Test Bank For Boscart Ebersole and Hess' Gerontological Nursing and Healthy Aging in Canada, Third Edition Chapter 1-28
Chapter 01: Introduction to Healthy Aging Boscart: Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada, 3rd Edition MULTIPLE CHOICE
1. A man is terminally ill with end-stage prostate cancer. What is the best statement about this man‘s wellness? a. Wellness is not possible, because the patient uses medication to assist in management of his medical care. b. Wellness is unfortunately not a real option for the patient. c. Wellness is the same thing as faith healing, and if the patient were more receptive, he could be back at work in a few weeks. d. Nursing interventions can help empower a patient to achieve a higher level of wellness. ANS: D Feedback A B C D
Incorrect. An individual can achieve wellness even if using medications. Incorrect. All persons, regardless of age or life–health situation, can be helped to achieve a higher level of wellness. Incorrect. Biomedical approaches and other treatments and techniques are used to achieve realistic improvements in wellness. Correct. A nurse can foster wellness at all levels of the needs hierarchy.
PTS: 1 DIF: Application OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 2. In differentiating between health and wellness in health care, which of the following statements is true? a. Health is a broad term encompassing attitudes and behaviours. b. The concept of wellness was rarely or never considered by previous generations. c. Wellness and self-actualization develop simultaneously through learning and compromise. d. It is impossible to have wellness when one‘s health is compromised. ANS: A Feedback
A B C D
Correct. Holistically, health includes wellness, which involves one‘s whole being. Incorrect. Throughout history, basic self-care requirements have been recognized. Incorrect. As basic needs are met, higher level needs can be satisfied in turn, with ever-deepening richness to life. Incorrect. Even with chronic illness, with multiple disabilities, or in dying, movement toward higher wellness is possible.
PTS: 1 DIF: Comprehension TOP: NCLEX: Health Promotion and Maintenance
OBJ: 2
3. Which province or territory is predicted to have the fastest growing older-person population in Canada between the years 2006 and 2031? a. Ontario b. British Columbia c. Yukon d. Newfoundland ANS: C Feedback A
B
C
D
Incorrect. As shown in Figure 1-1 in your text, the older-person population of Ontario does not rise as rapidly as the older-person population of Yukon between 2006 and 2031. Incorrect. As shown in Figure 1-1 in your text, the older-person population of British Columbia does not rise as rapidly as the older-person population of Yukon between 2006 and 2031. Correct. As shown in Figure 1-1 in your text, the older-person population of Yukon rises faster than any of the other provinces and territories between 2006 and 2031. Incorrect. As shown in Figure 1-1 in your text, the older-person population of Newfoundland does not rise as rapidly as the older-person population of Yukon between 2006 and 2031.
PTS: 1 DIF: Knowledge OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 4. Historical influences that have shaped the lives of the majority of the middle-old in Canada today include which of the following? a. Influenza epidemic of 1918 b. Immigration from Communist Europe c. Child-rearing during the Depression d. Post-World War II effects ANS: D Feedback A
Incorrect. A person who survived the influenza epidemic would be at least 93
B C D
years old in 2011 and therefore be considered old-old, or centenarian. Incorrect. Those who are middle-old in 2011 were born between 1920 and 1930, before Communism swept Europe. Incorrect. Most of those who are middle-old in 2011 had not reached childbearing age by the end of the Depression. Correct. Those who are middle-old in 2011 were in their teens and twenties during the war; in particular, the men were very likely to have fought in it.
PTS: 1 DIF: Comprehension TOP: NCLEX: Health Promotion and Maintenance
OBJ: 3
5. A nurse prepares for the arrival of older persons evacuated from a forest fire in northern Manitoba to a shelter for short-term care. Which of the following is the priority nursing intervention? a. Demonstrate that the staff is prepared to meet their needs. b. Use individual medical records to develop a medication plan. c. Help older persons to display family photos and memorabilia. d. Help older persons to teach one another a new skill in the shelter. ANS: B Feedback A
B
C
D
Incorrect. Providing safety and security from the fire is evident and implied, as the older persons have been evacuated from danger. The priority nursing intervention is caring for any health concerns; e.g., medication or treatments that were left behind. Correct. The nurse prepares for short-term care by prioritizing the needs of the older persons, and this intervention helps to maintain the therapeutic plan, thereby addressing the need for physiological integrity. Furthermore, the nurse maintains continuity of care by preparing a medication schedule to prevent missed doses of medication. Incorrect. In emergency conditions, the nurse provides basic care relating to safety, security, and physical well-being. Maintaining a sense of belonging is important, but not in emergency conditions. Incorrect. A state of emergency is not the time to develop self-esteem because meeting safety, security, and physical needs is more important.
