Test Bank For Ebersole And Hess' Gerontological Nursing & Healthy Aging, 5Th Edition By Theris A. Touhy, And Kathleen F Jett 2024 || All Chapters A+

TEST BANK FOR EBERSOLE AND HESS' GERONTOLOGICAL NURSING & HEALTHY AGING, 5TH EDITION BY THERIS A. TOUHY, AND KATHLEEN F JETT 2024 || All Chapters A+ Table Of Contents 1.Chapter01:IntroductiontoHealthyAging 2. Chapter02:Cross-CulturalCaringandAging 3 :BiologicalTheoriesofAgingandAge-RelatedPhysicalChanges 4 :Psychosocial,Spiritual,and Cognitive Aspects of Aging 05:Gerontological Nursing and Promotion of Healthy AgingChapter06:Gerontological Nursing Across the Continuum of Care Chapter07:Economi cand Legal IssuesChapter08:AssessmentandDocumentationforOptimalCare Chapter09:SafeMedicationUse Chapter10:Nutrition Chapter11:HydrationandOralCare Chapter12:Elimination Chapter13:Rest,Sleep,andActivity Chapter14:PromotingHealthySkin Chapter15:FallsandFallRiskReduction Chapter16:PromotingSafety Chapter17:LivingWithChronicIllness Chapter18:PainandComfort Chapter19:DiseasesAffectingVisionandHearing Chapter20:MetabolicDisorders Chapter21:BoneandJointProblems Chapter22:CardiovascularandRespiratoryDisorders Chapter23:NeurologicalDisorders Chapter24:MentalHealth Chapter25:CareofIndividualsWithNeurocognitiveDisorders Chapter26:Relationships,Roles,andTransitions Chapter27:Caregiving Chapter28:Loss,Death,andPalliativeCare Chapter01:IntroductiontoHealthyAging Touhy&Jett:EbersoleandHess’GerontologicalNursing&HealthyAging,5thEdition MULTIPLECHOICE 1. Aman is terminally ill with end-stage prostate cancer. Which is the best statement about this man’s wellness? a. Wellnesscanonlybeachievedwithaggressivemedical interventions. b. Wellnessisnotarealoptionforthisclientbecausehe isterminallyill. c. Wellness isdefined asthe absenceof disease. d. Nursinginterventionscanhelpempoweraclientto achieveahigherlevelofwellness. ANS: D Nursing interventions can help empower a client to achieve a higher level of wellness; a nurse can foster wellness in his or her clients. Wellness is defined by the individual and is multidimensional. It is not just the absence of disease.A wellness perspective is based on the belief that every person has an optimal level of health independent of his orher situation or functional level. Even in the presence of chronic illness or while dying, a movement toward wellnessis possible if emphasis of care is placed on the promotion of well-being in a supportive environment. PTS: 1 DIF: Apply REF: p.7 TOP: NursingProcess:DiagnosisMSC: Health Promotion and Maintenance 2. Indifferentiatingbetweenhealthandwellnessinhealthcare,whichofthefollowingstatements is true? a. Healthisabroadtermencompassingattitudesand behaviors. b. Theconceptofillnesspreventionwasneverconsidered bypreviousgenerations. c. Wellnessandself-actualizationdevelopthroughlearningandgrowth. d. Wellnessis impossible when one’s health is compromised. ANS: A Health is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves one’s whole being. The concept of illness prevention was never considered by previous generations; throughout history, basic self-care requirements have been recognized. Wellness and self-actualization develop through learning and growth—as basic needs are met, higher level needs can be satisfied in turn, with ever-deepening richness to life. Wellness is possible when one’s health is compromised—even with chronic illness, with multiple disabilities, or in dying, movement toward a higher level of wellness is possible. PTS: 1 DIF: Understand REF: p.7 TOP: NursingProcess:EvaluationMSC: Health Promotion and Maintenance 3. WhichracialorethnicgrouphasthehighestlifeexpectancyintheUnitedStates? a. NativeAmericans b. AfricanAmericans c. HispanicAmericans d. AsianandPacificIslandAmericans ANS: C As shown in Figure 1.4, Hispanic men and women have the highest life expectancy of all. In 2011, for those of Hispanic origin of any race, the overall life expectancy at 65 years of age was 20.7 more years in 2011 (19.1 years for men and 21.8 years for women). PTS: 1 DIF: Understand REF: p.6 TOP: NursingProcess: Assessment MSC: Safe,EffectiveCareEnvironment 4. Historical influences that have shaped the lives of the majority of the in-between cohort in the United States today include which of the following? a. Influenzaepidemicof1918 b. WorldWar I c. ChildrearingintheDepression d. WorldWar II ANS: D Those who are in the in-between cohort in 2016 were born between 1915 and 1945. The men were likely to have fought in World War II. The last of the Holocaust survivors are in this group. A person who survived the influenza epidemic would be at least 98 years old in 2016 and therefore would be considered old-old or a centenarian. Most of thosewhoareofthein-betweencohorthadnotreachedchildbearingagebytheendoftheDepression.Individuals in the inbetween cohort would not have been old enough to fight in World War II. PTS: 1 DIF: Understand REF: p.5 TOP: NursingProcess: Assessment MSC: Safe,EffectiveCareEnvironment 5. Accordingtoresearchers,whichcharacteristicdomostcentenariansshare? a. Female b. Hispanic c. Livinginruralareas d. LocatedintheMidwesternstates ANS: A Based on the U.S. census report of 2010, centenarians were overwhelmingly white, female, and living in the urban areas of the Southern states. PTS: 1 DIF: Remember REF: p.5 TOP: NursingProcess: Assessment MSC: Safe,EffectiveCareEnvironment 6. Whichnursinginterventionisaholisticapproachtoanolderadult? a. Performsglucosetestingduringtheweeklyworship Service b. Wheelsambulatoryadultstoexercisewhenrunning Late c. AssignsfemalenursestoolderwomenwhoareIslamic d. Allowsolderadultsinanursinghometoeatmeals Alone ANS: C The nurse uses a holistic approach to the care of an older female adult who is Islamic because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture. Interrupting an older adult’s worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older adult’s life by testing for glucose before the service begins. In transporting ambulatory adults to the exercise program in wheelchairs to save time, the nurse disregards the need for self-esteem and exercise, both important aspects of physical well-being. Ambulatory adults can walk with assistance, if needed, to exercise programs and can benefit from the additional activity and independence. The nurse can be tempted to allow an older adult to eat meals alone in his or her room if this will motivate the person to eat or if the older adult has dysphasia and is embarrassed. However, although focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being. PTS: 1 DIF: Understand REF: p.7 TOP: NursingProcess:EvaluationMSC: Health Promotion and Maintenance 7. An older man who resides in a nursing home has a total cholesterol level of 245 mg/dL. Which nursing intervention is most likely to assist this man in achieving his highest level of wellness? a. Instructhimaboutincreasingdietaryfiber. b. Askthehealthcareproviderforalow-fatdiet. c. Scheduleaconsultationforhimwiththedietitian. d. Reviewamenuwithhimtochoosesuitablefoods. ANS: D The nurse collaborates with the older adult to choose suitable foods, which is likely to be an effective nursing intervention to help an older adult with hyperlipidemia achieve optimal health and well-being; it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol. Informing the older man about dietary fiber offers no control to him because he is not part of the decision. Nursing interventions developed with the older adult’s collaboration are most likely to help the older adult achieve health and wellness. Collaborating with the healthcareproviderforalow-fatdietisareasonableapproachtohelpthismanwithhyperlipidemiatoachieve health and wellness. However, he is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has had some