Test Bank for Gerontological Nursing, 9th Edition

Gerontological Nursing 9th Edition Eliopoulos Test Bank Chapter 1 The Aging Population Test Bank om MULTIPLE CHOICE 1. The nurse explains that in the late 1960s, health care focus was aimed at the older adult kt an k. c because: a. disability was viewed as unavoidable. b. complications from disease increased mortality. c. older adults needs are similar to those of all adults. d. preventive health care practices increased longevity. ba n ANS: D Increased preventive health care practices, disease control, and focus on wellness helped people st live longer. w .te DIF: Cognitive Level: Comprehension REF: 2 OBJ: 2 TOP: Aging Trends KEY: Nursing Process Step: Implementation w MSC: NCLEX: Health Promotion and Maintenance: Growth and Development w 2. The nurse clarifies that in the terminology defining specific age groups, the term aged refers to persons who are: a. 55 to 64 years of age. b. 65 to 74 years of age. c. 75 to 84 years of age. d. 85 and older. ANS: C The term aged refers to persons who are 75 to 84 years of age. DIF: Cognitive Level: Comprehension REF: 2, Table 1-1 OBJ: 1 TOP: Age Categories KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development kt an k. c a. discriminate against persons solely on the basis of age. b. fear aging. c. be culturally sensitive to concerns of aging. d. focus on resources for the older adult. om 3. The nurse cautions that ageism is a mindset that influences persons to: ANS: A Ageism is a negative belief pattern that influences persons to discriminate against persons solely ba n on the basis of age and can lead to destructive behaviors toward the older adult. st DIF: Cognitive Level: Comprehension REF: 5 OBJ: 3 w .te TOP: Ageism KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 4. The nurse points out that the most beneficial legislation that has influenced health care for the w w older adult is: a. Medicare and Medicaid. b. elimination of the mandatory retirement age. c. the Americans with Disabilities Act. d. the Drug Benefit Program. ANS: A The broadest sweeping legislation beneficial to the older adult is Medicare and Medicaid. DIF: Cognitive Level: Application REF: 16 OBJ: 6 TOP: Legislation KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 5. The nurse clarifies that a housing option for the older adult that offers the privacy of an ANS: C kt an k. c a. government-subsidized housing. b. long-term care facility. c. assisted-living center. d. group housing plan. om apartment with restaurant-style meals and some medical and personal care services is the: Assisted-living arrangements offer the privacy of an apartment or condominium with meals ba n prepared and served, limited medical care, and a variety of personal services. DIF: Cognitive Level: Application REF: 14 OBJ: 9 st TOP: Housing Options KEY: Nursing Process Step: Implementation w .te MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The 75-year-old man who has been hospitalized following a severe case of pneumonia is w concerned about his mounting hospital bill and asks if his Medicare coverage will pay for his w care. The nurses most helpful response is Yes. Medicare: a. pays 100% of all medical costs for persons older than 65. b. Part B pays hospital costs and physician fees. c. Part A pays for inpatient hospital costs. d. Part D pays 80% of the charges made by physicians. ANS: C Medicare Part A pays inpatient hospital costs, Part B pays 80% of physicians charges, and Part D helps defray prescription drug costs. DIF: Cognitive Level: Application REF: 16 OBJ: 6 TOP: Medicare Provisions KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 7. The daughter of a patient who has been diagnosed with terminal cancer asks which documents are required to allow her to make health care decisions for her parent. The nurses most om informative response is: kt an k. c a. Advance directives indicate the degree of intervention desired by the patient. b. A Do Not Resuscitate document signed by the patient transfers authority to the next of kin. c. A durable power of attorney for health care transfers decision-making authority for health care to a designated person. d. A living will transfers authority to the physician. ba n ANS: C A durable power of attorney for health care transfers the authority for decision making to a st designated person. w .te DIF: Cognitive Level: Application REF: 19 OBJ: 11 TOP: Advance Directives KEY: Nursing Process Step: Implementation w MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation w 8. The daughter of a resident in a long-term care facility is frustrated with her 80-year-old mothers refusal to eat. The nurse explains that the refusal to eat is a behavior that is an: a. effort to maintain a portion of independence and self direction. b. indication of approaching Alzheimer disease. c. effort to gain attention. d. indication of the dislike of the institutional food. ANS: A Loss of independence and control is a significant issue for the older adult. Some residents will exercise whatever control they may retain. DIF: Cognitive Level: Application REF: 21 OBJ: 11 TOP: Loss of Independence KEY: Nursing Process Step: Implementation om MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 9. The nurse clarifies that the conditions of a living will go into effect when: kt an k. c a. the patient declares that desire in writing. b. a family member indicates the desire for curative therapy to cease. c. two physicians agree in writing that the criteria in the living will have been met. d. the physician and a family member agree that the criteria in the living will have been met. ba n ANS: C Two physicians must agree in writing that the criteria of the living will have been met before the st document can go into effect. w .te DIF: Cognitive Level: Application REF: 19 OBJ: 11 TOP: Living Wills KEY: Nursing Process Step: Implementation w MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care w 10. In the 1980s, Medicare initiated a program of diagnosis-related groups (DRGs) to reduce hospital costs by: a. classifying various diagnoses as ineligible for hospitalization. b. allotting a set amount of hospital days and prospective payment on the basis of the admitting diagnosis. c. specifying particular physicians to treat specified diagnoses. d. using frequency of a particular diagnosis to set a payment schedule. ANS: B DRGs set up a system of preset hospitalization time and payment on the basis of the admitting diagnosis. DIF: Cognitive Level: Comprehension REF: 16 OBJ: 6 TOP: DRGs KEY: Nursing Process Step: N/A MSC: NCLEX: N/A physical therapy, the nurse would recommend a(n): kt an k. c a. basic care facility. b. skilled care facility. c. subacute care facility. d. assisted-living residence. om 11. When discussing extended care with a patient who has had a hip replacement and needs ANS: B ba n Skilled care facilities offer not only basic care but also services from trained licensed professionals such as nurses, physical therapists, speech therapists, and occupational therapists. st DIF: Cognitive Level: Application REF: 16 OBJ: 9 w .te TOP: Extended-Care Facilities KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care w 12. The 80-year-old woman who is recovering from a stroke is being sent to an extended-care facility. She is concerned about the expense. The nurse can allay anxiety by explaining that w Medicare will cover extended-care facility costs: a. for a period of 30 days. b. for a period of 45 days for physical therapy. c. for a period of 100 days for needed skilled care. d. until she is able to be discharged home. ANS: C Medicare will cover extended-care costs for 100 days while skilled care is being applied to the resident. After 100 days, the resident must revert to private pay or ancillary long-term care insurance. DIF: Cognitive Level: Application REF: 16 OBJ: 8 TOP: Extended Care KEY: Nursing Process Step: Implementation om MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 13. The senior citizen political action group that uses volunteers and lobbyists to advance the kt an k. c interests of older adults is the: ba n a. American Association of Retired Persons (AARP). b. National Council of Senior Citizens (NCSC). c. National Alliance of Senior Citizens (NASC). d. Gray Panthers. ANS: A st The AARP uses volunteers and lobbyists to advance the interests and welfare of older adults. w .te DIF: Cognitive Level: Knowledge REF: 12 OBJ: 7 TOP: Political Action Groups KEY: Nursing Process Step: N/A w MSC: NCLEX: N/A w 14. The nurse gives an example of the caregiver who is guilty of elder abuse as the: a. daughter who uses her mothers Social Security money to purchase her mothers medication. b. son who puts an alarm on the front door to prevent his mother from wandering out of the house. c. wife who allows her mentally competent husband to refuse to take a bath for a week. d. frail spouse who is unable to bathe or change the clothes of her physically dependent husband. ANS: D Unintentional abuse or neglect can occur when the caregiver lacks the stamina to meet care needs. Even though physically unable, the frail wife is guilty of elder abuse. The wife should seek assistance to prevent neglect. TOP: Elder Abuse KEY: Nursing Process Step: Implementation kt an k. c MSC: NCLEX: Physiological Integrity: Basic Care and Comfort om DIF: Cognitive Level: Analysis REF: 22 OBJ: 13 15. The nurse cautions that the most frequent response to elder abuse by the abused older adult a. anger. b. physical retaliation. c. notification of authorities. d. nothing at all. st ANS: D ba n is: w .te Fear of retaliation or abandonment keeps most abused elders silent. DIF: Cognitive Level: Application REF: 25-26 OBJ: 14 w TOP: Response to Abuse KEY: Nursing Process Step: Implementation w MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 16. Many nurses today do not seek careers in gerontology because: a. the physical work is too difficult. b. their technological skills are not used. c. there is not enough challenge. d. there are limited options for employment. ANS: B Many nurses feel that their technical skills will not be used in the care of the older adult. There are many employment options that offer challenge and fulfillment. DIF: Cognitive Level: Application REF: 5 OBJ: 2 TOP: Employment Options KEY: Nursing Process Step: N/A om MSC: NCLEX: N/A 17. The nurse clarifies that the term baby boomers refers to persons who: kt an k. c a. entered school in 1945. b. served in the military in World War II. c. were born between 1946 and 1964. d. were eligible for Social Security benefits in 2000. ANS: C ba n Baby boomers are those born between 1946 and 1964. The impact of the retirement of this cohort is unprecedented in terms of the impact on society. st DIF: Cognitive Level: Comprehension REF: 8 OBJ: 5 w .te TOP: Baby boomers KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation w w 18. Restraining an older adult in a recliner to prevent wandering is an example of: a. physical abuse. b. neglect. c. emotional abuse. d. self-neglect. ANS: A Physical abuse is any action that causes physical pain or injury. Inappropriate use of drugs, force-feeding, physical restraints, or punishment of any kind are examples of physical abuse. DIF: Cognitive Level: Application REF: 23 OBJ: 13 TOP: Types of Abuse KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 19. Nonprovision of medical care because of lack of finances is an example of: kt an k. c om a. physical abuse. b. neglect. c. emotional abuse. d. self-neglect. ANS: B Neglect is a passive form of abuse in which caregivers fail to provide for the needs of the older person under their care. Failure to provide necessary medical care may constitute neglect because ba n with no means of going to the doctor or pharmacy, the older person may suffer or even die. DIF: Cognitive Level: Application REF: 23 OBJ: 13 w .te MSC: NCLEX: N/A st TOP: Types of Abuse KEY: Nursing Process Step: N/A 20. Health care workers eating a residents candy without permission is an example of: w w a. physical abuse. b. neglect. c. emotional abuse. d. self-neglect. ANS: C Emotional abuse is more subtle and difficult to recognize than physical abuse or neglect. It often includes behaviors such as isolating, ignoring, or depersonalizing older adults. Health care workers eating a residents candy without permission is an ignorant behavior that can be depersonalizing. DIF: Cognitive Level: Application REF: 23 OBJ: 13 TOP: Types of Abuse KEY: Nursing Process Step: N/A MSC: NCLEX: N/A MULTIPLE RESPONSE om 1. The nurse is aware that a persons attitude about aging is influenced mainly by his or her __________. (Select all that apply.) kt an k. c a. life experiences b. income level c. level of education d. current age e. occupation ba n ANS: A, D A persons current age and life experiences are the main influences on his or her attitude relative st to aging. w .te DIF: Cognitive Level: Comprehension REF: 4 OBJ: 2 TOP: Attitudes toward Aging KEY: Nursing Process Step: Planning w MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation w 2. Gerontology encompasses application to __________. (Select all that apply.) a. appropriate housing b. health care c. public education d. business ventures e. government-sponsored pensions ANS: A, B, C, D Gerontological concerns extend and influence provision of appropriate housing, health care, public education, business ventures, and political stands relative to the welfare of the older adult. DIF: Cognitive Level: Application REF: 2 OBJ: 1 TOP: Gerontology KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 3. Medicare Part C allows eligible persons to receive Medicare benefits via the services of kt an k. c a. health maintenance organization (HMO) b. preferred provider organization (PPO) c. provider-sponsored organization (PSO) d. private fee for service organization (PFFS) e. medical service organization (MSO) om private insurance companies through the services of a __________. (Select all that apply.) ANS: A, B, C, D organization is not one of them. ba n Medicare Part C allows benefits via the services of managed care organizations. Medical service st DIF: Cognitive