Test Bank Gerontologic Nursing 5th Edition, Meiner
Chapter 01: Overview of Gerontologic Nursing
1. In 2010, the revised Standards and Scope of Gerontological Nursing Practice was published. The nurse would use these standards to:
a. promote the practice of gerontologic nursing within the acute care setting.
b. define the concepts and dimensions of gerontologic nursing practice.
c. elevate the practice of gerontologic nursing.
d. incorporate suggested interventions from others who practice gerontologic nursing.
2. When attempting to minimize the effect of ageism on the practice of nursing older adults, a nurse needs to first:
a. recognize that nurses must act as advocates for aging patients.
b. accept that this population represents a substantial portion of those requiring nursing care.
c. self-reflect and formulate one’s personal view of aging and the older patient.
d. recognize ageism as a form of bigotry shared by many Americans.
3. When discussing factors that have helped to increase the number of healthy, independent older Americans, the nurse includes the importance of:
a. increased availability of in-home care services.
b. government support of retired citizens.
c. effective antibiotic therapies.
d. the development of life-extending therapies.
4. Based on current data, when presenting an older adult’s discharge teaching plan, the nurse includes the patient’s:
a. nonrelated caretaker.
b. paid caregiver.
c. family member.
d. intuitional representative.
5. The nurse planning care for an older adult who has recently been diagnosed with rheumatoid arthritis views the priority criterion for continued independence to be the patient’s:
b. financial status.
d. functional status.
6. A nurse working with the older adult population is most likely to assess a need for a financial social service’s referral for a(n):
a. white male.
b. black female.
c. Hispanic male.
d. Asian American female.
7. Which of the following statements made by a nurse preparing to complete a health assessment and history on an older patient reflects an understanding of the general health status of this population?
a. “I’ll need to document well regarding the medications the patient is currently prescribed.”
b. “I would like to understand how supportive the patient’s family members are.”
c. “Most older patients are being treated for a variety of chronic health care issues.”
d. “It will be interesting to see whether this patient sees herself as being healthy.”
8. The nurse is caring for an older adult who has been admitted to an acute care hospital for treatment of a fractured femur. The family expresses concern about the patient’s pending transfer to a subacute care facility. What response by the nurse is best?
a. “Acute care facilities lack the long-term physical therapy support your dad requires.”
b. “Your dad will be much happier in a more serene, private environment.”
c. “The subacute facility will focus on helping your dad maintain his independence.”
d. “Insurance, including Medicare, will cover only a limited amount of time here.”
9. To best assure both the quality of care and the safety of the older adult patient who requires in-home unlicensed assistive personal (UAP) assistance, the geriatric nurse:
a. evaluates the competency of the UAP staff.
b. assumes the roles of case manager and patient advocate.
c. arranges for the needed UAP provided services.
d. assesses the patient for functional limitations.
10. The nurse working with older adults understands what information about certification in gerontologic nursing?
a. It is mandatory for those in long-term care settings.
b. It is voluntary and shows clinical expertise in an area.
c. It allows nurses to be paid by third-party payers.
d. It allows nurses to advance their careers in a job.
Chapter 02: Theories of Aging
1. The practitioner who believes in the free radical theory of aging is likely to recommend that the older adult:
a. avoid excessive intake of zinc or magnesium.
b. supplement his or her diet with vitamins C and E.
c. increase intake of complex carbohydrates.
d. avoid the use of alcohol or tobacco.
2. To provide effective care to the older adult, the nurse must understand that:
a. older adults are not a homogeneous sociologic group.
b. little variation exists in cohort groups of older adults.
c. health problems are much the same for similar age groups of older adults.
d. withdrawal by an older adult is a normal physiologic response to aging.
3. The nurse is using the eight stages of life theory to help an older adult patient assess the developmental stage of personal ego differentiation. The nurse does this by assisting the patient to:
a. determine feelings regarding the effects of aging on the physical being.
b. describe feelings regarding what he or she expects the future to hold.
c. identify aspects of work, recreation, and family life that provide a sense of self-worth and pleasure.
d. elaborate on feelings about the prospect of his or her personal death.
4. A patient is recovering from a mild cerebral vascular accident (stroke). The home care nurse notes that the patient is talking about updating a will and planning funeral arrangements. Which of the following responses is most appropriate for the nurse to make?
a. “You seem to be preoccupied with dying.”
b. “Is there anything I can do to help you?”
c. “Are you worried about dying before you get your affairs in order?”
d. “Let’s focus on how you are recovering rather than on your dying.”
5. Your patient’s spouse died recently from a sudden illness after 45 years of marriage. The patient was the primary caregiver for the spouse during this time. The patient is now depressed and withdrawn and has verbalized feelings of uselessness. Which action by the nurse is best?
a. Encourage the patient take up a hobby that will occupy some time.
b. Explain that volunteering would be an excellent way to stay useful.
c. Assure the patient that these feelings of sadness will pass with time.
d. Ask the patient to share some cherished memories of the spouse.
6. A patient has recently been diagnosed with end-stage renal disease. The patient has cried often throughout the day and finally confides in the nurse that “I am going home to be with my Lord.” The nurse’s best response is:
a. “There is no reason to believe the end is near.”
b. “Do you want me to call your family?”
c. “We have a wonderful chaplain if you’d like me to call him.”
d. “I think this is the time for us to pray together.”
7. A nurse is responsible for the care of 20 older adults in a unit of an assisted living facility. In order to best address the needs and wants of the entire unit’s population, the nurse:
a. strictly adheres to facility policies so that all patients will be treated equally.
b. encourages specific age cohorts to gather in the dayroom because they share similar interests.
c. has the unit vote on which television programs will be watched each evening.
d. schedules the patients’ bathing times according to their individual preferences.
8. An older patient who reports being “healthy enough to cut my own fire wood” is being assessed prior to outpatient surgery. The nurse recognizes which assessment observation as a possible result of the wear-and-tear theory?
a. Swollen finger joints
b. Red, watery eyes
c. Grimacing when raising left arm
d. Bilaterally bruising on the forearms
9. A nurse cares for many older patients. Which finding should the nurse identify as pathologic in a 72-year-old?
a. Two hospitalizations in 6 months for respiratory infections
b. Patient reports of sleeping only of 5 to 6 hours each night
c. Thinning hair and brittle nails
d. Dry, tissue paper–like skin
10. In planning the care for an older adult patient, the nurse will best promote health and wellness by:
a. encouraging independent living and self-care.
b. scheduling regular cardiac and respiratory health screenings.
c. effectively delivering health-related educational information.
d. promoting a nutritious diet and an age-appropriate exercise routine.
Chapter 03: Legal and Ethical Issues
1. A nurse caring for older adult patients shows an understanding of the implementation of standards of care when:
a. dialing the telephone when the patient wants to call his daughter.
b. requesting the patient’s favorite dessert on his birthday.
c. closing the patient’s door when he is praying.
d. reminding the patient to call for assistance before getting out of bed.
2. A nurse new to geriatric nursing asks the nurse manager to clarify how to handle a patient’s claim that she has been physically abused. The nurse manager responds most appropriately when stating:
a. “I’ll show you where you can find this state’s reporting requirements.”
b. “As a nurse you are considered a ‘mandated reporter’ of elder abuse.”
c. “As long as you are reasonably sure abuse has occurred, report it.”
d. “You need to report any such claims directly to me.”
3. The nurse recognizes that a nursing aide likely to abuse an older patient is one who has:
a. ineffective verbal communication skills.
b. little experience working with the older population.
c. poor stress management skills.
d. been a victim of abuse.
4. An older adult resident of a long-term care nursing facility frequently attempts to get out of bed and is at risk of sustaining an injury. The nurse’s planned intervention to minimize the patient’s risk for injury is guided by:
a. the patient’s right to self-determination and to be free to get out of bed.
b. an understanding that nondrug interventions must be tried before medications.
c. the knowledge that application of a vest restraint requires a physician’s order.
d. the patient’s cognitive ability to understand and follow directions.
5. During the state inspection of a skilled nursing facility, a surveyor notes suspicion that a particular nurse may not be providing the proper standard of care. The nurse manager informs the nurse to expect:
a. a review of the situation by the state board of nursing.
b. termination of employment from the facility.
c. mandatory remediation related to the suspect care issues.
d. unannounced reevaluation of performance within the next 3 months.
6. An 87-year-old patient is unsure of the purpose of a living will. The nurse describes its purpose best when stating:
a. “It’s a legal document that Social Services can help you create.”
b. “It designates a family member to make decisions if you become incompetent.”
c. “It provides a written description of your wishes in the event you become terminally ill.”
d. “It assures you won’t be subjected to treatments you don’t want.”
