NUR 304 EXAM 1 2025

NUR 304 EXAM 1 2025 Comorbidity - -the presence of multiples chronic conditions simultaneously You see two patients walking into a room and locking the door (about to have intercourse) What do you do? - -turn around and walk away Industrial revolution - -persons of advanced age left unprotected The first significant step in improving the lives of older adults was - -the passage of the Federal Old Age Insurance Law under the Social Security Act in 1935. Young-old - -60-74 Middle-old - -75-84 Old-old - -85-100 Centenarians - -people 100 years old or older "Asset rich and cash poor" relates to which of the following statements regarding older adults? A. Net worth of older adults is half the national average of middle-aged adults. B. Homes are paid for, but there is not enough money available for monthly expenses. C. The majority of older adults live below the poverty level. D. problems in the older adult population are due to the level of debt. - -B. Homes are paid for, but there is not enough money available for monthly expenses. Median net worth of older households is nearly twice the national average because of the high prevalence of home ownership, but many older adults are "asset rich and cash poor"−they live in a house that has appreciated in value over the years, but they barely have sufficient monthly income to meet basic expenses. Leading chronic conditions - -arthritis, hypertension, hearing issues, heart conditions, visual impairments, orthopedic issues, diabetes, sinusitis, allergies, and varicose veins. True or False? Chronic disorders most prevalent in the older adult population are ones that can have a significant impact on independence and the quality of life. - -True. Chronic illness is a major problem for the older population and results in limitations in ADLs, IADLs, and quality of life. Ethnogeriatrics - -The effects of ethnicity and culture on the health and well-being of older adults NUR 304 NUR 304 True or False? An understanding of cultural and ethnic differences can help erase the stereotypes and biases that can interfere with effective care and assist in the demonstration of an appreciation for the unique characteristics of each individual - True. The growing diversity of the older population presents challenges for gerontological nursing in providing culturally competent care. Essential to the provision of culturally competent care is an understanding of cultural and ethnic differences to help erase stereotypes. True or False? There is a lower life expectancy of Black Americans; however, once a black individual reaches the seventh decade of life, survival begins to equal that of a similarly aged white person. - -True. After reaching the seventh decade of life, black older adults can hope to enjoy a life expectancy equal to that of their white counterparts. Which statement best describes a belief held by most Jewish Americans? A. Life-sustaining or support measures are denied. B. Sundown Saturday to sundown Sunday is the practiced day of Sabbath. C. An autopsy is usually opposed. D. Modern medical care is discouraged. - -C. An autopsy is usually opposed. True or False? One powerful means to improve nursing care for individuals of different cultures is to learn about cultural influences by asking patients to describe their life stories. - -True. Nurses will be more able to convey sensitivity and caring when they try to recognize and support patients' ethnic and cultural backgrounds. Durable power of attorney - -Allows competent individuals to appoint someone to make decisions on their behalf in the event that they become incompetent Malpractice - -deviation from standard of care Negligence - -failure to conform to the standard of care Public laws - -Scope of nursing practice, Requirements for licensure, governs relationships between individuals and/or organizations Private laws - -Individual rights, Standards of conduct, governs relationships between private parties and the government Situations that may increase the risk of liability - -- Working with insufficient resources - Not following agency policies and procedures - Bending rules - Taking shortcuts - Working when physically/emotionally exhausted Conditions that warrant malpractice - -Duty Negligence Injury NUR 304 NUR 304 True or False? Nurses can be protected from malpractice suits if they are following the accepted standard of care. - -True. Nurses are expected to provide services to patients in a careful, competent manner according to a standard of care. The standard of care is considered the norm for what a reasonable individual in a similar circumstance would do. When performance deviates from the standard of care, nurses can be liable for malpractice. Situations That May Result in Negligence - -- failing to take action - contributing to pt. injury - failing to report a hazardous situation - handling pt. possessions inappropriately - failing to follow policies and procedures Elements of informed consent include all of the following except? A. The purpose