(Test Bank) Gerontologic Nursing

Meiner, 6

Medicine

Test Bank

6th Edition

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Test Bank for Gerontologic Nursing, The downloadable file consists of 189 pages, and the total size of the file is 4.64 MB. Purchase now only for highly discounted price.

Author(s): Meiner

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GERONTOLOGIC NURSING 6TH EDITION BY MEINER ALL CHAPTERS INCLUDED TEST BAN K Chapter 01: Overview of Gerontologic Nursing Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. In 2010, the revised Standards and Scope of Gerontological Nursing Practice was published. The nurse would use these standards to: a. promote the practice of gerontologic nursing within the acute care setting. b. define the concepts and dimensions of gerontologic nursing practice. c. elevate the practice of gerontologic nursing. d. incorporate suggested interventions from others who practice gero ntologic nursing. ANS: D The current publishing of the Standards and Scope of Gerontological Nursing Practice in 2010 incorporates the input of gerontologic nurses from across the United States. It was not intended to promote gerontologic nursing practice within acute care settings, define concepts or dimensions of gerontologic nursing practice, or elevate the practice of gerontologic nursin g. DIF: Remembering (Knowledge) REF: Page 2 OBJ: 1 -1 TOP: N/A MSC: Safe and Effective Care Environment 2. When attempting to minimize the effect of ageism on the practice of nursing older adults, a nurse needs to first: a. recognize that nurses must act as advocates for aging patients. b. accept that this population represents a substantial portion of those requiring nursing care. c. self-reflect and formulate one’s personal view of aging and the older patient. d. recognize ageism as a form of bigotry shared by many Americans. ANS: C Ageism is an ever -increasing prejudicial view of the effects of the a ging process and of the older population as a whole. With nurses being members of a society holding such views, it is critical that the individual nurse self -reflect on personal feelings and determine whether such feelings will affect the nursing care that he or she provides to the aging patient. Acting as an advocate is an important nursing role in all settings. Simply accepting a fact does not help end ageism, nor does recognizing ageism as a form of bigotry. DIF: Applying (Application) REF: N/A OBJ: 1-9 TOP: Teaching -Learning MSC: Safe and Effective Care Environment 3. When discussing factors that have helped to increase the number of healthy, independent older Americans, the nurse includes the importance of: a. increased availability of in-home care services. b. government support of retired citizens. c. effective antibiotic therapies. d. the development of life -extending therapies. ANS: C The health and ultimate autonomy of older Americans has been positively impacted by the development of antibiotics, better sanitation, and vaccines. These public health measures have been more instrumental in increasing the numbers of healthy, independent older Americans than have in -home care services, government programs, or life-extending therapies. DIF: Remembering (Knowledge) REF: Page 2 OBJ: 3-3 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 4. Based on current data, when presenting an older adult’s discharge teaching plan, the nurse includes the patient’s: a. nonrelated caretaker. b. paid caregiver. c. family member. d. intuitional representative. ANS: C Less than 4% of older adults live in a formal health care environment. The majority of the geriatric population lives at home or with family members. DIF: Applying (Application) REF: N/A OBJ: 3-3 TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment 5. The nurse planning care for an older adult who has recently been diagnosed with rheumatoid arthritis views the priority criterion for continued independence to be the patient’s: a. age. b. financial status. c. gender. d. functional status. ANS: D Maintaining the functional status of older adults may avert the onset of physical frailty and cognitive impairment, two conditions that increase the likelihood of institutionalization. DIF: Remembering (Knowledge) REF: Page 8 OBJ: 1 -6 TOP: Nursing Process: Planning MSC: Physiologic Integrity 6. A nurse working with the older adult population is most likely to assess a need for a financial social service’s referral for a(n): a. white male. b. black female. c. Hispanic male. d. Asian American female. ANS: B The poverty rate among older black women is substantially higher than that seen among males or females of other ethnic groups. White males had the least poverty. DIF: Applying (Application) REF: N/A OBJ: 1-4 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment 7. Which of the following statements made by a nurse preparing to complete a health assessment and history on an older patient reflects an understanding of the general health status of this population? a. “I’ll need to document well regarding the medications the patient is currently prescribed.” b. “I would like to understand how supportive the patient’s family members are.” c. “Most older patients are being treated for a variety of chronic health care issues.” d. “It will be interesting to see whether this patient sees herself as being healthy.” ANS: D It is a misconception that old age is synonymous with disease and illness. The nurse should always determine the patient’s sense of wellness and independence when conducting a health and history assessment. An assessment of medication use and family suppor t is important for any patient. Many older adults do have chronic health conditions, but their perception is more important than a single number. DIF: Applying (Application) REF: N/A OBJ: 1-4 TOP: Nursing Process: Assessment MSC: Health Promotion 8. The nurse is caring for an older adult who has been admitted to an acute care hospital for treatment of a fractured femur. The family expresses concern about the patient’s pending transfer to a subacute care facility. What response by the nurse is best? a. “Acute care facilities lack the long-term physical therapy support your dad requires.” b. “Your dad will be much happier in a more serene, private environment.” c. “The subacute facility will focus on helping your dad maintain his independence.” d. “Insurance, including Medicare, will cover only a limited amount of time here.” ANS: C The transfer of the patient to a subacute facility is based on the need to maintain the patient’s level of function and independence, a task the acute care facility is not prepared to address once the patient is physiologically stable. The patie nt may or m ay not be happier in the new setting; the nurse should not make this judgment. It is true that insurance only pays for a limited amount of time in an acute care facility, but this is not the best reason for the patient to transfer. DIF: Applying (Applicati on) REF: N/A OBJ: 1 -6 TOP: Communication and Documentation MSC: Health Promotion and Maintenance 9. To best assure both the quality of care and the safety of the older adult patient who requires in -home unlicensed assistive personal (UAP) assistance, the geriatric nurse: a. evaluates the competency of the UAP staff. b. assumes the roles of case manager and patient advocate. c. arranges for the needed UAP provided services. d. assesses the patient for functional limitations. ANS: A As more care traditionally provided by professional nurses is being transferred to UAP, the nurse must assume more responsibility for educating, training, and evaluating the competency of UAP staff to provide safe, effective care for the old er adult patient. DIF: Applying (Application) REF: N/A OBJ: 1 -2 TOP: Communication and Documentation MSC: Safe and Effective Care Environment 10. The nurse working with older adults understands what information about certification in gerontologic nursing? a. It is mandatory for those in long-term care settings. b. It is voluntary and shows clinical expertise in an area. c. It allows nurses to be paid by third -party payers. d. It allows nurses to advance their careers in a job. ANS: B Certification is voluntary and shows that a nurse has additional knowledge and expertise in a certain area of practice. It is not mandatory in specific care settings. It does not allow for third -party reimbursement. It may be part of a career ladder progra m, but that is not true of all work settings. DIF: Remembering (Knowledge) REF: Page 2 OBJ: 1-2 TOP: Teaching -Learning MSC: Safe Effective Care Environment 11. A nurse works in a gerontologic clinic. What action by the nurse takes highest priority? a. Serving as a patient advocate b. Educating patients about diseases c. Helping patients remain independent d. Referring patients to home health care ANS: C One of the challenges and priorities of the gerontologic nurse is helping patients maintain their independence. DIF: Remembering (Knowledge) REF: Page 10 OBJ: 1 -2 TOP: Nursing Process: Implementation MSC: Health Promotion 12. A nurse is caring for an older patient in the emergency department. What information about the patient will be most helpful in creating a plan of care? a. Baseline physical and cognitive functioning b. Living conditions and family support c. Medications and current medical problems d. Results of the Mini Mental State examination ANS: A The nurse is encouraged to view older patients as individuals and