control. Scheduling a consultation with a dietitian is a reasonable approach to an older adult with hyperlipidemia and is a part of a multifaceted approach to optimizing his health. However, the older adult ismore likely to engage in a regimen over which he has input. PTS: 1 DIF: Analyze REF: p.7 TOP: NursingProcess:PlanningMSC: Health Promotion and Maintenance 8. Which approach requires the nurse to integrate and balance all aspects of an individual’s life into the plan of care? a. Holisticnursing b. HealthyPeople2020 c. Maslow’shierarchyofhumanneeds d. Orem’sself-carerequirements ANS: A Holistic nursing integrates all aspects of an individual’s life into the plan of care by balancing an individual’s internal and external environment with psychosocial, spiritual, cultural, and physical processes. HealthyPeople2020, an updated document from 2000 that outlines the goals for achieving health in this country, is a mandate for health care professionals to follow with 467 objectives in 28 focus areas. Maslow’s hierarchy of human needs provides a basisfor understanding individuals in context and for ranking nursing assessments, diagnoses, goals, and interventions in order of importance. Dorothea Orem’s self-care requirements lists human needs, including the need for air, fluids, nutrition, hygiene, elimination, activity, comfort, relief from suffering, and skin integrity. The nurse helps individu- als meet these needs to achieve optimal health and wellness. PTS: 1 DIF: Remember REF: p.7 TOP: NursingProcess: Assessment MSC: Safe,EffectiveCareEnvironment 9. The nurse plans activities for older women born between 1920 and 1930 and who reside in an assisted-living facility. Which is the best intervention for the nurse to implement? a. Havethembakecookiestwiceaweek. b. Conductinterviewsforspecificinterests. c. Arrangedogandcatvisitsfromvolunteers. d. Take themtothelibraryforguestspeakers. ANS: B The nurse conducts individual interviews with the women to determine their interests and to avoid generalizing; as people live longer, they become more and more unique. Because most of these women are in their 80s and 90s were bornbetween1920and1930andhavegenerallyspenttheirlivesashomemakers,thenursepresumestoknowwhat activities they will enjoy. The nurse avoids arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older adult to a pet visit. Unless it is organized on a voluntary basis, the nurse avoids arranging visits by guest speakers. In addition, the nurse will assess each older woman before an outside visit to avoid embarrassing events, including incontinence and hearing and vision problems. PTS: 1 DIF: Analyze REF: p.5 TOP: NursingProcess:Implementation MSC: Safe,EffectiveCareEnvironment 10. WhichofthefollowingissuesinthecareofolderadultsareidentifiedinHealthyPeople2020? a. Delineatingnursingstaffinglevelsinlongtermcare b. Eradicatingpressureulcersinallcaresettings c. Identifyingminimumlevelsoftrainingforpeoplewho careforolderadults d. Institutingmandatorytraininginidentificationofelder abuseforallcaregiversofolderadults ANS: C Identifying minimum training levels for people who care for older adults is one of the issues identified in HealthyPeople2020. The rest of the issues are not discussed in HealthyPeople2020. PTS: 1 DIF: Remember REF: p.8 TOP: TeachingandLearningMSC: Health Promotion and Maintenance 11. An older man asks a nurse: “How do you define aging? Do I meet the criteria of a seniorcitizen?” The nurse understands that one can define aging in many different manners. If the nurse chooses to define aging as “social aging,” the nurse would consider which of the following aspects? a. Themanretiredfromhisjobasapoliceofficer. b. Themantakessixdifferentmedicationsmultipletimes overthecourseoftheday. c. Themanwalkswitharollingwalker. d. Themancelebratedhis65thbirthday. ANS: A Social aging is determined by changes in roles. Taking multiple medications multiple times over the course of the day and walking with a rolling walker are functional determinants of aging. Age refers to chronological aging. PTS: 1 DIF: Understand REF: p.7 TOP: NursingProcess: Assessment MSC: HealthPromotionandMaintenance 12. Theholistichealthmovementhasimpactedhealthcareinwhichofthefollowingways? a. Ithasfocusedhealthcareondiseaseprevention. b. Ithasreshapedhowhealthandhealthcareareperceived. c. Ithasimprovedaccesstohealthcare. d. Ithasintroducednumerousalternativemodalitiesinto healthcare. ANS: B The holistic paradigm has reshaped how health and health care are perceived. Wellness is seen as a state of being which can be defined anywhere along the continuum of health. PTS: 1 DIF: Understand REF: p.7 TOP: TeachingandLearningMSC: Health Promotion and Maintenance MULTIPLERESPONSE 1. According to HealthyPeople2020, older adults have been identified as a priority, with a goal to improve their health, function, and quality of life. Identify the targeted chronic focus areas for improvement. (Selectallthatapply.) a. Diabetes b. Arthritis c. Congestiveheartfailure d. Dementia e. Cancer f. Pressureulcers ANS: A,B,C,D In a push toward wellness, older adults were identified as a priority area for the first time. The targeted chronic areas of focus were identified as diabetes, arthritis, congestive heart failure, and dementia. PTS: 1 DIF: Remember REF: p.8 TOP: NursingProcess:PlanningMSC: Health Promotion and Maintenance 2. IdentifytheHealthyPeople2020emergingissuesinthehealthofolderadults.(Selectallthat apply.) a. Coordinatingcarefortheolderadultpopulation b. Assistingolderadultsinthemanagementoftheirown care c. Identifyinglevelsoftrainingforthosecaringforolder adults d. Makingcommunityresourcesavailableforolderadults e. Increaseinhealthdisparitiesforruralolderadults ANS: A,B,C According to United States Department of Health and Human Services’HealthyPeople2020, emerging issues in the health of older adults include coordinating care, helping older adults manage their own care, establishing quality measures, identifying minimum levels of training for people who care for older adults, and researching and evaluating appropriate training to equip providers with the tools they need to meet the needs of older adults. PTS: 1 DIF: Remember REF: p.8 TOP: NursingProcess:PlanningMSC: Health Promotion and Maintenance 3. Researchers hypothesize that most super-centenarians survive and are in good health due to which of the following factors? (Selectallthatapply.) a. Theyhaveadifferentgeneticmakeupthanotherolder adultshave. b. Theytendtoliveinwealthierareasoftheworld. c. Theexactcauseofthisphenomenonisnotknown. d. Contributingfactorstotheirgoodhealthincludequalitymedicalcareandimprovedsocialconditions. e. Theyhavelargeextendedfamiliestoassistintheir care. ANS: C,D The exact cause of super-centenarians’longevity is not known; researchers describe it as attributable to “rare and unpredictable reasons.” Contributing factors include medical care and improved sociopolitical conditions. There isno known difference in biological or sociological factors between super-centenarians and other older adults. Super- centenarians exist all over the world. PTS: 1 DIF: Understand REF: p.4-5 TOP: NursingProcess: Assessment MSC: HealthPromotionandMaintenance 4. The nurse in an assisted living facility (ALF) is preparing a lecture on aging for the residents. The philosophy of theALF is to approach aging from the viewpoint of health. Based on this philosophy, the nurse includes which of the following topics? (Selectallthatapply.) a. “TheManyChronicIllnessesofAging” b. “ChannelingYourInnerStrengthTowardWellness” c. “Maximizing FunctionAsYouAge” d. “ConservingYourStrengthAsYouAge” e. “Keep Moving, MaintainYour Mobility” ANS: B,C,D Awellness perspective is based on the belief that every person has an