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C475 Care of The Older Adult TEST BANK

Western Governors University CARE OF THE ELDERLY C475 Care of The Older Adult TEST BANK A negative attitude towards aging and the aged is called: A. geriatrics B. racism C. ageism D. ethnocentrism Answer: Which of the following is not considered a core competency for nurses caring for older adults? A. Analyze the impact of an aging society on the health care system B. Obtain certification in gerontological nursing C. Prevent or reduce common risk factors that contribute to functional decline D. Recognize one's own attitudes about aging Answer: The nurse wishes to obtain basic certification in the specialty of gerontological nursing. Which of the following is true about this credential? A. there is an experience requirement B. one must pass an exam C. one must have a BSN D. a and b only Answer: When the nurse reads an article and uses the findings of a study to improve the quality of the patients for whom she cares, she is implementing the role of: A. teacher B. manager C. research consumer D. advocate Answer: A lawyer wishes to hire a nurse consultant who has advanced education and certification in gerontology. Based on their listed credentials, which of the following nurses best fits his wishes? A. Sally Smith, RN, BSN, BC B. Mary Malloy, RN, MS, GNP C. Andy Jones, LPN, CRRC D. Greg Reed, RN, MSN Answer: The AACN/John A. Hartford Foundation Competencies are helpful to nurses because they: A. offer suggestions about how to gain employment in geriatrics B. provide a guideline for the knowledge that is expected to provide quality care to older adults C. were designed to prepare nurses to pass the State Board Exam D. were written for nurses working on a graduate degree in gerontology Answer: The nurse has a question about the appropriateness of an older patient's medication dose. Which of the following professionals would be best qualified to answer such a question? A. the geropsychologist B. the geropharmacist C. the financial gerontologist D. the gerontological rehabilitation nurse Answer: The health care professional who wants to gain experience in working with older adults who are post-acutely recovering from serious illness or injury, have challenging medical issues needing 24 hour per day nursing, but who cannot yet tolerate a full rehabilitation program may be best suited for employment in what setting: A. acute care hospital B. assisted living C. rehabilitation D. subacute care Answer: Which of the following levels of care would be most appropriate for a healthy 84 year old man who can take care of himself, but wants to live in a place where he can socialize and have help available if needed? A. a group foster home B. a transitional care unit C. an independent unit in a senior living complex D. assisted living in a nursing home Answer: Which of the following is not true about assisted living facilities? A. if their care needs become too great, they may have to seek other living arrangements B. persons pay for assistance out of pocket C. the average resident is in his 60's D. they have assumed about 15% of the previous nursing home population Answer: A person aged 84 would be classified, according to current systems, as: A. young B. middle C. old D. very old Answer: The clinical nurse specialist (CNS) in gerontology differs from the GNP in that: A. the GNP usually works in a collaborative practice with a physician B. the CNS has less education than the GNP C. the GNP has a doctorate D. the CNS does less consulting than the GNP Answer: What is the most compelling reason for health professionals to be educated in the area of gerontology? A. to address the comprehensive nursing shortage B. to make an increase in salary C. to prepare to be challenged by the educated baby boomers D. to prepare to care for the growing number of older persons in the population Answer: An intergenerational approach to care for the aging is advisable because of what fact? A. baby boomers want their children to take of them in old age B. Gen X and Gen Y persons do not know anything about aging C. most older persons are cared for by their children D. nearly a half million grandparents are raising their grandchildren Answer: What best explains the lack of prepared, qualified health professionals to care for the aged? A. a shortage of nursing faculty B. medical programs not including gerontology content C. not enough health professionals choosing gero as a specialty D. the current nursing shortage Answer: There were approximately 36 million Americans over the age of 65 years in 2000 and this number is expected to grow to 71 million by 2030 A. TRUE B. FALSE Answer: Over half of women over the age of 85 are widowed A. TRUE B. FALSE Answer: There are more males in the population than females A. TRUE B. FALSE Answer: Most centenarians (people over the age of 100 years) are White and female A. TRUE B. FALSE Answer: Minority elderly groups are growing and thus present unique challenges for nurses today A. TRUE B. FALSE Answer: The majority of older persons live alone A. TRUE B. FALSE Answer: Older women who live alone tend to be more from lower income groups than those who are married A. TRUE B. FALSE Answer: Elderly Hispanics rate their overall health significantly higher than those from other ethnic groups A. TRUE B. FALSE Answer: Older persons tend to die from acute illnesses more than chronic diseases A. TRUE B. FALSE Answer: The major causes of death in the older age group are heart disease, AIDS, and tuberculosis A. TRUE B. FALSE Answer: (It's Heart Disease, Cancer and Strokes) Which ethnic/cultural group has a higher rate of diabetes, hypertension, and chronic renal disease than other ethnic groups? A. African Americans B. Hispanics C. Asians and Pacific Islanders D. American Indians and Alaskan natives Answer: Which ethnic/cultural group is the most rapidly growing ethnic minority, and less likely to obtain preventive services such as flu vaccines and mammograms? A. African Americans B. Hispanics C. Asians and Pacific Islanders D. American Indians and Alaskan natives Answer: Which ethnic/cultural group is comprised of many subgroups and generally have a longer life expectancy than white Americans? A. African Americans B. Hispanics C. Asians and Pacific Islanders D. American Indians and Alaskan natives Answer: Which ethnic/cultural group makes up a small percentage of America's elderly population and have increased morbidity and mortality related to diabetes and renal disease? A. African Americans B. Hispanics C. Asians and Pacific Islanders D. American Indians and Alaskan natives Answer: List the three leading causes of death in the elderly: Answer: Heart disease, Cancer, Stroke The theory of aging that says that personality and coping patterns remain consistent through life is: A. continuity B. gerotranscendence C. human needs D. life course Answer: Erikson's stages of personality development for a person that is 76 years old would be: A. autonomy versus shame B. integrity versus despair C. generativity versus isolation D. trust versus mistrust Answer: A biological theory of aging that is based on random events that cause cellular damage versus genetically programmed events is called: A. nonstochastic B. Orgel / error C. selective optimization D. stochastic Answer: A scientist who believes that people have a genetic programming that determines or predicts longevity is a supporter of which theory? A. age stratification B. cross-link C. free radical D. gene/biological Answer: When a Native American Indian elder goes out into the woods to die and the tribe does not search for him, but allows him to