(Test Bank) Ebersole and Hess’ Gerontological Nursing and Healthy Aging

Touhy, 5

Nursing

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5th Edition

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Ebersole and Hess Gerontological Nursing and Healthy Aging 5th Edition Touhy Test Bank Chapter 01: Introduction to Healthy Aging Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. A man is terminally ill with end -stage prostate cancer. Which is the best statement about this man’s wellness? a. Wellness can only be achieved with aggressive medical interventions. b. Wellness is not a real option for this client because he is terminally ill. c. Wellness is defined as the absence of disease. d. Nursing interventions can help empower a client to achieve a higher level of wellness. ANS: D Nursing interventions can help empower a client to achieve a higher level of wellness; a nurse can foster wellness in his or her clients. Wellness is defined by the individual and is multidimensional. It is not just the absence of disease. A wellness perspective is based on the belief that every person has an optimal level of health independent of his or her situation or functional level. Even in the presence of chronic illness or whil e dying, a movement toward wellness is possible if emphasis of care is placed on the promotion of well -being in a supportive environment. PTS: 1 DIF: Apply REF: p. 7 TOP: Nursing Process: Diagnosis MSC: Health Promotion and Maintenance 2. In differentiating b etween heNalUthRaSndIwNeGllTneBss.iCn OheMalth care, whi ch of the following statements is true? a. Health is a broad term encompassing attitudes and behaviors. b. The concept of illness prevention was never considered by previous generations. c. Wellness and self-actualization develop through learning and growth. d. Wellness is impossible when one’s health is compromised. ANS: A Health is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves one’s whole being. The concept of illness prevention was never considered by previous generations; throughout history, basic self -care requirements have been recognized. Wellness and self -actualization develop through learning and growth —as basic needs are met, higher level needs can be satisfied in turn, with ever -deepening richness to life. Wellness is possible when one’s health is compromised —even with chronic illness, with multiple disabilities, or in dying, movement toward a higher level of wellness is possible. PTS: 1 DIF: Understand REF: p. 7 TOP: Nursing Process: Evaluation MSC: Health Promotion and Maintenance 3. Which racial or ethnic group has the highest life expectancy in the United States? a. Native Americans b. African Americans c. Hispanic Americans d. Asian and Pacific Island Americans ANS: C As shown in Figure 1.4, Hispanic men and women have the highest life expectancy of all. In 2011, for those of Hispanic origin of any race, the overall life expectancy at 65 years of age was 20.7 more years in 2011 (19.1 years for men and 21.8 years for women). PTS: 1 DIF: Understand REF: p. 6 TOP: Nursing Process: Assessment MSC: Safe, Effect ive Care Environment 4. Historical influences that have shaped the lives of the majority of the in -between cohort in the United States today include which of the following? a. Influenza epidemic of 1918 b. World War I c. Child rearing in the Depression d. World War II ANS: D Those who are in the in-between cohort in 2016 were born between 1915 and 1945. The men were likely to have fought in World War II. The last of the Holocaust survivors are in this group. A person who survived the influenza epidemic would be a t least 98 years old in 2016 and therefore would be considered old -old or a centenarian. Most of those who are of the in-between cohort had not reached childbearing age by the end of the Depression. Individuals in the in-between cohort would not have been old enough to fight in World War II. PTS: 1 DIF: Understand REF: p. 5 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 5. According to researchers, whNichRchaIractGerisBtic.dCo mMost centenarians share? a. Female b. Hispanic c. Living in rural areas U S N T O d. Located in the Midwestern states ANS: A Based on the U.S. census report of 2010, centenarians were overwhelmingly white, female, and living in the urban areas of the Southern states. PTS: 1 DIF: Remember REF: p. 5 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 6. Which nursing intervention is a holistic approach to an older adult? a. Performs glucose testing during the weekly worship service b. Wheels ambulatory adults to exercise when running late c. Assigns female nurses to older women who are Islamic d. Allows older adults in a nursing home to eat meals alone ANS: C N R I G B.C M The nurse uses a holistic approach to the care of an older female adult who is Islamic because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture. Interrupting an older adult’s worship with glucose tes ting 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 adult’s life by testing for glucose before the service begins. In transporting ambulatory adults to the exercise program in wheelchairs to save time, the nurse disregards the need for self -esteem and exercise, both important aspects of physical well -being. Ambulatory adults can walk with assistance, if needed, to exercise programs and can benefit from the ad ditional activity and independence. The nurse can be tempted to allow an older adult to eat meals alone in his or her room if this will motivate the person to eat or if the older adult has dysphasia and is embarrassed. However, although focusing on physica l needs, the nurse ignores psychosocial and other aspects of health and well-being. PTS: 1 DIF: Understand REF: p. 7 TOP: Nursing Process: Evaluation MSC: Health Promotion and Maintenance 7. An older man who resides in a nursing home has a total cholesterol level of 245 mg/dL. Which nursing intervention is most likely to assist this man in achieving his highest level of wellness? a. Instruct him about increasing dietary fiber. b. Ask the health care provider for a low-fat diet. c. Schedule a consultation for him with the dietitian. d. Review a menu with him to choose suitable foods. ANS: D The nurse collaborates with the older adult to choose suitable foods, which is likely to be an effective nursing int ervention tUo heSlp aNn oTlder aduOlt with hype rlipidemia achieve optimal health and well -being; it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol. Informing the older man about dietary fiber offers no control to him because he is not part of the decision. Nursing interv entions developed with the older adult’s collaboration are most likely to help the older adult achieve health and wellness. Collaborating with the health care provider for a low -fat diet is a reasonable approach to help this man with hyperlipidemia to achi eve health and wellness. However, he is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has had some control. Scheduling a consultation with a dietitian is a reasonable approach to an older adult with hyperlipidemia an d is a part of a multifaceted approach to optimizing his health. However, the older adult is more likely to engage in a regimen over which he has input. PTS: 1 DIF: Analyze REF: p. 7 