NURS 421 Final Exam

True or false GI age related changes include increased motility, decreased blood flow, increased absorption - False, decreased motility Identify the correct statement describing the abuse of elderly persons in the United States. A. Elder abuse is the most often reported form of domestic violence B. Statistically, neglect is the most common form of elder abuse C. Most cases of elder abuse are reported to the proper authorities D. Healthcare practitioners are only mandated to report verified, not suspected, cases of elder abuse - b. Statistically, neglect is the most common form of elder abuse Which of the following cases seen by a nurse working in the ED identifies a situation that suggests a case of elder mistreatment? A. An 85 yr old male who has several areas of bruising on the back of the hands and is taking Clopidogrel sisulfate(Plavix) and aspirin daily B. An 86 yr old woman who has 3 dime sized burned areas on her upper inner thigh C. A 77 yr old woman who fell at home after tripping over her dog and broke her arm about 30 minutes earlier D. A 73 yr old male with a history of gastric ulcers who is found to be anemic after vomiting blood 3 hours earlier - b. An 86 yr old woman who has 3 dime sized burned areas on her upper inner thigh Which of the following are examples of appropriate communication techniques for dealing effectively with persons with dementia? A. Ask open ended questions so the person feels that he or she feels they can make choices B. For people in the later stages of dementia, talk to them as you would a child C. Maintain good eye contact and a relaxed and smiling approach D. When a person forgets something, remind them not forget it the next time - c. Maintain good eye contact and a relaxed and smiling approach Mr Reynolds experienced a transient ischemic attack (TIA) 3 weeks ago that had significant effects on his motor and sensory function. Which of the following assessment findings should signal to the nurse to the possibility that Mr Reynolds is experiencing dysphagia? A. Mr. Reynolds complains of being excessively hungry in the mid afternoon and evening B. When providing oral care, the nurse finds food pocketed in Mr Reynolds cheek C. Mr Reynolds drinks large amounts of water, before, during and after meals D. Mr Reynolds prefers to sit in a high fowlers position after meals - b. When providing oral care, the nurse finds food pocketed in Mr Reynolds cheek Statistically, which of the following clients is at greatest risk for mistreatment in the domestic setting? A. An active 70 yr old woman with well controlled diabetes who live alone B. A healthy 75 yr old man who is a retied businessman and lives with his son C. An 82 yr old woman with severe osteoarthritis and macular degeneration who lives with her single daughter who has an adult son with cerebral palsy D. A 77 yr old man who has a history of coronary bypass surgery and lives with his wife - c. An 82 yr old woman with severe osteoarthritis and macular degeneration who lives with her single daughter who has an adult son with cerebral palsy When a patient is admitted to a hospital, he or she is asked if an advance directive is available in case terminal care is necessary. What does an advance directive do? A. It gives the patient's family control over terminal care regardless of the patient's wishes B. It gives the patient control over terminal care by appointing an decision maker in the event they cannot make their own decisions C. It gives the hospital control over terminal care D. It gives the attending physician control over terminal care - b. It gives the patient control over terminal care by appointing an decision maker in the event they cannot make their own decisions A 78 yr old woman was diagnosed with colorectal cancer 18 mos ago and underwent chemotherapy. A recent CT scan has shown has metastasized to her lungs and liver. The woman states that she feels well and does not want to undergo any further debilitating chemotherapy. The son and daughter are adamantly opposed to their mother's forgoing treatment and have appealed to the nurse. What factor is the primary consideration in this scenario? A. The family's wishes B. The woman's prognosis C. The woman's autonomy D. The woman's treatment options - c. The woman's autonomy Which of the following are social risk factors for impaired nutrition? Select all that apply. A. Isolation B. Loneliness C. Depression D. Poverty - a, b, and d A mini nutritional score between 8 and 11 indicates dehydration. True or false - False Lab values associate with poor nutrition include... Select all that apply. A. Serum albumin B. Increased magnesium C. Serum prealbumin D. Cholesterol - a, c, and d What contributes to neuron death & may progress to Alzheimers? - B-amyloid What should you do before treating a patient with delirium? - Identify the underlying cause TRUE OR FALSE: During hospice care one physician must determine the patient has 6 months to live - FALSE; two physicians Hospice care is not appropriate in which of these circumstances? A. The patient decides to forego curative treatment. B. The patient's prognosis is 3 to 6 months. C. The patient is undergoing experimental chemotherapy. D. The patient