optimal level of wellness independent of functional ability. This viewpoint approaches aging with an emphasis on resilience, strength, resources, and capabilities rather than focusing on existing pathological conditions. PTS: 1 DIF: Analyze REF: p.6-7 TOP: TeachingandLearningMSC: Health Promotion and Maintenance Chapter02:Cross-CulturalCaringandAging Touhy&Jett:EbersoleandHess’GerontologicalNursing&HealthyAging,5thEdition MULTIPLECHOICE 1. Whichofthefollowingisatruestatementaboutdifferinghealthbeliefsystems? a. Personalisticormagicoreligiousbeliefshavebeensupersededin Westernmindsbybiomedicalprinciples. b. Inmostcultures,olderadultsarelikelytotreatthemselvesusingtraditionalmethodsbeforeturningtobiomedicalprofessionals. c. AyurvedicmedicineisanothernamefortraditionalChinesemedicine. d. Thebeliefthathealthdependsonmaintainingabalanceamongoppositequalitiesischaracteristicofamagicoreligiousbeliefsystem. ANS: B Older adults in most cultures usually have had experience with traditional methods that have worked as well as expected. After these treatments fail, older adults turn to the formal health care system. Even in the United States, it is common for older adults to pray for cures or wonder what they did to incur an illness as punishment. TheAyurvedic system is a naturalistic health belief system practiced in India and in some neighboring countries. This belief is characteristic of a holistic or naturalistic approach. PTS: 1 DIF: Understand REF: p.16-17 TOP: NursingProcess: Assessment MSC: HealthPromotionandMaintenance 2. Whichofthefollowingconsiderationsismostlikelytobetruewhenworkingwithaninterpreter? a. Aninterpreterisneverneededifthenursespeaksthesamelanguageasthepatient. b. Whenworkingwithinterpreters,thenursecanusetechnicaltermsormetaphors. c. Apatient’syounggranddaughterwhospeaksfluentEnglishwouldmakethebestinterpreterbecausesheis familiarwithandlovesthepatient. d. Thenurseshouldfacethepatientratherthantheinterpreter. ANS: D Thenurseshouldfacethepatientratherthantheinterpreterisatruestatement;theintentistoconversewiththepatient, not with a third party about the patient. Many reasons may prevent the patient from speaking directly to a nurse. Technical terms and metaphors may be difficult or impossible to translate. Cultural restrictions may prevent some topics from being spoken of to a grandparent or child. PTS: 1 DIF: Understand REF: p.18-19 TOP: NursingProcess:Implementation MSC: Safe,EffectiveCareEnvironment 3. An older adult who is a traditional Chinese man has a blood pressure of 80/54 mm Hg and refuses to remain in the bed. Which intervention should the nurse use to promote and maintain his health? a. Havethehealthcareproviderspeaktohim. b. Useprinciplesoftheholistichealthsystem. c. Askabouthisperceptionsandtreatmentideas. d. ConsultwithapractitionerofChinesemedicine. ANS: C Using the LEARN model (listen with sympathy to the patient’s perception of the problem, explain your perception of the problem, acknowledge the differences and similarities, recommend treatment, and negotiate agreement), the nurse gathers information from the patient about cultural beliefs concerning health care and avoids stereotyping the patient. In the assessment, the nurse determines what the patient believes about caregiving, decision making, treatment, and other pertinent health-related information. Speaking with the health care provider is premature until the assessment is complete. Unless he accepts the beliefs, principles of the holistic health system can be potentially unsuitable and insulting for this patient. Unless he accepts the treatments, consulting with a practitioner of Chinese medicine can also be unsuitable and insulting forthis patient. PTS: 1 DIF: Apply REF: p.18 TOP: NursingProcess:Implementation MSC: HealthPromotionandMaintenance 4. Whichactionshouldthenursetakewhenaddressingolderadults? a. Speakinanexaggeratedpitch. b. Usealowerqualityofspeech. c. Useendearingtermssuchas“honey.” d. Speakclearly. ANS: D Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons and fewerof those who are healthy and active. Providers should not assume that all older adults are hearing or mentally impaired.The most appropriate action when addressing an older adult would be to speak clearly. Examples of unintentional ageism in language are an exaggerated pitch, a demeaning emotional tone, and a lower quality of speech. PTS: 1 DIF: Apply REF: p.15 TOP: NursingProcess: Assessment MSC: HealthPromotionandMaintenance 5. The nurse prepares an older woman, who is Polish, for discharge through an interpreter and notes that she becomes tense during the instructions about elimination. Which intervention should the nurse implement? a. Moveontothediscussionaboutmedication. b. Asktheolderwomanhowshefeelsaboutthistopic. c. Instructtheinterpretertorepeattheinstructions. d. Havetheolderwomanrepeattheinstructionsforclarity. ANS: B When working with an interpreter, the nurse closely watches the older adult for nonverbal communication and emotion regarding a specific topic and therefore validates the assessment about the older adult’s tension before proceeding. Because the nurse notices her tension, the nurse temporarily suspends the preparation to validate her assessment. If the nurse proceeds and the older adult is uncomfortable discussing elimination, then important instructions can be missed, leading to adverse effects for the older adult. Repeating the instructions can aggravate the older adult’s discomfort. Instructing theolder adult to repeat the nurse’s instruction ignores her needs. PTS: 1 DIF: Apply REF: p.18-19 TOP: Communication and DocumentationMSC:Safe, Effective Care Environment 6. The nurse plans care for an olderAfricanAmerican man who is from Jamaica and resides in NewYork City. Which should the nurse include in planning care? a. Attributehisillnesstobreakingavoodoo. b. Helphimimprovesocialrelationships. c. Maintainbloodpressurebelow120/70mmHg. d. Reviewtheprinciplesofthemagicoreligioussystem. ANS: C BecauseAfricanAmericans tend to be at risk for cardiovascular disease and hypertension, the nurse plans to maintain the patient’s blood pressure at or below the current recommendation by the American Heart Association. The nurse can be incorrectly assuming that he practices and believes in the magicoreligious system. The nurse should assess his spiritual beliefs and determine how much they influence his attitudes toward Western health care. The magicoreligious system maintains social relationships in good condition to prevent illness; however, if the older adult does not follow this cultural practice, then this goal can be unsuitable. The older adult may not believe in this system; therefore, the information can be irrelevant. PTS: 1 DIF: Apply REF: p.18-19 TOP: NursingProcess:PlanningMSC: Safe, Effective Care Environment 7. Whichhealthbeliefsystemusestreatmentstorepairabodypart? a. Holistic b. Biomedical c. Personalistic d. Magicoreligious ANS: B Because dysfunction or a structural abnormality is thought to cause disease, the biomedical system believes in repairingthe structural abnormality. The holistic system holds that health is attained through balance. The personalistic system uses treatments such as meditation, fasting, and praying. The magicoreligious system is the same as the personalistic system. PTS: 1 DIF: Understand REF: p.17 TOP: NursingProcess: Assessment MSC: Safe,EffectiveCareEnvironment 8. Anurse is caring for a culturally diverse patient who has missed follow-up appointments with the primary care provider three times over the past year. The patient has a chronic illness that requires periodic monitoring of blood test values. The patient tells the nurse: “You don’t understand—in my culture, we don’t do things like that. I cannot be