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 8. Which approach requires the nurse to integrate and balance all aspects of an individual’s life into the plan of care? a. Holistic nursing b. Healthy People 2020 c. Maslow’s hierarchy of human needs d. Orem’s self-care requirements ANS: A N R I G B.C M Holistic nursing integrates all aspects of an individual’s life into the plan of care by balancing an individual’s internal and external environment with psychosocial, spiritual, cultural, and physical processes. Healthy People 2020 , an updated document from 2000 that outlines the goals for achieving health in this country, is a mandate for health care professionals to follow with 467 objectives in 28 focus areas. Maslow’s hierarchy of human needs provides a basis for understanding individuals in context and for ranking nursing assessments, diagnoses, goals, and interventions in order of importance. Dorothea Orem’s self-care requirements lists human needs, including the need for air, fluids, nutrition, hygiene, elimination, activity, comfort, relief from suffering, and skin integrity. The nurse helps individuals meet these needs to achieve optimal health and wellness. PTS: 1 DIF: Remember REF: p. 7 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 9. The nurse plans activities for older women born between 1920 and 1930 and who reside in an assisted -living facility. Which is the best intervention for the nurse to implement? a. Have them bake cookies twice a week. b. Conduct interviews for specific interests. c. Arrange dog and cat visits from volunteers. d. Take them to the library for guest speakers. ANS: B The nurse conducts individual interviews with the women to determine their interests and to avoid generalizing; as people live longer, they become more and more unique. Because most of these women are in their 80s and 90s were born between 1920 and 1930 and have generally spent their lives as homemakers, the nurse presumes to know what activities they will enjoy. The nurse avoids arranging group activities until individual interests are determined. In addition, the nurse must assessUforSalleNrgieTs and inOdividual fears of animals before exposing an older adult to a pet visit. Unless it is organized on a voluntary basis, the nurse avoids arranging visits by guest speakers. In addition, the nurse will assess each older woman before an outside visit to avoid embarrassing events, including incontinence a nd hearing and vision problems. PTS: 1 DIF: Analyze REF: p. 5 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 10. Which of the following issues in the care of older adults are identified in Healthy People 2020 ? a. Delineating nursing staffing levels in long term care b. Eradicating pressure ulcers in all care settings c. Identifying minimum levels of training for people who care for older adults d. Instituting mandatory training in identification of elder abuse for all caregivers of older adults ANS: C Identifying minimum training levels for people who care for older adults is one of the issues identified in Healthy People 2020 . The rest of the issues are not discussed in Healthy People 2020 . PTS: 1 DIF: Remember REF: p. 8 TOP: Teaching and Learning MSC: Health Promotion and Maintenance U S N T O 11. An older man asks a nurse: “How do you define aging? Do I meet the criteria of a senior citizen?” The nurse understands that one can define aging in many different manners. If the nurse chooses to define aging as “social aging,” the nurse would consider which of the following aspects? a. The man retired from his job as a police officer. b. The man takes six different medications multiple times over the course of the day. c. The man walks with a rolling walker. d. The man celebrated his 65th birthday. ANS: A Social aging is determined by changes in roles. Taking multiple medications multiple times over the course of the day and walking with a rolling walker are functional determinants of aging. Age refers to chronological aging. PTS: 1 DIF: Understand REF: p. 7 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 12. The holistic health movement has impacted health care in which of the following ways? a. It has focused health care on disease prevention. b. It has reshaped how health and health care are perceived. c. It has improved access to health care. d. It has introduced numerous alternative modalities into health care. ANS: B The holistic paradigm has reshaped how health and health care are perceived. Wellness is seen as a state of being which can be defined anywhere along the continuum of health. PTS: 1 N R I G B.C M DIF: Understand REF: p. 7 TOP: Teaching and Learning MSC: Health Promotion and Maintenance MULTIPLE RESPONSE 1. According to Healthy People 2020 , older adults have been identified as a priority, with a goal to improve their health, function, and quality of life. Identify the targeted chronic focus areas for improvement. ( Select all that apply .) a. Diabetes b. Arthritis c. Congestive heart failure d. Dementia e. Cancer f. Pressure ulcers ANS: A, B, C, D In a push toward wellness, older adults were identified as a priority area for the first time. The targeted chronic areas of focus were identified as diabetes, arthritis, congestive heart failure, and dementia. PTS: 1 DIF: Remember REF: p. 8 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 2. Identify the Healthy People 2020 emerging issues in the health of older adults. ( Select all that apply .) a. Coordinating care for the older adult population b. Assisting older adults in the management of their own care c. Identifying levels of training for those caring for older adults d. Making community resources available for older adults e. Increase in health disparities for rural older adults ANS: A, B, C According to United States Department of Health and Human Services’ Healthy People 2020 , emerging issues in the health of older adults include coordinating care, helping older adults manage their own care, establishing quality measures, identifying minimum levels of training for people who care for older adults, and researching and evaluating appropriate training to equip providers with the tools they need to meet the needs of older adults. PTS: 1 DIF: Remember REF: p. 8 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 3. Researchers hypothesize that most super -centenarians survive and are in good health due to which of the following factors? (Select all that apply .) a. They have a different genetic makeup than other older adults have. b. They tend to live in wealthier areas of the world. c. The exact cause of this phenomenon is not known. d. Contributing factors to their good health include quality medical care and improved social conditions. e. They have large extended families to assist in their care. ANS: C, D The exact cause of super -centenarians’ longevity is not known; researchers describe it as attributable to “rare and unpredictable reasons.” Contributing factors include medical care and improved sociopolitical conditions. There is no known difference in biological or sociological factors between super -centenarians and other older adults. Super -centenarians exist all over the world. PTS: 1 DIF: Understand REF: p. 4-5 TOP: Nursing Proces s: Assessment MSC: Health Promotion and Maintenance 