Geriatrics 4

Question 1

An older patient describes having to go to the bathroom more frequently at night. What manifestation is this patient experiencing?

1. Fluid overload
2. Increased glycosuria
3. Normal changes of aging
4. Impairment of drug excretion

Answer 1

3: The kidneys of older adults excrete more fluid and electrolytes at night than in the daytime. More urine is formed at night, frequently interrupting sleep patterns.

Question 2

An older patient who has been experiencing a fever, nausea, and vomiting has a urine specific gravity below normal. The patient denies being thirsty. What should the nurse suspect the patient is experiencing?

1. Dehydration
2. Fluid overload
3. Congestive heart failure
4. Normal changes of aging

Answer 2

1: The elderly are less able to concentrate their urine, making them susceptible to dehydration. In addition, there is a deficit of the thirst response. The patient’s symptoms of nausea and vomiting suggest decreased intake and increased output through vomiting, placing the patient at risk for dehydration.

Question 3

The nurse is having difficulty inserting a urinary catheter in an older female patient. Which position should the nurse use to help facilitate the insertion of the catheter?

1. Side-lying lifting up the buttock
2. Supine with the bed flat, legs bent and apart
3. Supine with the HOB elevated at 30 degrees
4. Supine with the head of bed (HOB) elevated at 90 degrees

Answer 3

1: Because of estrogen-mediated changes in the perineal area of postmenopausal women, the urinary meatus may be very difficult to visualize. The side-lying position lifting up the buttock is an alternative that provides better visualization of the urinary meatus.

Question 4

An older female patient asks the home care nurse what can be done to help with painful intercourse. What recommendations should the nurse make to the patient?
Standard Text: Select all that apply.
1. Avoid intercourse.
2. Decrease the frequency of intercourse.
3. Use vaginal lubricants during intercourse.
4. Use the hand to guide the penis into the vagina.
5. Tolerate the problem because it is a normal part of aging.

Answer 4

3: It is not uncommon for an elderly female to report painful intercourse, which is related to a decrease in vaginal lubrication as well as the lack of elevation of the labia during sexual arousal. Vaginal lubricants can be very effective in reducing the pain experienced during intercourse.
4: The older female might be advised to use her hand to guide her partner’s penis into the vagina.

Question 5

An older patient with chronic renal failure has not had a bowel movement for two days. What does the nurse realize this patient is at risk for developing?

1. Hypokalemia
2. Hyperkalemia
3. Metabolic acidosis
4. Increased serum creatinine levels

Answer 5

2: Constipation exacerbates hyperkalemia and it is important to monitor patients with chronic renal failure for daily bowel movements since the potassium levels are already impaired.

Question 6

Which assessment findings does the nurse recognize as being a normal part of aging for an older patient?
Standard Text: Select all that apply.
1. Nocturia
2. Delayed urination
3. Less frequent voiding
4. New onset urinary incontinence
5. Decreased urine specific gravity

Answer 6

1: Nocturia is a normal urinary change found in older people.
2: Delayed urination is a normal urinary change found in older people.
3: Less frequent voiding is a normal urinary change found in older people.
5: Decreased urine specific gravity is a normal urinary change found in older people.

Question 7

An older male patient with benign prostatic hypertrophy (BPH) is experiencing an increase in symptoms. Which finding would explain the reason for this patient’s change in symptoms?

1. Recent vasectomy
2. Decreased oral intake at night
3. Use of over-the-counter saw palmetto
4. Use of over-the-counter cold medication

Answer 7

4: Urinary retention in men with BPH can be precipitated by several classes of medications, such as over-the-counter medications for the common cold.

Question 8

An older male patient reports having blood in the urine. For which health problems does the nurse expect the patient will be evaluated?
Standard Text: Select all that apply.
1. Pyuria
2. Renal failure
3. Bladder cancer
4. Prostate cancer
5. Urinary tract infection

Answer 8

3: Blood in the urine is associated with bladder cancer.
5: Blood in the urine can be a symptom of a urinary tract infection.

Question 9

An older patient who is postmenopausal is experiencing uterine bleeding. Which action would be appropriate for the nurse to take at this time?

1. Provide hygienic care.
2. Collect a urine specimen.
3. Direct the patient for evaluation for endometrial cancer.
4. Instruct the patient on normal changes of the reproductive system in the elderly.

Answer 9

3: Any older woman who reports postmenopausal uterine bleeding should be assumed to have endometrial cancer until proved otherwise. The patient should be directed to seek healthcare to evaluate for the presence of endometrial cancer.

Question 10

The nurse is instructing an older female patient on reproductive cancer screenings. Which information would the nurse include in this teaching?

1. Eliminate Pap smears if high risk factors are absent.
2. Obtain mammography every other year after the age of 40.
3. Avoid hormone replacement therapy for vasomotor symptoms.
4. Eliminate self-examination of the breasts if the patient finds this socially unacceptable.

Answer 10

1: Current recommendations are that women who are over age 65, who have had a regular history of normal Pap smears, and who are not at high risk because of other factors should not receive routine Pap smears.

Question 11

The nurse is reviewing the list of medications prescribed for an older patient. Which medications could lead to toxicity because of renal excretion changes in this patient?
Standard Text: Select all that apply.
1. Aspirin
2. Digoxin
3. Antibiotic
4. Vitamin C
5. ACE inhibitor

Answer 11

2: Because of renal excretion changes the older patient is prone to toxicity. Digoxin can cause toxicity.
3: Because of renal excretion changes the older patient is prone to toxicity. Antibiotics can cause toxicity.
5: Because of renal excretion changes the older patient is prone to toxicity. ACE inhibitors can cause toxicity.

Question 12

An older patient is diagnosed with chronic renal failure. Which manifestations will the nurse most likely assess in this patient?
Standard Text: Select all that apply.
1. Pruritis
2. Anorexia
3. Generalized edema
4. Postural hypotension
5. Elevated blood pressure

Answer 12

1: Pruritis is a manifestation of chronic renal failure.
2: Anorexia is a manifestation of chronic renal failure.
3: Generalized edema is a manifestation of chronic renal failure.
5: Elevated blood pressure is a manifestation of chronic renal failure.

Question 13

An older patient who is a widower explains that routine sexual encounters remain an important part of his life. What teaching should the nurse provide to this patient?

1. Actions to ensure safe sex
2. Importance of an adequate fluid intake
3. Reasons to abstain from sexual activity
4. Interventions to prevent erectile dysfunction

Answer 13

1: Sexually active older adults are at risk for the same sexually transmitted infections that affect younger adults. They should be offered the same education about safer sex, including the use of condoms.

Question 14

A 60-year-old male patient is planning to marry a woman in her 30s and is concerned about the need for contraception. How should the nurse respond to this patient?

1. “After age 50, you are considered virtually infertile.”
2. “It is still possible at this time of life to father a child.”
3. “You should have a vasectomy to avoid fathering a child.”
4. “You will only need to be concerned about fertility for another few years.”

Answer 14

2: Approximately half of all men continue to produce viable sperm up to the age of 90 years. Older men can father children.

Question 15

When reviewing the hormone levels of a menopausal patient, which findings should the nurse recognize as being expected for the patient?
Standard Text: Select all that apply.
1. Reduced estrogen level
2. Reduced testosterone level
3. Elevated thyroid hormone level
4. Elevated luteinizing hormone level
5. Elevated follicle stimulating hormone level

Answer 15

1: Estrogen levels fall off dramatically and remain at very low levels for the rest of the woman’s life.
2: Because women also produce small amounts of testosterone, loss of libido in an older woman may be related to a decrease in testosterone.
4: Once menopause has occurred, luteinizing hormone stabilizes at levels much higher than in younger women.
5: Once menopause has occurred, follicle stimulating hormone stabilizes at levels much higher than in younger women.

Question 16

The nurse is assessing an older male patient. Which finding indicates the need for further investigation?

1. The absence of libido
2. Orgasms of reduced intensity
3. Difficulty delaying ejaculation
4. An erection that is less firm than in earlier years

Answer 16

1: Although the libido of a man may diminish with aging, the loss of sexual drive should be viewed with concern.

Question 17

An older patient is experiencing overflow incontinence. What should the nurse identify as causes for this change in urinary functioning?
Standard Text: Select all that apply.
1. History of dementia
2. Enlarged prostate gland
3. Treatment for gastric ulcers
4. Diagnosis of diabetes mellitus
5. Prescribed a calcium channel blocker

Answer 17

2: An enlarged prostate gland is associated with overflow incontinence.
4: Diagnosis of diabetes mellitus is associated with overflow incontinence.
5: Calcium channel blockers are associated with overflow incontinence.

