TOWARD HEALTHY AGING
11TH EDITION
THERIS A. TOUHY, KATHLEEN F. JETT
CHAPTER NO 01: GERONTOLOGICAL NURSING ACROSS THE CONTINUUM OF CARE
MULTIPLE CHOICE QUESTION & ANSWERS
Q-1. When did serious and well-controlled research studies on aging first become
available?
a. Only in the past 60 years.
b. Since the turn of the 20th century.
c. Following the Great Depression.
d. Since the year 2000.
ANS: A
Only in the past 60 years have serious and carefully controlled research studies flourished.
Before that, anecdotal evidence was used to illustrate issues assumed to be universal, making
all the remaining options incorrect.
DIF: Cognitive Level: Remembering TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
Q-2. The son of a nursing home resident asks a nurse: “What is the significance of
being certified in gerontology? I see that you are, but not all of the nurses are.” What re-
sponse best answers the family member’s question?
a. “National certification as a gerontological nurse is a way to demonstrate special
knowledge in caring for older adults.”
b. “National certification in gerontology is required for all nurses who have worked in
this setting for 2 or more years.”
c. “National certification is only available to nurses who have a Baccalaureate degree
in nursing.”
d. “Only advanced practice nurses, like nurse practitioners, are certified in gerontol-
ogy.”
ANS: A
,National certification is a way to demonstrate special expertise in caring for older adults. It is
not required for practice in any setting across the continuum of care, and it is not exclusive to
nurses with Baccalaureate degrees. There is both a generalist and a specialist gerontological
nursing certification. The generalist functions in a variety of settings providing care to older
adults and their families. The specialist has advanced gerontological education at a master’s
level.
DIF: Cognitive Level: Understanding
TOP: Integrated Process: Communication and Documentation
MSC: Client Needs: Management of Care
Q-3. The major goal of the NICHE (Nurses Improving Care for Healthsystem Elders)
program includes which of the following?
a. Improve outcomes for hospitalized older adults.
b. Increase the number of older adults cared for in hospitals.
c. Increase the number of iatrogenic complications that occur in hospitalized older
adults.
d. Decrease 30-day readmission rates for hospitalized older adults.
ANS: A
The goal of NICHE is to improve outcomes for hospitalized older adults. Although option D is a
good outcome for hospitalized older adults, it is not one of the major goals of NICHE, which
are broader. Options B and C are not goals that would improve care for older adults but would
be negative outcomes themselves.
DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE QUESTION & ANSWERS
Q-1. What is the impact of the Hospital Readmission Reduction Program (HRRP) on
avoidable readmissions? (Select all that apply.)
a. Readmission rates for the selected conditions have dropped nationwide.
b. Many hospitals have instituted system-wide interventions to prevent readmissions.
c. Hospitals are keeping patients longer to avoid readmissions.
d. Potentially avoidable hospitalizations among nursing home residents is increasing.
,e. Hospitals have a financial incentive to develop programs to reduce readmissions.
ANS: A, B, E
The Hospital Readmission Reduction Program (HRRP) was established as a provision in the Af-
fordable Care Act (ACA) requiring Medicare to reduce payments to hospitals with relatively
high readmission rates for selected conditions for patients in traditional Medicare. Since the
HRRP, readmission rates for the selected conditions have dropped nationwide but estimates
are that in 2018, about 80% of hospitals evaluated by CMS will face penalties totaling $564
million (Advisory Board, 2017). Additionally, the HRRP has been the impetus for many hospi-
tals to institute system-wide interventions to prevent readmissions that have also contributed
to the decline in readmission rates. The rate of potentially avoidable hospitalizations among
SNF residents has fallen by nearly a third in recent years as a result of many quality improve-
ment initiatives.
DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
Q-2. Which of the following are true statements about the current health care
workforce? (Select all that apply.)
a. Approximately 10% of registered nurses (RNs) are certified in gerontological nurs-
ing.
b. The number of geriatricians is expected to increase about 50% over the next 25
years.
c. The professions of social work, physical therapy, and psychiatry are demonstrating
the same trends as nursing.
d. The world’s older population is expected to grow to at least 1.3 billion in the next
20 years.
e. It is anticipated that there will be a need for approximately 3million additional di-
rect care and professional health care workers by the year 2030.
