TEST BANK for Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition by Touhy. All

Test Bank Ebersole and Hess Gerontological Nursing and Healthy Aging 6th Edition by Touhy

Chapter 01: Gerontological Nursing and Promotion of Healthy Aging Touhy: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 6th Edition MULTIPLE CHOICE 1. Which statement best relates information regarding characteristics of acute care for the elderly

(ACE) units? a. They are seldom a part of a hospital facility. b. They facilitate admission to nursing home situations. Association (ANA) offered a certification program. c. They support promotion of health and support for maximal independence. d. Their purpose is to rehabilitate any hospital incurred functional disability.

ANS: C

ACE units are distinct areas of a hospital specifically designed to reduce the incidence of functional disability of older adults occurring during hospitalization for acute medical illness by proactively identifying and managing geriatric syndromes to help maintain the patient’s function, reducing admission to nursing homes, and lowering the cost of hospitalizations.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: 6 MSC: Health Promotion and Maintenance

2. Which gerontological nursing organization welcomes nurses from all educational

backgrounds? a. The National Gerontological Nursing Association (NGNA) b. The National Conference of Gerontological Nurse Practitioners (NCGNP) c. The National Association of Directors of Nursing Administration in Long-Term Care (NADONA/LTC) d. The American Society on Aging (ASA) ANS: A

The NGNA was formed specifically for all levels of nursing personnel: registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and certified nursing assistants (CNAs). The NCGNP is, as its name implies, limited to nurse practitioners.

The NADONA/LTC is, as its name implies, limited to directors and assistant directors of nursing. The ASA is an interdisciplinary organization not limited to nurses.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: 3 | 4 MSC: Health Promotion and Maintenance

3. Which statement accurately describes gerontological nursing education? a. Gerontological nursing content has long been integrated into the curriculum of the

typical school of nursing. b. Undergraduate nursing programs extensively cover gerontological nursing in

dedicated courses, comparable with the coverage of psychiatric nursing. c. The Hartford Foundation has funded significant work regarding the specialty of

gerontological nursing. d. Accreditation of a nursing program guarantees that appropriate amounts of

gerontological nursing content are included in the curriculum.

ANS: C

The most significant influence in enhancing the specialty of gerontological nursing has been the work of The Hartford Institute for Geriatric Nursing, established in 1996 and funded by the John A. Hartford Foundation. Only recently has gerontological nursing content begun to appear in nursing school curricula. Most nursing schools still do not have such courses. At present, no minimum requirements exist for the coverage of care of older adults.

PTS: 1 DIF: Remember REF: 3 MSC: Health Promotion and Maintenance

TOP: Teaching/Learning

4. Based on current demographic data, which of the following statements identifies a predictive

trend regarding the health care needs of society? a. Most nurses will not need to care for older persons. b. More nursing services will be required to serve the needs of the population older than 85 years of age. c. Fewer nurses will be needed to care for older adults since the older population is healthier. d. Older adults expect their quality of life to be less than that of earlier generations at their ages.

ANS: B

Gerontological nursing will be the most needed specialty in nursing as the number of older adults continues to increase and the need for our specialized knowledge becomes even more critical in every specialty and every health care setting. Most nurses can expect to care for older people during the course of their careers. By 2050, the United Nations predicts that more Americans will be over the age of 60 years than those under the age of 15 years. Older people are better educated and more affluent and expect a higher quality of life than their elders had at their age.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: 4 | 5 MSC: Health Promotion and Maintenance

5. What is the primary purpose of geriatric nursing certifications? a. Assuring the basic competency of the geriatric nurse b. Raising the level of professionalism for the geriatric facility c. Addressing the current shortage of specialized geriatric nurses d. Demonstrating commitment to the special needs of the geriatric client ANS: D

Certification assures the public of nurses’ commitment to specialized education and qualification for the care of older adults. None of the other options accurately identify the primary purpose of geriatric nursing certification.

PTS: 1 DIF: Remember REF: 10 | 11 MSC: Safe, Effective Care Environment

TOP: Teaching/Learning

6. An older adult client is transferred to a hospice facility with end -stage disease. Which is a

suitable nursing intervention for this older adult and his family according to the goals of hospice? a. Decrease the analgesic dose to prevent sedation. b. Provide a basin and towels for morning self-care.

c. Inform family members about strict visiting hours. d. Facilitate family rituals related to death and dying.

ANS: D

To promote comfort and dignity, the nurse facilitates the enactment of family wishes, rituals, or religious practices related to death and dying. To promote comfort, the gerontological nurse administers medications as prescribed and avoids restricting analgesic agents to clients, regardless of the setting or the nurse’s personal views. Although fostering independence is within the scope of the gerontological nursing practice, the nurse should assess the older adult and family before assuming that he will want or be able to perform self-care. Although hospice can have regular visiting hours, the older adult may need his family at the bedside for comfort, strength, or companionship. Thus to provide comfort and promote dignity, the gerontological nurse adapts visiting hours to suit the older adult’s needs.

PTS: 1 DIF: Apply REF: 9 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 7. A nursing home executive interviews RNs to fill a full-time position for direct client care to

maintain the standards of elder care. Which nurse should the nursing home hire? a. Nurse from a certified college b. Certified gerontological nurse c. Nurse with 15 years of experience d. Gerontological nurse practitioner ANS: B

A certified gerontological nurse receives education and training to care for older adults, assuring the nursing home and the public that the nurse has mastered the specialized skills and knowledge to care for older adults according to gerontological nursing standards. A nurse educated in a certified college does not necessarily have specialty education and training in gerontology. A nurse with 15 years of experience might have no experience with gerontology and offers no proof of specialized knowledge or skills. Although a gerontological nurse practitioner receives specialized education and training in gerontology, these nurses provide primary care in a nursing home.

PTS: 1 DIF: Apply REF: 9 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 8. Mezey and Fulmer (2002) justify gerontological nursing research and the work of

gerontological advanced practice nurses by concluding the following: a. Other scientists devalue gerontological nursing research. b. The research influences outcomes from nursing care in a positive way. c. Gerontological care is expensive but required in long-term care. d. Gerontological nursing research is well known to practicing nurses.

ANS: B

The practices of advanced practice nurses, who base their practice on nursing research, have resulted in positive older adult outcomes and cost-effectiveness. The scientific community widely accepts the research. Advanced practice nurses generate positive outcomes and are cost effective in many settings. Mezey and Fulmer believe the goal of gerontological nursing is to disseminate the knowledge from gerontological nursing research to all nurses and to have the knowledge applied to their practices.

PTS: 1 DIF: Understand REF: 5 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

9. The gerontological nurse collaborates with the wound care team about an older client who has

an ulcer. How is this nurse demonstrating leadership in the care of older people? a. Assessing older adults effectively b. Facilitating access to elder care programs c. Coordinating members of the health care team d. Empowering older adults to manage chronic illness ANS: C

The nurse demonstrates leadership in the care of older adults by initiating and coordinating collaboration with the wound care team to improve the health of an older adult. Screening and assessing are only indirectly related to collaboration. In this case, the nurse’s collaborative efforts are unrelated to facilitating access to a program. Thus far, the nurse has not educated or trained this client in wound care.

PTS: 1 DIF: Apply REF: 5 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

10. Which organization had the largest role in enhancing the specialty of gerontological nursing? a. American Association of Retired Persons (AARP) b. John Hartford Foundation c. Medicare d. Mutual of Omaha Insurance ANS: B

The most significant influence in enhancing gerontological nursing has been the work of the Hartford Institute for Geriatric Nursing, funded by the John A. Hartford Foundation. The foundation seeks to shape the quality of the nation’s health care for older Americans by promoting geriatric nursing excellence to both the nursing profession and the larger health care community. Initiatives in nursing education, nursing practice, nursing research, and nursing policy include enhancing geriatrics in nursing education programs through curricular reform and faculty development and the development of nine Centers of Geriatric Nursing Excellence. AARP is a foundation that helps struggling seniors by being a force for change on the most serious issues they face today. Medicare is a national social insurance program, administered by the US federal government since 1965, that guarantees access to health insurance for Americans ages 65 years and older and younger people with disabilities. Mutual of Omaha is a Fortune 500 mutual insurance and financial services company based in Omaha, Nebraska.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: 3 MSC: Safe, Effective Care Environment

11. Which of the following statements is true about the National Hartford Centers of

Gerontological Nursing Excellence initiative? a. It was developed to support the professional development and leadership growth of nurses who provide care to older adults in long-term care. b. It offers a Distinguished Educator in Gerontological Nursing Program. c. It provides predoctoral and postdoctoral scholarships for study and research in

geriatric nursing. d. It developed the first certification in gerontological nursing.

ANS: B

The National Hartford Center of Gerontological Nursing Excellence offers a Distinguished Educator in Gerontological Nursing Program. Sigma Theta Tau’s Center for Nursing Excellence in Long-Term Care sponsors the Geriatric Nursing Leadership Academy (GNLA) and offers a range of products and services to support the professional development and leadership growth of nurses who provide care to older adults in long-term care. The ANA developed the gerontological certification exam.

PTS: 1 DIF: Remember REF: 3 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 12. What is one of the goals of Nurses Improving Care for Health System Elders-Long Term Care

(NICHE-LTC)? a. To insure that all older adults are only cared for by nurses who are certified in gerontological nursing. b. To decrease the cost of care for hospitalized older adults. c. To increase access to care for adults age 64 and older. d. To promote the role of the Geriatric Certified Nursing Assistant.

ANS: D

The vision of NICHE is for all clients 65 and over to be given sensitive and exemplary care.

PTS: 1 DIF: Remember REF: 7 | 9 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment MULTIPLE RESPONSE 1. Advanced Practice Nurses have demonstrated the most significant impact in improving which

of the following for older adults? (Select all that apply.) a. Health outcomes b. Length of stay c. Cost-effectiveness d. Reimbursement measures e. Interprofessional communication ANS: A, C

Advanced practice nurses have demonstrated their skill in improving health outcomes and cost-effectiveness. Many of these advanced practice nurses have nursing facility practices managing complex care of frail older adults in collaboration with interprofessional teams.

This role is well established, and positive outcomes include increased client and family satisfaction, decreased costs, less frequent hospitalizations and emergency department visits, and improved quality of care. Reimbursement measures and interprofessional communication have not been identified as areas that advanced practice nurses have demonstrated their skill in improving.

PTS: 1 DIF: Remember REF: 11 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Evaluation

2. The ANA Scope and Standards of Gerontological Nursing (2010) addresses which of the

following? (Select all that apply.) a. The skills and knowledge required to address gerontological client needs b. The levels of gerontological nursing practice c. Requirements for certification as a gerontological nurse d. Standards of gerontological nursing practice e. Continuing education requirements for gerontological nurses ANS: A, B, D

The ANA Scope and Standards of Gerontological Nursing provides a comprehensive overview of the scope of gerontological nursing, the skills and knowledge required to address the full range of needs related to the process of aging, and the specialized care of older adults as a group and as individuals. The document also identifies levels of gerontological nursing practice (basic and advanced) and standards of clinical gerontological nursing care and gerontological nursing performance. Certification requirements and continuing education requirements are not addressed.

PTS: 1 DIF: Remember REF: 2 | 3 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 3. In the document “Recommended Baccalaureate Competencies and Curricular Guidelines for

the Nursing Care of Older Adults” developed by AACN and the Hartford Institute for Geriatric Nursing, New York University, recommendations include which of the following?

(Select all that apply.) a. Provision of a free-standing course in gerontology within the curriculum b. Integration of gerontological content throughout the curriculum c. Requirement of gerontological certification for all students prior to completion of a BSN program d. Structured clinical experiences with older adults across the continuum of care e. Faculty with expertise in gerontological nursing ANS: A, B, D, E

Best practice recommendations for nursing education include provision of a stand -alone course, as well as integration of content throughout the curriculum so that gerontology is valued and viewed as an integral part of nursing care. It is important to provide students with nursing practice experiences caring for elders across the health-wellness continuum. Faculty with expertise in gerontological nursing is an important recommendation.

PTS: 1 DIF: Remember REF: 4 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 4. Which of the following organizations have interdisciplinary membership? (Select all that

apply.) a. Gerontological Society of America b. National Gerontological Nurses Association c. American Society on Aging d. Association of Gerontology in Higher Education e. National Association Directors of Nursing Administration in Long Term Care ANS: A, C, D

Gerontological Society of America, American Society on Aging, and Association of Gerontology in Higher Education are all interdisciplinary organizations. National Gerontological Nurses Association and National Association Directors of Nursing Administration in Long Term Care are nursing organizations.

PTS: 1 DIF: Remember REF: 4 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment 5. Common iatrogenic complications for hospitalized older adults include (Select all that apply.) a. delirium. b. new onset incontinence. c. acute myocardial infarction. d. hip fracture. e. falls.

ANS: A, B, E

Common iatrogenic complications include functional decline, pneumonia, delirium, new-onset incontinence, malnutrition, pressure ulcers, medication reactions, and falls.

PTS: 1 DIF: Remember REF: 7 TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment

Chapter 02: Introduction to Healthy Aging Touhy: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 6th Edition MULTIPLE CHOICE 1. A man is terminally ill with end-stage prostate cancer. Which statement best describes the

nurse’s role regarding this man’s wellness? a. Providing the client with aggressive medical interventions. b. It is not a real option for this client because he is terminally ill. c. Educating the client that wellness is dependent upon the absence of disease. d. Providing nursing interventions that can help empower a client to achieve his highest level of wellness.

ANS: D

Nursing interventions can help empower a client to achieve a higher level of wellness; a nurse can foster wellness in his/her clients. Wellness is defined by the individual and is multidimensional. It is not just the absence of disease. A wellness perspective is based on the belief that every person has an optimal level of health independent of his/her situation or functional level. Even in the presence of chronic illness or while dying, a movement toward wellness is possible if emphasis of care is placed on the promotion of well-being in a supportive environment.

PTS: 1 DIF: Apply REF: 20 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

2. In differentiating between health and wellness in health care, which of the following

statements is true? a. Health is a broad term encompassing attitudes and behaviors. b. The concept of illness prevention was never considered by previous generations. c. Wellness and self-actualization develop through learning and growth. d. Wellness is impossible when one’s health is compromised.

ANS: A

Health is a broad term that encompasses attitudes and behaviors; holistically, health includes wellness, which involves one’s whole being. The concept of illness prevention was never considered by previous generations; throughout history, basic self-care requirements have been recognized. Wellness and self-actualization develop through learning and growth—as basic needs are met, higher level needs can be satisfied in turn, with ever-deepening richness to life. Wellness is impossible when one’s health is compromised—even with chronic illness, with multiple disabilities, or in dying, movement toward a higher level of wellness is possible.

PTS: 1 DIF: Understand REF: 18 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

3. Which racial/ethnic group has the highest life expectancy in the United States? a. Native Americans b. African Americans c. Hispanic Americans d. Asian/Pacific Island Americans

ANS: C

Hispanic men and women have the highest life expectancy of all. This information makes all the other options incorrect.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: 15 MSC: Safe, Effective Care Environment

4. Historical influences that have shaped the lives of the majority of the in-between cohort in the

United States today include which of the following? a. Influenza epidemic of 1918 b. World War I c. Child rearing in the Depression d. World War II ANS: D

Those who are in the in-between cohort were born between 1920 and 1945. The men were likely to have fought in it. The last of the holocaust survivors are in this group. A person who survived the influenza epidemic would be over 100 years old and therefore would be considered old-old or a centenarian. Most of those who are of the in-between cohort had not reached childbearing age by the end of the Depression. Individuals in the in-between cohort would not have been old enough to fight in WWI. PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: 17 MSC: Safe, Effective Care Environment

5. According to researchers, which characteristic do most centenarians share? a. Female b. Hispanic c. Living in rural areas d. Located in the Midwestern states ANS: A

Based on the US census report of 2010, centenarians were overwhelmingly white, female, and living in the urban areas of the Southern states.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: 17 MSC: Safe, Effective Care Environment

6. Which nursing intervention is a holistic approach to an older adult? a. Performs glucose testing during the weekly worship service b. Wheels ambulatory adults to exercise when running late c. Basing interventions on the client’s functional abilities d. Allows older adults in a nursing home to eat meals alone ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank TOP: Nursing Process: Assessment

MSC: Safe, Effective Care Environment

1. The Affordable Care Act (ACA) of the Obama administration has impacted the health of older

adults in which of the following ways? (Select all that apply.) a. Expanded access to preventative care b. Institution of the Medicare annual wellness visit c. Reduced medication costs d. Elimination of all copayments for services e. Provision of hospice services to all Medicare enrollees ANS: A, C

The ACA has expanded access to preventative care and reduced medication costs. The Medicare annual wellness visit was in place before the ACS, as was hospice. The ACA did not eliminate all copays.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 79 MSC: Safe, Effective Care Environment

2. The “Welcome to Medicare” exam includes which of the following? (Select all that apply.) a. Height, weight, and blood pressure measurements b. Simple vision testing c. Hearing evaluation d. Functional status assessment e. Calculation of body mass index ANS: A, B, E

The “Welcome to Medicare” exam includes height, weight, blood pressure measurements, simple vision testing, calculaN t ionRof bIod yGmaBss.iC nd eM x, and a written prevent ive health plan U S N T along with other evaluations that are individually determined for the patient.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 82 MSC: Safe, Effective Care Environment

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 09: Safe Medication Use Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which pharmacokinetic parameter is affected most by decreased intestinal motility related to

the aging process? a. Absorption b. Distribution c. Metabolism d. Excretion ANS: A

Decreased intestinal motility increases the amount of time a substance remains in contact with the intestinal mucosa of the small intestine, where most absorption takes place. With increased exposure, absorption can be increased and the drug effect enhanced. Many medications taken by older adults can also decrease intestinal motility, thereby complicating the titration of medications or introducing new adverse effects through drug-to-drug interactions. Decreased body water leads to higher serum concentrations of water-soluble drugs, increased body fat increases the longevity of fat-soluble drugs, and decreased serum albumin increases the serum concentration of serum protein–bound drugs. Reduced liver mass and hepatic dysfunction can impair oxidative metabolism, which can lead to an accumulation of toxic levels of a drug.

Impaired renal function can impair the excretion of drugs through the kidneys.

PTS: 1 DIF: UnNderR stanI d GREF B:.pC. 11M1-113 MSC: Saf e, Ef f ective Care EnviU ron S menN t T

TOP: Nursing Process: Evaluation

2. Which process is increased in the early morning? a. Fibrinolytic activity b. Blood plasma c. Asthma symptoms d. Rheumatoid arthritis pain ANS: A

Fibrinolytic activity is increased in the early morning. Blood plasma volume falls at night, thus hematocrit increases. Asthma symptoms peak at approximately 4 to 5 AM. Pain from rheumatoid arthritis is most severe in the late afternoon.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 114 MSC: Physiological Integrity

3. In questioning an older adult, which question is likely to elicit the most accurate information

about the individual’s adherence to the medication plan? a. “You take digoxin (Lanoxin) at the correct time, don’t you?” b. “Why didn’t you take all of your digoxin (Lanoxin) last month?” c. “How many doses of digoxin (Lanoxin) do you think you missed?” d. “You have never missed a dose of digoxin (Lanoxin), have you?”

ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank “How many doses of digoxin (Lanoxin) do you think you missed?” is a question that is worded to put the client at ease and to elicit information in a matter-of-fact way. “You take digoxin (Lanoxin) at the correct time, don’t you?” sounds like a challenge to the patient’s personal qualities. In addition, the nurse is leading the patient to the answer. The patient is likely to respond simply, “Oh, yes.” Although the question, “Why didn’t you take all of your digoxin (Lanoxin) last month?” is meant to elicit the reason for nonadherence, it has an accusatory tone that is likely to make the patient defensive. “You have never missed a dose of digoxin (Lanoxin), have you?” is a question that can be interpreted as judgmental.

PTS: 1 DIF: Understand REF: p. 119 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Evaluation

4. When completing medication reconciliation for an older woman, the nurse notes that the

patient is being discharged home on anticoagulant therapy. The nurse also notes that at admission, the patient reported that she uses herbal supplements at home. Which instruction should the nurse include during discharge teaching? a. “You may need to supplement with only ginkgo while on anticoagulant therapy.” b. “You may need to increase the use of garlic supplements while on anticoagulant therapy.” c. “Avoid using Hawthorn supplements while taking an anticoagulant medication.” d. “Avoid using chamomile supplements while on anticoagulant therapy.”

ANS: D

The nurse’s priority is to stop this older adult’s intake of chamomile supplements at home; they will increase the effectiveness of anticoagulation. The nurse instructs this individual to avoid chamomile while she is taking an anticoagulant because the woman’s blood will be much less able to clot, exposing her to a very high risk of a catastrophic injury in the event of G Tto B.C a f all or trauma. The patient N d oU eR s nS otInNeed suppOlement with only ginkgo; the patient should cease taking ginkgo while on anticoagulant therapy, as well as the use of garlic supplements.

Both increase the effectiveness of anticoagulation. The use of Hawthorn supplements has not been shown to affect the use of anticoagulant medications.

PTS: 1 DIF: Analyze REF: p. 116 MSC: Pharmacological and Parenteral Therapies

TOP: Nursing Process: Planning

5. The nurse provides instruction about medication safety to older adults. Which instruction

should the nurse provide? a. Nausea and vomiting are common, harmless drug side effects. b. Keep a supply of medications at the bedside for convenience. c. Ask the health care provider to describe the purpose of therapy. d. Take your daily medications on an empty stomach with water.

ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Older adults should ask the health care provider for the purpose of each drug and record the information. Although nausea and vomiting are among the most common adverse effects of pharmacotherapy, they can indicate medication toxicity and should be reported to the health care provider. Keeping a medication at the bedside is dangerous for anyone and can be especially dangerous for older adults who are taking antianxiety agents, hypnotic agents, and opioid analgesics; these and other medications can cause respiratory depression with and without excessive dosing. If sleepy or lethargic, then the older adult can inadvertently take more than the correct dose and have serious consequences as a result. Taking a medication on an empty stomach with water is a suitable instruction for many medications; however, many medications that are likely to cause nausea are taken with food. The nurse should instruct older adults to keep a record of the recommended method of administration.

PTS: 1 DIF: Understand REF: p. 124-125 TOP: Teaching and Learning MSC: Safe, Effective Care Environment 6. A nurse is preparing to administer medications to an older patient. The nurse consults the drug

reference book, which provides the half-life of the drug. The nurse understands that half-life is defined as a. the amount of time that the drug is stable after prepared. b. the amount of time that it takes for the drug to be excreted by the body. c. the amount of time that the drug remains active in the body. d. the amount of time between drug ingestion and absorption.

ANS: C

Half-life is defined as the amount of time that the drug remains active in the body.

PTS: 1 DIF: Remember REF: p. 113-114 N ntat R SiI G B.C M TOP: Nursing Process: ImplemeU on N MTSC: PhO armaco logical and Parenteral Therapies 7. An older patient who has a history of atrial fibrillation, myocardial infarction, and

hypertension is taking warfarin, aspirin, and a beta blocker is purchasing lunch in the cafeteria after his outpatient appointment. Which of the following meals is most appropriate for this patient? a. Tuna salad on a bed of spinach and a glass of a cup of decaffeinated coffee b. Tuna salad sandwich on whole wheat bread and a cup of decaffeinated coffee c. Tuna and kale salad with a whole wheat roll and a cup of decaffeinated coffee d. Large romaine lettuce salad with broccoli, carrots, tomatoes, and grilled chicken and a cup of decaffeinated coffee ANS: B

Leafy green vegetables decrease the anticoagulant effects of warfarin. A tuna salad sandwich on whole wheat bread and a cup of decaffeinated coffee does not include leafy green vegetables.

PTS: 1 DIF: Apply REF: p. 117 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 8. A nurse is caring for an older adult in a nursing home. During medication reconciliation, the

nurse notes that the patient is prescribed two medications that are listed on the Beers criteria.