7. The nurse is caring for an unresponsive patient who has terminal cancer with a Do Not Resuscitate order in effect. A family member tells the nurse, “I’ll sue you and every other nurse here if you don’t do everything possible to keep her alive.” The nurse understands that protection from legal prosecution in this situation is provided by:
a. legal immunity granted when acting according to the patient’s expressed wishes.
b. the legal view that the duty to put into effect the patient’s wishes falls to the physician.
c. knowledge of and compliance with facility policies and procedures regarding end-of-life care.
d. implementing interventions that preserve the patient’s right to self-determination.
8. The nurse is caring for a terminally ill older patient who has a living will that excludes pulmonary and cardiac resuscitation. The family expresses a concern that the patient may “change her mind.” The nurse best reassures the family by stating:
a. “The nursing staff will watch her very closely for any indication she has changed her mind.”
b. “We will discuss her wishes with her regularly.”
c. “She can change her mind about any provision in the document at any time.”
d. “Your mother was very clear about her wishes when she signed the document.”
9. A patient residing in a long-term care facility has been experiencing restlessness and has often been found by nursing staff wandering in and out of other patients’ rooms during the night. The nurse views the patient’s PRN antipsychotic medication order as:
a. an appropriate intervention to help assure his safety.
b. an option to be used only when all other nondrug interventions prove ineffective.
c. inappropriate unless the physician is notified and approves its use.
d. not an option because it should not be used to manage behaviors of this type.
10. An alert but disoriented older patient lives with family members. The home health nurse, being aware of the role of patient advocate, recognizes the obligation to report possible patient abuse based on:
a. a family member stating, “It’s hard being a caregiver.”
b. assessment showing bruises in the genital area.
c. observation of mild changes in orientation.
d. patient’s report of always being hungry.
Chapter 04: Gerontologic Assessment
1. The geriatric nurse recognizes that the body’s homeostatic mechanisms may be compromised in the:
a. 79-year-old with moderate Alzheimer disease who requires assistance with all activities of daily living (ADLs).
b. 73-year-old with a history of chronic bronchitis who lives with family.
c. 86-year-old who lost a spouse and is moving into an assisted living facility.
d. 69-year-old with peripheral vascular disease who is visited by home health care weekly.
2. To best minimize patient anxiety and help ensure a successful history assessment interview, the geriatric nurse first:
a. asks whether the patient has any questions about the interview.
b. makes sure the interview area is comfortable and private.
c. explains the reason for asking the questions.
d. assures the patient that all answers will be kept confidential.
3. An older patient is admitted for bacterial pneumonia. The only abnormal assessment values include a heart rate of 102 beats per minute, slight cyanosis of the nail beds, and mild confusion. The patient’s daughter questions the possibility of pneumonia stating, “He isn’t coughing or having any difficulty breathing.” The nurse responds most appropriately by saying:
a. “We are lucky to determine the problem in its early stage.”
b. “Respiratory problems develop only after the infection is well established.”
c. “People your dad’s age often lack the muscular strength to cough.”
d. “Older adults frequently lack the typical signs of a respiratory infection.”
4. A nurse aide working in the geriatric unit’s dining room tells the nurse that a patient who was oriented to time and place this morning is now confused about what day it is and why she’s “here.” The nurse appropriately directs the nurse aide to:
a. take the patient back to her room and put her safely in bed.
b. place a falls risk identification bracelet on the patient and add the status care plan.
c. immediately take the patient’s vital signs and report them to her.
d. reorient the patient to time and place frequently and document the patient’s response.
5. The nurse most effectively implements guided reminiscence during a patient interview by:
a. reminding the patient to share important memories of the past.
b. scheduling several short interviews rather than one long one.
c. controlling the interview by selecting the memories to be discussed.
d. encouraging the patient to relive his or her memories while maintaining focus.
6. To establish a mutually respectful relationship with an older adult patient being admitted to a skilled nursing unit, the nurse first introduces himself and then asks:
a. how the patient would like to be addressed.
b. if the patient has any specific requests to make of the staff.
c. the patient to share a little about his or her personal likes and dislikes.
d. the patient to read the orientation materials that the facility provides.
7. The nurse showing the best understanding of how personal attitude affects the interview process during a health assessment of an older adult patient is one who:
a. proceeds with the interview as if the patient were not an older adult.
b. incorporates therapeutic communication into the assessment process.
c. treats all patients with respect regardless of age.
d. has self-reflected on his or her own feelings regarding aging.
8. An older patient is being admitted to a long-term care facility. The nurse recognizes that the primary purpose of the initial geriatric health assessment is to:
a. identify the patient’s physiologic baselines.
b. ultimately create a plan of care that prevents disability and dependence.
c. initiate the therapeutic nurse-patient relationship.
d. document self-care deficiencies that the patient exhibits.
9. A 76-year-old postsurgical diabetic patient has reported feeling dizzy and clammy. The daily serum glucose level shows the patient’s levels to be within normal limits. The geriatric nurse shows an understanding of established health norms for the older adult when stating:
a. “This patient’s normal may not be within the typical lab norms.”
b. “I’ll ask the lab to rerun the test so we can double-check the results.”
c. “There must be another reason for the symptoms.”
d. “I’ll compare the patient’s baseline lab work with today’s results.”
10. A patient is being admitted after a fall that has caused a painful leg injury. In preparing to interview the patient for a health history, the nurse is initially concerned that:
a. the family should be present to help answer questions.
b. a therapeutic nurse-patient relationship should be established.
c. the patient should be free of hearing and vision barriers.
d. the patient’s pain should be effectively managed.
Chapter 05: Cultural Influences
1. A postmenopausal black woman who has been experiencing uterine bleeding tells the nurse, “I expect I’ll need a total hysterectomy because when my sister had this problem that’s what she had done.” The nurse recognizes that this woman belongs to a cultural subgroup whose health care beliefs are most influenced by the:
a. biomedical model.
b. magico-religious model.
c. balance/harmony model.
d. personal experience.
2. A Hispanic patient explains that the Hispanic culture believes that dietary management would be just as effective in managing her problems as medication, so the patient’s prescription has not been filled. Which action by the nurse illustrates cultural accommodation?
a. Asking the patient to give more details regarding this belief
b. Discussing how to add dietary preferences into the treatment plan
c. Offering to have a registered nutritionist discuss the situation with the patient
d. Researching the patient’s proposed dietary beliefs
3. A geriatric nurse practitioner working with a tribe of Native Americans makes the decision to acculturate in an attempt to provide culturally appropriate care. The nurse does this best by:
a. living the values of the tribe.
b. researching the tribe’s belief systems.
c. learning the language of the tribe.
d. residing among the tribe members.
4. The nurse in an assisted living facility is practicing a form of cultural bias called ethnocentrismwhen:
a. requesting the bridge group only use the game room for 2 hours at a time.
b. encouraging Christian residents to attend mass or church services.
c. repeatedly confiscating herbs and food products used in healing.
d. telling potential patients who are Jewish that the facility does not have a kosher kitchen,
5. While caring for an older Korean patient, the nurse notes that the patient answers questions regarding health history when asked but is otherwise silent and does not maintain eye contact. Being culturally sensitive, the nurse recognizes that the patient’s actions are most likely a(n):
a. sign of respect for the wisdom and expertise of the nurse.
b. indication that he has no questions regarding the care he is receiving.
c. expression of discomfort discussing personal matters.
d. means of communicating his dissatisfaction with his care.
6. The culturally sensitive nurse will recognize that an older adult patient with a high-context ethnic background will appreciate:
a. not having a treatment scheduled during a favorite television program.
b. both a written and verbal explanation describing how to monitor her blood sugar levels.
c. a concise explanation as to why her physical therapy appointment has been canceled.
d. having a conversation about her grandchildren while her dressing is changed.
7. In an attempt to be sensitive to varying cultural responses to touch, before shaking a patient’s hand, the nurse will:
a. offer the patient his or her upturned palm.
b. wait until the patient extends his or her hand.
c. establish eye contact with the patient first.
d. address the patient by his or her full name.
8. A older Asian patient receiving physical therapy after hip surgery has developed a low-grade fever. The patient explains that the fever will lessen if the treatment includes the principles of yin/yang. The nurse expects to support the patient by:
a. providing privacy when his shaman visits.
b. arranging for his diet to include cold foods and liquids.
c. planning his physical therapy so it does not conflict with meditation.
d. keeping a magical amulet under his pillow.
9. The nurse in an assisted living facility is preparing to admit an older adult patient who speaks very little English. The nurse decides that it is most important that an interpreter be present when the patient:
a. indicates a desire to talk with the physician.
b. is being oriented to the facility.
c. is required to sign official documents.
d. begins crying and is inconsolable.
10. When attempting to provide culturally sensitive care according to the explanatory model, the nurse asks the patient:
a. “Who will be able to help you when you go home?”
b. “Do you think the treatment is helping?”
c. “When did you first notice the problem?”
d. “Has this illness changed your life?”