withdraw, this could be an example of: A. activity theory B. disengagement theory C. subculture D. person-environment fit Answer: A 99 year old widow who has lived alone in her own home for 40 years experiences a fall and is sent by her children and grandchildren to a nursing home. The woman refuses to eat and exhibits signs and symptoms of depression and withdrawal. Which theory does this most describe? A. functional consequences B. theory of thriving C. neuroedncorine D. immunological Answer: The physician tells his 81-year-old male patient that his health has deteriorated due to the exogenous sources of free radicals to which he has exposed himself for many years. To what is the physician most likely referring? A. the ozone layer B. the patient's cigarette smoking C. the patient's alcohol consumption D. radiation from the patient's microwave Answer: MATCHING 1) continuity theory A. personality and coping patterns remain consistent through life 2) stochastic theories B. remaining active and involved promotes life satisfaction in later year 3) neuroendocrine theory C. transformation towards oneness with the universe 4) activity theory D. cells wear out with age 5) gerotranscendence theory E. five basic needs that motivate behavior 6) nonstochastic theories F. problems with gland feedback leads to disease 7) theory of thriving G. based on random events that cause cellular damage 8) human needs theory H. genetically programmed events cause cellular damage that lead to aging 9) functional consequences theory I. failure to thrive is from discord in relationships 10) wear and tear theory J. (Miller’s Theory) nurse’s role is risk reduction to enhance safety Answer: 1) continuity theory (A) A. personality and coping patterns remain consistent through life 2) stochastic theories (G) B. remaining active and involved promotes life satisfaction in later year 3) neuroendocrine theory (F) C. transformation towards oneness with the universe 4) activity theory (B) D. cells wear out with age 5) gerotranscendence theory (C) e. five basic needs that motivate behavior 6) nonstochastic theories (H) F. problems with gland feedback leads to disease 7) theory of thriving (I) G. based on random events that cause cellular damage 8) human needs theory (E) H. genetically programmed events cause cellular damage that lead to aging 9) functional consequences theory (J) I. failure to thrive is from discord in relationships 10) wear and tear theory (D) J. (Miller’s Theory) nurse’s role is risk reduction to enhance safety Which of the following visual changes is not usually associated with normal aging? a. presbyopia b. yellowing of the lens c. night blindness d. decreased accommodation Answer: All of the following are considered IADLs (Instrumental Activities of Daily Living) except: a. toileting b. balancing the checkbook c. using the phone d. shopping Answer: (this is considered an ADL) Old persons may have difficulty picking up their pills from a medicine cup because of: a. macular degeneration b. decreased touch sensation that comes with old age c. peripheral neuropathy d. all of the above Answer: An older adult who complains of a dark spot in the center of the visual field is showing signs of: A. cataracts B. macular degeneration C. acute glaucoma D. diabetic retinopathy Answer: An older adult who complains of seeing dark shadows around the center of the visual field is showing signs of: A. cataracts B. macular degeneration C. glaucoma D. diabetic retinopathy Answer: An older adult who complains of blurry vision and has a bluish-white coating that can be seen on the lens is showing signs of: A. cataracts B. macular degeneration C. acute glaucoma D. diabetic retinopathy Answer: Which of the following factors could contribute to an older person's inability to hear instructions given by the nurse? A. cerumen impaction B. nurse not facing the person when giving directions C. loss of high frequency pitches D. all of the above Answer: The nurse is trying to take a history from a cooperative but fearful older person with mild dementia. Which of the following would be the most therapeutic strategy to use for this interaction? A. sit calmly in a chair next to the person and ask questions in a non-threatening manner B. ask loud, direct questions C. have the person write down the information on the chart D. ask the family member instead of the person Answer: While speaking with a patient who is experiencing depression, which of the following strategies might be most helpful? A. speaking very loudly since they are certainly hard of hearing B. recording important information for them in a notebook to refer to later C. ignoring the person and discussing their condition with a family member D. telling them that their depression will go away on its own if they think positively Answer: In caring for a person experiencing delirium, which of the following is least effective in enhancing communication? A. speak in simple sentences B. offer frequent reassurance C. use physical restraints to control anxious behavior D. use large print clocks and calendars Answer: List five nursing strategies for enhancing memory in the older adults with mild dementia. Answer: Journaling, keeping a record of the day, using familiar items, posting reminders, using calendars and clocks If an older person with hearing impairment complains of not being able to hear what the nurse is saying, what could be a contributing cause of this? A. normal age-related changes B. build up of cerumen C. the nurse not facing the person when speaking D. all of the above Answer: An older patient has had a stroke that resulted in Broca's aphasia. Which of the following would be most typical of Broca's aphasia? A. fluent speech B. impaired comprehension C. broken speech D. global problems Answer: Which of the following signs would you consider an abnormal finding for a 75 year old female? A. blood pressure of 110/78 B. Hct (hematocrit) of .41 C. resting pulse of 80 D. urinary incontinence Answer: A significant result of changes in the respiratory system with advanced age is: A. lower carbon dioxide levels in the bloodstream B. less useful oxygen available with each breath C. more efficient gas exchange at the alveolar level D. the ability to hold one's breath longer Answer: One of the most significant changes in the reproductive system for older females who are sexually active is: A. decreased vaginal lubrication B. atrophy of uterus C. decreased libido D. lack of male partners Answer: You are helping care for your 89 year old grandmother who is sick with "the flu". Her temperature is 101.2. What other information would be most useful to better assess your grandmother's condition? A. what her temperature was yesterday B. how long she has felt sick C. what her usual temperature is D. how much she ate today Answer: Which of the following would be an abnormal finding in assessment of an 80 year old male? A. decreased cardiac output B. decreased stage IV sleep C. loss of hearing of low frequency tones D. age spots on the hands and face Answer: Which of the following changes in the skeletal system is least characteristic of normal aging? A. decreased range of motion B. loss of height up to 10 cm C. chronic inflammation of joints D. loss of some muscle mass Answer: All of the following are intrinsic changes in the integumentary system except: A. increased skin temperature B. sagging and wrinkling C. age spots D. increased risk of bruising Answer: Which of the following is true about normal aging changes in the GI system? A. absorption of nutrients does not change with age B. absorption of certain vitamins does change with age C. small intestine transit rate is