Test Bank For Ebersole And Hess Gerontological Nursing And Healthy Aging 4e by Touhy - Jett

Chapter 3: Care Across the Continuum Test Bank MULTIPLE CHOICE 1. An older female resident in the residential facility keeps a large collection of personal items and photographs of her late husband on her bedside table, but the nursing assistant and resident frequently argue about this. Why should the nurse intervene between the resident and the nursing assistant? a. Resident is attempting to maintain her sense of personal space. b. Resident needs to accept the reality of her spouse’s death. c. Resident’s argumentative nature can indicate early dementia. d. Clutter from all the personal items is a safety and liability risk. ANS: A A thoughtful nurse respects and supports the resident’s boundaries. Even if the resident needed to accept the reality of her spouse’s death, the resident’s grief process and personal space should be respected. Although the resident’s argumentative nature can indicate early dementia, the resident’s behavior can also be understood as a healthy defense of personal space. Although the rationale of the nurse assistant is probably that the clutter from all the personal items is a safety and liability risk, the assistant should realize that this resident is entitled to the personal use of her personal space. PTS: 1 DIF: Apply REF: 12 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 2. Which statement is true about living arrangements for older adults? a. Older adults are more independent in their own homes than in a residential community. b. The increase in real estate values makes home ownership essential to security. c. Program for All-Inclusive Care for the Elderly (PACE) is a community alternative to nursing home care for frail older adults. d. Florida is an example of a naturally occurring retirement community (NORC). ANS: C PACE is an alternative to nursing home care for frail older people who want to live independently in the community with a high quality of life. Although relief from the burden of home maintenance can free a person for more independent living, this statement can or cannot be accurate, depending on the real estate market at the time. In addition, taxes and maintenance costs have also risen. A NORC is an organization formed by older adults living at home in geographic proximity to each other to provide supportive services for each other. PTS: 1 DIF: Understand REF: 5 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 3. As the nurse admits an older woman to a long-term care facility from her home of 50 years, she mistakes the nurse for her daughter. Which diagnosis does the nurse use to plan care for this woman? a. Hypoxia as a result of chronic disease b. Relocation stress syndrome c. Alzheimer disease (AD) d. Attention-seeking behavior ANS: B Relocation, especially if sudden, causes stress that may lead to altered mental status. Many conditions other than hypoxia can cause altered mental status, including relocation stress. Many conditions other than AD can cause altered mental status, including relocation stress. The nurse has no confirmatory evidence to regard the older woman’s error as something other than a mistake; in addition, it can be understood as relocation stress syndrome. PTS: 1 DIF: Apply REF: 16 TOP: Nursing Process: Diagnosis MSC: Safe, Effective Care Environment 4. Which statement is true about residential living for older adults? a. A residential care facility is the new term for a nursing home. b. An assisted living facility (ALF) must have an registered nurse (RN) on staff. c. Administrators are realizing that their duty is to care for the residents as people. d. A “granny flat” is an apartment in a high-rise building reserved for seniors. ANS: C The movement is under way from an institution-centered culture to a person-centered one. A residential care facility houses older adults who cannot live independently but do not need the round-the-clock, complex care capabilities of a nursing home. In most states, ALFs are not required to provide skilled nursing. A “granny flat” is the term used in Australia for a small, prefabricated housing unit where an older adult can live separately from, but close to, family on family property. PTS: 1 DIF: Understand REF: 12-13 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 5. A family that has three small children prepares to move an older female parent into their home knowing that she stays up all night. The nurse helps the family prepare for the change. Which part of planning should the nurse indicate is the family’s priority? a. Sharing household responsibilities b. Preparing the house for her arrival c. Helping her use her skills and talents d. Setting limits on nighttime activities ANS: B To reduce the risk of injury and falls, the family’s priority is to prepare the house for an older adult’s arrival including preparing the parent’s private space, removing hazards, providing adequate lighting, installing handrails where necessary, and completing other safety measures. In addition, the parent needs to prepare mentally for the challenges presented when the children create new safety hazards for an older adult, such as spills and leaving toys on the floor. Sharing household responsibilities should be part of the preparation; however, safety concerns are more important. Helping the older adult to use her skills and talents provides meaningful activities; however, safety concerns are more important. Setting limits on her nighttime activities is important preparation to avoid conflicts; however, safety concerns are the priority. PTS: 1 DIF: Analyze REF: 3 TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment 6. A resident of a long-term care facility has been asking to have the drain in the bathroom sink repaired for 2 months. The nurse responds by saying that when they move to the new building, the sinks will work