What is the best action by the nurse? a. Refuse to administer the medications.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank b. Substitute an alternate medication of the same drug classification. c. Contact the prescriber and to inform the prescriber that the medications are on the

list. d. Inform the resident.

ANS: C

The Beers criteria includes lists of medications that have been demonstrated to cause harm; those specific drug–drug interactions known to cause harm, medications that should only be used with caution, and those that require dosage adjustments in the presence of altered kidney function. The best action by the nurse is to contact the prescriber and notify him or her of the fact that the medications are on the Beers list. The nurse cannot substitute a medication without a prescriber’s order, nor should the nurse refuse to administer the medications.

Informing the resident is important, but most important is resolving the issue with the prescriber.

PTS: 1 DIF: Analyze REF: p. 120 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 9. A nurse is caring for an older resident in a long-term care facility who has a history of

dementia and is becoming agitated. The best response by the nurse to the patient’s agitation is to a. call the prescriber and request an order for a psychotropic medication. b. ignore the behavior because psychoactive medications have potentially dangerous side effects in older patients. c. use only nonpharamacologic interventions to manage the patient’s behavior. d. conduct a thorough nursing assessment of the patient related to the patient’s behavior.

ANS: D

NURSINGTB.COM

A patient should be prescribed a psychotropic medication only after thorough medical, psychological, and social assessments. Nursing assessment before medication intervention contributes knowledge and baseline information that can optimize the patient’s medical and psychological improvement. At the same time, assessments should be done quickly to enable the patient to receive the appropriate treatment as soon as possible. Pharmacologic interventions should always be supplemented by nonpharmacologic measures such as counseling, changes in the environment, and other actions that promote healthy aging.

PTS: 1 DIF: Analyze REF: p. 120 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 10. An older patient who is receiving haloperidol (Haldol) is noted to have a change in mental

status (increasing confusion). Upon assessment, the nurse notes that the patient has a fever, with temperature,102°F; blood pressure, 92/60 mm Hg; heart rate, 118 beats/min; and respirations, 24 breaths/min. The patient is noted to have rigidity of the upper and lower extremities. The first action of the nurse is to a. administer acetaminophen (Tylenol) for the elevated temperature. b. place the patient on fall precautions because of the rigidity of the lower extremities. c. contact the medical provider immediately. d. force fluids to treat the low blood pressure.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: C

A rare but potentially life-threatening adverse drug reaction to antipsychotics is neuroleptic malignant syndrome (NMS). The most typical symptoms are fever greater than 100.4°F, muscle rigidity, autonomic instability (e.g., labile BP, tachycardia), and altered mental status.

The onset is rapid, and unless the patient is treated appropriately, death can occur quickly. The drug most associated with NMS is haloperidol (Haldol), but NMS has also been seen when a person is taking chlorpromazine (Compazine) and promethazine (Phenergan). It occurs most often in the first 2 weeks of the start of treatment but must also be considered whenever a dose is increased. The medical provider must be contacted immediately because this is a medical emergency.

PTS: 1 DIF: Analyze REF: p. 123 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which herbal supplements when taken with an anticoagulant increase the effectiveness of the

medication and should be avoided during anticoagulant therapy? (Select all that apply.) a. Chamomile b. Garlic c. Ginkgo d. Hawthorn e. Ginseng f. Green tea ANS: A, B, C, E, F

The intake of chamomile, garNlic,RginI kgoG , ginBse.nC nd green tea supplements at home should U Sthe Neffectiveness T g, OaM be avoided because each increases of anticoagulation. Individuals should avoid these herbal supplements while taking an anticoagulant because the patient’s blood will be significantly less able to clot, exposing them to the risk of a catastrophic injury in the event of a fall or trauma. The use of Hawthorn supplements has not been shown to affect the use of anticoagulants.

PTS: 1 DIF: Remember REF: p. 116 MSC: Pharmacological and Parenteral Therapies

TOP: Nursing Process: Planning

2. Through which pathways are drugs and their metabolites eliminated? (Select all that apply.) a. Sweat b. Saliva c. Kidneys d. Spleen ANS: A, B, C

Drugs and their metabolites are excreted in sweat, saliva, and other secretions but primarily through the kidneys. Metabolites are not eliminated through the spleen.

PTS: 1 DIF: Remember REF: p. 113-114 TOP: Nursing Process: Planning MSC: Pharmacological and Parenteral Therapies 3. A nurse is administering medications to an older patient who has renal insufficiency. The

nurse understands which of the following? (Select all that apply.)

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank a. Certain drugs may need to be avoided in this patient. b. Certain drug dosages may need to be adjusted based on this patient’s creatinine

clearance. c. Larger doses of most drugs frequently need to be administered in this patient. d. This patient should never be administered acetaminophen (Tylenol). e. Drug effects would in general be diminished in this patient.

ANS: A, B

Drugs that are metabolized in the kidneys may need to be avoided or dosages adjusted based on the patient’s creatinine clearance. Dosages of drugs usually are decreased in patients with renal insufficiency. Because of renal insufficiency, drug effects would be increased, not decreased. In general, Tylenol is not avoided in older patients; it is just limited to a maximum of 4 g/day. Tylenol is of greatest concern in patients with hepatic issues.

PTS: 1 DIF: Analyze REF: p. 113-114 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 4. A nurse is reviewing an older resident’s medication list in a long-term care facility. The nurse

notices that two of the medications are on the Beers criteria. The nurse understands that the Beers criteria (Select all that apply.) a. include medications that are not permitted to be administered in long-term care facilities. b. include medications that should be used in caution in older adults. c. include specific drug–drug interactions that are known to cause harm in older adults. d. include medications that need to be dose adjusted in older adults with impaired kidney function.

NURSINGTB.C OM e. include medications that are not reimbursed by Medicare and Medicaid.

ANS: B, C, D

The Beers criteria include lists of medications that have been demonstrated to cause harm, specific drug–drug interactions known to cause harm, medications that should only be used with caution, and those that require dosage adjustments in the presence of altered kidney function.

PTS: 1 DIF: Remember REF: p. 120 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 5. Common side effects of the selective serotonin reuptake inhibitors (SSRIs) include (Select all

that apply.) a. decreased appetite. b. dry mouth. c. nausea. d. sexual dysfunction. e. dizziness.

ANS: B, C, D, E

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank The SSRIs (e.g., Zoloft, Prozac, Lexapro, Celexa) and serotonin–norepinephrine reuptake inhibitors (e.g., Effexor) have been found to be highly effective, with minimal or manageable side effects, and are the drugs of choice for use in older adults. Most of these cause initial problems with nausea or a dry mouth. Although effective, these drugs must be used with caution especially related to serum sodium levels. The SSRIs should also be used with caution in persons with a history of falls because of the potential to produce ataxia or dizziness. One side effect of the SSRIs that does not resolve with time, if experienced, is sexual dysfunction.

PTS: 1 DIF: Remember REF: p. 121 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 6. Common symptoms of digoxin toxicity include which of the following? (Select all that

apply.) a. Ataxia b. Blurred vision c. Confusion d. Halo vision e. Orthostatic hypotension ANS: B, C, D

Common symptoms of digoxin toxicity include confusion, headache, anorexia, vomiting, arrhythmias, blurred vision or visual changes (halos, frost on objects, color blindness), and paresthesias.

PTS: 1 DIF: Remember REF: p. 118-119 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies 7. Common causes of polypharN maUcR yS inIoN ldG erTpB at. ieC ntO s M includ e which of the f ollowing? (Select all

that apply.) a. Use of multiple different health care providers b. Presence of multiple chronic conditions c. Use of multiple pharmacies to obtain medications d. High cost of medications e. Lack of adequate education on medications ANS: A, B, C, E

Polypharmacy is a common problem in older adults. Contributing factors include multiple chronic conditions, multiple health care providers, use of multiple pharmacies, and inadequate education on medications provided to the patient.

PTS: 1 DIF: Apply REF: p. 115 TOP: Nursing Process: Implementation MSC: Pharmacological and Parenteral Therapies

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 10: Nutrition Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which combination is suitable for the daily diet of older adults? a. Vitamin B12 , 2.4 mcg, and fiber, 15 g b. Three 8-oz glasses of fluid and 1600 calories c. Vitamin B12 , 1.1 mcg, and 40% of daily calories from fat d. Calcium, 1200 mg, and vitamin D, 600 to 800 units ANS: D

Daily recommendation is 1200 mg of calcium, and 600 to 800 units of vitamin D are needed to enable the body to use the calcium. Daily vitamin B 12 intake is correct, but older adults require 20 g to 35 g of fiber. Although 1600 calories per day is correct, fluid intake (preferably water) should be 1500 mL, approximately six to eight 8-oz glasses. Vitamin B12 intake should be 2.4 mcg per day, and calories from fat should be 20% to 25%.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 130-133 MSC: Health Promotion and Maintenance

2. Which is a common age-related physical change that may affect digestion and food intake? a. Loss of the majority of taste buds b. Decreased motility in the esophagus c. Decreased cholecystokiniN n seRcretIionG B.C M d. Loss of smell

U S N T

O

ANS: B

Decreased motility in the esophagus is a common age-related change and can affect the ease of swallowing. A loss of the majority of taste buds is not a common age-related physical change. A small number of taste buds are lost beginning around 60 years of age, but it does not affect all flavors equally. Decreased cholecystokinin secretion is not common; however, increased cholecystokinin secretion is. A loss of smell is not a common age-related physical change.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 130-131 MSC: Health Promotion and Maintenance

3. Which of the following is a true statement about nutrition for older adults? a. Older people should be encouraged to practice strict controls on cholesterol intake

to ensure protection against heart disease. b. Transportation can be a critical factor in nutritional insufficiency in older adults. c. Soul food is a concern primarily for the African American culture. d. No government programs promote congregate dining among older adults.

ANS: B

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Older persons often have difficulty in obtaining adequate transportation to remote supermarkets and may choose light-weight but less nutritious food items rather than heavy fresh fruits and vegetables. Cholesterol phobia, or the excessive concern over cholesterol control, can contribute to malnutrition in older adults. Every culture has some particular foods and ways of preparing food that can bring great comfort for a person raised in that culture.

Title VII of the Older Americans Act provides funding for outreach centers that serve social meals open to all older adults, regardless of their ability to pay.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 130-131 MSC: Health Promotion and Maintenance

4. The nurse is trying to improve the nutritional status of residents in the nursing home. Which

recommendations should the nurse implement? a. Develop a seating chart for the main dining room based on the unit to facilitate a more organized and efficient meal delivery. b. Replace the fluorescent lighting with candles at every table to create a cozy, restaurant-like atmosphere. c. Provide nutritious food according to the residents’ expressed food preferences with a liberal use of seasonings that do not exceed any sodium restrictions. d. Distribute “med-pass” nutritional supplements.

ANS: C

Only nutritious food that is actually eaten can enhance a person’s nutritional status. Older adults are more likely to eat food they like, and seasonings can make food more palatable.

Developing a seating chart for the main dining room based on the unit to facilitate a more organized and efficient meal delivery is not for the benefit of the residents but is an action for the benefit of management and degrades the dignity of the residents. Older adults require NUcan RSd I GT B.C M d im to see ad equately. Distributing greater amount s of light to see; leN ligh t can beOtoo “med-pass” nutritional supplements is costly, and they often are not dispensed or are not consumed as ordered.

PTS: 1 DIF: Understand REF: p. 135 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

5. The nurse instructs the unlicensed assistive personnel to feed an older adult. If the nurse is

unable to observe feeding directly, then which action should the nurse use to assess the older adult’s risk for aspiration immediately after feeding? a. Note food volume eaten. b. Observe skin color. c. Inspect for pocketing. d. Monitor for bradypnea.

ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank The nurse is able to assess the risk for aspiration by assessing the adult for pocketing, which is residual accumulations or pockets of food in the mouth that the older adult can aspirate after the meal is complete. If food is found in the mouth, then the nurse removes it and evaluates the current plan of care. The amount of food consumed by an older adult is unrelated to the risk of aspiration; therefore, noting the amount of food that is eaten is unsuitable for detecting the risk for aspiration. An alteration in circulation as evidenced by a change in skin color can be a late indicator of aspiration. Thus, a change in skin color can indicate the presence of aspiration, but an older adult with a change in skin color is not necessarily at risk for aspiration. The nurse monitors for tachypnea as an indicator of aspiration; however, tachypnea does not indicate a risk for aspiration.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 136-137 MSC: Health Promotion and Maintenance

6. The nursing home staff needs assistance to feed properly the residents who need assistance

with feeding. Which of the following should the nurse implement to ensure that the residents are properly fed? a. Instruct the feeding assistants to feed four people at a time. b. Draw on the availability of family members who are able to follow instructions. c. Ask some residents to self-feed for part of the mealtime. d. Assign a small group of nursing assistants to do the feeding.

ANS: B

With adequate training and cooperation, the nurse allows family members to feed residents who need assistance with feeding. While the family is assisting with feeding, the nurse supervises the feeding, offers feedback to family members, if necessary, and evaluates the outcome. The nurse avoids assigning more than three residents to each assistant for feeding; NU RSt I GT. IB.C four resid ents are too many to assis saN fely f a reO sid ent need s assistance with f eed ing, then attempting to self-feed can be dangerous, humiliating, and frustrating for a resident. If a small group of assistants performs all of the feeding, then the residents will potentially have to wait for long periods before being fed. Because the time required to implement feeding assistance is 38 minutes, a lengthy delay can result in adverse effects or injury for the resident and increase the risk of errors for the assistants, leading to frustration with the residents.

PTS: 1 DIF: Apply REF: p. 137 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 7. A nurse is educating a patient who has been recently diagnosed with osteoporosis on foods

high in calcium. The nurse should include which food choice? a. Okra b. Plain yogurt c. Turnip greens d. Whole wheat bread ANS: B

Plain yogurt has 452 mg of calcium per 8 oz. Okra has 30 mg of calcium per serving. Turnip greens have 14 mg of calcium per serving. Whole wheat bread has 26 mg of calcium per serving.

PTS: 1 DIF: Apply REF: p. 133 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

8. What is the recommended daily intake of fiber for older adults? a. 10 g b. 25 g c. 30 g d. 50 g ANS: B

A daily intake of 25 g of fiber is recommended along with adequate amounts of water.

PTS: 1 DIF: Remember REF: p. 132 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

9. A nurse is caring for an older client in the community who has a diagnosis of advanced

dementia. The client’s caregiver reports that over time, the patient has progressively decreased her oral intake and at present is not swallowing the food put in her mouth. The patient’s caregiver reports that the primary care provider has contacted her and asked her to consider placement of a feeding tube. The caregiver asks the nurse what considerations they should be thinking about in making the decision. The nurse responds based on the knowledge that a. there are significantly better outcomes in older patients with dementia who have feeding tubes. b. careful hand feeding for patients with advanced dementia is recommended instead of feeding tubes. c. there are fewer infections in older patients with dementia who have feeding tubes. d. feeding tubes are relatively low risk in older patients with dementia.

ANS: B

The American Geriatrics SocN ietyRrecI nB d s.cC arefM ul hand f eed ing f or patients with ad vanced GeT U SomNm dementia rather than feeding tube placement. Research demonstrates that there are no better outcomes for patients who have feeding tubes. Feeding tubes are high risk and problem prone particularly in older patients with dementia.

PTS: 1 DIF: Understand REF: p. 137-138 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 10. A nurse administers the Mini Nutritional Assessment (MNA) to an older patient. The patient

is assessed to have a score of 11. The nurse understands which of the following? a. The next step is for the nurse to administer the assessment section of the tool. b. No further action is required at this time. c. Artificial nutrition should be considered. d. The patient is at very high risk of nutritional deficit and needs immediate referral to a dietitian.

ANS: A

A score of 12 or less on the MNA indicates that the patient is at nutritional risk and the next action is to complete the assessment portion of the tool.

PTS: 1 DIF: Apply REF: p. 139 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 11. A nurse assesses an older woman in an outpatient setting. The patient’s height is measured at

5’1” and her weight is recorded as 100 lb. The patient is surprised by her weight and says to the nurse, “I think I lost some weight since last month.” The nurse checks the medical record, and 1 month ago, the patient’s weight was 106 lb. The next action by the nurse is a. continue to monitor the patient’s weight on a monthly basis. b. do a thorough assessment of the patient; this is a significant weight loss and of concern. c. suggest that the patient begin to take in between meal supplements. d. recommend that the patient have several small meals instead of three large meals daily.

ANS: B

Five percent or more of body weight loss is significant and a reason for concern. A thorough assessment is warranted. The assessment needs to be completed before a plan of care being developed. Weight loss of this magnitude in an older adult requires action as opposed to waiting and monitoring for another month.

PTS: 1 DIF: Analyze REF: p. 140 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

12. A nurse is assessing an older adult’s nutritional status. The nurse understands that which of

the following is the most important indicator for a potential nutritional deficit? a. Decreased serum albumin levels b. Decreased vitamin D levels c. Unintentional weight loss d. Anorexia lasting more than 24 hours ANS:

C

NURSINGTB.COM

Unintentional weight loss is the most important indicator of nutritional deficit. The relevance of serum albumin levels as a marker of malnutrition is limited. Vitamin D levels are not considered indicators of malnutrition. There are many possible causes for anorexia, hence it is not a marker of malnutrition.

PTS: 1 DIF: Understand REF: p. 140 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

13. A resident’s family member is concerned that the resident is not eating adequately and is at

risk for malnutrition. The family member says to a nurse, “I heard that there are drugs that can make my mother eat better. Do you think she should be on one?” The best response by the nurse is: a. “Yes, there are some very effective drugs out there. Your mother should be on one of them.” b. “Use of drugs results in minimal improvement in appetite and weight gain and can have some serious side effects.” c. “There are no drugs that impact appetite or weight gain.” d. “These drugs are not permitted to be used in a long-term care facility.”

ANS: B

Drugs to stimulate appetite and weight gain have demonstrated minimal improvement and can have serious side effects.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank PTS: 1 DIF: Apply REF: p. 142 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

MULTIPLE RESPONSE 1. Which recommendations for daily food intake is correct for older adults according to MyPlate

for Older Adults? (Select all that apply.) a. Three 8-oz glasses of water b. Two servings of deep-colored fruit c. Four or more servings of high-quality protein d. One or two servings of brightly colored vegetables e. Three or more servings of low-fat or nonfat dairy products f. Six or more servings of fortified, enriched, or whole grain foods ANS: B, E, F

The Tufts’ food pyramid recommends two or more servings of deep-colored fruit; three or more servings of low-fat or nonfat dairy products such as milk and yogurt; and six or more servings of whole, enriched, or fortified grain products such as brown rice and whole grain cereal and bread. The Tufts’ food pyramid also recommends eight 8-oz glasses of fluid in the form of water, milk, and soup, among others; two or more servings of protein; and three or more servings of brightly colored vegetables.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 131-132 MSC: Health Promotion and Maintenance

2. Which medications affect appetite and nutrition in older adults? (Select all that apply.) a. Digoxin NURSINGTB.COM b. Theophylline c. Iron supplements d. Aspirin e. Phenergan ANS: A, B, C, D

Many medications affect appetite and nutrition, including digoxin, theophylline, nonsteroidal anti-inflammatory drugs, iron supplements, antidepressants, and psychotropic medications.

Clinically significant drug–nutrient interactions can result in nutrient loss, and evidence is accumulating that shows the use of nutritional supplements may counteract these possible drug-induced nutrient depletions. A thorough medication review is an essential component of nutritional assessment, and individuals should receive education about the effects of prescription medications, as well as herbals and supplements, on their nutritional status.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 134 MSC: Health Promotion and Maintenance

3. Which interventions can be used to improve intake for individuals with dementia? (Select all

that apply.) a. Serve soup in a plastic bowl. b. Cut up foods before serving. c. Use clear cups to serve drinks. d. Provide one utensil at a time.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: B, D

Cutting food before serving decreases the risk for choking and makes it easier for patients to feed themselves. Soups should be served in mugs instead of bowls to enable patients to hold the cups for ease of consuming. The use of red cups, not clear cups, has been shown to increase food intake. Providing one utensil at a time can often decrease confusion during meal times.

PTS: 1 DIF: Apply REF: p. 137 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

OTHER 1. The following nursing interventions represent each of the four steps of a nutritional

assessment. Rank them in order, beginning with the first step. a. Measure the midpoint of the upper arm. b. Obtain blood for serum transferrin level. c. Examine the lips, gums, and oral cavity. d. Ask for an up-to-date list of medications.

ANS:

D, C, A, B The first step in a nutritional assessment is to interview the older adult to obtain a health and nutritional history, including an up-to-date list of medications and an overview of daily food habits and resources for obtaining food. The second part of the assessment includes a physical examination to gather data about the older adult’s current state of health. The third part of the assessment includ es anthropoNmUoR rpS hiI cN mG eaTsuBre.mCeO ntMs such as height, weight, mid arm circumference, and triceps skinfold thickness. The biochemical examination is the final step and includes the prealbumin, transferrin, hemoglobin, and cholesterol levels.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 139 MSC: Health Promotion and Maintenance

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 11: Hydration and Oral Care Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following is a true statement about dental health in older adults? a. Most people can expect to lose most of their teeth by old age. b. Excessive saliva production is a common problem among older adults. c. Dentures should be cleaned once a day by brushing and soaking in a cleaning

solution. d. A little blood on the toothbrush is normal.

ANS: C

Careful cleaning of dentures is necessary to prevent the buildup of residues that contribute to staining and odor, as well as to infection. Older adults can lose teeth, but more adults are retaining their teeth into older age. Tooth loss is most often a result of periodontal disease.

Inadequate saliva production (xerostomia) is a common problem for older persons. Bleeding gums is a sign of periodontal disease.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 150 MSC: Health Promotion and Maintenance

2. An older adult with a gastrostomy tube has difficulty using the dominant hand. Which of the

following should the nurse provide to prevent complications of the gastrostomy tube? a. Use f oam swabs to brushN theRteetI h. G B.C M O b. Provid e oral care every 4 hoUursS . N T c. Supply a soft tooth brush and floss. d. Position the patient at 90 degrees for tube feedings.

ANS: B

The nurse provides oral care every 4 hours and brushes the teeth after meals to decrease the microorganism count in the mouth of an older adult with a gastrostomy tube. Foam swabs are ineffective tools to remove plaque, regardless of the toothpaste. Because this older adult has difficulty with the dominant hand, providing oral care supplies can be a waste of time unless the nurse assists the older adult to maintain oral health with the supplies. The nurse positions the older adult at a 30- to 45-degree angle during tube feedings to facilitate gastric emptying.

PTS: 1 DIF: Apply REF: p. 152 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 3. Which of the following is a true statement? a. Urine flow gradually decreases in older age. b. Older adults generally need less fluid than younger people because of their lower

body water content. c. Urine-specific gravity and skin turgor can be used to diagnose dehydration in older

adults and in younger people. d. Multiple physiological changes of aging place older adults at a greater risk of

dehydration than middle-aged persons or children.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: D

The loss of water-containing tissues, the loss of concentrating power in the kidneys, and a decreased sense of thirst all increase an older person’s risk for dehydration. Urine flow does not diminish in old age. Specifically, it does not diminish in the presence of dehydration as it does in a younger patient. Lower body water content places an older patient at greater risk of dehydration, not a lower risk. These signs are less reliable in older age because of changes to the tissues.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 145 MSC: Health Promotion and Maintenance

4. Which increases the risk for chronic dehydration in older adults? a. Overuse of diuretic agents b. Poor cognitive function c. Dry mucous membranes d. Fluid loss from vomiting ANS: B

Poor cognitive functioning, depending on others for ambulation, living in a residential facility, and having four chronic illnesses are factors that increase the risk of chronic dehydration. An overuse of diuretic agents is more likely to cause acute dehydration. Dry mucous membranes are reliable indicators of chronic dehydration. Fluid loss from vomiting leads to acute dehydration.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 146 MSC: Health Promotion and Maintenance

5. Which of the f ollowing is a trNuU eR st aSteIm bo.uC t fO luMid intake f or old er ad ults?

NeGntTaB a. Daily total volume should be 1500 to 2000 mL. b. Coffee is a suitable beverage for maintaining hydration. c. Caffeinated beverages are sometimes preferable to water. d. Total daily fluid intake should be approximately 10 mL per kg of body weight.