relatively unchanged with age D. all of the above Answer: Which of the following aging changes is most significant to renal efficiency? A. loss of up to half of functioning nephrons B. decreased cardiac output C. nocturia D. a and b Answer: The aging eye shows all of the following changes except: a. better ability to focus on near objects b. decreased lens accommodation c. decreased peripheral vision d. presbyopia Answer: A 72 year old female with the following assessment factors is admitted to the acute care for elderly (ACE) unit. Which of the following requires the most immediate treatment? A. BP = 140/ 90 mm Hg B. Hgb (hemoglobin) = 7 g/dl C. hypogeusia D. presbycusis Answer: Mrs. Jones is a 50 year old female who complains of hot flashes, moodiness, and skipping menstrual periods. She tells you that the physician suggests she is going through menopause, and asks, "aren't I too young for menopause?" What is your best response? A. Yes, you are too young. Your symptoms must be something else. B. The average age for menopause is 51, but many women experience these symptoms earlier. C. I think you should get a second opinion in case it is something serious. D. No. You are not too young for menopause, but the average age is 56. Answer: Immunosenescence refers to: A. acquired immunity B. innate immunity C. aging of the immune cells D. better replication of the cells that fight infection Answer: Which of the following is a reason why older females may develop vaginitis? A. lower estrogen levels B. atrophy of the vaginal canal C. decreased lubrication of the vagina D. all of the above Answer: The nurse wishes to use a tool to help assess the functional status of the older residents in the nursing home where she works. Which of the following would be least appropriate for this purpose? a. Katz index b. MDS c. Barthel Index d. Gibson self-care scale Answer: Which of the following is the best example of an open-ended question/statement that would promote verbalization from an older person? A. tell me about your major problem today B. do you have any complaints today? C. are you having any major problems? D. do you want to talk about your major complaint? Answer: Name four essential areas to address to promote communication as discussed in this chapter. Answer: Invite-respect, Environment, Understanding, Communication Changes in which of the following body systems are generally most noticeable to the naked eye? A. respiratory B. integumentary C. gastrointestional D. neurological Answer: The nurse working in rehabilitation would most likely see what measure used to evaluate progress of patients in rehabilitation? A. Katz index B. MDS C. FIM D. OASIS Answer: In assessing IADLs, the nurse will ask questions about all but which of the following patient activities? a. cooking b. shopping C. using the phone D. bathing Answer: In assessing the circulatory system of an older adult, the nurse would recognize which of the following as abnormal? A. resting pulse rate of 120 B. blood pressure of 118/78 C. respirations of 26 D. a and c Answer: When assessing the respiratory system of an older person, which of the following is the least essential to ask during history taking? A. use of tobacco products B. feelings of shortness of breath C. exposure to environmental toxins D. all are important to ask about Answer: All of the following may contribute to an older patient complaining of constipation except….. A. decreased thirst mechanism B. changes in peristalsis with age C. lack of fiber in diet D. increased physical activity Answer: 7) It is important to include sexuality in a comprehensive assessment of older persons because: A. changes occur with normal aging that may impact performance B. older adults still engage in sexual intercourse C. changes in sexual preference in later life often pose conflicts D. a and b Answer: Neurological assessment of the older person should include: A. history of medications and herbs used B. assessment of swallowing C. checking grip strength D. all of the above Answer: The Up and Go Test is useful for assessment because it: A. provides a quick measure of physical, especially walking, ability B. gives a precise indication of physical strength C. provide a statistically accurate number associated with grip strength D. gives an idea of cognitive function Answer: Which of the following new findings would be considered abnormal and requiring immediate attention in the older adult? A. presbyopia B. presbycusis C. MMSE score of 12 D. liver spots Answer: Which of the following would not be considered a normal aging change when assessing an older adult? a. presbyopia b. presbycusis c. a score of 3 on the geriatric depression scale (GDS) d. macular degeneration Answer: Of the following lab results, which of the following is most desirable for a healthy older adult? A. Total cholesterol of 300 mg/dl B. LDL of 60 mg/dl C. Triglycerides of 400 mg/dl D. FBS of 235 Answer: The nurse is administering medications in the nursing home to over 40 residents. Which of the following is not one of the five rights that she should check on each person? A. right patient B. right route C. right time D. right place Answer: Which of the following lab results would alert the nurse to an abnormality in an older adult? A. glucose = 100 B. albumin = 2.5 C. TSH = 4.0 D. blood culture = negative Answer: The physician orders a peak and trough to be drawn on a patient receiving Vancomycin. The nurse correctly draws the peak: A. when the highest level of medication is in the blood B. when the lowest level of medication is in the blood C. two minutes after the medication is given D. three hours prior to the medication being given Answer: 5) Which of the following normal aging changes affects the way medications are processed in the body of an older adult? a. decreased renal clearance B. decreased cardiac output C. impaired absorption in the gut D. all of the above Answer: Opioids are rarely prescribed for persons with dementia because of what adverse reaction? A. dry mouth B. sedation C. confusion D. constipation Answer: Which of the following is true about the elderly and medications? A. about 1/6 of all medications are for the elderly B. medications may stay in the body longer C. there is a decreased risk of side effects with aging D. dosing should be the same for young and old adults Answer: Polypharmacy is a significant problem for the elderly because: A. the more medications one takes, the greater the risk of side effects B. older persons are unable to take medications correctly C. older adults are not accustomed to taking multiple medications D. a and c only Answer: Diphenhyrdramine (Benadryl) is not recommended for use in older adults because of: A. confusion and severe anticholinergic effects B. risk of seizures C. prolonged half life D. dosage problems Answer: Which of the following questions is least appropriate to ask when taking a medication history? A. use of over the counter medications B. drug allergies C. home remedies used D. all of the above are appropriate Answer: List five strategies for teaching older adults. Answer: stay active, see doctor regularly, maintain relationships, prevent falls, maintain healthy weight and diet The nurse is preparing a teaching session about diabetes to a group of older adults in assisted living. Which of the following is most essential to consider for this audience? A. whether they are part of the Baby boomer generation B. the accommodations needed for them to participate in the presentation C. literacy level if there are handouts D. b and c Answer: Which of the following strategies used by the nurse in teaching older adults is a principle of adult