ANS: C, D, E
Less than 1% of RNs are certified in gerontological nursing. Geriatric medicine faces similar
challenges with about 7000 prepared geriatricians, 1 for every 2546 older Americans; and this
number is falling with the trend predicted to be less than 5000 by 2040 (IOM, 2008). By 2040
the number of older adults in the world will be at least 1.3 billion. Other professions such as
social work, physical therapy, and psychiatry have similar shortages. It is estimated that by
2030 nearly 3 million additional health care professionals and direct care workers will be
needed to meet the care needs of a growing older adult population. Healthy People 2030 has
addressed this concern..
, DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
Q-3. Best practice recommendations for nursing education in relation to gerontolo-
gy include which of the following? (Select all that apply.)
a. Provision of a “stand-alone” course in gerontological nursing
b. Integration of gerontological content throughout the curriculum
c. Replacement of acute care pediatric clinical experiences with gerontological clini-
cal experiences
d. Recruitment of nurses with Master and Doctoral degrees and a specialty in geron-
tology to faculty roles
e. Requiring all undergraduate nursing students to obtain gerontological certification
as a requirement for graduation
ANS: A, B, D
Best practices include providing a stand-alone gerontological nursing course as well as inte-
grating gerontology throughout the curriculum. Recruitment of nurses with a specialty in
gerontology and a Master or Doctoral degree to faculty roles is a critical step in making sure
that the next generation of nurses is prepared to care for older adults. Best practices do not
recommend removing pediatric clinical experiences and replacing them with gerontological
experiences. Nursing certification is only available to practicing nurses who meet specific ed-
ucation and practice requirements. It is not applicable to nursing students.
DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
Q-4. What are the current initiatives being implemented to enhance the specialty of
gerontological nursing? (Select all that apply.)
a. Mandating of a minimum of a Baccalaureate degree in nursing in order to care for
older adults
b. Geriatric Nursing Leadership Academy (GNLA) project
c. Promotion of geriatric nursing to excellence to the nursing community
d. Requiring a nursing certification specifically required to long-term care
e. Offering scholarships for study and research in geriatric nursing
ANS: B, C, E
11TH EDITION
THERIS A. TOUHY, KATHLEEN F. JETT
CHAPTER NO 01: GERONTOLOGICAL NURSING ACROSS THE CONTINUUM OF CARE
MULTIPLE CHOICE QUESTION & ANSWERS
Q-1. When did serious and well-controlled research studies on aging first become
available?
a. Only in the past 60 years.
b. Since the turn of the 20th century.
c. Following the Great Depression.
d. Since the year 2000.
ANS: A
Only in the past 60 years have serious and carefully controlled research studies flourished.
Before that, anecdotal evidence was used to illustrate issues assumed to be universal, making
all the remaining options incorrect.
DIF: Cognitive Level: Remembering TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
Q-2. The son of a nursing home resident asks a nurse: “What is the significance of
being certified in gerontology? I see that you are, but not all of the nurses are.” What re-
sponse best answers the family member’s question?
a. “National certification as a gerontological nurse is a way to demonstrate special
knowledge in caring for older adults.”
b. “National certification in gerontology is required for all nurses who have worked in
this setting for 2 or more years.”
c. “National certification is only available to nurses who have a Baccalaureate degree
in nursing.”
d. “Only advanced practice nurses, like nurse practitioners, are certified in gerontol-
ogy.”
ANS: A
,National certification is a way to demonstrate special expertise in caring for older adults. It is
not required for practice in any setting across the continuum of care, and it is not exclusive to
nurses with Baccalaureate degrees. There is both a generalist and a specialist gerontological
nursing certification. The generalist functions in a variety of settings providing care to older
adults and their families. The specialist has advanced gerontological education at a master’s
level.
DIF: Cognitive Level: Understanding
TOP: Integrated Process: Communication and Documentation
MSC: Client Needs: Management of Care
Q-3. The major goal of the NICHE (Nurses Improving Care for Healthsystem Elders)
program includes which of the following?
a. Improve outcomes for hospitalized older adults.
b. Increase the number of older adults cared for in hospitals.
c. Increase the number of iatrogenic complications that occur in hospitalized older
adults.
d. Decrease 30-day readmission rates for hospitalized older adults.