PTS: 1 DIF: Analysis OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment 6. According to researchers, which characteristic will most centenarians share in the future? a. Being female b. Having dementia c. Being malnourished d. Being wheelchair-bound ANS: A Feedback
A B C D
Correct. Researchers expect women to comprise the majority of centenarians in the future. Incorrect. Gerontologists expect dementia to be common among older persons, but they are not predicting most centenarians will have dementia. Incorrect. Malnutrition is common among older persons, but researchers have not predicted that most centenarians will be malnourished. Incorrect. Decreased mobility is common among older persons, but researchers have not predicted that most centenarians will be confined to a wheelchair.
PTS: 1 DIF: Knowledge OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 7. Which statement describes aging in developing countries? a. Many developing countries have historically had many members live to be centenarians. b. The biggest problem for older persons will be lack of food. c. Most of the world‘s older persons are likely to reside in developing countries. d. Like fertility, life expectancy is increasing, although at a different rate. ANS: C Feedback A B C D
Incorrect. Historically only 2% of the world‘s population was defined as old. Incorrect. The biggest problem of the world‘s oldest persons is most likely to be lack of regular income. Correct. Developing countries contain 62% of the world‘s older persons already. Incorrect. Life expectancy is increasing, but fertility is decreasing worldwide.
PTS: 1 DIF: Knowledge OBJ: 3 TOP: NCLEX: Health Promotion and Wellness 8. The nurse develops a community program to promote exercise for older persons. Which of the following should the nurse include in the exercise program? a. Reinforce the ease of exercising every day. b. Use exercise to relax any dietary restrictions. c. Describe ways to resume exercise after lapses. d. Teach participants that exercise achieves wellness. ANS: C Feedback A
B
C
Incorrect. The nurse tells the participants that achieving wellness takes work and regular effort. Instead of offering false hope, the nurse shares practical advice about how to incorporate exercise into everyday life. Incorrect. The nurse avoids suggesting that older persons can look forward to relaxing dietary or medical restrictions by using a single method because it is unethical to offer false hope, the plan can be ineffective, and the plan can have adverse effects. Correct. Because the path to wellness includes progression as well as regression,
D
the nurse shares information to help participants anticipate these events. The nurse encourages participants by telling them to expect periods of regression, that progress made up to that point is not lost, and how to approach resumption in progress toward wellness with exercise. Incorrect. The nurse avoids instructing older persons to rely on one method of achieving wellness because wellness is achieved by balancing emotional, spiritual, social, cultural, and physical processes.
PTS: 1 DIF: Application OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 9. Determinants of health are the underlying causes of illness and wellness. Which of the following describes the older person who is likely to experience the best overall health and well-being? a. Resides in assisted-living facility, watches television alone, uses herbal remedies, is underweight b. Resides alone, was moved to a new city recently by the family for their convenience, has osteoarthritis c. Has prostate cancer with metastasis to the lungs, is receiving radiation therapy, is wealthy, has a large family d. Uses a wheelchair, has peripheral arterial disease, attends weekly baseball games with three friends ANS: D Feedback A
B
C
D
Incorrect. This older person is not thriving in an assisted-living facility, despite having other people in the facility, as evidenced by television viewing habits and weight, both potential indicators of depression. Various aspects of this person‘s life are unbalanced, thus inhibiting progress on the path to optimal health and wellness. In addition, the use of herbal remedies can be aggravating or precipitating the problems. Incorrect. After a move to a new region, an older person, especially one who lives alone and is moved to a new area for the family‘s convenience, is likely to experience loneliness and isolation until a new social network is established. Thus, although this person has a less-acute health problem, the social isolation is likely to create significant disruption on the path to health and wellness. Incorrect. Although this older person‘s financial resources are plentiful, the existence of a large family does not ensure any type of psychosocial support. Most likely, this person faces a grim prognosis because the prostate cancer has crossed the diaphragm, thus reducing the likelihood of a prolonged life. Correct. Despite a serious chronic illness and mobility restrictions, this person has a social network and planned activities with friends. Further, this older person overcomes mobility issues to pursue personal interests; thus, this person is most likely to experience the best health and well-being because of an optimal functional status.