learning? A. Adults need a motivation to learn. B. Adults are independent learners. C. Adults learn best through lecture. D. a and b Answer: The nurse plans his educational program to enhance learning of the older adult audience through all the following except: A. avoiding glare from windows B. facing the audience when speaking C. using handouts with larger print D. using PowerPoint slides with large amounts of material on them Answer: The nurse is working with a culturally diverse group of older adults in an impoverished geographic area. Which of the following would be most important to first consider when choosing what educational topics to teach them related to health? A. what they wish to learn about B. the number of people who will attend C. the time of day of the presentation D. what the nurse thinks they should know Answer: Of the following techniques, which is the most essential to meet the long-term goal of increasing the health literacy of minority elders through the introduction of computer technology? A. recruiting large numbers of participants for the first session B. offering rewards to participants C. assuring access to the technology D. limiting the age group of participants to the young old Answer: Which of the following titles of presentations that the nurse may give to a group of seniors who are members of a wellness center would be most likely to attract attention? A. Hypoglycemia and Hyperglycemia B. Understanding HemoglobinA1C C. Preventing a Stroke: Knowing This Could Save Your Life! D. Information about Advance Directives Answer: In conducting a one-to-one teaching session about the role of nutrition in preventing osteoporosis, the nurse should first: A. establish rapport with the person B. assess readiness to learn C. evaluate outcomes D. provide information Answer: Which of the following aging changes could pose a barrier to learning? A. hearing loss B. visual impairment C. literacy level D. all of the above Answer: Which of the following techniques for developing a web page for older adults is least appropriate? A. use large font on the website B. use computer lingo in the text C. create a memorable web address D. make the site user friendly to older adults Answer: List three activities discussed in this chapter that may prevent the course of frailty. Answer: stay active, see doctor regularly, maintain relationships, prevent falls, maintain healthy weight and diet Which of the following are thought to contribute to healthy aging? A. doing for others and maintaining interests B. engaging in isolated activities C. avoiding connection with religious institutions D. pushing oneself into new situations Answer: Which of the following is most true of older widowers? A. they may focus more on themselves B. they have an increased self esteem C. they may lose interest in social activities D. they experience a heightened sense of sexuality Answer: For an older person (living with an adult child) who needs some help and lessinteraction during the day while their family member is at work, which of the following care settings would the nurse most likely recommend? A. hospice B. assisted living C. adult day care D. nursing home Answer: When an older adult lives with family members, which of the following principles would not be appropriate for the nurse to apply in assisting the family to promote quality of life for their older loved one? A. help them recognize their own needs and limitations B. provide referrals to community resources C. recommend nursing home placement immediately to avoid stress D. respect all family caregivers as an important part of the team Answer: When an older adult lives with family members, which of the following principles would not be appropriate for the nurse to apply in assisting the family to promote quality of life for their older loved one? A. help them recognize their own needs and limitations B. provide referrals to community resources C. recommend nursing home placement immediately to avoid stress D. respect all family caregivers as an important part of the team Answer: Name five nursing interventions that may help promote nighttime sleep in the elderly. Answer: dtime routine, reduce noise, relaxation, music, daytime sunlight Of the following exercise regimens, which would be most suitable for the nurse to recommend to a 77-year-old healthy woman with no restrictions from her physician? A. five miles of bicycling per day on the county roads B. walking for a total of 20 - 30 minutes, five days per week C. swimming 50 laps per day in the community swimming pool D. horse back riding in the country alone three times per week Answer: Successful coping among older adults has been shown to include all of the following except: A. humor B. increase in number of sexual partners C. prayer D. positive social support Answer: Of the following list, which is the least therapeutic to use as an alternative to physical restraints? A. chemical restraints B. increased staff C. safer physical design of the living area D. manipulation of the environment Answer: According to the Delaney sisters, which of the following factors are important in healthy aging? A. engaging in enjoyable activities B. cherishing family traditions C. seeking the companionship of others D. all of the above Answer: Name five nursing interventions that may help promote nighttime sleep in the elderly. Answer: dtime routine, reduce noise, relaxation, music, daytime sunlight Of the following exercise regimens, which would be most suitable for the nurse to recommend to a 77 year old healthy woman with no restrictions from her physician? A. five miles of bicycling per day on the county roads B. walking for a total of 20 – 30 minutes five days per week C. swimming 50 laps per day in the community swimming pool D. horse back riding in the country alone three times per week Answer: According to the Merck Institute on Aging and Health, older adults fell short of the Healthy People 2000 goals in all but which of the following area? A. physical activity B. influenza vaccination C. eating fruits and vegetables D. overweight Answer: The nurse is counseling a patient regarding Medicare prevention efforts. Which of the following is included? A. initial physical examination B. smoking cessation counseling C. nutrition therapy for everyone D. a and b only Answer: The nurse chooses to use a health contract/calendar as a behavior-changing tool for an older adult client who wants to lose weight. Which of the following principles should the nurse keep in mind when choosing this tool? A. it relies on the self-management capability of a client, after initial assistance is provided by a clinician or health educator B. it relies on the ability and skill of the educator C. it has been shown to be less effective with females who are older and widowed D. it cannot be used in older adults with less than a high school education Answer: The advantages of using a health contract for behavior change include all of the following except: a. it identifies and enhances motivation b. it assures that change will occur c. it clarifies measurable and modest goals d. it suggests tips to remember new behaviors Answer: The nurse is instructing a new patient on the benefits of exercise. She would include which of the following in providing the most current recommendations for older adults? a. the emphasis is on being more physically active rather than a narrow adherence to a rigid exercise regimen B. older adults should exercise one solid hour per day to achieve benefits C. research has shown that older adults need to burn more calories than younger adults in order to obtain cardiac benefit from exercise d. all