Years ago, the daughter and her mother made a pact never to put her in a nursing home, but now the physical demands of the daughter's caregiving are becoming too great. Which of the following is the best thing a nurse can do to help the daughter?

A) Persuade her to admit her mother to a nursing home.

B) Aid her in finding help with in-home care.

C) Praise her success in being a good daughter and keeping her promise.

D) Point out her mistaken altruism.

Page 5

19. A visiting nurse becomes concerned about a caregiver daughter. Although she does not seem overburdened, she may be drinking too much. The recycling bin contains many wine bottles, and visitors come to the home. What action should the nurse take?

A) Direct the daughter to a local Alcoholics Anonymous (AA) chapter.

B) Ignore the signs unless they interfere with caregiving.

C) Find a new caregiver in the family or outside it.

D) Assess the daughter's motivation and ability to provide care.

20. Ms. O is an 80-year-old nursing home resident who has diabetes. She is taken to a dialysis center three times a week in the home's van. She has no family left, but does have a few friends who visit her when they can. As they are also elderly, they can't drive and must ride buses to visit her. How might the nursing home's social worker help in this situation?

A) The social worker should defer to the nursing staff.

B) Help her friends find easier transportation.

C) Tell her to make friends at the dialysis center.

D) Ask other residents' families to bring her friends with them.

21. During a home visit, a nurse notes that an 80-year-old female patient's blood pressure is 166/99 despite the recent introduction of a diuretic to her medication regimen. The patient admits that her son refuses to give her the diuretic because it has precipitated incontinence episodes and states, “He gets so furious when I soil myself.” What action should the nurse prioritize in this potential case of elder abuse?

A) Improving or salvaging the family dynamics.

B) Teaching the son why his actions are inappropriate.

C) Initiating legal action.

D) Taking measures to protect the patient's safety.

22. Which of the following statements by family caregivers would the nurse consider most indicative of elder abuse?

A) “Mom can't handle her own money any more so I've had to take over her banking.”

B) “When my dad starts wandering around the house I give him sleeping pills until he calms down and falls asleep in his chair.”

C) “My mother says she wants me to do everything for her, but I think it's better if she keeps on doing everything she's still capable of.”

D) “I get so frustrated because my father used to be so competent and now he can't even use a toilet.”

Page 6

23. Which of the following persons is likely at the greatest risk for elder abuse?

A) A 73-year-old woman who lives with a son and can't drive a car.

B) A 76-year-old woman who lives with a daughter and has no income except for Social Security.

C) A 78-year-old woman who lives alone and has no income except for Social Security.

D) A 74-year-old woman who lives alone and has a good income from investments.

24. A visiting nurse notices bruises on Mr. B's arms; when she asks him about them, he acts evasive and apprehensive. She suspects that his caregiver has abused him. What should the nurse do?

A) Call the authorities to report suspected elder abuse.

B) Wait until the next visit to see if he is all right.

C) Confront his caregiver and threaten to report her suspicions.

D) Continue questioning to assess the degree of abuse, but be reassuring.

25. Mrs. M is an elderly woman who has had a series of strokes and is unable to attend to her own activities of daily living. She is a very sweet woman and lives with her middle-aged adult son in substandard housing. Her son does not work outside the home, is noted to drink frequently, and appears to depend on his mother financially.

A local home care agency has been providing skilled nursing care and home health aides for this patient subsequent to a recent hospitalization. The son has been verbally abusive of staff of this home care agency on numerous occasions. At this time, Mrs. M no longer meets the Medicare requirements for continued skilled home care nursing and is being discharged from home care. The son has become increasingly belligerent as the staff plan to discharge the patient from home care. It is not believed that the son will provide adequate care for the client after discharge from home care as it is evident that the only time the client receives bathing and dressing is on the days when the home care agency provides services. The home care agency is bound by Medicare requirements and lacks alternative funding to continue to provide the services for this patient. What would be the most appropriate action by the nurse who works for the home care agency at this time?