very well. Which right of a resident of a long-term care facility has the nurse violated? a. Right to be free of all forms of abuse b. Right to be transferred for appropriate reasons c. Right to voice grievances and have them remedied d. Right to information about conditions and treatments ANS: C The nurse has violated the resident’s right to voice a grievance and to have the problem fixed. If the residents were moving into the new building in a few days, then the nurse’s response might be suitable; however, without specifying a time limit, the nurse has violated the resident’s right to voice a grievance and have it remedied. A clogged sink is not abuse. The resident is not going to be transferred; all of the residents are moving to a new facility. A resident’s condition or treatments are not mentioned by the resident. PTS: 1 DIF: Apply REF: 29 Text Box 3-5 TOP: Nursing Process: Evaluation MSC: Safe, Effective Care Environment 7. A nursing home is converting to a person-centered culture from an institution-centered culture. Which nursing intervention will be suitable in the new culture? a. Maintain consistent resident assignments. b. Provide structured activities for the residents. c. Assign nursing assistants to perform bathing. d. Determine mealtime on the basis of staffing levels. ANS: A As part of a person-centered culture, nurses should have consistent resident assignments to establish rapport with their residents and become familiar with their unique qualities and preferences. Activities structured by the staff are part of the institution-centered culture. Assigning assistants to perform bathing is part of the institution-centered culture because it focuses on tasks. Schedules are determined for the staff’s convenience as part of the institution-centered culture. PTS: 1 DIF: Apply REF: 12-13 | Text Box 3-6 on 30 TOP: Nursing Process: Evaluation MSC: Safe, Effective Care Environment 8. The nurse prepares to transfer an older adult to a long-term care facility and calls the facility to give a report. Which nursing actions are the responsibilities of the transferring nurse and the receiving nurse? a. Incorporating patient goals into the plan b. Ensuring the patient is stable for transfer c. Supplying patient documents for planning d. Providing continuity of care during the transfer ANS: D A shared responsibility of the sending and the receiving nurses or care team is to regard the transition as a transfer versus a discharge and to provide continuous and consistent nursing care throughout the transfer phase. To accomplish this, the two nurses or groups must have clear, comprehensive communication. The receiving nurse incorporates patient goals into the plan. The sending nurse ensures that the patient is stable for the transfer to prevent decompensation during the trip or shortly after arrival at the new facility. The sending nurse is responsible for providing clear, comprehensive, and complete patient documentation. PTS: 1 DIF: Understand REF: 12-15 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 9. The nurse assesses a resident who was transferred yesterday from an acute care hospital. Which should the nurse assess to determine whether this individual is under stress from the transfer? a. Length of the resident’s stay in the acute care facility b. Availability of disposition options before the transfer c. Presence of familiar people throughout the transfer d. Tour of the new facility shortly after transfer ANS: B To help assess the resident for stress, the nurse reviews the sequence of events that led to the relocation including whether the resident had relocation options and what those options were before relocation. If the resident played an active role in the choice of facilities and had several available options, then the resident is likely to experience less stress upon relocation. The length of stay in the acute care facility is an unreliable index of stress in a resident who has been recently relocated. The presence of familiar people is an unreliable predictor of relocation stress. Touring the new facility is an unreliable predictor of relocation stress; if the tour is conducted too soon or when the resident is in pain, tired, or distracted, then the resident is unlikely to benefit from the tour. PTS: 1 DIF: Apply REF: 32 Text Box 3-8 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 10. Which is characteristic of relocation stress syndrome in a resident of a long-term care facility? a. Agitation c. Caring family b. Apprehension d. Hallucinations ANS: B Apprehension is a major defining characteristic of stress relocation syndrome. Agitation is uncharacteristic of stress relocation syndrome. An inadequate support system is characteristic of this syndrome. Hallucinations are uncharacteristic of this syndrome. PTS: 1 DIF: Remember REF: 16 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 11. A nurse completing a hospital discharge to home understands that which of the following interventions is most important before discharge. a. Medication reconciliation b. Providing a list of community resources c. Contacting a durable medical equipment facility d. Educating the client on appropriate range-of-motion exercises ANS: A Medication reconciliation is the most important intervention to complete before discharge. Medication discrepancies are the most prevalent adverse event after hospital discharge and the most challenging component of a successful hospital-to-home transition. Nurses’ attention to an accurate prehospital medication list, medication reconciliation during hospitalization and at discharge, and patient and family education about medications are required to enhance safety. Educating the client on appropriate range-of-motion exercises, providing a list of community resources, and contacting a durable medical equipment facility are all important and should be completed as well, but medication