4. The nurse in an assisted living facility (ALF) is preparing a lecture on aging for the residents. The philosophy of the ALF is to approach aging from the viewpoint of health. Based on this philosophy, the nurse includes which of the following topics? (Select all that apply .) a. “The Many Chronic Illnesses of Aging” b. “Channeling Your Inner Strength Toward Wellness” c. “Maximizing Function As You Age” d. “Conserving Your Strength As You Age” e. “Keep Moving, Maintain Your Mobility” ANS: B, C, D A wellness perspective is based on the belief that every person has an optimal level of wellness independent of functional ability. This viewpoint approaches aging with an emphasis on resilience, strength, resources, and capabilities rather than focusing o n existing pathological conditions. PTS: 1 DIF: Analyze REF: p. 6-7 TOP: Teaching and Learning MSC: Health Promotion and Maintenance Chapter 02: Cross -Cultural Caring and Aging Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following is a true statement about differing health belief systems? a. Personalistic or magicoreligious beliefs have been superseded in Western minds by biomedical principles. b. In most cultures, older adults are likely to treat themselves using traditional methods before turning to biomedical professionals. c. Ayurvedic medicine is another name for traditional Chinese medicine. d. The belief that health depends on maintaining a balance among opposite qualities is characteristic of a magicoreligious belief system. ANS: B Older adults in most cultures usually have had experience with traditional methods that have worked as well as expected. After these treatments fail, older adults turn to the formal health care system. Even in the United States, it is common for older adults to pray for cures or wonder what they did to incur an illness as punishment. The Ayurvedic system is a naturalistic health belief system practiced in India and in some neighboring countries. This belief is characteristic of a holistic or naturalistic approach. PTS: 1 DIF: Understand REF: p. 16 -17 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 2. Which of the following consiNdUerRatSioInsNisGmToBs.t lCikOelMy to be true when working with an interpreter? a. An interpreter is never needed if the nurse speaks the same language as the patient. b. When working with interpreters, the nurse can use technical terms or metaphors. c. A patient’s young granddaughter who speaks fluent English would make the best interpreter because she is familiar with and loves the patient. d. The nurse should face the patient rather than the interpreter. ANS: D The nurse should face the patient rather than the interpreter is a true statement; the intent is to converse with the patient, not with a third party about the patient. Many reasons may prevent the patient from speaking directly to a nurse. Technical terms and metaphors may be difficult or impossible to translate. Cultural restrictions may prevent some topics from being spoken of to a grandparent or child. PTS: 1 DIF: Understand REF: p. 18 -19 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 3. An older adult who is a traditional Chinese man has a blood pressure of 80/54 mm Hg and refuses to remain in the bed. Which intervention should the nurse use to promote and maintain his health? a. Have the health care provider speak to him. b. Use principles of the holistic health system. c. Ask about his perceptions and treatment ideas. d. Consult with a practitioner of Chinese medicine. ANS: C Using the LEARN model ( listen with sympathy to the patient’s perception of the problem, explain y our perception of the problem, acknowledge the differences and similarities, recommend treatment, and negotiate agreement), the nurse gathers information from the patient about cultural beliefs concerning health care and avoids stereotyping the patient. In the assessment, the nurse determines what the patient believes about caregiving, decision making, treatment, and other pertinent health -related information. Speaking with the health care provider is premature until the assessment is complete. U nless he accepts the beliefs, principles of the holistic health system can be potentially unsuitable and insulting for this patient. Unless he accepts the treatments, consulting with a practitioner of Chinese medicine can also be unsuitable and insulting f or this patient. PTS: 1 DIF: Apply REF: p. 18 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 4. Which action should the nurse take when addressing older adults? a. Speak in an exaggerated pitch. b. Use a lower quality of speech. c. Use endearing terms such as “honey.” d. Speak clearly. ANS: D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons and fewer of those who are healthy and active. Providers should not assume that all older adults are hearing or mentally impaired. The most appropriate action when addressing an older aduNltUwRoSulIdNbeGtToBsp.eCakOcMlearly. E xamples of un intentional ageism in language are an exaggerated pitch, a demeaning emotional tone, and a lower quality of speech. PTS: 1 DIF: Apply REF: p. 15 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 5. The nurse prepares an older woman, who is Polish, for discharge through an interpreter and notes that she becomes tense during the instructions about elimination. Which intervention should the nurse implement? a. Move on to the discussion about medication. b. Ask the older woman how she feels about this topic. c. Instruct the interpreter to repeat the instructions. d. Have the older woman repeat the instructions for clarity. ANS: B When working with an interpreter, the nurse closely watches the older adult for nonverbal communication and emotion regarding a specific topic and ther efore validates the assessment about the older adult’s tension before proceeding. Because the nurse notices her tension, the nurse temporarily suspends the preparation to validate her assessment. If the nurse proceeds and the older adult is uncomfortable d iscussing elimination, then important instructions can be missed, leading to adverse effects for the older adult. Repeating the instructions can aggravate the older adult’s discomfort. Instructing the older adult to repeat the nurse’s instruction ignores her needs. PTS: 1 DIF: Apply REF: p. 18 -19 TOP: Communication and Documentation MSC: Safe, Effective Care Environment 6. The nurse plans care for an older African American man who is from Jamaica and resides in New York City. Which should the nurse include in planning care? a. Attribute his illness to breaking a voodoo. b. Help him improve social relationships. c. Maintain blood pressure below 120/70 mm Hg. d. Review the principles of the magicoreligious system. ANS: C Because African Americans tend to be at risk for cardiovascular disease and hypertension, the nurse plans to maintain the patient’s blood pressure at or below the current recommendation by the American Heart Association. The nurse can be incorrectly assuming that he practices and believes in the magicoreligious system. The nurse should assess his s piritual beliefs and determine how much they influence his attitudes toward Western health care. The magicoreligious system maintains social relationships in good condition to prevent illness; however, if