of the above are true Answer: An older client is discussing his desire to continue walking during the winter months, but expresses fear of being out in the colder weather. The nurse appropriately recommends for him to: a. suspend all walking activities until the weather is favorable b. walk inside at the local shopping mall c. join a health club and walk on the treadmill d. continue to walk outside no matter what the weather Answer: Nutrition counseling is thought to be important for older adults because of which factors? A. older adults are more vulnerable to obesity than other age groups B. older adults are more vulnerable to malnutrition than other age groups C. eating and drinking habits are linked to several leading causes of death D. all of the above Answer: Which of the following foods should the nurse encourage the older client to eat 5 – 13 servings of per day? a. grains b. meat/eggs c. dairy d. fruits/vegetables Answer: Mr. Thin is a 5 foot 8 inch, 79 year old male with a history of hyperlipidemia. Which of the following risk factors does not fit with his diagnosis? A. he drinks four glasses of Jack Daniels per day B. history of hypertension C. smokes 1 pack of cigarettes per day D. weight of 125 pounds Answer: To help Mr. Thin in the above scenario, which risk factor will the nurse focus on first in teaching lifestyle modifications? A. weight loss B. stress reduction C. smoking cessation D. food restrictions Answer: Tobacco use is significantly related to all but which of the following cancers in older persons? A. lung B. larynx C. breast D. bladder Answer: Of the following scales, which is least useful in assessing the cognitive function of an older adult? A. the Kenny Cognitive Scale B. the mini mental state examination (MMSE) C. the CLOX (clock drawing) D. the Controlled Oral Word Association Test Answer: The nurse would follow all of the following guidelines when doing nutritional counseling with an older female except: A. limit alcohol to 1 drink per day B. limit water intake to 1000 cc per day C. limit fat and cholesterol D. ensure adequate calcium and vitamin D intake Answer: The nurse is assessing an older woman with dementia, brought to the emergency room by her adult son caregiver. Which of the following signs most alert the nurse to the possibility that the woman may be abused? A. the woman has bruises of various colors on many inner aspects of her body B. the woman is confused C. the woman is stiff when she walks D. the son says his mother does dangerous things sometimes Answer: When an elderly person is adequately physically cared for in the home by adult children, but socially isolated and expresses no purpose or will to live, this is a sign of: A. psychological or emotional neglect B. psychological or emotional abuse C. direct physical abuse D. physical neglect Answer: The emergency room nurse is evaluating a 90-year old male that she suspects may have been abused by a caregiver. Which of the following data most supports her suspicion? A. the man has a skin tear on his hand B. the man has a small bruise on his outer leg C. the man has a numerous large bruises of different colors on various parts of his body D. the man’s explanation of his bruises fits the appearance of the injury Answer: An elderly person who just bumped his head is complaining of vision problems that seem like a curtain is drawing across his right eye. What should you do first? A. have him sit still B. call his family C. tell him he is showing signs of glaucoma D. call his doctor Answer: Which of the following do some persons living in long term care facilities use to cope with arthritic pain? A. self-massage B. exercise C. positive thinking D. all of the above Answer: One of the most difficult activities for an older woman with upper extremity hemiplegia due to stroke would be: A. ambulating B. putting on a long-sleeved shirt C. putting hair in a pony tail D. washing her face Answer: In caring for a person with middle to late stage or moderately severe Alzheimer’s disease, which of the following concerns takes priority? A. safety B. socialization C. body-image D. coping Answer: The nurse is caring for a 65 year old Black female patient with newly diagnosed diabetes who already has numerous complications. The following questions (13 – 16) pertain to this situation. From the information provided, which of the following is least likely true about this patient’s situation and diabetes? A. she is typical for age, gender, and ethnic background B. early diagnosis may have been difficult C. she will exhibit increased urine output, excessive thirst, and hunger D. she is likely to also have hypertension Answer: What other labs/tests might the nurse least expect to see ordered for this patient? A. Fasting blood sugar B. Glucose tolerance test C. HgBA1C D. MRI Answer: In teaching this patient about her diabetes, which has lowest priority? A. foot care B. balancing medications, diet, and exercise C. reducing risk of complications D. importance of attending support groups Answer: A 70 year old male is exhibiting signs of weight loss, heat intolerance, insomnia, sensitivity to light, and heart palpitations. The doctor writes the admitting diagnosis of hypothyroidism on the chart. What is the nurse’s most appropriate reaction to the doctor’s diagnosis? A. discuss the disease process with the patient and family so they know what to expect B. ask the doctor if this was the diagnosis he intended to record on the chart C. do nothing – you have to wait for lab tests D. continue the usual plan of care for a person with hypothyroidism Answer: Which of the following is true about subclinical hypothyroidism? A. TSH is mildly elevated B. T3 is elevated C. T4 is elevated D. TSH is normal Answer: An older adult diagnosed with Hashimoto’s disease would probably display which of the following signs/symptoms? A. perspiration and alcoholism B. fatigue and weakness c. weight loss and lack of appetite d. diarrhea and tachycardia Answer: Which of the following is true of hyperthyroidism? A. there is no ethnic variation B. family history is not a risk factor C. medications will cure the problem D. beta-blockers are given to decrease the production of thyroid hormone Answer: What is the best explanation for cancer being associated with old age? A. mutant cells attach themselves and surface as cancer B. the immune system stops working around age 80 C. decreased ability to resist disease and prolonged exposure to carcinogens D. rate of smoking among older adults has increased in the past decades Answer: The primary sign of bladder cancer is: A. painful hematuria B. painless hematuria C. painful hemorrhoids D. frequent urination Answer: An older female is diagnosed with vaginitis. Which of the following is least appropriate to teach this patient to prevent recurrence? A. avoid douches B. avoid feminine deodorant sprays C. wear cotton underwear D. use Vaseline as a lubricant Answer: If a patient has bladder cancer that has invaded the bladder muscle, which is the nurse most likely to observe during an assessment of this patient after surgery to correct the problem? A. a colostomy B. a urostomy C. an indwelling foley catheter D. a suprapubic catheter Answer: Which of the following would be the least likely cause of a 93 year old woman (newly placed in the nursing home) showing signs of delirium? A. a sodium level that was out of balance B. dehydration C. unfamiliar surroundings D. overeating Answer: Delirium differs from dementia in which of the following ways? A. delirium has a slower onset B. dementia patients have a higher mini mental status exam result C. delirium is considered temporary D. dementia patients are