PTS: 1 DIF: Analysis OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance
10. Which of the following nursing interventions represent a holistic approach to caring for an older person? a. Performs glucose testing during the weekly worship service b. Wheels ambulatory adults to exercise when running late c. Assigns female nurses to older female persons who are Muslim, if requested d. Allows older persons in a nursing home to eat meals alone ANS: C Feedback A
B
C
D
Incorrect. Interrupting an older person‘s worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older person‘s life by testing for glucose before the service begins. Incorrect. In transporting the older persons to the exercise program in a wheelchair to save time, the nurse disregards the need for self-esteem and exercise, important aspects of physical well-being. Ambulatory older persons can walk, with assistance if needed, to exercise programs and benefit from the additional activity and independence. Correct. The nurse uses a holistic approach to the care of an older female person who is Muslim because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture. Incorrect. The nurse can be tempted to allow an older person to eat meals alone in his or her room if this will motivate the person to eat or if the older person has dysphagia and is embarrassed. However, while focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being.
PTS: 1 DIF: Comprehension TOP: NCLEX: Health Promotion and Maintenance
OBJ: 4
11. An older-person male (pronouns he/him) who resides in a nursing home has very high cholesterol levels. Which nursing intervention is most likely to assist this man in achieving his highest level of wellness? a. Instruct him about increasing dietary fibre. b. Ask the health care provider for a low-fat diet. c. Schedule a consultation for him with the dietitian. d. Review a menu with him to choose suitable foods. ANS: D Feedback A
B
Incorrect. Informing the older person about dietary fibre offers no control to the older person because he is not part of the decision. Nursing interventions developed with the older person‘s collaboration are most likely to help him achieve health and wellness. Incorrect. Collaborating with the health care provider for a low-fat diet is a reasonable approach to help this man with dyslipidemia achieve health and wellness. However, the older person is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has some control.
C
D
Incorrect. This is a reasonable approach for an older person with dyslipidemia and is a part of a multifaceted approach to optimizing his health. However, he is more likely to engage in a regimen over which he has input. Correct. The nurse collaborates with the older person to choose suitable foods. This is likely to be an effective nursing intervention to help an older person with dyslipidemia achieve optimal health and well-being because it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol.
PTS: 1 DIF: Analysis OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 12. An older-adult male (pronouns he/him) living in an adult community becomes a widower one month after retirement. Two months later, he has not resumed a weekly outing with his fishing club. Which of the following should the nurse implement? a. Ask the older person why he is not fishing. b. Have club members visit him at home. c. Meet with him to assess his interests. d. Enroll him in a weekly card game. ANS: C Feedback A
B
C
D
Incorrect. The nurse avoids confronting the older person, even in a gentle manner. ―Why‖ questions can be interpreted as confrontational, and the man may be unable or unwilling to articulate a reason. Incorrect. The nurse avoids asking club members to visit him because it removes the older person from the decision making. Although this effort can be well-meaning, it can be misinterpreted as an invasion of privacy. Correct. The nurse meets with the older person to determine how and when to establish new relationships and social activities in light of his wife‘s death. Even though the man engaged in fishing beforehand, the nurse respects the older person‘s wishes and needs as he transitions to a different life. Incorrect. The older person is much more likely to participate in an activity in which he has input. In addition, the nurse‘s action can be misinterpreted as disrespectful because an adult has the right to control his own life.