troubled with worrying about appointments in the future; I deal with each day as it comes.” The nurse understandswhich of the following about the patient’s culture? a. TheculturedoesnotvalueWesternmedicine. b. TheculturehasadifferentorientationtotimethanWesternmedicine. c. Thecultureisaninterdependentculture. d. Theculturedoesnotbelieveinpreventativecare. ANS: B Time orientation is a culturally constructed factor. Westernized medical care is future oriented. Conflicts between future oriented Westernized medical care and those with a present or past time orientation may arise. Patients are likely to be labeled as noncompliant for failing to keep appointments. PTS: 1 DIF: Understand REF: p.15-17 TOP: NursingProcess:PlanningMSC: Safe, Effective Care Environment 9. Apaperoncultureandillnesswouldbelikelytoincludethestatementthat a. cultureisthesameasethnicity. b. ethnicgroupsalwayssharecommongeographicoriginandreligion. c. ethnicityinvolvesrecognizedtraditions,symbols,andliterature. d. mostmembersofanethnicgroupexhibitidenticalculturaltraits. ANS: C Ethnicity is a complex phenomenon that includes traditions, symbols, literature, folklore, food preferences, and dress. It isasharedidentity.Ethnicityismorethanjustculture.Itissocialdifferentiationbasedonculture.Evenwithinethnic groups, there is considerable diversity. PTS: 1 DIF: Remember REF: p.12 TOP: TeachingandLearningMSC: PsychosocialIntegrity 10. Ahome care nurse is caring for an older patient from a different culture who is bedbound and high risk for development of a pressure ulcer. The nurse discusses the plan of care with the patient’s daughter, emphasizing the importance of turning every 2 hours, and posts a turning clock on the wall. When the nurse returns later in the week, the turning clock has been removed, and the patient’s daughter reports that she turns her mother occasionally. She states, “I am taking very good care of my mother.You just don’t understand—our ways do not involve doing things on schedules.” The best response by the nurse is: a. “Youmustfollowmyguidelinesandturnherevery2hours,orIwillnotbeabletotakecareofher.” b. “Iunderstandthatyouvalueyourculture,butculturecannotstopyoufromprovidinggoodcaretoyour mother.” c. Iunderstandthatyoucareverymuchforyourmother.Perhapscaringforheristoomuchforyou.” d. “Howcanwebestworktogethertoprovidethebestcareforyourmother?” ANS: D In providing cross-cultural care, it is important that the nurse work with the patient and family and listen carefully and finda way to include the values and beliefs of the patient in the plan of care. PTS: 1 DIF: Analyze REF: p.15 TOP: CommunicationandDocumentation MSC: PsychosocialIntegrity 11. An older patient learns that she has metastatic cancer. The patient states: “I must have angered God.” This is an example of which type of belief? a. Biomedical b. Magicoreligious c. Naturalistic d. Ayurvedic ANS: B Magicoreligious beliefs view illness as caused by actions of a higher authority. Biomedical beliefs view disease as a result of abnormalities in structure and function and disease caused by intrusion of pathogens into the body. Naturalistic beliefs are based on the concepts of balance; health is seen as a sign of balance. Ayurvedic beliefs are of the oldest known paradigm in the naturalistic system; illness is seen as an imbalance. PTS: 1 DIF: Remember REF: p.17 TOP: CommunicationandDocumentation MSC: PsychosocialIntegrity 12. Thetermhealthdisparityisdefinedas a. thesystematiceliminationofthecultureofanotherresultingindecreasedwellness. b. differencesinhealthoutcomesamonggroups. c. thedifferencebetweenanexpectedincidenceandprevalenceandthatwhichactuallyoccursinacomparison populationgroup. d. theexistenceofmorethanonegroupwithdifferingvaluesandperspective. ANS: B Health disparities are defined as differences in health outcomes among groups. Cultural destructiveness is defined as the systematic elimination of the culture of another. Health inequities are defined as the difference between an expected incidence and prevalence and that which actually occurs in a comparison population group. Cultural diversity is defined as the existence of more than one group with differing values and perspective. PTS: 1 DIF: Remember REF: p.13 TOP: TeachingandLearningMSC: PsychosocialIntegrity MULTIPLERESPONSE 1. The nurse is assessing an older adult from a culture different than the nurse’s by asking questions from the explanatory model for culturally sensitive assessment. Which question(s) should the nurse ask to follow this model? (Selectallthatapply.) a. Howcanwenegotiatetosolvetheproblem? b. Whattreatmentcanimproveyourcondition? c. Shouldwetrymyplanfirsttoseeifithelps? d. Canwediscussdifferencesinourplansnow? e. Howlonghaveyouexperiencedtheproblem? f. Who,otherthanme,canmakeyoufeelbetter? ANS: B,E,F Asking about potential therapies is a question from the explanatory model and asks what the individual believes will help clear up the problem. The nurse asks about the duration of the problem as a part of applying the explanatory model. The nurse asks about other disciplines that the individual believes can be therapeutic. This question is based on the LEARN model. PTS: 1 DIF: Apply REF: p.14 TOP: NursingProcess: Assessment MSC: HealthPromotionandMaintenance 2. Anurse caring for older adults must be aware of which consequences of ageism in language? (Selectallthatapply.) a. Reducedsenseofself b. Poornutritionalintake c. Loweredsenseofself-competence d. Decreasedmemoryperformance ANS: A,C,D Somehealthprofessionalsdemonstrateageism,inpartbecauseproviderstendtoseemanyfrail,olderpersonsandfewer of those who are healthy and active. Consequences of ageism have been identified as a reduced sense of self, lowered self- esteem, lowered sense of self-competence, and decreased memory performance. Poor nutritional intake has not been iden- tified as a consequence. PTS: 1 DIF: Apply REF: p.15 TOP: NursingProcess: Assessment MSC: HealthPromotionandMaintenance 3. Whichfactor(s)is/areassociatedwiththeprovisionofculturallycompetentcare?(Selectallthat apply.) a. Culturalawareness b. Culturalknowledge c. Culturalskills d. Culturalconnections e. Knowledgeofspecificdetailsoftraditionsandpracticesofallthedifferentcultures ANS: A,B As nurses move toward cultural competence, they increase their cultural awareness, knowledge, and skills. Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. Cultural connections have not been identified as a factor. PTS: 1 DIF: Apply REF: p.15 TOP: NursingProcess: Assessment MSC: HealthPromotionandMaintenance 4. Anurse completes a cultural assessment of an older adult who is being admitted to an assisted living facility. Reasons for completing a cultural assessment include (Selectallthatapply.) a. cultureguidesdecisionmakingabouthealth,illness,andpreventivecare. b. cultureprovidesdirectionforindividualsonhowtointeractduringhealthcareencounters. c. cultureimpactsattitudestowardaging. d. allmembersofaculturereactinthesamewayinsimilarsituations. e. knowledgeofcultureeliminateshealthcaredisparities. ANS: A,B,C Although knowledge of culture has the potential to optimize care, not all individuals will respond in the same way to a specific situation. Knowledge of an individual’s culture will not eliminate health care disparities. PTS: 1 DIF: Understand REF: p.15-16 TOP: TeachingandLearningMSC: PsychosocialIntegrity 5. A nurse in the ambulatory care setting is preparing to do an interview with a non–English-speaking client. The nurse secures an interpreter. To have the most effective interview, the nurse should do which of the following? (Selectallthatapply.) a. Lookandspeaktotheinterpreter. b. Usetechnicalterminologytoensureaccuracy. c. Allowmoretimefortheinterview. d. Watchtheclient’snonverbal