is receiving palliative chemotherapy. - c. The patient is undergoing experimental chemotherapy. Rationale: Hospice care is not appropriate for patients undergoing active curative therapy. All other statements are correct regarding hospice care. Mrs. Jones is receiving hospice care in the nursing home. During the assessment, the nurse observes the patient is unconscious and has wet, noisy respirations and cool, mottled extremities. The nurse understands which of the following actions are indicated? (Select all that apply.) A. Notifying the patient's family B. Requesting an order for an anticholinergic medication C. Notifying the patient's provider D. Performing a sternal rub to assess the patient's response E. Performing a full systems assessment - A, B, and C Rationale: Unconsciousness is not unexpected inthe patient in hospice care. Performing a painful assessment strategy would be inappropriate and performing a full system assessment would be unnecessary as death is expected. We would wantto notify the family and provider of this change and an order for an anticholinergic medication is appropri- ate to help reduce noisy respirations by drying up secretions. Mr. Smith's wife is in the terminal stage of chronic obstructive pulmonary disease (COPD). He is very anxious that his wife be comfortable during her last hours. The nurse finds him tearful in the hall outside the room. Which communication should the nurse use first? A. "My aunt had COPD, and she died on a ventilator. Count your blessings that your wife is not on a machine." B. "I can see you're upset, Mr. Smith. Would you like to talk about it?" C. "Is your family here?" D. "Do you think your wife would like a visit from pastoral care?" - B. "I can see you're upset, Mr. Smith. Would you like to talk about it?" Rationale: As a nurse, we would not want to make light of a family member's anxiety. Initiating a conver- sation with Mr. Smith might relieve some of his anxieties. We can then refer to other support services as necessary. The nurse asks the patient and family members if they have any questions about the patient's diagnosis and plan of care. This is an example of which PC domain? A. Physical aspects of care B. Psychological and emotional aspects of care C. Ethical and legal aspects of care D. Structure and process of care - D. Structure and process of care Rationale: Domain 1: Structure and process of care addresses the plan of care and the patient and family knowledge about the disease course, prognosis, and benefits and risks/burdens of diagnostic evaluation and treatments. The nurse understands that moral distress may result in which of the following? (Select all that apply.) A. Physical exhaustion B. Disagreements among staff C. Anger at family D. Anger at providers E. Feelings of undeserved power - A, B, C, D, and E Rationale: All of the cited examples may be a result of moral distress. The nurse understands appropriate actions to take after a distressing discussion with a provider over end-of-life issues for a patient include: A. Avoid communicating with the provider except through the electronic medical record B. Having a drink after work to calm frazzled nerves C. Arguing with colleagues who disagree D. Soliciting support from a nurse manager or ethics consultation - D. Soliciting support from a nurse manager or ethics consultation Rationale: It is best to talk about the stressful conversa- tion with your nurse manager or peers for support before going home and sleeping—the stress may stillbe present upon waking. Drinking or arguing do not help alleviate stress. Also, it is not helpful to avoid face-to-face communication with the provider. After soliciting advice from the nurse manager, a follow up conversation with the provider might be appropriate. Mrs. Foster, aged 84, is in the nursing home with dementia, hypertension, and mild renal failure. She has a feeding tube. Mrs. Foster suffers a catastrophic stroke and is taken to the emergency department. The nurse discovers that the patient has an advance directive and does not wish to be put on a ventilator. The nurse brings this to the team's attention during the family meeting to discuss the goals of care. The nurse's behavior is an example of: A. Nonmaleficence B. Advocacy C. Veracity D. Beneficence - B. Advocacy Rationale: Palliative care is appropriate for patients at the time of initial diagnosis, even if death is not immi- nent, during the course of active treatment, dependent on technology such as dialysis or artificial ventilation, and for patients who are dying because it focuses on the relief of suffering and promotion of quality of life Palliative care is appropriate in which of the following situations? (Select all that apply.) A. The patient is undergoing cancer treatment. B. The patient is diagnosed with congestive heart failure. C. The patient is dying. D. The patient is dependent on technology. E. The patient is not imminently dying. - A, B, C, D, and E Rationale: Palliative care is appropriate for patients at the time of initial diagnosis, even if death is not immi- nent, during the course of active treatment, dependent on technology such as dialysis or artificial ventilation, and for patients who are dying