consider their baseline physical and cognitive functional status as a standard by which to compare the patient’s current status. The other information is also important, but the basis o f individualized care begins with the patient’s strengths and weaknesses. DIF: Applying (Application) REF: N/A OBJ: 1-6 TOP: Nursing Process: Assessment MSC: Health Promotion 13. The faculty member explains to students that many older Americans continue to work past the “retirement age.” What best explains this trend? a. Feeling healthier longer b. Changing financial outlook c. Becoming bored in retirement d. A desire to give back ANS: B As financial situations may have declined as a result of many economic factors, more older adults work past their “retirement age.” The other options may be reasons for some to continue working, but financial necessity is the reason the majority continue t o do so. DIF: Remembering (Knowledge) REF: Page 7 OBJ: 1 -3 TOP: Teaching -Learning MSC: Health Promotion 14. What information does the faculty member teach students about Medicare? a. Covers anyone with end stage renal disease b. Part A covers some prescription costs c. Part B covers inpatient hospital costs d. Part D eliminates the drug “donut hole” ANS: A Although Medicare is primarily for those over the age of 65, it does cover people of any age with end -stage kidney disease. Part A co vers hospital costs. Part B is medical insurance. The “donut hole“ was fixed by the Affordable Care Act. DIF: Understanding (Comprehension) REF: Page 9 OBJ: 1 -3 TOP: Teaching -Learning MSC: Health Promotion 15. A nursing manager notes that many older patients are admitted to the nursing unit for acute problems. What action can the manager take to most benefit this population? a. Provide mandatory education on the needs of the older patient. b. Provide restorative therapy programs designed for this group. c. Ensure staffing numbers are adequate for dependent patients. d. Encourage all nurses to obtain gerontologic certification. ANS: B Many older adults need acute care for sudden illness and injury but live in a state of functional decline, which could possib ly be prevented by establishing a restorative therapy program. The other actions will help the older patients cared for in the u nit, but only to limited degrees. DIF: Applying (Application) REF: N/A OBJ: 1-4 TOP: Nursing Process: Implementation MSC: Physiologic Integrity: Reduction of Risk Potential 16. The dean of a new nursing program wishes to ensure graduates are prepared to care for older patients. What document should guide the dean in designing the curriculum? a. The Nurse Practice Act for that state b. The American Nurses Association (ANA) code of ethics for nurses c. Healthy People 2020 d. The Recommended Baccalaureate Competencies and Curricular Guidelines ANS: D The Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults is an updated version of The Essentials of Baccalaureate Education for Professional Nursing Practice. This document was first published by the American Association of Colleges of Nursing (AACN) in 2008 and was updated in 2010. The other three documents do not have information about curricular requirements to prepare students to care for the older population. DIF: Applying (Applic ation) REF: N/A OBJ: 1 -2 TOP: Teaching -Learning MSC: Health Promotion 17. A nurse wants to plan a community event at a retirement center. What topic would most likely be best received? a. Heart healthy living b. Financial planning c. Avoiding scams d. Ethnic cooking classes ANS: A Older adults are demanding more programs and services aimed at healt h maintenance and promotion and disease and disability prevention. Based on this information, the heart healthy living presentation would be best received. DIF: Applying (Application) REF: N/A OBJ: 1 -3 TOP: Teaching -Learning MSC: Health Promotion 18. What does the bedside nurse understand about his or her role in nursing research? a. Research is only done by doctorally prepared nurses. b. All nurses have a role in delivering research -based care. c. A bedside nurse can be part of a hospital research team. d. The bedside nurse can collect data if the nurse has been properly trained. ANS: B All nurses are charged to deliver patient -centered care based on evidence -based practice, research, quality improvement, and informatics. The bedside nurse is part of an interdisciplinary team that is responsible for redesigning the health care struc ture of the future. DIF: Understanding (Comprehension) REF: Page 13 TOP: Teaching -Learning MSC: Safe Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. The clinic nurse caring for an older diabetic patient with a sixth grade education anticipates that the patient may experience difficulty (Select all that apply.) a. recognizing the importance of keeping clinic appointments. b. following a low-carbohydrate diet. c. paying for insulin and syringes. d. deciding on a primary health care provider. e. naming a health care surrogate. ANS: A, B, C Even though the educational level of the older population has steadily increased, as a population they are less educated than the general population. This deficiency can account for a lack of understanding regarding the need for medical care and the import ance of following a treatment plan. These patients may also have fewer financial resources to devote to health care issues. DIF: Analyzing (Analysis) REF: N/A OBJ: 1-4 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Envir onment 2. The nurse studying the history of gerontologic nursing learns which information about the specialty? (Select all that apply.) a. The number of older Americans is diminishing. b. The geriatric nursing conference group was established in 1962. c. The gerontologic clinical nurse specialist certification was offered in 1989. d. There were no writings about the care of older persons until World War II. e. The first Standards of Practice for Geriatric Nursing was written in 1969. ANS: B, C, E The geriatric nursing conference group was established in 1962, the geront ologic clinical nurse specialist certification was first offered in 1989, and the first Standards of Practice for Geriatric Nursing was written in 1969. The population of older Americans is the fastest -growing subset of the population. Writings about care of the aged can be found from as early as 1900. DIF: Remembering (Knowledge) REF: Page 2 -3 OBJ: 1 -2 TOP: Teaching -Learning MSC: Nursing Process: Assessment 3. The student asks the gerontologic clinic nurse why so many older people are women. What information does the nurse provide? (Select all that apply.) a. Reduced maternal mortality b. Decreased deaths from infectious diseases c. More deaths from chronic disease in men d. More deaths in war occur in men e. Women tend to smoke and drink less than men ANS: A, C, D A decrease in maternal mortality, decreased deaths from infectious diseases, and more chronic illness in men account for the disparity in genders as people age. DIF: Understanding (Comprehension) REF: Page 6 OBJ: 1 -5 TOP: Teaching -Learning MSC: Health Promotion 4. The gerontologic nurse plans community programming for older women, noting what facts about this population subgroup? (Select all that apply .) a. More likely to live alone b. Increased chance of living in poverty c. Taking care of a spouse d. Suffering many chronic diseases e. Living with extended families ANS: A, B, D Older women have a greater chance than men of living alone and in poverty. They also have a greater degree of functional impairment and chronic disease. DIF: Remembering (Knowle dge) REF: Page 6 OBJ: 1 -5 TOP: Nursing Process: Analysis MSC: Health Promotion 5. The nurse knows that the most common causes of death in the older population result from which diseases? (Select all that apply.) a. Cerebrovascular disease b. End-stage kidney disease c. Heart disease d. Cancer e. Diabetes ANS: A, C, D The most common causes of death in the older population are cerebrovascular disease, heart conditions, and cancer. End - stage renal disease and diabetes are not among the top three causes of death. Chapter 02: Theories of Aging Meiner: Gerontologic Nursing , 5th Edition MULTIPLE CHOICE 1. The practitioner who believes in the free radical theory of aging is likely to recommend that the older adult: a. avoid excessive intake of zinc or magnesium. b. supplement his or her diet with vitamins C and E. c. increase intake of complex carbohydrates. d. avoid the use of alcohol or tobacco. ANS: B Vitamins C and E are two naturally occurring antioxidants that appear to inhibit the functioning of the f ree radicals or possibly decrease their production in the body. The free radical theory of aging is not related to zinc, magnesium, carbohydrates, or alcohol and tobacco. DIF: Applying (Application) REF: N/A OBJ: 2-2 TOP: Nursing Process: Planning MSC: Health Promotion 2. To provide effective care to the older adult, the nurse must understand that: a. older adults are not a homogeneous sociologic group. b. little variation exists in cohort groups of older adults. c. health problems are much the same for similar age groups of older adults. d. withdrawal by an older adult is a normal physiologic response to aging. ANS: A The key societal issue addressed by the age stratification theory is the concept of interdependence between the aging person and society at large. This theory views the aging person as an individual element of society and also as