ANS: A

Daily total volume of fluid should be 1500 to 2000 mL. Caffeine increases urine production and therefore aggravates dehydration rather than relieving it. Total daily fluid intake should be 30 mL per kg of body weight, not 10 mL. PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 145 MSC: Health Promotion and Maintenance

6. The nurse notices that an older adult’s urine is greenish-brown. Which step should the nurse

implement next? a. Increase oral fluid intake. b. Review laboratory reports. c. Evaluate the medication list. d. Determine fluid volume status.

ANS: D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank The nurse assesses the older adult’s fluid status to develop a suitable plan of care. The nurse selects the correct nursing interventions, depending on the cause of the problem. Increasing oral fluid intake is implemented after the nurse completes the fluid assessment, if the intervention is determined to be suitable. The nurse reviews pertinent laboratory data as part of the fluid assessment. The nurse evaluates the medication list as part of the fluid assessment to eliminate a medication as the cause of the dark urine.

PTS: 1 DIF: Analyze REF: p. 147 TOP: Nursing Process: Implementation MSC: Physiological Integrity 7. An older woman asks a nurse, “You always seem to be telling me that I need to drink more

water. How much water do I really need to drink?” The nurse bases her response on the knowledge that: a. older adults should consume at least 1000 mL of fluid per day. b. older adults should consume at least 1500 mL of fluid per day. c. older adults should consume at least 2000 mL of fluid per day. d. older adults should consume at least 2500 mL of fluid per day.

ANS: B

Older adults, with the exception of those who require a fluid restriction, should consume at least 1500 mL of fluid per day.

PTS: 1 DIF: Remember REF: p. 145 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

8. A nurse administers hypodermoclysis (HDC) to an older nursing home resident. The purpose

of hypodermoclysis is a. to rehyd rate an ind ivid ualNw d eBh. ydC raOtiM on.

UitRhSseIvNerGe T b. to quickly administer 4 to 5 L of fluid within a 24-hour period. c. to rehydrate an individual with mild to moderate dehydration. d. as a supplement to intravenous (IV) hydration to expedite rehydration.

ANS: C

HDC is an infusion of isotonic fluids into the subcutaneous space. It is an alternative to I V administration for individuals with mild-to-moderate dehydration. It cannot be used in individuals with severe dehydration or for any situation requiring more than 3 L over 24 hours.

PTS: 1 DIF: Remember REF: p. 147 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

9. Which of the following statements describing oral care for the older population is correct? a. Regular dental examinations can prevent tooth loss and improve the ability to

chew healthful foods. b. Losing one’s teeth is considered a normal part of the aging process. c. Oral malignancies seldom occur in older adults, so oral examinations are of low

priority. d. Preventative dental care is covered under Medicare.

ANS: A

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Regular dental care is essential and can prevent tooth loss. Losing one’s teeth is not a normal part of aging about 25% of adults older than 65 years of age are edentulous. Oral cancers occur more often in older individuals. The median age at diagnosis is 61 years. Oral examinations can assist in early identification and treatment. Medicare does not provide any coverage for oral care services.

PTS: 1 DIF: Remember REF: p. 150 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

10. In a long-term care facility, a nurse is having a discussion with the nurse aides about ways to

deal with dementia clients who are uncooperative with mouth care. Appropriate methods to use include a. speaking to the client sternly and instructing the client to open the mouth and cooperate immediately. b. having another nurse aide assist in holding the client’s mouth open with a tongue depressor. c. involving the client in the process of oral hygiene, such as using the hand-over-hand technique to brush the client’s teeth. d. quickly performing oral hygiene without explanation because the client is uncooperative.

ANS: C

With uncooperative individuals, it is important for the caregiver to be at eye level and explain all actions with step-by-step instructions. Speaking to the client sternly, having another nurse aide hold the patient’s mouth open, or performing oral hygiene without an explanation will only serve to agitate the patient. Involving the client and having the client participate to the extent possible is important. Usin N Rg aIhanGd -oBve.r-ChanMd technique is ef f ective.

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PTS: 1 DIF: Analyze REF: p. 152 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

11. A nurse is observing a nurse aide perform denture care for a resident in the nursing home. The

nurse recommends that the nurse aide receive additional education on denture care when the nurse observes which of the following? a. The nurse aide places a face cloth in the sink and fills the sink half full with water. b. The nurse aide uses toothpaste to clean the dentures. c. The nurse aide uses a specially designed denture brush to clean the dentures. d. The nurse aide stores the dentures in a denture cup filled with denture cleansing solution.

ANS: B

Toothpaste is not used to clean dentures because it abrades denture surfaces. All of the other options are correct steps in the process to cleanse dentures.

PTS: 1 DIF: Remember REF: p. 151 MSC: Health Promotion and Maintenance MULTIPLE RESPONSE

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 1. According to Healthy People 2020, older adults have been identified as a priority, addressing

goals to improve dental health. Identify the correct dental health goals for older adults. (Select all that apply.) a. Reduce the proportion of adults with untreated dental decay. b. Prevent and control oral and craniofacial diseases, conditions, and injuries. c. Reduce the proportion of oral and pharyngeal cancers detected at the earliest stages. d. Improve access to preventive services and dental care. e. Reduce the proportion of older adults with untreated caries. f. Increase the proportion of older adults 65 to 74 years of age who have lost all of their natural teeth.

ANS: A, B, D, E

In a push toward wellness, older adults were identified as a priority area for the first time.

Good oral hygiene and timely assessment of oral health are essentials of nursing care.

PTS: 1 DIF: Remember REF: p. 149 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

2. Which of the following are age-related changes that affect hydration status? (Select all that

apply.) a. Decrease in thirst sensation b. Decrease in total body water c. Decrease in ability of kidneys to maximally concentrate urine d. Decrease in bone marrow mass e. Decrease in bladder capacity ANS: A, B, C

NURSINGTB.COM

As one ages, thirst sensation decreases and is not proportional to metabolic needs in response to dehydrating conditions. There is a decrease in total body water. The kidneys are less able to maximally concentrate urine, resulting in a loss of water. Although there is a decrease in bone marrow mass, this does not impact hydration status. As one ages, bladder capacity decreases; however, this does not directly impact hydration status.

PTS: 1 DIF: Remember REF: p. 146 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

3. A nurse is performing an admission assessment on an older patient who presented with a high

fever and cough, reduced oral intake for 3 days, and lower extremity weakness. The patient has sunken eyes, and the patient’s skin turgor over the sternum is poor. The nurse suspects that the patient is dehydrated. Which of the following are indicators of dehydration in this patient? (Select all that apply.) a. Poor skin turgor over the sternum b. Lower extremity weakness c. High fever d. Sunken eyes e. Cough ANS: B, D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Older adults often present atypically when dehydrated. Skin turgor over the sternum is not a reliable marker in older adults because of the loss of subcutaneous tissue with aging. Lower extremity weakness and sunken eyes may indicate dehydration. A high fever and cough can be associated with many other conditions and are not typically signs of dehydration.

PTS: 1 DIF: Apply REF: p. 146 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

4. Which of the following nursing interventions should be implemented to prevent dehydration

in hospitalized older adults? (Select all that apply.) a. Implementing intake and output recording for any patients with fever, diarrhea, vomiting, or an infection b. Limiting duration of nothing by mouth (NPO) requirements for diagnostic tests and procedures c. Administering intravenous (IV) fluids to all hospitalized older adults d. Limiting the use of diuretic medications in hospitalized older adults e. Making sure that hospitalized patients have easy access to fluids ANS: A, B, E

To prevent dehydration, it is essential to closely monitor hospitalized older adults. Any individual who develops fever, diarrhea, vomiting, or an infection should be monitoring closely by implementing intake and output records and providing additional fluids. NPO requirements for diagnostic tests and procedures should be as short as possible. It is not appropriate to administer IV fluids to all hospitalized older adults. IV fluids are administered when there is a clinical indication. It is not appropriate to limit the use of diuretics. Diuretics are an important treatment for many older patients. Hydration management involves acute and ongoing management of oralNintaRke.I OraG l hyB d rat .CionMis the f irst line of treatment f or dehydration prevention.

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PTS: 1 DIF: Apply REF: p. 147 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

5. An older adult complains of xerostomia. Which of the following interventions should the

nurse implement for this patient? (Select all that apply.) a. Encourage the patient to brush and floss teeth regularly. b. Encourage the patient to have regular dental screenings. c. Provide antiseptic mouth wash (such as Listerine) for the patient. d. Encourage adequate intake of water. e. Provide saliva substitutes.

ANS: A, B, D, E

Individuals with xerostomia should have regular dental screenings and be encouraged to practice good oral hygiene. Adequate intake of water is important, as if avoidance of alcohol and caffeine. Saliva substitutes may be helpful. Antiseptic mouth washes usually contain alcohol, which can further dry the mouth.

PTS: 1 DIF: Apply REF: p. 149 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 6. A nurse is caring for an older adult who has a gastrostomy tube. The nurse is developing a

care plan related to oral care. Which of the following should the nurse consider for this patient? (Select all that apply.) a. Oral care should be provided every 4 hours. b. Teeth should be brushed with a toothbrush after each tube feeding. c. Lemon glycerin swabs should be used in between feedings to keep the mouth moist. d. Foam swabs should be used in place of a toothbrush to clean the teeth after each tube feeding. e. Oral care should be provided only twice daily if the older adult is edentulous.

ANS: A, B

Tube feeding is associated with significant pathological contamination of the mouth, greater than in individuals who receive oral feeding. Oral care should be provided every 4 hours for patients with gastrostomy tubes and teeth should be brushed with a toothbrush after each feeding to decrease the risk of aspiration pneumonia. Lemon glycerin swabs should never be used for oral care because they dry and inhibit saliva production. Foam swabs do not remove plaque as well as tooth brushes. Oral care is required even if the individual is edentulous.

PTS: 1 DIF: Apply REF: p. 152 MSC: Health Promotion and Maintenance

NURSINGTB.COM

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 12: Elimination Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following is a true statement about elimination in older adults? a. Defecation less than once each day is not necessarily constipation. b. Mineral oil is recommended as a laxative for older adults. c. Excessive sleep can be a symptom of constipation. d. Leaking liquid feces should be treated as diarrhea.

ANS: A

Constipation is present when fewer than three bowel movements occur per week or when the frequency decreases. Mineral oil and saline laxatives can be harmful. Fiber, fruit, and fluids are the first recommendations; stimulant laxatives such as senna and cascara can be used on a short-term basis. Altered cognitive status, increased agitation, and unexplained falls can be symptoms of constipation; these behaviors may be the only clinical symptom of constipation in cognitively impaired older persons. Excessive sleep has not been identified as a symptom.

Liquid feces may be leaking around a fecal impaction, and antidiarrheal treatment can aggravate the impaction.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 164 MSC: Physiological Integrity

2. Which action should be incluN d edRin aIll bG lad dBer-r .CetraMining programs?

U S N T O a. Toileting at bedtime b. Using adult incontinence pads c. Toileting every hour d. Providing 1000 mL of fluids daily ANS: A

Toileting at bedtime should be incorporated for all patients. This intervention decreases the amount of urine in the bladder during the night. Incontinence pads are not encouraged during the retraining process. Toileting is not automatically scheduled every hour but is based on the individual’s needs. The volume of scheduled fluid intake is also based on the individual’s needs.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 159

3. The nurse understands that stress incontinence occurs a. with a urinary tract infection (UTI). b. because of emotional strain. c. as a result of increased intra-abdominal pressure. d. with a specific amount of urine in the bladder.

ANS: C

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank If intra-abdominal pressure increases, then the patient can have dribbling. A UTI causes frequency as a result of irritation in the bladder. Emotional strain can cause frequency.

Specific volume of urine in the bladder triggers reflex incontinence.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 157 MSC: Health Promotion and Maintenance

4. What is the most important aspect of care for the nurse to maintain when assisting an older

patient with urinary incontinence? a. Availability of protective rubber garments b. Using indwelling urinary catheters c. Using smooth muscle relaxants d. Maintaining an attitude that is respectful and positive about resolving the problem ANS: D

The nurse recognizes that incontinence is a sign of an underlying problem and not an inevitable result of aging. In addition, the nurse offers dignity, hope, and understanding by maintaining a positive and respectful manner and by communicating that effective treatments are available. Rubber garments, in particular, are hot and can cause skin irritation. Internal catheters should be used only for a short time and under limited circumstances. Using a smooth muscle relaxant is indicated only for urge incontinence and for an overactive bladder.

PTS: 1 DIF: Understand REF: p. 157 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 5. Which option is part of a program that addresses bowel incontinence in an older adult patient? a. Ensuring that a toilet or commode is readily accessible to the patient

RoSfIwNatGerTeBve.ryCdOaMy b. Encouraging the intake ofN1UL c. Expecting a rapid and full recovery d. Toileting the patient 10 to 15 minutes after meals ANS: A

Difficult access to facilities within the time available is a factor in bowel incontinence and bladder incontinence. The intake of 1 L of fluid is less than the recommended amount to protect against dehydration and constipation. Realistic expectations and goals should be discussed with the patient. Toileting should occur 20 to 40 minutes after regularly scheduled meals when the gastrocolic reflex is active.

PTS: 1 DIF: Remember REF: p. 166 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

6. An older adult who is on bed rest after surgery is prescribed morphine for pain. Which of the

following is the nurse’s priority for preventive care? a. Constipation b. Diarrhea c. Poor solid food intake d. Poor liquid intake ANS: A

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank This older adult is at high risk for developing constipation as a result of being on bed rest and being prescribed an opiate for pain. A decrease in activity, combined with the use of an opiate, often leads to constipation, not diarrhea. Appetite can be poor for the first few days after surgery, but it often returns without incidence. Decreased fluid intake is often supplemented with intravenous fluids for the first few days after surgery.

PTS: 1 DIF: Apply REF: p. 165-166 TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance 7. The nurse is caring for a patient who has recently had an indwelling catheter placed. The

nurse should assess the patient for a. an increase in oral fluid intake. b. a change in mental status. c. upper back pain. d. a decrease in activity.

ANS: B

The nurse assesses the older adult’s mental status. Changes in mental status, character of urine, decreased appetite, abdominal pain, chills, low back pain, urethral discharge in men, new onset of incontinence, or even respiratory distress may signal a possible urinary tract infection in older people. An indwelling catheter does not often cause a decrease in activity.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 163 MSC: Physiological Integrity

8. The nurse assesses a male resident in a nursing home for urinary incontinence and determines

that he is unaware of the problem. Which recommendation should the nurse implement? a. Limit oral fluid intake. NURSINGTB.COM b. Provide regular toileting. c. Apply absorbent undergarment. d. Encourage frequent rest periods.

ANS: B

The nurse provides regular toileting to promote voiding and to prevent incontinence for a resident with a potential cognitive impairment. The nurse avoids limiting oral fluid intake; older adults, especially those living in residential facilities, are at higher risk for dehydration than younger people. Using absorbent undergarments may be unnecessary if the incontinence can be controlled with regular toileting. Nursing research supports the claim that ambulatory residents are less likely to be incontinent. This resident may have dementia, but maintaining mobility will have a greater impact in preventing incontinence.

PTS: 1 DIF: Apply REF: p. 167 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

9. A large residual urine volume characterizes what type of incontinence? a. Urge b. Stress c. Overflow d. Functional ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Dribbling, hesitancy, and a large residual urine volume characterize overflow incontinence.

Both urge incontinence and stress incontinence are associated with a small residual urine volume. Functional incontinence is not associated with residual urine volume.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 157 MSC: Physiological Integrity

10. The nurse wants to begin helping a resident who is overweight and has urinary incontinence

with healthy bladder behavior skills. Which intervention should the nurse implement? a. Begin a low-calorie diet for weight management. b. Schedule voiding at 2- to 4-hour intervals. c. Instruct the resident to practice abdominal exercises. d. Reduce the time between an urge to void and voiding.

ANS: B

Healthy bladder behavior skills include scheduling voiding at 2- to 4-hour intervals for residents either independently or with prompting. Beginning a low-calorie diet can be a reasonable approach to urinary incontinence, but the nurse first applies low-cost behavioral techniques. Pelvic floor exercises will help control urinary incontinence. Bladder training involves increasing the time between the urge to void and voiding.

PTS: 1 DIF: Apply REF: p. 158 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 11. An older woman tells the nurse practitioner that she fears her family will place her in a

nursing home because she developed stress incontinence. Which recommendation should the nurse implement? a. Tell her to eliminate the uNseUR of ScI af fNeG inaTteBd.bC evOeM rages. b. Coordinate a family conference with the older adult. c. Recommend exercises to strengthen the pelvic floor. d. Schedule voiding for every 2 hours around the clock.

ANS: C

The nurse practitioner recommends pelvic floor exercises to strengthen the pelvic floor and the muscles that surround the urethra, vagina, and rectum to decrease the incidence of stress incontinence. Stress incontinence is usually caused by weakened pelvic floor muscles; therefore, eliminating caffeinated beverages can be an ineffective treatment. Arranging a family conference is premature and potentially embarrassing for older adults. Many therapies are available to decrease this older adult’s incontinence. Scheduled voiding is recommended at 2- to 4-hour intervals during the day and at 4-hour intervals at night.

PTS: 1 DIF: Apply REF: p. 159 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 12. A nurse visits an older woman in her home. The woman was recently discharged from a

subacute rehabilitation facility where she went after a left hip open reduction and internal fixation. The patient ambulates steadily and slowly with a rolling walker. The patient reports that she has an “embarrassing problem” and states that she doesn’t always make it to the bathroom and often wets herself on the way. She attributes this to the fact that she moves slowly. The patient has no complaints of burning or pain on urination. The nurse suspects which type of urinary incontinence?

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank a. b. c. d.

Stress Overflow Functional Urge

ANS: C

Functional incontinence is related to the inability to get to the bathroom because of mobility or environmental issues. This patient moves slower and therefore cannot get to the bathroom in time.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 157 MSC: Health Promotion and Maintenance

13. An older woman presents to the geriatric clinic for a routine annual wellness visit. Upon

assessment, the patient reports that she needs to wear a pad because she loses urine when she coughs and sneezes. She also reports that this happens when she picks up her 2-year-old grandson. The nurse suspects which type of urinary incontinence? a. Stress b. Overflow c. Functional d. Urge ANS: A

Stress incontinence is defined as a loss of small amount of urine with activities that increase intra-abdominal pressure (e.g., coughing, sneezing, exercising, lifting, bending).

PTS: 1 DIF: Apply REF: p. 157 TOP: Nursing Process: AssessN menRt I GMSB C:.H CealMth Promotio n and Maintenance

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MULTIPLE RESPONSE 1. Long-term use of external catheters can lead to which complications? (Select all that apply.) a. Fungal skin infections b. Penile skin maceration c. Atrophy d. Edema e. Phimosis ANS: A, B, D, E

Long-term use of external catheters can lead to fungal skin infections, penile skin maceration, edema, fissures, contact burns from urea, phimosis, UTIs, and septicemia. The catheter should be removed and replaced daily and the penis cleaned, dried, and aired to prevent irritation, maceration, and the development of pressure ulcers and skin breakdown. If the catheter is not sized appropriately and applied and monitored correctly, then strangulation of the penile shaft can occur. Atrophy has not been identified as a complication.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 162-163 MSC: Health Promotion and Maintenance

2. Continuous indwelling catheter use is indicated for which conditions? (Select all that apply.) a. Urethral obstruction

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank b. c. d. e.

Urinary retention Stress incontinence Severely impaired skin integrity Gait impairment

ANS: A, B, D

Continuous indwelling catheter use is indicated for those with urethral obstruction or urinary retention because these patients are unable to empty their bladders without this device. Stress incontinence is not a condition that warrants a continuous indwelling catheter. Continuous indwelling catheter use is indicated for patients with severely impaired skin integrity to decrease the risk of further deterioration of skin integrity. Immobility is not an evidence-based indication for an indwelling catheter.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 162 MSC: Health Promotion and Maintenance

3. A nurse is conducting education on urinary incontinence at a senior center. The nurse is

discussing lifestyle changes that are associated with an improvement in urinary incontinence.

The nurse includes which of the following interventions? (Select all that apply.) a. Weight reduction b. Smoking cessation c. Increase in physical activity d. Fluid restriction e. Blood sugar control ANS: A, B, C

Several lifestyle factors have been associated with an improvement in urinary incontinence.

These includ e increased f luidNiU ntaRkS e,IsN mG okTinBg.ceCsO saM tion, bowel management, physical activity, and weight reduction. Fluid restriction is not an intervention associated with an improvement in urinary incontinence, nor is blood sugar control.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 161 MSC: Health Promotion and Maintenance

4. An older adult with moderate dementia is seen in the geriatric clinic. As the nurse is

evaluating the patient, the patient’s wife states that her husband has developed an increasing number of episodes of incontinence. She does not know what is precipitating the episodes and states, “Maybe he just doesn’t remember that he needs to urinate, or maybe it’s me; it takes me a while to walk him to the bathroom.” The nurse develops a plan of care for this patient and includes which of the following interventions to manage the incontinence? (Select all that apply.) a. Use of adult incontinence briefs b. Use of an external catheter c. Development of a toileting schedule d. Use of a commode close by to where the patient spends most of his time e. Bladder diary to be completed by the patient’s wife ANS: C, D, E

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank A bladder diary is a helpful tool used to assess an individual’s voiding patterns and to assist in assessment of incontinence. Development of a toileting schedule can be helpful in individuals with dementia who might no longer be aware of the cues to void. A commode may be helpful in this case because the wife indicates that it takes her some time to bring her husband to the toilet. Adult incontinence briefs and external catheters are not first-line interventions for this individual.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 159-161 MSC: Health Promotion and Maintenance

NURSINGTB.COM

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 13: Rest, Sleep, and Activity Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following is a true statement about sleep in older adults? a. The time spent in bed increases, but the time spent asleep decreases. b. The amount of leg movement during sleep remains steady throughout life. c. Rapid eye movement (REM) sleep becomes more unevenly distributed with age. d. The amount of stage III sleep increases steadily throughout life.

ANS: A

Older persons tend to spend less time asleep than younger persons, although they spend more time in bed. This statement is true because sleep takes longer to arrive and is more fragmented. Leg movements during sleep often tend to increase with age. REM sleep becomes more evenly distributed with age. Stage III sleep decreases with age and virtually disappears in older adults.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 171 MSC: Health Promotion and Maintenance

2. Which of the following is a true statement about sleeping in older adults? a. Older adults tend to fall asleep quickly but are awakened throughout the night. b. Sleep disturbances in older adults can be caused by chronic illness. c. Benzodiazepine agents are the medications of choice for sleep disorders.

R I arGe T B.C M d. The times of d ay that meN d icUatioSns N given haOs no ef f ect on sleep d isturbances.

ANS: B

Chronic illness is an internal risk factor that can contribute to sleep disorders. It takes older adults more time to fall asleep, and older adults are awakened throughout the night more frequently than younger people. Benzodiazepines should not be used to induce sleep; these substances are highly addictive, and if their administration is suddenly withdrawn, then rebound insomnia can occur. In addition, older adults who take benzodiazepines for sleeping are more likely to experience a “hangover” after waking that can increase the risk of accidents and injuries. The times of day that medications are given can also contribute to sleep problems—for example, a diuretic given before bedtime or sedating medications given in the morning.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 172 MSC: Physiological Integrity

3. An older man has Alzheimer’s disease, and his wife says he is up and wandering around the

house at night. Which intervention should the nurse implement to increase the man’s duration of sleep? a. Instruct the wife to increase his daily physical activity. b. Collaborate with the health care provider to administer a hypnotic medication. c. Teach the wife how to apply a vest restraint during sleep. d. Help the wife plan daily periods for napping and activity.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: A

Regular exercise can help increase the duration of sleep during the night. Adding a new medication to the existing pharmacotherapy can increase adverse drug interactions and complicate the problem; the existing therapeutic regimen can be already contributing to the problem. Administering a hypnotic medication is the therapy of last resort and can be ineffective. The nurse avoids recommending the use of restraints; restraint use is associated with an increased incidence of injury and accidents. In addition, restraints can be an ineffective therapy and can contribute to hostility and combativeness. Excessive napping during the day may be contributing to the problem.