because it focuses on the relief of suffering and promotion of quality of life. Nursing care priorities at the end of life include which of the following? (Select all that apply.) A. Communication with the patient and family B. Encouraging the family to get rest C. Rationalizing the patient's pain D. Managing pain and other distressing symptoms E. Providing education about the dying process - A, B, D, and E Rationale: Rationalizing pain is incorrect—we need to treat pain in the dying patient. Members of Mr. Smith's family are in the waiting area of the intensive care unit. They have just been told that Mr. Smith has amyotrophic lateral sclero- sis, a neurodegenerative disease that is fatal, and are questioning this diagnosis. Later in the day, you meet with the family. What is your best response to the family at this time? A. "Mr. Smith will soon be better. The doctors here are the best." B. "What are your fears at this time?" C. "Families always have a rough time with this information." D. "I will contact pastoral care." - B. "What are your fears at this time?" Rationale: Encouraging the family to express their fears allows them to process their concerns so they can move forward with a plan of care. Response A. Is an example of false reassurance. Response C. Has the effect of categorizing the family's distress to the general population and does not take into account their individual experience in this place at this time. Response D. Is inappropriate; the family should first be asked if they would like to see pastoral care. The ethical principle of beneficence involves: A. Assuring that a patient's wishes are honored B. Not doing harm to the patient C. Acting for the good of the patient D. Asking family members about their concerns - C. Acting for the good of the patient Rationale: The good of the patient is the essence of beneficence. Answer A is an example of advocating for the patient. Answer B is an example of nonmaleficence. Answer D is an example of the processes of communication and offering practical and emotional support. Efforts to support family members include which Of the following? (Select all that apply.) A. Assuring them that the end is near and it is okay To go home B. Encouraging final private conversations with the patient C. Asking them to bring a few of the patient's favorite things to her room D. Telling them to encourage the patient to hold on for them E. Encouraging active discussions about favorite family memories - B, C, and E Rationale: Sending the family home is inappropriate unless they desire to leave; encouraging the patient to hold on may prolong the dying process; encour- aging private conversations, family discussions, And bringing favorite things from home helps relieve anxiety. The nurse understands the use of morphine sulfate to treat symptoms may result in which of the following? (Select all that apply.) A. Improved mobility B. Relief of pain C. Slowing of respirations D. Relief of nausea E. Improved appetite - B and C Rationale: The use of morphine will not improve mobility or appetite. It does not relieve nausea, but it will relieve pain and slow respirations. Mrs. Kelso's death can be described as a well- managed death because of which of the following statements? A. It allowed enough time for the family to accept it was coming. B. It occurred in the hospice unit. C. There was appropriate pain and symptom management. D. The family accepted the care team's decisions. - C. There was appropriate pain and symptom management. Rationale: A death occurring in the hospice unit and/or an accepted death or team decision are acceptable but do not really reflect a well-manged death. That is when the patient's symptoms are well managed to allow the patient to be as comfortable as possible. As an experienced palliative care nurse, your response to Mrs Kelso's nurse when expressing concern that giving pain medication and sedatives may hasten patient death is which of the following? A. "Don't worry, we do this all of the time." B. "We are covered ethically by the principal of double effect." C. "Don't worry, we have a doctor's order." D. "We are covered ethically by the principal of beneficence." - B. "We are covered ethically by the principal of double effect." Rationale: Although the use of morphine in this sit- uation is common, the palliative care nurse should provide a better explanation than "we do this all of the time" or "we have a doctors order" in order to help the nurse understand the situation. It is ethi- cally correct but not because of the principal of beneficence, which means doing or promoting good. Although reliving pain is doing good, the principal of double effect "covers" the nurse ethically. Double effect means it is permissible to perform an act in the pursuit of good knowing that the action may also cause a bad result. A patient with Stage 2 Alzheimer disease visits the mental health clinic. During theinterview, the patient becomes hostile and refuses to answer further questions. The gerontological nurse's best action is to: A. Ask if the questions upset the patient in any way. B. Discontinue the interview. C. Explain that the information is needed to plan the patient's care. D. Ignore the patient's