Question 18

The nurse is planning care for an older patient with stress incontinence. Which interventions would be appropriate for the nurse to suggest to the patient?
Standard Text: Select all that apply.
1. Timed voiding
2. Kegel exercises
3. Bladder training
4. Restricting fluids
5. Increasing citrus juices

Answer 18

1: Timed voiding has been demonstrated to be effective for older women with stress incontinence.
2: Kegel exercises are another intervention that works well for stress incontinence.
3: Bladder training is similar to timed voiding, but the intervals between trips to the toilet are gradually lengthened, training the bladder to hold slightly increased amounts of urine.

Question 19

The nurse is planning an inservice for a group of nursing assistants about urinary infections. What information should be included in the presentation?

1. Men are most likely to experience descending urinary tract infections.
2. The rate of urinary tract infections is similar between men and women.
3. Men need a longer course of antibiotics to manage a urinary tract infection than women.
4. Catheterization is the only way to get a urine specimen to check for a urinary tract infection.

Answer 19

3: Men will usually be prescribed a longer course of therapy to manage a urinary tract infection. They have a longer urethra. When they are infected with an infection to the system, it is typically more complicated than in a woman.

Question 20

An older patient tells the nurse about leaking urine when sneezing. To what does the nurse realize that is type of urinary incontinence is attributed?

1. Result of a system blockage
2. Result of bladder overstretching
3. Damage of the urinary apparatus
4. Increase in intra-abdominal pressure

Answer 20

4: Incontinence is most often caused by an increase in intra-abdominal pressure combined with an inability to retain the urine in the bladder.

Question 21

The results of an older patient’s urinalysis reveal bacteria in the urine. What action should the nurse perform next?

1. Notify the physician.
2. Order a repeat urinalysis to confirm the initial test.
3. Order a culture and sensitivity to identify the exact type of bacteria.
4. Review the nursing assessment for reports consistent with a urinary tract infection.

Answer 21

4: Many elders with urinary tract infections may be asymptomatic. The nurse should review the data collected to determine if the patient has reported any supportive data.

Question 22

The nurse is teaching bladder retraining to an older patient recovering from bladder surgery. Which patient statement indicates understanding of the teaching provided?

1. “I will gradually space my voiding times to longer periods.”
2. “I should force fluids to promote my bladder to hold more urine.”
3. “I should try to see how long I can hold my urine before voiding.”
4. “Research has not supported theories linking dietary intake to bladder irritation.”

Answer 22

1: Bladder training is an ongoing process in which the bladder is gradually trained to lengthen times between voiding.

Question 23

The nurse instructs an older patient with benign prostatic hyperplasia (BPH) on the pathophysiology of the health problem. Which patient statement indicates further teaching is needed?

1. “There are nonsurgical treatment options available.”
2. “This condition may lead to cancer of the prostate.”
3. “As my condition progresses, I may need to consider surgical management.”
4. “Alpha blockers can be used to control my symptoms.”

Answer 23

2: BPH is a benign condition and does not lead to cancer of the prostate.

Question 24

An older male patient diagnosed with prostate cancer is not prescribed any treatment. What does the nurse realize as the reason for this treatment approach?

1. The cancer is slow growing.
2. The patient will not survive treatment.
3. The patient has less than 10 years to live.
4. The cancer is growing quickly and no treatment will be helpful.

Answer 24

1: Prostate cancer in older men is slow growing, and “watchful waiting” is a realistic option for older men.

Question 25

The nurse is planning a seminar on ways to ensure healthy genitourinary functioning when aging. What information should the nurse include in this presentation? Standard Text: Select all that apply. 1. Drink plenty of water. 2. Expect to develop urinary incontinence. 3. Be aware of responses to new medications. 4. It is normal to continue to desire sexual activity. 5. Take steps to prevent sexual transmitted infections.

Answer 25

1: Drinking plenty of water is one way to ensure healthy genitourinary functioning. 3: Be aware of responses to new medications because age-related changes in the kidney may lead to over- or under-dosing. 4: It is normal to continue to desire sexual activity. It is also normal to have little interest in sex, particularly if that has been a long-term pattern. 5: If going to engage in sexual activity, take appropriate precautions to prevent sexually transmitted infections.

Question 26

The nurse is preparing discharge instructions for an 84-year-old patient that includes plans for smoking cessation. The nurse believes that since the patient has been smoking for years, he isn't going to stop now. Which concept does this nurse's belief reflect? 1. Negative stereotyping 2. Character assessment 3. Reality orientation 4. Senescence

Answer 26

1: Often people characterize the elderly in a negative way, believing that after a certain age, things cannot be changed. This is the concept of stereotyping in a negative way.

Question 27

``` The nurse is planning to conduct a blood pressure screening at a local senior citizen's high-rise apartment building in the inner-city impoverished location. What are characteristics of the residents living in this location? Standard Text: Select all that apply. 1. Older women 2. Married men and women 3. Widowed women 4. Less educated women 5. Residents living alone ```

Answer 27

1: Women now comprise the majority of the older population and in the United States, women outnumber men. 3: Since the life expectancy of men in the United States is less than that of women, the majority of the residents will most likely be widowed. 4: Older women are more likely to be less educated and have fewer years of labor experience, making older women more likely to live in poverty. 5: Since older women are more likely to be widowed, they are more likely to live alone.

Question 28

While completing an admission assessment, the nurse learns that a female adult patient has smoked one pack/day for 20 years and works at a chemical plant. From this information, what is this patient at risk for developing? 1. Decreased fertility 2. Increased life expectancy because she is female 3. No difference in risk because of social and occupational circumstances 4. Environmental and occupational hazards that may affect life expectancy

Answer 28

4: Exposure to environmental and occupational risk factors has been known to affect life expectancy in men and will have the same effect on women given similar circumstances.

Question 29

An African American male patient has a blood pressure of 180/104 mm Hg. When asked about the blood pressure, the patient states that he is not on any medication and is unsure if the blood pressure level is unsafe. What should the nurse do? 1. Nothing since the blood pressure may not be accurate and does not need to be addressed 2. Initiate secondary prevention to prevent the progression of illness. 3. Nothing since this is normal for someone in the hospital 4. Reassess the blood pressure with the patient in a standing position.

Answer 29

2: One good strategy to control chronic illness and prevent progression and disability is to identify opportunities to diagnose and treat chronic illnesses. The nurse should initiate secondary prevention to prevent the progression of illness in the patient.

Question 30

An older patient is worried about the cost of healthcare and supplies now that he has been diagnosed with type 2 diabetes mellitus. How should the nurse respond to this patient's concerns? 1. "I believe that some parts of Medicare will cover preventative care, such as diabetes monitoring." 2. "You only need to check your blood sugar once a day, so the cost should not be too high." 3. "Don't worry. I don't think the total bill will be too much." 4. "I don't know anything about insurance."

Answer 30

1: At the current time, Medicare pays for a yearly wellness visit and routine physical examination. Medicare also covers diabetes screening and diabetes self-management training.

Question 31

The nurse is assessing an older female patient admitted to the hospital for generalized weakness and a cough. Which assessment findings would be considered normal changes related to aging? Standard Text: Select all that apply. 1. Elevated blood pressure 2. Needing to urinate every 3 hours 3. Needing to wear eye glasses for reading 4. Pulse rate 104 beats per minute and thready 5. Respiratory rate 22 per minute after walking a short distance

Answer 31

2: With aging, bladder capacity declines. Needing to urinate every 3 hours would be evidence of reduced bladder capacity. 3: With aging, difficulty focusing up close would necessitate the need for reading glasses. This would be considered a normal change with aging. 5: Maximum breathing capacity may decline by about 40% between the ages of 40 and 70. A respiratory rate of 22 per minute after walking a short distance can be considered a normal change related to aging.

Question 32

The family of an older male patient asks why the patient needs to be hospitalized for pneumonia when the youngest daughter had the same infection a few months ago and was treated at home. How should the nurse respond to the family? 1. "The patient has chronic illnesses that put him at risk." 2. "I don't think you can compare your grandfather to yourself." 3. "There are some differences between men and women and illness." 4. "Aging decreases the body's ability to restore balance to body systems with an infection."

Answer 32

4: The loss of organ reserve that can occur with aging can lead to the concept of homeostenosis or inability of the body to restore homeostasis after even minor environmental challenges, such as trauma or infection. An older person may die from pneumonia, which may have only been a minor illness to a younger person.

Question 33

A patient takes herbal supplements in order to "slow down" the aging process. The nurse realizes that the patient is following which theory of aging? 1. Cross-link 2. Wear-and-tear 3. Free radical 4. Emerging biological

Answer 33

3: The free radical theory states that accumulated damage caused by oxygen radicals causes cells, and eventually organs, to lose function and organ reserve. The use of antioxidants and vitamins is believed to slow this damage.

Question 34

``` An older patient is demonstrating signs of sadness and depression. Upon assessment, the patient expresses remorse over not accomplishing much in life and is not looking forward to eventual death. Which theories of aging would be applicable for the nurse to use to help this patient? Standard Text: Select all that apply. 1. Endocrine theory 2. Programmed longevity 3. Somatic DNA damage theory 4. Jung's theory of individualism 5. Erikson's developmental theory ```

Answer 34

4: Jung's theory of individualism states that with aging the focus is away from the external world and moves towards the inner experience. This is a psychosocial theory of aging and would be appropriate for the nurse to use to help this patient. 5: Erikson's developmental theory states that there are developmental stages that a person goes through in life. This is a psychosocial theory of aging and would be appropriate for the nurse to use to help this patient.