Level: Comprehension REF: 17 OBJ: 6 w .te TOP: Medicare Part C KEY: Nursing Process Step: N/A w MSC: NCLEX: N/A 4. The nurse is aware that a familys emotional response to an aging loved ones attempts to cope w with diminishing abilities and increased care needs would include __________. (Select all that apply.) a. grief b. anger c. frustration d. loss e. resentment ANS: A, B, C, D As the family witnesses the decline of a loved one and attempts to respond to the increasing care needs, the emotional responses are varied and changing. The responses include grief, anger, frustration, loss, and confusion. DIF: Cognitive Level: Application REF: 21 OBJ: 11 kt an k. c MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation om TOP: Impact of Aging on the Family KEY: Nursing Process Step: Planning 5. The nurse outlines the characteristics of the typical caregiver for an aging family member as __________. (Select all that apply.) st ANS: B, C, D, E ba n a. 32 years of age b. female c. having full-time employment d. having a care recipient older than 70 e. giving care for an average of 18 years w .te The average age of the caregiver is 46. w DIF: Cognitive Level: Application REF: 20 OBJ: 11 w TOP: Characteristics of Family Caregiver KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 6. The nurse reminds a family that indicators of self-neglect in the aging person include __________. (Select all that apply.) a. misbalanced check book b. reduced personal hygiene c. increased alcohol consumption d. irritability e. loss of weight ANS: A, B, C, E Indicators may be to manage personal finances, reduced hygiene, substance abuse, and loss of DIF: Cognitive Level: Application REF: 22 OBJ: 11 kt an k. c TOP: Self-Neglect KEY: Nursing Process Step: Implementation om weight due to inability to obtain adequate food. Irritability is not a consistent characteristic. MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 7. The nurse reminds a group of prospective caregivers that elder abuse may take the form of w .te st a. causing physical harm b. misappropriation of finances c. psychological intimidation d. emotional depersonalization e. abandonment ba n __________. (Select all that apply.) ANS: A, B, C, D, E w Elder abuse may take the form of physical injury, misusing the older persons finances for w personal gain, psychological intimidation, and depersonalization and abandonment. DIF: Cognitive Level: Application REF: 25-26 OBJ: 13 TOP: Elder Abuse KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 8. The nurse explains that research done by the National Institute on Aging found that __________. (Select all that apply.) a. older patients receive less information regarding health management than younger patients b. information on lifestyle changes were directed at younger people c. older patients were denied timely appointments for evaluation of acute illnesses d. rehabilitation programs offered limited services to the older adult e. older patients receive less evaluation and fewer treatment options for acute illnesses om ANS: A, B, D, E The study showed there was less information on health management and lifestyle changes. Rehabilitation programs were limited in their service to the older adult, and only 47% of kt an k. c physicians interviewed felt the older patient received the same evaluation for acute illnesses. DIF: Cognitive Level: Application REF: 5 OBJ: 2 TOP: Attitudes toward Aging KEY: Nursing Process Step: Implementation ba n MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 9. The Nursing Competence in Aging initiative advocates enhancing nurses __________. (Select st all that apply.) w w .te a. knowledge in gerontics b. skills in geriatrics c. opportunities for employment d. political sensitivity for the older adult e. attitudes related to the older adult w ANS: A, B, E The Nursing Competence in Aging initiative advocates for all nurses greater knowledge, skills, and broader attitudes toward the older adult. Chapter 2 Theories of Aging MULTIPLE CHOICE 1. A theory differs from a fact in that a theory: a. proves how different influences affect a particular phenomenon. b. attempts to explain and give some logical order to observations. c. is a collection of facts about a particular phenomenon. d. shows a relationship among facts about a particular phenomenon. om ANS: B A theory is an unproven concept that attempts to explain and give some logical order to kt an k. c observations. For a theory to become a fact, there must be reproducible evidence. DIF: Cognitive Level: Comprehension REF: 28 OBJ: 1 TOP: Fact vs. Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A programmed process in which: ba n 2. The biological theory of aging uses a genetic perspective and suggests that aging is a w ANS: B w .te st a. each person will age exactly like those in the previous generation. b. a biological clock ticks off a predetermined number of cell divisions. c. genetic traits can overcome environmental influences. d. age-related physical changes are controlled only by genetic factors. w The biological theory of programmed process suggests that there is a biologic clock set with a predetermined number of cell divisions that will occur before the introduction of the aging process. DIF: Cognitive Level: Application REF: 28 OBJ: 2 TOP: Biological Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 3. The Gene Theory of aging proposes that: a. the presence of a master gene prolongs youth. b. genes interact with each other to resist aging. c. specific genes target specific body systems to initiate system deterioration. d. the activation of harmful genes initiates the aging process. om ANS: D The Gene Theory suggests that there is an activation of harmful genes that initiate the aging kt an k. c process. DIF: Cognitive Level: Application REF: 28 OBJ: 2 TOP: Gene Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A w ANS: A w .te a. free radical b. molecular c. neuroendocrine d. crosslink st theory. ba n 4. The theory that identifies an unstable molecule as the causative factor in aging is the _____ w The free radical theory identifies free radicalsunstable moleculesthat will cause aging after accumulation in the body. DIF: Cognitive Level: Application REF: 29 OBJ: 2 TOP: Free Radical Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 5. The nurse assesses that the patient who uses good health maintenance practices believes in the aging theory known as the _____ theory. a. wear-and-tear b. free radical c. neuroendocrine d. molecular om ANS: A The wear-and-tear theory suggests that health maintenance practices will prevent wear and tear kt an k. c on the cells of the body and will delay the aging process. DIF: Cognitive Level: Analysis REF: 29 OBJ: 2 TOP: Wear-and-Tear Theory KEY: Nursing Process Step: Assessment ba n MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. The nurse describes the neuroendocrine theory of aging as a complex process of: w ANS: C w .te st a. relating thyroid function to age-related changes. b. the effects of adrenal corticosteroids, which inhibit the aging process. c. stimulation