the older adult does not follow this cultural pract ice, then this goal can be unsuitable. The older adult may not believe in this system; therefore, the information can be irrelevant. PTS: 1 DIF: Apply REF: p. 18 -19 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment 7. Which health belief system uses treatments to repair a body part? a. Holistic b. Biomedical c. Personalistic d. Magicoreligious ANS: B Because dysfunction or a structural abnormality is thought to cause disease, the biomedical system believes in repairing the structural abnormality. The holistic system holds that health is attained through balance. The personalistic system uses treatments such as meditation, fasting, and praying. The magicoreligious system is the same as the personalistic system. PTS: 1 DIF: Understand REF: p. 17 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 8. A nurse is caring for a culturally diverse patient who has missed follow -up appointments with the primary care provider three times over the past year. The patient has a chronic illness that requires periodic monitoring of blood test values. The patient te lls the nurse: “You don’t understand —in my culture, we don’t do things like that. I cannot be troubled with worrying about appointments in the future; I deal with each day as it comes.” The nurse understands which of the following about the patient’s cultu re? a. The culture does not value Western medicine. b. The culture has a different orientation to time than Western medicine. c. The culture is an interdependent culture. d. The culture does not believe in preventative care. ANS: B Time orientation is a culturally constructed factor. Westernized medical care is future oriented. Conflicts between future oriented Westernized medical care and those with a present or past time orientation may arise. Patients are likely to be labeled as n oncompliant for failing to keep appointments. PTS: 1 DIF: Understand REF: p. 15 -17 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment 9. A paper on culture and illness would be likely to include the statement that a. culture is the same as ethnicity. b. ethnic groups always share common geographic origin and religion. c. ethnicity involves recognized traditions, symbols, and literature. d. most members of an ethnic group exhibit identical cultural traits. ANS: C Ethnicity is a complex phenomenon that includes traditions, symbols, literature, folklore, food preferences, and dress. It is a shared identity. Ethnicity is more than just culture. It is social differentiation based on culture. Even within ethnic groups, there is considerable diversity. PTS: 1 DIF: Remember REF: p. 12 TOP: Teaching and Learning MSC: Psychosocial Integrity 10. A home care nurse is caring for an older patient from a different culture who is bedbound and high risk for development of a pressure ulcer . The nurse discusses the plan of care with the patient’s daughter, emphasizing the importance of turning every 2 hours, and posts a turning clock on the wall. When the nurse returns later in the week, the turning clock has been removed, and the patient’s daNuUghRteSr IreNpoGrTts Bth.atCsOheMturns h er mother occasional ly. She states, “I am taking very good care of my mother. You just don’t understand —our ways do not involve doing things on schedules.” The best response by the nurse is: a. “You must follow my guidelines and turn her every 2 hours, or I will not be able to take care of her.” b. “I understand that you value your culture, but culture cannot stop you from providing good care to your mother.” c. ‘I understand that you care very much for your mot her. Perhaps caring for her is too much for you.” d. “How can we best work together to provide the best care for your mother?” ANS: D In providing cross -cultural care, it is important that the nurse work with the patient and family and listen carefully and find a way to include the values and beliefs of the patient in the plan of care. PTS: 1 DIF: Analyze REF: p. 15 TOP: Communication and Documentation MSC: Psychosocial Integrity 11. An older patient learns that she has metastatic cancer. The patient states: “I must have angered God.” This is an example of which type of belief? a. Biomedical b. Magicoreligious c. Naturalistic d. Ayurvedic ANS: B Magicoreligious beliefs view illness as caused by actions of a higher authority. Biomedical beliefs view disease as a result of abnormalities in structure and function and disease caused by intrusion of pathogens into the body. Naturalistic beliefs are bas ed on the concepts of balance; health is seen as a sign of balance. Ayurvedic beliefs are of the oldest known paradigm in the naturalistic system; illness is seen as an imbalance. PTS: 1 DIF: Remember REF: p. 17 TOP: Communication and Documentation MSC: Psychosocial Integrity 12. The term health disparity is defined as a. the systematic elimination of the culture of another resulting in decreased wellness. b. differences in health outcomes among groups. c. the difference between an expected incidence and prevalence and that which actually occurs in a comparison population group. d. the existence of more than one group with differing values and perspective. ANS: B Health disparities are defined as differences in health outcomes among groups. Cultural destructiveness is defined as the systematic elimination of the culture of another. Health inequities are defined as the difference between an expected incidence and prevalence and that which actually occurs in a comparison population group. Cultural diversity is defined as the existence of more than one group with differing values and perspective. PTS: 1 DIF: Remember REF: p. 13 TOP: Teaching and Learning MSC: Psychosocial Integrity MULTIPLE RESPONSE 1. The nurse is assessing an older adult from a culture different than the nurse’s by asking questions from the explanatory model for culturally sensitive assessment. Which question(s) should the nurse ask to follow this model? (Select all that apply .) a. How can we negotiate to solve the problem? b. What treatment can improve your condition? c. Should we try my plan first to see if it helps? d. Can we discuss differences in our plans now? e. How long have you experienced the problem? f. Who, other than me, can make you feel better? ANS: B, E, F Asking about potential therapies is a question from the explanatory model and asks what the individual believes will help clear up the problem. The nurse asks about the duration of the problem as a part of applying the explanatory model. The nurse asks about other disciplines that the individual believes can be therapeutic. This question is based on the LEARN model. PTS: 1 DIF: Apply REF: p. 14 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 2. A nurse caring for older adults must be aware of which consequences of ageism in language? (Select all that apply .) a. Reduced sense of self b. Poor nutritional intake c. Lowered sense of self-competence d. Decreased memory performance ANS: A, C, D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons and fewer of those who are healthy and active. Consequences of ageism have been identified as a reduced sense of self, lowered self -esteem, lowered sense of self-competence, and decreased memory performance. Poor nutritional intake has not been identified as a consequence. PTS: 1 DIF: Apply REF: p. 15 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 3. Which factor(s) is/are associated with the provision of culturally competent care? ( Select all that apply .) a. Cultural awareness b. Cultural knowledge c. Cultural skills d. Cultural connections e. Knowledge of specific details of traditions and practices of all the different cultures ANS: A, B As nurses move toward cult uNraUl RcoSmIpeNteGnTceB, .thCeyOiMncrease their cultur al awareness, knowledge, and skills. Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. Cultural connections have not been identified as a factor. PTS: 1 DIF: Apply REF: p. 15 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 4. A nurse completes a cultural assessment of an older adult who is being admitted to an assisted living facility. Reasons for completing a cultural assessment include (Select all that apply .) a. culture guides decision making about health, illness, and preventive care. b. culture provides direction for individuals on how to interact during health care encounters. c. culture impacts attitudes toward aging. d. all members of a culture react in the same way in similar situations. e. knowledge of culture eliminates health care dispariti es. ANS: A, B, C Although knowledge of culture has the potential to optimize care, not all individuals will respond in the same way to a specific situation. Knowledge of an individual’s culture will not eliminate health care disparities. PTS: 1 DIF: Understand REF: p. 15 -16 TOP: Teaching and Learning MSC: Psychosocial Integrity 5. A nurse in the ambulatory care setting is preparing to do an interview with a non–English -speaking client. The nurse secures an interpreter. To have the most effective interview, the nurse should do which of the following? ( Select all that apply .) a. Look and speak to the interpreter. b. Use technical terminology to ensure accuracy. c. Allow more time for the interview. d. Watch the client’s nonverbal communication. e. Through the interpreter, check whether the client understands the communication. ANS: C, D, E For the most effective interview the nurse should look and speak directly to the client; avoid the use of jargon and technical terminology; observe the client’s nonverbal communications; and clarify understanding by asking the client to state in his or her own words what he or she understood, facilitated by the interpreter. The interview will naturally take longer. PTS: 1 DIF: Remember REF: p. 18-19 TOP: Communication and Documentation MSC: Psychosocial Integrity N R I G B.C M Chapter 03: Biological Theories of Aging and Age-Related Physical Changes Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Decreased functioning of which physical structure is likely to result in decreased metabolism in older adults? a. Kidney b. Thyroid gland c. Brain d. Skeleton ANS: B Secretion of thyroid hormones tends to decrease with age, resulting in a greater likelihood of a slower metabolism, hypothyroidism, and thinning hair and nails. Decreased kidney function leads to dec reased glomerular filtration rate and the ability of the kidneys to concentrate urine and clear waste. Decreasing brain function tends to result in decreased cognitive functioning. Osteoclastic activity tends to decrease with age, increasing the risk for o steopenia and osteoporosis. PTS: 1 DIF: Understand REF: p. 32 TOP: Nursing Process: Assessment MSC: Physiological Integrity 2. An older female patient is reading a large -print magazine and states that reading is difficult for her in the evening. Which intervention should the nurse implement? a. Put a high -intensity lamp aUt theSheNad oTf her beOd. b. Explain to her that the gray-yellow ring around her cornea, arcus senilis, is interfering with visual acuity. c. Put more powerful tubes in the fluorescent room lights. d. Examine her retinas for signs of damage. ANS: A The pupils become gradually smaller with age; therefore, the eye requires three times as much light. A high -intensity light on the object of interest is more effective than increasing the overall room illumination. The arcus senilis does not affect vision. The patient is describing a gradual overall change, not the more localized or sudden effects of macular degeneration or retinal detachment. PTS: 1 DIF: Apply REF: p. 35 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 3. Aging ordinarily leads to decreases in which of the following? a. Creatinine clearance and insulin secretion b. Blood carbon dioxide and saliva production c. Left ventricle -wall thickness and skin healing time d. Serum triiodothyronine (T3) and gastric pepsin ANS: D Serum T 3 and pepsin secretion both decrease with aging. Creatinine clearance declines, but insulin secretion normally remains stable. Saliva production decreases, but blood carbon dioxide normally remains unchanged. Left ventricle wall thickness and skin healing ti me both increase with aging. PTS: 1 DIF: Understand REF: p. 30 -31 TOP: Nursing Process: Assessment MSC: Physiological Integrity 4. Which change in the skin is abnormal in an older person? a. Thinner and more fragile skin b. Red, swollen 3-day-old wound c. Greater number of freckles d. Loss of hair on the extremities ANS: B Although the skin of an older person may require 48 to 72 hours to mount an initial inflammatory response to a wound, increasing redness after that time, particularly with purulent discharge , is a sign of infection. This change is normal as ridges in the skin are lost. Melanin distribution becomes more uneven with age. Hair is commonly lost from the legs and other areas of older adults. Hair loss from the legs is not a sign of peripheral vascular disease. PTS: 1 DIF: Understand REF: p. 27 TOP: Nursing Process: Assessment MSC: Physiological Integrity 5. The nurse designs a group exercise program at a senior center. Which room should the nurse choose for the program? a. Room with a beautiful hardwood floor tastefully appointed with throw rugs b. Spacious room with no wNinUdRowSsIbNutGwTitBh.flCuoOreMscent lighting and a natural stone floor c. Room with a hardwood floor and large windows overlooking a garden area d. End room with a linoleum floor and a fan for ventilation to compensate for the room’s broken air conditioner ANS: C The hardwood floor provides an even surface. If the daylight from the large windows causes a glare problem, then curtains may be used. Throw rugs can slide underfoot and can lead to a fall, particularly when the sense of balance has declined with age. Fluorescent lighting ca n lead to a glare problem, and the irregularities of the natural stone floor can lead to a fall. The linoleum floor also presents a glare problem, and overheating is a risk in older persons who have a reduced sweat -gland response to heat. PTS: 1 DIF: Apply REF: p. 35 TOP: Nursing Process: Assessment MSC: Physiological Integrity 6. The latest trends in medicine encourage health care providers to prescribe nutrient -dense foods and exercise to prevent or delay the shortening of telomeres. On which biological theory of aging are these practices based? a. Genetic research b. Caloric restriction c. Oxidative stress d. Cross -link U S N T O ANS: A Genetic researchers have found that telomeres shorten with each