Chapter 06: Family Influences
1. While children voice concern about their father living alone after having a mild stroke that resulted in only minimal disability, the patient angrily disagrees, stating that he’s always managed on his own and can do so now. The nurse can be most helpful to this family by:
a. assuring them that their father’s physical limitations should not cause a safety issue.
b. assisting them in identifying how they can help their father to live independently.
c. offering to arrange a social service consult to arbitrate the conflict.
d. suggesting that the patient accept the services of a home care aide on a short-term trial basis.
2. The physical changes that occur naturally as a result of the aging process often create an autonomy versus safety issue and is most problematic when:
a. protracted reaction time increases the risk for driving accidents.
b. arthritic knee and hip joints make falls more prevalent.
c. eyesight diminishes, making following written instruction more difficult.
d. responding to warning alarms is affected because of impaired hearing acuity.
3. When discussing stressors with the primary caregiver of an 83-year-old patient, the nurse explores the issue of dissolving familiar social boundaries when asking:
a. “Has it been a problem taking over the role of head of the family?”
b. “What do you do to help relax and revitalize yourself?”
c. “Do you find it difficult to ask for help when you need it?”
d. “Are there any physical care tasks that you find difficult to complete?”
4. The family of an 80-year-old patient shares with the nurse that they are concerned that the patient is too frail to be living alone. The nurse’s initial intervention is to:
a. help the patient express the importance of living independently to the family members.
b. assess the patient’s functional abilities related to being able to safely live independently.
c. have the family provide specific examples of behaviors that cause them concern.
d. identify ways the family can help assure the patient’s safety while living independently.
5. An older patient with cognitive impairment is being cared for by family members. They have expressed concerns about providing appropriate care as his functional level declines. The nurse responds:
a. “I’m glad that you are interested enough in his care that you’ve expressed this concern.”
b. “His abilities will certainly decline. This is the time to discuss other care options.”
c. “You are right to be concerned. Let’s talk about issues that may come up in the future.”
d. “The condition will get worse, so think about what will happen if you can’t meet his needs.”
6. An older patient who lives with family has a history of chronic alcohol abuse and poor compliance with the medical plan. The patient has begun to experience a marked decline. His family tells the nurse that these problems are a result of their inability to care for the patient properly. The nurse best responds by:
a. evaluating the care the family has been providing.
b. suggesting that care should be assumed by a professional caregiver.
c. helping the family recognize that the decline is a result of the patient’s condition and personal choices.
d. assuring them they are providing the patient with care motivated by love.
7. An adult child is finalizing arrangements to provide in-home care for a dependent parent. In order to best foster the long-term wellness for both the patient and the caregiver, the nurse:
a. explains the patient’s plan of care in detail with both the patient and the caregiver.
b. discusses the importance and availability of respite care.
c. encourages the patient and caregiver to seek assistance with problems as they arise.
d. provides written information regarding available in-home services.
8. An 80-year-old patient with diminishing cognitive function is being discharged into the care of his 72-year-old spouse. The nurse recognizes that besides the spouse’s physical ability to provide appropriate care, there is a need to evaluate the:
a. couple’s financial resources.
b. couple’s social support system.
c. spouse’s cognitive level of function.
d. patient’s long-term health prognosis.
9. The family member caring for a dependent older patient tells the nurse that she feels his care is “so out of my control.” To best assist the caregiver in achieving a sense of confidence, the nurse:
a. encourages the caregiver to regularly attend the meeting of a local support group.
b. identifies the skills and resources that the caregiver needs to provide for the patient.
c. arranges for in-home support services to assist with care as needed.
d. explores reasons why the caregiver feels such a lack of control.
10. The adult child of a patient diagnosed with Alzheimer disease has shared that he feels “so sad” that he is not able to carry on a social conversation with the patient anymore because of her loss of memory. The nurse suggests:
a. keeping conversations short while focusing on things that happened in the past.
b. concentrating on doing things his mother enjoys rather than focusing on talking.
c. participating in support groups that offer suggestions for communication.
d. allowing his mother to pick the topic and then simply being with her “in her world.”
Chapter 07: Socioeconomic and Environmental Influences
1. Before becoming an effective advocate for the older adult patient, the nurse must:
a. be familiar with the physical and mental effects of aging.
b. gain insight into the patient’s world by talking with and listening to him or her.
c. learn the details of the patient’s medical and social histories.
d. be a member of the patient’s formal support system.
2. To best respect an older patient’s autonomy when assisting him in finding appropriate, affordable housing, the nurse:
a. provides examples of various options that include assistive services.
b. locates housing near a senior citizen community center to minimize social isolation.
c. identifies housing close to the services he will need.
d. asks the patient to provide examples of where he would like to live.
3. A nurse working with older adults recognizes that the patient at greatest risk for homelessness is the:
a. female with a psychiatric diagnosis.
b. male with a chronic illness.
c. female with a history of social isolation.
d. male with an alcohol abuse issue.
4. A nurse volunteers at a facility that provides free lunches for older adults. To minimize the tendency of these patients to withdraw socially, the nurse:
a. frequently reinforces that everyone is welcome to have lunch with the group.
b. makes every effort to engage them in conversation during the meal.
c. encourages them to make friends with the other patients.
d. asks if they would assist those who need help with getting their food.
5. When the traditional roles are blurred as an older married couple begins to experience personal disease and disability, there will most likely be:
a. a rapid decline in their mental health as well.
b. a loss of self-esteem and satisfaction with life.
c. increased martial stress and discord.
d. increased social isolation.
6. A 69-year-old patient who has both Medicare and long-term supplemental health care insurance shares with the nurse that he is in need of a visual examination as a follow-up after his cataract surgery. The nurse suggests that such treatment is most likely covered by:
a. Medicare Part A.
b. Medicare Part B.
c. Medicare Part D.
d. Supplemental policy.
7. The nurse recognizes that health and wellness are better among the educated older adult population because they tend to:
a. place a high value on health and wellness.
b. frequently take advantage of health screening options.
c. have occupations that are less physically demanding.
d. manage emotional stress in a more productive manner.
8. Which patient is most likely to be seen at a clinic that services older adults who are at or below the poverty level?
a. A Hispanic male living with extended family
b. An African American male living with a spouse
c. A Hispanic female who lives alone
d. An African American female who lives with her sister
9. The nurse is addressing a senior citizens group that is composed of members who are 75 years of age and older. The nurse expects that the group will be primarily:
a. widows who have never worked outside of their homes.
b. widowers with at least one chronic illness.
c. females who have part-time jobs.
d. males with pensions plus Social Security income.
10. A patient who grew up during the 1930s in an urban community has been prescribed several medications for a variety of chronic health issues. To help ensure medication compliance based on knowledge of this age cohort, the nurse:
a. provides a detailed explanation about the importance of taking the medications appropriately.
b. educates the patient about the cost-effectiveness of generic brands of the prescribed medications.
c. includes family members with the patient in the medication education plan.
d. offers suggestions on ways to minimize the risk of “forgetting” to take medication correctly.
Chapter 08: Health Promotion and Illness/Disability Prevention
1. When the home health nurse assists the older adult patient with rearranging furniture within the home to prevent the patient from falling, the nurse is demonstrating:
a. health promotion.
b. health protection.
c. health prevention.
d. disease prevention.
2. The primary focus of the health belief model of health promotion is addressed when the nurse:
a. accompanies the assisted living residents on a walk before dinner.
b. asks a senior citizens’ group what health screening they want to have.
c. plans a program on cooking diabetic-friendly meals in cooperation with a dietician.
d. asks the patient if he believes smoking puts him at risk for lung cancer.
3. Financial considerations are a major barrier to the older adult’s participation in health promotion because:
a. most older adults have accepted poor health as a part of growing older.
b. Medicare often does not cover the cost of preventive services.
c. many already have been diagnosed with chronic illnesses.
d. they generally place more value on saving their disposable income.
4. To engage the older adults who frequently attend a senior citizens’ center in primary disease prevention, the nurse:
a. immunizes those attending a weekly luncheon against the H1N1 virus.
b. arranges for a colorectal cancer screening at the center.
c. schedules a speaker to discuss cooking for diabetic patients.
d. surveys the members to identify health issues of interest to them.
5. The nurse has the greatest impact on a patient’s health promotion when:
a. evaluating a diabetic patient’s ability to administer his insulin injections.
b. encouraging an obese patient to limit both fat and carbohydrate intake.
c. volunteering to take blood pressures at a community health fair.
d. educating the patient about vitamin D and calcium to prevent bone loss.
6. A nurse is assessing a patient’s ability to manage existing health problems. What question by the nurse is most helpful?
a. “Can you tell me why it’s important to test your blood glucose level at least daily?”
b. “What were the results of your most recent A1C blood test?”
c. “Which pharmacy do you use when your prescription needs to be refilled?”
d. “Have you been experiencing pain in your feet?”
7. During a home visit, a nurse is assessing the nutritional awareness of an older adult patient who lives alone. The nurse is most effective in obtaining objective information when:
a. asking to see what types of foods the patient keeps readily available.
b. reviewing the components of a healthy diet with the patient.
c. asking the patient to describe what he or she ate for all three meals yesterday.
d. observing the patient eat a meal that he or she has prepared.