a member, with peers , interacting in a social process. The theory attempts to explain the in terdependence between older adults and society and how they constantly influence each other in a variety of ways. Variation exists among the members of a cohort. Health problems are not the same for every individual of the same age. Withdrawal by an older adult is not a normal response to aging but may be a sign of depression. DIF: Understanding (Comprehension) REF: Page 16 OBJ: 2-2 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 3. The nurse is using the eight stages of life theory to help an older adult patient assess the developmental stage of personal ego differentiation. The nurse does this by assisting the patient to: a. determine feelings regarding the effects of aging on the physical being. b. describe feelings regarding what he or she expects the future to hold. c. identify aspects of work, recreation, and family life that provide a sense of self-worth and pleasure. d. elaborate on feelings about the prospect of his or her personal death. ANS: C During the stage of ego differentiatio n versus work role preoccupation, the task for older adults is to achieve identity and feelings of worth from sources other than the work role. The onset of retirement and termination of the work role may reduce feelings of self -worth. In contrast, a perso n with a well -differentiated ego, who is defined by many dimensions, can replace the work role as the major defining source for self -esteem. Determining feelings related to the effects of aging, future death, or what the future may hold is not part of this theory. DIF: Applying (Application) REF: N/A OBJ: 2-4 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 4. A patient is recovering from a mild cerebral vascular accident (stroke). The home care nurse notes that the pat ient is talking about updating a will and planning funeral arrangements. Which of the following responses is most appropriate for the nurse to make? a. “You seem to be preoccupied with dying.” b. “Is there anything I can do to help you?” c. “Are you worried about dying before you get your affairs in order?” d. “Let’s focus on how you are recovering rather than on your dying.” ANS: B According to Peck’s expansion of Erikson’s theory, the older adult who has su ccessfully achieved ego integrity and ego transcendence accepts death with a sense of satisfaction regarding the life led and without dwelling on its inevitability. Th e patient’s action reflects a healthy transition and should be supported. DIF: Applying (Application) REF: N/A OBJ: 2-4 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 5. Your patient’s spouse died recently from a sudden illness after 45 years of marriage. The patient was the primary caregiver for the spouse during this time. The patient is now depressed and withdrawn and has verbalized feelings of uselessness. Which action by the nurse is best? a. Encourage the patient take up a hobby that will occupy some time. b. Explain that volunteering would be an excellent way to stay useful. c. Assure the patient that these feelings of sadness will pass with time. d. Ask the patient to share some cherished memories of the spouse. ANS: B Volunteering will help the patient to interact with people and feel productive and valued for the ability to help others as s tated in the activity theory. A hobby does not offer the chance to help others. Assuring the patient that feelings will pass is fal se reassurance and does nothing to help the patient to be proactive. Reminiscing is a valued activity, but it is not the best ch oice for regaining a sense of usefulness. DIF: Applying (Application) REF: N/A OBJ: 2-4 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 6. A patient has recently been diagnosed with end -stage renal disease. The patient has cried often throughout the day and finally confides in the nurse that “I am going home to be with my Lord.” The nurse’s best response is: a. “The re is no reason to believe the end is near.” b. “Do you want me to call your family?” c. “We have a wonderful chaplain if you’d like me to call him.” d. “I think this is the time for us to pray together.” ANS: C It is important for the nurse to acknowledge the spiritual dimension of a person and support spirit ual expression and growth while addressing spirituality as a component in holistic care without imposing upon the patient. Because the patient has made reference to the Lord, the nurse can safely offer religion -oriented spiritual care. Telling the patient there is no reason to believe that death is near does not help the patient work through emotions. Asking about calling the family is a yes/no question and is not therapeutic. The nurse is assuming too much by saying it is time to pray. DIF: Applying (Application) REF: N/A OBJ: 2-4 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 7. A nurse is responsible for the care of 20 older adults in a unit of an assisted living facility. In order to best address the needs and wants of the entire unit’s population, the nurse: a. strictly adheres to facility policies so that all patients will be treated equally. b. encourages specific age cohorts to gather in the dayroom because they share similar interests. c. has the unit vote on which television programs will be watched each evening. Stuvia.com - The Marketplace to Buy and Sell your Study Material d. schedules the patients’ bath ing times according to their individual preferences. ANS: D Older adults continue to feel valued and viewed as active members of society when allowed to maintain a sense of control over their living environment by attention to personal choices and rituals. Adhering strictly to policies does not allow for individualized care. Not all in the same age cohort will have similar interests. Voting on television programs does not ensur e each individual feels a sense of worth. DIF: Applying (Application) REF: N/A OBJ: 2-5 TOP: Nursing Process: Planning MSC: Psychosocial Integrity 8. An older patient who reports being “healthy enough to cut my own fire wood” is being assessed prior to outpatient s urgery. The nurse recognizes which assessment observation as a possible result of the wear -and-tear theory? a. Swollen finger joints b. Red, watery eyes c. Grimacing when raising left arm d. Bilaterally bruising on the forearms ANS: C This theory proposes that cells wear out over time because of continued use. The pain caused by movement of the shoulder is the observation most likely a result of the patient’s practice of cutting his own firewood. The other choices do not demonstrate continued use that is part of the wear -and-tear theory of aging. DIF: Applying (Application) REF: N/A OBJ: 2-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 9. A nurse cares for many older patients. Which finding should the nurse identify as pathologic in a 72-year-old? a. Two hospitalizations in 6 months for respiratory infections b. Patient reports of sleeping only of 5 to 6 hours each night c. Thinning hair and brittle nails d. Dry, tissue paper –like skin ANS: A Although there is an age -related decrease in immune function, reoccurring infections serious enough to require hospitalization are not considered a norm al age -related finding. Decreased sleeping, thinning hair, brittle nails, and dry skin are all normal signs of aging. DIF: Application (Apply) REF: N/A OBJ: 2-1 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 10. In planning the care for an older adult patient, the nurse will best promote health and wellness by: a. encouraging independent living and self-care. b. scheduling regular cardiac and respiratory health screenings. c. effectively delivering health -related educational information. d. promoting a nutritious diet and an age -appropriate exercise routine. ANS: C Providing well -prepared and effectively delivered health -related educational information will provide the best means of promoting a patient’s ability to impact his or her wellness and general health. Each of the other options is too narrow to be the most e ffective way to promote health and wellness. DIF: Applying (Application) REF: N/A OBJ: 2-5 TOP: Nursing Process: Planning MSC: Health Promotion 11. The student learning about aging theories understands that the main difference between stochastic theories and nonstochastic theories is which of the following? a. Stochastic theories view aging as a random, cumulative process. b. Stochastic theories view aging as similar among all people. c. Nonstochastic theories view aging as a result of psychosocial factors. d. Nonstochastic theories are backed by research, whereas stochastic theories are not. ANS: A Stochastic theories view aging as a result of random events and their cumulative effects. Nonstochastic theories view aging a s a result of predetermined, timed pheno mena. Both are types of biologic theories. DIF: Remembering (Knowledge) REF: Page 17 OBJ: 2-1 TOP: Teaching -Learning MSC: Physiologic Integrity: Physiologic Adaptation 12. Which theory of aging does the student learn is related to problems with DNA transcription? a. Radical theory b. Error theory c. Cross linkage theory d. Wear -and-tear theory ANS: B The error theory poses that errors in DNA transcription lead to aging. The radical theory views the effects of free radicals as critical to aging. The cross linkage theor y states that normally separated molecular structures are bound together through chemical reactions and that this