communication. e. Throughtheinterpreter,checkwhethertheclientunderstandsthecommunication. ANS:C,D,E For the most effective interview the nurse should look and speak directly to the client; avoid the use of jargon and technical terminology; observe the client’s nonverbal communications; and clarify understanding by asking the client to state in his or her own words what he or she understood, facilitated by the interpreter. The interview will naturally take longer. PTS:1 DIF:Remember REF:p.18-19 TOP:CommunicationandDocumentation MSC:PsychosocialIntegrity Chapter03:BiologicalTheoriesofAgingandAge-RelatedPhysicalChanges Touhy&Jett:EbersoleandHess’GerontologicalNursing&HealthyAging,5thEdition MULTIPLECHOICE 1. Decreasedfunctioningofwhichphysicalstructureislikelytoresultindecreasedmetabolisminolder adults? a. Kidney b. Thyroidgland c. Brain d. Skeleton ANS: B Secretion of thyroid hormones tends to decrease with age, resulting in a greater likelihood of a slower metabolism, hypothyroidism, and thinning hair and nails. Decreased kidney function leads to decreased glomerular filtration rate and the ability of the kidneys to concentrate urine and clear waste. Decreasing brain function tends to result in decreased cognitive functioning. Osteoclastic activity tends to decrease with age, increasing the risk for osteopenia and osteoporosis. PTS: 1 DIF: Understand REF: p.32 TOP: NursingProcess: Assessment MSC: PhysiologicalIntegrity 2. An older female patient is reading a large-print magazine and states that reading is difficult for her in the evening. Which intervention should the nurse implement? a. Putahigh-intensitylampattheheadofherbed. b. Explaintoherthatthegray-yellowringaroundhercornea,arcussenilis,isinterferingwithvisualacuity. c. Putmorepowerfultubesinthefluorescentroomlights. d. Examineherretinasforsignsofdamage. ANS: A The pupils become gradually smaller with age; therefore, the eye requires three times as much light.Ahigh-intensity light on the object of interest is more effective than increasing the overall room illumination. The arcus senilis does not affect vision. The patient is describing a gradual overall change, not the more localized or sudden effects of macular degeneration or retinal detachment. PTS: 1 DIF: Apply REF: p.35 TOP: NursingProcess:Implementation MSC: Safe,EffectiveCareEnvironment 3. Agingordinarilyleadstodecreasesinwhichofthefollowing? a. Creatinineclearanceandinsulinsecretion b. Bloodcarbondioxideandsalivaproduction c. Leftventricle-wallthicknessandskinhealingtime d. Serumtriiodothyronine(T3)andgastricpepsin ANS: D Serum T3and pepsin secretion both decrease with aging. Creatinine clearance declines, but insulin secretion normally remains stable. Saliva production decreases, but blood carbon dioxide normally remains unchanged. Left ventricle wall thickness and skin healing time both increase with aging. PTS: 1 DIF: Understand REF: p.30-31 TOP: NursingProcess: Assessment MSC: PhysiologicalIntegrity 4. Whichchangeintheskinisabnormalinanolderperson? a. Thinnerandmorefragileskin b. Red,swollen3-day-oldwound c. Greaternumberoffreckles d. Lossofhairontheextremities ANS: B Although the skin of an older person may require 48 to 72 hours to mount an initial inflammatory response to a wound, increasing redness after that time, particularly with purulent discharge, is a sign of infection. This change is normal as ridges in the skin are lost. Melanin distribution becomes more uneven with age. Hair is commonly lost from the legs and other areas of older adults. Hair loss from the legs is not a sign of peripheral vascular disease. PTS: 1 DIF: Understand REF: p.27 TOP: NursingProcess: Assessment MSC: PhysiologicalIntegrity 5. The nurse designs a group exercise program at a senior center. Which room should the nurse choose for the program? a. Roomwithabeautifulhardwoodfloortastefullyappointedwiththrowrugs b. Spaciousroomwithnowindowsbutwithfluorescentlightingandanaturalstonefloor c. Roomwithahardwoodfloorandlargewindowsoverlookingagardenarea d. Endroomwithalinoleumfloorandafanforventilationtocompensatefortheroom’sbrokenairconditioner ANS: C The hardwood floor provides an even surface. If the daylight from the large windows causes a glare problem, then curtains maybeused. Throwrugscanslideunderfootandcanleadtoafall,particularlywhenthesenseofbalancehasdeclined with age. Fluorescent lighting can lead to a glare problem, and the irregularities of the natural stone floor can lead to a fall. The linoleum floor also presents a glare problem, and overheating is a risk in older persons who have a reduced sweat-gland response to heat. PTS: 1 DIF: Apply REF: p.35 TOP: NursingProcess: Assessment MSC: PhysiologicalIntegrity 6. The latest trends in medicine encourage health care providers to prescribe nutrient-dense foods and exercise to prevent or delay the shortening of telomeres. On which biological theory of aging are these practices based? a. Geneticresearch b. Caloricrestriction c. Oxidativestress d. Cross-link ANS: A Genetic researchers have found that telomeres shorten with each cellular reproduction and continue to do so until the cell dies. Selected animal studies since the 1930s conclude that calorie restrictions of 30% can lead to a longer life expectancy, slower metabolism, lower body temperature, and delay of age-related disorders. The pacemaker theory, which is alsoknown as the neuroendocrine control theory, holds that critical functions of selected endocrine glands slow and can haltwith age. The cross-link theory suggests that aging is a result of the stiffening of proteins caused by cross-linking, leadingto stiffer joints, rougher skin, and decreased cellular elasticity. PTS: 1 DIF: Understand REF: p.22-26 TOP: NursingProcess: Assessment MSC: PhysiologicalIntegrity 7. During a nursing assessment, an older adult tells the nurse about increasing loss of balance. Further assessment indicates musculoskeletal changes. Which patient teaching should the nurse implement to address musculoskeletal reasons for the loss of balance? a. Exercisewithlightweights. b. Standononefootatatimewhilesupported. c. Train withtheuseofsit-ups. d. Work out in aswimming pool. ANS: B The loss of balance from a musculoskeletal perspective is usually caused by a loss of core muscle strength; thus, the nurse suggests standing on one foot at a time while holding onto a chair back, if necessary, and working to increase the durationoftheexercise.Liftingweightshelpsincreasemusclestrength.Sit-upsarecontraindicatedforolderadultsbecausethey put tremendous amounts of stress on the lumbar spine. Low-impact aerobic exercise helps improve conditioning and endurance. PTS: 1 DIF: Apply REF: p.28 TOP: NursingProcess:Implementation MSC: TeachingandLearning 8. Whichage-relatedchangecontributestoanorexiaandweightlossinolderadults? a. Excessivesaliva b. Fewertastebuds c. Wearingdentures d. Softenedtoothenamel ANS: B The number of taste buds declines with age and can decrease the enjoyment of food, which can result in less motivation to eat and a resulting weight loss or loss of appetite. Saliva production tends to decrease with age. As long as dentures fit properly and the wearer practices good oral hygiene, wearing dentures does not necessarily contribute to anorexia and weight loss. Older adults tend to lose enamel. PTS: 1 DIF: Remember REF: p.32-33 TOP: NursingProcess: Assessment MSC: HealthPromotionandMaintenance 9. Anurse is caring for an older adult who asks the following: “I have heard that it is important to eat a diet that is high in fruits and vegetables to age successfully. Is that correct?” The nurse considers which of the following theories of aging when responding to the older adult’s question? a. Oxidativestresstheory b. Immunologicaltheory c. Freeradicaltheory