more easily treated Answer: Sundowner syndrome is characterized by which of the following that the nurse may observe in an older adult? A. early morning confusion B. oversleeping C. nocturnal confusion D. violent behavior after sundown Answer: If the nurse suspects that a patient has delirium, which of the following factors should be further investigated? A. UTI b. medications c. oxygen saturation d. all of the above Answer: Recent research suggests that most incontinence among the elderly is due to: A. stress B. overactive bladder C. lack of Kegel exercises D. multiple pregnancies Answer: Which of the following best describes a characteristic of the earliest phase of Alzheimer’s disease? A. impaired speech B. personality changes C. total dependence upon others for care D. progressive forgetfulness Answer: The nurse is asked to assist a family with finding help to care for their terminally ill grandfather who was just diagnosed with inoperable brain cancer. To which of the following programs would the nurse refer the family? A. the hospital B. respite care C. hospice D. visiting nurse association Answer: Which of the following is least likely a risk factor associated with those who abuse the elderly? A. history of mental illness B. overwhelmed C. poor self-image D. female Answer: A 60 year old African American male with known hypertension comes to the emergency room with complaints of bad indigestion that has continued all night and a little bit of numbness in his left arm. What action should the admitting nurse take? A. have the patient sit in the waiting room to be seen in order B. treat him as if it he could be having a heart attack C. give him some antacids immediately after checking with the physician D. call 911 and let the paramedics decide what to do Answer: One of the most significant changes in the reproductive system for older females that are sexually active is: A. decreased vaginal lubrication B. atrophy of uterus C. decreased libido D. lack of male partners Answer: The nurse is helping an older patient with a history of angina ambulate in the hallway after minor surgery. The patient complains of chest tightness. What should the nurse do first? A. administer nitroglycerin sublingually B. call for help C. have the patient sit and rest D. take the vital signs Answer: If the nurse wishes to know about the patient’s overall nutritional health, what is the best lab value to look at? A. triglycerides B. iron C. serum albumin D. red blood cells Answer: An older person with GERD should avoid which of the following? A. laying flat after meals B. caffeine C. chocolate D. all of the above Answer: The physician is discussing an older person who has just had a stroke. He says that he will try to give t-PA to minimize the ischemic penumbra. What does this tell you? A. he believes the person will die B. he believes the person has had a hemorrhagic stroke that can be helped by medication C. he believes the person has had a stroke from a clot which, if eliminated, may result in less damage D. he doesn’t know what he is talking about Answer: Which of the following signs exhibited by an older female at home is one that would cause you to call 911? A. a bad headache B. sudden coughing C. forgetting where her car keys are D. sudden numbness of her right arm Answer: Match the type of incontinence with the associated symptoms. 1. sudden, unexpected need to void A. stress incontinence 2. frequent or continual incontinence of small to moderate amounts B. urge incontinence 3. inability to get to bathroom facilities C. overflow incontinence 4. triggered by laughing, coughing, sneezing D. reflex incontinence 5. no warning; large amounts urine lost E. functional incontinence Answer: 1. sudden, unexpected need to void (B) A. stress incontinence 2. frequent or continual incontinence of small to moderate amounts (c)B. urge incontinence 3. inability to get to bathroom facilities (E) C. overflow incontinence 4. triggered by laughing, coughing, sneezing (A) D. reflex incontinence 5. no warning; large amounts urine lost (D) E. functional incontinence An African American male, age 72, is admitted to the nurse’s unit for a blood pressure of 180/100. Based on this information, what does the nurse suspect? A. this patient eats too much salt, causing a rise in blood pressure B. this patient probably has hypertension and is at increased risk for stroke C. this patient is overweight and does not exercise D. all of the above Answer: The nurse is teaching a 69 year old female with congestive heart failure about self-management of her disease. Which of the following would be considered appropriate to teach this patient? A. maintain healthy weight, limit sodium intake, exercise regularly, take meds as ordered B. lose 20 pounds, weigh daily at home, report weight gain of more than 1 pound to the physician C. see the doctor weekly, take meds as ordered, limit sodium intake D. keep blood pressure at 160/90, eat a diet low in fats, exercise twice per week Answer: A 90 year old female with no significant history is admitted to the ER for acute ischemic stroke with symptoms that began 7 hours prior to admission. Which of the following interventions would the nurse reasonably expect to be done for this patient? A. diagnostic testing such as MRI B. discussion of t-Pa as immediate treatment C. stroke team consult D. a and c only Answer: Of the following nursing interventions, which would be least appropriate for a person in rehabilitation post-stroke who states “I just can’t believe this happened to me. I can’t wait for this to be over so I can go back to my normal life”? A. teach all of the information the person will need to know to adapt to life after stroke B. provide reassurance and emotional support C. provide essential information, but avoid teaching at this stage D. provide direct care, ensure safety, and involve the family Answer: Which of the following would be the most appropriate bowel program for an older person with constipation who is recovering from a stroke? A. daily soap suds enema B. increase fiber, fluids, and activity C. Colace four times per day D. digital stimulation every morning after a suppository Answer: Which of the following signs is most indicative of prostate cancer in a 75 year old male? A. PSA of 12 ng/ml B. hard, nodular lump on physical palpation through rectal exam C. blood in the urine D. all of the above may be signs of prostate cancer Answer: Side effects of Viagra reported by an older person that would require immediate attention include: A. headache B. nasal congestion C. visual problems D. flushing Answer: A patient newly diagnosed with Parkinson’s disease wishes some information. Which of the following would not be accurate for the nurse to teach the patient? A. the cardinal signs include bradykinesia, tremor, and rigidity B. the disease is chronic and progressive C. there is no known cure D. a surgery called pallidotomy can cure severe tremors in 80% of cases Answer: A patient with BPPV complains of dizziness because: A. he has Meniere’s disease B. he has a history of stroke C. he has otoconia that are dislodged D. the Epley maneuver is working Answer: Which of the following best represents the percentage of elderly persons with co-morbid conditions who suffer from depression. A. 15% B. 25% C. 37% D. 50% Answer: Which of the following is true about depression? A. it does not affect community dwelling elders B. some symptoms can mimic dementia C. usually occurs in early stages of dementia D. leads to suicide in 50% of older males Answer: Which of the following is true about elderly suicide? A. rates are highest among elderly Black females B. 10% of all suicides are