PTS: 1 DIF: Application TOP: NCLEX: Psychosocial Integrity
OBJ: 2
13. The nurse plans activities for female older adults born between 1930 and 1940 who reside in an assisted-living facility. Which is the best intervention for the nurse to implement? a. Have them bake cookies twice a week. b. Conduct interviews for specific interests. c. Arrange dog and cat visits from volunteers. d. Take them to the library for guest speakers. ANS: B Feedback
A
B
C
D
Incorrect. The nurse incorrectly presumes to know what activities they will enjoy because most of these women are in their 80s, and women born between 1930 and 1940 generally spent their lives as homemakers. Correct. The nurse conducts individual interviews with the older persons to determine their interests and avoids generalizing, because as people live longer, they become more and more unique. Incorrect. The nurse should avoid arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older person to a pet visit. Incorrect. Unless it is done on a voluntary basis, the nurse should avoid arranging visits by guest speakers. In addition, the nurse assesses each older person before outside visits, to avoid embarrassing events related to incontinence and hearing and vision problems.
PTS: 1 DIF: Analysis OBJ: 1 TOP: NCLEX: Health Promotion and Maintenance 14. The nurse plans care for an older male adult (he/him) who lives on Old Age Security pension and a small pension after retirement, and has type 2 diabetes mellitus. Which aspect of this man‘s life should the nurse integrate into a positive approach to his health and well-being? a. He practises effective glucose control. b. He lives alone in a high-rise apartment. c. He lacks low-cost, reliable transportation. d. He attends weekly lunches at his local diner. ANS: A Feedback A
B
C
D
Correct. Practising effective glucose control demonstrates this man‘s resilience and capacity to effectively manage the challenges associated with a chronic illness, and thus is a strength the nurse uses in a positive approach toward his health and well-being. Incorrect. Living alone is not ideal for an older person, especially one with diabetes, because of the potential for loneliness and complications from diabetes such as hypoglycemia. This is a negative aspect of this man‘s life and one which has to be resolved for his safety and well-being. Incorrect. The nurse cannot include this man‘s transportation issues into a positive plan because it is a problem to overcome, not a strength on which to capitalize. Incorrect. Going out to lunch is a positive approach to maintaining good mental health, although eating at a local diner may not be the best approach for controlling his diabetes mellitus.
PTS: 1 DIF: Analysis OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance
15. Mrs. McCloud (pronouns she/her), 70 years old, lives in Attawapiskat and speaks mostly Cree. She is transferred to a hospital in a larger city in Ontario for hemodialysis. While Mrs. McCloud is in hospital, what should the nurse take into account when developing nursing interventions based on health promotion? a. Instruct the older person to monitor her fluid intake on an hourly basis. b. Demonstrate, through pictures, how to eat a healthy, well-balanced diet. c. Ask the older person about her home and how she accesses health care. d. Ask the older person why she did not seek help sooner, to prevent the need for hemodialysis. ANS: C Feedback A
B
C
D
Incorrect. The nurse avoids instructing older persons to monitor their own health, because patients are more likely to engage if they are asked if they are able or want to do so. Incorrect. Even though pictures might be a creative way to engage someone who speaks another language, in isolated communities it is often challenging and expensive to eat a healthy, well-balanced diet. Correct. When the nurse asks the older person about her home, the nurse creates a personal connection with the older person. Finding out about accessibility to health care is important, because services for older persons are limited in rural and remote regions. Incorrect. Asking clients ―why‖ questions can be construed as measuring, evaluating, or confronting, and the older person may not be able to articulate a reason.
PTS: 1 DIF: Analysis OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 16. Mr. Levesque (pronouns he/him), 65 years old, has been living on the street and in homeless shelters for the last three years after having lost his job as a maintenance attendant at a local store. He suffers from alcoholism and appears malnourished upon arrival at the hospital, after falling on the sidewalk and injuring his left shoulder. When implementing a primary health care approach, what is the main principle the nurse should consider with this older person? a. Health promotion b. Accessibility c. Primary care d. Public participation ANS: A Feedback A
B
Correct. Health promotion is the process of enabling people to increase control over and improve their health. Health promotion addresses the determinants of health. It includes health education, public education, nutrition, sanitation, and prevention and control of diseases. Incorrect. Accessibility looks solely at access to health care services and how they can be made more accessible; arriving at hospital indicates that accessibility
C
D
is not necessarily an issue for Mr. Levesque. Incorrect. Primary care is not a principle of primary health care. Primary care is the first contact people have with the health care system. Principles of primary health care include accessibility, public participation, health promotion, appropriate technology, and intersectoral collaboration. Incorrect. Public participation implies that older persons are active partners in making decisions about their health care and the health of their communities. It is difficult to determine if this patient is able to make decisions at this time about becoming an active participant in the health needs of the community.