Question 35

A 62-year-old former professional football player is in the hospital for a total knee replacement as a result of osteoarthritis. Which theory of aging would help explain this patient's current health problem? 1. Cross-link 2. Free radical 3. Wear-and-tear 4. Somatic DNA damage

Answer 35

3: Osteoarthritis is characteristic of degeneration that results from joint usage. This disease is characteristic of the aspects of the wear-and-tear theory, which states that there is a "master clock" that controls all organs and cellular functions, which becomes less efficient over time. Abusing one organ or bodily system through repeated injury that occurs with contact sports may result in premature aging and diseases such as osteoarthritis.

Question 36

An older patient is refusing to receive the influenza and pneumococcal vaccinations because he believes he is "too old." How should the nurse respond to this patient? 1. "I understand your feelings." 2. "I will report your concerns to the physician." 3. "You are likely to get sick if you do not take the vaccines." 4. "It is never too late in life to begin health promotion activities."

Answer 36

4: Receiving vaccinations for communicable diseases is a form of health promotion. The patient should be advised that age should not restrict health-saving activities.

Question 37

A nursing student is preparing a program to review health concerns for seniors. Which statement should the student include in the presentation? 1. Heart disease is the leading cause of death for senior citizens. 2. Decreases have been shown in the rate of Alzheimer's disease. 3. The rate of heart disease death for senior citizens is increasing. 4. Cancer is the leading cause of death in the senior citizen population.

Answer 37

1: Heart disease is the leading cause of death in the senior population even though it has decreased by 2.4% between 2009 and 2010.

Question 38

The nurse provides care to patients in a long-term care facility that embraces the Continuity Theory of Aging. Which actions will the nurse plan to promote this theory? Standard Text: Select all that apply. 1. Plan rest periods between activities. 2. Introduce patients to a wide variety of new activities. 3. Encourage family members to visit with the patients. 4. Suggest avoiding activities that do not bring satisfaction. 5. Remind patients that withdrawing from activities is expected

Answer 38

1: In the Continuity Theory of Aging, the pace of activities may be slowed so rest periods between activities would be appropriate. 3: In the Continuity Theory of Aging, successful aging involves maintaining family ties. Encouraging family members to visit with the patients would be appropriate. 4: In the Continuity Theory of Aging, activities pursued in life that did not bring satisfaction may be dropped. Suggesting that patients avoid activities that do not bring satisfaction would be appropriate.

Question 39

A graduate nurse is nervous about caring for older adult patients because of the personality changes that occur with aging. How should the nurse's preceptor respond to this statement? 1. "Personality is relatively stable throughout life." 2. "The losses many elderly experience understandably will impact their personality." 3. "The personalities of the elderly do undergo some significant changes after the eighth decade of life. 4. "After retirement, feelings of disuse cause many elderly to begin demonstrating personality changes."

Answer 39

1: Personality is stable throughout adult life and rarely do healthy older people show signs of personality change during their final years.

Question 40

A patient voices concerns about her body weight despite diligently following a healthy diet. Which age-related change would explain this patient's issue with body weight? 1. Body fat increases until middle age. 2. Body weight increases after middle age. 3. Fat is redistributed to the hips after middle age. 4. Body fat promotes a pear-shaped appearance for aging women.

Answer 40

1: Body fat typically increases until middle age and then stabilizes until late life, when weight tends to decline.

Question 41

A 60-year-old patient in good health has asked the nurse about what steps can be taken to build muscle mass. What information should be provided to the patient? 1. Exercise can slow the loss of muscle mass. 2. Increasing protein and fat intake will increase muscle mass. 3. Muscle mass declines by 40% between the ages of 30 and 70. 4. There is little that can be done to reduce the loss of muscle mass associated with aging.

Answer 41

1: Without exercise muscle mass declines 22% for women and 23% for men between the ages of 30 and 70. Exercise can slow this rate of loss.

Question 42

The nurse is planning a program about the Immunological Theory of Aging for a group of senior citizens. Which information should the nurse include in this program? Standard Text: Select all that apply. 1. Restrict spending time with others who are ill. 2. A healthy diet supports immune function in the older person. 3. A healthy lifestyle supports immune function in the older person. 4. Immune function improves after exposure to urinary tract infections and pneumonia. 5. Obtaining an annual influenza vaccination supports immune function in the older person.

Answer 42

1: Limiting exposure to pathogens can support immune function in the older person. 2: A healthy diet can support immune function in the older person. 3: A healthy lifestyle supports immune function in the older person. 5: Preventive health measures such as a yearly influenza vaccination can support immune function in the older person.

Question 43

An older patient expresses anger about the loss of her husband to a younger, more attractive woman 4 years ago. She blames this for her physical and social decline. Which theory of aging supports this patient's belief? 1. Activity Theory 2. Disengagement Theory 3. Jung's Theory of Individualism 4. Erickson's Developmental Theory

Answer 43

3: A key focus of Jung's theory is the impact of an inability to accept past accomplishments and failures to promote successful aging.

Question 44

The nurse at an assisted living facility is planning secondary prevention activities for a group of residents at risk for cardiac problems. Which activities would be appropriate for this level of care? Standard Text: Select all that apply. 1. Blood pressure monitoring 2. Demonstration on the use of walkers and canes 3. Explanation on why tobacco should be avoided 4. Discussion with a dietitian for elevated cholesterol levels 5. Discussion with a physical therapist for loss of muscle tone

Answer 44

1: Blood pressure monitoring is a secondary prevention intervention and would be appropriate for the residents at risk for cardiac problems. 4: Discussion with a dietitian for elevated cholesterol levels is a secondary prevention intervention and would be appropriate for these residents. 5: Discussion with a physical therapist for loss of muscle tone is a secondary prevention intervention and would be appropriate for these residents.

Question 45

A patient who is new to Medicare has been reviewing coverage for health screening tests. Which statements indicate the patient understands the recommendations provided by Medicare? Standard Text: Select all that apply. 1. "I can have a Pap smear once a year." 2. "I can have a mammogram once a year." 3. "I can have a colonoscopy every 15 years." 4. "I can have fecal occult blood testing every 2 years." 5. "I can have bone mass screening every 2 years if I'm at risk."

Answer 45

1: Medicare recommends a Pap smear once a year. 2: Medicare recommends a mammogram once a year. 5: Medicare recommends bone mass screening every 2 years for those at risk.

Question 46

The nurse is preparing a care plan for an older African American patient at risk for colon cancer. What should be included in the plan of care? 1. Colonoscopy every 2 years 2. Serum cancer marker testing every year 3. Flexible sigmoidoscopy testing annually 4. Fecal occult blood screening every 2 years

Answer 46

1: Currently, colonoscopy screening is recommended every 2 years for those at high risk.

Question 47

The nurse manager recognizes that the types of patients and associated diagnoses admitted to a care area are consistent with nationwide demographics. Which statement supports this observation? 1. Diabetes is not a significant problem in the African American community. 2. Hispanic patients have a greater incidence of obesity than Caucasian patients. 3. African American patients have a lower incidence of hypertension than Caucasian patients. 4. Female patients with chronic disorders are more self-sufficient than men with similar ailments.

Answer 47

2: There is an increasing rate of obesity in the Hispanic population.

Question 48

``` The nurse is planning a program for community members to highlight the Healthy People 2020 areas applicable to older people. Which topics would the nurse include in this program? Standard Text: Select all that apply. 1. Cancer 2. Food safety 3. Tobacco use 4. Employment 5. Heart disease ```

Answer 48

1: Cancer is a focus area in Healthy People 2020 that is applicable to older people. 2: Food safety is a focus area in Healthy People 2020 that is applicable to older people. 3: Tobacco use is a focus area in Healthy People 2020 that is applicable to older people. 5: Heart disease is a focus area in Healthy People 2020 that is applicable to older people.

Question 49

``` After completing an assessment, the nurse is concerned that a middle-aged patient is at risk for having a disability later in life. What did the nurse assess in this patient? Standard Text: Select all that apply. 1. High blood pressure 2. Plays golf 3 times a week 3. Smokes 1 pack per day for 25 years 4. History of lower back pain 5. Works as a fork lift operator ```

Answer 49

1: Atherosclerosis is considered one of the most common causes of disability in the United States. High blood pressure can be caused by atherosclerotic changes in the arteries. 3: Smoking 1 ppd for 25 years can lead to lung or a respiratory problem, which is considered as being one of the most common causes of disability in the United States. 4: Degenerative joint disease is considered one of the most common causes of disability in the United States. A history of lower back pain could be an indication of degenerative joint disease in the spine.