interferes with metabolic processes. The wear -and-tear theory postulates that normal activity causes wear and tear on the body, leading to agi ng. DIF: Remembering (Knowledge) REF: Page 19 OBJ: 2-1 TOP: Teaching -Learning MSC: Physiologic Integrity: Physiologic Adaptation 13. According to which theory does cancer occur as a possible result of aging? a. Radical theory b. Error theory c. Immunity theory d. Pacemaker theory ANS: C Immunosenescence is the term used in immunity theory to describe an age -related decrease in immune functioning. According to this theory, as people age, they are more prone to getting cancer or autoimmune diseases because of this phenomenon. This is a nonstochastic theory. Radical and error theories are both stochastic. The pacemaker theory looks at the interrelated role of the neurologic and endocrine systems and aging. DIF: Remembering (Knowledge) REF: Page 19 OBJ: 2-1 TOP: Teaching -Learning MSC: Physiologic Integrity: Physiologic Adaptation 14. A nurse assesses an older patient who has lost a great deal of weight in a short time. When asked, the patient states this behavior started after the patient read a magazine article on the benefits of extreme caloric restrictions. Wha t response by the nurse is best? a. “That research was done on rodents and not on humans.” b. “You shouldn’t restrict your calories so severely.” c. “You have lost so much weight you need dietary supplements.” d. “You can’t believe everything you read in those magazines.” ANS: A The metabolic theory of aging postulates that organisms have a specific metabolic lifetime and that by lowering metabolic rate, life span can be increased. However, this has been demonstrated in rodents and the nurse should educate the patient on this information. The other options do not give information that will help the patient make an infor med decision as to whether or not to follow this activity. DIF: Applying (Application) REF: N/A OBJ: 2 -1 TOP: Communication and Documentation MSC: Physiologic Integrity: Reduction of Risk Potential 15. A nurse is caring for an older patient who is sedentary and does not want to participate in any activities. What action by the nurse is best? a. Inform the patient about the consequences of immobility. b. Promote activity by explaining the “use it or lose it” concept. c. Tell the patient he or she will feel better by being more active. d. Explain the relationship of being active and being independent. ANS: D Activity increases circulation, provides range of motion, and leads to clearer mental functioning. Activity helps a person remain independent and able to perform activities of daily liv ing (ADLs) and instrumental ADLs. Presenting information in a positive light that encourages the patient to take control of one’s own health is more likely to be successful than stressing the negative such as consequences of immobility or the concept of “u se it or lose it.” Telling the patient that he or she will feel better does not give concrete information the patient can use to make decisions. DIF: Applying (Application) REF: N/A OBJ: 2 -4 TOP: Teaching -Learning MSC: Health Promotion 16. The nurse working wi th older patients teaches the student that disengagement theory potentially causes which problem? a. Fear b. Isolation c. Anxiety d. Malnutrition ANS: B The no -longer supported disengagement theory posed that older people withdrew from society as they aged and that this was a mutually agreed upon behavior. The result would be isolation as the person became focused solely on him - or herself. Fear, anxiety, or malnutrition could be a further consequence, but isolation and withdrawal from society was “expected” according to this theory. DIF: Understanding (Comprehension) REF: Page 22 OBJ: 2 -5 TOP: Teaching -Learning MSC: Psychosocial Integrity 17. The nurse workin g in a long -term care facility used the developmental theory of aging in practice. In caring for a frail, nearly bed bound patient, how can the nurse use this theory? a. Engage the patient in intellectually stimulating activities. b. Encourage the patient to participate in chair exercises. c. Ensure that the patient participates in all the group activities. d. Give the patient small “chores” to do for the facility. ANS: A In this theory, be ing active can mean physical or intellectual activity. The nurse can engage the patient in intellectually stimulating activities that allows the person a sense of satisfaction. The other options all call for physical activity, whic h the patient may or may not be able to perform. DIF: Applying (Application) REF: N/A OBJ: 2-4 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 18. The nurse working at a long -term care facility notes that one patient who is usually outgoing refuses to participate in games that require keeping score. What action by the nurse is best? a. Ask the patient why he or she won’t participate. b. Assess the patient’s level of frustration with these activities. c. Find other activities for the patient to participate in. d. Do nothing; the patient can choose activities to engage in. ANS: B Although it is true that patients should be able to choose activities in which to participate, the best option is to assess t he patient for frustration or anxiety associated with these types of activities. Once that is determined, the nurse can find other activities the patient can engage in successfully and is willing to participate in if the games are not an option. Asking “wh y” questions often puts people on the defensive and is not a therapeutic communication technique. DIF: Applying (Application) REF: N/A OBJ: 2-4 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 19. The nurse planning community events for older people uses sociologic theories to guide practice. Which activity planned by the nurse best fits these theor ies? a. Group exercise programs b. Volunteering at a day care c. Healthy cooking classes d. Reminiscing therapy ANS: B Using the sociologic theories to guide care, the nurse would plan events that allowed the older adult to remain active in the community and a valued member of society. Volunteering would offer the adult a way to stay engaged and provide a service to successive generations. Exercise and cooking classes would more fit in the biologic theories. Reminiscing therapy is a technique using psychological theories. All are good id eas for activities, but the one that specifically uses sociologic theory is the volunteer work. DIF: Applying (Application) REF: N/A OBJ: 2-2 TOP: Nursing Process: Analysis MSC: Psychosocial Integrity 20. What statement by a patient most indicates healthy aging according to Jung? a. “I wish I had traveled more when I was younger because now I can’t.” b. “I am proud of my past accomplishments at work and home raising my kids.” c. “My leg amputation makes things harder, but I still find a way to work.” d. “I still like to read the paper and novels and enjoy a little gardening.” ANS: C This patient shows acceptance of past accomplishments and finds value in him - or herself despite current limitations, which is healthy aging according to Jung. The person who wants to travel more displays remorse. The focus on past accomplishments does not show current acceptance. Rea ding and gardening do not show acceptance of past accomplishments. DIF: Analyzing (Analysis) REF: N/A OBJ: 2-2 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 21. A nurse is trying to teach a hospitalized older patient how to self -inject insulin. The patient is restless and does not seem to be paying attention. What action by the nurse is best? a. Ask if the patient needs to use the bathroom. b. Tell the patient you’ll try again later in the day. c. Ask if the patient prefers that you teach the family. d. Refer the patient for home health care services. ANS: A According to Maslow, physical needs take priority over other activities. This patient may be hungry, cold, tired, or need to use the bathroom. Telling the patient you’ll try again later, asking if you should teach the family, and referring to home he alth care does not provide for any unmet physical needs. DIF: Applying (Application) REF: N/A OBJ: 2-4 TOP: Nursing Process: Implementation MSC: Physiologic Integrity: Basic Care and Comfort 22. The new nurse at a long -term care center asks the director of nursing why he needs to learn so many theories of aging. What response by the director is best? a. “No theor ies have been proven yet.” b. “A wide range of theories allows for holistic care.” c. “It’s required knowledge for certification exams.” d. “All the theories are important, so we use them all.” ANS: B Using a combination of different theories, each with its own focus, allows the nurse to plan individualized, holistic nursing care. DIF: Applying (Application) REF: N/A OBJ: 2-5 TOP: Communication and Documentation MSC: Psychosocial Integrity MULTIPLE RESPONSE 1. According to Maslow, a fully actualized person displays which traits? (Select all that apply.) a. Spontaneity b. Self-direction c. Creativity d. Ethical conduct e. Acceptance of self ANS: A, B, C, E A fully actualized person displays the following characteristics: perception of reality; acceptance of self, others, and natu re; spontaneity; problem -solving ability; self -direction; detachment and the desire for privacy; freshness of peak experiences; identification with other human beings; satisfying and changing relationships with other people; a democratic character