cellular reproduction and continue to do so until the cell dies. Selected animal studies since the 1930s conclude that calorie restrictions of 30% can lead to a longer life expectancy, slower metabolism, lower body temperature, and delay of age -related disorders. The pacemaker theo ry, which is also known as the neuroendocrine control theory, holds that critical functions of selected endocrine glands slow and can halt with age. The cross -link theory suggests that aging is a result of the stiffening of proteins caused by cross -linking , leading to stiffer joints, rougher skin, and decreased cellular elasticity. PTS: 1 DIF: Understand REF: p. 22 -26 TOP: Nursing Process: Assessment MSC: Physiological Integrity 7. During a nursing assessment, an older adult tells the nurse about increasing loss of balance. Further assessment indicates musculoskeletal changes. Which patient teaching should the nurse implement to address musculoskeletal reasons for the loss of balance? a. Exercise with light weights. b. Stand on one foot at a time while s upported. c. Train with the use of sit -ups. d. Work out in a swimming pool. ANS: B The loss of balance from a musculoskeletal perspective is usually caused by a loss of core muscle strength; thus, the nurse suggests standing on one foot at a time while holding o nto a chair back, if necessary, and working to increase the duration of the exercise. Lifting weights helps increase muscle strength. Sit -ups are contraindicated for older adults because they put tremendous amounts of stresNs onRtheIlumGbarBs.piCne. MLow-impact aerobic exercise helps improve conditioning and endurance. PTS: 1 DIF: Apply REF: p. 28 TOP: Nursing Process: Implementation MSC: Teaching and Learning 8. Which age-related change contributes to anorexia and weight loss in older adults? a. Excessive saliva b. Fewer taste buds c. Wearing dentures d. Softened tooth enamel ANS: B The number of taste buds declines with age and can decrease the enjoyment of food, which can result in less motivation to eat and a resulting weight loss or loss of appetite. Saliva production tends to decrease with age. As long as dentures fit properly and the wearer practices good oral hygiene, wearing dentures does not necessarily contribut e to anorexia and weight loss. Older adults tend to lose enamel. PTS: 1 DIF: Remember REF: p. 32 -33 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 9. A nurse is caring for an older adult who asks the following: “I have heard that it is important to eat a diet that is high in fruits and vegetables to age successfully. Is that correct?” The nurse considers which of the following theories of aging when res ponding to the older adult’s question? a. Oxidative stress theory b. Immunological theory c. Free radical theory d. Telomere theory ANS: C Although the intake of supplemental antioxidants is deleterious to one’s health, there is evidence that diets inclusive of natural antioxidants, such as those high in fruits and vegetables or a Mediterranean diet rich in red wine and olive oil, are healthful. PTS: 1 DIF: Apply REF: p. 23 -26 TOP: Nursing Process: Implementation MSC: Physiological Integrity 10. The family member of a patient asks a nurse if vitamin C will prevent aging. In formulating a response, the nurse considers which of the following theories? a. Free radical theory b. Immunological theory c. Oxidative stress theory d. Telomere theory ANS: A The free radical theory posits that aging is a result of random damage from free radicals. Research is ongoing on the ability of substances with antioxidant effects to counter the actions of free radicals. For many yeNarUs,RitSwIasNtGhoTuBgh.t CthOatMconsumption of suppl ement al antioxidants, such as vitamin C, could delay of minimize the effects of aging. PTS: 1 DIF: Apply REF: p. 23 -26 TOP: Nursing Process: Implementation MSC: Physiological Integrity 11. A community health nurse provides an annual flu prevention workshop at a local senior center. The activities include a lecture on preventing infections, which includes hand washing and limiting exposure to individuals who are ill, as well as an influenza i mmunization clinic. The nurse is basing her activities on what theory of aging? a. Free radical theory b. Immunologic theory c. Oxidative stress theory d. Telomere theory ANS: B The immunologic theory of aging describes changes in cells of the immune system, which make an older person more susceptible to infection. Prevention of infection is very important in older adults and can be accomplished by education and immunization. PTS: 1 DIF: Apply REF: p. 23 -26 TOP: Nursing Process: Implementation MSC: Physiological Integrity 12. A nurse is caring for an older patient in the hospital who reports: “I am worried because simple tasks such as balancing my checkbook seem to take me longer. Is there something wrong with me?” The best response by the nurse is: a. “As you age, normal changes in the brain occur that make central processing take longer, so don’t worry.” b. “You have every reason to be concerned. This is an abnormal finding; we need to contact your physician.” c. “As you age, changes in the brain lead to decreased intellectual performance, so don’t worry.” d. “Any changes in function are a cause for worry. You need to be evaluated immediately.” ANS: A As one ages, central processing slows down, which may make performance of tasks slower. This is not an abnormal finding in older adults. Intellectual performance without brain dysfunction remains constant. Many changes in function are part of normal aging. PTS: 1 DIF: Analyze REF: p. 34 TOP: Nursing Process: Implementation MSC: Physiological Integrity 13. An older woman was seen in her physician’s office after falling at home. The patient receives a comprehensive assessment, and it is determined that she has a positive urine culture and is started on antibiotic therapy for a urinary tract infection (UTI). The patient is surprised at the diagnosis. The woman reported that she had experienced some pai n on urination the previous day but did not think that she had a UTI because her temperature was only 99°F. One reason why the patient may not have developed a higher temperature is a. the p atient’s UTI was notNyetRserIiousGenoBu.ghCtoMcause a significant increase in body temperature. U S N T O b. normal age-related changes to the immune system function affect an older person’s response to illness; a low -grade fever may signify serious illness. c. older adults do not run fevers when they are ill. d. this patient likely has an alteration to her immune system that impacts her response to infection. ANS: B Change in immune function affect an older person’s response to illness consistent with the immunologic theory of aging. Older adults typically have lower core body temperatures. A lack of fever cannot be used to rule out infection. The nurse needs to consi der the patient from a holistic perspective. A recent fall is often an atypical presentation of a serious illness or infection. PTS: 1 DIF: Analyze REF: p. 37 TOP: Nursing Process: Implementation MSC: Physiological Integrity MULTIPLE RESPONSE 1. Which factor(s) associated with aging contribute(s) to the high incidence of type 2 diabetes mellitus in older adults? (Select all that apply .) a. Fewer T lymphocytes b. Less lean