PTS: 1 DIF: Apply REF: p. 180 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 4. Exercises are prescribed for older adults as therapy to improve which one of the following

qualities? a. Relative intensity b. Muscle strength c. Muscle retraining d. Body sculpting ANS: B

Exercises that improve muscle strength are important for balance, strong bones, and metabolic processes. Relative intensity is the level of effort required by a person to an activity. When using relative intensity, people pay attention to how physical activity affects heart rate and breathing. Muscle strength is not a therapeutic concern. Muscle retraining refers to muscles that have been trained, detrained, and trained again and is not a therapeutic concern. Muscle d ef inition is a quality valued by bod ybuild ers, but it is not a therapeutic concern.

N R I G B.C M U S N T O

PTS: 1 DIF: Remember REF: p. 180 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

5. During the night, an older woman complains to the nurse that she has not slept more than 2

hours since admission to the hospital. Which intervention should the nurse implement to increase the duration of this woman’s sleep? a. Inquire about her sleep habits used at home. b. Suggest that she avoid napping during the day. c. Tell her that sleep is fragmented in older people. d. Offer a book to her or suggest watching a movie.

ANS: A

Hospitalization often disrupts normal sleeping patterns; therefore, reestablishing these patterns is the best first step to improving the quality of sleep in the hospital. Avoiding napping during the day is a reasonable approach to complaints of sleeplessness, but it may not be this woman’s problem. Sleep is increasingly fragmented in older adults; however, understanding that issue may or may not help this woman sleep for longer periods. A book or movie can help some people become drowsy, but becoming drowsy will not usually increase the quality or duration of sleep. In fact, books and movies can be stimulating and decrease the ability to fall asleep.

PTS: 1 DIF: Apply REF: p. 173 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

6. What is the difference between rest and sleep? a. Sleep occurs with rest. b. Rest is an extension of sleep. c. Rest occurs only in brief periods. d. Sleep is restorative and recuperative.

ANS: D

Sleep provides an important survival tool to rest, restore, and rejuvenate the body. Rest occurs during sleep. Sleep is an extension of rest. Rest can occur in brief periods and in extended cycles during sleep.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 170 MSC: Physiological Integrity

7. An older woman maintains an active lifestyle playing various games with friends. She reports

to the nurse that she experiences wakefulness during the night and an inability to fall asleep after waking up at night. Which intervention should the nurse implement to improve the quality of this woman’s sleep? a. Recommend preparation for sleep. b. Suggest trying a cup of warm milk at bedtime. c. Inquire about her nightly sleep rituals. d. Propose volunteer work at a thrift shop.

ANS: C

The nurse completes an assessment of the woman’s sleeping habits and other pertinent information before planning care and implementing nursing interventions to individualize therapy. Preparing f or sleep iN saR onabGle B UreasSI N Tint.erCvenMtion to propose af ter completing an assessment. Sipping warm milk is also a reasonable intervention to suggest after completing an assessment. Engaging in meaningful activities can improve the quality of sleep and is a reasonable intervention to propose after the assessment.

PTS: 1 DIF: Apply REF: p. 173 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 8. The nurse completes an admission assessment on an older adult patient. The nurse identifies

which factor that may contribute to sleep problems? a. Exposure to sunlight b. Polypharmacy c. Use of a sleep aid d. Decreased fluid intake ANS: B

Polypharmacy contributes to sleep problems as a result of medication side effects and drug interactions. Decreased exposure to sunlight contributes to sleep problems. Sleep aids may assist with sleep issues. Decreased fluid intake may lead to dehydration, which may result in lethargy.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 173

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 9. The nurse at an assisted-living facility uses the Exercise and Screening for You (EASY) tool

to plan an exercise program for a female resident who is in good health except that her height has decreased inch. Which exercise safety tip from EASY calls for the nurse to assess the resident before planning care? a. Do not exercise a red, warm, or swollen joint. b. Avoid stretches that cause you to bend at the waist. c. Evaluate your surroundings for outdoor exercising. d. Begin by warming up with low- to moderate-intensity exercises.

ANS: B

The nurse needs more information because the reason the resident’s height has decreased is not known. Therefore, to obtain the information, the nurse decides to complete a resident assessment before planning an exercise program. The shrinkage can be due to atrophy of intervertebral disks, compression fractures, or changes in the curvature of the spine, any of which can be aggravated by incorrectly exercising. With a complete assessment, however, the nurse can plan a suitable exercise program for the resident. Red, warm, swollen joints are usually caused by gout or rheumatoid arthritis; fortunately, the resident does not have these health problems. However, this is a good recommendation for anyone who exercises.

Evaluating an individual’s surroundings when exercising does not alert the nurse who is considering an exercise plan for this resident; however, this is a good, general recommendation for anyone who exercises. Warming up with low- to moderate-intensity exercises is a good recommendation for anyone who exercises.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 179 MSC: Health Promotion and Maintenance

10. A patient who reported “a pro leepGing”B s.hoCwsMan und erstand ing of good sleep hygiene NbleRm sI

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when a. doing 10 pushups before bed to encourage a “pleasant tiredness.” b. seldom eating a bedtime snack. c. engaging in computer games as a prebed activity. d. limiting the afternoon nap to just 30 minutes.

ANS: D

Limiting daytime napping to 30 minutes or less is a good sleep hygiene practice. Exercise should be completed at least 4 hours before retiring while bedtime snack is acceptable if the food is light and so easily digested. Computer-focused activities are not generally encouraged as a part of a bedtime routine.

PTS: 1 DIF: Apply REF: p. 174 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

11. When an older adult patient is diagnosed with restless leg syndrome (RLS), the nurse is

confident that patient education on the condition’s contributing factors has been effective when the patient states: a. “A warm bath at night instead of in the morning is my new routine.” b. “Eating a banana at breakfast assures me the potassium I need.” c. “I’ve cut way back on my caffeinated coffee, teas, and sodas.” d. “I elevate my legs on a pillow to improve circulation.”

ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Increased caffeine use can be a contributing factor to RLS. There is no research to confirm that a warm bath before sleep or elevating the legs will minimize or prevent RLS. Potassium deficiency has not been identified as a contributing factor to RLS. PTS: 1 DIF: Apply REF: p. 177 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

12. An older patient asks a nurse, “I really have trouble sleeping, and my doctor does not want to

prescribe a sleeping pill for me. He says they are not good for older people. I really don’t understand his response. Can you help me?” The best response by the nurse is: a. “Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep.” b. “Prescription sleeping medications have many adverse effects in older people.

Why don’t you try using an over-the-counter medication?” c. “Sleeping medications do not provide any improvement in sleep for older people.” d. “Sleep problems are common in older people. There really is nothing that you can do to help with that.”

ANS: A

Adverse effects of sleep medications, including over-the-counter medications, include problems with daily function, changes in mental status, motor vehicle accidents, daytime drowsiness, and increased risk of falls with only minimum improvement in sleep. Sleep problems are common in older adults; however, many nonpharmacologic interventions can be used to improve sleep.

PTS: 1 DIF: Apply REF: p. 175 MSC: Health Promotion and Maintenance B.C M

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TOP: Teaching and Learning

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13. A 75-year-old woman asks a nurse, “I know I should be moving, but how much is the right

amount of exercise for me?” The best response of the nurse is: a. “You need to engage in 30 minutes of moderate intensity exercise on at least 5 days a week.” b. “You need to engage in at least 30 minutes of moderate-intensity exercise every day of the week.” c. “Because you are 75 years old, the recommendation is for 30 minutes of moderate-intensity exercise three times a week.” d. “There are no specific recommendations for someone of your age; just keep moving.”

ANS: A

Older adults need at least 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (e.g., brisk walking, swimming, bicycling) every week and muscle-strengthening activities on 2 or more days that work all major muscle groups (legs, hips, abdomen, chest, shoulders, and arms).

PTS: 1 DIF: Remember REF: p. 180 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

14. During a routine physical examination, the patient reports, “I have problems falling asleep at

night. I regularly engage in vigorous exercise to tire myself every evening.” What response by the nurse is indicated?

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank a. “Exercise is recommended and should be done immediately before bedtime to tire

you out.”

b. “Exercise should only be done in the morning; otherwise, it can ruin your sleep.” c. “A regular exercise regimen is helpful; it can deepen sleep, but it should not be

done immediately before bedtime.” d. “Exercise is helpful, but vigorous exercise can lead to restless leg syndrome, which

can contribute to insomnia.”

ANS: D

A regular exercise regimen, for those who are able, can deepen sleep, increase daytime arousal, and decrease depression. It is important, however, to avoid exercise before bedtime.

Vigorous exercise is not a contributor to restless leg syndrome.

PTS: 1 DIF: Apply REF: p. 174 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. The nurse observes that a male patient is snoring every night. Which should the nurse assess

in this patient to diagnose the potential for sleep apnea? (Select all that apply.) a. Change in appetite b. Rituals for sleeping c. Number of daytime naps d. Headaches in the morning e. Irritability during the day f. Awakening during the night ANS: C, D, E, F

NURSINGTB.COM

The nurse asks the patient to evaluate how restorative or refreshing sleeping is for him; awakening unrefreshed is a risk factor for sleep apnea. In addition, morning headaches, daytime irritability and personality changes, and periods of nighttime wakefulness are all risk factors for sleep apnea. Changes in appetite and rituals for sleeping are rarely associated with an increased risk for sleep apnea.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 176 MSC: Health Promotion and Maintenance

2. A nurse will be conducting an education session at the local senior citizen’s center on the

importance of physical activity. Which activities should the nurse include as an example of moderate-intensity aerobic activity? (Select all that apply.) a. Biking b. Range of motion (ROM) c. Weight lifting d. Dancing ANS: A, D

Biking and dancing incorporate large muscle groups and are classified as moderate-intensity aerobic activity. ROM exercises are classified as stretching activities. Weight lifting is considered an exercise that uses body weight and is a muscle-strengthening activity.

PTS: 1

DIF: Understand

REF: p. 179

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank MSC: Health Promotion and Maintenance 3. The nurse should encourage which of the following exercises to assist with balance for a

patient who is at high risk for falls? (Select all that apply.) a. Tai Chi b. Use of resistance bands c. ROM activities d. Walking heel to toe ANS: A, D

Tai Chi and walking heel to toe are considered balance exercises. The use of resistance bands is considered muscle strengthening, and ROM activities are considered stretching exercises.

PTS: 1 DIF: Understand REF: p. 180 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

4. An older adult who has a balance disorder and has sustained repeated falls is recommended to

start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual? (Select all that apply.) a. Yoga b. Tai Chi c. Swimming d. Pilates e. Weight lifting ANS: A, B

Yoga and Tai Chi are exercises that improve balance, as they use movements that improve the ability to maintain control of NtheR ver tBhe.bCaseMof support to avoid f alling. Swimming, IyNoG U bod S T Pilates, and weight lifting do not do this.

PTS: 1 DIF: Remember REF: p. 180 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 14: Promoting Healthy Skin Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following is an important consideration about the skin of older adults? a. Generous amounts of soap should be used for cleansing. b. Sweat gland activity increases. c. Skin becomes more vulnerable to damage. d. Skin becomes darker in unexposed areas.

ANS: C

Thin skin–reduced sebaceous protection, vascular insufficiency, and longer periods in stationary positions promote skin damage for older adults. Because moisture is lost more rapidly from the skin of older adults, excessive use of soap tends to dehydrate the skin more severely than it does in younger people. Sweat gland activity does not increase in older age, but moisture is lost more rapidly because the skin is thinner and sebum secretion is reduced.

Changes of skin color in areas exposed to the sun are of greater concern than those in unexposed areas.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 186 MSC: Health Promotion and Maintenance

2. A dermatologist should promptly evaluate which one of the following skin lesions? a. Circumscribed, raised area resembling a blob of brown wax b. Multicolored raised lesionNU wR ithSaIf N uzG zyTbBo. rdC eO r M c. Bright red, glazed area with satellite lesions around it d. Brown spot on the skin with no raised area ANS: B

A multicolored raised lesion with a fuzzy border must be promptly evaluated; this lesion is a malignant melanoma. A circumscribed, raised area resembling a blob of brown wax reflects seborrheic keratosis. A bright red, glazed area with satellite lesions around it is a Candida infection. A brown spot on the skin with no raised area, such as a freckle, is lentigo.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 191 MSC: Health Promotion and Maintenance

3. An older patient complains of dry skin and asks for advice. Which advice should the nurse

offer for improving dry skin? a. Add oil to the bath water to keep skin soft. b. Use tepid bath water. c. Move to a climate with lower humidity. d. Vigorously dry skin with a rough towel after bathing.

ANS: B

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Tepid bath water minimizes moisture loss from skin. Oil added to the bathtub increases the risk of slipping and falling, which can result in a catastrophic injury. Oils should be applied directly to moist skin after bathing. Humidity should be maintained at approximately 60%; the person may not be able to move. Vigorous, rough towel drying increases skin irritation.

PTS: 1 DIF: Apply REF: p. 186 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 4. Which of the following is a true statement about impaired skin integrity? a. Stage III pressure ulcer cannot regress to stage II because the subcutaneous tissues

regenerate. b. Stasis ulcer is another term for pressure ulcer. c. Muscle and fat cannot regenerate. d. Weight reduction is recommended to help prevent pressure ulcers.

ANS: C

Because subcutaneous tissues such as muscle and fat are not regenerated but simply replaced by granular tissue, the staging of pressure ulcers is never reversed. Stasis ulcers are the result of the leakage of blood from veins beneath the skin. Pressure ulcers are caused when perfusion to the tissue is impaired by external pressure that causes tissue injury and death.

Sufficient nutrition is essential in maintaining skin integrity.

PTS: 1 DIF: Remember MSC: Physiological Integrity

REF: p. 195

TOP: Nursing Process: Evaluation

5. Which of the following is a true statement about skin care for older adults? a. A licensed practical nurse is qualified to care for the feet of a patient with diabetes. b. Onychomycosis is quicklN yU erR adSicIaN t edGw ntO ifM ungal creams or powd ers.

TiBth.aC c. A ram’s-horn nail should be cut to give a smooth, rounded edge. d. Maintaining oral hydration may reduce the incidence of xerosis.

ANS: D

Oral hydration and lubrication decrease the incidence of xerosis. Only a registered nurse who has special training, a nurse practitioner, or a podiatrist should perform diabetic foot care. The treatment of onychomycosis is difficult because of the limited blood supply to the nails. Oral medications are expensive and toxic. A toenail should be cut flat across. Rounding can lead to ingrown toenails.

PTS: 1 DIF: Remember REF: p. 186 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

6. The nurse plans care to protect the skin covering an older adult’s greater trochanter. Which of

the following interventions is the nurse’s priority when the older adult is positioned on the side? a. Implement a turning schedule. b. Place a cushion between the knees. c. Keep the skin clean and dry. d. Use the Sims’ position.

ANS: A

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank The most important nursing intervention when an older adult is positioned on the side is to relieve pressure on the head of the femur and the greater trochanter; the greater trochanter is the most prominent bony projection on the side of a body. By turning the older adult at intervals, the nurse helps maintain tissue perfusion, thus providing oxygenation to tissues and allowing the removal of waste from vulnerable skin. The nurse places a pillow between the knees to help maintain physiological body alignment and to prevent strain on the hips and spine; if positioned properly, the pillow can help maintain tissue integrity of the medial malleolus and ankle by elevating them off the mattress. However, because the nurse’s priority is to maintain tissue oxygenation, preventing muscle and joint strain is not as important. The nurse keeps the skin clean and dry to help maintain skin integrity, but this intervention is not as important as maintaining tissue oxygenation. The nurse uses the Sims’ position to supplement turning; when in the Sims’ position, the patient is on the side but rotated slightly forward, allowing the chest and abdomen to fall forward to relieve some of the pressure on the patient’s side.

PTS: 1 DIF: Analyze REF: p. 197 TOP: Nursing Process: Implementation MSC: Physiological Integrity 7. An older adult is vitamin deficient. Which of the following does the nurse offer to the older

adult to provide the important missing vitamin for maintaining healthy skin and enhancing tissue repair? a. Carrot sticks b. Nonfat milk c. Orange slices d. Unsalted nuts ANS: C

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Orange slices provide vitamin C, which is important for healthy tissues and gums, tissue repair and healing, and the maintenance of blood vessels. Although carrots sticks are a good source of beta carotene, fiber, and vitamin A and important in the formation of epithelial tissue and although milk provides calcium for bone strength and protein for tissue repair, neither carrots nor milk addresses vitamin deficiency. Unsalted nuts provide healthy fats, fiber, and other nutrients but not vitamin C. PTS: 1 DIF: Apply REF: p. 198 TOP: Nursing Process: Implementation MSC: Physiological Integrity 8. The nurse monitors for which clinical indicator when the older adult complains of pruritus? a. Coarse skin b. Brown macule c. Brownish skin d. Regional edema ANS: A

The nurse is alert for rough, dry, flaky skin when an older adult complains of pruritus to be able to prevent linear excoriation leading to skin breaks, excoriation, inflammation, and infection. A brown macule is a freckle or a liver spot, an indication of sun exposure. Brownish skin is a clinical indicator of venous insufficiency. Regional edema is a sign of fluid overload and venous insufficiency; localized edema is a sign of infection.

PTS: 1

DIF: Understand

REF: p. 186

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank MSC: Health Promotion and Maintenance 9. The nurse cares for an older man who has a malignant melanoma. Which intervention should

the nurse implement for this man to prevent a recurrence or advancement of this condition in the future? a. Place posters about sunscreen in the halls of his apartment building. b. Promote the application of a sunscreen at his neighborhood health fair. c. Tell him to schedule all outdoor activities after 4 PM daily. d. Instruct him to wear sun-protective clothing and a hat at all times.

ANS: D

The nurse caring for an older adult in acute care instructs him to wear sun-protective garments at all times to help prevent additional skin cancers, as well as apply an effective sunscreen to protect his skin against ultraviolet light. Placing posters and promoting sunscreen at a health fair are interventions for a community nurse. Scheduling activities after a specific time can be impractical or impossible.

PTS: 1 DIF: Apply REF: p. 192 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 10. Which infection-control practice should the nurse implement when caring for an older adult

who has active herpes zoster? a. Wear a face shield and gown for all patient contact. b. Instruct the staff and visitors to wear a type of respirator mask. c. Use a hospital room that has negative airflow circulation. d. Cover ruptured skin lesions with a nonabsorbent dressing.

ANS: D

NURSINGTB.COM

Herpes zoster in an adult is spread through contact; therefore, the nurse applies the principles of contact precautions when caring for an older adult with active herpes zoster. To reduce the transmission of the virus through contact, the nurse keeps the ruptured lesions covered. A face shield is not necessary when caring for an adult with herpes zoster; however, a gown can be necessary during dressing changes or any time that splashing can occur. Airborne precautions and a respirator-type mask are indicated for infections transmitted through the air. Because active herpes zoster in an older adult is transmitted through contact, negative airflow is not indicated.

PTS: 1 DIF: Understand REF: p. 188 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 11. The nurse is conducting an admission assessment on an older adult and notes a small lesion

with a multicolor appearance. Which assessment approach should the nurse use? a. Braden scale b. Wound staging c. ABCD (asymmetry, border, color, diameter) rule d. Pressure ulcer scale for healing (PUSH) tool ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank The ABCD rule is used to assess potential cancerous lesions for asymmetry, border irregularity, color, and diameter. The Braden scale is used for predicting pressure ulcers.

Wound staging is used during the assessment of pressure ulcers. The PUSH tool provides a detailed form that covers all aspects of an assessment.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 192 MSC: Physiological Integrity

12. A nurse will be conducting an educational session on preventing skin cancer at a local senior

citizen’s center. Which should the nurse include in the session? a. Squamous cell cancer may appear similar to a wart. b. Basal cell carcinoma is more common in women. c. Actinic keratosis begins as a pearly papule. d. Melanoma is characterized by rough, scaly patches.

ANS: A

Squamous cell lesion may appear like a wart and be hard with defined borders. Basal cell carcinoma is more prevalent in fair-skinned older men and begins as a pearly papule. A multicolored, raised lesion with asymmetrical borders characterizes melanoma.

PTS: 1 DIF: Apply REF: p. 190 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

13. Which nursing intervention is most likely to prevent the creation of an environment conducive

to fungal growth? a. Provide oral care with soft-bristled brush. b. Apply nystatin powder to reddened tissue. c. Use mild skin cleansing aN geUnR tsSaI ndNbGloTt B d r. y.COM d. Apply gauze soaked with antifungal lotion.

ANS: C

Fungal infections are most likely to begin in moist, dark areas of the body such as under the breasts and at the perineum; thus, the nurse works to keep the skin of these areas, as well as all skin, clean and dry and to prevent tissue irritation from harsh drying. Providing oral care with a soft-bristled brush is ineffective therapy for preventing an oral Candida infection (thrush).

Besides, thrush is usually an opportunistic infection caused by immunosuppression. Reddened tissue can be already infected; nonetheless, applying an antifungal agent is an indicated treatment for a fungal infection. Applying antifungal lotion and keeping an area moist can contribute to fungal overgrowth.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 189 MSC: Physiological Integrity

14. An older person is admitted to the hospital with an exacerbation of congestive heart failure.

The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse, “How did I get something like this?” The best response by the nurse is: a. “Scabies is highly contagious and spreads easily through physical contact.” b. “Scabies is commonly seen in older adults due to normal age-related changes in the skin.” c. “Scabies is only seen in older adults who have multiple chronic illnesses.”

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 15: Falls and Fall Risk Reduction Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which one of the following is a true statement about mobility and safety for older adults? a. Use of restraints on older patients helps prevent injuries from falls. b. Falls that do not cause physical injury are not significant. c. The Get Up and Go test provides a measure of a patient’s energy and initiative. d. Lowering the bed and fluorescent tapes are interventions to increase safety.

ANS: D

Adjusting the bed height to match the length of the resident’s lower leg and marking the path from the bed to the toilet with bright fluorescent tape are some of the many possible interventions to improve residents’ safety. Restraints have not been shown to increase safety and may contribute to morbidity and mortality. Even if a fall does not cause injury, it can contribute to the fear of falling, inhibiting activities of daily living. The Get Up and Go test, in which the person rises from a straight-backed chair, walks 10 feet, returns, and sits down, assesses balance and gait.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 210 MSC: Safe, Effective Care Environment

2. Which of the following is a true statement about assistive devices to aid older adults with

impaired mobility?

NURSINGTB.C OM a. A walker can be used when climbing stairs. b. Cane tips should be smooth. c. Older adults save money by adapting assistive devices from their friends. d. A cane is most useful for unilateral disabilities but not bilateral problems.

ANS: D

Canes can relieve stress on arthritic joints on one side. A walker can equally relieve pressure on joints on both sides. Cane tips should be flat on the bottom with a series of rings, not smooth. Older adults are tempted to save money by using assistive devices from nonmedical sources; however, regardless of the source of the assistive device, the device should be fitted to the older adult. An older adult should never try to adapt to the assistive device; an ill-fitted device can contribute to falls and injuries. Using a walker is contraindicated when climbing stairs. Improperly selected or improperly used assistive devices can be risk factors for falling.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 210 MSC: Safe, Effective Care Environment

3. The health care provider has not ordered the use of a restraint for an alert patient at high risk

for falling. The nurse should implement which side rail use? a. Two full-length rails b. One -length rail c. No side rails d. Four -length rails

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: B

The use of one -length rail is not considered a restraint; it can be used to assist the patient in getting in and out of bed. Two full-length rails and four -length rails would be considered a restraint. The use of no side rails is not considered a restraint; however, the use of one rail to maneuver in and out of bed may be most beneficial to the patient.