structure; creativity; and a sense of values. Maslow does not specify ethical conduct. Chapter 03: Legal and Ethical Issues(FREE) Chapter 03: Legal and Ethical Issues Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. A nurse caring for older adult patients shows an understanding of the implementation of standards of care when: a. dialing the telephone when the patient wants to call his daughter. b. requesting the patient’s favorite dessert on his birthday. c. closing the patient’s door when he is praying. d. reminding the patient to call for assistance before getting out of bed. ANS: D A standard of care is a guideline for nursing practice and establishes an expectation for the nurse to provide safe and appropriate care, such as reminding the patient to call for assistance before getting out of bed. Standards of care may be established on national or regional levels. Dialing the phone for the patient, closing the patient’s door, and requesting a special dessert are not actions that conform to standards of care. DIF: Applying (Application) REF: N/A OBJ: 3-1 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 2. A nurse new to geriatric nursing asks the nurse manager to clarify how to handle a patient’s claim that she has been physically abused. The nurse manager responds most appropriately when stating: a. “I’ll show you where you can find this state’s reporting re quirements.” b. “As a nurse you are considered a ‘mandated reporter’ of elder abuse.” c. “As long as you are reasonably sure abuse has occurred, report it.” d. “You need to report any such claims directly to me.” ANS: A To be responsive to the legal obligation to report reasonably suspicio us acts of abuse and because there is great variation among the states, nurses should determine the specific reporting requirements of their jurisdictions, including where reports and complaints are received and in what form they must be made. The statemen ts that the nurse is a mandatory reporter and that abuse should be reported if suspected are true, but they do not help the nurse learn to handle the complaint. The manage r may want to know about claims of abuse and it may be facility policy to report up t he chain of command, but the nurse is responsible for filing the formal complaint. DIF: Applying (Application) REF: N/A OBJ: 3-8 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 3. The nurse recognizes that a nursing aide likely to abuse an older patient is one who has: a. ineffective verbal communication skills. b. little experience working with the older population. c. poor stress management skills. d. been a victim of abuse. ANS: C It has been shown that the primary abusers of nursing facility residents are nurse aides and orderlies who have never receive d training in stress management. DIF: Remembering (Knowledge) REF: Page 32 OBJ: 3-8 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment 4. An older adult resident of a long -term care nursing facility frequently attempts to get out of bed and is at risk of sustaining an injury. The nurse’s planned intervention to minimize the patient’s risk for injury is guided by: a. the patient’s right to self-determination and to be free to get out of bed. b. an understanding that nondrug interventions must be tried before medications. c. the knowledge that application of a vest restraint requires a physician’s order. d. the patient’s cognitive ability to understand and follow directions. ANS: B The drug use guidelines are based on the principles that certain problems can be handled with nondrug interventions and that such forms of treatment must be ruled out before drug therapy is initiated. The patient does have the right to self - determination, but the staff must ensure the patient’s safety. Vest restraints do require an order, but environmental measures must be tried before chemical or physical restraints. The patient’s cognitive abilities do not allow for unjustified physical or chemical restraints. DIF: Remembering (Knowledge) REF: Page 35-6 OBJ: 3-7 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 5. During the state inspection of a skilled nursing facility, a surveyor notes suspicion that a particular nurse may not be providing the proper standard of care. The nurse manager informs the nurse to expect: a. a review of the situation by the state board of nursing. b. termination of employment from the facility. c. mandatory remediation related to the suspect care issues. d. unannounced reevaluation of performance within the next 3 months. ANS: A In such cases, the surveyor may forward the record showing the relevant findings to the appropriate state agency or board for review of the nurse’s practice, requesting a determination of whether the nurse may have violated the state’s nurse practice act. Regulations do not specify that the nurse be terminated, have remediation, or have an unannounced reevaluation. DIF: Understanding (Comprehension) REF: Page 37 OBJ: 3 -1 TOP: Communication and Documentation MSC: Safe and Effective Care Environment 6. An 87 -year-old patient is unsure of the purpose of a living will. The nurse describes its purpose best when stating: a. “It’s a legal document that Social Services can help you create.” b. “It designates a family member to make decisions if you become incompetent.” c. “It provides a written description of your wishes in the event you become terminally ill.” d. “It assures you won’t be subjected to treatments you don’t want.” ANS: C Living wills are intended to provide written expressions of a patient’s wishes regarding the use of medical treatments in the event of a terminal illness or condition. DIF: Understanding (Comprehension) REF: Page 39 OBJ: 3-10 TOP: Teaching -Learning MSC: Safe and Effective Care Environment 7. The nurse is caring for an unresponsive patient who has terminal cancer with a Do Not Resuscitate order in effect. A family member tells the nurse, “I’ll sue you and every other nurse here if you don’t do everything possible to keep her alive.” The nurse understands that protection from legal prosecution in this situation is provided by: a. legal immunity granted when acting according to the patient’s expressed wishes. b. the legal view that the duty to put into effect the patient’s wishes falls to the physician. c. knowledge of and compliance with facility policies and procedures regarding end-of-life care. d. implementing interventions that preserve the patient’s right to self -determination. ANS: C In this case, immunity applies onl y to the physician and not to the nurse because the physician is given the legal duty to put into effect the patient’s wishes. Consequently, the nurse must rely on effective communication with the physician, patient, and family, and on the quality of the facility’s policies and procedures, to be sure that his or her actions are consistent w ith the legally required steps. DIF: Understanding (Comprehension) REF: Page 42 OBJ: 3-10 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 8. The nurse is caring for a terminally ill older patient who has a living will that excludes pulmonary and cardiac resuscitation. The family expresses a concern that the patient may “change her mind.” The nurse best reassures the family by stating: a. “The nursing staff will watch her very closely for any indication she has changed her mind.” b. “We will discuss her wishes with her regularly.” c. “She can change her mind about any provision in the document at any time.” d. “Your mother was very clear about her wishes when she signed the document.” ANS: A AMD provisions appropriately provide that people can change t heir minds at any time and by any means. Nurses need to be alert to any indications from a patient. Based on the person’s medical condition, subtle signs such as a gesture or a nod of the head may be easily overlooked. The patient may or may not be able to discuss her condition. Stating that the mother was very clear in her wishes does not take into account the fact that patients can change their minds any time. DIF: Applying (Application) REF: N/A OBJ: 3-7 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment 9. A patient residing in a long -term care facility has been experiencing restlessness and has often been found by nursing staff wandering in and out of other patients’ rooms during the night. The nurse views the patient’s PRN antip sychotic medication order as: a. an appropriate intervention to help assure his safety. b. an option to be used only when all other nondrug interventions prove ineffective. c. inappropriate unless the physician is notified and approves its use. d. not an option because it should not be used to manage behaviors of this type. ANS: D Reasons for the use of antipsychotic drugs do not include behavio rs such as restlessness, insomnia, yelling or screaming, inability to manage the resident, or wandering. The staff must provide nondrug alternatives to help calm the patient. DIF: Analysis (Analyze) REF: N/A OBJ: 3-7 TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment 10. An alert but disoriented older patient lives with family members. The home health nurse, being aware of the role of patient advocate, recognizes the obligation to report possible patient ab use based on: a. a family member stating, “It’s hard being a caregiver.” b. assessment showing bruises in the genital area. c. observation of mild changes in orientation. d. patient’s report of always being hungry. ANS: B Even when a patient exhibits disorientation, any