d. Telomeretheory ANS: C Although the intake of supplemental antioxidants is deleterious to one’s health, there is evidence that diets inclusive of natural antioxidants, such as those high in fruits and vegetables or a Mediterranean diet rich in red wine and olive oil, are healthful. PTS: 1 DIF: Apply REF: p.23-26 TOP: NursingProcess:Implementation MSC: PhysiologicalIntegrity 10. The family member of a patient asks a nurse if vitamin C will prevent aging. In formulating a response, the nurse considers which of the following theories? a. Freeradicaltheory b. Immunologicaltheory c. Oxidativestresstheory d. Telomeretheory ANS: A The free radical theory posits that aging is a result of random damage from free radicals. Research is ongoing on the ability of substances with antioxidant effects to counter the actions of free radicals. For many years, it was thought that consumption of supplemental antioxidants, such as vitamin C, could delay of minimize the effects of aging. PTS: 1 DIF: Apply REF: p.23-26 TOP: NursingProcess:Implementation MSC: PhysiologicalIntegrity 11. Acommunity health nurse provides an annual flu prevention workshop at a local senior center. The activities include a lecture on preventing infections, which includes hand washing and limiting exposure to individuals who are ill, as well as an influenza immunization clinic. The nurse is basing her activities on what theory of aging? a. Freeradicaltheory b. Immunologictheory c. Oxidativestresstheory d. Telomeretheory ANS: B The immunologic theory of aging describes changes in cells of the immune system, which make an older person more susceptible to infection. Prevention of infection is very important in older adults and can be accomplished by education and immunization. PTS: 1 DIF: Apply REF: p.23-26 TOP: NursingProcess:Implementation MSC: PhysiologicalIntegrity 12. Anurse is caring for an older patient in the hospital who reports: “I am worried because simple tasks such as balancing my checkbook seem to take me longer. Is there something wrong with me?” The best response by the nurse is: a. “Asyouage,normalchangesinthebrainoccurthatmakecentralprocessingtakelonger,sodon’tworry.” b. “Youhaveeveryreasontobeconcerned.Thisisanabnormalfinding;weneedtocontactyourphysician.” c. “Asyouage,changesinthebrainleadtodecreasedintellectualperformance,sodon’tworry.” d. “Any changesin functionare acause forworry.Youneedto beevaluated immediately.” ANS: A As one ages, central processing slows down, which may make performance of tasks slower. This is not an abnormal finding in older adults. Intellectual performance without brain dysfunction remains constant. Many changes in function arepart of normal aging. PTS: 1 DIF: Analyze REF: p.34 TOP: NursingProcess:Implementation MSC: PhysiologicalIntegrity 13. An older woman was seen in her physician’s office after falling at home. The patient receives a comprehensive assessment, and it is determined that she has a positive urine culture and is started on antibiotic therapy for a urinary tract infection (UTI). The patient is surprised at the diagnosis. The woman reported that she had experienced some pain on urination the previous day but did not think that she had a UTI because her temperature was only 99°F. One reason why the patient may not have developed a higher temperature is a. thepatient’sUTIwasnotyetseriousenoughtocauseasignificantincreaseinbodytemperature. b. normalage-relatedchangestotheimmunesystemfunctionaffectanolderperson’sresponsetoillness;alowgradefevermaysignifyseriousillness. c. olderadultsdonotrunfeverswhentheyareill. d. thispatientlikelyhasanalterationtoherimmunesystemthatimpactsherresponsetoinfection. ANS: B Change in immune function affect an older person’s response to illness consistent with the immunologic theory of aging. Older adults typically have lower core body temperatures.Alack of fever cannot be used to rule out infection. The nurse needs to consider the patient from a holistic perspective.Arecent fall is often an atypical presentation of a serious illness or infection. PTS: 1 DIF: Analyze REF: p.37 TOP: NursingProcess:Implementation MSC: PhysiologicalIntegrity MULTIPLERESPONSE 1. Which factor(s) associated with aging contribute(s) to the high incidence of type 2 diabetes mellitus in older adults? (Selectallthatapply.) a. FewerT lymphocytes b. Lessleanmusclemass c. Decreasedthyroidfunction d. Decreasedphysicalactivity e. Leftventricularhypertrophy f. Decreasedinsulinsensitivity ANS: B,C,D,F Less lean muscle mass means that the body has fewer insulin receptor sites; thus, glucose circulates in the blood stream longer, leading to hyperglycemia and type 2 diabetes mellitus. Decreased thyroid function decreases the metabolic rate. If the metabolic rate decreases without a corresponding decrease in caloric intake, then the body consumes more food than it needs for its metabolic rate, and hyperglycemia occurs. Decreased physical activity contributes to type 2 diabetes in two ways. First, a less active person has less lean muscle mass than an active person. Second, physical activity helps metabolize glucose; if activity decreases and food consumption does not decrease, then hyperglycemia occurs. Insulin sensitivity decreases with age and increases the need for insulin in older adults. To prevent hyperglycemia, older adults must increase physical activity and decrease food consumption. Fewer T lymphocytes are associated with age-related changes caused by autoimmune reactions wherein the body recognizes itself as a foreign substance and works to destroy it. Type 1 diabetes mellitus is considered an autoimmune disorder. Left ventricular hypertrophy is not directly related to the increased incidence of type 2 diabetes in older adults; however, if hypertrophy leads to exercise intolerance, then it can be related to an increased incidence of type 2 diabetes. PTS: 1 DIF: Understand REF: p.31-32 TOP: NursingProcess: Assessment MSC: PhysiologicalIntegrity 2. When caring for an older man patient, the nurse is aware that which changes are associated with the male reproductive system and aging? (Selectallthatapply.) a. Testessoften. b. Seminiferoustubulesthicken. c. Spermcountdecreases. d. Ejaculationisslower. e. Incontinenceiscommon. ANS: A,B,D Although men have the ability to produce sperm throughout their lives, they also experience changes in the functioning of the reproductive and the urogenital organs in later life. The changes are usually more subtle and noticed only as they accumulate, beginning when men are in their 50s. The testes atrophy and soften. The seminiferous tubules thicken, and obstruction caused by sclerosis and fibrosis can occur. Although sperm count does not decrease, fertility may be reduced because of a higher number of sperm lack motility or have structural abnormalities. Erectile changes are also seen; more stimulation is needed to achieve a full erection, ejaculation is slower and less forceful, and refractory periods are longer. Incontinence is not a normal age-related change. PTS: 1 DIF: Understand REF: p.32 TOP: NursingProcess: Assessment MSC: PhysiologicalIntegrity 3. Anurse performs an assessment of an older adult’s oral cavity. Which of the following findings are normal age related changes? (Selectallthatapply.) a. Missingteeth b. Recessionofgums c. Awhitefilmonthetongue d. Decreasedsalivaproduction e. Gumsthatbleedeasily ANS: A,B,D There are many age-related changes in the oral cavity. With wear and tear, teeth lose enamel and dentin and become more vulnerable to decay. Without care, teeth may be lost. Gums recede, and there is a decrease in saliva production. Bleeding gums is indicative of infection, and a white film on the tongue is also indicative of an infection. PTS: 1 DIF: Understand