8. The nurse is discussing an older adult’s past marital history during the admission assessment. The nurse can best determine that the patient has a healthy ability to cope with emotional stressors when the patient states:
a. “After my husband died, I managed to raise and educate our two children by myself.”
b. “Since my husband’s death, I’ve grown even closer to my sisters.”
c. “It’s been hard since my husband died, but you manage to go on somehow.”
d. “After my husband died, I married a good man who was there for me and my children.”
9. An older adult patient has recently experienced some difficulty sustaining an erection as a result of medication he has been prescribed. The nurse best assesses the patient’s perception of his own sexuality by asking:
a. “How are you and your wife coping with your sexual dysfunction?”
b. “What problems has your sexual dysfunction caused between you and your wife?”
c. “What impact has this dysfunction had on your ability to be intimate with your wife?”
d. “Are you and your wife prepared to deal with this dysfunction over the long term?”
10. The nurse admitting an 89-year-old patient to an assisted living facility notes that the patient is currently taking numerous prescribed and over-the-counter medications. The nurse’s initial intervention is to:
a. confirm with the physician that all the medications are required.
b. evaluate the patient’s understanding of why he is taking each medication.
c. explain to the patient the dangers of taking so many different medications.
d. review the listed medications for possible interactions.
Chapter 09: Health Care Delivery Settings and Older Adults
1. What action by the nurse is most important for preventing hospital-acquired infections in the older population?
a. Appropriate hand hygiene
b. Rapid isolation for infection
c. Strict sterile procedures
d. Ensuring patient nutrition
2. The nurse on a medical acute care unit is preparing for the admission of an 84-year-old patient with several diagnosed chronic illnesses. The nurse begins the plan of care for this patient based on the understanding that the older adult is likely to:
a. develop hospital-induced delirium.
b. require special attention related to sensory deficits.
c. need a social services consult before discharge.
d. present with a need for a high level of nursing care.
3. The nurse is planning the discharge of a 70-year-old patient who lives alone and is recovering from a fractured ankle. What action by the nurse shows an understanding of factors affecting the patient’s ultimate return to preinjury function?
a. Encourages the patient to comply with recommendations made by the physical therapist
b. Arranges for the patient’s meals to be delivered daily for several weeks after discharge
c. Assesses the barriers to self-ambulation that exist in the patient’s home
d. Educates the patient on the importance of a diet that promotes both bone and muscle healing
4. The nurse in an acute care facility is caring for a patient recovering from a cerebral vascular accident that has resulted in a mild loss of muscle function in his right arm and leg. The nurse is best addressing the patient’s need via the functional model of care when:
a. assessing the patient’s right-sided muscle strength daily.
b. reaffirming to the patient that physical therapy will improve his muscle strength.
c. instructing the patient’s family on how to properly assist the patient in walking.
d. placing the telephone where the patient can reach it with his left hand.
5. The nurse is caring for an older adult patient who was admitted with a stage 3 pressure ulcer on the left heel and who also has a history of Parkinson disease and chronic renal failure. To minimize the patient’s risk of developing an iatrogenic illness, the nurse:
a. uses sterile technique when changing the heel’s dressings.
b. reviews all the patient’s medications for possible adverse reactions.
c. instructs the patient to call for assistance when needing to go to the bathroom.
d. assists the patient in choosing the appropriate foods from the daily menu.
6. The nurse best addresses the possible intrinsic factors that contribute to falls experienced by older adult patients in an acute care setting by:
a. encouraging patients to wear their glasses.
b. keeping a low-level light on in the room at night.
c. keeping the patient’s bed low to the floor.
d. assessing the room for clutter on the floor.
7. The nurse caring for an older patient is concerned when the patient begins experiencing mild confusion. The nurse notes that the vital signs are all within normal limits for this patient. To best assess related symptoms, the nurse initially:
a. asks the patient to “Squeeze my hand as hard as you can.”
b. reviews documentation about how the patient has been eating.
c. reviews the patient’s medication for possible adverse reactions.
d. asks the patient’s daughter if her mother has been confused before.
8. The nurse is caring for a confused patient. Which action by the nurse shows the best understanding of managing the cascading effects of iatrogenic illnesses in this population cohort?
a. Reorienting the patient to person, place, and time frequently
b. Offering the patient liquids each time there is patient-nurse contact
c. Repositioning the patient every 2 hours
d. Using restraints to ensure patient safety only as a last resort
9. An 80-year-old patient with visual and hearing deficits is admitted for hip replacement surgery. The patient has begun to show mild confusion and has become resistant to care and treatment. To minimize this problem, the nurse initially edits the patient’s care plan to include:
a. frequent reorientation to people in the patient’s environment.
b. putting on the patient’s glasses and hearing aid as a part of activities of daily living (ADLs).
c. assigning the same staff to provide patient care whenever possible.
d. minimizing the number of off-unit trips for the patient.
10. What action by the nurse best shows an understanding of the effects of acute hospitalization on the functional abilities of the older patient?
a. Setting goals that support a short hospitalization.
b. Attempting to adapt nursing care to individual needs
c. Administering a systematic functional assessment
d. Assessing for a decline from original baseline function
Chapter 10: Nutrition
1. A 73-year-old patient is concerned about staying healthy for as long as possible. When asked what lifestyle changes the patient should consider, the nurse suggests:
a. “As your metabolism slows, you will need to increase your intake of fat.”
b. “If you are having difficulty sleeping, a mild sedative will help you sleep.”
c. “Regular exercise will help you preserve function and reduce your risk for disease.”
d. “Minimize stress by being willing to ask your family for help when you need it.”
2. The nurse caring for older adult patients best minimizes the patient’s risk of developing dehydration by:
a. identifying the patient’s oral fluid preferences and offering them regularly.
b. carefully monitoring the effects of daily diuretics via blood sodium levels.
c. minimizing the patient’s reliance on laxatives by increasing dietary fiber intake.
d. carefully monitoring of the rate of infusion of all intravenous fluids prescribed.
3. A patient is newly widowed and lives alone. Which suggestion by the nurse will help the adult children maximize the patient’s nutritional status?
a. Help identify possible barriers to their mother achieving good nutritional health.
b. Ensure that the patient has an adequate supply of healthy, easily prepared foods available.
c. Contact a food delivery service to provide one nutritiously sound meal a day.
d. Arrange a schedule that allows someone to have dinner with her each evening.
4. The nurse is caring for four postsurgical patients who have experienced similar abdominal procedures and are all 68 years of age. The nurse anticipates that the patient with the greatest risk for complications resulting in an extended hospitalization has:
a. a history of Crohn disease.
b. developed mild confusion.
c. an allergy to latex.
d. severe postoperative nausea and vomiting.
5. The nurse conducting a food recall assessment on an older adult patient shows an understanding of the requirements of the process when:
a. having the patient identify any existing food allergies.
b. asking the family to verify the patient’s statements.
c. asking how the food being discussed was prepared.
d. correlating diet information with signs of malnutrition.
6. An older adult patient has been prescribed a specialized enteral formula after an extensive surgical procedure. The nurse anticipates and addresses a concern of many patients in this age cohort when assuring the patient that:
a. her family can easily manage the formula after she is discharged.
b. Medicare will cover the expense of the treatment.
c. the treatment will be discontinued as soon as she is able to eat sufficiently.
d. this is the most effective form of nutrition for her at this time.
7. During a nutritional assessment, a 79-year-old patient responds, “My weight is fine. I weigh the same as I did 15 years ago.” The nurse responds based on the understanding that older patients:
a. generally guess their weight rather than weigh themselves.
b. often rely on how their clothes fit to determine whether their weight has changed.
c. sometimes experience altered metabolic problems that hide weight change.
d. often exchange lean muscle mass for body fat so weight stays the same.
8. An older adult patient has experienced severe nausea and vomiting for 2 days since undergoing abdominal surgery. A prealbumin serum blood test is ordered. The nurse explains the rationale for the test to the patient’s family by saying:
a. “The provider is interested in whether there is enough available protein in the blood.”
b. “This test is designed to determine how the body is meeting current demands for protein.”
c. “The test will tell us if the vomiting has created a problem with protein metabolism.”
d. “Healing from such a surgery requires protein, and this test measures protein.”
9. Based on recent surveys identifying nutritional information concerning the daily diet of older adults in America, the nurse suggests:
a. substituting carbohydrates with lean protein sources.
b. adding calories through the addition of fruits and vegetables.
c. introducing a protein at each meal.
d. relying on foods that are both easy to chew and easy to digest.
10. An older adult patient with a history of a myocardial infarction tells the nurse that he takes his daily dose of prescribed aspirin with breakfast each morning. The nurse’s response is:
a. “Food interferes with the drug’s absorption, so take it between meals.”
b. “Taking aspirin with food increases your likelihood of stomach upset.”
c. “Taking the drug with food is likely to alter the taste of the food.”
d. “Eating as you take the aspirin is likely to result in constipation.”