report of mistreatment or neglect is to be considered reasonably suspicious and so should be reported. Bruises in the genital area raise suspicions of abuse. The family stating caregiving is hard does no t mean they don’t have enough support to cope. Mild changes in orientation may be expected in a disoriented patient. The patient who is always hungry should be followed up with a nutrition assessment, and this may or may not be a sign of abuse. DIF: Application (Apply) REF: N/A OBJ: 3 -8 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment 11. An older adult patient has been approached to participate in a research study. The nurse best advocates for the patient’s right of self-determination by: a. evaluating the patient’s cognitive ability to understand the consequence of the study. b. determining what risks to the patient are involved. c. discussing the importance of the study with the patient and his family. d. encouraging the patient to discuss the decision with trusted family or friends. ANS: A The right to self -determination has its basis in the doctrine of informed consent. Informed consent is the process by which competent individuals are provided with information that enables them to make a reasonable decision about any treatment or intervent ion that is to be performed on them. The other options do not address autonomy and self -determination. DIF Applying (Application) REF: N/A OBJ: 3 -7 TOP: Communication and Documentation MSC: Safe and Effective Care Environment 12. A nurse responsible for the care of older adult patients shows the best understanding of the nursing standards of practice when basing nursing care on the: a. physician’s medical orders. b. stated requests of the individual patient. c. care that a responsible geriatric nurse would provide. d. implementation of the nursing process. ANS: C Nursing standards of practice are measured according to the expected level of professional practice of those in similar roles and clinical fields. Nursing care is not judged against the physician’s orders, stated requests of the patient, or implementa tion of the nursing process. DIF: Remembering (Knowledge) REF: Page 30 OBJ: 3-1 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 13. The nurse caring for an older patient who resides in an assisted living facility is asked to obtain and witness the patient’s signature on a living will document. The nurse responds most appropriately when stating: a. “I will, because such a document is so valuable to the patient’s plan of care.” b. “I’ll ask the patient’s family if they agree that the patient should sign the document.” c. “First I need to discuss the purpose of this document with the patient.” d. “I’m sorry but I cannot ethically do that.” ANS: D It is not permissible for the nurse to secure the patient’s signature or to witness the patient’s signature on a living will document. Generally speaking, an employee or owner of a facility in which the patient resides cannot witness this document. DIF: Application (Apply) REF: N/A OBJ: 3 -9 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 14. A graduate nurse learns about the provisions of the Health Insurance Portability and Accountability Act (HIPAA), which include which of the following? a. Requires employers to offer health care insurance b. Regulates the amount employers can charge for insurance c. Mandates that employers provide specific benefits d. Helps maintain coverage when a person changes jobs ANS: D HIPAA has several provisions, one of which is that it helps people maintain health care insurance when they are changing jobs. The other statements are common misconceptions about HIPAA. DIF: Rememb ering (Knowledge) REF: Page 31 OBJ: 3-5 TOP: Teaching -Learning MSC: Safe Effective Care Environment 15. The nurse manager in a long-term care facility reviews resident care plans at what interval? a. Quarterly b. Every 60 days c. Annually d. When changes occur ANS: A The resident care plan is routinely reviewed quarterly. DIF: Remembering (Knowledge) REF: Page 33 OBJ: 3-1 TOP: Nursing Process: Assessment MSC: Safe Effect ive Care Environment 16. The manager of a long -term care facility is evaluating patients’ use of drugs. The resident on which of the following medications would be allowed to continue taking medications to control behavior? a. On anxiolytics; now able to participate in group activities b. Given a benzodiazepine at night; roommate now sleeps well c. Given sedatives; eats 100% of meals if resident is fed d. Taking an antipsychotic; no longer wanders at night ANS: A Drugs should not be used to control behavior. If used to manage health conditions, the patient should show improvement. The patient who is now able to participate in activities shows an increase in functional ability, so this medication is therapeutic for this patient. The other patients are given drugs to control behavior. DIF: Applying (Application) REF: N/A OBJ: 3-7 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 17. To meet current guidelines regarding incontinence in a long -term care facility, what action by the director of nursing is best? a. Assess residents for the ability to participate in a bladder training program. b. Take all residents to the toilet every 2 hours and after meals. c. Ensure all residents wear incontinence briefs, which are changed routinely. d. Ask physicians and other providers to prescribe medications for bladder control. ANS: A Urinary incontinence is a common problem that can lead to several complications. The extent to which residents participate in bladder training programs is an area of focus for facility inspectors. Some residents may need routine toileting, wearing briefs, and medications, but they should all be assessed for the ability to participate in bladder training. DIF: Applying (Application) REF: N/A OBJ: 3-4 TOP: Nursing Process: Assessment MSC: Physiologic Integrity: Reduction of Risk Potential 18. The director of nursing at a long -term care facility is getting ready for the annual inspection. What information guides the director? a. Visits cannot be unannounced. b. The director must be off site during the inspection. c. Nurses must answer questions from the inspectors. d. Results will be sha red only through the mail. ANS: C Nurses present during inspections must answer questions posed by the inspectors. Visits can be unannounced. The director should be present during the survey. Results are shared during a conference, then a report is mailed later. DIF: Remembering (Knowledge) REF: Page 36 OBJ: 3 -4 TOP: Communication and Documentation MSC: Safe Effective Care Environment 19. The nursing student learns about the Patient Self-Determination Act. What is a key provision of this act? a. It establishes new rights for patients in medical facilities. b. It requires facilities to educate patients on their rights. c. It allows families to be approached for organ donation. d. It spells out the procedures for creating an advance directive. ANS: B The intent of this law is to ensure that patients are given information about the extent to which their rights are protected under state law. It does not establish new rights, is not related to organ donation, and does not specify procedures for advance directives. DIF: Remembering (Knowledge) REF: Page 42 OBJ: 3-7 TOP: Teaching -Learning MSC: Safe Effective Care Environment MULTIPLE RESPONSE 1. To best address the patient’s right to self -determination, which of the follow questions does the nurse ask at the time the patient is admitted to a nursing facility? (Select all tha t apply.) a. “Do you understand what a living will and durable power of attorney are?” b. “If you have already prepared an advance care directive, can you provide it now?” c. “Are you prepared to discuss your end-of-life choices with the nursing staff?” d. “Have you discussed your end-of-life choices with your family or designated surrogate?” e. “Would you like help with preparing a living will or a durable power of attorney?” ANS: A, B, D, E All the correct options address the patient’s right to make an informed decision regarding health care issues by using va rious advance directives. The patient does not need to discuss end -of-life choices with the staff in order to exercise the right to self - determination. DIF: Application (Apply) REF: N/A OBJ: 3 -7 TOP: Integrated Process: Teaching -Learning MSC: Safe and Effective Care Environment 2. What provisions for nursing service are part of the Omnibus Budget Reconciliation Act (OBRA) as it pertains to long -term care facilities? (Select all that apply.) a. Resident assessments b. Annual screenings c. Minimum staffing d. Ensuring resident rights e. Registered nurse educational requirements ANS: A, B, C, D OBRA’s service requirements include resident assessments and screenings, minimum staffing requirements, and ensuring resident rights. Ed ucational requirements for nurses are not part of this mandate. DIF: Remembering (Knowledge) REF: Page 33 OBJ: 3-4 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 3. The director of nursing at a certified long -term care facility overhauls the nursing assistant training program to include which features? (Select all that apply.) a. 12 hours of classroom content b. Training in infection control measures c. Instruction on resident rights d. 6 hours of quarterly in -service education e. Education on safety measures ANS: B, C, D, E Requirements for a nursing assistant’s education includes training in infection control and interpersonal skills, instruction on resident rights and safety procedures, and 6 h ours of education through in -services quarterly. Nursing assistants must have classroom training before working with residents, but the amount of time is not specified. DIF: Applying (Application) REF: N/A OBJ: 3-3 TOP: Teaching -Learning MSC: Safe Effective Care Environment 4. The adult child of a long -term care facility resident receives a phone call from the director of nursing stating that her parent has 30 days to move out of the home. Under what conditions can a facility require a resident to move ?