and/or inhibition of the hypothalamus, causing age-related changes. d. adrenal medulla inhibition of epinephrine, causing age-related changes. w The neuroendocrine theory proposes that the hypothalamus stimulates or inhibits the pituitary gland to produce hormones that initiate the aging process. DIF: Cognitive Level: Application REF: 29 OBJ: 2 TOP: Neuroendocrine Theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 7. The nurse explains that psychosocial theories differ from biologic theories in that psychosocial theories: a. focus on methods to delay the aging process. b. are directed at decreasing depression in the older adult. c. are organized to enhance the perception of aging. d. attempt to explain responses to the aging process. om ANS: D kt an k. c Psychosocial theories attempt to explain the various responses of persons to the aging process. DIF: Cognitive Level: Comprehension REF: 30 OBJ: 3 TOP: Focus of Psychosocial Therapies KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development ba n 8. The major objection to the disengagement theory is that the theory: ANS: A w .te st a. justifies ageism. b. addresses the diversity of older adults. c. does not clarify the aging process. d. diminishes the self-esteem of the older adult. w The disengagement theory seems to justify ageism by proposing that there is a mutual desire w between the community and the older adult to be disengaged. According to the theory, this desire apparently does not diminish self-esteem because the older adult desires to be disengaged. DIF: Cognitive Level: Application REF: 30 OBJ: 3 TOP: Disengagement Theory KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 9. The 80-year-old who teaches Sunday school every week and delivers food for Meals on Wheels is following _____ theory. a. Newmans developmental b. the life course c. the activity d. the disengagement om ANS: C kt an k. c Purposeful activity increases self-esteem and maintains cognitive function well into older age. DIF: Cognitive Level: Application REF: 30 OBJ: 3 TOP: Activity Theory KEY: Nursing Process Step: N/A MSC: NCLEX: N/A ba n 10. The nurse would recognize successful aging according to Jungs theory when the nurse notes that a resident at a long-term care facility: w ANS: D w .te st a. takes special care to dress for dinner in a manner that pleases his tablemates. b. asks permission to sit on the patio with other residents. c. asks persons in his hall if his television is bothering them. d. wears a large cowboy hat at all times because he likes it. w Jung describes a successful adjustment to aging as being accepting and valuing of self regardless of the view of others. DIF: Cognitive Level: Application REF: 30 OBJ: 3 TOP: Jungs Developmental Theory KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 11. The older adult female patient is positive that the free radical lipofuscin can be counteracted by: a. avoiding animal fat. b. use of antioxidants. c. building up muscle mass. d. outdoor exercise. om ANS: B Individuals who follow this theory believe that free radicals can be reduced by antioxidants such kt an k. c as vitamins A, C, E, zinc, and phytochemicals. DIF: Cognitive Level: Comprehension REF: 29 OBJ: 2 TOP: Antioxidants KEY: Nursing Process Step: Planning ba n MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 12. A recently widowed woman moved to an assisted living community because of her hypertension and joined a group to learn how to do water color painting with other women her w ANS: B w w .te a. Jung. b. Havighurst. c. Erikson. d. Newmon. st age. The nurse assesses that the patient is following the aging theory of: Havighurst proposes that the process of aging is defined by adjusting to the loss of a spouse, establishing a relationship with ones own age group, and establishing a satisfactory living arrangement. DIF: Cognitive Level: Application REF: 30 OBJ: 3 TOP: Havighurst KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease MULTIPLE RESPONSE 1. The nurses list of age-related illnesses thought to cause the accumulation of free radicals includes __________. (Select all that apply.) kt an k. c om a. arthritis b. colon cancer c. osteoporosis d. diabetes e. atherosclerosis ANS: A, D, E Cancer and osteoporosis are not considered to be diseases that accumulate free radicals. ba n DIF: Cognitive Level: Application REF: 29 OBJ: 2 TOP: Free Radical Influence KEY: Nursing Process Step: Implementation st MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease w .te 2. The nurse emphasizes that the relatively new theory that correlates restricted caloric intake to slowing of the aging process would probably extend the life span of the person, provided that the person __________.(Select all that apply.) w w a. consistently eats high-nutrient, low-calorie foods b. maintains a regular exercise program c. consumes 2000 to 3000 mL of fluid a day d. supports the diet with adequate fat-soluble vitamins e. eats only organically grown foods ANS: A, B This new theory encourages high-nutrient, low-calorie foods combined with regular exercise to delay the aging process. DIF: Cognitive Level: Application REF: 30 OBJ: 2 TOP: Calorie Restriction Theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 3. The nurse points out that the positive outcomes from a life review, according to Erikson, kt an k. c a. wisdom and integrated self-image b. comparing self with others c. understanding self and relationships d. seeking anothers opinion of his or her achievement e. acceptance of self om would include __________. (Select all that apply.) ANS: A, C, E Acceptance of self and understanding self and relationships with accumulated wisdom is the goal ba n of Erikson. Seeking the opinion of others suggests that the older adult is experiencing doubt and gloom, which are negative outcomes according to Erikson. st DIF: Cognitive Level: Application REF: 30 OBJ: 2 w .te TOP: Eriksons Developmental Theory KEY: Nursing Process Step: Implementation w MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 4. When a patient asks what can be done to neutralize the free radicals in his system, the nurse w responds that antioxidant therapy is thought to inhibit free radicals. Antioxidants include __________. (Select all that apply.) a. fruits b. vegetables c. organ meat d. folic acid e. vitamin D ANS: A, B, D Antioxidants can be obtained largely from fruits and vegetables. Organ meat and vitamin D are not antioxidants. Chapter 3 Diversity om MULTIPLE CHOICE 1. A postmenopausal black woman who has been experiencing uterine bleeding tells the nurse, I kt an k. c expect Ill need a total hysterectomy because when my sister had this problem thats 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. d. personal experience. st ANS: A ba n c. balance/harmony model. w .te The patient shows a tendency to identify with the biomedical model, which views the body as a functioning machine. When a part gives out or is functioning abnormally, traditional Western medical treatment is sought and expected. The magico-religious models believe that health is a w reward