Question 50

The nurse is working on a care area that focuses on tertiary prevention. Which goal is consistent with this focus? 1. Patients at risk for skin breakdown will be turned every 2 hours. 2. Patients with pressure ulcers will have whirlpool therapy as indicated. 3. Patients are assessed for factors that place them at risk for skin breakdown. 4. Patients are instructed to move in bed at least every 2 hours to prevent skin breakdown.

Answer 50

2: Treating a pressure ulcer is an example of a tertiary prevention goal.

Question 51

The nurse supports an older patient's desire to discuss advance directives with the patient's family. What action is the nurse performing with this patient? 1. Facilitation of palliative care 2. Engagement in professional development 3. Collaboration with the interdisciplinary team 4. Accountability to protect patient’s rights and autonomy

Answer 51

4: The nurse is demonstrating accountability by supporting the patient who desires control over end-of-life decisions and communicating the patient's wishes to family members. This is included in the knowledge and skills of gerontological nurses.

Question 52

The nurse supports an older patient's decision to stop further chemotherapy treatments after diagnostic testing shows a recurrence of a malignancy. Which ethical principle is this nurse demonstrating? 1. Justice 2. Autonomy 3. Beneficence 4. Nondisclosure

Answer 52

2: Autonomy is the respect for a patient's self-determination, freedom, and rights including the right to refuse treatment.

Question 53

The nurse is preparing to assess an older patient using functional health patterns. How does this approach ensure holistic care will be provided to the patient? 1. Focuses on the effects of diseases 2. Predicts the outcome for patients with disabilities 3. Demonstrates the patient's interaction with the environment 4. Identifies the potential for rehabilitation early in the process

Answer 53

3: Functional health patterns are an interrelated group of behavioral areas that provides a view of the whole person and the relationship with the environment.

Question 54

Which action by the gerontological nurse demonstrates the role of manager? 1. Performing blood pressure screenings at a senior citizen health fair 2. Participating in a skin assessment survey of patients in a nursing home 3. Writing a letter of support for a patient who is seeking custody of a grandchild 4. Arranging respite care for a patient while the adult child caregiver recovers from surgery

Answer 54

4: The nurse is functioning in the role of manager by connecting a patient to community resources and coordinating the transfer of care of the patient needing respite care.

Question 55

The nurse is completing a functional health pattern assessment with an older patient who volunteers for political functions. In which functional health pattern would this information be categorized? 1. Values-beliefs 2. Cognitive-perceptual 3. Coping-stress tolerance 4. Self-perception-self-concept

Answer 55

2: The functional health pattern assessment consists of 11 health patterns. The cognitive-perceptual pattern includes how the patient thinks and perceives the world and current events. The patient's activities with political functions would be part of this assessment.

Question 56

The nurse would document a patient's religious affiliation and participation in the local parish within which functional health pattern category? 1. Values-beliefs 2. Cognitive-perceptual 3. Coping-stress tolerance 4. Self-perception-self-concept

Answer 56

1: The values-beliefs category of the functional health pattern assessment includes beliefs, values, and perceptions about the meaning of life. A patient's participation in a religion would be part of this assessment.

Question 57

A nurse caring for geriatric patients is considering becoming certified in gerontological nursing. What does this credential indicate? 1. The nurse has a master's degree in nursing. 2. The nurse works in administration at a nursing home. 3. The nurse has worked full time at least 2 years in gerontological nursing. 4. The nurse's clinical competence in gerontological nursing has been validated.

Answer 57

4: Certification is a formal process by which clinical competence is validated in a specialty area of practice.

Question 58

An older patient with chronic health problems does not want to be admitted to a nursing home for continued care. What can the nurse explain to the patient about nursing homes today? Standard Text: Select all that apply. 1. Nursing homes are for short-term stays. 2. Nursing homes help the patient with activities of daily living. 3. Nursing homes are being replaced with community-based services. 4. Nurses in nursing homes provide at least 5 hours of care to each patient each day. 5. Nursing homes help with bathing, toileting, meals, and medication administration,

Answer 58

1: The number of discharges from nursing homes has increased over the years, which indicate that many long-term care facility residents are short-stay rehabilitation patients. 2: Nursing home residents are assisted with activities of daily living. 3: The decline in nursing home occupancy is attributed to more community-based services, which can delay or prevent nursing home placement in older persons. 5: Nursing homes help patients with bathing, dressing, eating, toileting, walking, and medications.

Question 59

``` The director of nursing at a skilled facility is implementing knowledge, skills, and attitudes to improve the quality of care of the older residents. Which criteria will be implemented? Standard Text: Select all that apply. 1. Safety 2. Teamwork 3. Staff incentives 4. Patient-centered care 5. Quality improvement ```

Answer 59

1: Safety is a knowledge, skill, or attitude that will improve the quality of care of the facility's residents by minimizing risk of harm to patients and providers. 2: Teamwork is a knowledge, skill, or attitude that will improve the quality of care of the facility's residents by fostering open communication, mutual respect, and shared decision making to achieve better quality. 4: Patient-centered care is a knowledge, skill, or attitude that will improve the quality of care of the facility's residents by providing care that is based upon respect for patient's references, values, and needs. 5: Quality improvement is a knowledge, skill, or attitude that will improve the quality of care of the facility's residents by using data to monitor the outcomes of care and implement changes to continuously improve the quality.

Question 60

The nurse has identified a nursing intervention for an older patient that is classified as being Class IIa level B. How effective is this intervention for the patient? Standard Text: Select all that apply. 1. Useful and effective 2. Based on expert opinion or case studies 3. Usefulness is less established by opinion. 4. Weight of evidence is in favor of efficacy. 5. Limited evidence from nonrandomized studies

Answer 60

4: Class IIa interventions are weighted in favor of usefulness and efficacy. 5: Level B interventions have limited evidence from nonrandomized studies.

Question 61

An older patient begins to cry when talking about the death of a daughter 20 years ago. Which response should the nurse make first? 1. Assess the patient for depression. 2. Touch the patient's arm and listen in silence. 3. Ask the patient to describe the details of the death. 4. Explain that crying is an effective means to express emotions.

Answer 61

2: Attentive listening is the key to effective communication, and the most appropriate response is to demonstrate empathy and support for the patient in the expression of strong feelings. Crying can be therapeutic to the older patient and offers release from persistent feelings of sadness.

Question 62

After an assessment, the nurse determines that the diagnosis of Constipation is appropriate for an older patient recovering from surgery. What would be a goal for this nursing diagnosis? 1. Decrease the frequency of pain medication. 2. Know the importance of hydration and activity in regard to constipation. 3. Drink at least 1,500 ml of noncaffeinated and nonalcoholic beverages each day. 4. Evacuate a formed bowel movement at least every 2 days with minimal distress.

Answer 62

4: The goal should be linked to the nursing diagnosis—be measurable, realistic, and achievable—and include a time frame for attainment. The type and frequency of bowel movement is directly connected to the nursing diagnosis. This is an appropriate goal for the nursing diagnosis of Constipation.

Question 63

During a home visit, an older patient recovering from cardiac surgery is concerned about weakness and not being able to enjoy dancing with the spouse anymore. What would be an appropriate response for the nurse to make to the patient? 1. "It's okay, honey. In time your strength will return." 2. "Tell me more about not feeling able to do what you want to do." 3. "What type of dancing do you want to do? Some are more strenuous than others." 4. "Do you think you are pushing yourself enough to return to that type of activity in the near future?"

Answer 63

2: Open-ended statements will encourage the patient to talk. Sentences that ask the patient to "tell me more" are helpful.

Question 64

The gerontological nurse is identifying interventions based upon evidence-based practice. Why are these interventions preferred? 1. They reflect methods that were previously effective for a particular patient. 2. They have been highly effective in the nurse's own practice and experience. 3. They are stated specifically in the policy and procedures manual of the healthcare facility. 4. They show evidence of cause-and-effect between intervention and outcomes.

Answer 64

4: Interventions that support evidence-based practice are those that have been tested and have the best chance of establishing a cause-and-effect relationship between the intervention and the desired outcome of care.

Question 65

Which nursing action will promote effective communication when caring for an older patient? 1. Avoiding periods of silence while communicating 2. Asking for clarification if the content is not understandable 3. Speaking loudly because most older patients are hard of hearing 4. Changing the subject if the nurse begins to feel emotional about a subject

Answer 65

2: The nurse should avoid misunderstandings by saying, "I'm not sure what you mean," which helps to clarify content.

Question 66

An older patient is being discharged to live with adult children who need to work during the day. What referral information would be beneficial for the patient and family members? 1. Transitional care unit 2. Retirement community 3. Skilled nursing facility 4. Community nursing care

Answer 66

4: Community nursing care such as visiting nurses is an option for many older patients requiring skilled care in the home. Visits can be made by nurses, home health aides, or homemakers.

Question 67

``` The administrator at a skilled nursing facility is concerned about registered nursing vacancies in the organization. If these positions remain vacant, what could be the consequences? Standard Text: Select all that apply. 1. Higher risk of pneumonia 2. Increased risk of aspiration 3. Reduction in pressure ulcers 4. Higher risk of patient deaths 5. Inadequate nutritional intake ```

Answer 67

1: Inadequate nurse staffing could lead to pneumonia because of aspiration during mealtimes. 2: Inadequate nurse staffing could lead to poor nutrition, leading to aspiration during mealtimes. 4: Inadequate nurse staffing is associated with the risk of death among patients. 5: Inadequate nurse staffing is a barrier to adequate nutritional intake in nursing homes.