muscle mass N R I G B.C M c. Decreased thyroid function d. Decreased physical activity e. Left ventricular hypertrophy f. Decreased insulin sensitivity ANS: B, C, D, F Less lean muscle mass means that the body has fewer insulin receptor sites; thus, glucose circulates in the blood stream longer, leading to hyperglycemia and type 2 diabetes mellitus. Decreased thyroid function decreases the metabolic rate. If the metaboli c rate decreases without a corresponding decrease in caloric intake, then the body consumes more food than it needs for its metabolic rate, and hyperglycemia occurs. Decreased physical activity contributes to type 2 diabetes in two ways. First, a less active person has less lean muscle mass than an active person. Second, physical activity helps metabolize glucose; if activity decreases and food consumption does not decrease, then hyperglycemia occurs. Insulin sensitivity decreases with age and increases the need for insulin in older adults. To prevent hyperglycemia, older adults must increase physical activity and decrease food consumption. Fewer T lymphocytes are associated with age -related changes caused by autoimmune reactions wherein the body recognizes itself as a foreign substance and works to destroy it. Type 1 diabetes mellitus is considered an autoimmune di sorder. Left ventricular hypertrophy is not directly related to the increased incidence of type 2 diabetes in older adults; however, if hypertrophy leads to exercise intolerance, then it can be related to an increased incidence of type 2 diabetes. PTS: 1 DIF: Understand REF: p. 31 -32 TOP: Nursing Process: Assessment MSC: Physiological Integrity 2. When caring for an older man patient, the nurse is aware that which changes are associated with the male reproductive sysUtemSandNagiTng? (SeOlect all that apply .) a. Testes soften. b. Seminiferous tubules thicken. c. Sperm count decreases. d. Ejaculation is slower. e. Incontinence is common. ANS: A, B, D Although men have the ability to produce sperm throughout their lives, they also experience changes in the functioning of the reproductive and the urogenital organs in later life. The changes are usually more subtle and noticed only as they accumulate, beg inning when men are in their 50s. The testes atrophy and soften. The seminiferous tubules thicken, and obstruction caused by sclerosis and fibrosis can occur. Although sperm count does not decrease, fertility may be reduced because of a higher number of sp erm lack motility or have structural abnormalities. Erectile changes are also seen; more stimulation is needed to achieve a full erection, ejaculation is slower and less forceful, and refractory periods are longer. Incontinence is not a normal age-related change. PTS: 1 DIF: Understand REF: p. 32 TOP: Nursing Process: Assessment MSC: Physiological Integrity 3. A nurse performs an assessment of an older adult’s oral cavity. Which of the following findings are normal age related changes? (Select all that apply .) a. Missing teeth b. Recession of gums c. A white film on the tongue d. Decreased saliva production e. Gums that bleed easily ANS: A, B, D There are many age -related changes in the oral cavity. With wear and tear, te eth lose enamel and dentin and become more vulnerable to decay. Without care, teeth may be lost. Gums recede, and there is a decrease in saliva production. Bleeding gums is indicative of infection, and a white film on the tongue is also indicative of an infection. PTS: 1 DIF: Understand REF: p. 32 -33 TOP: Nursing Process: Assessment MSC: Physiological Integrity 4. A nurse is caring for an older adult in the hospital who reports decreased hearing. Which of the following interventions should the nurse use when communicating with this patient? (Select all that apply. ) a. Raise the pitch of the voice when speaking with the patient. b. Speak very slowly using simple words when speaking to the patient. c. Face the patient when speaking. d. Decrease background noise when speaking with the patient. e. Obtain a sign language interpreter to speak with the patient. ANS: C, D With normal age-related hearing loss, the patient can still hear, so a sign language interpreter would not be appropriate. In addition, it is not known whether or not this patient is able to communicate in sign language. Presbycusis, age -related hearing loss, is primarily the loss of the ability to he ar high-frequNenUcyRsSoIunNdGs.TTBhe.reCfoOreM, raising the pitch of the voice would not help the situation. Speaking very slowly and using simple words may be seen as demeaning to the patient. It is important to face the patient and to decrease background noise. Facing the patient is helpful if the patient reads lips. PTS: 1 DIF: Apply REF: p. 36 TOP: Nursing Process: Assessment MSC: Physiological Integrity N R I G B.C M Chapter 04: Psychosocial, Spiritual, and Cognitive Aspects of Aging Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. In which context are members of a cohort described when using the age-stratification theory to explain the effect of similar events, conditions, and circumstances? a. Historical b. Biological c. Sociological d. Chronological ANS: A In the age-stratification model, historical context is used to understand members of a cohort in terms of similar events, conditions, and circumstances and the effect these have on the group as a whole. A good example of such a cohort is older adults who lived through World War II. Biological context is not important in considering the age -stratificat ion theory. The age-stratification theory is a sociological theory of aging that uses historical context to describe cohorts. Chronological context of a cohort will span a range, but historical context is what describes the cohort. PTS: 1 DIF: Knowledge REF: p. 42 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. An older patient who was just diagnosed with a terminal disease states, “All my life I attended church, but I am still worried aUbouSt whNat wTill hapOpen after d eath.” The nurse’s best respon se is which of the following? a. “The unknown may be frightening. Do you want to talk about this?” b. “Religious people know that God is a good God.” c. “People that have had near-death experiences say it is peaceful.” d. “You must feel good about attending church most of your life.” ANS: A “Often the unknown is very frightening” uses the reflective technique to identify the patient’s feelings regarding the fear of the unknown. “Religious people know that God is a good God” denies the patient’s feelings. “People that have had near -death experiences say it is peaceful” focuses on the experience of others. “You must feel good about attending church most of your life” ignores the patient’s concern about death. PTS: 1 DIF: Apply REF: p. 48 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 3. The nurse plans care for older adults who are in good health but isolated from their families. If the nurse’s goal is to move the adults toward gerotranscendence, which intervention should the nurse use in the plan of care? a. Give a daily tea party for the group. b. Call each family to encourage visiting. c. Assist them to resume midlife patterns. d. Help each person with individual activities. U S N T O ANS: D In Tornstam’s theory, aging offers the potential for