from a higher power. The balance/harmony models state that illness is the result of a state w of imbalance in body energies. Personal experience influences all of these models. DIF: Understanding (Comprehension) REF: Page 91 OBJ: 5-5 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 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 patients 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 patients proposed dietary beliefs ANS: B om Cultural care accommodation or negotiation refers to those assistive, supportive, facilitative, or enabling creative professional actions and decisions that help people of a designated culture adapt to or negotiate with others for a beneficial or satisfying health outcome. The nurse can ask kt an k. c the patient to share more about beliefs, offer a consultation with a nutritionist, or research the beliefs, but these actions do not show accommodation. DIF: Applying (Application) REF: N/A OBJ: 5-9 ba n TOP: Caring MSC: Psychosocial Integrity 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: st a. living the values of the tribe. w .te b. researching the tribes belief systems. c. learning the language of the tribe. w ANS: A w d. residing among the tribe members. Acculturation is a process that occurs when a member of one cultural group adopts the values, beliefs, expectations, and behaviors of another group, usually in an attempt to become recognized as a member of the group. The other actions might be helpful in acculturating. DIF: Applying (Application) REF: N/A OBJ: 5-3 TOP: Nursing process: Implementation MSC: Psychosocial Integrity 4. The nurse in an assisted living facility is practicing a form of cultural bias called ethnocentrism when: 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. om d. telling potential patients who are Jewish that the facility does not have a kosher kitchen, kt an k. c ANS: C Ethnocentrism is a belief that ones own cultural group is superior to that of anothers. In nursing we have a unique culture and expect our patients to adapt to us rather than attempting to adapt to the culture of the patient. Confiscating items used in healing rituals shows ethnocentrism and disrespect to the resident. Limiting activities in a group room, encouraging people to attend church services of their religion, and letting prospective Jewish residents know that the facility ba n does not have a kosher kitchen are not examples of ethnocentrism. DIF: Applying (Application) REF: N/A OBJ: 5-6 w .te st TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 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. w Being culturally sensitive, the nurse recognizes that the patients actions are most likely a(n): w 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. ANS: A Asian cultures generally view eye contact as rude and are often passive in their care. The patient may or may not have further questions. It is not a sign of discomfort or dissatisfaction. DIF: Remembering (Knowledge) REF: Page 93 OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 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. om b. both a written and verbal explanation describing how to monitor her blood sugar levels. kt an k. c 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. ANS: D The interactional patterns of high-context (universalism) patients refer to the characteristics of ba n relationships and behaviors toward others. When a person from a high-context culture interacts with the nurse, a more personal relationship is expected. This is not related to television shows, st teaching materials, or appointment cancellations. w .te DIF: Understanding (Comprehension) REF: Page 92 OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity w 7. In an attempt to be sensitive to varying cultural responses to touch, before shaking a patients w 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. ANS: B The best way to show respect and implement the appropriate response is to follow the lead of the patient by waiting for the patient to extend a hand. DIF: Applying (Application) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 8. A older Asian patient receiving physical therapy after hip surgery has developed a low-grade yin/yang. The nurse expects to support the patient by: kt an k. c a. providing privacy when his shaman visits. om fever. The patient explains that the fever will lessen if the treatment includes the principles of 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. ba n ANS: B The yin/yang theory proposes that health is a result of balance within the body. A principle of this theory is that an illness is either hot or cold and must be treated by elements of the opposite w .te amulets. st state in order to put the system back into balance. It is not related to shaman visits, meditation, or DIF: Applying (Application) REF: N/A OBJ: 5-9 w w TOP: Caring MSC: Psychosocial Integrity 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. ANS: C The more complex the decision making, the more important it is to have an interpreter present. Although all situations would benefit from an interpreter, the most important time is when the patient is signing official documents that have legal implications. DIF: Applying (Application) REF: N/A OBJ: 5-8 om TOP: Communication and Documentation MSC: Psychosocial Integrity nurse asks the patient: kt an k. c 10. When attempting to provide culturally sensitive care according to the explanatory model, the 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? ba n d. Has this illness changed your life? ANS: D w .te patients perspective. st The gerontologic nurse uses this model to explore the meaning of the health problem from the DIF: Applying (Application) REF: N/A OBJ: 5-7 w TOP: Caring MSC: Psychosocial Integrity w 11. The nurse is caring for an older adult patient in need of hospitalization. The nurse is aware this patient is a member of an ethnic group that holds a collectivist perspective on community. The nurse best addresses the patients medical needs by: a. calling an interpreter to assure the patient is making an informed decision. b. assuring the patient that his spiritual advisor will meet him at the hospital. c. arranging for admission to a hospital that is familiar with this patients culture. d. offering to phone the patients family and ask them to come in and discuss the hospitalization. ANS: D People with a collectivist perspective derive their identity from affiliation with and participation in a social group such as a family or clan. The needs of the group are more important than those of the individual, and decisions are made with consideration of the effect on the whole. Health om care decisions may be made by a group (such as the tribal elders) or a group leader (such as the oldest son). The other options may or may not be needed depending on the specifics of the kt an k. c patients case. DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity ba n 12. The nurse is most effectively using the concept of future time orientation when: a. promising to help the patient call his daughter each