Question 68

The family of an older patient asks the nurse if the patient qualifies for Medicaid to help with hospital bills. What information should the nurse provide to the family? 1. Eligibility for Medicaid is based upon income, not age. 2. Medicaid is available to individuals once they reach the age of 65. 3. Medicaid is intended to assist low-income individuals over the age of 65. 4. Older adults are eligible for Medicaid if they are planning to enter a long-term care facility.

Answer 68

1: Medicaid is for low-income individuals. To qualify for Medicaid, the older person must "spend down" their assets to cover the costs of long-term care.

Question 69

The nurse caring for older patients wants to return to school to become a gerontological nursing specialist. Which criteria would the nurse need to achieve in order to fulfill this career goal? Standard Text: Select all that apply. 1. Have a master's degree with advanced nursing practice specialization. 2. Complete at least 500 supervised hours of providing care to older patients. 3. Have a gerontological nurse manager recommend the nurse for the credential. 4. Complete a course in advanced pathophysiology and other health-related courses. 5. Have a doctor of nursing practice degree with advanced nursing practice specialization.

Answer 69

1: To be considered as a gerontological nursing specialist, the nurse would need a master's degree with advanced nursing practice specialization. 2: To be considered as a gerontological nursing specialist, the nurse would need to complete at least 500 supervised hours of providing care to older patients. 4: To be considered as a gerontological nursing specialist, the nurse would need to complete a course in advanced pathophysiology and other health-related courses. 5: To be considered as a gerontological nursing specialist, the nurse would need to have a doctor of nursing practice degree with advanced nursing practice specialization.

Question 70

At times, the gerontological nurse functions in the role of consultant when working with older patients. Which activities does the nurse perform while functioning in this role? Standard Text: Select all that apply. 1. Develops clinical pathways 2. Implements evidence-based practices 3. Develops quality assurance standards 4. Provides information about regulations 5. Provides instruction about healthy aging

Answer 70

1: As a consultant, the gerontological nurse will participate in the development of clinical pathways. 2: As a consultant, the gerontological nurse will participate in the implementation of evidence-based practices. 3: As a consultant, the gerontological nurse will participate in the development of quality assurance standards.

Question 71

A gerontological nurse is planning an educational program to discuss the current and anticipated nursing staffing needs of the future. What should be included in the presentation? Standard Text: Select all that apply. 1. More nurses will be needed to work in assisted living care settings. 2. The number of nursing homes has begun to increase over the last 10 years. 3. The number of nurses employed in hospital settings has increased since 1980. 4. Adding nurses has no impact on the long-term health of nursing home residents. 5. More complex nursing skills are needed to provide care in long-term care and rehabilitative care facilities.

Answer 71

1: There is an increase in assistive care settings in the United States. More nurses will be needed to work in this care setting. 5: Patients in long-term care and rehabilitation care facilities are more ill because hospital lengths of stays have decreased. The patients are being admitted to long-term care facilities with more health problems.

Question 72

The nurse is planning care for an older patient with chronic illnesses. After formulating nursing diagnoses, what will guide the nurse when selecting interventions for the patient's care? Standard Text: Select all that apply. 1. Intervention linked to the desired outcome 2. Acceptance of the intervention to the patient 3. Assurance that the intervention is appropriate 4. Knowledge, experience, and skill of the nurse 5. Applicability of the intervention to teaching

Answer 72

1: After formulating nursing diagnoses, nursing interventions will be selected based upon the linkage to the desired outcome. 2: After formulating nursing diagnoses, nursing interventions will be selected based upon acceptance of the intervention to the patient. 3: After formulating nursing diagnoses, nursing interventions will be selected based upon assurance that the intervention is appropriate. 4: After formulating nursing diagnoses, nursing interventions will be selected based upon the knowledge, experience, and skill of the nurse.

Question 73

The nurse is planning care for a patient admitted for surgery with the primary nursing diagnosis being Knowledge Deficit related to pre- and postoperative care. Which goal statement is the most appropriate for this diagnosis? 1. The nurse will administer the prescribed medications. 2. The patient will understand the prescribed medications. 3. The patient will be afebrile during the postoperative period. 4. The patient will verbalize the purpose of preoperative medications prior to surgery.

Answer 73

4: The statement "The patient will verbalize the purpose of preoperative medications prior to surgery" is specific to the nursing diagnosis, patient focused, and measurable.

Question 74

An older patient who is still physically active complains of progressive inability to maintain the home. The patient wants to research other living options and has significant financial resources. What should the nurse recommend to help meet the patient's living needs? 1. Adult day care 2. Retirement community 3. Skilled-nursing facility 4. Residential care facility

Answer 74

2: A retirement community is a senior citizen community that ranges in size, scope of services, types of apartments, and different levels of activities. This is the type of facility in which the patient would most benefit.

Question 75

``` An older patient with end stage renal failure has stage 4 pressure ulcers on both heels and is losing weight. The patient expresses a desire to stop all care but the family is insisting that everything be done to help the patient recover. Which aspects of ethical decision making will the nurse use to help the patient and family plan future care? Standard Text: Select all that apply. 1. Patient finances 2. Patient assessment 3. Patient preferences 4. Home environment 5. Competing interests ```

Answer 75

2: The patient assessment to include the patient's condition, medical problems, nursing diagnosis, prognosis, treatment goals, and treatment recommendations is a part of the ethical decision-making process. 3: The patient preferences, specifically understanding of the health condition, views on quality of life, values regarding treatment, and advance directives, are a part of the ethical decision-making process. 5: Competing interests, specifically the interests of the family, healthcare providers, healthcare organization, and futile utilization of scarce resources is a part of the ethical decision making process.

Question 76

The charge nurse is made aware that a 96-year-old patient does not want to be cared for by African Americans. What does this patient's attitude exemplify? 1. Culture 2. Ethnicity 3. Life trajectory differences 4. Complexity of the Cultural Care triad

Answer 76

4: The patient's age would indicate that the patient was born during a time when racial bias was acceptable. Although the nurse may not possess the same racial bias, this circumstance illustrates the complexity of the Cultural Care triad, where the nurse, patient, and caregiver come from diverse backgrounds, ethnicities, and life experiences.

Question 77

The husband of a female patient of the Islamic culture asks that only a female doctor examine his wife. How should the nurse respond to the husband? 1. A female doctor will be provided. 2. The request is unreasonable and cannot be honored. 3. Both male and female doctors respect the patient's privacy. 4. The patient's body will be covered during any examinations.

Answer 77

1: A common cultural conflict is misunderstanding a cultural practice of modesty and the need for gender-specific care. The nurse should recognize this as a legitimate request and make every attempt to honor the request.

Question 78

The nurse learns that a patient of the Jewish faith does not eat certain types of foods and fasts on religious holidays. What should the nurse do to ensure that this patient's needs are met? 1. Report the patient's needs to the oncoming nurse. 2. Document the patient's preferences on the assessment form. 3. Talk with the dietitian to obtain food preferences for the patient's meals. 4. Explain to the patient that eating is needed to maintain nutritional status.

Answer 78

3: Talking with the dietitian to obtain food preferences for the patient's meals meets the patient's needs.

Question 79

An infant of African origin is being cared for by parents who immigrated to the United States 6 months prior. The mother is using an herbal paste to treat the baby's diaper rash. What should the nurse do to ensure cultural competence? 1. Instruct the mother to stop using the paste. 2. Ask the mother to explain the ingredients in the paste. 3. Provide the mother with another cream to use for the diaper rash. 4. Explain to the mother that herbal ingredients are harmful to the baby.

Answer 79

2: To recognize cultural practices, the nurse must acknowledge that use of folk and home remedies are part of caregiving practices. Asking the mother what ingredients are in the paste allows the nurse to best evaluate what the mother is using, and then a determination of the benefit or detriment to the infant can be made in a nonjudgmental manner.

Question 80

A patient of the Latino culture is recovering from surgery and has not requested any pain medication. What should the nurse include when assessing this patient for pain? Standard Text: Select all that apply. 1. Does pain indicate that death is near? 2. What is the patient's cultural perspective towards pain? 3. Does the patient believe that pain is punishment for past behaviors? 4. What are the socially acceptable behaviors of pain in the patient's culture? 5. Is experiencing pain an expected part of living within the patient's culture?

Answer 80

2: The nurse needs to understand the patient's beliefs about pain. One area to assess is the patient's cultural perspective towards pain. 3: The nurse needs to understand the patient's beliefs about pain. One area to assess is if the patient believes that pain is punishment for past behaviors. 4: The nurse needs to understand the patient's beliefs about pain. One area to assess is the socially acceptable behaviors of pain within the patient's culture.

Question 81

The family of a 95-year-old patient of the Chinese culture is planning on caring for the patient in the home. How can the nurse best meet the patient's needs? 1. Discussing how other families have approached this problem 2. Explaining to the family that resources are available to help the patient 3. Exploring the resources the family has to meet the patient’s needs in its home 4. Insisting that the family reconsider its decision and look at other care options

Answer 81

3: Helping the family explore resources to meet the patient's needs is the best method to respect the tradition of the cultural background of this patient and family.

Question 82

An older patient is refusing a prescribed course of treatment because it goes against religious principles. The nurse realizes that religion plays what role within ethnocultural heritage? Standard Text: Select all that apply. 1. Provides a system of practices 2. Provides a meaningful philosophy 3. Gives the patient a frame of reference 4. Conducive to spiritual harmony and health 5. Increases morbidity and mortality of older patients

Answer 82

1: A component of a person's heritage is religion, which provides a system of practices. 2: A component of a person's heritage is religion, which provides a meaningful philosophy about health. 3: A component of a person's heritage is religion, which gives the patient a frame of reference. 4: A component of a person's heritage is religion, which is conducive to spiritual harmony and health.

Question 83

The nurse is caring for an older patient who only speaks Spanish. To meet the national standards for culturally and linguistically appropriate services in healthcare, what will the nurse do? Standard Text: Select all that apply. 1. Offer language assistance services to the patient. 2. Post signs in the patient's room written in Spanish. 3. Encourage the patient's family members to serve as interpreters. 4. Explain the cost to employ an interpreter to help the patient with language needs. 5. Provide a written notice in the patient's language informing of the right to receive language assistance services.

Answer 83

1: To meet the national standards for culturally and linguistically appropriate services, the nurse needs to offer language assistance services to the patient. 2: To meet the national standards for culturally and linguistically appropriate services, the nurse needs to post signage in the patient's native language. 5: To meet the national standards for culturally and linguistically appropriate services, the nurse needs to provide the patient with a written notice in the patient's language, informing the patient of the right to receive language assistance services.

Question 84