PTS: 1 DIF: Apply REF: p. 212 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Planning

4. After assessing an older man in his bed, the nurse determines that he is at high risk for falls.

The nurse leaves the room to get a fall risk sign and returns to find him on the floor pleading for help. Which of the following was the most important intervention the nurse should have implemented to prevent this event? a. Call for someone to bring the sign. b. Show the older man how to use the call bell. c. Provide a urinal and drinking water. d. Instruct the patient to call for help.

ANS: D

The nurse accomplished the most important aspect of fall prevention with the assessment.

However, in an attempt to communicate the fall risk to other staff members, the nurse failed to communicate properly to the patient about fall prevention before leaving the room. Calling for someone to bring the sign would have been a reasonable approach to communicating the risk of falls, but it does not take the place of directly instructing the patient about prevention. The needs of an older adult can contribute to the risk of falls as an individual leans and reaches for something; therefore, call bell instructions are a reasonable approach for preventing falls.

However, bef ore provid ing thNe caRll bIell G U S Ninstr TBuc.tiConsM, the nurse need ed to tell him to call f or help. A urinal and drinking water are common items that an older man needs, but reaching for them can contribute to falls.

PTS: 1 DIF: Analyze REF: p. 204 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Evaluation

5. The nurse assesses the quality of which of the following patient characteristics when applying

the Get Up and Go test from the Hendrich II Fall Risk Model? a. Stride b. Speed c. Balance d. Flexibility ANS: C

Using the Get Up and Go test, the quality of the older adult’s movements is assessed. The nurse instructs the individual to rise from a chair, walk, and return to the chair and be seated.

The stride is not specifically assessed in this test, although it is an aspect of gait and can be a factor in balance. The older adult’s speed is not assessed in this test. Flexibility is not specifically assessed in this test, although it can be an important factor in balance.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 205 MSC: Health Promotion and Maintenance

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 6. An older woman who receives intravenous (IV) fluids is making wide gesticulations with her

arms and loudly insulting the nursing staff. Which intervention should the nurse implement to maintain safe, effective nursing care initially? a. Apply bilateral upper extremity restraints. b. Administer haloperidol (Haldol) for agitation. c. Close the door to her room to reduce the noise. d. Determine the patient’s needs.

ANS: D

To help maintain her independence and permit the administration of IV fluids yet provide safe, effective care, the nurse should determine what the patient is attempting to convey and then address those needs. Restraining one side creates a potential threat from the other arm to the integrity of the IV, but bilateral restraints can be justified for the protection of the IV site.

However, as a first step, the nurse should determine if the patient has a need that has not been met before moving to a restraint. Administering an antipsychotic agent can be justified for agitation but not in this patient. Less intrusive measures are available for initial protective measures. Although nurses tend to keep the doors of patients’ and residents’ rooms slightly ajar to maintain privacy, closing this woman’s door is contraindicated to control noise because it can contribute to the risk of falls and injury and does nothing to maintain the integrity of the IV. PTS: 1 DIF: Analyze REF: p. 207 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Planning

7. The nurse wants to use exercise according to the recommendations of the American Geriatrics

Society (AGS) for an older woman who lost her balance and fell. Which nursing intervention is suitable for this older adult according to the AGS? RS IuNnti GT a. Tell her to use an assistiveNU d ev ice l B.C her baO lance improves. b. Provide information on group exercises for balance training. c. Help her to learn how to exercise the core group of muscles. d. Instruct her to enroll in an exercise program for 8 weeks.

ANS: B

The AGS states that group exercises can be effective to improve balance as part of a fall prevention program for older adults. Using an assistive device can help prevent falls; however, assistive devices are not part of an exercise program. Although the AGS states that the relationship between exercise and reducing the risk for falls is strong, the recommended type, duration, and intensity of the exercises are not clear. The AGS states that to improve balance with exercise, an older adult must participate in exercise for at least 10 weeks.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 203 MSC: Safe, Effective Care Environment

8. The nurse is discharging an older woman who uses a walker from rehabilitative care. Which

observation does the nurse use to determine whether the patient is prepared for discharge? a. She holds the front of the walker. b. She has a walker with four wheels. c. She takes four steps into the walker. d. She takes the walker to the elevator.

ANS: D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 18: Pain and Comfort Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Compared with acute pain, which of the following statements is true of persistent pain? a. Leads to significantly altered vital signs b. Is usually described as a burning pain c. Is generally gone within 4 months d. Can bring about long-term changes in lifestyle ANS: D

Persistent pain affects the patient’s experience on a continuing basis. Both acute pain and persistent pain can affect the vital signs. Persistent pain may be described in many possible ways. Persistent pain is unrelenting.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 238 MSC: Physiological Integrity

2. The nurse admits an older man who had abdominal surgery. Admission vital signs are heart

rate (pulse) (P), 73 beats/min; respiration rate (R), 20 breaths/min; and blood pressure (BP), 136/84 mm Hg. He is receiving intravenous (IV) fluids but has not requested pain medication since surgery. Seven hours later, his vital signs are P, 98 beats/min; R, 26 breaths/min; and BP, 164/90 mm Hg, and he denies pain. Which intervention should the nurse implement? a. Ad minister an opioid med ication by I V rou te.

N R I G B. C M O b. Check the surgical d ressingUforSbleN ed inTg. c. Report the vital signs to the health care provider. d. Ask if he has about discomfort at the surgical site or any other location.

ANS: D

The patient’s P, R, and BP increased significantly since his admitting vital signs and indicate the potential for pain or discomfort from the surgical incision. This patient may also be experiencing pain unrelated to the surgery because of arthritic changes, neuropathies, and so on. The patient can be misunderstanding the nurse’s question or be barred from saying “yes” by cultural patterns. Such miscommunication is common; therefore, the nurse rewords the question using another term for pain such as discomfort, burning, or pressure. Administering an opioid medication by IV route is unethical without the patient’s request. When checking the surgical dressing for bleeding, the patient may show signs of pain rather than blood loss.

Reporting the vital signs to the health care provider would be premature; the patient’s pain assessment is not complete.

PTS: 1 DIF: Apply REF: p. 239 TOP: Nursing Process: Implementation MSC: Communication and Documentation 3. An older woman had hip replacement surgery 1 day ago, and the nurse thinks that the woman

also has dementia. Which patient assessment does the nurse use to determine whether this woman is experiencing pain? a. Holds her abdomen tightly b. Has stable vital signs

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank c. Is not verbalizing d. Moves during sleep ANS: A

Because this older adult has a potential cognitive impairment and is likely to self-report pain unreliably, the nurse uses additional clinical indicators to detect pain. Muscle rigidity and guarding are clinical indicators of pain for a postoperative older adult, regardless of a cognitive impairment. An individual experiencing pain is unlikely to have stable vital signs.

Not verbalizing can indicate a sensory impairment and warrants further investigation by the nurse. Nonetheless, this older adult’s verbalizations are potentially unreliable indicators of pain. Older adults move normally during sleep to adjust their position in bed; moving during sleep is not an indicator of pain unless the movements are agitated or restless in nature.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 240 MSC: Physiological Integrity

4. Which of the following statements is true about analgesic medications for older adults? a. Opioids are less effective in older patients than in younger patients. b. Stool softeners and laxatives should be used with opioids. c. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are generally

harmless. d. The dose limit for acetaminophen is difficult to reach for older adults.

ANS: B

Opioids often cause constipation and necessitate bowel stimulation to prevent constipation. A bowel regimen should be instituted at the same time as opioid treatment. Because of changes in metabolism with aging, opioids have a greater and longer lasting analgesic effect in older patients. NSAI Ds can cause gNaU strRoS inI t eN st G inaTlBbl. eeCdO inM g, kid ney and liver d amage, and d rug interactions with potentially fatal results. The maximum daily dose of acetaminophen is 4000 mg, and the limit is lower for patients with kidney or liver failure and patients who use alcohol. A typical dose is two 500-mg (“extra-strength”) tablets.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 243 MSC: Physiological Integrity

5. Each of the following is a pharmacologic intervention for pain except which one? a. Acupuncture treatments b. Adjuvant therapy c. Lidocaine patch d. Capsaicin ANS: A

Acupuncture is a nonpharmacologic treatment that helps reduce the perception of pain. An adjuvant is a medication that has been developed for a different purpose but serves to alter the perception of pain, possibly in combination with a pain medication. Lidocaine patches are a pharmacologic treatment for pain relief. Capsaicin is a pharmacologic means of providing comfort and alleviating pain and distress.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 245 MSC: Physiological Integrity

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 6. An older adult admitted for back surgery asks for opioid pain medication. The nurse knows

the patient asks for pain medication 15 minutes before it is due. Which recommendation should the nurse implement? a. Validate the pain with other assessment data. b. Administer the pain medication as requested by the patient. c. Tell the patient that it is too soon for pain medication. d. Teach the patient alternative comfort measures.

ANS: B

The nurse should administer the opioid pain medication as requested because the patient is asking for the pain medication within the prescription’s time limit. Most institutions allow the nurse to administer opioid medications 15 to 30 minutes before the designated time on the prescription; therefore, the patient is not asking for the medication too early. In addition, the nurse has an obligation to the patient to administer the pain medication; not doing so violates the patient’s rights. The nurse can rely on the patient’s report to determine the need for pain medication. As long as the timing is suitable and the patient is stable, the nurse should administer the medication. The nurse should use assessment data to support withholding pain medication in the presence of oversedation or another assessment that would be potentially aggravated by administering the pain medication. The nurse violates the patient’s rights by stating that it is too soon for the medication and ignores the possibility that the patient’s pain is real. Although the nurse may believe the patient is not having pain and is exhibiting drug-seeking behavior, the nurse must administer the medication. The nurse must administer the pain medication as requested. When patients are experiencing pain, most often, it is not the optimal time to teach patients. However, when the patient’s pain is under control, the nurse should teach alternative comfort measures. Comfort measures can be used to enhance the therapeutic effect of the medication and breakthrough pain.

N R I G B.C M

U S N REF: T p.O244 PTS: 1 DIF: Apply TOP: Nursing Process: Implementation MSC: Physiological Integrity 7. The nurse administers an opioid analgesic to an older male postoperative patient in the

surgical unit. Which is the most important intervention for the nurse to implement before leaving the patient’s room? a. Place all side rails up. b. Position the patient comfortably. c. Offer toileting and a sip of water. d. Instruct him to ask for help before getting up.

ANS: D

The most important intervention for fall and injury prevention is for the nurse to instruct the older adult to ask for help before getting up after receiving an opioid medication. This intervention is important because the medication can cause sedation and dizziness; therefore, the nurse instructs him to ask for help to prevent a fall or injury. Putting all side rails up is considered a restraint and may place the patient at risk for injury. Comfortable positioning is also a good supplemental intervention after administering pain medication. Offering toileting and hydration is a reasonable intervention to implement after administering pain medication, but it does not offer the same degree of safety as instructing the patient to call for help.

PTS: 1 DIF: Analyze REF: p. 244 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 8. The older adult is at a higher risk for acute psychological pain than a younger adult because

older adults a. have many illnesses. b. possess fewer assets. c. experience more loss. d. live with impairments.

ANS: C

Older adults are at higher risk for acute psychological pain than younger adults because they experience more loss such as the pain occurring in early bereavement or in a major depressive episode. Older adults tend to have more illnesses than younger adults, and illness can trigger depression. The lack of assets of younger and older adults is unlikely to be related to acute psychological distress unless a sudden loss of a large asset is experienced. Older adults do not necessarily live with impairments. Furthermore, if impairment causes psychological distress, then the acute phase is likely to occur at the onset rather than in day-to-day activities.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 237 MSC: Psychosocial Integrity

9. An older Hispanic man states that he is not having pain, but he had knee replacement surgery

2 days ago. Which is the best pain assessment tool as recommended by the Hartford Institute for Geriatric Nursing (HIGN) from “Try This” for the nurse to apply for this man? a. Numeric Rating Scale b. Verbal Descriptor Scale c. Iowa Pain Thermometer d. Faces Pain Scale–revised (FPS-R) ANS:

D

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Hispanic men are less likely to report pain because their culture tells them to deny and withstand pain without complaining. The nurse uses the FPS-R to validate the patient’s report because the postoperative period in knee replacement surgery is very painful; this fact makes the nurse think that the patient is likely to have pain. The HIGN has data that support the claim that Hispanic and African American older adults prefer using the FPS-R for evaluating pain. The Numeric Rating Scale, the Verbal Descriptor Scale, and the Iowa Pain Thermometer are valid and reliable assessment tools, but older Hispanic adults prefer using the FPS-R. PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 240 MSC: Physiological Integrity

10. The nurse uses comfort measures to enhance an older adult’s pharmacologic pain

management. Which of the following would be most helpful for the nurse to use to identify the relationships between the comfort measures, activity, and pharmacotherapy, and the older adult’s pain level? a. Older adult’s self-report b. Older adult’s pain diary c. Faces Pain Scale–revised (FPS-R) d. Pain medication frequency ANS: B

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank The nurse instructs the older adult to maintain a pain diary to help the individual achieve some control over the pain experience. The diary is then used to identify trends or the timing of pain and the relationships between the patient’s pain level and the comfort measures, activity, and pain medications. Many older adults report feeling useful and having some control over the pain, or at least the pain management program, through maintaining a pain diary.

Self-reporting is one parameter used to evaluate pain, but drawing a relationship between the pain level and other factors is still necessary. The FPS-R is a reliable pain assessment tool, but the task remains to link the pain rating to other factors. The frequency of medication administration provides a clue about the patient’s pain level.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 242

TOP: Nursing Process: Planning

11. When educating a client on the use of an adjuvant medication, which statement best

demonstrates the nurse’s understanding of this therapy? a. “These medications are used instead of opioids to decrease the likelihood of addiction.” b. “Adjuvant medications are prescribed because they seldom cause any significant side effects.” c. “These types of medications are used to eliminate the side effects of opioid medications.” d. “These drugs are used in combination with analgesics to increase the effect of the analgesics.”

ANS: D

Adjuvant medications are not analgesics but are thought to alter the perception of pain and are used with analgesics to potentiate the effect of the analgesics. Adjuvant medications are used N g RhaSlfI-liNves GTinB.C with opioid s and may have lonU old eO r ad ults. The nurse must monitor the patient for adverse effects. Adjuvant medications do not eliminate the side effects of opioids.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 244

TOP: Teaching and Learning

12. An older client who was recently admitted to the subacute setting after having a knee

replacement, is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement? a. Share with the patient that it’s important to get out of bed and that there is pain medication available if it does hurt. b. Use the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain. c. Offer pain medication, administer the medication, and wait 20 minutes before getting her out of bed. d. Allow the patient to remain in bed but share that getting up will be required at least twice a day starting the next morning.

ANS: C

The administration of an as-needed analgesic 20 to 30 minutes before an activity may eliminate discomfort and fear of discomfort. It may also enhance the individual’s capacity for the activity. It is not true that performing an activity quickly will lessen the pain or that the patient will get used to the pain. A Hoyer lift is only indicated when an individual is completely immobile. Activity is an important part of rehabilitation.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 242

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. Which conditions are likely to cause an older adult chronic pain? (Select all that apply.) a. Hip replacement b. Bone metastasis c. Hypoproteinemia d. Migraine headache e. Compression fracture f. Postherpetic neuralgia ANS: B, E, F

Bone metastasis is likely to cause an older adult chronic pain because it is extremely difficult to eradicate cancer metastasis from bone. In addition, the invasion of cancer into bone can be very painful as a result of tumor growth pressing on nerves. Compression fractures are likely to cause chronic pain because the compressed vertebra is likely to press on spinal nerves, causing muscle spasms. Postherpetic neuralgia is a result of nerve damage from shingles and is likely to cause chronic pain; it is very difficult to treat effectively. A hip replacement is performed to relieve chronic pain or to repair a fracture and is more likely to cause acute pain.

Hypoproteinemia is unlikely to cause chronic pain but is more likely to cause fatigue. A migraine headache is likely to cause acute, intense pain. Although headaches can be recurrent, they are usually time limited.

PTS: 1 DIF: UnNderR . 23M7 U stan S Id NGRE TFB:.pC TOP: Nursing Process: Assessment MSC: Physiological Integrity 2. Which of the following statements are true about pain in older adults? (Select all that apply.) a. Pain is not a normal aging process. b. Pain sensitivity decreases with age. c. If patients do not complain, they do not have pain. d. Opioid analgesics are often the best treatment for persistent pain.

ANS: A, D

Pain is not a normal aging process. Something pathological is usually causing the pain. Pain sensitivity does not decrease with age. Some patients have a variety of reactions to pain; many are stoic and refuse to give in to their pain. Opioid analgesics are beneficial for moderate to severe persistent pain.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 239 MSC: Physiological Integrity

3. Which of the following pain sensations are associated with neuropathic pain? (Select all that

apply.) a. Infection b. Obstruction c. Inflammation d. Postamputation

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: D

Neuropathic involves a pathophysiological process of peripheral or central nervous system.

Infection, obstruction, and inflammation are considered nociceptive pain sensations that are associated with injury to skin, mucosa, muscle, or bone.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 237 MSC: Physiological Integrity

4. An older aphasic client has severe osteoarthritis, bilateral contractures of the lower

extremities, and a stage IV pressure ulcer. The nurse practitioner prescribes analgesic medications to be administered around the clock, with as-needed doses to be administered as appropriate. What observation by the nurse would indicate that the pain regimen is effective?

(Select all that apply.) a. The client slept throughout the night. b. The client winces only when turned and repositioned. c. The client slept during dressing change. d. The client cooperative during morning care. e. The client ate 80% of breakfast, 70% of lunch, and 100% of dinner.

ANS: A, C, D, E

Pain cues presented by this client is the wincing when being turned, indicating that this intervention is pain producing. The remaining observations are concurrent with effective pain management.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 239

TOP: Teaching and Learning

Mpairment who recently had hip surgery.

5. A nurse is caring f or an old erNaU d uRltSwIitN hG coTgB n i. t ivCeOim The nurse assesses the client for pain. The nurse would suspect that the client is in pain when the client demonstrates which of the following? (Select all that apply.) a. The client ate all of her meals. b. The client pushes caregivers away when they attempt to change the dressing on her hip. c. The client rocks back and forth repetitively when sitting in a chair. d. The client sleeps soundly throughout the night. e. The client cries out repeatedly when anyone approaches her.

ANS: B, C, E

Pain cues in people with communication difficulties involve changes in behavior including restlessness, resistance to care, repetitive movements, and vocalizations. Other cues including sleeplessness and a decreased appetite.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 239

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 19: Diseases Affecting Vision and Hearing Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following diseases affects the eyesight of an older adult by damaging the central

part of the retina? a. Glaucoma b. Presbyopia c. Cataract d. Macular degeneration ANS: D

Macular degeneration is a disease characterized by damage to the central part of the retina that leaves the outer edges of the visual field intact. Presbyopia, a gradual decline in the flexibility of the lens, makes close-up focusing more difficult and is a common age-related change but not a disease. Glaucoma, a disease marked by increased pressure within the eye that potentially leads to optic nerve damage, is the most common cause of blindness in those 65 years of age and older. A cataract is a disease marked by clouding and blurring of the lens.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 254 MSC: Physiological Integrity

2. Which of the following is used to treat the most common cause of impairment to an older

person’s hearing? a. Hearing aids b. Cochlear implants c. Ear canal irrigation d. Sign language

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ANS: C

Irrigation is used to dissolve and remove impacted cerumen, the most common cause of impaired hearing in older adults. Hearing aids are useful for sensorineural hearing loss, but the most common cause impairing the hearing of older persons is cerumen impaction. Cochlear implants are useful for profound sensorineural deafness, but the most common cause impairing the hearing of older persons is cerumen impaction. Sign language has been used primarily by those who become deaf in childhood or at birth, but it is not considered a treatment.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 259

TOP: Nursing Process: Planning

3. A medical illustration shows a man with the blunt end of a tuning fork pressed to the center of

his forehead. The man is being tested for which of the following? a. Sensorineural hearing loss b. Presbycusis c. Tinnitus d. Unilateral conductive hearing loss

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: D

Weber’s test, in which a vibrating tuning fork is placed on the center of the forehead, detects the differences in hearing between one ear and the other caused by poor sound conduction.

During testing, the patient is asked to describe the sensation felt when the tuning fork is activated and then placed on the forehead. If the patient’s hearing by conduction is intact, then he or she will feel vibrations conducted through the bones of the skull from the tuning fork.

Weber’s test with the tuning fork is used to detect conductive hearing loss. Presbycusis affects both ears and has a sensorineural origin. The tuning fork test is used to detect conductive hearing loss in one ear. Tinnitus is a hearing sensation not caused by an actual sound. The tuning fork test is used to detect hearing loss caused by poor sound conduction.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 262 MSC: Physiological Integrity

4. Persons with normal age-related sensory changes are likely to have the most difficulty

distinguishing which of the following? a. Spoken pairs of phrases such as “she’s praised” and “fees raised” b. Orange towel hanging on a beige wall c. “Go” and “to” in lowercase letters in fine print d. Spoken word pairs like “cupful” and “capful” ANS: A

A person with presbycusis has trouble hearing the higher frequencies, where most of the differences between consonant sounds occur. The contrast between a vivid color such as orange and a pale color such as beige can help an older person distinguish objects. The details of the letters may be poorly focused, but their overall shape, relative to the line around them, helps distinguish them. Age-related hearing impairments affect the hearing of consonants N R I G B.Cuble M d istinguishing “cupf ul” and “couple.” more than vowels. A person woUuldShavNe mTore troO PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 258 MSC: Physiological Integrity

5. Which of the following interventions should the nurse use when communicating with a

hearing impaired older patient? a. Stand beside the patient’s chair when speaking. b. Always clearly identify yourself and others with you. c. Exaggerate your voice, depending on the cause of the hearing loss. d. Select colors for paint, furniture, and pictures with rich intensity.

ANS: B

Always speak promptly, and clearly identify yourself and others who are with you. State when you are leaving to ensure that the person is aware of your departure. Get down to the person’s level and face him or her when speaking. Speak normally but not from a distance; do not raise or lower your voice and continue to use gestures if doing so is natural to your communication.

Selecting colors for paint, furniture, and pictures with rich intensity is for the visually impaired, not those with a hearing impairment.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 262

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 6. The nurse plans the care of an older female resident of a nursing home who has experienced a

sudden deterioration in visual acuity. Which intervention should the nurse complete first? a. Prevent behavioral and social decline. b. Tell her to hold onto the rails during ambulation. c. Examine her mood and functional status. d. Use problem solving involving the resident.

ANS: C

The most important intervention for the nurse to complete first is to assess the impact of the visual impairment on the resident’s quality of life, mood, and functional ability. The resulting assessment data will provide the basis for solving new problems caused by the loss of vision and finding compensatory mechanisms for the resident. Preventing decline can be a goal in the overall plan of care for this resident, but that cannot be determined until the assessment is complete. Telling her to hold onto rails during ambulation is a potential nursing intervention for patient teaching; however, in problem solving, a different compensatory solution can be developed, based on the assessment. Problem solving takes place after a complete assessment.

PTS: 1 DIF: Analyze MSC: Physiological Integrity

REF: p. 256

TOP: Nursing Process: Planning

7. An older man who has tinnitus complains to the nurse that it is very annoying. Which should

the nurse implement to alleviate the stress he is experiencing from tinnitus? a. Irrigate the bilateral eustachian tubes. b. Assess for modifiable risk factors. c. Propose a hearing aid and a masker. d. Use white noise to override the tinnitus.