reaction and proceed. - B. Discontinue the interview. A 75-year-old patient who sustained a stroke has residual left-sided weakness. Fromthe first day of hospitalization, the patient has been combative and demanding, and hasrefused to swallow any medication. The most constructive nursing action is to: A. Continue to attempt to follow the physician's orders. B. Determine the patient's premorbid personality. C. Restrain the patient and request a change in the route of medication. D. Wait for the patient to become more cooperative. - B. Determine the patient's premorbid personality. A physician has just informed an older adult patient that test results indicate that thepatient has cancer and will require extensive surgery. The patient says, "I know thetests are wrong. I feel fine." The gerontological nurse's most appropriate response is to: A. Acknowledge that the patient looks healthy and encourage seeking a secondopinion. B. Advise the patient to join a support group. C. Convey availability to talk to the patient. D. Tell the patient that the tests are reliable and accurate. - C. Convey availability to talk to the patient. A gerontological nurse at a nursing home conducts a reminiscence therapy group forresidents with confusion. A member of the group stands up and says, "I just heard my cow. I have to go and milk her now." The nurse's most therapeutic response is: A. "All right, you may leave the group now." B. "Please tell us about your cow." C. "That wasn't a cow; maybe you heard a vacuum cleaner." D. "You live here at the nursing home now, not on the farm." - B. "Please tell us about your cow." An alert and oriented 82-year-old woman, who lives with her daughter, has beenadmitted to the hospital with bruises about the face and head. The daughter reports thather mother fell. Which behavior by the daughter raises the greatest suspicion of elder abuse? A. Becoming defensive when questions are asked B. Complaining about care delivered by hospital staff C. Giving an illogical account of her mother's fall D. Refusing to leave her mother alone to answer questions - D. Refusing to leave her mother alone to answer questions The most appropriate environment for a person with chronic dementia is one that: A. Changes often to decrease boredom. B. Contains familiar objects. C. Is limited in color and sound. D. Is stimulating so as to challenge thought. - B. Contains familiar objects. The nurse caring for the elderly population understands that movement slows with aging. This is most likely due to: A. Cognitive function B. Changes in musculoskeletal and nervous systems C. Laziness and a feeling that life is over D. A recent change in medical condition - b. Changes in musculoskeletal and nervous systems The nurse recognizes that involuntary movements may appear in the elderly patient and be normal. These normal involuntary movements may present as which of the following? A. Seizures B. Tongue protrusions C. Resting tremors D. Eye twitches and spasms - c. Resting tremors Which of the following statements made by a family caregiver would a nurse consider most indicative of elder abuse? A. "I get so frustrated because my father used to be so competent and now cannot feed himself." B. "My dad wanders at night and I can't be bothered with him, so I mix sleeping pills in his dinner so that he will fall asleep" C. "Mom asks me to do everything for her, but I think it is better if she keeps doing as much as she is capable of." D. "Mom cannot pay her own bills anymore. We went to the bank and arranged for me to have access to her checking account and help her pay the bills." - B. "My dad wanders at night and I can't be bothered with him, so I mix sleeping pills in his dinner so that he will fall asleep" The nurse caring for a patient would identify a need for additional interventions related to family dynamics when A. Extended family offers to help. B. Family members express concern. C. The ill member demands attention. D. Memories are shared. - C. The ill member demands attention. Rationale: It is not uncommon for the ill family member to become demanding and indicate that they deserve special treatment and care, and the supportive family may need assistance in understanding the dynamics of the illness in order to continue to be supportive. The most appropriate initial nursing intervention when the nurse notes dysfunctional interactions and lack of family support for a patient would be to A. Enforce hospital visiting policies. B. Monitor the dysfunctional interactions. C. Notify the primary care provider. D. Role model appropriate support - D. Role model appropriate support Rationale: Nurses can, at times, role model more appropriate interactions or provide suggestions for improving communication and interactions among family members. The nurse planning to assess the structure of a family should ask which question? A. "Who lives with you in this home?" B. "Who does the grocery shopping?" C. "Who provides support in your family?" D. "How old are the members of your family?" - A. "Who lives with you in this home?" Rationale: The structure of the family includes who is in the family and what their relationship is. The nurse is counseling a woman who is caring for her 