``` An older patient from an Asian background is refusing to eat. What are the consequences if the patient continues to avoid eating? Standard Text: Select all that apply. 1. Hostility 2. Depression 3. Weight loss 4. Withdrawal 5. Dehydration ```

Answer 84

3: Refusing to eat will lead to the patient outcome of weight loss. 5: Refusing to eat will lead to the patient outcome of dehydration.

Question 85

While conducting an assessment, the nurse learns that an older patient from a European country practices heritage consistency. What did the nurse assess in this patient? Standard Text: Select all that apply. 1. The patient's name has not been Americanized. 2. The patient attended social activities at the church. 3. The patient does not participate in any cultural events. 4. The patient has returned to the mother land several times. 5. The patient immigrated to the United States as a young adult.

Answer 85

1: A factor that indicates heritage consistency is the patient's name has not been Americanized. 2: A factor that indicates heritage consistency is attending social activities at the church. 4: A factor that indicates heritage consistency is returning to the old country. 5: A factor that indicates heritage consistency is growing up as a child in the country of origin.

Question 86

The geriatric nurse caring for older Spanish-speaking patients is learning Spanish. Why is this important? 1. The nurse will be able to communicate better with the patients' families. 2. It really does not matter because it is not important to learn the patients’ language. 3. Older people are moving south and learning Spanish will help the nurse in the future. 4. The elderly Hispanic population is the fastest growing elderly population in the United States.

Answer 86

4: More than half of the growth in the total US population between 2000 and 2010 resulted from an increase in the Hispanic population. Knowing Spanish will help the nurse communicate with the Spanish-speaking patients.

Question 87

``` The nurse manager of a unit with older non-English-speaking patients notes that an unusually large number of conflicts occur between the younger nursing assistants and the patients. What should the manager identify as reasons for these conflicts? Standard Text: Select all that apply. 1. Language 2. Education 3. Birth order 4. Decade of birth 5. Generation in the United States ```

Answer 87

1: Changes in the past several decades have created cultural barriers that create misunderstandings between caregivers and patients. One source of conflict is language. 2: Changes in the past several decades have created cultural barriers that create misunderstandings between caregivers and patients. One source of conflict is education. 4: Changes in the past several decades have created cultural barriers that create misunderstandings between caregivers and patients. One source of conflict is decade of birth. 5: Changes in the past several decades have created cultural barriers that create misunderstandings between caregivers and patients. One source of conflict is generation in the United States.

Question 88

The nurse is preparing to admit an elderly patient who is deaf. What should the nurse do to ensure effective communication with the patient? 1. Use the hospital-approved interpreter program. 2. Use the patient's family members to communicate with the patient. 3. Ask the patient to read assessment questions off of the computer screen. 4. Ask if anyone who is currently working could help communicate with the patient.

Answer 88

1: Using the hospital-approved interpreter program is the intervention of choice when communicating with any patient who is deaf or has limited English proficiency.

Question 89

The nurse overhears a student nurse discussing the three areas of focus regarding Cultural Care nursing. Which statement by the student indicates a lack of understanding of Cultural Care nursing? 1. "A nurse must apply the underlying background knowledge that must be possessed to provide a given patient with the best healthcare possible." 2. "A nurse must understand and attend to the total context of the patient's situation. It is a complex combination of knowledge, skills, and attitudes." 3. "A nurse must understand the basic traditions of diverse cultural groups and be able to explain to patients how these traditions must be changed to fit into the plan of care." 4. "A nurse must possess some basic knowledge of and constructive attitudes toward the health traditions observed among the diverse cultural groups found in the practice setting."

Answer 89

3: A nurse must have basic knowledge of diverse cultural groups, but in Cultural Care nursing the goal is to incorporate their traditions, not change them to meet the plan of care.

Question 90

Which assessment finding indicates that an older patient is practicing heritage consistency? 1. A patient who changed his name so that it is Americanized 2. A patient who does not maintain regular contact with extended family 3. A patient who resides in an ethnic neighborhood different from her own ethnic background 4. A patient who attended parochial school with a religious philosophy similar to the family's background

Answer 90

4: Attending parochial school with a religious philosophy similar to the family's background is an example of heritage consistency.

Question 91

Which statement made by a nursing assistant indicates that education regarding culturally competent care is needed? 1. "I will always address all patients by their last name." 2. "I will ask my patients how they would like for me to address them." 3. "I will respect my patients' need for privacy when they wish to pray." 4. "I will allow my patients to spend time with their families and not interrupt them when it's their scheduled time for a shower."

Answer 91

1: It is appropriate to address patients by their last names until they give permission to use another name.

Question 92

The nurse is preparing to perform a cultural assessment on a patient recently admitted to a long-term care facility. Which questions will the nurse use to assess the patient's communication pattern? Standard Text: Select all that apply. 1. Does the patient speak or defer to a family member? 2. What nonverbal communication behaviors are exhibited? 3. How does the patient avoid using nonverbal communication? 4. How does the patient react to the nurse's movement towards them? 5. What is the patient's proximity to other people and objects within the environment?

Answer 92

1: It is important to learn about the patient's communication patterns by asking the question, "Does the patient speak or defer to a family member?" 2: It is important to learn about the patient's communication patterns by asking the question, "What nonverbal communication behaviors are exhibited?" 4: It is important to learn about the patient's communication patterns by asking the question, "How does the patient react to the nurse's movement towards them?" 5: It is important to learn about the patient's communication patterns by asking the question, "What is the patient's proximity to other people and objects within the environment?"

Question 93

The staff development instructor is preparing a presentation on the Cultural Care triad. What information should the instructor include in this presentation? Standard Text: Select all that apply. 1. The triad consists of the nurse, patient, and direct caregiver. 2. Based on recent statistics, there is a demographic parity in this triad. 3. Based on recent statistics, there is demographic disparity in this triad. 4. The number of patients over the age of 100 is the lowest that it has ever been. 5. The registered nurse is a white female between the ages of 40 and 55, married with no children.

Answer 93

1: The Cultural Care triad does consist of the nurse, caregiver, and patient. 3: There is demographic disparity or variations below given percentages of the total population within this triad.

Question 94

Which statement that a nurse makes about ethnocultural heritage would need to be corrected? 1. "A person can only value characteristics that are heritage consistent." 2. "Heritage consistency describes the degree to which a person's lifestyle reflects his or her respective tribal culture." 3. "Ethnicity pertains to a social group within the social system that claims to possess variable traits such as a common religion or language." 4. "Culture is the thoughts, communications, actions, beliefs, values, and institutions of racial, ethnic, religious, or social groups."

Answer 94

1: A person can value characteristics that are both heritage consistent (traditional) and heritage inconsistent (modern). These values exist on a continuum.

Question 95

The nurse is completing a heritage assessment with an older patient from a non-English-speaking culture. Which question would not be a part of this assessment? 1. Where was your mother born? 2. Did you live in an extended family? 3. Where did your father go to school? 4. Do you belong to a religious institution?

Answer 95

3: The question "Where did your father go to school?" is not a question asked when completing a heritage assessment.

Question 96