elderly persons C. older women tend to use more lethal means than men D. older men tend to use more lethal means than women Answer: Common causes for urinary incontinence that the nurse should always check in the elderly include: A. lack of mobility and no toilet facilities B. urinary tract infections and electrolyte imbalances C. stress and multiple pregnancies D. birth defects and prior surgeries Answer: Kegel exercises may help many forms of incontinence because they: A. decrease bladder contractions B. increase outlet resistance C. strengthen the pelvic floor muscles D. counteract the effects of multiple pregnancies Answer: Of the following sleep disorders in the elderly, which is the most common? A. restless legs syndrome B. insomnia C. muscle cramps D. nightmares Answer: A score of 12 on the MMSE would indicate: A. situational depression B. cognitive impairment, probably dementia C. delirium D. a normal result Answer: If a person is suffering from dementia, what could have caused this? A. Creutzfeld-Jacob disease B. Lewy body disorder C. Alzheimer’s disease D. All of the above Answer: A large stage 4 pressure ulcer that occur in the nursing home on a resident who was admitted with intact skin one week prior is most likely a sign of: A. direct physical abuse B. an albumin of 4.5 C. inadequate nursing care D. being give the wrong tube feeding Answer: A patient the nurse has recently given medications to complaints of nausea and vomits up the pills, stating that they “make her sick”. This is an example of: A. toxicity B. dependence C. addiction D. adverse drug reaction Answer: The nurse is teaching a patient and his family about medication safety. Which of the following statements should not be included in the teaching? A. With older adults, the general rule for medications is start low and go slow. B. The more medications a person takes, the greater the risk of interactions and side effects. C. Medicare covers all medications for Seniors. D. Medication regimens may often be enhanced by lifestyle modifications that also address the individual’s health. Answer: If the nurse is assessing for extrinsic factors for falls, which of the following should be included? A. throw rugs B. ataxia C. cognition D. dizziness Answer: Of the following nursing interventions for fall prevention, which is the least helpful? A. minimize clutter in the environment B. physical restraints C. strengthening exercises D. walking Answer: An older person presents in the emergency with symptoms such as tachycardia, shortness of breath, light-headedness, and trembling. Having ruled out any physical causes, what might be the most likely discharge diagnosis seen on the chart? A. generalized anxiety disorder B. panic attack/panic disorder C. delirium D. depression Answer: Drugs that can cause or worsen anxiety include all the following except: A. baclofen B. theophylline C. acetaminophen D. caffeine Answer: In providing nursing care for the older adult with anxiety, which of the following interventions is least appropriate? A. increase environmental stimuli B. stay with the patient. C. speak slowly in a soft, calm voice. D. avoid reciprocal anxiety Answer: The nurse is instructing a group of older women living in the community about ways to minimize the risk of UI. Which of the following is least appropriate to include in the discussion? A. limit fluids B. avoid bladder irritants C. avoid constipation D. strengthen and tone the pelvic floor muscles Answer: Nursing interventions to prevent pressure ulcers include all of the following except: A. use lift devices for transferring or moving patient in bed B. assess each patient for risk C. turn all patients every two hours D. use pressure relieving devices for patients at risk Answer: In charting on a 70-year old man with a wound that appears as a shallow crater, the nurse would stage this as a: A. stage I B. stage II C. stage III D. stage IV Answer: Poor nutrition and subsequent skin breakdown is associated with which of the following lab results? A. Serum albumin of 3.0 B. Serum transferrin of 250 C. Cholesterol of 200 D. none of the above Answer: Aspiration can occur at which point(s)? A. before the swallow B. after the swallow C. during the swallow D. all of the above Answer: In teaching a patient with GERD to modify their lifestyle, which of the following do not exacerbate symptoms in most people? A. decaffeinated tea B. chocolate C. smoking D. citrus Answer: Clinically, Lewy body dementia (LBD) can be distinguished from Alzheimer’s disease (AD) by: A. motor symptoms in the early stage of LBD B. visual halluincations in late LBC C. fluctuating mental status as a feature of AD but not LBD D. response of motor symptoms to dopaminergic agents Answer: The daughter of a patient with AD wants to know what the risk factors for dementia are. The nurse appropriately explains that all of the following are risk factors except: A. age B. family history C. male gender D. history of head injury Answer: The nurse screening for Alzheimer’s Disease recognizes the diagnostic criteria to include all but which of the following? A. impaired short or long-term memory B. aphasia C. apraxia D. dysphagia Answer: An older patient has recently been diagnosed with moderate stage AD. The nurse practitioner orders a noncompetitive receptor antagonist such as Namenda. The nurse would instruct the patient and family that this medication: A. stops the decline of the disease B. is taken over a long period of time to achieve best results C. may result in significantly higher function over time D. b and c only Answer: A patient presents to the clinic with confusion and provides a list of medications to the nurse. Which of the following medications could be a source of this problem? A. meperidine B. aspirin C. benzodiazapines D. a and c Answer: An older adult who presents with complaints of insomnia, loss of energy, impaired concentration and diminished pleasure in activities she once enjoyed is showing signs of: a. delirium B. dementia C. depression D. confusion Answer: In educating patients and families about depression, the gerontological nurse recognizes that depression is: A. a prevalent condition B. often undertreated c. common cause of excess disability D. all of the above Answer: Environmental interventions for patients with dementia include all of the following except: A. a cool room temperature B. alarms on exits C. disguising exits D. areas for safe wandering Answer: If an older adult wishes to have another person make health care decisions in his behalf should he become unable to do so himself, he should appoint: A. a living will B. a health care representative C. a durable power of attorney for healthcare D. b or c Answer: A family member asks the nurse to witness the signing of a Living Will at the bedside of a mentally competent, alert, adult patient. In signing as a witness, the nurse is stating: A. the signature of this person was valid and not coerced B. the person was mentally competent to sign C. the person is terminally ill at the time D. a and b only Answer: If an older person wishes to have a DNR status on himself, which of the following is true? A. he needs to have the physician sign a form that states this B. he will receive less quality care than those who are not DNR status C. he should place a copy on his refrigerator at home D. a and c only Answer: The nurse is caring for a healthy older patient who tells her that he is going to die and wishes no heroic measures to be taken. There are no advance directives on the chart. The nurse leaves the room and returns minutes later to find the patient with no pulse and not breathing. What should the nurse do? A. call