83-year-old father in her home, who is becoming more confused. The nurse knows the daughter understands the father's care needs when she states which of the following? A. "Dad will only need my help for a short time, and then he will get better." B. "I can leave dad alone during the day; i'll just deadbolt the door." C. "I can send dad to the adult daycare; that way I can work and care for him at night." D. "Dad misses mom since she passed; he will be okay in a few weeks." - C. "I can send dad to the adult daycare; that way I can work and care for him at night." Rationale: The father will be cared for at the adult daycare, and it is a nice alternative for the daughter. She will be able to work and know that her father is safe during the day. A student nurse observes caregivers in a long-term care facility where she is employed. Which observations might indicate abusive behavior? (Select all that apply.) A) Failing to close bedside curtains during care activities. B) Use of physical restraints to decrease wandering behavior. C) Providing extra snacks as a reward for good behavior. D) Laughing and talking with co-workers while providing care. E) Speaking negatively about an older adult while in the break room. F) Responding slowly to the call light of a demanding older adult. - A, B, and F The nurse is caring for an older patient who is receiving palliative care. Which intervention is the highest priority for this patient? A. Invasive testing B. Pain management C. Aggressive chemotherapy D. Aggressive invasive surgery - B. Pain management Rationale: Palliative care improves the quality of life of older adults and their families when facing the problems associated with life-threatening illness. This is achieved through prevention and relief from suffering, early identification, impeccable assessment, and treatment of pain. Which patients seen by a nurse working in the emergency department identify a situation that suggests a case of elder mistreatment? A. An 86-year-old patient who has three dime-size burned areas on the upper inner thigh B. A 77-year-old patient who fell at home after tripping over the dog and broke an arm about 30 minutes earlier C. A 73-year-old patient with a history of gastric ulcers who is found to be anemic after vomiting blood 3 hours earlier D. An 85-year-old patient who has several small areas of bruising on the back of the hands and is taking medication for platelets and coagulation - A. An 86-yearold patient who has three dime-size burned areas on the upper inner thigh What are common manifestations found in the older adult related to perfusion? Select all that apply. A. Decrease in BP B. Increase in workload of myocardium C. Decrease in cardiac output D. Increase in BP upon standing E. Increase in arterial stiffening - B, C, and E Which of the following is an expected finding in an older adult? A. Diastolic murmurs B. Cardiovascular disease C. Systolic murmurs D. Weakened pulse - C. Systolic murmurs Which of the following is NOT the normal changes with aging? A. The cilia become less responsive and less effective B. Diminished cough reflexes C. Chemoreceptor function is altered at the peripheral D. Airwary obstruction - D. Airwary obstruction A nurse at a long-term care facility is contributing to the plan of care for an older adult client who has dementia. Which of the following interventions should the nurse include in the plan? A. Vary the staff members caring for the client B. Use photographs as memory triggers C. Provide a minimum of three activity choices to the client D. Break client tasks down to three or four steps at a time - B. Use photographs as memory triggers A nurse at a long-term care facility is contributing to the plan of care for a client who has Alzheimer's disease and wanders at night. Which of the following interventions should the nurse include in the plan? A. Place the client in wrist restraints at night B. Request a prescription for a psychotropic medication C. Assign the client to a room closer to the nurse's station D. Keep the television on at night - C. Assign the client to a room closer to the nurse's station A nurse is collecting data from an 85-year-old client. Which of the following findings should the nurse report to the provider? A. A widened anterior-posterior chest diameter B. Presence of an S4 heart sound C. Differences in pulse strength between lower extremities D. Post-void residual of 75 ml - C. Differences in pulse strength between lower extremities A nurse is collecting data from an older adult client who had a right-sided stroke two days ago. For which of the following findings should the nurse notify the provider immediately? A. Increased restlessness B. Weak grip on the left side C. Decreased sensation in the lower left extremity D. Absent gag reflex - A. Increased restlessness A nurse is reviewing the basic needs of older adult clients with a group of assistive personnel. Which of the following statements should the nurse include? A. "Caloric needs are increased." B. "Renal function is increased." C. "Deep sleep is decreased." D. "Exercise needs are decreased." - C. "Deep sleep is decreased." A nurse is reviewing the record of a group of older adult clients. Which of the following