A) Continue to provide home care services and bill Medicare for these services.

B) Provide home care services independently and be reimbursed directly from the son for the services.

C) Discharge the patient from home care and report the concerns about inadequate care to the local Area Agency on Aging.

D) Discharge the patient from home care and do nothing more because it is not her business to determine if the son is neglectful of his mother after her discharge from home care.

Page 7

26. During a family meeting that the nurse organized during an older adult's discharge planning from hospital, there is visible animosity between the son and daughter of the patient. What should the nurse's initial response be to the apparent family dysfunction?

A) Teach the patient's children alternative methods of interaction.

B) Encourage the family to choose one spokesperson to represent all the children.

C) Organize separate meetings with the son and with the daughter.

D) Assess the family history and the nature of the son and daughter's relationship.

27. An elderly man has relied on one of his sons for his care. Now the son has become very involved with a religion other than the one in which he was raised. As a result, he now refuses to help his father. What can a nurse do to help in this family situation?

A) Set up a family conference that includes the son.

B) Bring in help from other family members or outside.

C) Insist that the son help, along with other family members.

D) Ask the family's own spiritual adviser to intervene.

28. Mr. K has dementia. Having a good deal of money, he has a private room at Haven Nursing Home. He is a retired industrialist whose children and current wife are already squabbling bitterly over his estate. During visits, they often get into shouting matches that disturb the other residents and Mr. K himself. How should an administrator handle this family?

A) Emphasize that they must behave civilly when visiting.

B) Have them set up separate visiting schedules.

C) Ask them to stay away.

D) Close Mr. K's door when they visit.

29. Haven Nursing Home is in a park-like setting in the hills east of San Francisco.

Haven serves a variety of residents, ranging from well-to-do local families to those that are very poor. The home provides a wealth of activities, and the meals are excellent. The overall atmosphere is one of quiet calm. Mr. and Mrs. H had a series of cardiovascular disorders that quickly used up their modest retirement savings, and they now live at Haven, with Medicaid paying the bills. Their children are very loving but have little money of their own. They live in the family house in an area that is becoming industrial and must travel a long distance to visit their parents. They can visit only occasionally. What might a nurse suggest to help the grown children make the most of their limited incomes and time with their parents?

A) Help them find nearby spots for picnics or other free outings.

B) Refer the family to a more appropriate practitioner.

C) Suggest they take out a second mortgage on the family house.

D) Encourage the entire family to participate in activities at Haven.

Page 8

Answer Key 1. D 2. A, B, C, D 3. D 4. A 5. B 6. A 7. C 8. D 9. A 10. C 11. B 12. C 13. B 14. D 15. B 16. B 17. B 18. B 19. D 20. B 21. D 22. B 23. B 24. D 25. C 26. D 27. A 28. B 29. A

Page 9

Name: __________________________ Date: _____________ 1. The 45-year-old son of a dying woman is profoundly uncomfortable with discussions of her expected time of death, funeral preparations, and the signs and symptoms that may signal that death is imminent. Which of the following historical phenomena may have contributed to the son's reluctance to acknowledge the reality of death?

A) In the past death was viewed positively as a welcome transition, while it is now often seen as an undesirable evil.

B) The declining death rate means that individuals live longer and survive to experience more unsettling symptoms and discomfort than in past generations.

C) Many people now die in institutional settings, limiting the amount of previous exposure to death that many individuals have.

D) Modern medical technology and increasing vigilance of treatment has brought about a mistrust of the natural dying process.

2. Mrs. W, a 70-year-old woman with cancer, has been told she could die at any time.

Her illness is more serious than it appears, and her daughter is not sure what to tell the grandchildren, who are aged 10 and 12. Which of the following is the best thing a nurse might tell the grandchildren?

A) Tell them that Mrs. W is going to die.

B) Tell them nothing until Mrs. W worsens.