Chapter 11: Sleep and Activity
1. A patient reports to the nurse that he seems to be sleeping less at night but now regularly requires at least two short naps a day. He expresses a concern that “something is wrong.” The nurse responds that:
a. “Aging alters our sleep patterns, so what you describe is really quite common.”
b. “Circadian sleep rhythms are controlled by the hypothalamus, which is affected by age.”
c. “Sleep patterns are affected by so many things; have you been under a lot of stress lately?”
d. “Can you be more specific about what you think is wrong with your sleep pattern?”
2. What is the best bedtime snack for older adult patients with failure to thrive and insomnia?
a. Ice cream in a waffle cone
b. Bowl of grapes
c. Glass of milk and a macaroon cookie
d. Cup of cream of broccoli and cheese soup
3. An older patient is being admitted to an acute care unit after surgical repair of a fractured tibia. To minimize any negative factors affecting the patient’s ability to sleep, the nurse’s initial intervention is to:
a. be sure postoperative pain is being well managed.
b. manipulate the environment to manage light and noise.
c. plan care to minimize the number of times the patient is disturbed.
d. ask the patient about usual sleeping habits.
4. A confused older patient has been hospitalized for a cardiac problem that requires both antihypertensive and diuretic therapies. The nurse minimizes the patient’s risk of disturbed sleep by:
a. keeping the door shut so noise from the hallway is not disruptive.
b. organizing care to minimize the number of times the patient is awakened.
c. administering medications at least 4 hours before bedtime.
d. offering to toilet the patient whenever the nurse finds the patient awake during the night.
5. An older frail adult patient has begun displaying symptoms of sleep disturbance while being hospitalized. Since these symptoms were observed, the nurse has arranged for a bed alarm to be placed near the patient because:
a. lack of adequate sleep can result in delirium.
b. the patient has difficulty using the call light.
c. lack of sleep make the patient at risk for falls.
d. the patient will remember not to get out of bed.
6. An older patient reports that sleep was being severely affected by the need to urinate frequently. The patient states he has begun restricting his fluid intake after 5 PM to help with the problem. The nurse responds:
a. “Have you seen a decrease in waking up since you cut back on fluids?”
b. “You need sufficient fluids, so don’t be too restrictive.”
c. “You need the same amount over 24 hours, so drink enough by dinnertime.”
d. “Have you had your prostate checked by your health care provider?”
7. An older patient being treated for symptoms of seasonal allergies reports to the nurse that although she is careful about her caffeine intake, she has been having trouble getting to sleep at night. The nurse responds most appropriately to this patient when stating:
a. “Allergy reactions such as nasal stuffiness can cause sleep problems.”
b. “If you are using over-the-counter nasal decongestants, that could be the problem.”
c. “Many different foods contain hidden caffeine; be sure to check the labels.”
d. “There are many different causes of sleep disturbances besides caffeine intake.”
8. The daughter of an older cognitively impaired patient responds to the nurse’s suggestion to keep her father physically active by stating, “Dad is so easily agitated it would be a major battle to take him on a walk.” The nurse’s initial response is based on the understanding that:
a. caregivers are often overwhelmed by the challenges of caring for such patients.
b. physical exercise has been proven helpful in managing anger in such patients.
c. exercise such as walking is likely to appeal to patients such as her father.
d. her father’s general health and wellness will be positively affected by walking.
9. The nurse is preparing to instruct a family member regarding how to appropriately assist a 76-year-old patient incorporate a healthy daily walk into the family’s routine. The nurse includes a suggestion that:
a. a 30-minute walk after dinner is the best form of exercise for someone that age.
b. if the patient appears to be having difficulty talking while walking, it is time to stop.
c. the patient should be encouraged to walk a few feet farther each evening.
d. the family member selects a flat, easily accessible walking path to follow.
10. An older adult patient who has been seen at a neighborhood clinic for years tells the nurse that he will be moving to live with his son in a neighboring state. The nurse impacts the patient’s health and wellness the most therapeutically when stating:
a. “Be sure to reestablish with a health care provider as soon as you get settled.”
b. “You seem to have a good relationship with your son; I’m sure this will be a good move.”
c. “You need to continue to be compliant with your plan of care regardless of where you live.”
d. “Moving often causes temporary sleep disturbances, so stick to your evening routine.”
Chapter 12: Safety
1. Which nursing intervention best demonstrates the understanding that older adults are at increased risk for falls because of normal age-related changes?
a. Speaking in a loud voice when warning the patient about safety hazards
b. Turning on bright lights so the patient can see objects such as furniture
c. Encouraging the patient to rise from a supine position slowly
d. Advising the patient to avoid exercising painful joints
2. An older adult’s risk for a fall-related injury is directly correlated to his or her ability to regain balance. To evaluate this ability, the nurse assesses the patient’s:
a. inner ear for possible fluid buildup.
b. musculoskeletal hip, ankle, and shoulder strength.
c. large muscle strength in thighs and upper arms.
d. gait for steadiness.
3. The geriatric nurse’s decision to identify a specific patient as a falls risk is primarily based on the:
a. presence of visual deficiencies and musculoskeletal weakness.
b. results determined by cognitive and physiologic assessment tools.
c. degree of frailty and functional limitation observed.
d. inability to follow instructions and communicate effectively.
4. An older adult has been diagnosed with presbyopia. To minimize the patient’s risk for falls, the nurse suggests:
a. that the edges of steps be painted a contrasting color.
b. the patient wear sunglasses when driving.
c. the patient wear a wide-brimmed hat when spending time outdoors.
d. hanging blinds over sunny windows.
5. An older adult has been diagnosed with a sinus infection. To minimize the risk for a fall-related injury, the nurse teaches the patient:
a. that there is a possibility of prodromal falls.
b. to take her antibiotic medication with food.
c. to recognize symptoms of fluid buildup in the middle ear.
d. about the increased risks of falls related to normal aging.
6. The nurse identifies the older adult patient at the greatest risk for a fall-related injury as the:
a. male with a history of a vitamin deficiency.
b. female with a diagnosis of osteoporosis.
c. male with a cognitive deficient.
d. female with a history of depression.
7. An older patient diagnosed with dementia has begun behaviors that increase the risk of falling. The patient’s son tells the nurse that “physical restraints may be used.” The nurse responds:
a. “I’ll document that, so that the staff can use them when necessary.”
b. “Physical restraints are seldom effective on patients with dementia.”
c. “The staff will use physical restraints only as a last resort.”
d. “There are more effective methods to use to help ensure her safety.”
8. A patient is being discharged after hip replacement surgery. The geriatric nurse recognizes that the most effective intervention to minimize the potential of a fall injury is to:
a. identify the most common causes of falls that the patient is likely to encounter.
b. discuss what kind of in-home assistance the patient will need.
c. impress the patient with the importance of being careful not to fall.
d. educate the patient that falling is not a normal part of aging.
9. A patient is diagnosed with bilateral osteoarthritis of the knees. To best address the long-term risk for falls, the nurse encourages the patient to:
a. use assistive mobility devises when necessary.
b. report exacerbation of symptoms promptly.
c. add a daily walk to exercise the knees appropriately.
d. take analgesic medication as prescribed to manage joint pain.
10. A cognitively impaired older adult patient is a resident at a skilled nursing facility. The nurse acting as the patient’s advocate will consistently address the patient’s risk for injury issues based on:
a. preferences generally expressed by cognitive patients.
b. professional nursing knowledge.
c. implementation of the less restrictive intervention.
d. established facility policies and procedures.
Chapter 13: Sexuality and Aging
1. Which statement made by a nurse reflects a lack of understanding regarding sexual intimacy and the older adult patient?
a. “Older adults express less interest in intimacy as both acute and chronic illnesses develop.”
b. “Sexual expression is considered an enhancement to the quality of the older adult’s life.”
c. “Expressing sexual needs may be difficult or impossible for some older adults.”
d. “Interest in physical contact tends to persist throughout life for both genders.”
2. A 70-year-old female patient shares with the nurse her concern that recently it takes more time to achieve an organism. The nurse responds most therapeutically when answering:
a. “You’ve described a common result of aging for both men and women.”
b. “If you experience difficulty achieving orgasms, you should discuss that with your doctor.”
c. “Your body produces fewer sex hormones now, and you need more stimulation to climax.”
d. “I understand your concern. Let’s talk more about the changes you’ve noticed.”
3. A type 2 insulin-dependent diabetic 70-year-old recently lost his wife and is experiencing impotence. Besides educating the patient on the normal effects of aging on sexual function, the nurse should initially include information regarding:
a. the effect that stress has on sexual performance.
b. the effect of diabetes mellitus on the vascular system.
c. the link between depression and sexual dysfunction.
d. sexual dysfunction related to long-term use of insulin.