PTS: 1 DIF: Application OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 17. To help meet the needs of an increasingly ethnoculturally diverse older-person population, which of the following should be done? a. Hire more male nurses. b. Offer more second-language courses in nursing schools. c. Provide more reading material in various languages. d. Increase the number of health care providers from various cultures. ANS: D Feedback A B C D
Incorrect. Gender specific hiring would not address changes in ethnocultural needs. Incorrect. Offering courses in languages other than English would not ensure various cultural needs have been met. Incorrect. Reading materials are not often well utilized for teaching purposes and also would not serve to meet a variety of ethnocultural needs. Correct. Having more HCPs from various cultures would help address the variety of cultures represented in the older-person age group and increase understanding as well as comfort levels.
PTS: 1 DIF: Knowledge OBJ: 3 TOP: NCLEX: Safe and Effective Care Environment 18. How is fertility rate defined? a. b. c. d.
The ability of a person to become pregnant The average number of children born to a person in their lifetime The number of children born to a specific person in their lifetime The inability of a person to become pregnant
ANS: B Feedback A B
Incorrect. Although related to fertility (the quality of being fertile), this is not related to rate. Correct. Fertility rate is the average number of children born to a person in their lifetime; it is reported for countries and global regions.
C D
Incorrect. Fertility rate is not an individualized number. Incorrect. This would be considered infertile.
PTS: 1 DIF: Knowledge OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance
Chapter 02: Gerontological Nursing History, Education, and Roles Boscart: Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada, 3rd Edition MULTIPLE CHOICE
1. Which of the following statements best identifies gerontological nursing? a. Nurses have only recently become involved in the care of the older person. b. Gerontological care, while important, is the smallest specialty group within the Canadian Nurses Association (CNA). c. The purposes of gerontological nursing include promotion of health and support for maximal function. d. Canadian Nurses Association certification is available only for gerontological nurses in research positions. ANS: C Feedback A B C
D
Incorrect. Nurses have always cared for older-person patients. Incorrect. Gerontological care is the largest specialty group within the Canadian Nurses Association. Correct. Promoting health and fostering independence are purposes of the practice, as reflected, for example, in the Canadian Gerontological Nursing Association‘s Standards of Practice. Incorrect. The CNA certification program includes a variety of positions, such as nurse practitioners, clinical specialists, researchers, and administrators.
PTS: 1 DIF: Knowledge OBJ: 1 TOP: NCLEX: Health Promotion and Maintenance 2. Which one of the following Canadian Gerontological Nursing Association Standards of Practice recognizes that certain behaviours are not necessarily related to pathology, but instead may be related to the circumstances within the physical or social environment surrounding older persons? a. Physiological health b. Relationship care c. Responsive care d. Health system ANS: C
Feedback A
B C
D
Incorrect. Physiological health assists clients to maintain homeostatic regulation through assessment and management of physiological care to minimize adverse events associated with medications, diagnostic or therapeutic procedures, health care–associated infections, or environmental stressors. Incorrect. Relationship care occurs when gerontological nurses develop and preserve therapeutic relationship care. Correct. The responsive care approach recognizes that certain behaviours are not necessarily related solely to pathology, but instead may be related to circumstances within the physical or social environment surrounding well older persons and those with dementia, and may be an expression of unmet need. Incorrect. Health system focuses on the economic and political influences that provide or facilitate care that supports access to and benefit from the health care delivery system.
PTS: 1 DIF: Knowledge OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 3. Which of the following is an accurate statement regarding gerontological nursing education? a. Gerontological nursing content has long been integrated into the curriculum of the typical school of nursing. b. Undergraduate nursing programs cover gerontological nursing extensively in dedicated courses, comparable to the coverage of psychiatric nursing. c. Issues most lacking in gerontological nursing education include faculty not being supportive and students lacking interest in this area of nursing. d. Accreditation of a nursing program guarantees that appropriate amounts of gerontological nursing content are included in the curriculum. ANS: C Feedback A B C
D
Incorrect. Only recently has gerontological nursing content begun to appear in nursing school curricula. Incorrect. Most nursing schools still do not have courses dedicated to gerontological nursing. Correct. The most evident issues that are most lacking in gerontological nursing education are lack of expertise in nursing faculty, nonsupportive nursing faculty, the belief that gerontological nursing content is integrated throughout the nursing program, and students‘ lack of interest in this area of nursing. Incorrect. At present, there are no minimum requirements for coverage of care of older persons.