C) Tell them that Mrs. W is ill and that the nurses are concerned.

D) Tell them that Mrs. W is ill but will recover.

3. After an elderly hospital patient had a heart attack, his cardiac and pulmonary functions ceased. How is that criterion of death documented?

A) Brain death B) Molecular death C) Somatic death D) Cardiopulmonary death.

4. A 79-year-old woman with a long-standing diagnosis of chronic leukemia experienced a blast crisis 1 week ago and died overnight. Place the stages of the coping mechanisms that the woman's family will go through in the most likely chronological order. (Use all the options.)

A) Anger.

B) Denial.

C) Acceptance.

D) Bargaining.

E) Depression.

Page 1

5. The daughter of a 79-year-old man with a diagnosis of small cell lung cancer has learned that her father has been found to have bone metastases. The daughter has approached the oncologist who is caring for him with information that she has found on the Internet that promises to cause remission of cancer through intensive antioxidant therapy. She is adamant that the physician facilitate the treatment and liaise with the providers who are located overseas. Which of the stages of KüblerRoss' conceptual framework is the daughter most likely experiencing?

A) Depression.

B) Anger.

C) Denial.

D) Bargaining.

6. Faced with the crushing reality of his imminent death, a 72-year-old female patient with advanced pancreatic cancer has become withdrawn and quiet, with her family stating that they believe she is depressed. Which of the following interventions should the nurse prioritize?

A) Creating a physical environment with more natural light and privacy.

B) Emphasize the patient's need for a sustained serotonin reuptake inhibitor (SSRI) to her care team.

C) Provide gentle encouragement and assure the patient that the care team will prioritize her pain control.

D) Focus on being truly with the patient and using therapeutic touch appropriately.

7. Which of the following is the most important nursing action to take during a patient's denial stage of dying?

A) Act as a shock absorber for the patient's emotions while the patient confronts reality.

B) Allow the patient to express the feeling that nothing is right.

C) Accept the dying patient's reactions and provide an open door for honest dialogue.

D) Impress upon the patient and his or her family that the inevitable cannot be postponed.

8. Knowing that she was dying, Mrs. P tried to use her condition to obtain sympathy and special treatment from the staff. Worse, she became angry at the slightest provocation. If a nurse failed to answer a light signal immediately, Mrs. P started cursing loudly. Once, she threw a saucer at a nursing assistant who annoyed her.

How can a nurse who feels disturbed by her handle this patient?

A) Accept Mrs. P's anger without comment, and forget about it.

B) Return Mrs. P's anger to let her feel justified in being difficult.

C) Turn her or his own anger into a joking response to Mrs. P. D) Accept Mrs. P's anger without comment, but talk with a colleague about it.

Page 2

9. Mr. G has been an atheist for many years, although he was raised as a Catholic. In talking with his nurse, he has said he wants nothing to do with organized religion.

Now he is dying and depressed. What helpful advice might the nurse give his family about dealing with Mr. G's depression?

A) Make his physical environment more pleasant.

B) Bring in a priest to visit with him.

C) Make an effort to improve his mood.

D) Stay with him for support.

10. Which of the following statements about hope are accurate? (Select all that apply.)

A) Hope commonly permeates all stages of the dying process.

B) Hope is inappropriate for persons who are dying as there is no hope that the person will survive the experience.

C) A realistic confrontation of impending death does not negate the presence of hope.

D) Hope is one of the classic stages of grief.

E) Hope may provide a caregiver with a sense of a special mission to comfort an individual through the last days.

11. The children and wife of a man dying of renal failure are eager to interact with him as much as possible in the days before his death. Consequently, the daughter has questioned the nurse's decision to administer the man's scheduled hydromorphone, stating that he does not appear to be in pain at the present time and that the drug tends to make him drowsy. What is the nurse's most appropriate first action?

A) Explain the rationale for preventative pain control to the family.

B) Document the family's reservations and administer the drug after they have completed their visit.