reconciliation should be the priority. PTS: 1 DIF: Apply REF: 13-22| 22 Box Safety Alert TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment MULTIPLE RESPONSE 1. A family is touring selected nursing homes in preparation for their mother’s future. Which qualities of a nursing home should the family include if they decide on a person-centered nursing home? (Select all that apply.) a. Staff members cover all nursing units. b. Residents and families have a council. c. Residents choose stimulating activities. d. Staff members respond to residents’ needs. e. Group activities are scheduled on the hour. f. Staff members help residents stay well-groomed. ANS: B, C, D, F A characteristic of a person-centered culture is family and resident councils to discuss resident issues, needs, and solutions. A second characteristic of a person-centered culture is residents choosing their own activities to suit their interests. A third characteristic of a person-centered culture is a responsive staff that promptly meets resident needs. A fourth characteristic of a person-centered culture is assisting residents to maintain their appearance and to stay well-groomed. Consistent nursing assignments are a characteristic of a person-centered culture. Predetermined schedules are characteristic of an institution-centered culture. PTS: 1 DIF: Understand REF: 12 Box 3-4 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 2. An elder-friendly community includes components that: (Select all that apply.) a. Address basic needs b. Optimize physical health c. Provide financial assistance d. Maximize independence e. Provide social engagement ANS: A, B, D, E Components of an elder-friendly community include addressing basic needs, optimizing physical health and well being, maximizing independence for the frail and disabled, and providing social and civic engagement. Elder-friendly communities do not provide financial assistance. PTS: 1 DIF: Understand REF: 2 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 3. Which home modification interventions are designed to enhance the ability of older adults to remain in their homes? (Select all that apply.) a. A 36-inch-wide doorway b. Entryways with less than two steps c. Electrical outlets at chest level d. A bathroom on the first floor ANS: A, D Many state and local governments are assessing the community and designing interventions to enhance the ability of older people to remain in their homes and familiar environments. Home design features such as 36-inch-wide doorways and hallways, a bathroom on the first floor, an entry with no steps, outlets at wheelchair level, and reinforced walls in bathrooms to support grab bars. PTS: 1 DIF: Understand REF: 2 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment Chapter 6: Social, Psychological, Spiritual, and Cognitive Aspects of Aging Test Bank MULTIPLE CHOICE 1. Which of the following is a true statement about the theories of aging? a. Research data support the disengagement theory, activity theory, and continuity theory. b. Everyone should be able to achieve the three tasks of Peck’s model of integrity. c. The exercise of rights is not a task of aging in Kelly’s model. d. A person may choose to avoid pursuing inner discovery in older age. ANS: D Some persons do not value inner psychological exploration and remain action oriented even in an older age, and others are still subject to the same demands of daily living as they were in middle age. None of these theories is clearly supported by data. Peck’s tasks of ego differentiation, body transcendence, and ego transcendence demand a great deal of courage and energy that not everyone possesses. Tasks of aging in Kelly’s model are accepting reality, fulfilling responsibility, and exercising rights. PTS: 1 DIF: Understand REF: 4-12 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. Which of the following is a true statement about neuropsychiatric function in older adults? a. Overall cognitive abilities are progressively degraded by neuron loss in the cerebral cortex with aging. b. Improving cognitive functions in an older person calls for sporadic mental activity around ideas the person finds significant and interesting. c. Nerve cells regenerate in the hippocampus. d. Mood does not influence an older person ability to remember verbal instructions. ANS: C Nerve cells regenerate in the hippocampus; this is a true statement. Although neurons can regenerate in the hippocampus, regeneration is impeded by stress. Overall cognitive abilities are progressively degraded by neuron loss in the cerebral cortex with aging; this statement is not true. Neuron loss does not harm overall cognitive ability, although it makes neural processes run more slowly. Improving cognitive functions in an older person calls for sporadic mental activity around ideas the person finds significant and interesting; this is not a true statement. Neural functions can be retrained, but “exercising” the brain on a regular basis is necessary. Older adults learn best when new information is relevant to what is already familiar. Mood does not influence whether an older person remembers verbal instructions; this is a not a true statement. Recalling events, including communication, is impaired by a crisis situation or anxiety. PTS: 1 DIF: Remember REF: 16 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 3. Which of the following statements is true about social and emotional health of older adults? a. Contemporary society has strong norms for the behavior of adults older than 80 years. b. The transition to old age entails a declining level of contribution to others as one becomes increasingly dependent on them. c. Computers and the Internet have little to contribute to older adults in their need for social support. d. Nurses are often significant sources of social and emotional support for older adults. ANS: D Nurses are often important confidants