PTS: 1 DIF: Knowledge OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance 4. What was the first formal action taken by the Canadian Gerontological Nursing Association (CGNA) in relation to gerontological nursing? a. The CGNA established the first provincial gerontological nursing association.
b. The CGNA established gerontological nursing standards. c. The CGNA created the Canadian Association of Older Adults. d. The CGNA formed the Canadian Association of Gerontology. ANS: B Feedback A B C D
Incorrect. In Canada, the first provincial gerontological nursing association was formed in Ontario in 1974, prior to the establishment of the CGNA in 1983. Correct. In 1987, gerontological nursing standards were established by the CGNA. Incorrect. The Canadian Association of Older Adults does not exist. Incorrect. The Canadian Association of Gerontology was founded in 1971, 14 years before the Canadian Gerontological Nursing Association (CGNA) was founded.
PTS: 1 DIF: Knowledge OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 5. A male older adult is transferred to a hospice facility with end-stage disease. Which of the following is a suitable nursing intervention for this older adult and his family, according to the Canadian Gerontological Nursing Association‘s Standards of Practice? a. Decrease the analgesic dose to prevent sedation. b. Provide a basin and towels for morning self-care. c. Inform family members about strict visiting hours. d. Facilitate family rituals related to death and dying. ANS: D Feedback A
B
C
D
Incorrect. To promote comfort, the gerontological nurse administers medication as prescribed and avoids restricting analgesia to patients regardless of the setting or the nurse‘s personal views. Incorrect. Although fostering independence is within the scope of gerontological nursing practice, the nurse should assess the older person and family before assuming the older person will want or be able to perform self-care. Incorrect. Although hospice can have regular visiting hours, the older person may need his family at the bedside for comfort, strength, or companionship. Thus, to provide comfort and promote dignity, the gerontological nurse adapts visiting hours to suit the older person‘s needs. Correct. To promote dignity, the nurse facilitates enactment of family wishes, rituals, or religious practices related to death and dying. This nursing action relates to Standard III: Responsive care, and Standard IV: Relationship care.
PTS: 1 DIF: Application OBJ: 2 TOP: NCLEX: Safe and Effective Care Environment 6. A nursing home executive interviews RNs to fill a full-time position for direct patient care, to maintain the standards of older-person care. Which nurse should the nursing home hire? a. A nurse from a certified nursing program
b. A certified gerontological nurse c. A nurse with 15 years of experience d. A gerontological nurse practitioner ANS: B Feedback A B
C D
Incorrect. A nurse educated in a certified university does not necessarily have specialty education and training in gerontology. Correct. A certified gerontological nurse receives education and training to care for older persons, assuring the nursing home and the public that the nurse has mastered the specialized skills and knowledge to care for older persons according to gerontological nursing standards. Incorrect. A nurse with 15 years‘ experience might have no experience with gerontology and offers no proof of specialized knowledge or skills. Incorrect. Although a gerontological nurse practitioner receives specialized education and training in gerontology, the nurse being hired provides primary care in a nursing home.
PTS: 1 DIF: Application OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment 7. The gerontological nurse collaborates with the wound care team about an older person who has an ulcer. How is this nurse demonstrating leadership in the care of an older adult? a. The nurse is screening and assessing older persons effectively. b. The nurse is facilitating access to older person care programs. c. The nurse is coordinating members of the health care team. d. The nurse is empowering older persons to manage chronic illness. ANS: C Feedback A B C
D
Incorrect. Screening and assessing are only indirectly related to collaboration. Incorrect. In this case, the nurse‘s collaborative efforts are unrelated to facilitating access to a program. Correct. The nurse demonstrates leadership in the care of older persons by initiating and coordinating collaboration with the wound care team to improve the health of an older person. This action is congruent with Standard IV: Relationship care of the CGNA‘s Standards of Practice. Incorrect. Thus far, the nurse has not educated or trained this client in wound care.