REF: p.32-33 TOP: NursingProcess: Assessment MSC: PhysiologicalIntegrity 4. Anurse is caring for an older adult in the hospital who reports decreased hearing. Which of the following interventions should the nurse use when communicating with this patient? (Selectallthatapply.) a. Raisethepitchofthevoicewhenspeakingwiththepatient. b. Speakveryslowlyusingsimplewordswhenspeakingtothepatient. c. Facethepatientwhenspeaking. d. Decreasebackgroundnoisewhenspeakingwiththepatient. e. Obtainasignlanguageinterpretertospeakwiththepatient. ANS: C,D With normal age-related hearing loss, the patient can still hear, so a sign language interpreter would not be appropriate. In addition, it is not known whether or not this patient is able to communicate in sign language. Presbycusis, age-related hearing loss, is primarily the loss of the ability to hear high-frequency sounds. Therefore, raising the pitch of the voice would not help the situation. Speaking very slowly and using simple words may be seen as demeaning to the patient. It is important to face the patient and to decrease background noise. Facing the patient is helpful if the patient reads lips. PTS: 1 DIF: Apply REF: p.36 TOP: NursingProcess: Assessment MSC: PhysiologicalIntegrity Chapter04:Psychosocial,Spiritual,andCognitiveAspectsofAging Touhy&Jett:EbersoleandHess’GerontologicalNursing&HealthyAging,5thEdition MULTIPLECHOICE 1. In which context are members of a cohort described when using the age-stratification theory to explain the effect of similar events, conditions, and circumstances? a. Historical b. Biological c. Sociological d. Chronological ANS: A In the age-stratification model, historical context is used to understand members of a cohort in terms of similar events, conditions, and circumstances and the effect these have on the group as a whole.Agood 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: p.42 TOP: NursingProcess: Assessment MSC: PsychosocialIntegrity 2. 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. “Theunknownmaybefrightening.Doyouwanttotalkaboutthis?” b. “ReligiouspeopleknowthatGodisagoodGod.” c. “Peoplethathavehadnear-deathexperiencessayitispeaceful.” d. “Youmustfeelgoodaboutattendingchurchmostofyourlife.” ANS: A “Often the unknown is very frightening” uses the reflective technique to identify the patient’s feelings regarding the fear of the unknown. “Religious people know that God is a good God” denies the patient’s feelings. “People that have had near-death experiences say it is peaceful” focuses on the experience of others. “You must feel good about attending church most of your life” ignores the patient’s concern about death. PTS: 1 DIF: Apply REF: p.48 TOP: NursingProcess:Implementation MSC: PsychosocialIntegrity 3. The nurse plans care for older adults who are in good health but isolated from their families. If the nurse’s goal is to move the adults toward gerotranscendence, which intervention should the nurse use in the plan of care? a. Give adailyteapartyforthegroup. b. Calleachfamilytoencouragevisiting. c. Assistthemtoresumemidlifepatterns. d. Helpeachpersonwithindividualactivities. ANS: D In Tornstam’s theory, aging offers the potential for gerotranscendence, a culmination of an individual’s life, wisdom, and spiritual growth that allows older adults to live contentedly with and without social activities.An older adult spends more time on meditation and solitude and less time on materialism and self-consciousness about body image. Individual activities or self-selected activities are satisfactory. Solitude is satisfactory. Midlife patterns are no longer relevant to contentment. PTS: 1 DIF: Apply REF: p.43 TOP: NursingProcess:PlanningMSC: PsychosocialIntegrity 4. The nurse observes older women learning advanced knitting techniques. The nurse concludes that this learning activity is suitable for these women because it accomplishes which of the following? a. Helpsmaintainjointflexibility b. Improvesthegroup’scohesiveness c. Providesaneededsocialopportunity d. Addstotheirexistingknowledgebase ANS: D Learning advanced techniques is a suitable activity for older adults because it builds on knowledge they already have. Furthermore, this activity is suitable because it is concrete and practical for experienced knitters to develop advancedskills. Joint flexibility is a physical activity and not necessarily a learning activity. The members share enjoyment of knit- ting; 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: p.50 TOP: NursingProcess:EvaluationMSC: PsychosocialIntegrity 5. The nurse at a nursing home wants to help decrease the risk ofAlzheimer’s disease (AD) in the residents. Which should the nurse do to implement this goal? a. Keepthecurtainsopenintheirrooms. b. Offerbeadsforthemtostringonyarn. c. Showmoviesthattheresidentschoose. d. Assistresidentswithambulationtomeals. ANS: D Engaging in physical activity and social interaction are associated with a lower risk forAD. 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 activityand therefore unlikely to decrease the risk for AD; physical activity is associated with a lower risk for AD. Watchingmovies is a sedentary but not a mentally stimulating activity for an adult with a normal intelligence. PTS: 1 DIF: Apply REF: p.50 TOP: NursingProcess:PlanningMSC: Health Promotion and Maintenance 6. Which physiological change in the brain is the reason the nurse allows more time for answering questions with older adults? a. Increasedsecretionofcholinesterase b. Decreasedsecretionofneurotransmitters c. Lossofspinalcordandbrainstemneurons d. Atrophyofdendritesinthecerebralcortex ANS: D Dendrites are the receiving end of neurons (receiving electrochemical signals) and the branched ends extending from thecell 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 andthe cerebral cortex lose neurons with age, the cerebral cortex more than the spinal cord. PTS: 1 DIF: Understand REF: p.49 TOP: NursingProcess: Assessment MSC: Safe,EffectiveCareEnvironment 7. The nurse provides opportunities for nursing home residents to read aloud to others. Which cognitive skill is this nursing intervention most likely to improve? a. Verbalfluency b. Logicalanalysis c. Objectnaming d. Visuospatialskills 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 displayingobjectsispartofthereading. Visuospatialskillsrequiretheabilitytoperceivetherelationshipofobjectsintermsof the space each object occupies; reading is unlikely to improve this skill. PTS: 1 DIF: Understand REF: p.49 TOP: NursingProcess:EvaluationMSC: Health Promotion and Maintenance 8. Mandatoryretirementatage65yearsisconsistentwithwhichtheoryofaging? a. Roletheory b. Disengagementtheory c. Age-stratificationtheory d. Socialexchangetheory ANS: B Disengagement theory states that in the natural course of aging, the individual does and should withdraw from society to allow for the transfer of power to younger generations. PTS: 1 DIF: Apply REF: p.41-42 TOP: NursingProcess: Assessment MSC: PsychosocialIntegrity 9. An older woman retires after a long career as an elementary school principal and begins to volunteer in the local library reading to children. The older woman is very pleased with her volunteer activities. This is consistent with which theory of aging? a. Roletheory b. Disengagementtheory c. Age-stratificationtheory d. Socialexchangetheory ANS: A Role theory posits that self-identity is believed to be defined by one’s role in society. Successful aging means that as one role is completed, it is replaced by another or comparative value to the individual. PTS: 1 DIF: Apply REF: p.41 TOP: NursingProcess: Assessment MSC: PsychosocialIntegrity 10. An older married couple move to a continuing care retirement community. The older woman who was always