of the procedure B. The time required to complete the procedure C. Alternatives to the procedure D. Expected consequences and risks of the procedure - -B. The time required to complete the procedure Written informed consent includes a description of the procedure, its purpose, alternatives to the procedure, expected consequences, and risks. Scope of practice does not include preparing, compounding, dispensing, or retailing medications - -As a nurse, you can't dispense or make medication Omnibus Budget Reconciliation Act (OBRA) - -- Imposes strict standards on use of restraints: both chemical (medication) and physical - Restraints: anything restricting movement - Alternatives to restraints should be used whenever possible - Physician order required with specific conditions - Agency must have a policy Which statement is true related to the use of restraints? A. Geriatric chairs are not restraints. B. Alternatives to restraints should be used whenever possible. C. Physicians' orders for restraints are not required in long-term care facilities. D. The Omnibus Budget Reconciliation Act (BORA) heightened the impact of restraints in acute care settings. - -B. Alternatives to restraints should be used whenever possible. Geriatric chairs are considered restraints, physician orders are required for restraint use in any health care setting, and BORA increased the awareness of restraint use in long term care. Alternatives to restraints should be used whenever possible to promote safe and effective care. NUR 304 NUR 304 Advance directives - -express patient desires for terminal care, life-sustaining measures. Patient Self-Determination Act - -requires health care facilities to ask a patient about advance directives. Elder Assessment Instrument (EAI) - -Helps identify those being abused Indications of possible abuse or neglect include - -malnutrition (withhold food from patient) and dehydration, among others. True or False? To prevent unsafe care and the potential for malpractice, nurses should be knowledgeable about their agency's policies and procedures and adhere to them. - True. Legal safeguards for nurses include following agency policies and procedures as laws and regulations impose additional responsibilities in patient-provider and employee employer relationships. Almshouses - -Limited resources; basic care at best, Able residents expected to work at the institution Characteristics of "total institutions" (sociologist Erving Goffman, 1961) - -This approach to care cast residents as inmates rather than as unique individuals Isolation from mainstream society Residents developed abnormal behaviors 1935: Social Security enacted 1946: Hill-Burton Hospital Survey and Construction Act 1960s: Effect of Medicare and Medicaid 1987: Omnibus Budget Reconciliation Act (OBRA) - -1935: Social Security enacted 1946: Hill-Burton Hospital Survey and Construction Act 1960s: Effect of Medicare and Medicaid 1987: Omnibus Budget Reconciliation Act (OBRA) Which of the following government initiatives had the first impact on promoting the growth of nursing homes? A. Social Security B. Hill-Burton Act C. Medicare and Medicaid D. Private insurance availability - -B. Hill-Burton Act (Know about this act) In 1946, the government contributed to nursing home growth by granting funds to help construct long-term care facilities through the Hill-Burton Hospital Survey and Construction Act. NUR 304 NUR 304 What percentage of the older adult population resides in an LTC facility at any given time? 5% 10% 15% 20% - -At any given time, only 5% of the older adult population resides in an LTC facility. A higher percentage will need this form of care at some future point in their lives. True or False? The Minimum Data Set (MDS) is a standardized assessment tool that must be completed when a patient is admitted to an LTC facility, whenever there is a change in the resident's status, and annually. - -True. The MDS assessment tool is coordinated by a registered nurse, and most of the entries on the MDS rely on nursing assessment. The tool is completed when an individual is admitted to an LTC facility, whenever there is a change in the resident's status, and annually. Assisted Living Communities - -Care for individuals with less complex needs Less stringent regulations Fewer licensed nurses available increasing number of beds Private pay (majority) Challenges for gerontological nurses Hierarchy of resident needs: - -Hygiene Holism Healing Assumptions of the model of holism and healing True or False? When interviewing older adults, it is important to explore all persons who are "significant others" to an individual and fulfill a family role. - -True. When interviewing older adults, it is important to explore all persons who are "significant others" to an individual and fulfill a family role, regardless of whether they are unrelated or reside in different households. Which of the following statements best describes the deviant family member role? A. One who is granted responsibility even though that person