a code or 911 and begin CPR B. quickly write and sign advance directives C. leave the room and close the door D. call the doctor before beginning CPR Answer: The principle of distributive justice is best described as: A. the greatest good for the greatest number B. the wisest use of resources C. giving to the poor D. socialism Answer: Palliative care refers to care that is: a) comfort-based b) curative c) less that standard d) a and b Answer: One of the goals of hospice is to help persons: A. get well B. live until they die C. live longer than expected d) prolong life Answer: In communicating bad news about a diagnosis to an older patient, the nurse should do which of the following first? A. find out what the patient wants to know B. communicate the news gently C. find out what the patient knows d) respond to feelings Answer: The PSDA provides information about which of the following? A. advance directives B. hospice care C. funeral arrangements D. palliative care Answer: In describing the benefits of hospice to a dying older patient’s family, the nurse correctly states that hospice care may include: A. counseling services B. medical supplies C. social services d) all of the above Answer: Using the Five Wishes with patients at end of life is beneficial because: A. it allows them to make their desires more specifically known B. it tells their wishes for their family after death C. it tells the five things that are most important to them D. none of the above Answer: To treat dyspnea at end of life, the nurse would expect to give which of the following medications? A. Codeine B. Oxycontin C. Morphine D. Lasix Answer: The common causes of delirium at end of life may include: A. constipation, dyspnea, pain B. dyspnea, happiness, frustration C. tachycardia, diarrhea D. none of the above Answer: The dying older person may be under-medicated for pain due to which of the following misconceptions? A. pain perception decreases with age B. pain is an inevitable part of aging C. if a person does not state they have pain, they must not be in pain D. all of the above Answer: Which of the following screenings would the nurse not routinely recommend to an older adult? A. mammogram every 1 - 2 years for females B. annual physical C. dementia D. flexible sigmoidoscopy and FOBT Answer: An older person with a spinal cord injury wishes to be taken off of life support three months after his injury occurred. The physician will not allow this or sign the order for it. What two principles are in conflict in this situation? A. autonomy versus paternalism B. autonomy versus justice C. nonmaleficence versus beneficence D. veracity versus fidelity Answer: When a nurse tells a patient the truth about his terminal condition, she is engaging in: A. beneficence B. autonomy C. veracity D. fidelity Answer: One nursing strategy to use when striving to make persons comfortable in the hospital setting in relation to their dietary habits is: A. assure them that the hospital food is nutritious B. insist that they eat at least 80% of all meals C. provide nutritious snacks D. provide foods that are culturally familiar Answer: The nurse is caring for an older person from a different culture than her own. What is her best approach to providing holistic care to this patient? A. provide care as she would to all other patients B. learn more about the person’s culture C. talk to family members about the person’s medical condition D. ask other nurses what they do to care for this person Answer: The nurse is assigned to a patient in home care who is an 89 year old African American woman widowed and living alone. Before even making the first visit, which of the following might the nurse expect, based on her knowledge? A. the patient will be cared for by relatives in a middle class neighborhood B. the patient may have fewer financial resources and have a number of health problems C. the patient is likely to be healthy and financially secure D. the patient is most likely able to pay for all her medications without difficulty Answer: Which of the following should the nurse include in his teaching about hypertension to a group of African American seniors at the community wellness center? A. hypertension is less prevalent among people of color B. vitamin D deficiency is thought to be a factor in hypertension C. hypertension may be caused by overexposure to the sun D. persons with hypertension are at lower risk for heart attack and stroke Answer: Nancy is a nurse of Hispanic background who is working with a population of older white males on an Alzheimer’s unit at the Veteran’s Hospital. One of the patients makes an angry racist comment to Nancy about all Latinos being lazy. What is Nancy’s best response? A. consider his disease process and excuse the behavior B. report the incident to the nurse manager C. correct the patient by saying, “I am not lazy” D. ask to be removed from caring for that patient Answer: Which of the following is important for nurses to remember when providing spiritually competent care to older adults? A. older adults tend to avoid religion B. prayer and faith are commonly used coping strategies by religious elders C. participation in an organized religion has no effect on depression or coping D. religion and spirituality are the same terms Answer: In addressing the sexual needs of an older couple, the nurse should remember that all of the following may be recognized as common problems the nurse may intervene with except: A. dyspareunia B. utertine prolapse C. incontinence D. vaginal dryness Answer: The nurse is caring for a 70 year old male in the emergency room who is admitted after a car accident. What is the best question for her to ask the patient when trying to contact a loved one? A. should I call your wife? B. do you have a wife? C. who should I call? D. do your children live around here? Answer: The nurse is giving an educational program about HIV to a group of seniors living in a retirement community in Florida. Many of the attendees are widows and widowers. Which of the following information is appropriate for the nurse to include in her discussion? A. Persons over 50 comprise approximately 10% of HIV cases. B. There is an increase in heterosexual transmission of HIV in older adults. C. African American and Hispanic women report higher levels of risk taking behaviors. D. all of the above Answer: Which of the following should the nurse recognize as untrue about sexuality and aging? A. male erections may take longer to achieve and not be as full as in younger years B. male orgasm may not occur with each encounter C. sexual desire will permanently disappear after years without a partner D. decreased vaginal lubrication is often a problem for women Answer: Teams in geriatrics are generally focused on…. A. education, consultation, treatment B. assessment, consultation, management C. management, counseling, treatment D. diagnosis, counseling, evaluation Answer: The model from which GITTs came involved which of the following disciplines? A. speech therapy B. advanced practice nursing C. pastoral care D. all of the above Answer: One of the major differences between a multidisciplinary and interdisciplinary geriatric team is: A. more physicians on an interdisciplinary team B. the number of therapists C. team members sharing common goals D. the amount of outcome evaluation Answer: Name three of the most commonly used natural CAM products among older adults. Answer: include: Echinacea, ginseng, gingko biloba, garlic, glucosamine, St. John’s wort, peppermint, fish oils, ginger, soy) List the five behavioral determinants of healthy aging as described

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