4. Upon entering the room of a cognitively impaired older adult patient, the nurse observes that he is exposed and rubbing his genitals. The nurse’s initial concern is to:
a. alert staff to be aware of this new behavior.
b. provide the patient with privacy.
c. assess him for possible pain and fever.
d. provide a verbal cue for him to stop the behavior.
5. To effectively assess an older adult patient’s sexual needs, the nurse must initially:
a. reflect on personal feelings that create barriers to effective communication with the patient.
b. be familiar with the sexual needs of the older adult population.
c. assess the patient’s physical capacity to engage in sexual activities.
d. inform the patient of the personal nature of the detailed questioning this assessment requires.
6. An older adult patient recovering from a radical prostatectomy is discussing his postsurgical care plan with the nurse when he expresses concern about long-term impotence. The nurse initially responds:
a. “I’d suggest a consult with a sexuality counselor for you and your partner.”
b. “When you’ve healed sufficiently, we can discuss prosthetic devices that help.”
c. “There are medications called phosphodiesterase inhibitors that minimize that problem.”
d. “While postsurgical erectile dysfunction is likely, it is generally temporary.”
7. The charge nurse on an extended care unit recognizes an immediate need for additional unit education regarding sexuality and the older adult when overhearing a staff member state:
a. “I’ve had to tell her to stop touching my breasts twice today.”
b. “Someone needs to tell him to keep his pants zipped.”
c. “I realize they have needs, but I’m not sure how to handle that.”
d. “It’s sad that Alzheimer disease causes them to become sexual perverts.”
8. An older adult female patient who has multiple sexual partners asks the nurse if the risk for contracting HIV really does increase as we age. The nurse shows the best understanding of this risk when responding:
a. “Any time one engages in sex with multiple partners, the risk for contracting HIV increases.”
b. “Changes in vaginal tissue and immune function increase the risk, especially if sex is unprotected.”
c. “Unless you are engaging in unprotected oral sex, your risk does not increase substantially.”
d. “Yes, your risk of contracting a sexually transmitted disease (STD) including HIV, dramatically increases as you age.”
9. Through the open door of the patient’s room, the nurse observes a male patient and his long-term partner in a romantic embrace. The nurse’s priority intervention is directed toward:
a. reinforcing for the staff the patient’s intimacy needs.
b. explaining to the patient the challenges that his relationship poses for the staff.
c. offering to discuss the barriers to intimacy that the patient and his partner face.
d. quietly closing the door to address the patient’s right to privacy.
10. The gerontologic nurse wants to begin assessing concerns related to sexuality among the population of patients seen in the clinic. What action by the nurse is best?
a. Give the patients questionnaires to fill out.
b. Get permission to discuss sexuality with them.
c. Tell the patients you are now assessing sexuality.
d. Ask the patients if they have concerns about sex.
Chapter 14: Pain
1. When planning care for the older adult experiencing pain, the nurse bases interventions on the realization that:
a. generally pain control is less effective than it is for younger adults.
b. this cohort is less pain sensitive than younger adults.
c. older adults are more likely to verbally express pain than younger adults.
d. pain is undertreated in this cohort compared to younger adults.
2. An older patient is observed grimacing whenever walking and getting in and out of bed. When assessed, the patient regularly denies having any pain. To best provide the patient with effective pain control, the nurse initially:
a. discusses the effects of untreated pain on the patient’s general wellness.
b. offers the patient a prescribed prn analgesic.
c. asks the patient why he is denying the presence of pain.
d. documents the symptoms that the patient is exhibiting.
3. The nurse caring for an older adult patient experiencing carpal tunnel syndrome anticipates the patient will best achieve pain control when prescribed a(n):
a. narcotic (e.g., fentanyl).
b. opioid (e.g., oxycodone).
c. tricyclic antidepressant (e.g., amitriptyline [Elavil]).
d. nonpharmacologic strategy (e.g., wrist bracing).
4. When planning care for the older adult patient with a history of persistent pain, the nurse acknowledges the effects of the mind-body connection by including:
a. regular pain assessments.
b. prompt response to reports of pain.
c. pain consults.
d. relaxation techniques.
5. An older adult patient has been prescribed an opioid to manage chronic pain resulting from a shoulder injury. To eliminate a common barrier to opioid drug compliance, the nurse:
a. encourages the patient to use the opioid only as prescribed.
b. educates the patient about the appropriate management of constipation.
c. assures the patient that dizziness will decrease as therapeutic levels are reached.
d. suggests the patient take the medication with meals or a snack.
6. The nurse is discussing pain control with an older patient who has been prescribed an opiate. When the patient expresses concerns about the diminishing effect that the medication has had on the pain, the nurse responds:
a. “It appears that the dosage you take needs to be adjusted upward.”
b. “We need to be concerned about you developing a drug tolerance.”
c. “This drug category is well known for its low ceiling effect.”
d. “Opiate addiction is a concern when tolerance occurs.”
7. An older patient is being treated for arthritic pain with a nonsteroidal anti-inflammatory drug (NSAID). Which question best assesses for side effects of this medication class?
a. “Have you noticed your heart skipping beats since you began taking this drug?”
b. “Did you know you should not to stand up too quickly?”
c. “Are you aware that you should take your pain medication with food?”
d. “Have you had any episodes of shortness of breath since starting this medicine?”
8. The nurse is caring for an older adult patient with terminal cancer who is receiving medication via patient-controlled analgesic (PCA) pump. The nurse shows an understanding of primary end-of-life concerns when asking the patient:
a. “Do you have any concerns about receiving your medication intravenously?”
b. “Are you satisfied with the way your pain is being managed?”
c. “Are you worried about becoming addicted to the narcotic analgesics?”
d. “Do you have any questions concerning how to use the PCA properly?”
9. The nurse is performing a pain assessment when the older adult patient reports pain in his left shoulder that radiates down into the forearm. The nurse immediately:
a. recognizes that the patient is experiencing cardiac distress.
b. alerts the rapid response team to provide emergency care.
c. asks whether he has ever experienced this pain before.
d. questions the patient about additional related symptoms.
10. An older adult who injured her knee several years ago tells the nurse that she has been managing the resulting intermittent pain with a prescription for propoxyphene (Darvon). The nurse is concerned with this treatment plan, primarily because:
a. less expensive alternative analgesics are available.
b. this long-term need for a narcotic warrants investigation.
c. aspirin would likely be as effective in managing the pain.
d. the knee should not still be causing pain for the patient.
Chapter 15: Infection
1. To educate patients on health promotion measures to minimize the effect of normal age-related changes in immunity, the geriatric nurse:
a. describes the effects of low-dosage antibiotic therapy on opportunistic infections.
b. reinforces the usefulness of lymphocyte counts to detect new infections.
c. discusses the need for yearly flu immunization.
d. stresses the importance of maintaining intact skin and mucous membranes.
2. An older adult patient who is generally in good health starts experiencing numerous colds and now pneumonia. What factor from the nursing history most likely has placed the patient at increased risk for the development of these infections?
a. A beloved pet died 6 months ago.
b. The patient was diagnosed with osteoarthritis 5 years ago.
c. The patient worked as an oncology nurse before retiring.
d. The patient’s spouse is immunosuppressed.
3. An older patient smoked tobacco most of the adult life. When planning health promotion education for this patient, the nurse includes information that such smoking:
a. may produce alterations in the immune response.
b. is a risk factor for community-acquired pneumonia.
c. decreases the production of an immunoglobulin called IgA.
d. increases the risk of gastric cancer.
4. An older adult patient is experiencing problems with chewing while recovering from extensive oral surgery. The nurse best affects this patient’s risk for infection by:
a. ordering a mechanical soft diet for the patient.
b. monitoring the patient regularly for any low-grade fever.
c. providing regular oral care with an antibiotic mouthwash.
d. asking which flavors of protein supplement drink the patient would prefer.
5. The nurse caring for a cognitively impaired older adult admitted to an acute care facility best minimizes this particular patient’s risk for developing a nosocomial infection by:
a. proper hand washing after each patient contact.
b. admitting the patient to a private room.
c. assigning staff to assist the patient with eating meals.
d. screening visitors to minimize contract with pathogens.
6. An immunosuppressed older adult patient reports symptoms of fatigue, facial rash, intermittent low-grade fever, and painfully swollen finger joints. The nurse anticipates that diagnosis will be confirmed by:
a. the presence of subcutaneous nodules on the hands.
b. a positive antinuclear antibody (ANA) blood serum test.
c. a liver biopsy that confirms cirrhosis.
d. the presence of bilateral ocular scleritis.
7. The geriatric nurse identifies the patient with the greatest risk of immunosuppression as:
a. having a roommate infected with MRSA.
b. having numerous oral mucosal ulcers.
c. receiving treatment for rheumatoid arthritis.
d. being cognitively impaired.
8. The nurse caring for an older adult patient currently receiving traditional drug therapy for methicillin-resistant Staphylococcus aureus (MRSA) recognizes that the patient is at risk for developing:
a. Clostridium difficile infection.
b. vancomycin-resistant Enterococcus (VRE) infection.
c. autoimmune hepatitis.
d. systemic lupus erythematosus.