ANS:

B

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The nurse assesses the patient for risk factors potentially contributing to tinnitus that can be altered such as smoking cigarettes, consuming caffeine, drinking alcohol, experiencing fatigue, and taking medications that carry a high risk of causing tinnitus. Removing these potential offenders can help give the patient a sense of control, as well as provide potential relief from tinnitus. The nurse irrigates the external auditory canal for impacted cerumen to decrease the risk of tinnitus. Although a hearing aid and a masker have the potential to alleviate tinnitus, introducing them can also serve as a potential source of additional stress, depending on the financial and functional status of the individual. Although white noise has the potential to alleviate tinnitus, it can be ineffective or serve as a potential source of additional stress.

PTS: 1 DIF: Apply MSC: Psychosocial Integrity

REF: p. 262

TOP: Nursing Process: Planning

8. An older adult complains about experiencing dry eyes daily. Which of the following should

the nurse assess to help determine the cause of the patient’s complaint? a. Vitamin B deficiency b. Use of a humidifier at home c. History of diabetes mellitus d. Prescription antihistamine use ANS: D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Medications can cause dry eye, especially antihistamines, diuretic agents, beta blockers, and some sleeping pills. Vitamin A deficiency is a risk factor, not vitamin B deficiency. The use of a humidifier should help with dry eyes, not cause it. Diabetes mellitus is an endocrine disorder, and dry eyes are an exocrine disorder.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 256 MSC: Physiological Integrity

9. A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma. The

nurse bases the response on the knowledge that the increase in intraocular pressure is a result of a. the exact etiology of glaucoma is variable and often unknown. b. spasms of the orbicular muscle. c. changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves. d. bits of broken coalesced vitreous from the peripheral or central part of the retina.

ANS: A

The etiology of glaucoma is variable and often unknown. However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. Spasms of the orbicular muscle can cause the lower eyelid to turn inward. If it stays this way, it is called entropion. The changes described contribute to decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters.

PTS: 1 DIF: Remember REF: p. 251 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

10. An old er nursing home resid N enU t rR epSoI rtsNtG hT at B he.r C hO eaM ring loss is getting worse. What is the f irst

action of the nurse? a. Refer the resident for an evaluation for a hearing aid. b. Raise her voice in when speaking to the resident. c. Examine the resident’s ears for cerumen impaction. d. Teach the resident to read lips.

ANS: C

When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing loss. Raising one’s voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.

PTS: 1 DIF: Analyze REF: p. 259 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of

sensorineural hearing loss include (Select all that apply.) a. tumors of the middle ear. b. cerumen impaction.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank c. infections of the external and middle ear. d. age-related hearing impairment. e. excessive and loud noise.

ANS: D, E

Age-related hearing impairment (presbycusis) is a form of sensorineural hearing loss.

Excessive and loud noise can cause noise-induced hearing loss, which is also a common type of sensorineural hearing loss. The other options are associated with conductive hearing loss.

PTS: 1 DIF: Remember REF: p. 258 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

2. Which population groups are most at risk for developing macular degeneration? (Select all

that apply.) a. African American b. Asian American c. Caucasian d. Hispanic ANS: B, C

Individuals who are white or Asian American are most at risk for developing macular degeneration than are African Americans or Hispanics.

PTS: 1 DIF: Understand REF: p. 254 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. When preparing a patient teaching session on diabetic retinopathy, the nurse should include

which interventions when d isNcusR singItreatm G en B.tsCforMslowing the progression of the d isease?

(Select all that apply.) a. Glucose control b. Blood pressure control c. Laser therapy d. Cornea transplant

U S N T

ANS: A, B, C

Better control of glucose, blood pressure, and cholesterol can assist in halting the progression of diabetic retinopathy. Laser therapy is also a treatment. A cornea transplant is not an option.

PTS: 1 DIF: Understand REF: p. 253 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

4. The nurse recognized which of the following as symptoms of wet age-related macular

degeneration (AMD)? (Select all that apply.) a. Rarely causes severe visual impairment b. Yellow deposits under the retina c. Decrease in central vision d. Visual distortion ANS: C, D

Patients with wet AMD experience a decrease in central vision and visual distortion. Wet AMD leads to blindness. With distortion, edges or lines become wavy. Dry AMD rarely causes severe visual impairment, and yellow deposits under the retina are a classic sign.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 254 MSC: Health Promotion and Maintenance

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Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 20: Metabolic Disorders Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following statements is true about diabetes mellitus? a. Type 2 diabetes is the result of the failure of the pancreas to produce insulin. b. Diabetes is diagnosed after two fasting plasma glucose readings over 125 mg/dL. c. Non–insulin-dependent diabetes mellitus is another name for type 1 diabetes. d. The incidence of diabetes mellitus does not increase with age.

ANS: B

Whereas a fasting plasma glucose reading of over 125 mg/dL is considered diabetes, a level between 110 mg/dL and 125 mg/dL is considered to be impaired fasting glucose. Type 2 diabetes is present when insulin is produced but does not lower the blood glucose level. Type 1 diabetes was formerly called insulin-dependent diabetes mellitus, and type 2 diabetes was formerly called non–insulin-dependent diabetes mellitus.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 267 MSC: Physiological Integrity

2. Which laboratory results are goals for reducing a person’s risk for diabetes and heart disease? a. Triglyceride value greater than 150 mg/dL b. Cholesterol value 250 mg/dL c. High-density lipoprotein (HDL) level greater than 40 mg/dL

R I anG1T5B .C/d L d. Fasting blood glucose valN uU e lesSs thN 0 mgO ANS: C

To reduce the risk for diabetes and heart disease, the serum triglycerides value should be less than 150 mg/dL. The cholesterol value should be less than 200 mg/dL to reduce the risk for heart disease and diabetes. The HDL level should be greater than 40 mg/dL to reduce the risk for heart disease and diabetes. The fasting blood glucose value should be less than 126 mg/dL. PTS: 1 DIF: Remember MSC: Physiological Integrity

REF: p. 270

TOP: Nursing Process: Planning

3. When teaching a patient about foods that do not increase blood glucose, which should the

nurse include? a. White bread b. Baked beans c. Broccoli d. Corn ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Broccoli does not raise blood glucose levels. White bread quickly breaks down to glucose and therefore tends to cause a rapid, brief rise in the blood sugar level. Whole grains provide a more sustained release of glucose and are a better source of carbohydrates. The blood glucose level increases after eating baked beans, but the increase occurs more slowly, reaching a lower level of hyperglycemia and remaining for a longer period. Corn is a starchy vegetable and raises the blood glucose level almost as much as sugar itself.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 273 MSC: Physiological Integrity

4. An older man with diabetes mellitus complains to the nurse that his feet feel like they are

burning. Which of the following interventions should the nurse recommend to this older adult to reduce his discomfort? a. Wear well-fitting leather shoes. b. Wear knee-high nylon stockings. c. Soak his feet in warm water. d. Apply antifungal powder on his feet.

ANS: A

The older adult is potentially experiencing a peripheral neuropathy from peripheral nerve damage from hyperglycemia. To prevent trauma to his feet, the nurse instructs him to wear comfortable, well-fitting, tie-on shoes with a broad toe space and low heels for protection.

Nylon stockings for men tend to have restrictive ends that can inhibit tissue perfusion; because this patient is at risk for peripheral tissue damage, the constricted area can break down. The nurse also instructs him to avoid sitting with one leg crossed over the other or with both legs crossed at the knee; these positions restrict blood flow to the feet. Foot soaks can potentially cause excessive dryness. To maintain skin integrity, feet should be washed daily NU R SIsuN but not soaked . I rritating chem icals chGaT s B.C antif uO ngal powd er and corn or wart preparations should not be used on the feet of individuals with diabetes.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 272

TOP: Teaching and Learning

5. The older adult who has type 2 diabetes mellitus has a sensory impairment and unstable blood

sugar levels. Which of the following alterations in sensory function does the nurse address in the plan of care for stabilizing the blood sugar? a. Requires reading glasses at 2.0 strength b. Has difficulty hearing in crowded rooms c. Enjoys spicy food more than bland food d. Awakens with periodic left-foot numbness ANS: B

The nurse focuses on the hearing impairment to plan care for stabilizing this patient’s blood glucose level; hearing impairment is a factor that affects blood glucose control in older adults with diabetes mellitus. Reading glasses at 2.0 are medium-strength glasses, and the need for such glasses is common and not considered a visual impairment. A preference for spicy food does not indicate an impaired sense of taste. Although numbness is a sensory impairment, episodic numbness associated with sleeping is more likely to be caused by a poorly positioned extremity.

PTS: 1

DIF: Apply

REF: p. 272

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank MSC: Physiological Integrity 6. Which comorbidity commonly associated with type 2 diabetes mellitus enhances the

development of the microvascular complications of diabetes mellitus? a. Hyperlipidemia b. Hypothyroidism c. Venous insufficiency d. Chronic constipation ANS: A

Hyperlipidemia, a condition commonly associated with type 2 diabetes mellitus, accelerates the development of microvascular complications of diabetes mellitus because high serum, low-density lipoproteins contribute to the formation of atherosclerotic plaque. The plaque first accumulates in the smallest arteries, causing complications of diabetes mellitus, including peripheral arterial disease, retinopathy, and nephropathy. Hypothyroidism, venous insufficiency, and chronic constipation are not associated with type 2 diabetes mellitus.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 268 MSC: Physiological Integrity

7. The nurse assists an older man who has type 2 diabetes mellitus to improve his glucose

control. Which of the following instructions does the nurse give to this individual when he plans to walk more than usual in 1 day? a. Omit antidiabetic medication. b. Wear sturdy open-toed shoes. c. Supplement caloric intake. d. Prepare to administer insulin. I G B.C M ANS: C

N UR S N T

O

Diabetes mellitus is controlled by balancing exercise, calories, and hypoglycemic medication; if one element of therapy is altered, then one or both of the remaining elements must be adjusted. When the patient’s activity is going to metabolize more calories, the medication has to be reduced or the calories have to increase. For a patient with type 2 diabetes mellitus, adjusting the medication can be difficult; therefore, the nurse instructs this older adult to supplement his caloric intake, which can be accomplished by eating snacks during the walk or by increasing the glycemic load before walking. The patient ensures glucose control during these activities by testing his blood sugar levels. The nurse cannot tell the patient to omit medication because doing so is not within a nurse’s scope of practice. The nurse instructs the older adult to wear closed, well-fitting leather shoes to protect the feet from trauma. Although many individuals with type 2 diabetes mellitus periodically take insulin, insulin is administered to induce hypoglycemia. Because the individual plans to walk more than usual, more calories are needed to prevent hypoglycemia.

PTS: 1 DIF: Apply REF: p. 273 TOP: Nursing Process: Implementation MSC: Physiological Integrity 8. Which is the best goal when planning nursing care for an older patient with diabetes mellitus? a. Stabilize the serum glucose. b. Prevent disease progression. c. Set walking distance goals. d. Plan for consistent exercise.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

ANS: B

The most important goal for planning nursing care for a patient with diabetes mellitus is to prevent disease progression. Stabilizing the serum glucose, managing hyperlipidemia, controlling the blood pressure, preventing infection, maintaining a normal weight (if applicable), and obtaining regular medical evaluation will accomplish this goal. Stabilizing the serum glucose is a part of preventing disease progression. Setting goals for walking is part of a consistent walking regimen. Planning for consistent exercise is part of stabilizing the serum glucose.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 271

TOP: Nursing Process: Planning

9. An older, non-Hispanic white man has a fasting blood sugar level above 130 mg/dL. Which

patient assessment does the nurse use to confirm a high risk for diabetes mellitus in this man? a. 68 years of age b. 120/80 mm Hg c. Palpable peripheral pulses d. Total cholesterol 198 mg/dL ANS: A

Diabetes is significantly more prevalent among older Americans. This man’s blood pressure is normal. Palpable peripheral pulses are a normal finding. A total cholesterol level below 200 mg/dL is normal and highly desirable for a man at risk for diabetes.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 268

TOP: Nursing Process: Diagnosis

N R I G B.C M

10. Which is the most likely reasonUt haSt tyN pe 2Td iabeteOs mellitus is of ten d if ficult to d iagnose in

older adults? a. Presenting symptoms occur very quickly. b. The disease rarely occurs in older adults. c. The classic symptoms may not be present in older adults. d. There are no recognizable symptoms; it is a “silent killer.”

ANS: C

The symptoms are also often masked by normal aging changes and conditions common in older adults. Polydipsia often does not occur because of the decreased thirst mechanism in older adults, polyphagia is often not recognized because of normal appetite declines associated with aging, and polyuria is often not recognized because of frequent urinary tract infections in older adults. Presenting symptoms usually occur very slowly. Type 2 diabetes mellitus is very common in older adults. There are symptoms of diabetes mellitus in older adults; however, they may be different than in younger adults.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 268

TOP: Teaching and Learning

11. A nurse is caring for an older adult who is diagnosed with type 2 diabetes. The patient is

prescribed oral medication for diabetes. The nurse can expect that which of the following medications is prescribed as a first line therapy? a. Insulin b. Sulfonureas

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank c. Metformin d. Chlorpropamide ANS: C

Metformin (Glucophage) is commonly prescribed as first-line therapy; it does not cause hypoglycemia or weight gain. Sulfonylureas were used for many years as first-line agents for all persons with type 2 diabetes. However, they are associated with hypoglycemia and can only be used in persons who can either be aware of the signs themselves or who have a caregiver capable of doing so; therefore, metformin is considered the first line of therapy.

Insulin is used for individuals with type 2 diabetes, however, is not first-line therapy.

Chlorpropamide is contraindicated because of its long half-life and because it can cause prolonged hypoglycemia.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 273

TOP: Teaching and Learning

12. An older adult with type 2 diabetes who is being treated with insulin wants to increase his

activity level and begin a walking program. What recommendations should the nurse provide to this patient? a. A walking program is not recommended for an older adult with diabetes. b. The walking regimen needs to be done on a regularly scheduled basis. c. Regular exercise should not exceed 30 minutes three times a week. d. Insulin can most probably be discontinued if the individual adheres to the walking program.

ANS: B

If the person is using insulin, exercise needs to be done on a regular rather than an erratic basis. Exercise is an importanNt U paRrtSoI fN d iG abTetBes.sC elf management. I n some cases, exercise in O-M conjunction with an appropriate diet may be sufficient to maintain blood glucose levels within normal levels; however, it is not likely that insulin will be able to be discontinued.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 273

TOP: Teaching and Learning

13. Hyperglycemia is harder to detect in older adults because of which of the following? a. There is a higher tolerance for elevated levels of circulating glucose in older

adults. b. Older adults tend to metabolize glucose at a faster rate than younger adults. c. Fingerstick glucose monitoring is inaccurate in older adults. d. The classic signs of elevated glucose levels, polyuria, polyphagia, and polydipsia

are rarely present in older adults.

ANS: A

Hyperglycemia in older adults is harder to detect than in a younger adult. With aging, there is a higher tolerance for elevated levels of circulating glucose. It is not unusual to find persons with fasting glucose levels of 200 to 600 mg/dL or higher. It is not true that older adults metabolize glucose at a faster rate than younger adults or that fingerstick glucose monitoring is inaccurate in older adults. Although it is true that older adults usually do not have the classic symptoms of elevated glucose levels, this does not explain why hyperglycemia is harder to detect in older adults.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 270

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. The nurse teaches an older adult who has diabetes mellitus and takes metoprolol (Lopressor)

to recognize clinical indicators of hypoglycemia. Which clinical indicators of hypoglycemia does the nurse include in patient teaching as the indicators this man is most likely to detect?

(Select all that apply.) a. Shaking b. Dizziness c. Weakness d. Diaphoresis e. Tachycardia f. Impaired vision ANS: B, C, F

Dizziness is a clinical indicator of moderate hypoglycemia. It is unlikely to be masked by the effects of metoprolol, a beta-adrenergic blocker, because beta blockers effectively mask the early signs of hypoglycemia. Weakness is a clinical indicator of moderate hypoglycemia and is unlikely to be masked by the effects of metoprolol. Impaired vision is a clinical indicator of moderate hypoglycemia and is unlikely to be masked by the effects of metoprolol. Shaking is an early clinical indicator of hypoglycemia and likely to be masked by the action of a beta-adrenergic blocker such as metoprolol; beta blockers oppose the surge of epinephrine in early hypoglycemia. Diaphoresis is an early clinical indicator of hypoglycemia, and it is likely to be masked by the action of a beta-adrenergic blocker such as metoprolol. Increased heart rate is an early clinical ind icaN toUr R ofShI ypNoG glyc mC i aOaM nd is likely to be masked by the action of a TBe. beta-adrenergic blocker such as metoprolol.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 270

TOP: Teaching and Learning

2. The nurse recognizes which of the following signs and symptoms as an indication of

hypothyroidism? (Select all that apply.) a. Decline in cognitive function b. Decrease in functional status c. Decrease in thyroid-stimulating hormone (TSH) and thyroxine (T4 ) d. Heat intolerance ANS: A, B, D

A decline in cognitive function, functional status, and heat intolerance are all indicative of hypothyroidism. An elevated TSH and decrease in T4 indicates hypothyroidism.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 266 MSC: Physiological Integrity

3. The nurse is caring for a patient diagnosed with hyperthyroidism. Which signs and symptoms

indicate hyperthyroidism? (Select all that apply.) a. Atrial fibrillation b. Heart failure c. Constipation

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank d. Heat intolerance ANS: A, B, C

Compared with hypothyroidism, the onset of hyperthyroidism may be quite sudden. The signs and symptoms in older adults include unexplained atrial fibrillation, heart failure, constipation, anorexia, muscle weakness, and other vague complaints. Symptoms of heart failure or angina may cloud the clinical presentation and prevent the correct diagnosis. The person may be misdiagnosed as being depressed or having dementia. On examination, the person is likely to have tachycardia, tremors, and weight loss. Heat intolerance is attributed to hyperthyroidism.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 266 MSC: Physiological Integrity

4. An older patient asks a nurse: “I went to my diabetes doctor and everything was stable. The

nurse practitioner spent the entire time teaching me about decreasing my risks of heart disease. It seemed odd that she did not focus on teaching me how to better control my diabetes. Do you know why?” The nurse formulates a response based on the understanding that (Select all that apply.) a. promoting cardiovascular health has the potential to minimize the complications of diabetes. b. there is little evidence that demonstrates that the course of diabetes can be altered in an older adult. c. the benefits of better control of blood pressure and lipid levels are seen much quicker than the benefits of better glycemic control. d. older adults are less receptive to teaching about diabetes than they are to teaching about cardiovascular disease.

N RS ING T B.CO M e. d iabetes is not a common cU hronic cond ition in old er ad ults.

ANS: A, C

Although glycemic control is important, more emphasis is now on the prevention and treatment of cardiovascular diseases. Research has indicated that although it may take 8 years of glycemic control before benefits are seen, the benefits of better control of blood pressure and lipids are seen as early as 2 to 3 years. Promoting cardiovascular health has the potential to be the most efficacious in the minimization of complications in the persons with diabetes.

Education on self-management of diabetes is important for patients of all ages. Diabetes is a common chronic condition in older adults.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 270

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank The older adult uses the elevator to travel between floors of a building, demonstrating that she knows not to use a walker on the stairs and is thus safe to discharge. Older adults should use the arms of a walker for stability. A walker with four wheels can be easy to move; however, such ease of movement does not provide enough stability to be suitable as an assistive device.

To use a walker correctly, she should take two steps at a time into the walker.

PTS: 1 DIF: Apply REF: p. 210 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Evaluation

9. Which attempt by the family to prevent an older frail adult from falling causes the home

health nurse concern? a. Keeping several low wattage night lights on in the evening b. Installing wooden railings on the stairway to the bathroom c. Keeping the side rails up on the client’s bed at night d. Encouraging the client to use a cane when ambulating ANS: C

Keeping side rails up have proven to be a risk factor for falls rather than a positive intervention. The remaining interventions are appropriate and generally effective.

PTS: 1 DIF: Apply MSC: Safety and Infection Control

REF: p. 212

TOP: Teaching and Learning

10. A nurse in a long-term care facility notes that there has been an increase in falls on one unit

and that many of the falls are occurring immediately after mealtime. The nurse recommends that the nursing home conduct a trial of six smaller meals instead of the three traditional meals. The nurse makes this recommendation on the understanding that a. postural changes in bloodNpU reRssSurIeNaG reTcoBm.mCoOnMin old er ad ults and f requently occur around mealtimes. b. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. c. residents of long-term care facilities are often on many different medications that are given at mealtimes. d. it is common practice in to take long-term care residents to the bathroom immediately after meals.

ANS: B

Postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. Modifications such as increased water intake before eating or substituting six smaller meals daily for three larger meals may be effective.

Orthostatic hypotension is a cause of falls in older adults, but it does not just occur around mealtimes. Although it is true that residents of long-term care facilities take multiple medications and are usually toileted after meals, neither of these options addresses postprandial hypotension.

PTS: 1 DIF: Analyze MSC: Safety and Infection Control

REF: p. 206

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 11. A nurse is admitting and orienting an older adult to the hospital unit. She discusses fall

prevention and demonstrates the use of the call bell to the patient. The patient’s daughter asks: “Why don’t you just put up all the side rails to prevent my mother from getting out of bed by herself and falling? That should work, right?” The best response by the nurse is: a. “Side rails have only proven to be effective in decreasing falls in patients who have already fallen.” b. ‘There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury.” c. “Side rails are only effective when used with patients who have dementia” d. “Side rails do not decrease falls, but they do decrease fall-related injuries.”

ANS: B

There is no evidence to date that side rail use decreases the risk or rate of fall occurrence.

There are numerous reports and studies documenting the negative effects of side rail use, including entrapment deaths and injuries that occur when the person slips through the side rail bars or between split side rails, the side rail, and the mattress; between the headboard or footboard, the side rail, and the mattress; or between the headboard or footboard, the side rail, and the mattress.

PTS: 1 DIF: Apply MSC: Safety and Infection Control

REF: p. 212

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. Which of the following are assessed in a fall prevention assessment of an older adult? (Select

all that apply.) a. Environment b. Physical status c. Financial status d. Functional status e. Medical history f. Occupational history

NURSINGTB.COM

ANS: A, B, D, E

The nurse uses information about lighting, flooring, apparel, and other issues from the environmental assessment of an older adult to plan individualized fall prevention measures.

The nurse examines flexibility, muscle strength, vital signs, and other clinical indicators in the physical assessment of an older adult to plan individualized fall prevention measures. The nurse uses information about gait, balance, and ability to perform activities of daily living in the functional status assessment of an older adult to plan individualized fall prevention measures. The nurse examines medications, previous accidents and falls, comorbid conditions, and other factors in the historical assessment of an older adult to plan individualized fall prevention measures. Financial issues and occupational history are not directly related to a risk for falls.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 207 MSC: Safe, Effective Care Environment

2. Which factors in the patient care environment should be routinely assessed to decrease the

risk of falls? (Select all that apply.)

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank a. b. c. d.

Outdoor grounds Appropriate footwear All four bed rails raised Grab bars in place

ANS: A, B, D

The outdoor grounds should be checked for uneven areas, such as breaks in the sidewalk and items the patients could trip over. Ensuring that patients have the appropriate footwear in important to decrease the risk for falls. Raised bed rails can be considered a restraint. Grab bars are considered assistive devices and can decrease the risk for falls or injuries.

PTS: 1 DIF: Understand REF: p. 204 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Planning

3. Which assessment finding is a contributor to an older client’s risk for falls? (Select all that

apply.) a. The client is awaiting cataract surgery on right eye. b. The client type 2 diabetes is poorly controlled with diet and exercise alone. c. The client reports a fall in the past year. d. The client has a history of contact dermatitis and psoriasis. e. The client attends Tai Chi classes at the senior center.