weekend. b. offering to complete the health assessment history after the patient eats dinner. st c. encouraging an older patient to keep a follow-up clinic appointment. ANS: D w .te d. arranging for a colorectal cancer screen for senior citizens. w In the concept of future orientation, people accept the idea that what is done now affects future w health. This means that health screenings will help detect a problem today for potentially better health at a later time, days, weeks, or years ahead; it means that prevention may be worth pursuing. The other actions do not show a future orientation. DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 13. The student learns that which of the following is the best definition of culture? a. A group of similarly appearing individuals b. Shared beliefs, behaviors, and expectations of groups c. Group beliefs about what is right and wrong d. Groups that come from the same part of the world ANS: B om A culture is a set of shared and learned beliefs, behaviors, and expectations among a group of people. The individuals in different cultures may or may not look similar. Group beliefs about what is right or wrong are known as values. Cultural members may come from many different kt an k. c parts of the world. DIF: Remembering (Knowledge) REF: Page 87 OBJ: 5-3 TOP: Teaching-Learning MSC: Psychosocial Integrity ba n 14. A student nurse expresses frustration to the faculty member regarding an ethnic older adult who appears to be noncompliant. The student states, Why cant the patient just do what we teach her to do? What response by the nurse is best? st a. Yes, I realize how frustrating this must be for you. w .te b. People from her culture are never compliant. c. Maybe you can find a different way to get through. w ANS: D w d. Culture dictates how people respond to others. Culture is a blueprint for responding to individuals, family, and the community. Persons from strong cultural backgrounds cannot just change their behavior when instructed to do so. The nurse explains this to the student. Stating that the nurse understands the frustration is helpful but does not give the student any information that could help him or her work with this patient. Stating that people from a certain culture are never compliant is biased and prejudicial. Getting through to the patient implies ethnocentrism and bias. DIF: Applying (Application) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 15. A patient from a culture that differs from that of the nurse is hospitalized and near death. What action by the nurse best demonstrates cultural care preservation? b. Pinning a healing amulet to the patients gown c. Offering the family food and drink in the room kt an k. c d. Giving the family time to be alone with the patient om a. Allowing the family to remain at the bedside ANS: B Cultural care preservation refers to those assistive, supportive, facilitative, or enabling professional actions and decisions that help people of a particular culture to retain and maintain ba n their well-being, to recover from illness, or to face handicaps or death. Allowing the patient to have healing artifacts important in his or her culture nearby best demonstrates this concept. The other actions are caring but do not demonstrate this principle. w .te st DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 16. The nurse uses the LEARN model when providing care. What event best demonstrates that w w this model has been successful? a. The nurse learns about the patients culture and how it impacts care. b. The patient and nurse agree on a mutually acceptable plan of action. c. The nurse listens carefully to the patients concerns and beliefs. d. The patient understands how medical care will be beneficial. ANS: B The LEARN model includes listening to the patient, explaining your own perspectives, acknowledging the similarities and differences in both viewpoints, recommending a plan of action, and negotiating a final plan. If the patient and nurse have come to an agreement on a plan of action, this model has been successful. DIF: Evaluating (Evaluation) REF: N/A OBJ: 5-7 om TOP: Caring MSC: Psychosocial Integrity 17. A new nurse is caring for a patient from Appalachia. The patient seems guarded and kt an k. c secretive, which frustrates the new nurse. What advice from the mentor is most appropriate? a. Maybe you should ask to change your assignment. b. This is a normal behavior for this patients cultural group. c. You could try to apologize for anything you may have done. ba n d. Ask the patient why she is acting so strangely around you. ANS: B Patients from the Appalachian culture are typically wary and guarded around strangers and view st the hospital as a place to go and die. The nurse explains this to the new nurse. Changing w .te assignments will not help the new nurse become culturally competent. The new nurse could ask the patient if there has been some offense, but this is probably not the case. Why questions put people on the defensive and are not considered examples of therapeutic communication. w w DIF: Understanding (Comprehension) REF: Page 87 OBJ: 5-6 TOP: Caring MSC: Psychosocial Integrity 18. A nurse is caring for an Arab American patient in the hospital. The patient has many visitors who seem to be tiring the patient. What action by the nurse is best? a. Limit the number of visitors the patient can have. b. Only allow family members to visit the patient. c. Suggest shorter visits to the patients visitors. d. Require visitors to check in at the front desk. ANS: C In Arab American Muslim culture, visiting the sick is a cultural value and expectation. Although the visits may be tiring, they may also be important to the patient. The nurse can suggest shorter visits so the patient can have both the visitors and more rest. Limiting the number of visitors desk serves no useful purpose. TOP: Caring MSC: Psychosocial Integrity kt an k. c DIF: Applying (Application) REF: N/A OBJ: 5-6 om would violate this cultural norm as would limiting visits to family only. Checking in at the front 19. A director of nursing works in a hospital that serves many Jehovahs Witness patients. What action by the nurse would best facilitate culturally appropriate health care? ba n a. Establish a bloodless surgery program. b. Create an immunization clinic for children. c. Employ spiritual leaders from this faith. ANS: A w .te st d. Allow faith healing ceremonies. Jehovahs Witnesses generally are opposed to receiving all blood products. A bloodless surgery w w program would be a culturally competent way to improve the health care of this population. DIF: Applying (Application) REF: N/A OBJ: 5-5 TOP: Caring MSC: Psychosocial Integrity 20. An incapacitated older adult with dementia is brought to the emergency department by a rescue squad after falling and breaking an arm. When the patients children arrive, they are adamantly against the patient having any medical care and insist that prayer will heal the broken arm. What action by the nurse is most appropriate? a. Allow the family to pray with the patient then escort them