findings should the nurse identify as an unexpected manifestations of the aging process? A. Decreased absorption of nutrients B. Impaired excretion of medications C. High-pitched frequency hearing loss D. Obesity - D. Obesity A nurse is collecting data from an older adult client who lives alone. Although the client is able to answer all questions appropriately, the nurse notes that that client has a decreased attention span, expresses feelings of overwhelming sadness, and has a low energy level. The nurse should identify that the client is exhibiting manifestations of which of the following disorders? A. Delusions B. Dementia C. Delirium D. Depression - D. Depression A nurse at a long-term care facility is assisting with planning care for a group of older adult clients. When planning care, the nurse should consider that older adult clients are most likely to exhibit a decrease in which of the following? A. Short-term memory B. Creative ability C. Decision-making skills D. Cognitive capacity - A. Short-term memory A nurse is assisting with the care of an older adult client who has dementia. The client becomes agitated and confused at night and wanders into the hallway. Which of the following actions should the nurse take? A. Place the client's mattress on the floor B. Restrain the client during the nighttime hours C. Provide continuous orientation to the client D. Turn out the lights in the client's room at night - A. Place the client's mattress on the floor A nurse is caring for a client who has Alzheimer's disease and refused to take her morning anti-hypertensive medication. The client is orientated to name and place and is able to perform adls with minimal supervision. Which of the following actions should the nurse take? A. Crush the pills and feed them to the client in applesauce B. Insist the client comply by informing her of the possible implications of missing a dose C. Notify the provider of the need for further evaluation of the client's level of competence D. Ask the client to express her reasons for refusing the medication and document the event - D. Ask the client to express her reasons for refusing the medication and document the event During an assessment of an 82-year-old woman, a gerontological nurse learns that the woman has lost over 4 inches in height over the last several years. Which of the following factors have likely contributed to this phenomenon? Select all that apply. A) The woman's overall proportion of body water has decreased. B) The client has experienced a loss of cartilage. C) The woman's thyroid hormone levels have declined since the sixth decade. D) The client's vertebrae have thinned. E) Loss of stature is a consequence of the woman's diet. F) The woman's long bones have decreased in length. - A, B, and D An 80-year-old resident of an assisted living facility is proud of the fact that he was an elite athlete during his younger years. Despite his concerted efforts to remain physically active and maintain his stamina, he is lamenting his loss of exercise tolerance in recent years. How can his nurse best respond to these concerns? A) "It's inevitable that your heart increases in size as you age, and this is associated with a loss of cardiac efficiency." B) "It's normal for your heart to contract less strongly as you age, and this makes you somewhat less able to exercise vigorously." C) "As you age, it's common for your heart rate becomes less regular and this often results in fatigue." D) "The normal increase in blood pressure that accompanies aging leaves you with less cardiac reserve capacity than when you were young." - B) "It's normal for your heart to contract less strongly as you age, and this makes you somewhat less able to exercise vigorously." Rationale: Cardiac contractility decreases as a part of normal aging. Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation? A) An 81-year-old woman's glomerular filtration rate (GFR) is low. B) A 78-year-old male's stomach ph is increased. C) A 71-year-old male client's echocardiogram reveals slight left ventricular hypertrophy. D) A 78-year-old man has recently developed urinary incontinence. - D) A 78- year-old man has recently developed urinary incontinence. Rationale: The other answer choices represent normal age-related changes A 66-year-old man has undergone a digital-rectal exam (DRE) during a visit to his family physician. The exam reveals that the client's prostate has become enlarged since his last DRE. The most accurate conclusion that his care provider will draw from these findings is that they suggest: A) Prostate cancer B) A risk of malignancy that should be followed up C) A normal age-related change unlikely to have consequences D) A urinary tract infection - B) A risk of malignancy that should be followed up Rationale: Prostatic enlargement is exceedingly common among older men, but represents a risk of malignancy that necessitates further assessment and follow-up. A care aide at a long-term care facility has assured the family of a resident that their father's increasing forgetfulness is a normal part of the aging process. How can the nurse best respond to the care aide's statement to the family? A) "It's actually a myth that older people