and providers of social support in the lives of older adults. The diversity of cultures and individuals in a society such as the United States means that norms are almost nonexistent for those older than 80 years. Older adults have a great deal to contribute in wisdom and by example. E-mail and online chat rooms are a means of contact and social support for many older adults. PTS: 1 DIF: Understand REF: 12-20| 29 Box 6-1| 33 Box 6-5| 34 Box 6-6 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 4. Which role is most likely to have a significant effect on the type of aging process experienced by the older adult? a. Grandparent c. Friend b. Spouse d. Parent ANS: B The loss of a spouse is likely to be devastating for an older adult for economic and biopsychosocial reasons. When an older adult loses a spouse, the loss can include economic security, especially for a woman, and societal roles. Alterations in these roles are not usually as challenging as the loss of a spouse. Grandparenting can offer the potential for enhanced social experiences for an older adult; however, adults can age well without them when more basic needs are met. Alterations in these roles are not always as acutely demanding as the loss of a spouse. Alterations in these roles usually call for little or a gradual adjustment. PTS: 1 DIF: Understand REF: 12-13 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 5. The children in an African-American family attended college because their mother worked two jobs as they were growing up. She never finished high school, the children are grown, and she lives alone in retirement. Which noted weakness of sociological theories on aging explains why the social exchange theory is not applicable to this older adult? a. Gender c. Ethnicity b. Culture d. Opportunity ANS: D Social exchange theory ignores the effect that opportunity can have on aging because, according to this theory, the mother should be living with one of the children. They had the opportunities that she never had. Gender is not as relevant to this theory of the value of youth as being a period where social credits are earned for old age. Culture is not as relevant to this theory as the value of youth. Ethnicity is not as relevant to this theory as the value of youth. PTS: 1 DIF: Analyze REF: 7 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 6. In which context are members of a cohort described when using the age-stratification theory to explain the effect of similar events, conditions, and circumstances? a. Historical c. Sociological b. Biological d. Chronological ANS: A In the age-stratification model, historical context is used to understand members of a cohort in terms of similar events, conditions, and circumstances and the effect these have on the group as a whole. A good example of such a cohort is older adults who lived through World War II. Biological context is not important in considering the age-stratification theory. The age-stratification theory is a sociological theory of aging that uses historical context to describe cohorts. Chronological context of a cohort will span a range, but historical context is what describes the cohort. PTS: 1 DIF: Knowledge REF: 6 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 7. An older patient who was just diagnosed with a terminal disease states, “All my life I attended church, but I am still worried about what will happen after death.” The nurse’s best response is which of the following? a. “The unknown may be frightening. Do you want to talk about this?” b. “Religious people know that God is a good God.” c. “People that have had near death experiences say it is peaceful.” d. “You must feel good about attending church most of your life.” ANS: A “Often the unknown is very frightening,” uses the reflective technique to identify the patient’s feelings regarding the fear of the unknown. “Religious people know that God is a good God,” denies the patient’s feelings. “People that have had near death experiences say it is peaceful,” focuses on the experience of others. “You must feel good about attending church most of your life,” ignores the patient’s concern about death. PTS: 1 DIF: Apply REF: 12-16| 32 Box 6-4| 33 Box 6-5| 34 Box 6-6 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 8. An older man with severe knee pain tells the nurse how he lost his job and his home after starting a new business when he was 48 years old. Now he lives alone and relies on Social Security. Using Jung’s theory, what in this individual’s life is the most pivotal in his personality development? a. Living alone c. Severe knee pain b. Meager income d. Job and home loss ANS: D Jung’s theorizes that the personality forms, in part, after a crisis, as an individual moves from extroversion to introversion in aging. Living alone is a situation that is the result of many factors coalescing in an individual’s life. A meager income can be a result of the individual’s life work and other individual choices and events. His personality can affect how an individual deals with pain, and the pain can affect an individual’s personality. However, whether the pain is old or new is not known; thus a determination cannot be made. PTS: 1 DIF: Analyze REF: 9-10 TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance 9. The nurse plans care for older adults who are in good health but isolated from their families. If the nurse’s goal is to move the adults toward gerotranscendence, which intervention should the nurse use in the plan of care? a. Give a daily tea party for the group. b. Call each family to encourage visiting. c. Assist them to resume midlife patterns. d. Help each person with individual activities. ANS: D In Tornstam’s theory, aging offers the potential for gerotranscendence, a culmination of an individual’s life, wisdom, and spiritual growth that allows the older adult to live contentedly with and without social