is not geographically close B. One who provides direct services and manages the home C. One who is seen as the "scapegoat" and provides a sense of purpose for family members D. One who depends on other members of the family for economic support - -C. One who is seen as the "scapegoat" and provides a sense of purpose for family members The deviant, as a family member role, is described as the "problem child" who has strayed from family norms and may be the family scapegoat or may provide a sense of purpose for family members who "rescue" or compensate for this individual. Caregivers' TLC: - -Training, Leaving, Caring - main one is CARING NUR 304 NUR 304 True or False? Caregivers need to care for themselves through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, stress reduction, and health management. - -True. This is the "C" component of caregivers' TLC. Caregivers need to care for themselves through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, stress reduction, and health management. The gerontological nurse should review the TLC needs of caregivers during every contact to ensure their continued effectiveness. SSRIs used to treat depression - -SSRIs used to treat depression True or False? The rate of completed suicide among older persons is the lowest of any age group in the United States. - -False. The rate of completed suicide among older persons continues to be the highest of any age group in the United States, with nearly ¼ of all suicides committed by persons aged 65 years and older. Treatment/Management of Depression - -Psychotherapy Antidepressants Electroconvulsive therapy (ECT) Herbs Complementary/alternative (CAM) therapies Good basic health practices Patient must acknowledge the problem and take responsibility Criteria for Diagnosing Alcoholism - -- Drinks a fifth of whiskey a day or its equivalent in wine or beer (for a 180-lb person) - Alcoholic blackouts - Blood alcohol level greater than 150 mg/100 mL - Withdrawal syndrome: hallucinations, convulsions, gross tremors, delirium tremens - Continued drinking despite medical advice or problems caused by drinking (REMEMBER THESE CHOICES) Which of the following statements is true related to alcoholism and the older adult? A. Alcoholism is easily treated in the older adult. B. There is a decreased incidence of alcoholism with age. C. Health care professionals can easily detect alcoholism in an older adult. D. The long-term goal for the older adult with alcoholism is limited alcohol intake. Most older adults who are alcoholics are chronic EtOH abusers who have used it heavily throughout their lives. A significant number of chronic abusers die before reaching old age, contributing to a decreased incidence of alcoholism with age. - -B. There is a decreased incidence of alcoholism with age. Most older adults who are alcoholics are chronic EtOH abusers who have used it heavily throughout their lives. A significant number of chronic abusers die before reaching old age, contributing to a decreased incidence of alcoholism with age. NUR 304 NUR 304 Is the following statement true or false? The first nursing intervention necessary to address problem behaviors in the older adult population is assessment - -True. Assessing the cause of the behavior is the first step in assisting the patient who displays behavioral problems. Factors associated with the behavior should be closely observed and documented. Delirium: - -generally reversible Signs and symptoms: Rapid and altered level of consciousness Dementia - -irreversible loss of intellectual functioning caused by organic brain damage or disease Is the following statement true or false? Several coexisting factors can be responsible for delirium. - -True. As older adults often have multiple health conditions, it is important to remember that several coexisting factors can be responsible for delirium. Alzheimer's disease (AD) - -the most common cause of dementia in older people Treatment/management for Alhzeimer's - -- No current treatment to prevent/cure AD - Clinical trials in place to improve function and slow disease progression - Research on estrogen-conflicting results - Antioxidants, anti-inflammatory agents, folic acid, vitamins B6 and B12, and gene therapy Medications that slow acetylcholinesterase Which of the following statements best describes Creutzfeldt-Jakob disease? A. Neuronal atrophy of the frontal lobes of the brain B. Rare disease with a rapid onset and progression of the disease to death C. Behavioral rather than cognitive impairments in the early stages D. Caused by cerebral infarctions and history of cardiovascular disease - -B. Rare disease with a rapid onset and progression of the disease to death Creutzfeldt-Jakob disease is an extremely rare brain disorder that causes dementia. It has a rapid onset and progression and is characterized by severe neurological impairment that accompanies the dementia. The disease progresses rapidly, and death typically occurs within 1 year of diagnosis. True or False? The onset of behavioral problems in a person with dementia indicates the need for medications to suppress the behavior problem identified. - -False. Consideration must be given to the potential inability of the older adult with dementia to communicate their needs and discomforts. A subtle change in behavior or function, a facial grimace, or repeated touching of a body part may give clues that a problem exists. The underlying cause must be determined. Dyspareunia - -Painful intercoursE NUR 304 NUR 304 Erectile dysfunction - -The inability to attain and maintain an erection of the penis sufficient to engage in sexual intercourse Hormone replacement therapy (HRT) - -replacement of estrogen and/or progestin hormone that is no longer being made by the body Menopause - -the permanent cessation of menses for at least 1 year Perimenopause - -the several years prior to the onset of menopause Postmenopause - -time beginning 12 months after the last menstrual cycle True or False? Myths, ignorance, and the vulgar status previously associated with sex in general have been conferred on the sexuality of the older adult population, and these attitudes reinforce fear and aversion to growing old. - -True. Myths about older adults and sexuality are prevalent in our society. These misconceptions and prejudices are an injustice to persons of all ages and may repress meaningful sexual activity and lead to feelings of guilt and inferiority for an older adult and a fear of aging for younger generations True or False? Older adults who may be infected with HIV are usually diagnosed in a later stage of the disease process as they are embarrassed to seek attention and if they do present symptoms to a health care provider the symptoms are not associated with HIV. - -True. If older adults learn that a sexual partner is HIV positive, they may be embarrassed to seek medical attention, and when they do present with symptoms to a health care provider, the symptoms are not associated with HIV simply because the person is old. Menopause - -Permanent cessation of menses, completely gone Andropause - -- Testosterone levels decline in men - Does not occur in all men - Low testosterone levels in older men can result in reduced muscle mass, energy, strength, and stamina - Other changes: erectile dysfunction, breast enlargement, osteopenia, osteoporosis, and shrinkage of testes - Sexuality encompasses more than just physical acts - Love, warmth, caring, and sharing - Intimate exchange of words and touch - Feeling important and wanted by another person - Multiple losses have significant effect on intimacy Which statement is true related to age-related changes and sexual response? A. Older men get erect and ejaculate more quickly B. Older women lose interest in sex C. There is a decrease in sexual responsiveness in both genders NUR 304 NUR 304 D. Sexual activity declines after the fifth decade - -C. There is a decrease in sexual responsiveness in both genders Despite the physical ability to remain sexually active in old age, there is a decrease in sexual responsiveness and a reduction in the frequency of orgasm. Psychological Barriers of sexual intercourse in older adults - -• Negative attitudes from society • Fear of losing sexual abilities • Concerns about body image • Relationship issues • Misconceptions by older adults Erectile Dysfunction - -• Impotence or erectile dysfunction: unable to attain or maintain erection of penis for sexual intercourse • Multiple causes: atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structure abnormalities, medications, and psychological factors • Physical exam essential • Medical treatments and other options available Which disease most commonly causes erectile dysfunction in the older adult population? Measles Acromegaly Diabetes Benign prostatic hyperplasia - -Diabetes A chronic complication of diabetes is neuropathy, which can cause a decrease in innervation and thus erectile dysfunction. Dementia affects sexual behavior. Inappropriate behaviors can occur. Sexual history part of nursing assessment Identification of problems and potential solutions for problems Masturbation beneficial Holding, caressing and exchanging loving words as means for sexual satisfaction Nurses foster positive attitudes - -Dementia affects sexual behavior. Inappropriate behaviors can occur. Sexual history part of nursing assessment Identification of problems and potential solutions for problems Masturbation beneficial Holding, caressing and exchanging loving words as means for sexual satisfaction Nurses foster positive attitudes When were the Baby boomers born? What time period? - - NUR 304 NUR 304 What type of nurses need to increase for taking care of the population of 65 and older? - -gerontological nurses Which federally funded program primarily covers the hospital and physician services? - medicare What type of group of women are considered the higher survival rates of women, that marry older men? - -widows over 65 What factors increase life expectancy for older adults? - -diet, technology, disea