experience changes to their memory." B) "Memory losses are a normal age-related change many people experience." C) "Older adults have less working memory and slower retrieval, but this still requires further assessment." D) "There is no reason for healthy older adults to experience changes in their memory unless they are experiencing dementia." - C) "Older adults have less working memory and slower retrieval, but this still requires further assessment." Rationale: Older adults often experience delays in retrieval of memories and working memory. Some changes in memory, even in the absence of delirium or dementia, are to be expected but they should not be discounted and would require further assessment. A nurse practitioner is teaching a 90-year-old client about her new medication regimen. Which of the following principles should the nurse integrate into the teaching session? A) While numerous factors can interfere with learning, learning ability itself is not seriously altered with age. B) Older adults require simplified learning objectives and slower introduction of new directions. C) Simple association is well executed by older adults but complex analysis is normally absent. D) Successful learning late in life requires a multisensory teaching approach. - A) While numerous factors can interfere with learning, learning ability itself is not seriously altered with age. A gerontological nursing course syllabus includes the topic of helping elders ambulate safely. The major factor contributing to an increased risk of falls in the elderly is: A) Decline in brain weight B) Reduction of blood flow to the brain C) Flawed response to changes in balance D) Slowed nerve conduction velocity - C) Flawed response to changes in balance The family of an older patient is concerned because the patient at times complains of pain but at other times does not. The family does not know what to believe. What can the nurse explain to the family about aging and pain perception? A) "Older adults become progressively more sensitive to pain." B) "The only pain to be concerned about is pain that lasts longer than 3 months." C) "Older people have been shown to be less sensitive to pain than younger people." D) "It's actually not clear in the research what happens to people's perception of pain as they age." - D) "It's actually not clear in the research what happens to people's perception of pain as they age." The nurse is planning to assess the pain level of an older patient who is hearing impaired. Which assessment technique would be the most appropriate for the nurse to use? A) Withhold analgesia until the patient requests it. B) Ask the patient to rate pain on a scale of 1 to 10. C) Show the patient a scale with 0 being a smile and 6 being a crying grimace. D) Show the patient a picture of the body with a pain intensity scale, and use keywords to ask about her pain. - C) Show the patient a scale with 0 being a smile and 6 being a crying grimace. An older resident with dementia has been pacing and holding his right arm up against his chest. What should the nurse do first to help this patient? A) Notify the physician and get an order for an x-ray B) Document the behavior and report it to the next shift C) Check the resident's record for the history of this resident's behavior D) Medicate the resident with acetaminophen that is available PRN in his record - C) Check the resident's record for the history of this resident's behavior Rationale: A resident with cognitive impairment is not able to communicate pain in the most common way—verbally. It is important that caregivers document normal daily behavior so that any change can help staff-assess pain effectively. The nurse who cares for patients at an assisted living facility is planning a program to address safer sex in older adults. Why would this program be important? (Select all that apply.) A) Susceptibility to sexually transmitted infections (stis) increases with age. B) HIV/AIDS is spreading more quickly among older adults than among younger adults. C) Older adults frequently forego condom use because the risk of pregnancy does not exist. D) Many older adults assume that stis are problems of younger adults only. E) Because of the hormonal changes that accompany menopause, older women are in fact more prone to sexually transmitted diseases than younger adults. - B, C, and D The nurse wants to acknowledge and accommodate the sexual needs of older residents in a long-term care facility. Which statement provides the most accurate guide for the nurse's practice? A) Erectile dysfunction drugs can be used to significantly enhance older adults' lack of interest in sex. B) The nurse should gently and creatively seek to liberate older adults from the rigid gender roles of their youth. C) The nurse should remember that the general pattern and character of sexual behavior and identity is consistent throughout the life. D) The nurse should recognize that older adults experience an increased desire for emotional comfort and intimacy along with an accompanying decrease in desire for physical, sexual activity. - C) The nurse should remember that the general pattern and character of sexual behavior and identity is consistent throughout the life.