9. The nurse caring for an older adult patient being treated for influenza is especially careful to monitor and document assessment data related to:
a. cognitive function.
b. respiratory function.
c. fluid intake.
d. urinary output.
10. A patient who is currently being treated for rheumatoid arthritis exhibits symptoms suspicious of tuberculosis (TB). The nurse anticipates that:
a. the symptoms are a result of the patient’s rheumatoid arthritis.
b. the symptoms are actually side effects of corticosteroid therapy.
c. a chest radiograph will definitively confirm a diagnosis of TB.
d. a purified protein derivative (PPD) skin test will likely be negative.
Chapter 16: Chronic Illness and Rehabilitation
1. The nurse is preparing an older widowed patient with several chronic illnesses for discharge to home. The nurse addresses the primary nursing outcome for this patient when:
a. assuring the patient that social services will arrange for help with medical expenses.
b. arranging for in-home assistance in areas of activities of daily living (ADLs) and nursing care as needed.
c. educating the patient regarding the safety risks caused by these conditions.
d. identifying barriers to ensure adherence to the prescribed drug therapies.
2. The nurse is assessing patients diagnosed with chronic disease processes for the probability of hospitalization because of the exacerbation of related symptoms. The nurse recognizes that the patient with the highest probability is a(n):
a. 72-year-old male with congestive heart failure (CHF).
b. 82-year-old male with type 2 diabetes.
c. 72-year-old female with chronic bronchitis.
d. 82-year-old female with osteoporosis.
3. An older patient has developed moderate muscle weakness on the left side as a result of a cerebral vascular accident (CVA, stroke). The nurse determines the patient possesses the healthiest view of self-wellness when heard stating:
a. “I’ll certainly miss hiking, but I guess I’ll find something else to do outdoors.”
b. “I was getting too old to safely practice karate.”
c. “I’ve decided to take up oil painting because it’s difficult for me to knit.”
d. “It was getting difficult to work in the garden anyway.”
4. A 73-year-old patient has been diagnosed with congested heart failure (CHF). The nurse provides the greatest support for this patient’s positive view of self-wellness by presenting information regarding:
a. how to minimize the exacerbation of symptoms.
b. locally available supportive services.
c. the importance of adherence to medical treatment.
d. the need to report symptoms promptly.
5. The nurse is caring for an older patient who recently immigrated to the United States from Asia. To best address the patient’s apparent resistance to the medical and nursing plan of care, the nurse:
a. discusses the patient’s behavior with Asian staff members.
b. researches the patient’s cultural views on health care.
c. requests a cultural consultation from social services.
d. asks family members to discuss the patient’s views on health care.
6. The nurse feels most confident that an older patient is prepared to assume self-management of new type 2 insulin-dependent diabetes when the patient:
a. is heard asking her son to check the insulin’s expiration date.
b. is able to identify the symptoms of hypoglycemia.
c. asks why she needs to test her glucose levels so frequently.
d. inquires why she needs to have an A1C test every 3 months.
7. The nurse impacts the trajectory of a patient’s type 2 insulin-dependent diabetes best by:
a. evaluating the patient’s ability to administer insulin appropriately.
b. providing the patient with a written copy of the treatment plan.
c. explaining to the patient the importance of serum glucose control.
d. providing the patient with research-based nursing care.
8. An older patient diagnosed with severe osteoarthritis has recently moved in with his son ecause of a history of falls. The son describes how he and his family have eagerly assumed responsibility for “meeting all Dad’s needs.” The nurse is most concerned that this environment will result in the patient:
a. developing a sense of powerlessness and possibly a loss of hope.
b. becoming unnecessarily physically and emotionally dependent.
c. losing his will to “get better” and become independent again.
d. becoming resentful and argumentative with his son’s family.
9. To best assist an older adult patient to cope with a new diagnosis of chronic renal failure, the nurse:
a. asks the patient to describe her usual coping strategies.
b. provides the patient with descriptions of new coping strategies.
c. initiates discussions with the patient to explain the disease.
d. offers to arrange a meeting with another patient with the diagnosis.
10. To best help manage health care costs in older adults, the nurse entrepreneur would do which of the following?
a. Create a telehealth system where nurses could check on patients daily.
b. Provide local transportation services for older people to keep appointments.
c. Create educational videos in multiple languages seen in the community.
d. Build a nurse-run clinic to serve the homeless and underinsured population.
Chapter 17: Cancer
1. When planning an educational program on cancer for a group of older adults, the nurse incorporates information regarding racial and ethnic patterns of cancer in the United States that includes evidence that:
a. the incidence of cancer is highest among African Americans.
b. Native Americans have the highest overall incident rates of cancer.
c. incidence rates for lung cancer are lowest for white women.
d. Hispanic women have the lowest incidence rates of cervical cancer.
2. An older adult patient asks the nurse why so many of her friends are developing cancers. The nurse responds best when answering:
a. “Cancer cells generally develop as a result of prolonged exposure to external agents.”
b. “The longer we live the more exposure we have to environmental toxins.”
c. “Aberrant growth seems to be the risk factor in the older adult that is not well understood.”
d. “As we age, our cells are less able to regulate replication appropriately.”
3. An older adult patient expresses concern about developing cancer in the future and asks the nurse advice about cancer prevention. The nurse shares that:
a. “Eating foods high in protein, such as chicken and fish, promote cell growth and repair, thus minimizing the risk.”
b. “Although there are some behaviors that can help minimize your risk, the possibility of developing cancer is usually determined by age 65.”
c. “Most cancers that develop after age 65 generally respond well to cancer treatment modalities.”
d. “Cancers that develop late in life are generally slow growing, so they generally do not contribute to this group’s mortality.”
4. An older adult patient has rheumatoid arthritis, which limits her manual dexterity and ability to perform breast self-examinations. To address the patient’s need for breast health promotion, the nurse teaches the patient to:
a. use the palm of her hand to perform monthly breast examinations.
b. schedule a mammogram every 12 months.
c. check each breast while in the shower if possible.
d. visit her physician yearly for a breast examination.
5. Which statement, if made by an older Caucasian adult man, indicates the need for further teaching about prostate cancer and its prevention?
a. “Digital rectal examinations aren’t needed for screening.”
b. “I should discuss having a yearly PSA test.”
c. “Prostate cancer can look a lot like an enlarged prostate.”
d. “I am not in a high-risk category for prostate cancer.”
6. When obtaining a health history, the nurse recognizes that an older adult patient has a risk factor for colorectal cancer when he reports:
a. that he is a vegetarian who eats soy products.
b. that he often needs laxatives for constipation.
c. a history of inflammatory bowel disease.
d. that diarrhea occurs at least monthly.
7. While awaiting the results of testing to determine a diagnosis of cancer, an older adult patient asks a nurse to explain what happens when cancer metastasizes. The nurse responds:
a. “It is the result of prolonged exposure to an external agent.”
b. “Cancer cells convert from transformed cells into small clusters of clonal cells.”
c. “Cell control mechanisms fail, giving rise to aberrant cell growth.”
d. “Cancer cells move from one location to another unconnected location.”
8. The family of an older adult diagnosed with cancer asks the nurse to explain how gene therapy might be beneficial. The nurse responds:
a. “The treatment decreases blood flow to the tumor and it dies.”
b. “A virus is injected into the tumor and then it can’t grow.”
c. “The cancer cell’s nucleus is destroyed and the cell shrivels.”
d. “Photosensitizers are introduced into the cells so lasers can kill them.”
9. The nurse observes a suspicious mole on the back of an older adult who is undergoing palliative radiotherapy for brain metastasis. The nurse suspects that the mole:
a. is a result of the radiation.
b. is a secondary cancer.
c. will not be screened.
d. was the primary cancer.
10. An older adult patient with breast cancer is reluctant to agree to the suggested treatment plan because “I have heard such horrible things about radiation therapy.” The nurse responds:
a. “Radiation therapy no longer causes such terrible side effects.”
b. “Your chances of recovery are best when radiation is included.”
c. “Ask the oncologist if there are alternative treatments.”
d. “Actually there is very effective symptom control now.”
Chapter 18: Loss and End-of-Life Issues
1. The nurse documents that a newly widowed older adult patient is likely experiencing physical grief responses when she:
a. becomes hypotensive.
b. has difficulty getting up from the chair.
c. reports having tightness in the chest.
d. develops a red rash over her upper chest and back.
2. The nurse is confident that an older adult is successfully completing the tasks associated with mourning his wife’s death when he:
a. shares that, “No amount of wishing will bring her back.”
b. openly cries in the presence of family and friends.
c. takes cooking classes at the local community college.
d. takes a female acquaintance to the movies.