C) Administer an analgesic that is less likely to have a sedative effect.

D) Administer a partial dose of hydromorphone to the patient.

12. Mrs. H, age 80, experienced a severe hemorrhagic stroke 7 days ago and is not expected to survive the night. Mrs. H's family is gathered at her bedside with a member of her church's clergy. Her son has taken the nurse aside and asked how the family will be able to tell that their mother is about to die. How can the nurse best respond?

A) “People usually experience a gradual slowing of their heart rate in the hours before death.”

B) “A lack of sweating, even though they have a fever, often means that someone is coming to the end.”

C) “Often as death approaches the individual's eyes stop responding to light or else respond very slowly.”

D) “When a person's veins become prominent from the sudden increase in blood pressure it means the heart is making its final efforts.”

Page 3

13. Miss L is dying. She is pale and irritable, and the hospice nurse thinks she may be in pain. What should the nurse do?

A) Assume that Miss L must be in pain.

B) Ask Miss L if she is feeling pain.

C) Provide Miss L pain relief without asking.

D) Consult Miss L's chart for her previous presentation of pain.

14. An elderly man dying of cancer tells a nurse that his pain is becoming much worse and rates it as 9 on a scale of 0 to 10. What pain relief should be provided?

A) Codeine.

B) Meperidine .

C) Oxycodone.

D) Morphine or hydromorphone.

15. Mr. E is dying and has a great deal of pain. His oncologist is considering adding some alternative measures, such as hypnosis and acupuncture, to the drugs he already takes. What effect may such alternative measures have?

A) They may reduce the required drug dosages or potentiate their effects.

B) They may be useful substitutes for the analgesics.

C) They may interfere with the effects of the analgesics.

D) They may be effective but detract from the nurses' time to care for Mr. E. 16. An elderly dying woman becomes panicky, convinced that she is suffocating. What is a likely cause of the discomfort she is feeling?

A) Dyspnea.

B) Anxiety.

C) Dropping levels of blood gases.

D) Hypokalemia.

17. Even if they are hungry, dying patients may find it difficult to eat and keep food down. To help with this problem, which of the following would be best for a hospice nurse to give such a patient?

A) Small-portioned meals.

B) Analgesia with meals.

C) More nutritious meals.

D) Reduced fluid intake.

18. Four patients with terminal cancer are in a hospital ward. A nurse observing them on her rounds realizes that one may be near death. Which patient is it?

A) Patient A has a rapid, weak pulse.

B) Patient B is not perspiring.

C) Patient C has very red skin.

D) Patient D's blood pressure has risen suddenly.

Page 4

19. When a patient is admitted to a hospital, he or she is asked if an advance directive is available in case terminal care is necessary. What does an advance directive do?

A) It gives the patient's family control over terminal care.

B) It gives the patient control over terminal care.

C) It gives the hospital control over terminal care.

D) It gives the attending physician control over terminal care.

20. The death of an 86-year-old male hospital patient was overshadowed by the fact that his son and his daughter disagreed vehemently on the type and quantity of medical interventions undertaken near the end of their father's life. The daughter insisted, “Dad would want us to do everything reasonable that we could to save him” while the son countered, “He would want to go with dignity, not with tubes sticking out of him.” When should the issue of terminal care and life-sustaining measures have been raised?

A) When the patient received a diagnosis from his primary care provider.

B) When a family meeting could be organized by the care team.

C) When standard interventions had been exhausted.

D) When the patient was first admitted to the hospital.

21. At the beginning of her shift, a nurse has entered the room of a 78-year-old male patient who is in the late stages of liver failure. The patient's son, who has interacted with the nurse appropriately in the past, states, “If you all wouldn't have botched his treatment when he first had this problem he wouldn't be lying here dying.” The nurse would understand that which of the following phenomena may underlie the son's statement?

A) The son is exhibiting the effects of depression common in those experiencing a loss.