PTS: 1 DIF: Application OBJ: 5 TOP: NCLEX: Safe and Effective Care Environment 8. Gerontological nurses may be generalists or specialists. In order to prepare a nurse generalist, which of the following nursing practices experience would be the most meaningful and helpful? a. Working with older adults experiencing chronic health conditions found in acute care settings
b. Working with older adults across the continuum of care c. Working with older adults in long-term care facilities, because this is where most older persons reside d. Working with older adults in home care, because the goal is to keep them in their homes as long as possible ANS: B Feedback A
B
C D
Incorrect. Working with older adults experiencing chronic health conditions found in acute care settings is important, but it is only one aspect of caring for older persons. Correct. To prepare nurse generalists, it is important to provide nursing practice experiences with older adults across the continuum of care, not just in acute and long-term care settings. Incorrect. Working with older adults in long-term care facilities is important, but it is only one area of caring for older persons. Incorrect. Working with older adults in home care is important, and it is important to keep older persons in their familiar environment as long as they are safe and can be effectively cared for in their homes, but it is only one area of caring for older adults.
PTS: 1 DIF: Comprehension TOP: NCLEX: Health Promotion and Maintenance
OBJ: 6
9. Mrs. Jaciuk (pronouns she/her), 70 years of age, was admitted to the hospital after a recent fall in her home. Her left cheek is bruised and she complains that her left leg is very sore. After assessment and undergoing a CT scan of her head and an X-ray of her left leg, the physician is ready to discharge her home because there is no evidence of a fracture. Mrs. Jaciuk starts to cry when the nurse enters the room and she begs the nurse to allow her to stay, because she has no one at home and she fears she may fall again. What should the nurse consider when addressing Mrs. Jaciuk? a. Allow Mrs. Jaciuk to express her feelings. b. Understand that hospitals are dangerous places for older persons. c. Speak with the physician and request that Mrs. Jaciuk be allowed to stay another day. d. Instruct Mrs. Jaciuk about fall prevention, based on the Registered Nurses‘ Association (RNAO) Best Practice Guideline. ANS: B Feedback A
B
C
Incorrect. Encouraging Mrs. Jaciuk to express her feelings is important, but this will not address the underlying issue of hospitals being a dangerous place for older persons. Correct. Hospitals are dangerous places for older persons: 34% experience functional decline and iatrogenic complications (29% to 38%), a rate three to five times higher than the rate for younger patients. Incorrect. Requesting that Mrs. Jaciuk be allowed to stay one more day does not address the issue that older persons‘ hospital stay should be as brief as possible.
D
Incorrect. While providing Mrs. Jaciuk with evidence-informed practice information related to falls is valuable, it does not address the potential complications older persons are susceptible to if they stay in hospital.
PTS: 1 DIF: Analysis OBJ: 5 TOP: NCLEX: Safe and Effective Care Environment 10. Leadership in long-term care settings requires balancing the needs of the residents with the well-being of the staff. The turnover rate of Health Care Aides (HCAs) in long-term care facilities is almost 100%. You are working in a long-term care facility and have identified that whenever a particular HCA is unhappy with an assignment, the entire unit has a bad day. Which action should the unit nurse take first to correct this situation? a. Meet with the HCA to find out why the HCA is so unhappy. b. Place the HCA on probation for the negative behaviour. c. Discuss with the HCA the perceived attitude and the way it affects the unit. d. Suspend the HCA until the behaviour improves. ANS: C Feedback A B C
D
Incorrect. Meeting with the HCA to find out why she is so unhappy may lead to a long, drawn out, unproductive meeting. Incorrect. Placing the HCA on probation may only exacerbate the negative behaviour and does not address the behaviour. Correct. The first step is an informal meeting with the HCA to discuss the HCA‘s attitude and how it affects the staff. The manager should document the conversation. Incorrect. Suspension may only create more disharmony among the other HCAs, even if the individual behaving badly has been removed. The unit nurse must remember that turnover rate is approaching 100% and does not serve the residents well.