``` The nurse is conducting a heritage assessment with an older patient and wants to understand the patient's beliefs on expectations for healthcare. Which categories of belief will the nurse assess in the patient? Standard Text: Select all that apply. 1. Space 2. Manners 3. Employment 4. Independence 5. Death and dying ```

Answer 96

1: One category of belief is that of space. The nurse needs to understand if the patient needs space for privacy for prayer or other personal activities. 2: One category of belief is that of manners. The nurse needs to understand what the patient expects in regards to gender-specific care, modesty, and touch. 4: One category of belief is that of independence. The nurse needs to understand what the patient expects in regards to activity and living arrangements. 5: One category of belief is that of death and dying. The nurse needs to understand the patient's perspectives regarding death, life-sustaining treatments, and funeral rituals.

Question 97

The geriatric nurse wants to improve the ability to provide Cultural Care to older patients. What steps will the nurse need to perform to improve cultural competency? Standard Text: Select all that apply. 1. Become aware of patients' life trajectories. 2. Become aware of individual ethnocultural heritage. 3. Assume that all people of the same culture have similar beliefs. 4. Recognize adaptations patients made to live in the North American culture. 5. Focus on the patients’ ethnocultural heritage as the strongest link in the triad.

Answer 97

1: One step to develop cultural competency is becoming aware of patients' life trajectories. This will support mutual respect between the patient, caregiver, and nurse. 2: One step to develop cultural competency is becoming aware of individual ethnocultural heritage. Only by knowing one's own culture can a person be ready to learn about another's culture. 4: One step to develop cultural competency is recognizing adaptations patients made to live in the North American culture. This step helps the nurse identify the patients' and caregivers' preferences in health practices, diet, and hygiene.

Question 98

The nurse has identified the diagnosis of Risk for Impaired Verbal Communication for a patient with limited English skills. Which intervention would be appropriate for this diagnosis? 1. Asking a family member to act as an interpreter 2. Writing questions on a clip board for the patient to read 3. Using an interpreter when communicating with the patient 4. Speaking loudly and slowly when attempting to communicate with the patient

Answer 98

3: Using a competent interpreter is the most appropriate intervention.

Question 99

A student nurse is preparing a presentation to explain the steps in developing cultural competency. What questions should the student ask to become more aware of personal ethnocultural heritage? Standard Text: Select all that apply. 1. "Do you value stoic behavior?" 2. "Where were your parents and grandparents born?" 3. "What are examples of your ethnocultural life trajectories?" 4. "What do you see as seminal cultural events of your lifetime?" 5. "Which life experience stands out as an event in your heritage?"

Answer 99

1: One question to ask when becoming aware of personal ethnocultural heritage is "Do you value stoic behavior?" 2: One question to ask when becoming aware of personal ethnocultural heritage is "Where were your parents and grandparents born?" 3: One question to ask when becoming aware of personal ethnocultural heritage is "What are examples of your ethnocultural life trajectories?" 4: One question to ask when becoming aware of personal ethnocultural heritage is "What do you see as seminal cultural events of your lifetime?"

Question 100

The nurse has provided a presentation on Cultural Care to a group of nursing assistants. Which statement indicates that additional instruction is needed by the nurse? 1. "Cultural Care describes nursing care as culturally aware." 2. "Cultural Care describes nursing care as culturally sensitive." 3. "Cultural Care describes nursing care as culturally competent." 4. "Cultural Care describes nursing care as culturally appropriate."

Answer 100

1: Cultural Care is defined as nursing care that is culturally competent, culturally appropriate, and culturally sensitive. Being culturally aware is not a part of the definition of Cultural Care.

Question 101

During an interview, the nurse notes that an older patient is having mild difficulty with some words and forgets the names of people. The patient is alert, oriented to time, person, and place, and makes appropriate responses. What does the nurse determine this patient's cognitive changes to mean? 1. Normal signs of aging 2. Early symptoms of dementia 3. Indicators of depression in the elderly 4. Memory impairment that may be related to cerebral ischemia

Answer 101

1: Cognitive changes vary widely in the elderly; however, older people will not suffer significant memory impairment. Many may experience mild problems with word finding and remembering names. The changes observed in this patient are normal signs of aging.

Question 102

An older patient wakes up from sleep, confused, and insists a family member is in the other room. What information within the patient's medical record should the nurse consider as a source of the patient's confusion? 1. The patient is elderly. 2. The patient's spouse recently died. 3. The patient received pain medication. 4. The patient has a history of cardiac disease.

Answer 102

3: Certain medications like sleeping pills, tranquilizers, and some pain medications can cause symptoms similar to dementia.

Question 103

The nurse is providing discharge instructions to an older patient that includes the administration of insulin. Which strategy will the nurse use when instructing this patient to adjust to the normal changes experienced with aging? 1. Giving written materials to compensate for short-term memory losses 2. Using tools that repeat the information until the information is understood 3. Considering holding sessions for longer periods than usual so the patient can learn 4. Providing instruction to relatives so that the patient will not need to learn everything

Answer 103

2: Normal age-related changes include a slowing of information processing, which results in the need for repetition of information.

Question 104

The daughter of an older patient tells the nurse that the patient used to be a wonderful cook but now cannot remember how to use a blender. What does this information indicate to the nurse? 1. Short-term memory loss 2. Long-term memory loss 3. Normal cognitive change in an older person 4. Cognitive change that requires further assessment

Answer 104

4: Normal, healthy older persons who forget what an item is used for or how to use it should be referred for further evaluation and treatment.

Question 105

An older patient is concerned about remembering to take prescribed medications. What strategies should the nurse recommend to this patient? Standard Text: Select all that apply. 1. Rely on habit to take the medication. 2. Use an assistive device such as a pillbox. 3. Suggest a family member provide the medication. 4. Discuss moving to an assisted living facility for safety. 5. Discuss reducing the number of medications with the physician.

Answer 105

1: Reliance on habit helps to reduce the chances of forgetting vital information, such as taking prescribed medications. 2: Using assistive devices such as pillboxes helps to reduce the chances of forgetting vital information, such as taking prescribed medications.

Question 106

An older patient with cardiac disease is having sleep problems and insomnia. Of what health problem should the nurse consider these manifestations? 1. Normal signs of aging 2. Predictive signs of respiratory disease 3. Symptoms of the negative effects of stress 4. Expected manifestations of cardiac disease

Answer 106

3: Symptoms that indicate an older person may be suffering negative effects of stress include sleep problems and insomnia.

Question 107

``` An older African American patient is diagnosed with a mental health problem that has been untreated for many years. What does the nurse realize as reasons for this patient's problem not being adequately treated? Standard Text: Select all that apply. 1. Ageism 2. Poverty 3. Cultural bias 4. Discrimination 5. Respecting medical personnel ```

Answer 107

1: Minority elders are at risk for mental health problems because of ageism or a negative stereotype toward older adults. 2: One factor that contributes to poor mental health in minority elders is poverty. 3: Minority elders are at risk for mental health problems because of cultural bias. 4: One factor that contributes to poor mental health in minority elders is discrimination

Question 108

An older patient being treated for abdominal pain reports no relief of pain and other somatic complaints after receiving adequate pain medication. What additional intervention is indicated for this patient? 1. Reviewing the patient's lab values 2. Contacting the family to talk to the patient 3. Further assessment and treatment for depression 4. Obtaining an order for different pain medication

Answer 108

3: The major signs of depression in the older person include multiple somatic complaints and reports of persistent chronic pain.

Question 109

``` An older patient is demonstrating signs of paranoia. What does the nurse identify as possible causes for this type of psychosis? Standard Text: Select all that apply. 1. Delirium 2. Hearing loss 3. Physical illness 4. Social isolation 5. Cognitive impairment ```

Answer 109

1: Risk factors for paranoia include delirium. 2: Risk factors for the development of paranoia include hearing loss. 4: Risk factors for the development of paranoia include social isolation. 5: Risk factors for the development of paranoia include cognitive impairment.