B) A common manifestation of anger about the death of a loved one is to direct it elsewhere.

C) The son is reacting inappropriately to his imminent loss.

D) Survivors of a dying individual often attempt to bargain for their return to health.

22. Which of the following interventions is likely to be of greatest benefit to the family of an 81-year-old woman who has just died from a sudden myocardial infarction?

A) Begin working with the family immediately after the woman's funeral has been completed.

B) Negative emotions toward the deceased woman need to be explored before healing can begin.

C) Even though few survivors want to speak directly with a counselor or therapist, it is important to present the opportunity.

D) Survivors benefit from medical support, not just spiritual and psychosocial support.

Page 5

23. Rev. M, a minister in his early seventies, has pancreatic cancer and is expected to die soon. Both his son and daughter visit him often. The son causes trouble for the staff by continually criticizing them for no apparent reason. He also asks repeatedly why his father, a good and loving minister, should have to die at a relatively young age.

The daughter talks and prays with their father and brings him his favorite books for comfort. Although she is obviously distressed, she is already making tentative plans to move out of the family house and into an apartment. These preparations seem callous to her brother, who becomes further angered. Which stages of grief are the two exhibiting?

A) The son has reached the stage of acceptance; the daughter is in the stage of anger.

B) The son has reached the stage of bargaining; the daughter is in the stage of denial.

C) The son is in the stage of anger; the daughter has reached the stage of acceptance.

D) The son is in the stage of denial; the daughter has reached the stage of anger.

24. The hospital's nursing staff becomes very attached to Rev. M. When he dies, the nurse on duty hugs the son and daughter and cries with them. Which of the following is the best description of the nurse's behavior?

A) It would be appropriate in any similar situation.

B) It is appropriate in this situation.

C) It is unprofessional.

D) It is inappropriately emotional.

25. At which point is the level of need of support of the family and friends of a dying individual likely to be the highest and the level of support provided to the family and friends of a dying individual likely to be the lowest?

A) When the dying individual is still living.

B) At the time of death.

C) During the days immediately after the death.

D) During the weeks and month after the death.

Page 6

26. The nursing staff in a palliative care unit are helping an unlicensed care provider, who has had little prior exposure to death, adjust to the unique demands of working in such an environment. Which of the following actions are likely to benefit the care provider? (Select all that apply.)

A) The nurses encourage the care provider to find a confidante outside the hospital in order to avoid showing emotion openly while on duty.

B) The nurses encourage stepping back from intense situations and examining whether strong reactions are impacting the therapeutic relationship.

C) The nurses teach the care provider how to be therapeutic while still maintaining an emotionally detached relationship from patients and their families.

D) The nurses try to help the care provider verbalize emotions and reactions to death.

E) The nurses provide a location on the unit where all staff members can retreat during intense encounters.

27. A nurse is worried about his health because he believes he carries a gene for a fatal disease. What does he need to do for the sake of his own mental health and for that of his seriously ill patients?

A) Work with patients who are likely to recover.

B) Come to grips with his own mortality.

C) Work in the maternity ward.

D) Adopt a cheerful demeanor with all patients.

28. Which one of the following statements about grief and the individual nursing staff member is most accurate?

A) Nursing staff should be hardened to the realities of life and death.

B) It is acceptable for a nursing staff member to allow themselves to be so overcome with grief that they are unable to provide support and care for the dying person and their significant others.

C) Colleagues should help coworkers explore their own reactions to dying patients and recognize when those reactions interfere with a therapeutic nurse–patient relationship.

D) Each nursing staff member should keep their concerns about death and dying to themselves.

Page 7

Answer Key 1. C 2. C 3. C 4. B, A, D, E, C 5. C 6. D 7. C 8. D 9. D 10. A, C, E 11. A 12. C 13. B 14. D 15. A 16. C 17. A 18. A 19. B 20. D 21. B 22. D 23. C 24. B 25. D 26. B, D, E 27. B 28. C

Page 8