to the waiting room. b. Call security to keep the family from interfering with medical care. c. Check facility policies and contact the hospital social worker. d. Call the police who can force the family to accept medical care. ANS: C om This family may be Christian Scientists, who do not believe in medical care. Health crises are thought to be errors of the mind that can be altered by prayer. The nurse should check the facility policies for treating vulnerable adults and possibly notify social work, who can assist with kt an k. c ensuring adequate treatment occurs as allowed by policy. Allowing the family to pray with the patient is a caring action, but this complex situation requires more intervention. Calling security or the police will antagonize the family even more and demonstrates an adversarial relationship. DIF: Applying (Application) REF: N/A OBJ: 5-6 ba n TOP: Communication and Documentation MSC: Safe Effective Care Environment w .te st MULTIPLE RESPONSE 1. When attempting to reflect about personal cultural awareness, the nurse asks himself or herself which of the following quetions? (Select all that apply.) w a. What image do I want to project to members of other cultures? w b. What makes a culture worthy of biased treatment? c. Have my life experiences contributed to any biases regarding other cultures? d. Am I uncomfortable when interacting with members of other cultures? e. Does the patients culture rely on solid science to direct health care? ANS: A, C, D Self-reflection implies thinking that regards how I, the individual, perceives/believes/behaves. Awareness of ones thoughts and feelings about others who are culturally different from oneself is necessary to become culturally aware. No culture is worthy of biased treatment. Solid science is an ethnocentric principle. DIF: Applying (Application) REF: N/A OBJ: 5-4 TOP: Caring MSC: Psychosocial Integrity 2. What does the nurse working with older adults from many different cultures know about the a. Hispanics will become the largest minority group by 2030. kt an k. c b. Many persons of color are not counted in the census. om demographics of culture in the United States? (Select all that apply.) c. The percentage of Native Americans/Native Alaskans will decrease. d. The number of refugees and immigrants is expected to decrease. ANS: A, B, C ba n e. Some Native Americans want to identify as specific tribal members. Hispanics are expected to be the largest minority group in the United States by 2030. Many st persons of color are not represented in the census, and this underestimates their presence. The percentage of Native Alaskans and Native Americans will rise, as will the number of w .te immigrants/refugees. Some Native Americans may not view themselves as part of this larger group, preferring to identify as a member of a specific tribe. w Chapter 4 Life Transitions and Story w MULTIPLE CHOICE 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 patients world by talking with and listening to him or her. c. learn the details of the patients medical and social histories. d. be a member of the patients formal support system. ANS: B By listening to and consulting with older adults, the nurse develops an understanding of the values and perceptions that guide older adults thoughts and feelings about life. The nurse forms partnerships with older adults to defend and promote their rights. The other options are nice to know but not required to be an advocate. om DIF: Understanding (Comprehension) REF: Page 121 OBJ: 7-5 MSC: Safe Effective Care Environment kt an k. c TOP: Nursing Process: Nursing Assessment 2. To best respect an older patients autonomy when assisting him in finding appropriate, affordable housing, the nurse: a. provides examples of various options that include assistive services. ba n b. locates housing near a senior citizen community center to minimize social isolation. c. identifies housing close to the services he will need. ANS: D w .te st d. asks the patient to provide examples of where he would like to live. Whatever the housing status of the older person, it must be remembered that each person has a w right to determine where to live unless he or she is proven incompetent. The other options do not w help the patient maintain autonomy. DIF: Applying (Application) REF: N/A OBJ: 7-5 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 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. ANS: A Women are increasing in numbers among the homeless older adult communities. Approximately kt an k. c DIF: Remembering (Knowledge) REF: Page 131 OBJ: 7-1 om 30% of homeless older adults have mental illness or dementia. TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 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. ba n b. makes every effort to engage them in conversation during the meal. c. encourages them to make friends with the other patients. w .te ANS: D st d. asks if they would assist those who need help with getting their food. Older adults tend to feel an obligation to return favors. If someone does something for them, w such as helping them to get their food, they want to be able to reciprocate. If they are financially w unable to do this, they might withdraw so as not to be put in an embarrassing position. DIF: Applying (Application) REF: N/A OBJ: 7-3 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 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. ANS: B When the older adult loses his or her traditional role, self-esteem and satisfaction with life may satisfaction. kt an k. c DIF: Remembering (Knowledge) REF: Page 127 OBJ: 7-1 om be affected. The other events may happen, but a frequent outcome is loss of self-esteem and life TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 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 ba n cataract surgery. The nurse suggests that such treatment is most likely covered by: a. Medicare Part A. c. Medicare Part D. w ANS: B w .te d. Supplemental policy. st b. Medicare Part B. w A vision examination is a service covered by Medicare Part B. DIF: Remembering (Knowledge) REF: Page 126 OBJ: 7-4 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment 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. ANS: B More-educated people often have greater access to wellness programs and preventive health om options because they tend to have more financial resources and health insurance coverage. Education may lead to an increased value on health and wellness. Occupations may or may not kt an k. c be physically demanding. Educated older adults may not manage stress more productively. DIF: Remembering (Knowledge) REF: Page 124 OBJ: 7-1 TOP: Teaching-Learning MSC: Health Promotion 8. Which patient is most likely to be seen at a clinic that services older adults who are at or ba n below the poverty level? a. A Hispanic male living with extended family st b. An African American male living with a spouse c. A Hispanic female who lives alone w ANS: C w .te d. An African American female who lives with her sister w The highest rates of poverty are among Hispanic women