ANS: A, B, C

The correct options are those that affect the client’s vision, presence of factors affecting sensations in the legs and feet, and a history of falls. There is no research to connect the risk of falls with either of the skin conditions mentioned. Tai Chi improves balance, which decreases the risk of falls.

NURSINGTB.COM REF: p. 204

PTS: 1 DIF: Apply MSC: Safety and Infection Control

TOP: Teaching and Learning

4. A group of older women in an assisted living facility are talking about one of the residents

who fell and fractured her hip. The women ask a nurse the following: “It seems like so many of us fall and break our hips, and then it is downhill from there. Is this really true?” In formulating a response, the nurse considers which of the following? (Select all that apply.) a. Hip fractures are a leading cause of hospitalization for older people. b. The major cause of hip fractures is falls. c. Women have significantly higher mortality rates from hip fractures than do men. d. Nearly all older patients who sustain a hip fracture will regain prefracture mobility status within 1 year. e. Hip fractures are associated with very high morbidity and mortality rates.

ANS: A, B, E

Hip fracture is the second leading cause of hospitalization for older people. More than 95% of hip fractures among older adults are caused by falls. Older adults who fracture a hip have a five to eight times increased risk of death during the first 3 months after hip fracture. This excess mortality persists for 10 years after the fracture and is higher in men. Only 50% to 60% of patients with hip fractures will recover their prefracture ambulation abilities in the first year postfracture. Most research on hip fractures has been conducted with older women.

PTS: 1

DIF: Remember

REF: p. 202

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank MSC: Safety and Infection Control 5. A home health nurse is making a home visit to an older patient. A nurse conducts a home

safety assessment and screens the environment for potential hazards for falls. The nurse recommends that the patient eliminate which of the following? (Select all that apply.) a. Night lights b. Railings on the stairway c. Loose carpeting on the floors d. The use of a cane e. Excess clutter ANS: C, E

Extrinsic risk factors are external to the patient and related to the physical environment and include lack of support equipment by bathtubs and toilets, height of beds, condition of floors, poor lighting, inappropriate footwear, and improper use of or inadequate assistive devices.

Night lights, railings on the stairway, and the use of a cane are all measures that can ameliorate some extrinsic risk factors.

PTS: 1 DIF: Apply MSC: Safety and Infection Control

REF: p. 204

TOP: Teaching and Learning

6. A homecare nurse visits a client in the home to conduct a fall risk assessment. The nurse

assesses the client and the home for extrinsic risk factors for falls. Which of the following are extrinsic risk factors? (Select all that apply.) a. The client has an unsteady gait. b. The client uses a cane but the cane is not the appropriate size for the client. c. The client’s home is cluttered. I G B.C M R catiT d. The client is on two d if f N ereU nt mSed iN ons thatOcause orthostatic hypotension. e. There are no grab bars in the client’s bathroom.

ANS: B, C, E

Extrinsic risk factors are external to the patient and related to the physical environment and include inadequate support devices. Intrinsic risk factors are unique to each patient, such as having an unsteady gait or being on two different medications that cause orthostatic hypotension.

PTS: 1 DIF: Apply MSC: Safety and Infection Control

REF: p. 204

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 16: Promoting Safety Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. The nurse can place an older adult into one of four patient rooms. Which is the most suitable

room for an older adult? a. Brightly lit, blue room with cozy throw rugs b. Room with orange carpeting and soft lighting c. Brightly lit, blue room with waxed vinyl floors d. Room for television and children’s playtime ANS: B

The soft lighting avoids glare, and the carpet provides better traction than a glossy floor.

Lamps should be added to supply more light when desired. Throw rugs easily slip, and older adults can trip on them, resulting in injury. The patient’s feet should not be able to glide easily across the floor, and when the surface becomes wet, a waxed floor can be very slippery. The patient may stumble over children and toys.

PTS: 1 DIF: Apply REF: p. 209 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Planning

2. The overall temperature in your gerontological unit is 62 °F during the evening shift. In

documenting this concern to the administration, which factor is the most important for the health and well-being of old eN r adR ultsI ? G B.C M a. I t is not f air f or old er ad ultsUto S haveNtoTd eal wiO t h an uncomf ortable environment. b. Some of the residents are wearing blankets around their shoulders to keep warm. c. An ambient temperature of 62 °F is unsuitable for older people because they have impaired thermoregulation. d. It feels much warmer in the administration wing than out in the patient care areas.

ANS: C

Under no circumstances should the temperature drop below 65 °F because older adults are at risk for hypothermia. Furthermore, frail older adults need the temperature to be considerably higher. The issue is not one of fairness but a more fundamental issue of patient safety. Some of the residents wearing blankets may represent individual temperature preferences. The purpose is to make the point that the patients are vulnerable to low temperatures, not to make veiled accusations against the administrators.

PTS: 1 DIF: Apply REF: p. 218 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Planning

3. Which of the following statements is true about a safe, effective care environment for older

adults? a. Cold beer with steak and potatoes is a good meal for an older adult on a hot day. b. Older drivers are more likely to be in a fatal motor vehicle accident than younger drivers. c. Barrier-free buses and low fares make public transit a safe transportation option. d. A nurse’s perception of temperature is a useful guide for patient thermal needs.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

ANS: B

Although older adults have safer driving habits (e.g., less night driving, less driving in heavy traffic, shorter distances, less speeding and drunk driving) than younger drivers, the physical and sensory changes of aging contribute to a higher incidence of fatal accidents for older adults. Hot, heavy meals and alcohol should be avoided when ambient temperatures exceed 90 °F. The fear of crime often deters older adults from using public transit. Older adults’ perception of temperature is the important factor.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 221 MSC: Safe, Effective Care Environment

4. An older man was oriented and responded appropriately in the hospital, but he is now

disoriented and confused in his home after discharge. Which of the following issues is the first that the home nurse should examine to determine whether an environmental issue is contributing to the patient’s condition at home? a. Complaints of shivering b. Temperature of household c. Types of food preparation d. Presence of radon ANS: B

Older adults are at higher risk of hypothermia in the community because hypothermia is difficult to detect and because, as hypothermia sets in, the older adult can respond to a lower temperature. This man has clinical indicators of hypothermia; therefore, the home care nurse first assesses the ambient temperature for a baseline determination because the household temperature should have the most profound impact on his body temperature. Asking about shivering can be inef f ective w an old er ad ult who is conf used and d isoriented ; the response Nith U RSINGTB. M can be incorrect. However, to display respect, the nurse should ask the question. The type of food preparation can offer additional clues about the older adult’s hypothermia and mental status; if he is eating cold foods such as sandwiches and yogurt, then he can be unwittingly contributing to the problem. The presence of radon in the home may lead to lung cancer, not confusion.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 219 MSC: Health Promotion and Maintenance

5. The nurse recommends that a client diagnosed with moderate stage Alzheimer’s disease

attend a support group when he becomes defensive about not driving his automobile and the effects it will have on “being stuck at home.” Which is the priority outcome expected for this client when attending the group sessions? a. Facilitates socialization, thus minimizing the effects of social isolation b. Helps with minimizing the loss as a factor in causing depression c. Provides caregivers with respite while assuring the client is well attended to d. Allows for the opportunity for a mental health professional to assess the client ANS: B

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Participants attending the driving cessation support groups had an improvement in depression scores, were less angry, and were happier. Support groups designed specifically to deal with loss of driving privileges among individuals with dementia may be important in alleviating depressive symptoms and other negative outcomes associated with cessation of driving. The remaining options represent possible outcomes, but they do not have the priority that minimizing depression has for this client.

PTS: 1 DIF: Analyze REF: p. 222 MSC: Safe and Effective Care Environment

TOP: Teaching and Learning

6. A 79-year-old client resides independently in the community. The visiting home health nurse

finds even though it is 90 °F outside, the windows are closed, and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to a. cognitive changes that diminish the individual’s awareness of temperature changes. b. age-related neurosensory changes that diminish awareness of temperature changes. c. delirium related to an acute illness that is affecting body heat production. d. age-related motor deficiencies that result in self-neglect.

ANS: B

Neurosensory changes related to aging tend to delay or diminish the individual’s awareness of temperature changes and may impair behavior or thermoregulatory responses to dangerously high or low temperatures. There is no evidence in this scenario that the client has cognitive changes, an acute illness or is incapable of self-care, and such assumptions should not be routinely made based on age alone.

PTS: 1 DIF: Apply REF: p. 218 TOP: Teaching and Learning N RnvirIS G ent, B.C M MSC: Saf e and Ef f ective Care EU o nmN Physiol ogical Integrity T O 7. A home care nurse in an area of the country that is prone to tornadoes routinely discusses

disaster preparedness with older adult clients. What is the primary rationale for this intervention? a. Older adults are less likely to seek formal and informal help when affected by natural disasters. b. The older adult is more likely to live in a communal environment that provides assistance in times of natural disasters. c. Most older adults have insurance to help them recover from material losses because of a natural disaster. d. Federal and private assistance agencies generally provide older adults with priority attention in time of natural disasters.

ANS: A

Older adults are less likely to seek assistance than younger adults in times of disaster. The remaining options are not generally proven to be true for the majority of older adults.

PTS: 1 DIF: Apply MSC: Safety and Infection Control

REF: p. 221

TOP: Teaching and Learning

8. A homecare nurse visits an older patient who lives in a smart medical home community

environment. The nurse understands that smart homes are: a. an emerging technology to enhance safety of older adults by using environmental

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank control systems. b. an assistive technology that keeps data on vital signs, gait, behavior, and sleep

without providing an interactive medical-advising system. c. an emerging technology to aid in the prevention and later detection of disease

through the use of sensors and monitors. d. elder-friendly communities where residents participate in the design and operation

of the home.

ANS: A

Technology advances hold promise for improving quality of life, decreasing the need for personal care assistance, and enhancing independence and the ability to live safely. An emerging technology to enhance the safety of older adults by using environmental control systems is known as a smart house or intelligent home. Smart homes do provide an interactive medical-advising system. Smart medical homes are being studied as a way to aid in the prevention and early detection of disease through the use of sensors and monitors.

Elder-friendly communities are communities that provide increased opportunities to age in place, thus leading to enhanced health and well-being.

PTS: 1 DIF: Remember REF: p. 224 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. The nurse plans care to prevent a dangerous thermal environment for an older man who lives

in a northern climate of the United States. Which patient assessment data does the nurse recognize that can contribute to his risk of hypothermia? (Select all that apply.) a. Has a history of a cerebroN vasR t (C CVM A) Ucula SIr ac NGcidTeBn. b. Has a history of diabetes mellitus c. Builds miniature cars for a hobby d. Bathes three to four times a week e. Gets heat from a boiler in the cellar f. Becomes diaphoretic on warm days ANS: A, B, C, E

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank A CVA can impair an older adult’s thermoregulatory center and potentially diminish the individual’s awareness of temperature changes or the ability to respond suitably to a temperature change. In addition, if an older adult is left with a cognitive deficit or aphasia, then the older adult’s ability to communicate a thermal problem is potentially impaired. A history of diabetes mellitus can contribute to a dangerous thermal environment for older adults. A complication of diabetes is peripheral neuropathy, which potentially impairs the ability to sense temperature change. In addition, peripheral arterial disease associated with diabetes contributes to an individual’s ability to compensate to temperature changes with vasodilation or vasoconstriction. Building miniature cars is a sedentary activity. The associated metabolic activity is low, the older adult generates less heat from metabolic activity, and the individual is at a higher risk for hypothermia when the temperature is cool.

Household heat from a boiler in the cellar creates a potential regulatory problem for an older adult living in the building because adjustments to temperature affect the entire household and are only made in the cellar. Thermostats in individual rooms do not exist in such a heating system. If the individual has impaired mobility, then he might be unable to navigate the stairs to the cellar and adjust the temperature. Bathing three to four times a week limits the exposure of bare skin to the cooling effects of evaporation to reduce the risk of hypothermia.

Diaphoresis on a warm day is a suitable response to heat.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 220 MSC: Safe, Effective Care Environment

2. The nurse will be educating a group of senior citizens on adaptations for safer driving. Which

adaptations should the nurse include? (Select all that apply.) a. Wide rear-view mirrors b. Pedal extensions c. Global positioning system N(G ) dNevGice URPSSI TBs .COM d. Antiroll bars ANS: A, B, C

Wide rear-view mirrors, pedal extensions, and GPS devices are all suggested adaptations. The use of antiroll bars has not been identified as an adaptation.

PTS: 1 DIF: Remember REF: p. 222 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Planning

3. Benefits of telehealth include that it (Select all that apply.) a. promotes self-management of illness in rural and underserved areas. b. facilitates remote physical assessment and monitoring of chronic conditions. c. decreases costs by replacing the role of the nurse with technology. d. decreases costs by reducing hospital readmissions. e. is reimbursed by all health care insurance plans.

ANS: A, B, D

Telehealth promotes self-management of illness and facilitates remote assessment and monitoring in rural and underserved areas. Evidence has demonstrated that it reduces costs by decreasing hospital readmission. Telehealth does not replace the role of the nurse; the technology augments the ability of the nurse to reach clients in remote areas. Unfortunately, not all health care insurers reimburse for telehealth services.

PTS: 1

DIF: Remember

REF: p. 224

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank MSC: Health Promotion and Maintenance 4. The daughter of an older patient states the following to a nurse: “I am so concerned that my

dad is still driving. He is dangerous! He has had a couple of accidents, and I am worried that he is going to kill himself, or worse, somebody else. What can I do?” The nurse recommends which of the following involved type action strategies for driving cessation? (Select all that apply.) a. Report the person to the division of motor vehicles for license suspension. b. Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem. c. Arrange for alternate transportation for the person. d. Confiscate the keys to the car. e. Ask the patient’s physician to write a prescription for the person to stop driving.

ANS: B, C

Holding a family meeting with the older person to discuss the situation and arranging for alternate transportation are examples of involved action strategies for driving cessation. The other options are examples of imposed action strategies for driving cessation.

PTS: 1 DIF: Analyze REF: p. 224 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

5. A nurse is caring for a frail older adult in a long-term care facility and is concerned about

preventing hypothermia. Which of the following interventions should the nurse implement?

(Select all that apply.) a. Make sure that the temperature in the resident’s room is at least 65 °F. b. Cover residents well when in bed and while bathing.

NUthe RSres INidGenTt.B.C OM c. Provid e a head covering for d. Maintain resident in bed covered with heavy blankets at all times. e. Provide hot, high-protein meals and bedtime snacks.

ANS: A, B, C, E

Interventions to prevent hypothermia in frail elders include maintaining an ambient temperature of no lower than 65 °F; providing a head covering whenever possible (in bed, out of bed, and particularly out of doors); covering patients well when in bed and when bathing; and providing hot, high-protein meals and bedtime snacks to add heat and sustain heat production throughout the day and as far into the night as possible. In addition, it is important to get the patient out of bed and provide as much exercise as possible to generate heat from muscle activity.

PTS: 1 DIF: Remember REF: p. 219 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 17: Living With Chronic Illness Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. An older female patient is diagnosed with a chronic illness. Which of the following principles

should the nurse apply when answering her questions? a. The most prevalent form of disease in the United States is acute illness. b. Usually, chronic disease has a negligible impact on the family. c. Chronic illness is unending, and coping can be influenced by the perception of uncertainty. d. Older adults successfully cope with chronic disease by learning about the disease.

ANS: C

Chronic illnesses are enduring and necessitate lifetime adaptations. Uncertainty exacerbates the impact of a chronic disease. At this time, the most prevalent form of disease is chronic illness. The effect on the family, as on the patient, can be profound. There are no guarantees.

Knowledge requires effort on the part of all concerned to apply it.

PTS: 1 DIF: Apply REF: p. 229 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

2. Which of the following describes the nurse’s role for an older patient with a chronic illness? a. Implement an individualized therapeutic regimen that brings about a cure. b. Provide caring to help the patient live at the optimal level of health and wellness. c. Suggest that the patient aN ccU eR ptsSeIveNnGtuT alBd.eaCthOto red uce the burd ens on the

patient’s family. d. Encourage the patient to minimize the use of services to control costs.

ANS: B

A chronic illness cannot be cured, but with caring, the nurse can assist the patient to live without being dominated by the demands of the illness. Chronic illnesses are long-term problems, and cures are not usually available. If a patient has an incurable illness, then the nurse can provide a caring environment to facilitate the implementation of the patient and family’s wishes. The nurse can help the patient and family to formulate cost-cutting measures, if so requested; however, because the nurse is the patient’s advocate, the nurse avoids making recommendations about not using services.

PTS: 1 DIF: Understand REF: p. 232 MSC: Health Promotion and Maintenance

TOP: Caring

3. Which of the following statements is the most suitable for establishing goals when teaching an

older adult with a chronic illness about potential changes in the health maintenance regimen? a. Management of the patient’s chronic disease rests on the patient and the caregiver; therefore, the goals should be collaboratively set. b. The patient will be able to make needed changes in his or her life if the nurse provides accurate, written instructions. c. Psychological functioning is usually impaired only to a small extent in a patient with a chronic illness.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank d. The patient’s values, culture, and beliefs will have little to do with the types of

changes he or she will be able to make.

ANS: A

The patient must remain involved in the decision-making process; the patient and the caregiver may have different priorities. Instructions, by themselves, are not sufficient.

Psychological functioning may be more impaired than physical functioning. The patient’s values, cultures, and beliefs profoundly shape the patient’s response to chronic illness and to therapeutic interventions.

PTS: 1 DIF: Understand REF: p. 233 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

4. Acute illness is to chronic illness as to which of the following comparisons? a. An emergency department is to a nursing home b. A hospital staff nurse is to a nurse practitioner c. Health insurance is to Medicare for older adults d. Inpatient surgical care is to outpatient medical care ANS: A

Acute illness can be likened to an emergency department because it treats conditions with sudden onset and sudden exacerbations of existing conditions with short-term treatment options, compared with a nursing home, which cares for individuals with long-term conditions that warrant admission after a decline in health or to individuals with long-term health care needs. The acute–chronic analogy is a comparison of sudden and short term versus gradual and long term. The comparison between a nurse and a nurse practitioner is one of the practice settings and the scope of the practice. Medicare is a type of health insurance; however, chronic illness is not a type oN fU acR utS eI illN neGssT. B I n. paCt O ienMt surgical care can be emergent and elective, and outpatient medical care is usually for ongoing health care but can also be applied to emergent conditions.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 229 MSC: Safe, Effective Care Environment

5. More than 50% of the population aged 65 years and older has which one of the following

chronic health conditions? a. Hypertension b. Renal failure c. Multiple sclerosis d. Cancer ANS: A

More than 50% of the population aged 65 years and older has hypertension and arthritis followed by heart disease and diabetes.

PTS: 1 DIF: Understand REF: p. 230 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

6. An older man who is right handed works as a carpenter, but he has been left with a flaccid

right arm after a thrombus occluded a cerebral artery. Which is the most important goal for the plan of care to help this man achieve his optimal state of health and wellness? a. Maintain skin integrity of right arm.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank b. Collaborate with occupational therapy (OT). c. Promote plaque-reversing strategies. d. Support effective coping mechanisms.

ANS: B

The dominant arm, vital to the skill of a carpenter, is useless to this man unless he can adapt to the impairment with adaptive skills. Collaborating with OT is the most important goal for this older adult because adaptation is the greatest factor in establishing wellness, and OT can assist this man with adaptive tools, skills, and abilities to manage living with a flaccid dominant hand and arm. Maintaining skin integrity should be included in this man’s plan of care because a flaccid extremity is at risk for skin breakdown, but it is not the first priority.

Promoting plaque-reversing strategies, including diet and antilipid medication, should be part of this man’s plan of care. However, these strategies are not the most important goal for this man; adaptation is the most important factor in establishing health and wellness. Supporting effective coping mechanisms is a goal that should be included in this man’s plan of care; however, given the flaccidity of his dominant arm, the most effective measures toward adaptation are to help him develop the new skills and abilities he will need to cope effectively.

Supporting effective coping mechanisms can help enhance the work of OT. PTS: 1 DIF: Analyze REF: p. 233 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

7. An older woman has diabetes mellitus. Which patient assessment validates the nurse’s

conclusion that she is in the foreground perspective of the shifting perspectives model of chronic illness? a. Has an amputation of two toes b. Lives at home with her husband N R I G B.C M c. Frequently self -checks her U blooSd sN ugaT r d. Changes the battery in her glucometer

O

ANS: A

An older adult thinks and acts about diabetes mellitus in the foreground perspective when signs of disease progression occur, which is evidenced by the need for the amputation of two toes, because hyperglycemia damaged the lining of vessels and led to peripheral artery disease. The perfusion to this woman’s toes deteriorated to the extent that the tissue died; the dead tissue had to be removed to avoid infection. Living at home indicates she has a functional status that is sufficient to maintain independent living. This woman is able to monitor her blood sugar independently and retains enough functional ability to change a battery.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 232 MSC: Safe, Effective Care Environment

8. Which of the following qualities does the nurse need to provide caring? a. Sensitivity to the needs of other nurses b. Longing to help others live a healthy life c. Desire to have a stable career and income d. Ability to create a trusting environment ANS: D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Along with competence, compassion, conscience, and a commitment to provide caring, the nurse must be able to inspire confidence in the nursing care. The nurse with compassion has sensitivity to the needs of others in general. The desire to help others lead healthy lives is admirable; however, to provide caring, the nurse should not impose personal beliefs on patients. Nurses can provide caring by dedicating themselves to nursing as a lifelong commitment and not solely as a means to provide a living.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 233 MSC: Psychosocial Integrity

9. A nurse is caring for an older adult who is in the pretrajectory phase of the chronic illness

trajectory. The nurse knows that this phase is characterized by which of the following? a. The absence of signs or symptoms of the illness b. Diagnostic testing being conducted c. A progressive decline in physical and/or mental status d. A period of temporary remission from the crisis ANS: A

The pretrajectory phase is characterized by the absence of signs of symptoms of the illness.

The trajectory onset includes the diagnostic period. The downward phase is characterized by a progressive decline in physical or mental status, characterized by increasing disability or symptoms. The comeback phase is characterized as a period of temporary remission from the crisis.

PTS: 1 DIF: Remember MSC: Physiological Integrity

REF: p. 232

TOP: Teaching and Learning

10. A major d if f erence in the d iaN gnUoR sisSoIf N chGrT onB ic.dC isO eaM se between younger ad ults and old er

adults is that a. chronic disease is often diagnosed earlier in younger adults, and measures can be implemented to prevent later problems. b. chronic disease is often diagnosed earlier in older adults because they are more likely to seek medical care. c. chronic disease is usually not identified in older adults because of the many age-related changes. d. chronic illness is uncommon in younger adults.

ANS: A

In younger adults, the early signs of a pending chronic disease may be identified early enough to prevent later problems (e.g., a finding of an elevated cholesterol level). In older adults, a chronic disease may not be diagnosed until some amount of “end-organ damage” has already occurred. For example, diabetic retinopathy may be found during an annual eye examination, indicating that the diabetes has been present for some time. Although there are many age-related changes in older adults, it is still possible to identify chronic illness. Chronic illness is common in younger adults, although it is more common in older adults.

PTS: 1 DIF: Apply MSC: Physiological Integrity MULTIPLE RESPONSE

REF: p. 231

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 1. Which of the following types of phases are included in the chronic illness trajectory (CIT)?

(Select all that apply.) a. Caring b. Plateau c. Instability d. Bargaining e. Deterioration f. Rehabilitation ANS: B, C, E

The CIT includes a stable (plateau) phase, an unstable (instability) phase, and a downward and dying (deterioration) phase. The CIT does not include a caring phase, a bargaining phase, or a rehabilitation phase.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 232 MSC: Health Promotion and Maintenance

2. Which factors are modifiable health risk behaviors for chronic illness? (Select all that apply.) a. Physical activity b. Prescription medication use c. Poor nutrition d. Tobacco use ANS: A, C, D

Physical activity is modifiable; patients can begin an exercise program at any time. Nutrition is also a modifiable health risk behavior; patients have the ability to increase or decrease intake, depending on their weight and nutritional status. Tobacco use is also a modifiable behavior; patients can particiN paUteRiS n I aN smGoT kiB ng.cC eO ssaMtion program or use other assistance to stop smoking.