PTS: 1 DIF: Analysis OBJ: 5 TOP: NCLEX: Health Promotion and Maintenance 11. Advanced practice nurses (APNs) differ in their role from Nurse Practitioners (NPs) in that the APN role is: a. advanced but not considered extended in terms of license and scope of practice b. focused on only gerontological nursing c. a specialized role available only in certain provinces d. paid less for the same work ANS: A
A
B
Feedback Correct. APNs perform all of the functions of generalists but possess advanced clinical expertise, integrate health and social policy, and are proficient in planning, implementing, and evaluating health programs. Incorrect. APNs can work in many varied fields of nursing.
C D
Incorrect. APNs are found across many provinces and countries. Incorrect. Although pay rates may differ, this relates to the role, license, and area.
PTS: 1 DIF: Knowledge OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance
Chapter 03: Communicating with Older Adults Boscart: Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada, 3rd Edition MULTIPLE CHOICE
1. Which of the following is a true statement concerning communication with an older adult who has aphasia? a. Communication should be simplified, using very basic words. b. The older person should be exposed to a variety of different staff members to stimulate rehabilitation. c. A nurse should pay attention to what speech and word recognition patterns the patient uses. d. Alternative or augmentative tools exist for only a few types of aphasia. ANS: C Feedback A B
C
D
Incorrect. In most cases of aphasia, the person retains normal intellectual ability and could easily understand complex language. Incorrect. Having a small number of staff members consistently care for the patient is most helpful, so that they can learn to understand how the person is attempting to communicate. Correct. Nurses are responsible for accurately observing and recording the speech and word recognition patterns of the client and for implementing the speech pathologist‘s recommendations. Incorrect. Tools exist for every imaginable type of language disorder.
PTS: 1 DIF: Knowledge TOP: NCLEX: Physiological Integrity
OBJ: 3
2. Dysarthria is defined by which of the following descriptions? a. Dysarthria is difficulty in coming up with the correct word. b. Dysarthria is difficulty in physically producing the sounds of speech. c. Dysarthria is difficulty in speaking when the person is thinking about what to say. d. Dysarthria is difficulty in understanding speech. ANS: B Feedback A
Incorrect. Difficulty in coming up with the correct word is anomia or anomic aphasia.
B C
D
Correct. Dysarthria is caused by a weakness or incoordination of the speech muscles, interfering with the clarity of speech and pronunciation. Incorrect. Difficulty in speaking when one is thinking about what to say is usually a result of verbal apraxia, which does not interfere when the older person is not thinking about the words. Incorrect. Dysarthria interferes only with the production of speech sounds. Difficulty in understanding speech is encountered in fluent or global aphasia.
PTS: 1 DIF: Knowledge TOP: NCLEX: Physiological Integrity
OBJ: 6
3. Which of the following strategies is most useful for communicating with an older adult who is experiencing cognitive impairment? a. Speak normally, because the older adult can understand what you are saying. b. Communicate infrequently with the older adult, to diminish frustration. c. Correct the older adult and repeat until you are understood. d. Use multiple ways of communicating, such as by gesture and touch, as well as speech. ANS: D Feedback A B C D
Incorrect. Speaking slowly and allowing time for response are useful strategies for simplifying the communication. Incorrect. Communicate frequently with the older adult to diminish frustration and provide reassurance. Incorrect. The implementation of correction is not a useful strategy for encouraging communication and supporting a sense of personhood. Correct. Gesture and touch play an important role in communicating in an encouraging manner.
PTS: 1 DIF: Knowledge TOP: NCLEX: Physiological Integrity
OBJ: 6
4. A patient who has a speech impairment makes a statement that sounds like, ―Peace wing we uh meng meng.‖ What is your response? a. ―I‘m sorry, that doesn‘t make any sense.‖ b. ―Please try to speak more clearly.‖ c. ―Excuse me, I didn‘t understand that.‖ d. ―What would you like me to bring you?‖ ANS: D Feedback A B C
Incorrect. The nurse must believe that the patient is trying to communicate something important enough for the nurse to make the effort to understand it. Incorrect. The patient is speaking as clearly as he or she can. Incorrect. An open-ended reply is likely to frustrate the patient, who will probably answer by simply repeating the original utterance, no more