over the age of 65 who live alone. DIF: Remembering (Knowledge) REF: Page 123 OBJ: 7-3 TOP: Nursing Process: Assessment MSC: Health Promotion 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. ANS: A After age 75, women outnumber men in American society. Most women in this age group did benefits. kt an k. c DIF: Remembering (Knowledge) REF: Page 123 OBJ: 7-1 om not work outside the home, so their incomes depend on their spouses pensions or Social Security TOP: Nursing Process: Assessment MSC: Health Promotion 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 ba n on knowledge of this age cohort, the nurse: a. provides a detailed explanation about the importance of taking the medications appropriately. w .te st 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. w ANS: B w d. offers suggestions on ways to minimize the risk of forgetting to take medication correctly. Persons of this cohort (raised during the American depression of the 1930s) are generally frugal and often do not spend money, even if they have it. Suggesting a cost-effective way to purchase the medications will particularly appeal to this patient. DIF: Understanding (Comprehension) REF: Page 121 OBJ: 7-2 TOP: Teaching-Learning MSC: Health Promotion 11. The nurse who works with veterans from the 1940s and 1950s knows that individuals in this cohort are more likely than older adults to: a. obtain preventative health services b. hoard money for times of need c. work hard to keep families intact om d. be noncompliant with medications ANS: A kt an k. c Women and men who served in the armed forces during this time became accustomed to preventive medical and dental care. Those influenced by the Great Depression are more likely to hoard money. Families started becoming more mobile. This cohort is not as likely to be noncompliant because of cohort influences. ba n DIF: Remembering (Knowledge) REF: Page 122 OBJ: 7-2 TOP: Nursing Process: Assessment MSC: Health Promotion 12. An older patient appears to have few friends and little family. What action by the nurse is w .te st best? a. Encourage the patient to stay in contact with remaining family members. b. Help the patient find new social outlets and support systems. w c. Assess the patient for depression or substance abuse. w d. Ask the patient why there are so few friends and family. ANS: B Social networks are invaluable to help mitigate the effects of major life events on health. The nurse can encourage the patient to join groups or organizations in order to make new friends. Staying in touch with family may or may not be desired. The patient may need assessment for substance abuse, but this is not the best action. Asking why questions often puts people on the defensive, and this technique is not considered a therapeutic communication tool. DIF: Applying (Application) REF: N/A OBJ: 7-5 TOP: Communication and Documentation MSC: Psychosocial Integrity 13. An adult child of an older adult confides in the nurse that the patient has lost most of her friends because of her negative behavior. What action by the nurse is best? b. Encourage the patient to be more positive. c. Ask if the patient is aware of the problem. kt an k. c d. Suggest the patient take antidepressants. om a. Ask when the patient had her last physical exam. ANS: A Depressed or negative older adults have trouble maintaining relationships. If this is a change in status, the nurse should determine if the patient needs a checkup to look for underlying illness. ba n The other answers do not provide action that could possibly alleviate the situation. Giving the patient medications without a full workup is dangerous. st DIF: Applying (Application) REF: N/A OBJ: 7-5 w .te TOP: Nursing Process: Assessment MSC: Physiologic Integrity 14. A patient is not competent to manage financial affairs. What legal recourse does the older w person have? w a. Guardian b. Conservator c. Health care proxy d. Social worker ANS: B A conservator is appointed by the courts to handle a patients monetary affairs. A guardian helps with nonmonetary issues. Health care proxy and social workers do not manage financial affairs. DIF: Remembering (Knowledge) REF: Page 128 OBJ: 7-6 TOP: Teaching-Learning MSC: Safe Effective Care Environment 15. An older couple is considering moving into a retirement community. What reaction by the nurse is best? b. Check on what levels of care they provide. c. Do you have enough money to afford this? kt an k. c d. What does your family think of this idea? om a. Thats a good idea to consider at your age. ANS: B Retirement communities have differing levels of care; some are only for independent seniors, whereas others offer an array of arrangements. This is the most important factor for the couple to ba n consider, because they may face having to move to a chosen community as their needs change. DIF: Applying (Application) REF: N/A OBJ: 7-8 w .te st TOP: Teaching-Learning MSC: Psychosocial Integrity 16. An older adult is planning to move to an assisted living facility. What advice does the nurse provide to the adult children? w a. Let your father choose what items to take with him. w b. Warn your dad there will be little room for personal things. c. It is best to pick your dad up one day and move him in. d. Be aware your dad may suffer from depression or confusion. ANS: A Individuals who move can suffer from relocation stress, which is a negative consequence of moving. If the patient has input into the facility chosen, can take tours, and can bring cherished personal items with him or her, the chances of relocation stress lessen. Although there might be limited room, it is more important for the family to let the patient take wanted items. Moving precipitously can increase the chance of relocation stress. The family should be warned about the negative reactions to moving that are possible, but this does not give them the ability to lessen the impact. DIF: Application (Applying) REF: N/A OBJ: 7-5 om TOP: Teaching-Learning MSC: Psychosocial Integrity 17. An adult daughter brings a patient to the gerontology clinic and reports that the patient has nurse is best? a. Administer a mini mental state exam. b. Ask the patient why this is happening. c. Assess if the patient feels safe at home. ba n d. Determine if abuse is occurring. kt an k. c become increasingly withdrawn and no longer goes out during the day. What response by the ANS: C st Patients often withdraw and become isolated when they do not feel safe in their surroundings. w .te The nurse should first assess the patients perception of safety. The other options may or may not be necessary, but why questions should be avoided, as they generally place people on the defensive. w w DIF: Applying (Application) REF: N/A OBJ: 7-7 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 18. An older woman lives alone. What action by the nurse is best to keep the patient from becoming a victim of crime? a. Encourage the patient to take self-defense classes. b. Tell the patient that it is okay to hang up or not answer the door. c. Have the patient install a monitored security system.