Question 110

An older patient tells the nurse that alcohol is used occasionally to combat stress. The patient is a recent widow, retired, and admits to feeling worthless at times. The nurse realizes this patient is at risk for which health problem? 1. Suicide 2. Paranoia 3. Dementia 4. Liver failure

Answer 110

1: Older persons over the age of 65 have the highest suicide rates of all age groups. A major risk factor for suicide is depression. An inappropriate feeling of worthlessness is a symptom of depression.

Question 111

Which cognitive changes does the nurse recognize as being normal in an older patient? Standard Text: Select all that apply. 1. Decline in the ability to draw 2. Decrease in size of vocabulary 3. Difficulty filtering out irrelevant information 4. Difficulty switching attention from one person to another 5. Needing to repeat information to the patient several times

Answer 111

1: A decline in visuospatial task ability such as drawing declines with aging. 3: The ability to filter out irrelevant information declines with age. 4: The ability to switch attention between people declines with age. 5: Information-processing speed declines with age, necessitating the need to repeat information to the patient several times.

Question 112

What should the nurse instruct an older patient to do to cope with age-associated cognitive changes? Standard Text: Select all that apply. 1. Read daily. 2. Write "notes to self." 3. Play computer games. 4. Learn memory enhancement techniques. 5. Expect others to call attention to any gaffes.

Answer 112

1: One way to cope with age-associated cognitive changes is to read daily in order to keep the mind challenged and mentally active. 2: One way to cope with age-associated cognitive changes is to write "notes to self." 3: One way to cope with age-associated cognitive changes is to play computer games. 4: One way to cope with age-associated cognitive changes is to learn memory enhancement techniques.

Question 113

The son of an older patient is concerned about the patient's ongoing forgetfulness and asks the nurse to explain what could be wrong with the patient. How should the nurse respond to the son? 1. "Memory difficulties are hard for family members to deal with." 2. "My parents are the same age as yours, and they can't remember anything." 3. "Forgetfulness is common in older adults. It's nothing you need to worry about." 4. "Memory difficulties can be due to underlying issues including anxiety, chronic pain, or depression."

Answer 113

4: Cognitive changes can be due to anxiety, chronic pain, depression, or Alzheimer's disease.

Question 114

``` The nurse is preparing an educational program for nursing assistants at a long-term care facility about psychiatric issues in older patients. Which symptoms should the nurse include? Standard Text: Select all that apply. 1. Flat affect 2. Fear of death 3. Changes in sleep patterns 4. Delusions and hallucinations 5. Difficulty in performing ADLs ```

Answer 114

1: A psychiatric symptom that should be investigated and not written off as a normal change of aging includes problems with emotional expression such as a flat affect. 2: A psychiatric symptom that should be investigated and not written off as a normal change of aging includes a fear of death. 3: A psychiatric symptom that should be investigated and not written off as a normal change of aging includes changes in sleep patterns. 4: A psychiatric symptom that should be investigated and not written off as a normal change of aging includes delusions and hallucinations.

Question 115

``` The nurse is concerned that an older patient has a problem related to regular alcohol consumption. What did the nurse assess in this patient? Standard Text: Select all that apply. 1. Anxiety 2. Malnutrition 3. Social isolation 4. Bruises from falling 5. Dependence on family members ```

Answer 115

1: Problems related to excessive or regular alcohol consumption include anxiety. 2: Problems related to excessive or regular alcohol consumption include malnutrition or failure to prepare and eat an adequate diet. 3: Problems related to excessive or regular alcohol consumption include social isolation because of avoiding people who do not drink or are judgmental. 4: Problems related to excessive or regular alcohol consumption include recurrent bruises from falls.

Question 116

An older patient's spouse passed away 4 years ago; however, the patient still sets a place at the dinner table for the spouse and has never removed any clothing or other personal items from the home. What does the nurse suspect the patient is experiencing? 1. Normal grief 2. Hopelessness 3. Survivor guilt 4. Pathological grief

Answer 116

4: Grief persisting longer than 2 years is considered pathological in the United States.

Question 117

The nurse is preparing a presentation on grief. What information should be included regarding factors that can affect the duration and course of grieving? Standard Text: Select all that apply. 1. Centrality of loss 2. Nature of the death 3. Health of the survivor 4. Cultural and ethnic influences 5. Survivor's religious or spiritual belief system

Answer 117

1: Factors than can affect the duration and course of grieving include the centrality of the loss. 2: Factors than can affect the duration and course of grieving include the nature of the death. 3: Factors than can affect the duration and course of grieving include the health of the survivor. 5: Factors than can affect the duration and course of grieving include the survivor's religious or spiritual belief system.

Question 118

During an assessment, the nurse learns that an older patient experiences much stress and feels the heart racing at times. The nurse explains that this is the fight-or-flight response and is associated with which body chemical? 1. Serotonin 2. Dopamine 3. Epinephrine 4. Acetylcholine

Answer 118

3: The fight-or-flight response stimulates epinephrine release and increases pulse, blood pressure, blood glucose, and muscle tension.

Question 119

While organizing a walking program at an assisted living facility, one resident asks why older people should exercise. Which response would be the best for the nurse to make? 1. "You aren't too old to exercise." 2. "Exercise can help increase your blood pressure." 3. "Exercise has not been shown to have any benefits for people over 80." 4. "Exercise can help reduce the negative effects of stress, which can impact your physical health."

Answer 119

4: Exercise can help to break the cycle of long-term negative effects of stress and reduce the harmful effects of elevated cortisol levels caused by stress.

Question 120

The nurse caring for older patients in a long-term care facility is organizing a depression screening program for the residents. How will this screening program benefit the older patients? 1. Differentiates dysthymia from delirium 2. Supports care expectations of the older patients' family members 3. Depression symptoms are often associated with chronic illness and pain. 4. Depression is the easiest mood disorder to detect and treat in older patients.

Answer 120

3: Depression is the mental health problem of greatest frequency and magnitude in the older population. The risk of depression in the older person increases with other illnesses and when ability to function becomes limited. Symptoms of depression are often associated with chronic illness and pain.

Question 121

Which observation should indicate to the nurse to assess an older patient for depression? 1. Flat affect 2. Hyperactivity 3. Racing thoughts 4. Pressured speech

Answer 121

1: A flat affect or having minimal or no reaction to emotion is one clinical manifestation of depression in an older patient.

Question 122

The nurse is planning an educational session on suicide in the older patient population. What information should the nurse include in this presentation? Standard Text: Select all that apply. 1. Suicide rates are the highest in teens. 2. A patient should never be questioned about suicide intent. 3. Suicide rates are the highest in people age 65 and older. 4. An older person who contemplates suicide is more likely to complete the act than a younger person. 5. Approximately 70% of older adults who commit suicide had visited their primary care physician within the previous month.

Answer 122

3: Older persons age 65 and over have the highest suicide rates of all age groups. 4: An older person who contemplates suicide is more likely to complete the act than a younger person because older people often employ lethal methods when attempting suicide, experience greater social isolation, and generally have poorer recuperative capacity, which makes them less likely to recover from a suicide attempt. 5: Approximately 70% of older adults who commit suicide had visited their primary care physician within the previous month.

Question 123

Which statement made by an older patient indicates to the nurse that the patient might be contemplating suicide? 1. "I wish I could stop all of this pain." 2. "God will take me when it's my time." 3. "I'm ready to go when God calls me." 4. "I'm no use to anyone. I might as well be dead."

Answer 123

4: The statement that reflects uselessness and being dead is one that should be analyzed for suicidal intentions.

Question 124

An older patient is prescribed a monoamine oxidase inhibitor (MAOI) medication. Which meal choice indicates that the patient needs further education regarding this medication? 1. Pepperoni pizza and diet soda 2. Baked chicken, green beans, and cherry pie 3. Fried chicken, creamed corn, and French fries 4. Chicken salad on a croissant, carrot sticks, and fresh fruit

Answer 124

1: Because these drugs inhibit the metabolism of norepinephrine, hypertensive crisis can occur if they are administered with other drugs or food that raise blood pressure such as anticholinergics, stimulants, and foods containing tyramine including red wine, cheese, beer, bologna, pepperoni, liver, raisins, and bananas.

Question 125

The nurse is planning care for an older patient diagnosed with major depression who states that voices are telling the patient to kill himself. Which nursing diagnosis would be a priority for this patient? 1. Social isolation 2. Risk for suicide 3. Disturbed sleep pattern 4. Altered sensory perception

Answer 125

2: The patient is hearing voices that are telling him to kill himself. This patient is at risk for suicide