gerotranscendence, a culmination of an individual’s life, wisdom, and spiritual growth that allows older adults to live contentedly with and without social activities. An older adult spends more time on meditation and solitude and less time on materialism and self-consciousness about body image. Individual activities or self-selected activities are satisfactory. Solitude is satisfactory. Midlife patterns are no longer relevant to contentment. PTS: 1 DIF: Apply REF: p. 43 TOP: Nursing Process: Planning MSC: Psychosocial Integrity 4. The nurse observes older women learning advanced knitting techniques. The nurse concludes that this learning activity is suitable for these women because it accomplishes which of the following? a. Helps maintain joint flexibility b. Improves the group’s cohesiveness c. Provides a needed social opportunity d. Adds to their existing knowledge base ANS: D Learning advanced techniques is a suitable activity for older adults because it builds on knowledge they already have. Furthermore, this activity is suitable because it is concrete and practical for experienced knitters to develop advanced skills. Joint flexibility is a physical activity and not necessarily a learning activity. The members share enjoyment of knitting; other than being women and older, the group has no special bond on which to build. The need for socializing is not evident. PTS: 1 N R I G B.C M DIF: Apply REF: p. 50 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 5. The nurse at a nursing home wants to help decrease the risk of Alzheimer’s disease (AD) in the residents. Which should the nurse do to implement this goal? a. Keep the curtains open in their rooms. b. Offer beads for them to string on yarn. c. Show movies that the residents choose. d. Assist residents with ambulation to meals. ANS: D Engaging in physical activity and social interaction are associated with a lower risk for AD. Keeping the curtains open can make a resident’s room more pleasant but is likely to be counterproductive in lowering the risk; brightening the room can entice the resident to stay in the room and decrease social interaction. Stringing beads is a passive and sedentary activity and therefore unlikely to decrease the risk for AD; physical activity is associated with a lower risk for AD. Watching movies is a sedentary but not a mentally stimulating activity for an adult with a normal intelligence. PTS: 1 DIF: Apply REF: p. 50 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 6. Which physiological change in the brain is the reason the nurse allows more time for answering questions with older adults? a. Increased secretion of cholinesterase b. Decreased secretion of neurotransmitters c. Loss of spinal cord and brainstem neurons d. Atrophy of dendrites in the cerebral cortex ANS: D Dendrites ar e the receiving end of neurons (receiving electrochemical signals) and the branched ends extending from the cell body. The atrophy of dendrites contributes to slower thought processes with aging because the synapses are impaired; this changes the transmiss ion of neurotransmitters that are vital in the transmission of an electrical impulse from neuron to neuron. The secretion of cholinesterase, the enzyme that inactivates acetylcholine in the synapse, does not increase with aging. Changes in the transmission of neurotransmitters are associated with the atrophy of dendrites. The spinal cord and the cerebral cortex lose neurons with age, the cerebral cortex more than the spinal cord. PTS: 1 DIF: Understand REF: p. 49 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 7. The nurse provides opportunities for nursing home residents to read aloud to others. Which cognitive skill is this nursing intervention most likely to improve? a. Verbal fluency b. Logical analysis c. Object naming d. Visuospatial skills ANS: A Allowing residents to read aloud helps improve and maintain verbal fluency because it provid es an oppo rtunity to p rNacUtiRceStIheNseGsTkiBll.s.CROeaMding aloud do es not usu ally require analysis. Reading is unlikely to improve object recall unless displaying objects is part of the reading. Visuospatial skills require the ability to perceive the relationship of objects in terms of the space each object occupies; reading is unlikely to improve this skill. PTS: 1 DIF: Understand REF: p. 49 TOP: Nursing Process: Evaluation MSC: Health Promotion and Maintenance 8. Mandatory retirement at age 65 years is consistent with which theory of aging? a. Role theory b. Disengagement theory c. Age-stratification theory d. Social exchange theory ANS: B Disengagement theory states that in the natural course of aging, the individual does and should withdraw from society to allow for the transfer of power to younger generations. PTS: 1 DIF: Apply REF: p. 41 -42 TOP: Nursing Process: Assessment MSC: Psycho social Integrity 9. An older woman retires after a long career as an elementary school principal and begins to volunteer in the local library reading to children. The older woman is very pleased with her volunteer activities. This is consistent with which theory of aging? a. Role theory b. Disengagement theory c. Age-stratification theory d. Social exchange theory ANS: A Role theory posits that self -identity is believed to be defined by one’s role in society. Succ essful aging means that as one role is completed, it is replaced by another or comparative value to the individual. PTS: 1 DIF: Apply REF: p. 41 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 10. An older married couple move to a continuing care retirement community. The older woman who was always very social and outgoing quickly joins an exercise group, a book club, and a knitting circle. The older man who was always very solitary adopts a routine of a long daily walk and registers for an online course in creative writing. The behaviors of the older couple are consistent with which theory of aging? a. Activity theory b. Continuity theory c. Social exchange theory d. Disengagement theory ANS: B Continuity theor y proposes that individuals develop and maintain a consistent pattern of behavior over a lifetime. Aging, as an extension of earlier life, reflects a continuation of the patterns of roles, responsibilities, and activities. Personality influences the roles and activities chosen and the level of satisfaction drawn from these. Successful aging is associated with one’s ability to m aintain an dNcoUnRtinSuIe NprGevTioBu.s CbeOhMaviors and roles. PTS: 1 DIF: Apply REF: p. 41 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 11. A retirement community is divided into different communities with different activities available for the residents of each community. There is one community for individuals ages 65 to 74 years, one for individuals ages 75 to 85 years, and one community for individuals older than age 85 years. This is consistent with which theory of aging? a. Role theory b. Disengagement theory c. Age-stratification theory d. Social exchange theory ANS: C Age-stratification theory is based on the belief that aging can be best understood by considering the experiences of individuals as members of cohorts with similarities to others in the same group. PTS: 1 DIF: Apply REF: p. 42 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity MULTIPLE RESPONSE