(Select all that apply.) a. Nonpayment for services received b. Needs exceeding what the facility can provide c. Stay is no longer required based on the resident’s medical condition d. Facility is going out of business e. Frequent disruptive behavior during the night ANS: A, B, C, D A facility can require a resident to leave in four situations: nonpayment for services, needs that exceed what the facility c an provide, the patient’s medical condition no longer warrants long -term care, or the facility is going out of business. Being disruptive is not a cause for expelling a resident. Chapter 04: Gerontologic Assessment Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. The geriatric nurse recognizes that the body’s homeostatic mechanisms may be compromised in the: 79-year-old with moderate Alzheimer disease who requires assistance with all activities of daily living a. (ADLs). b. 73-year-old with a history of chronic bronchitis who lives with family. c. 86-year-old who lost a spouse and is moving into an assisted living facility. d. 69-year-old with peripheral vascular disease who is visited by home health care weekly. ANS: C Declining physiologic function and increased prevalence of disease, particularly in the old -old (age 85 or older), are in part a result of a reduction in the body’s ability to respond to stress through all of its homeostatic mechanisms. The important poi nt is that older adults often encounter profound and repeated losses; the time between the occurrences of these losses is often short, resulting in an inadequate period for resolution and return to a baseline state, thus putting them at risk for illness. Although the other patients may have compromised homeostatic mechanisms, the 86 -year-old patient is most likely to exhibit this phenomenon. DIF: Analyzing (Analysis) REF: N/A OBJ: 4-2 TOP: Nursing Process: Diagnosis MSC: Physiologic Integrity 2. To best minimize patient anxiety and help ensure a successful history assessment interview, the geriatric nurse first: a. asks whether the patient has any questions about the interview. b. makes sure the interview area is comfortable and private. c. explains the reason for asking the questions. d. assures the patient that all answers will be kept confidential. ANS: C To ensure a successful int erview, the nurse should explain the reason for the interview to the patient followed by a brief overview of the format to be followed. This helps alleviate anxiety and uncertainty, and the patient can then focus on providing the information. The other opt ions are all important actions during the assessment interview, but they will not diminish anxiety as much as an explanation of the purpose. DIF: Applying (Application) REF: N/A OBJ: 4-1 TOP: Nursing Process: Implementation MSC: Emotional Needs Related to Health Problems 3. An older patient is admitted for bacterial pneumonia. The only abnormal assessment values include a heart rate of 102 beats per minute, slight cyanosis of the nail beds, and mild confusion. The patient’s daughter questions the po ssibility of pneumonia stating, “He isn’t coughing or having any difficulty breathing.” The nurse responds most appropriately by saying: a. “We are lucky to determine the problem in its early stage.” b. “Respiratory problems develop only after the infection is well established.” c. “People your dad’s age often lack the muscular strength to cough.” d. “Older adults frequently lack the typical signs of a respiratory infection.” ANS: D The characteristic presentation of illness in older adults is more commonly one of blunted or atypical signs and symptoms. Stating, “we are lucky to determine the problem” does not give any useful information. Respiratory problems are often present early on in younger people. The lack of coughing is not caused by weakness. DIF: Understanding (Comprehension) REF: Page 57 OBJ: 4 -2 TOP: Teaching -Learning MSC: Physiologic Integr ity 4. A nurse aide working in the geriatric unit’s dining room tells the nurse that a patient who was oriented to time and place this morning is now confused about what day it is and why she’s “here.” The nurse appropriately directs the nurse aide to: a. take the patient back to her room and put her safely in bed. b. place a falls risk identification bracelet on the patient and add the status care plan. c. immediately take the patient’s vital signs and report them to her. d. reorient the patient to time and place frequently and document the patient’s response. ANS: C A sudden change in an older adult patient’s cognitive status is likely a symptom of a physiologic stressor such as an infecti on. The vital signs will allow the nurse to determine the presence of a fever or other deviation from the patient’s baseline vita ls. The patient may or may not need or wish to go to bed, but this does not provide any data for the nurse to evaluate. An ill patient may need to be on fall precautions, but again this does not provide data. Reorientation may be necessary, but if the patien t has an illness, this needs to be taken care of. DIF: Applying (Application) REF: N/A OBJ: 4-2 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 5. The nurse most effectively implements guided reminiscence during a patient interview by: a. reminding the patient to share important memories of the past. b. scheduling several short interviews rather than one long one. c. controlling the interview by selecting the memories to be discussed. d. encouraging the patient to relive his or her memories while maintaining focus. ANS: D This goal -directed interviewing process helps the patient share pertinent information through remembering. The tendency to reminisce may make it difficult for the patient to stay focused on the topic, so it is the nurse’s responsibility to refocus the interview when necessary. Reminding the patient to share memories, using several short interviews, and controlling the interview do not make best use of this technique. DIF: Applying (Application) REF: N/A OBJ: 4-4 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 6. To establish a mutually respectful relationship with an older adult patient being admitted to a skilled nursing unit, the nur se first introduces himself and then asks: a. how the patient would like to be addressed. b. if the patient has any specific requests to make of the staff. c. the patient to share a little about his or her personal likes and dislikes. d. the patient to read the orientation materials that the facility provides. ANS: A Respect is shown best by acquiring knowledge regarding the preferences held by a patient; using the patient’s surname is preferred unless the patient directs the staff to do o therwise. The other options are too narrow in focus to establish a mutually respectful relationship. DIF: Applying (Application) REF: N/A OBJ: 4-4 TOP: Integrated Process: Caring MSC: Psychosocial Integrity 7. The nurse showing the best understanding of how personal attitude affects the interview process during a health assessment of an older adult patient is one who: a. proceeds with the interview as if the patient were not an older adult. b. incorporates therapeuti c communication into the assessment process. c. treats all patients with respect regardless of age. d. has self -reflected on his or her own feelings regarding aging. ANS: D The nurse’s own anxiety and fear of personal aging as well as a lack of knowledge regarding older people contribute to commonly held negative attitudes, myths, and stereotypes about older people that interfere with a successful, effective assessment interview. The nurse must acknowledge the age -related differences in this patient. The nurse does use t herapeutic communication, but this may be hampered by unrealized stereotypes. The nurse should treat all patients with respect, but this statement does not give specific information on how to do so. DIF: Applying (Application) REF: N/A OBJ: 4-4 TOP: Nursin g Process: Assessment MSC: Communication and Documentation 8. An older patient is being admitted to a long -term care facility. The nurse recognizes that the primary purpose of the initial geriatric health assessment is to: a. identify the patient’s physiologic baselines. b. ultimately create a plan of care that prevents disability and dependence. c. initiate the therapeutic nurse -patient relationship. d. document self -care deficiencies that the patient exhibits. ANS: B Specifically, the purpose of older adult assessment is to identify patient strengths and limitations so that effective and appropriate interventions can be delivered to support, promote, or restore optimum function and to prevent disability and dependence. Physiologic baseline, therapeutic nurse -patient relationship, and self -care deficits are all important aspects of the assessment but not the major purpose for it. DIF: Remembering (Knowledge) REF: Page 55 