very social and outgoing quickly joins an exercise group, a book club, and a knitting circle. The older man whowas always very solitary adopts a routine of a long daily walk and registers for an online course in creative writing. The behaviors of the older couple are consistent with which theory of aging? a. Activitytheory b. Continuitytheory c. Socialexchangetheory d. Disengagementtheory ANS: B Continuity theory proposes that individuals develop and maintain a consistent pattern of behavior over a lifetime.Aging, as an extension of earlier life, reflects a continuation of the patterns of roles, responsibilities, and activities. Personality influences the roles and activities chosen and the level of satisfaction drawn from these. Successful aging is associated with one’s ability to maintain and continue previous behaviors and roles. PTS: 1 DIF: Apply REF: p.41 TOP: NursingProcess: Assessment MSC: PsychosocialIntegrity 11. Aretirement community is divided into different communities with different activities available for the residentsofeachcommunity. Thereisonecommunityforindividualsages65to74years,oneforindividualsages75to 85 years, and one community for individuals older than age 85 years. This is consistent with which theory of aging? a. Roletheory b. Disengagementtheory c. Age-stratificationtheory d. Socialexchangetheory ANS: C Age-stratification theory is based on the belief that aging can be best understood by considering the experiences of individuals as members of cohorts with similarities to others in the same group. PTS: 1 DIF: Apply REF: p.42 TOP: NursingProcess: Assessment MSC: PsychosocialIntegrity MULTIPLERESPONSE 1. Whichstatementsaretrueaboutagingandthebrain?(Selectallthatapply.) a. Mostareasofthebraindonotlosebraincells. b. Memorydeclineisinevitableaspeopleage. c. Basicintelligenceremainsunchangedwithage. d. Thebraindoesnotcontinuetomakenewbraincells. e. Therearedecrementsintheabilitytoprocessinformation. ANS: A,C,E Most areas of the brain do not lose brain cells.Although older adults may lose some nerve connections, this 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. There are decrements in the ability to process information. Many people reach older age and have no memory problems. Having a healthy diet and participation in physical exercise, stimulating mental activity, socialization, and stress management help brain health. PTS: 1 DIF: Understand REF: p.49-50 TOP: NursingProcess: Assessment MSC: PsychosocialIntegrity 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 which activities should the nurse encourage the patient to participate to maintain brain health? (Selectallthatapply.) a. Physicalexercise b. Stimulatingmentalactivity c. Socialization d. Increasingdietaryintake e. Crosswordpuzzles ANS: A,B,C,E Many people reach older age and have no memory problems. Having a healthy diet and participation in physical exercise, stimulating mental activity, socialization, and stress management help brain health. Puzzles are a cognitive stimulating activity. An increase in dietary intake has not been shown to influence brain health. PTS: 1 DIF: Apply REF: p.50-51 TOP: NursingProcess:PlanningMSC: Health Promotion and Maintenance 3. Anurse in an assisted living facility is planning an educational program on exercise for the residents. The nurse needs to consider which of the following when planning the activity? (Selectallthatapply.) a. Verysimplelanguagemustbeusedsothattheresidentswillunderstandthematerial. b. Largesizefontsmustbeusedonallwrittenmaterialprovidedtotheresidents. c. Theeducationalprogramshouldbeprovidedinaquietareawithoutexcessivebackgroundnoise. d. Thematerialdiscussedshouldfocusonlyontheconsequencesoffailuretoexercise. e. Thematerialdiscussedshouldbuildonthepriorknowledgeoftheresidents. ANS: B,C,E When educating older adults, one needs to pay attention to potential sensory deficits common in this population such as vision and hearing. Older adults do not normally experience a decline in intelligence. When teaching older adults, it is beneficial to present practical information that builds on the prior knowledge of the participants. There is no evidence that older adults learn better by focusing on the effects of nonadherence. PTS: 1 DIF: Apply REF: p.51 TOP: NursingProcess:PlanningMSC: Health Promotion and Maintenance 4. Which of the following are true statements about older adults and use of computer technology? (Selectallthatapply.) a. OlderadultscomprisethefastestgrowingpopulationusingcomputersandtheInternet. b. Olderadultstendtobereluctanttousesocialnetworkingsites. c. OlderadultsperceivetheInternetasavaluableresource. d. OlderadultsdonotroutinelyusetheInternettoconnectwiththeirhealthcareproviders. e. Olderadultshavemuchdifficultylearningtousetechnology. ANS: A,C Older adults comprise the fastest growing population using computers and the Internet. Older women comprise the fastest growing group using social networking sites such as Facebook, Twitter, and Myspace. Older adults perceive the Internet asa valuable resource and use it to communicate with friends, families, and health care providers and access health-related information. There is no evidence that older adults have difficulty learning to use technology. PTS: 1 DIF: Understand REF: p.52 TOP: NursingProcess:PlanningMSC: Health Promotion and Maintenance 5. Anurse in a long-term care facility is using the TimeSlips program with a group of cognitively impaired older adults. The nurse is using which of the following techniques? (Selectallthatapply.) a. Providesapictureforallgroupmemberstolookatandusetocreateastory b. Recordsthenumberofcorrectanswersthateachparticipantprovides c. Recordstheresponsesofallparticipants d. Complimentseachmemberforhisorhercontributiontothestory e. Readsthestorybackduringthesession,notingthecontributionsofeachparticipant ANS: A,C,D,E Using the TimeSlips format, group members looking at a picture are encouraged to create a story about the picture. All contributions are encouraged and welcomed, there are no right or wrong answers, and everything that the individuals sayis included in the story and written down by the scribe. Stories are read back to the participants during the session using their names to identify their contributions.At the beginning of each session, the story from the last session is read to the participants. Care is taken to compliment each member for his or her contribution to the wonderful story. There are no right or wrong answers. PTS: 1 DIF: Remember REF: p.45 TOP: NursingProcess:PlanningMSC: Health Promotion and Maintenance 6. An older adult who lives in an assisted living facility tells a nurse that she is engaged in life review. The nurse understands which of the following about life review? (Selectallthatapply.) a. Lifereviewisonlyusefulattheveryendofanindividual’slifeasheorsheisclosetodeath. b. Lifereviewandreminiscencearethesamephenomenon. c. Lifereviewisahighlypersonalactivity. d. Lifereviewcanhelpanindividualchangecourseorsetnewgoals. e. Lifereviewcanbehelpfultoanindividualexperiencingadepressiveepisode. ANS: C,D,E Life review is considered more of a formal therapy technique than reminiscence and takes a person through his or her lifein a structured and chronological order. Life review should occur not only when we are old or facing death but also fre- quently throughout our lives. This process can assist us to examine where we are in life and change our course or set new goals. Life review may be especially important for older people experiencing depressive symptoms. Life review is a high-ly personal activity. PTS: 1 DIF: Remember REF: p.45 TOP: NursingProcess:PlanningMSC: Health Promotion and Maintenance Chapter05:GerontologicalNursingandPromotionofHealthyAging Touhy&J