activities. An older adult spends more time on meditation and solitude, and less time on materialism and self-consciousness about body image. Individual activities or self-selected activities are satisfactory. Solitude is satisfactory. Midlife patterns are no longer relevant to contentment. PTS: 1 DIF: Apply REF: 12 TOP: Nursing Process: Planning MSC: Psychosocial Integrity 10. The nurse observes older female adults learning advanced knitting techniques. The nurse concludes that this learning activity is suitable for these women because it accomplishes which of the following? a. Helps maintain joint flexibility b. Improves the group’s cohesiveness c. Provides a needed social opportunity d. Adds to their existing knowledge base ANS: D Learning advanced techniques is a suitable activity for older adults because it builds on knowledge they already have; further, this activity is suitable because it is concrete and practical for experienced knitters to develop advanced skills. Joint flexibility is a physical activity and not necessarily a learning activity. The members share enjoyment of knitting; other than being women and older, the group has no special bond on which to build. The need for socializing is not evident. PTS: 1 DIF: Apply REF: 19-20 TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 11. The nurse at a nursing home wants to help decrease the risk of Alzheimer disease in the residents. Which should the nurse do to implement this goal? a. Keep the curtains open in their rooms. b. Offer beads for them to string on yarn. c. Show movies that the residents choose. d. Assist residents with ambulation to meals. ANS: D Engaging in physical activity and social interaction are associated with a lower risk for Alzheimer disease. Keeping the curtains open can make a resident’s room more pleasant but is likely to be counterproductive in lowering the risk; brightening the room can entice the resident to stay in the room and decrease social interaction. Stringing beads is a passive and sedentary activity and therefore unlikely to decrease the risk for Alzheimer disease; physical activity is associated with a lower risk for Alzheimer disease. Watching movies is a sedentary but not a mentally stimulating activity for an adult with a normal intelligence. PTS: 1 DIF: Apply REF: 15-18 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 12. Which physiological change in the brain is the reason the nurse allows more time for answering questions with older adults? a. Increased secretion of cholinesterase b. Decreased secretion of neurotransmitters c. Loss of spinal cord and brainstem neurons d. Atrophy of dendrites in the cerebral cortex ANS: D Dendrites are the receiving end of neurons (receiving electrochemical signals) and the branched ends extending from the cell body. The atrophy of dendrites contributes to slower thought processes with aging because the synapses are impaired; this changes the transmission of neurotransmitters that are vital in the transmission of an electrical impulse from neuron to neuron. The secretion of cholinesterase, the enzyme that inactivates acetylcholine in the synapse, does not increase with aging. Changes in the transmission of neurotransmitters are associated with the atrophy of dendrites. The spinal cord and the cerebral cortex lose neurons with age, the cerebral cortex more than the spinal cord. PTS: 1 DIF: Understand REF: 16 TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment 13. The nurse provides opportunities for nursing home residents to read aloud to others. Which cognitive skill is this nursing intervention most likely to improve? a. Verbal fluency c. Object naming b. Logical analysis d. Visuospatial skills ANS: A Allowing residents to read aloud helps improve and maintain verbal fluency because it provides an opportunity to practice these skills. Reading aloud does not usually require analysis. Reading is unlikely to improve object recall unless displaying objects is part of the reading. Visuospatial skills require the ability to perceive the relationship of objects in terms of the space each object occupies; reading is unlikely to improve this skill. PTS: 1 DIF: Understand REF: 16 TOP: Nursing Process: Evaluation MSC: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Which statements are true about aging and the brain? (Select all that apply.) a. Most areas of the brain do not lose brain cells. b. Memory decline is inevitable as people age. c. Basic intelligence remains unchanged with age. d. The brain does not continue to make new brain cells. ANS: A, C Most areas of the brain do not lose brain cells. Although older adults may lose some nerve connections, it can be part of the reshaping of the brain that comes with experience. Basic intelligence remains unchanged with age, and older adults should be provided with opportunities for continued learning. Many people reach older age and have no memory problems. Participation in physical exercise, stimulating mental activity, socialization, health diet, and stress management help brain health. PTS: 1 DIF: Understand REF: 12-Apr TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. The nurse is admitting a patient to a long-term care facility. During the admission, the patient verbalizes a concern about getting dementia now that he is in a nursing home. In what activity(ies) should the nurse encourage the patient to participate to maintain brain health? (Select all that apply.) a. Physical exercise c. Socialization b. Stimulating mental activity d. Increasing dietary intake ANS: A, B, C Many people reach older age and have no memory problems. Participation in physical exercise, stimulating mental activity, socialization, health diet, and stress management help brain health. An increase in dietary intake has not been shown to influence brain health. PTS: 1 DIF: Apply REF: 37 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance