TEST BANK FOR GERONTOLOGIC NURSING 5TH EDITION BY SUE E. MEINER COMPLETE (2023/2024)

Which nursing intervention best demonstrates the understanding that older adults are at increased risk for falls because of normal age-related changes? a. Speaking in a loud voice when warning the patient about safety hazards b. Turning on bright lights so the patient can see objects such as furniture c. Encouraging the patient to rise from a supine position slowly d. Advising the patient to avoid exercising painful joints ANS: C Older adults who lie supine and then get up quickly are likely to experience the effects of lack of tissue elasticity when the blood pressure drops and a feeling of lightheadedness develops. It is important to educate older individuals to change position slowly. DIF: Understanding (Comprehension) REF: Page 220 OBJ: 12-4 TOP: Teaching-Learning MSC: Safe Effective Care Environment 2. An older adult’s risk for a fall-related injury is directly correlated to his or her ability to regain balance. To evaluate this ability, the nurse assesses the patient’s: a. inner ear for possible fluid buildup. b. musculoskeletal hip, ankle, and shoulder strength. c. large muscle strength in thighs and upper arms. d. gait for steadiness. ANS: B Older adults who lose their balance are able to right themselves to an upright position when the musculoskeletal strength of the hips, ankles, and shoulders is adequate. The inability to regain balance because of insufficient strength can result in a fall. The other options are also possibilities, but they are not as significant as hip, ankle, and shoulder strength. 4. An older adult has been diagnosed with presbyopia. To minimize the patient’s risk for falls, the nurse suggests: a. that the edges of steps be painted a contrasting color. b. the patient wear sunglasses when driving. c. the patient wear a wide-brimmed hat when spending time outdoors. d. hanging blinds over sunny windows. ANS: A If older individuals are experiencing presbyopia, a reduction in the eye’s accommodation for changes in depth, such as when ascending or descending the stairs, instruction must be given for them to carefully watch door edges, curbs, and landing steps, which signal a change in height. Painting the edges of steps a contrasting color will make these depth changes more visible. The other suggestions are not related to this disorder. DIF: Applying (Application) REF: N/A OBJ: 12-1 TOP: Teaching-Learning MSC: Safe Effective Care Environment 5. An older adult has been diagnosed with a sinus infection. To minimize the risk for a fallrelated injury, the nurse teaches the patient: a. that there is a possibility of prodromal falls. b. to take her antibiotic medication with food. c. to recognize symptoms of fluid buildup in the middle ear. d. about the increased risks of falls related to normal aging. ANS: A Prodromal falling refers to the onset of frequent falling heralding an acute medical problem; an infectious disease typically causes this type of fall. Educating the patient regarding the most common sources of potential falls is the cornerstone of fall prevention and management. The other options do not relate directly to this condition. DIF: Understanding (Comprehension) REF: Page 224 OBJ: 12-4 TOP: Teaching-Learning MSC: Safe Effective Care Environment 6Thenurseidentifiestheolderadultpatientatthegreatestriskforafallrelatedinjuryasthe: ANS: D Physical restraint use does not prevent falls and therefore should never be employed for “safety precautions.” This is the best explanation because the nurse will then need to explain the other measures that will be taken to keep the patient safe. DIF: Understanding (Comprehension) REF: Page 223 OBJ: 12-3 TOP: Teaching-Learning MSC: Safe Effective Care Environment 8. A patient is being discharged after hip replacement surgery. The geriatric nurse recognizes that the most effective intervention to minimize the potential of a fall injury is to: a. identify the most common causes of falls that the patient is likely to encounter. b. discuss what kind of in-home assistance the patient will need. c. impress the patient with the importance of being careful not to fall. d. educate the patient that falling is not a normal part of aging. ANS: A Educating the patient regarding the most common sources of potential falls is the cornerstone of fall prevention and management. The patient may or may not need home care assistance, telling the patient how important it is not to fall does not provide the patient with a plan to avoid falling, and educating the patient on normal age-related changes also does not give the patient any information on how to avoid falling. DIF: Understanding (Comprehension) REF: Page 219 OBJ: 12-4 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 9. A patient is diagnosed with bilateral osteoarthritis of the knees. To best address the long-term risk for falls, the nurse encourages the patient to: a. use assistive mobility devises when necessary. b. report exacerbation of symptoms promptly. c. add a daily walk to exercise the knees appropriately. d. take analgesic medication as prescribed to manage joint pain. ANS: D Ifjointpaindevelopsandremainsuntreateditcancauseolderadultstobecomesedentaryor If patients are unable to make informed choices and no family members are available, the nurse must use nursing judgment and follow an acceptable standard of care to promote safety and security that are defined and described in official policies and procedure manuals. The preferences of other patients do not indicate this patient’s preferences. Professional nursing knowledge can be used but must remain within the policies. Less restrictive interventions are preferable, but again actions need to conform to policy. DIF: Understanding (Comprehension) REF: Page 228 OBJ: 12-6 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 11. When appropriately addressing safety issues, the geriatric nurse plans the patient’s care plan directed by the standard of care that requires: a. promoting both health and wellness by assuring safety. b. minimizing the patient’s risk for physical injury while preserving autonomy. c. identifying safety from injury as a patient right. d. emphasizing beneficence as a an ethical standard of nursing care. ANS: B When working with older adults, the gerontologic nurse must provide a standard of care that promotes safety and prevents foreseeable accidents or injuries while also respecting individuals’ autonomy to make decisions. This requires a delicate balance. The other options do not address standards. DIF: Remembering (Knowledge) REF: Page 228 OBJ: 12-6 TOP: Nursing Process: Analysis MSC: Safe Effective Care Environment 12. Which action is best to reduce burns in the home? a. Instruct patients to install smoke detectors, b. Tell patients to have their water heaters checked, c. Encourage patients to switch from gas to electric stoves, d. Teach patients not to smoke in their houses, ANS: B Themostcommoncauseofburnsinthehomeforolderpatientsisscaldingfromwaterthatis DIF: Applying (Application) REF: N/A OBJ: 12-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment 14. The nurse assesses which patient as being at the highest risk for poisoning related to mixing garden chemicals? a. The patient who has Parkinson disease with hand tremors b. The patient who has low vision or uses magnifying glasses c. The patient who has hearing impairment or wears hearing aid d. The patient who has osteoarthritis or using a wheeled walker ANS: A The patient with hand tremors is at greatest risk because of the potential for inaccurate mixing and spillage. DIF: Applying (Application) REF: N/A OBJ: 12-7 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 15. The student asks the nurse why ground beef and other ground meat products are more likely to be contaminated and cause food-borne illness. What response by the nurse is best? a. It’s because they are handled more. b. They are from cheaper cuts of meat. c. They are not kept cold during shipping. d. They are made from leftover meats. ANS: A Ground meat products are handled more during processing, increasing the risk of being contaminated with microbes that cause food-borne illnesses. DIF: Understanding (Comprehension) REF: Page 231 OBJ: 12-7 TOP: Teaching-Learning MSC: Safe Effective Care Environment 16. The nurse working with older patients would assess which patient as being at highest risk for developing secondary hypothermia? a. Warm blankets b. Warm heating lamps c. Peritoneal dialysis d. Warmed intravenous (IV) solutions ANS: D A core temperature this low requires active internal rewarming. Warmed IV solutions are appropriate. Blankets and a heating lamp are appropriate for mild hypothermia. Peritoneal dialysis is reserved for severe cases with cardiac instability. DIF: Applying (Application) REF: N/A OBJ: 12-8 TOP: Nursing Process: Analysis MSC: Physiologic Integrity 18. A nurse is watching a parade during the summer and notices an older adult looking faint and acting somewhat confused. The patient has hot dry skin. While waiting for the rescue squad, what action by the nurse is most effective? a. Spraying the person with a water mist b. Giving the person iced tea to drink c. Having the person sit down on the grass d. Pouring cold water over the person’s head ANS: A Spraying the person with a cold-water mist will help dissipate heat, especially if the nurse then fans the person. Iced tea is a diuretic and will increase fluid loss. Having the person sit down is a good idea, as long as the person sits in the shade. Pouring cold water over the person’s head is not as effective as a water spray mist. DIF: Applying (Application) REF: N/A OBJ: 12-8 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 19. The nurse teaches that which of the following is the best place to store medications? a. Bathroom medicine cabinet b. Near the kitchen sink cInthelaundryroom Slower reflexes and reaction times are a normal age-related change. Wearing glasses and hearing aids should correct the underlying problem and not be a cause for concern in themselves. Confusion is not a normal age-related change. DIF: Understanding (Comprehension) REF: Page 235 OBJ: 12-11 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 21. A patient has had several falls ascribed to “numb feet.” What action by the nurse is best? a. Assess patient for undiagnosed diabetes. b. Instruct the patient on using a cane. c. Ensure the patient has sturdy footwear. d. Tell the patient to lift the feet when walking. ANS: A Numbness in the feet is caused by peripheral neuropathy, which is a complication of diabetes mellitus. The nurse plans to assess the patient for this condition. The other options do not address the lack of sensation to the feet. DIF: Applying (Application) REF: N/A OBJ: 12-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE 1. When assessing an older adult for intrinsic risk factors for falls, the nurse is particularly interested in which of the following? (Select all that apply.) a. An unsteady gait when asked to walk without assistance b. The presence of throw rugs in the living room of the home c. The patient’s report that he wears corrective lenses d. An inability to see changes in height because of poor lighting e. Evidence of short-term memory deficiency ANS: A, C, E The most salient observations for intrinsic risk factors for falls relate to gait, balance, stability, DIF: Applying (Application) REF: N/A OBJ: 12-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity Chapter 13: Sexuality and Aging Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE 1. Which statement made by a nurse reflects a lack of understanding regarding sexual intimacy and the older adult patient? a. “Older adults express less interest in intimacy as both acute and chronic illnesses develop.” b. “Sexual expression is considered an enhancement to the quality of the older adult’s life.” c. “Expressing sexual needs may be difficult or impossible for some older adults.” d. “Interest in physical contact tends to persist throughout life for both genders.” ANS: A Although the need to express interest in sexuality continues among older adults, they face several barriers to sexual expression, including problems arising from low desire, aging, disease, and medications; societal beliefs; and changes in social circumstances. Sexuality remains important as people age and develop chronic and acute illnesses. DIF: Understanding (Comprehension) REF: Page 241 OBJ: 13-1 TOP: Teaching-Learning MSC: Psychosocial Integrity 2. A 70-year-old female patient shares with the nurse her concern that recently it takes more time to achieve an organism. The nurse responds most therapeutically when answering: a. “You’ve described a common result of aging for both men and women.” b. “If you experience difficulty achieving orgasms, you should discuss that with your doctor.” c. “Your body produces fewer sex hormones now, and you need more stimulation to climax.” d. “I understand your concern. Let’s talk more about the changes you’ve noticed.” ANS: B Erectile dysfunction (ED) can occur at any age. This patient’s chronic illness and its effect on the vascular system have priority when educating the patient about possible causes of ED. After discussing physiologic causes of ED, the nurse can then turn to psychosocial causes. Physical issues take priority over psychosocial ones. DIF: Applying (Application) REF: N/A OBJ: 13-4 TOP: Teaching-Learning MSC: Physiologic Integrity 4. Upon entering the room of a cognitively impaired older adult patient, the nurse observes that he is exposed and rubbing his genitals. The nurse’s initial concern is to: a. alert staff to be aware of this new behavior. b. provide the patient with privacy. c. assess him for possible pain and fever. d. provide a verbal cue for him to stop the behavior. ANS: C Dementia may result in unmet sexual needs resulting in such behavior; however, this behavior may also indicate pain, hyperthermia, or the need to be freed from a restrained situation. Later the nurse can inform staff of the behavior, particularly if it is a new behavior, and ensure the patient has privacy. There is no need to cue the patient to stop this behavior as long as it is done in a private setting. DIF: Applying (Application) REF: N/A OBJ: 13-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 5. To effectively assess an older adult patient’s sexual needs, the nurse must initially: a. reflect on personal feelings that create barriers to effective communication with the patient. b. be familiar with the sexual needs of the older adult population. c. assess the patient’s physical capacity to engage in sexual activities. d. inform the patient of the personal nature of the detailed questioning this assessmentrequires d. “While postsurgical erectile dysfunction is likely, it is generally temporary.” ANS: D Radical prostatectomy, a curative treatment for cancer of the prostate gland, involves a massive disturbance of hormone-producing glands, surrounding nerves, and urinary structures. This often results in temporary urinary incontinence and impotence. It may take 2 to 3 years to regain function. Referring the patient so quickly indicates a lack of willingness to discuss the issue. Prosthetic devices and medications imply the condition is permanent, and while the patient may need such assistive devices, the nurse should first provide encouraging information. DIF: Understanding (Comprehension) REF: Page 246 OBJ: 13-4 TOP: Teaching-Learning MSC: Physiologic Integrity 7. The charge nurse on an extended care unit recognizes an immediate need for additional unit education regarding sexuality and the older adult when overhearing a staff member state: a. “I’ve had to tell her to stop touching my breasts twice today.” b. “Someone needs to tell him to keep his pants zipped.” c. “I realize they have needs, but I’m not sure how to handle that.” d. “It’s sad that Alzheimer disease causes them to become sexual perverts.” ANS: D Although staff education about the sexuality and intimacy of older adults should include recognition of cues, desires, and interest in sexual activities, it needs to immediately address eliminating stereotypes, such as “the dirty old man” or “perverts.” The nurse is within his or her rights to limit behavior that includes touching inappropriately. A male patient may need to be reminded to keep his pants zipped. The staff member who is unsure how to help with sexual needs is expressing a legitimate concern. DIF: Applying (Application) REF: N/A OBJ: 13-6 TOP: Teaching-Learning MSC: Psychosocial Integrity 8. An older adult female patient who has multiple sexual partners asks the nurse if the risk for contractingHIVreallydoesincreaseasweageThenurseshowsthebestunderstandingof DIF: Understanding (Comprehension) REF: Page 245 OBJ: 13-3 TOP: Teaching-Learning MSC: Physiologic Integrity 9. Through the open door of the patient’s room, the nurse observes a male patient and his longterm partner in a romantic embrace. The nurse’s priority intervention is directed toward: a. reinforcing for the staff the patient’s intimacy needs. b. explaining to the patient the challenges that his relationship poses for the staff. c. offering to discuss the barriers to intimacy that the patient and his partner face. d. quietly closing the door to address the patient’s right to privacy. ANS: D All patients have the right to sexual expression if they are cognitively capable of making decisions. No matter the sexual orientation of the patient, privacy should be respected unless the need for safety is paramount. The nurse should close the door quietly. There is no need for other action unless the staff members need to be reminded of this information. DIF: Applying (Application) REF: N/A OBJ: 13-6 TOP: Caring MSC: Psychosocial Integrity 10. The gerontologic nurse wants to begin assessing concerns related to sexuality among the population of patients seen in the clinic. What action by the nurse is best? a. Give the patients questionnaires to fill out. b. Get permission to discuss sexuality with them. c. Tell the patients you are now assessing sexuality. d. Ask the patients if they have concerns about sex. ANS: B Many of today’s older population grew up when sexuality was not openly discussed, so they may feel uncomfortable with this topic. The nurse should bring up the subject and ask their permission to discuss this aspect of their lives. The other options are not as likely to start an open-ended conversation. DIF: Applying (Application) REF: N/A OBJ: 13-7 TOP:CommunicationandDocumentationMSC:PsychosocialIntegrity 12. The nurse notes the patient’s chart lists “dyspareunia” as a complaint. What teaching does the nurse plan to provide? a. Use of water-soluble lubricants b. Performing Kegel exercises c. Deep breathing and relaxation d. Use of antifungal medications ANS: A Dyspareunia is painful intercourse, which has several causes, one of which is vaginal dryness. The nurse can teach the woman about water-soluble lubricants. Kegel exercises are not related. Deep breathing and relaxation do not address the physical issue. Antifungal medications are not warranted. DIF: Applying (Application) REF: N/A OBJ: 13-4 TOP: Teaching-Learning MSC: Physiologic Integrity 13. The nurse using the permission, limited information, specific suggestions, and intensive therapy (PLISSIT) model offers specific suggestions when: a. Referring the patient to a sex therapist. b. Discussing over-the-counter lubricants. c. Teaching safer sex practices. d. Discussing sexual positioning after hip surgery. ANS: D Specific suggestions are those related to concerns about how medical conditions affect or are affected by sexuality. The nurse discussing positions acceptable after hip replacement surgery is offering specific suggestions. Referring is the intensive therapy (IT) component. The other two options fall under limited information (LI). DIF: Applying (Application) REF: N/A OBJ: 13-7 TOP: Teaching-Learning MSC: Psychosocial Integrity 14Thepatientwhorecentlyhadaradicalprostatectomyhasthenursingdiagnosisofineffective c. Ask the patient if there are any medical concerns related to sex. d. Tell the patient he or she may begin to have feelings of guilt. ANS: B The chances of STDs, including HIV, increase with the increased number of sexual partners. Many older patients do not know about safer sexual practices, so for patient safety, this is the priority. DIF: Applying (Application) REF: N/A OBJ: 13-9 TOP: Teaching-Learning MSC: Psychosocial Integrity 16. What information about sexuality is contrary to research on sexuality in older men? a. Erections are no