3. Although the family of a newly widowed older adult patient lives several hours away, they are interested in providing appropriate support. The nurse suggests it would be most helpful if they would:
a. telephone daily and arrange for a neighbor to help with the shopping.
b. assume responsibility for paying the bills and upkeep of the home.
c. encourage the patient to move into a smaller home and learn to drive.
d. include the patient in their yearly vacation plans
4. A man who recently lost his wife of 50 years shares with the nurse that he’ll “never get over missing her.” The nurse is most therapeutic when responding:
a. “We are here to help you anyway we can.”
b. “Focus on the beautiful memories you have of her and your life together.”
c. “Time will help you adjust to your loss.”
d. “You’ll never get over your loss but you can learn to live with it.”
5. The nurse documents that a patient is likely experiencing exaggerated grief when observing which behavior?
a. Keeps telling family and friends that her spouse “can’t be dead.”
b. Re-reads her late spouses diaries nightly since the death 2 years ago.
c. Develops severe abdominal pains on each anniversary of her spouse’s death.
d. Becomes agitated whenever someone refers to the spouse’s death or “moving on.”
6. The nurse is caring for an older adult who recently lost an adult child as a result of automobile accident. They shared a home and enjoyed a healthy parent-child relationship. The nurse is confident that the patient has progressed appropriately through the mourning process when the patient is observed doing which action?
a. Tells family members that her child is “in a better place.”
b. Arranges for personal grief counseling.
c. Cries softly during the family’s first year memorial service.
d. Plans a summer vacation with friends from work.
7. The nurse evaluates how an older adult patient will react to the death of a spouse based on how the patient:
a. expresses concern for his spouse during a prolonged illness.
b. reacts when their beloved dog was sent to live with an adult child.
c. demonstrates his or her philosophy of health and happiness.
d. expresses how his spouse’s illness has impacted their life together.
8. A novice hospice nurse shows the best understanding of the nursing role related to an older adult patient’s mourning over the loss of an adult child when stating:
a. “I see mourning as a very individualized process.”
b. “The patient’s coping skills need to be assessed regularly.”
c. “The patient needs all the help I can give to get better.”
d. “Hopefully the patient will be in a healthy mental state soon.”
9. An older adult man has been the primary caregiver for his chronically ill wife for the past 10 years. When his wife dies, the nurse prepares the family for the likely possibility that their father will express:
a. guilt that he is alive while she is dead.
b. deep despair for his loss.
c. personal relief that she has died.
d. concern that he could have cared for her better.
10. A hospice nurse shows the best understanding of the personal commitment to the dying patient by:
a. providing the patient with sufficient, effective pain management therapies.
b. addressing the patient’s need to feel valued by those attending to his or her death.
c. being available emotionally and physically throughout the dying process.
d. empathizing with the patient and his or her family and friends during the process.
Chapter 19: Laboratory and Diagnostic Tests
1. The leukocyte count of an older adult patient is elevated. The nurse shows the best understanding of the effect of aging on body function when:
a. checking the patient for drug allergies before requesting an antibiotic prescription.
b. asking that the patient’s temperature be taken before notifying the physician.
c. encouraging the patient to drink several glasses of water and then repeat the laboratory tests.
d. having the patient produce a urine sample and requesting a stat urinalysis.
2. The nurse helps minimize an older adult patient’s risk of developing pernicious anemia by:
a. suggesting supplementing vitamin A.
b. encouraging regular intake of citrus.
c. identifying iron-rich foods.
d. suggesting supplementing vitamin B12.
3. The nurse suspects that an acute postoperative infectious process may be developing in your older adult patient. What abnormal finding best supports this suspicion?
a. A thrombocyte count of 40,000/mm3
b. Decreasing erythrocyte sedimentation rate of 10 to 20 mm/hr
c. Increasing C-reactive protein level
d. Increased partial prothrombin time
4. On assessing the laboratory data of an older adult patient, the nurse notes the serum potassium level is 5.3 mEq/L. Based on this information, the nurse:
a. asks if the patient has been using a nonsteroidal antiinflammatory drug (NSAID).
b. determines if the patient is receiving a diuretic that promotes potassium loss.
c. suggests several potassium-rich foods to supplement dietary potassium intake.
d. monitors the patient’s urinary output for possible fluid retention.
5. An older adult patient is experiencing symptoms commonly associated with hyperglycemia. Which laboratory test is most reliable for detecting hyperglycemia in older adults?
a. A random serum glucose
b. An oral glucose tolerance test
c. An early morning urine test for glucose
d. A 24-hour urine glucose test
6. An older patient has a pressure ulcer that is resistant to healing despite aggressive therapy. The nurse suspects the need for a protein supplement based on a(n):
a. serum creatinine level of 1.1 mg/dL.
b. acid phosphate level of 0.9 U/L.
c. folate level of 18.2 ng/mL.
d. serum albumin level of 3.1 g/dL.
7. An older adult patient has an elevated prostate-specific antigen (PSA) level. The nurse shares with him that a diagnosis of prostate cancer would be confirmed with an analysis of his:
a. alkaline phosphatase level.
b. acid phosphatase level.
c. serum amylase level.
d. uric acid level.
8. The nurse explains to an older patient that the assessment of her thyroid health will require both a physical examination as well as laboratory test because:
a. thyroid studies are less accurate in older adults.
b. symptoms are similar to those caused by various infections.
c. thyroid problems can be present without overt symptoms.
d. T3 levels are normally increased during aging.
9. A 91-year-old patient learns that his urine protein is 8.2 mg/100 mL. When asked to explain the significance of the result, the nurse replies:
a. “It may be elevated because of a urinary tract infection.”
b. “The result is not significant because it’s within normal limits.”
c. “The level is usually elevated in people your age.”
d. “Mild chronic renal failure causes a decrease in urine protein.”
10. A 71-year-old patient has a cholesterol level of 182 mg/dL. The nurse evaluates this as:
d. unknown; no norms have been established for this age group.
Chapter 20: Pharmacologic Management
1. The nurse is preparing to apply a topical cream on the arm of a cognitively impaired, anorexic older adult patient in the terminal stage of lung cancer. The nurse carefully monitors the effectiveness of the medication because its effectiveness will be most negatively impacted by the patient’s:
b. cognitive limitations.
c. nutritional status.
d. cancer diagnosis.
2. When administering medications to older adults, the nurse shows an understanding of the effect of aging on drug distribution by monitoring the patient’s:
a. cardiac function.
b. liver function.
c. red blood cell count.
d. plasma albumin levels.
3. An older adult patient has been prescribed warfarin (coumadin). The nurse’s primary intervention involves daily review of the patient’s:
a. prothrombin time.
b. body for bruising.
c. serum creatinine level.
d. reflex tone.
4. A patient with diabetes and hypothyroidism is being admitted to an assisted living facility. During the admission assessment, the patient reports difficulty falling asleep. The nurse shows an understanding of sleep dysfunction and the older patient when asking:
a. “Have you ever been prescribed a sleeping medication?”
b. “How do you feel about leaving your home to live here?”
c. “How long have you been a diabetic?”
d. “Are you taking medication for your thyroid problem?
5. A patient is receiving propranolol (Inderal) for hypertension. Which outcome is the best indicator of goal success when considering the drug’s potential effect on the patient’s quality of life?
a. The patient verbalizes the importance of moderate exercise.
b. The patient experiences no injuries as a result of dizziness.
c. The patient’s blood pressure stays within normal limits.
d. The patient describes symptoms indicative of an adverse drug reaction.
6. The nurse responsible for administering medications to the residents of a long-term care facility shows an understanding of the risk of injury this population experiences when:
a. confirming the patient’s identity prior to providing the medication.
b. assessing the patient for a history of drug-related allergies.
c. implementing the 5 rights of medication administration routinely.
d. educating patients about the purpose and side efforts of their medications.
7. An older adult diabetic patient is mildly hypertensive. The nurse prepares to educate the patient regarding angiotensin II–blocking agents. These drugs are especially useful in older adults because they:
a. protect the kidney’s function.
b. have a well-defined therapeutic window.
c. are more effective than other drugs in the same class.
d. can be given when liver function is compromised.
8. The nurse shows an understanding of medication-related risk factors common to older adults when asking:
a. “Are you aware of the possible side effects of your medications?”
b. “Do you regularly take any dietary supplements?”
c. “How do you keep track of when your medications are due?”
d. “How many different physicians are prescribing medications for you?”
9. An older adult patient is having difficulty remembering when to take several of the prescribed medications. To improve the patient’s compliance with the medication regimen, the nurse:
a. asks the patient’s spouse to consistently administer the drugs.
b. checks the drug guide to see if decreasing the frequency if the drugs is possible.
c. informs the patient’s physician about the drug noncompliance.
d. teaches the patient to administer daily pills with a pill dispenser.
10. The nurse is caring for an older adult who reports severe chronic pain. To best assess age-related physiologic changes that could influence plans for initiating an appropriate drug regimen, the nurse prepares the patient for which laboratory evaluation?
a. White blood count
b. Glomerular filtration rate
c. Serum complement level
AND MUCH MORE