ANS: A
The goal of NICHE is to improve outcomes for hospitalized older adults. Although option D is a
good outcome for hospitalized older adults, it is not one of the major goals of NICHE, which
are broader. Options B and C are not goals that would improve care for older adults but would
be negative outcomes themselves.
DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE QUESTION & ANSWERS
Q-1. What is the impact of the Hospital Readmission Reduction Program (HRRP) on
avoidable readmissions? (Select all that apply.)
a. Readmission rates for the selected conditions have dropped nationwide.
b. Many hospitals have instituted system-wide interventions to prevent readmissions.
c. Hospitals are keeping patients longer to avoid readmissions.
d. Potentially avoidable hospitalizations among nursing home residents is increasing.
,e. Hospitals have a financial incentive to develop programs to reduce readmissions.
ANS: A, B, E
The Hospital Readmission Reduction Program (HRRP) was established as a provision in the Af-
fordable Care Act (ACA) requiring Medicare to reduce payments to hospitals with relatively
high readmission rates for selected conditions for patients in traditional Medicare. Since the
HRRP, readmission rates for the selected conditions have dropped nationwide but estimates
are that in 2018, about 80% of hospitals evaluated by CMS will face penalties totaling $564
million (Advisory Board, 2017). Additionally, the HRRP has been the impetus for many hospi-
tals to institute system-wide interventions to prevent readmissions that have also contributed
to the decline in readmission rates. The rate of potentially avoidable hospitalizations among
SNF residents has fallen by nearly a third in recent years as a result of many quality improve-
ment initiatives.
DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
Q-2. Which of the following are true statements about the current health care
workforce? (Select all that apply.)
a. Approximately 10% of registered nurses (RNs) are certified in gerontological nurs-
ing.
b. The number of geriatricians is expected to increase about 50% over the next 25
years.
c. The professions of social work, physical therapy, and psychiatry are demonstrating
the same trends as nursing.
d. The world’s older population is expected to grow to at least 1.3 billion in the next
20 years.
e. It is anticipated that there will be a need for approximately 3million additional di-
rect care and professional health care workers by the year 2030.
ANS: C, D, E
Less than 1% of RNs are certified in gerontological nursing. Geriatric medicine faces similar
challenges with about 7000 prepared geriatricians, 1 for every 2546 older Americans; and this
number is falling with the trend predicted to be less than 5000 by 2040 (IOM, 2008). By 2040
the number of older adults in the world will be at least 1.3 billion. Other professions such as
social work, physical therapy, and psychiatry have similar shortages. It is estimated that by
2030 nearly 3 million additional health care professionals and direct care workers will be
needed to meet the care needs of a growing older adult population. Healthy People 2030 has
addressed this concern..
, DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
Q-3. Best practice recommendations for nursing education in relation to gerontolo-
gy include which of the following? (Select all that apply.)
a. Provision of a “stand-alone” course in gerontological nursing
b. Integration of gerontological content throughout the curriculum
c. Replacement of acute care pediatric clinical experiences with gerontological clini-
cal experiences
d. Recruitment of nurses with Master and Doctoral degrees and a specialty in geron-
tology to faculty roles
e. Requiring all undergraduate nursing students to obtain gerontological certification
as a requirement for graduation
ANS: A, B, D
Best practices include providing a stand-alone gerontological nursing course as well as inte-
grating gerontology throughout the curriculum. Recruitment of nurses with a specialty in
gerontology and a Master or Doctoral degree to faculty roles is a critical step in making sure
that the next generation of nurses is prepared to care for older adults. Best practices do not
recommend removing pediatric clinical experiences and replacing them with gerontological
experiences. Nursing certification is only available to practicing nurses who meet specific ed-
ucation and practice requirements. It is not applicable to nursing students.
DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
Q-4. What are the current initiatives being implemented to enhance the specialty of
gerontological nursing? (Select all that apply.)
a. Mandating of a minimum of a Baccalaureate degree in nursing in order to care for
older adults
b. Geriatric Nursing Leadership Academy (GNLA) project
c. Promotion of geriatric nursing to excellence to the nursing community
d. Requiring a nursing certification specifically required to long-term care
e. Offering scholarships for study and research in geriatric nursing
ANS: B, C, E