OBJ: 4-8 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 9. A 76 -year-old postsurgical diabetic patient has reported feeling dizzy and clammy. The daily serum glucose level shows the patient’s levels to be within normal limits. The geriatric nurse shows an understanding of established health norms for t he older adu lt when stating: a. “This patient’s normal may not be within the typical lab norms.” b. “I’ll ask the lab to rerun the test so we can double -check the results.” c. “There must be another reason for the symptoms.” d. “I’ll compare the patient’s baseline lab work with today’s results.” ANS: A Relying on established norms for laboratory values when analyzing the assessment data of older adults could lead to incorrect conclusions. The nurse should try to determine what the patient’s normal range is after stabilizing the patient. DIF: Understandin g (Comprehension) REF: Page 56 OBJ: 4 -1 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity 10. A patient is being admitted after a fall that has caused a painful leg injury. In preparing to interview the patient for a health history, the nurse is ini tially concerned that: a. the family should be present to help answer questions. b. a therapeutic nurse -patient relationship should be established. c. the patient should be free of hearing and vision barriers. d. the patient’s pain should be effectively managed. ANS: D The acute pain the patient is experiencing will have the greatest impact on the success of the health a ssessment interview and must be removed as a barrier for the assessment to be successful. The other factors are important too, although depending on the cognitive status of the patient, the family may or may not need to be present. DIF: Application (Apply) REF: N/A OBJ: 4-5 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 11. The nurse has administered the Apgar screen tool to assess an older patient’s family function status. Upon determining that the family functions at a 4, the nurse: a. prepares to administer a more detailed tool. b. prepares to report reasonable suspicion of elder abuse. c. asks the patient to identify specific family members to include in care planning sessions. d. notifies social services that the family is not likely to be of much support to the patient. ANS: D An Apgar score of 4 to 6 suggests a moderately dysfunctional family, one that should not be depended on to provide physical, financial, or emotional support to the patient. DIF: Analysis (Analyze) REF: N/A OBJ: 4-9 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 12. The geriatric nurse admitting a patient to an assisted living facility recognizes the importance of tools such as the Katz and the Barthel indexes because of the impact they have on: a. planning the amount of help the patient will need with ADLs. b. the patient’s ability to be realistic about achieving independence. c. creating an appropriate, patient -specific nursing care plan. Stuvia.com - The Marketplace to Buy and Sell your Study Material DoDDwoonwwlonnaloldoaeadddeedbdyb:bySy::uAaprleiearshAia||lacabb|biaeilekecaslyiian1l@c2@@gmagomali.lac.ciolo.mcmom Distribution of this document is illegal d. appropriate staffing to ensure the safety needs of the patients are met. ANS: C These assessment tools are designed to assess a patient’s levels of function, particularly related to ADL. Determination of the degree of functional independence in these areas can identify a patient’s abilities and limitations, leading to appropriate interventions presented in the patient’s nursing care plan. It provides more information than just how much help the patient needs, it is not related to being realistic, and it is not designed to be used for staffing purposes. DIF: Analysis (Analyze) REF: N/A OBJ: 4-9 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 13. An older patient is reluctant to report multiple vague signs and symptoms, including lethargy, incontinence, and weight loss that have persisted for 6 weeks. The nurse recognizes that such symptoms place the patient at great risk for: a. viral infection. b. disorientation. c. malnutrition. d. physical frailty. ANS: D Self-reported vague signs and symptoms such as lethargy, incontinence, decreased appetite, and weight loss can be indicators of functional impairment. Ignoring older adults’ vague symptoms exposes them to an increased risk of physical frailty (impairments in the physical abilities). DIF: Remembering (Knowledge) REF: Page 56 OBJ: 4-7 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 14. An older patient is hospitalized after a fall that resulted in a fractured left ankle. By day 4 of the hospitalization, which includes reduction of the fracture and analgesic drug therapy, the patient has become mildly disoriented and is incontinent o f urine. The nurse explains to the family that these symptoms reflect the: a. relationship between aging and both physical and psychosocial responses to trauma. b. response exhibited by many older adults who are hospitalized. c. effects of stress -induced perceptual deficits often seen in the hospitalized older adult. d. results of the pharmacologic pain control therapy. ANS: A Many serious consequences are the result of the interaction of physical and psychosocial factors in the older patient. Although the other options have some degree of truth to them, the most comprehensive answer is the one that relates aging to response to trauma. DIF: Understanding (Comprehension) REF: Page 56 OBJ: 4 -2 TOP: Teaching -Learning MSC: Physiologic Integrity 15. When unsure about how to address older patients with advanced stage Alzheimer disease, the nurse recognizes that it is best to address the patient by: a. a pet name, because the patients are not likely to respond to their given names. b. the first name, to foster a friendly, relaxed atmosphere. c. the full name, to show respect for the patients as individuals. d. a childhood nickname, because long -term memory will likely still be intact. ANS: C Nurses should address all older patients by their full name, including Mr. Mrs., or Miss, to show respect, unless the patient specifically requests being called something e lse. DIF: Application (Apply) REF: N/A OBJ: 4 -4 TOP: Caring MSC: Psychosocial Integrity 16. A nurse is working with an older patient in the gerontology clinic. The patient reports a vague decline in function and says, “I guess I’m just getting older.” What action by the nurse is best? a. Help the patient find ways to cope with the changes. Stuvia.com - The Marketplace to Buy and Sell your Study Material b. Assess the patient for an undetected illness. c. Ask if the patient needs any home health services. d. Find out what the patient thinks of these changes. ANS: B Vague changes and declining function are often attributed to aging but can be the only signs of illness. The nurse should perform a thorough assessment to look for any possible ailments. If the findings are normal and the changes are age related, the nurse can help the patient find ways to cope, ask about home health care services, and determine the patient’s thoughts on the matter. DIF: Applying (Application) REF: N/A OBJ: 4-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 17. The nurse admitting a debilitated patient to a long -term care facility initially assesses the patient using the Katz Index. The student asks why the nurse chose that tool. What answer by the nurse is best? a. It is quick and simple for a baseline. b. The Katz Index is mandated by Medicare. c. It is comprehensive in nature. d. It shows functioning in 12 areas. ANS: A The Katz Index takes only about 5 minutes to complete and rates patients as to whether they are totally independent or dependent in six basic functions. For the debilitated patient who will tire easily, this is the best choice. It is not mandat ed by Medica re, it is not as comprehensive as other tools, and it only shows functioning in 6 areas. DIF: Understanding (Comprehension) REF: Page 71 OBJ: 4 -9 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 18. A nurse assesses a patient using the Barthel Index and scores the patient as a 98. What inference does the nurse draw from this assessment? a. The patient is nearly dependent in all areas measured. b. The patient is able to live independently. c. The patient is close to independent in the areas measured. d. The patient’s cognitive status impaired the assessment. ANS: C The Barthel Index has a maximum score of 100, with the higher the score meaning more independent functioning. However, the tool developers do not state that a high score equals being able to live independently. This tool does not measure cognitive function ing. DIF: Applying (Application) REF: N/A OBJ: 4-9 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 19. The staff members in a long -term care facility have noted a decline in cognitive function in one of the residents; however, each time the resident is given the Short Portable Mental Status Questionnaire (SPMSQ), the score does not change. What action by th e nursing manager is best? a. Provide in-service education on using this tool. b. Conduct the assessment him- or herself c. Switch to a different screening tool d. Determine that no changes have occurred. ANS: C The SPMSQ is given orally, and because it is short, it is easy to memorize. The manager should use a different tool. DIF: Applying (Ap plication) REF: N/A OBJ: 4 -10 TOP: Nursing Process: Assessment MSC: Physiologic Integrity