PTS: 1 DIF: Understand REF: p. 231 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. A nurse is planning health education on chronic illnesses for a group of seniors in the

community. When deciding upon which illnesses to focus on, the nurse knows that which of the following are the most common diseases in the United States? (Select all that apply.) a. Heart disease b. Hypertension c. Asthma d. Osteoarthritis e. Diabetes ANS: A, B, D

The most common chronic diseases in the United States are heart disease, hypertension, and osteoarthritis.

PTS: 1 DIF: Remember MSC: Physiological Integrity OTHER

REF: p. 230

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 1. The chronic illness trajectory (CIT) includes eight phases. List the phases in order, beginning

with the first phase. a. Crisis b. Unstable c. Downward d. Dying e. Stable f. Acute g. Trajectory onset h. Pretrajectory ANS:

H, G, A, F, E, B, C, D The phases of the CIT are pretrajectory, trajectory onset, crisis, acute, stable, unstable, downward, and dying.

PTS: 1 DIF: Understand REF: p. 232 MSC: Health Promotion and Maintenance

NURSINGTB.COM

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 17: Living With Chronic Illness Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. An older female patient is diagnosed with a chronic illness. Which of the following principles

should the nurse apply when answering her questions? a. The most prevalent form of disease in the United States is acute illness. b. Usually, chronic disease has a negligible impact on the family. c. Chronic illness is unending, and coping can be influenced by the perception of uncertainty. d. Older adults successfully cope with chronic disease by learning about the disease.

ANS: C

Chronic illnesses are enduring and necessitate lifetime adaptations. Uncertainty exacerbates the impact of a chronic disease. At this time, the most prevalent form of disease is chronic illness. The effect on the family, as on the patient, can be profound. There are no guarantees.

Knowledge requires effort on the part of all concerned to apply it.

PTS: 1 DIF: Apply REF: p. 229 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

2. Which of the following describes the nurse’s role for an older patient with a chronic illness? a. Implement an individualized therapeutic regimen that brings about a cure. b. Provide caring to help the patient live at the optimal level of health and wellness. c. Suggest that the patient aN ccU eR ptsSeIveNnGtuT alBd.eaCthOto red uce the burd ens on the

patient’s family. d. Encourage the patient to minimize the use of services to control costs.

ANS: B

A chronic illness cannot be cured, but with caring, the nurse can assist the patient to live without being dominated by the demands of the illness. Chronic illnesses are long-term problems, and cures are not usually available. If a patient has an incurable illness, then the nurse can provide a caring environment to facilitate the implementation of the patient and family’s wishes. The nurse can help the patient and family to formulate cost-cutting measures, if so requested; however, because the nurse is the patient’s advocate, the nurse avoids making recommendations about not using services.

PTS: 1 DIF: Understand REF: p. 232 MSC: Health Promotion and Maintenance

TOP: Caring

3. Which of the following statements is the most suitable for establishing goals when teaching an

older adult with a chronic illness about potential changes in the health maintenance regimen? a. Management of the patient’s chronic disease rests on the patient and the caregiver; therefore, the goals should be collaboratively set. b. The patient will be able to make needed changes in his or her life if the nurse provides accurate, written instructions. c. Psychological functioning is usually impaired only to a small extent in a patient with a chronic illness.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank d. The patient’s values, culture, and beliefs will have little to do with the types of

changes he or she will be able to make.

ANS: A

The patient must remain involved in the decision-making process; the patient and the caregiver may have different priorities. Instructions, by themselves, are not sufficient.

Psychological functioning may be more impaired than physical functioning. The patient’s values, cultures, and beliefs profoundly shape the patient’s response to chronic illness and to therapeutic interventions.

PTS: 1 DIF: Understand REF: p. 233 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

4. Acute illness is to chronic illness as to which of the following comparisons? a. An emergency department is to a nursing home b. A hospital staff nurse is to a nurse practitioner c. Health insurance is to Medicare for older adults d. Inpatient surgical care is to outpatient medical care ANS: A

Acute illness can be likened to an emergency department because it treats conditions with sudden onset and sudden exacerbations of existing conditions with short-term treatment options, compared with a nursing home, which cares for individuals with long-term conditions that warrant admission after a decline in health or to individuals with long-term health care needs. The acute–chronic analogy is a comparison of sudden and short term versus gradual and long term. The comparison between a nurse and a nurse practitioner is one of the practice settings and the scope of the practice. Medicare is a type of health insurance; however, chronic illness is not a type oN fU acR utS eI illN neGssT. B I n. paCt O ienMt surgical care can be emergent and elective, and outpatient medical care is usually for ongoing health care but can also be applied to emergent conditions.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 229 MSC: Safe, Effective Care Environment

5. More than 50% of the population aged 65 years and older has which one of the following

chronic health conditions? a. Hypertension b. Renal failure c. Multiple sclerosis d. Cancer ANS: A

More than 50% of the population aged 65 years and older has hypertension and arthritis followed by heart disease and diabetes.

PTS: 1 DIF: Understand REF: p. 230 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

6. An older man who is right handed works as a carpenter, but he has been left with a flaccid

right arm after a thrombus occluded a cerebral artery. Which is the most important goal for the plan of care to help this man achieve his optimal state of health and wellness? a. Maintain skin integrity of right arm.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank b. Collaborate with occupational therapy (OT). c. Promote plaque-reversing strategies. d. Support effective coping mechanisms.

ANS: B

The dominant arm, vital to the skill of a carpenter, is useless to this man unless he can adapt to the impairment with adaptive skills. Collaborating with OT is the most important goal for this older adult because adaptation is the greatest factor in establishing wellness, and OT can assist this man with adaptive tools, skills, and abilities to manage living with a flaccid dominant hand and arm. Maintaining skin integrity should be included in this man’s plan of care because a flaccid extremity is at risk for skin breakdown, but it is not the first priority.

Promoting plaque-reversing strategies, including diet and antilipid medication, should be part of this man’s plan of care. However, these strategies are not the most important goal for this man; adaptation is the most important factor in establishing health and wellness. Supporting effective coping mechanisms is a goal that should be included in this man’s plan of care; however, given the flaccidity of his dominant arm, the most effective measures toward adaptation are to help him develop the new skills and abilities he will need to cope effectively.

Supporting effective coping mechanisms can help enhance the work of OT. PTS: 1 DIF: Analyze REF: p. 233 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

7. An older woman has diabetes mellitus. Which patient assessment validates the nurse’s

conclusion that she is in the foreground perspective of the shifting perspectives model of chronic illness? a. Has an amputation of two toes b. Lives at home with her husband N R I G B.C M c. Frequently self -checks her U blooSd sN ugaT r d. Changes the battery in her glucometer

O

ANS: A

An older adult thinks and acts about diabetes mellitus in the foreground perspective when signs of disease progression occur, which is evidenced by the need for the amputation of two toes, because hyperglycemia damaged the lining of vessels and led to peripheral artery disease. The perfusion to this woman’s toes deteriorated to the extent that the tissue died; the dead tissue had to be removed to avoid infection. Living at home indicates she has a functional status that is sufficient to maintain independent living. This woman is able to monitor her blood sugar independently and retains enough functional ability to change a battery.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 232 MSC: Safe, Effective Care Environment

8. Which of the following qualities does the nurse need to provide caring? a. Sensitivity to the needs of other nurses b. Longing to help others live a healthy life c. Desire to have a stable career and income d. Ability to create a trusting environment ANS: D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Along with competence, compassion, conscience, and a commitment to provide caring, the nurse must be able to inspire confidence in the nursing care. The nurse with compassion has sensitivity to the needs of others in general. The desire to help others lead healthy lives is admirable; however, to provide caring, the nurse should not impose personal beliefs on patients. Nurses can provide caring by dedicating themselves to nursing as a lifelong commitment and not solely as a means to provide a living.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 233 MSC: Psychosocial Integrity

9. A nurse is caring for an older adult who is in the pretrajectory phase of the chronic illness

trajectory. The nurse knows that this phase is characterized by which of the following? a. The absence of signs or symptoms of the illness b. Diagnostic testing being conducted c. A progressive decline in physical and/or mental status d. A period of temporary remission from the crisis ANS: A

The pretrajectory phase is characterized by the absence of signs of symptoms of the illness.

The trajectory onset includes the diagnostic period. The downward phase is characterized by a progressive decline in physical or mental status, characterized by increasing disability or symptoms. The comeback phase is characterized as a period of temporary remission from the crisis.

PTS: 1 DIF: Remember MSC: Physiological Integrity

REF: p. 232

TOP: Teaching and Learning

10. A major d if f erence in the d iaN gnUoR sisSoIf N chGrT onB ic.dC isO eaM se between younger ad ults and old er

adults is that a. chronic disease is often diagnosed earlier in younger adults, and measures can be implemented to prevent later problems. b. chronic disease is often diagnosed earlier in older adults because they are more likely to seek medical care. c. chronic disease is usually not identified in older adults because of the many age-related changes. d. chronic illness is uncommon in younger adults.

ANS: A

In younger adults, the early signs of a pending chronic disease may be identified early enough to prevent later problems (e.g., a finding of an elevated cholesterol level). In older adults, a chronic disease may not be diagnosed until some amount of “end-organ damage” has already occurred. For example, diabetic retinopathy may be found during an annual eye examination, indicating that the diabetes has been present for some time. Although there are many age-related changes in older adults, it is still possible to identify chronic illness. Chronic illness is common in younger adults, although it is more common in older adults.

PTS: 1 DIF: Apply MSC: Physiological Integrity MULTIPLE RESPONSE

REF: p. 231

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 1. Which of the following types of phases are included in the chronic illness trajectory (CIT)?

(Select all that apply.) a. Caring b. Plateau c. Instability d. Bargaining e. Deterioration f. Rehabilitation ANS: B, C, E

The CIT includes a stable (plateau) phase, an unstable (instability) phase, and a downward and dying (deterioration) phase. The CIT does not include a caring phase, a bargaining phase, or a rehabilitation phase.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 232 MSC: Health Promotion and Maintenance

2. Which factors are modifiable health risk behaviors for chronic illness? (Select all that apply.) a. Physical activity b. Prescription medication use c. Poor nutrition d. Tobacco use ANS: A, C, D

Physical activity is modifiable; patients can begin an exercise program at any time. Nutrition is also a modifiable health risk behavior; patients have the ability to increase or decrease intake, depending on their weight and nutritional status. Tobacco use is also a modifiable behavior; patients can particiN paUteRiS n I aN smGoT kiB ng.cC eO ssaMtion program or use other assistance to stop smoking.

PTS: 1 DIF: Understand REF: p. 231 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. A nurse is planning health education on chronic illnesses for a group of seniors in the

community. When deciding upon which illnesses to focus on, the nurse knows that which of the following are the most common diseases in the United States? (Select all that apply.) a. Heart disease b. Hypertension c. Asthma d. Osteoarthritis e. Diabetes ANS: A, B, D

The most common chronic diseases in the United States are heart disease, hypertension, and osteoarthritis.

PTS: 1 DIF: Remember MSC: Physiological Integrity OTHER

REF: p. 230

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 1. The chronic illness trajectory (CIT) includes eight phases. List the phases in order, beginning

with the first phase. a. Crisis b. Unstable c. Downward d. Dying e. Stable f. Acute g. Trajectory onset h. Pretrajectory ANS:

H, G, A, F, E, B, C, D The phases of the CIT are pretrajectory, trajectory onset, crisis, acute, stable, unstable, downward, and dying.

PTS: 1 DIF: Understand REF: p. 232 MSC: Health Promotion and Maintenance

NURSINGTB.COM

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 18: Pain and Comfort Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Compared with acute pain, which of the following statements is true of persistent pain? a. Leads to significantly altered vital signs b. Is usually described as a burning pain c. Is generally gone within 4 months d. Can bring about long-term changes in lifestyle ANS: D

Persistent pain affects the patient’s experience on a continuing basis. Both acute pain and persistent pain can affect the vital signs. Persistent pain may be described in many possible ways. Persistent pain is unrelenting.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 238 MSC: Physiological Integrity

2. The nurse admits an older man who had abdominal surgery. Admission vital signs are heart

rate (pulse) (P), 73 beats/min; respiration rate (R), 20 breaths/min; and blood pressure (BP), 136/84 mm Hg. He is receiving intravenous (IV) fluids but has not requested pain medication since surgery. Seven hours later, his vital signs are P, 98 beats/min; R, 26 breaths/min; and BP, 164/90 mm Hg, and he denies pain. Which intervention should the nurse implement? a. Ad minister an opioid med ication by I V rou te.

N R I G B. C M O b. Check the surgical d ressingUforSbleN ed inTg. c. Report the vital signs to the health care provider. d. Ask if he has about discomfort at the surgical site or any other location.

ANS: D

The patient’s P, R, and BP increased significantly since his admitting vital signs and indicate the potential for pain or discomfort from the surgical incision. This patient may also be experiencing pain unrelated to the surgery because of arthritic changes, neuropathies, and so on. The patient can be misunderstanding the nurse’s question or be barred from saying “yes” by cultural patterns. Such miscommunication is common; therefore, the nurse rewords the question using another term for pain such as discomfort, burning, or pressure. Administering an opioid medication by IV route is unethical without the patient’s request. When checking the surgical dressing for bleeding, the patient may show signs of pain rather than blood loss.

Reporting the vital signs to the health care provider would be premature; the patient’s pain assessment is not complete.

PTS: 1 DIF: Apply REF: p. 239 TOP: Nursing Process: Implementation MSC: Communication and Documentation 3. An older woman had hip replacement surgery 1 day ago, and the nurse thinks that the woman

also has dementia. Which patient assessment does the nurse use to determine whether this woman is experiencing pain? a. Holds her abdomen tightly b. Has stable vital signs

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank c. Is not verbalizing d. Moves during sleep ANS: A

Because this older adult has a potential cognitive impairment and is likely to self-report pain unreliably, the nurse uses additional clinical indicators to detect pain. Muscle rigidity and guarding are clinical indicators of pain for a postoperative older adult, regardless of a cognitive impairment. An individual experiencing pain is unlikely to have stable vital signs.

Not verbalizing can indicate a sensory impairment and warrants further investigation by the nurse. Nonetheless, this older adult’s verbalizations are potentially unreliable indicators of pain. Older adults move normally during sleep to adjust their position in bed; moving during sleep is not an indicator of pain unless the movements are agitated or restless in nature.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 240 MSC: Physiological Integrity

4. Which of the following statements is true about analgesic medications for older adults? a. Opioids are less effective in older patients than in younger patients. b. Stool softeners and laxatives should be used with opioids. c. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are generally

harmless. d. The dose limit for acetaminophen is difficult to reach for older adults.

ANS: B

Opioids often cause constipation and necessitate bowel stimulation to prevent constipation. A bowel regimen should be instituted at the same time as opioid treatment. Because of changes in metabolism with aging, opioids have a greater and longer lasting analgesic effect in older patients. NSAI Ds can cause gNaU strRoS inI t eN st G inaTlBbl. eeCdO inM g, kid ney and liver d amage, and d rug interactions with potentially fatal results. The maximum daily dose of acetaminophen is 4000 mg, and the limit is lower for patients with kidney or liver failure and patients who use alcohol. A typical dose is two 500-mg (“extra-strength”) tablets.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 243 MSC: Physiological Integrity

5. Each of the following is a pharmacologic intervention for pain except which one? a. Acupuncture treatments b. Adjuvant therapy c. Lidocaine patch d. Capsaicin ANS: A

Acupuncture is a nonpharmacologic treatment that helps reduce the perception of pain. An adjuvant is a medication that has been developed for a different purpose but serves to alter the perception of pain, possibly in combination with a pain medication. Lidocaine patches are a pharmacologic treatment for pain relief. Capsaicin is a pharmacologic means of providing comfort and alleviating pain and distress.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 245 MSC: Physiological Integrity

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 6. An older adult admitted for back surgery asks for opioid pain medication. The nurse knows

the patient asks for pain medication 15 minutes before it is due. Which recommendation should the nurse implement? a. Validate the pain with other assessment data. b. Administer the pain medication as requested by the patient. c. Tell the patient that it is too soon for pain medication. d. Teach the patient alternative comfort measures.

ANS: B

The nurse should administer the opioid pain medication as requested because the patient is asking for the pain medication within the prescription’s time limit. Most institutions allow the nurse to administer opioid medications 15 to 30 minutes before the designated time on the prescription; therefore, the patient is not asking for the medication too early. In addition, the nurse has an obligation to the patient to administer the pain medication; not doing so violates the patient’s rights. The nurse can rely on the patient’s report to determine the need for pain medication. As long as the timing is suitable and the patient is stable, the nurse should administer the medication. The nurse should use assessment data to support withholding pain medication in the presence of oversedation or another assessment that would be potentially aggravated by administering the pain medication. The nurse violates the patient’s rights by stating that it is too soon for the medication and ignores the possibility that the patient’s pain is real. Although the nurse may believe the patient is not having pain and is exhibiting drug-seeking behavior, the nurse must administer the medication. The nurse must administer the pain medication as requested. When patients are experiencing pain, most often, it is not the optimal time to teach patients. However, when the patient’s pain is under control, the nurse should teach alternative comfort measures. Comfort measures can be used to enhance the therapeutic effect of the medication and breakthrough pain.

N R I G B.C M

U S N REF: T p.O244 PTS: 1 DIF: Apply TOP: Nursing Process: Implementation MSC: Physiological Integrity 7. The nurse administers an opioid analgesic to an older male postoperative patient in the

surgical unit. Which is the most important intervention for the nurse to implement before leaving the patient’s room? a. Place all side rails up. b. Position the patient comfortably. c. Offer toileting and a sip of water. d. Instruct him to ask for help before getting up.

ANS: D

The most important intervention for fall and injury prevention is for the nurse to instruct the older adult to ask for help before getting up after receiving an opioid medication. This intervention is important because the medication can cause sedation and dizziness; therefore, the nurse instructs him to ask for help to prevent a fall or injury. Putting all side rails up is considered a restraint and may place the patient at risk for injury. Comfortable positioning is also a good supplemental intervention after administering pain medication. Offering toileting and hydration is a reasonable intervention to implement after administering pain medication, but it does not offer the same degree of safety as instructing the patient to call for help.

PTS: 1 DIF: Analyze REF: p. 244 MSC: Safe, Effective Care Environment

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 8. The older adult is at a higher risk for acute psychological pain than a younger adult because

older adults a. have many illnesses. b. possess fewer assets. c. experience more loss. d. live with impairments.

ANS: C

Older adults are at higher risk for acute psychological pain than younger adults because they experience more loss such as the pain occurring in early bereavement or in a major depressive episode. Older adults tend to have more illnesses than younger adults, and illness can trigger depression. The lack of assets of younger and older adults is unlikely to be related to acute psychological distress unless a sudden loss of a large asset is experienced. Older adults do not necessarily live with impairments. Furthermore, if impairment causes psychological distress, then the acute phase is likely to occur at the onset rather than in day-to-day activities.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 237 MSC: Psychosocial Integrity

9. An older Hispanic man states that he is not having pain, but he had knee replacement surgery

2 days ago. Which is the best pain assessment tool as recommended by the Hartford Institute for Geriatric Nursing (HIGN) from “Try This” for the nurse to apply for this man? a. Numeric Rating Scale b. Verbal Descriptor Scale c. Iowa Pain Thermometer d. Faces Pain Scale–revised (FPS-R) ANS:

D

NURSINGTB.COM

Hispanic men are less likely to report pain because their culture tells them to deny and withstand pain without complaining. The nurse uses the FPS-R to validate the patient’s report because the postoperative period in knee replacement surgery is very painful; this fact makes the nurse think that the patient is likely to have pain. The HIGN has data that support the claim that Hispanic and African American older adults prefer using the FPS-R for evaluating pain. The Numeric Rating Scale, the Verbal Descriptor Scale, and the Iowa Pain Thermometer are valid and reliable assessment tools, but older Hispanic adults prefer using the FPS-R. PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 240 MSC: Physiological Integrity

10. The nurse uses comfort measures to enhance an older adult’s pharmacologic pain

management. Which of the following would be most helpful for the nurse to use to identify the relationships between the comfort measures, activity, and pharmacotherapy, and the older adult’s pain level? a. Older adult’s self-report b. Older adult’s pain diary c. Faces Pain Scale–revised (FPS-R) d. Pain medication frequency ANS: B

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank The nurse instructs the older adult to maintain a pain diary to help the individual achieve some control over the pain experience. The diary is then used to identify trends or the timing of pain and the relationships between the patient’s pain level and the comfort measures, activity, and pain medications. Many older adults report feeling useful and having some control over the pain, or at least the pain management program, through maintaining a pain diary.

Self-reporting is one parameter used to evaluate pain, but drawing a relationship between the pain level and other factors is still necessary. The FPS-R is a reliable pain assessment tool, but the task remains to link the pain rating to other factors. The frequency of medication administration provides a clue about the patient’s pain level.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 242

TOP: Nursing Process: Planning

11. When educating a client on the use of an adjuvant medication, which statement best

demonstrates the nurse’s understanding of this therapy? a. “These medications are used instead of opioids to decrease the likelihood of addiction.” b. “Adjuvant medications are prescribed because they seldom cause any significant side effects.” c. “These types of medications are used to eliminate the side effects of opioid medications.” d. “These drugs are used in combination with analgesics to increase the effect of the analgesics.”

ANS: D

Adjuvant medications are not analgesics but are thought to alter the perception of pain and are used with analgesics to potentiate the effect of the analgesics. Adjuvant medications are used N g RhaSlfI-liNves GTinB.C with opioid s and may have lonU old eO r ad ults. The nurse must monitor the patient for adverse effects. Adjuvant medications do not eliminate the side effects of opioids.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 244

TOP: Teaching and Learning

12. An older client who was recently admitted to the subacute setting after having a knee

replacement, is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement? a. Share with the patient that it’s important to get out of bed and that there is pain medication available if it does hurt. b. Use the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain. c. Offer pain medication, administer the medication, and wait 20 minutes before getting her out of bed. d. Allow the patient to remain in bed but share that getting up will be required at least twice a day starting the next morning.

ANS: C

The administration of an as-needed analgesic 20 to 30 minutes before an activity may eliminate discomfort and fear of discomfort. It may also enhance the individual’s capacity for the activity. It is not true that performing an activity quickly will lessen the pain or that the patient will get used to the pain. A Hoyer lift is only indicated when an individual is completely immobile. Activity is an important part of rehabilitation.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 242

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. Which conditions are likely to cause an older adult chronic pain? (Select all that apply.) a. Hip replacement b. Bone metastasis c. Hypoproteinemia d. Migraine headache e. Compression fracture f. Postherpetic neuralgia ANS: B, E, F

Bone metastasis is likely to cause an older adult chronic pain because it is extremely difficult to eradicate cancer metastasis from bone. In addition, the invasion of cancer into bone can be very painful as a result of tumor growth pressing on nerves. Compression fractures are likely to cause chronic pain because the compressed vertebra is likely to press on spinal nerves, causing muscle spasms. Postherpetic neuralgia is a result of nerve damage from shingles and is likely to cause chronic pain; it is very difficult to treat effectively. A hip replacement is performed to relieve chronic pain or to repair a fracture and is more likely to cause acute pain.

Hypoproteinemia is unlikely to cause chronic pain but is more likely to cause fatigue. A migraine headache is likely to cause acute, intense pain. Although headaches can be recurrent, they are usually time limited.

PTS: 1 DIF: UnNderR . 23M7 U stan S Id NGRE TFB:.pC TOP: Nursing Process: Assessment MSC: Physiological Integrity 2. Which of the following statements are true about pain in older adults? (Select all that apply.) a. Pain is not a normal aging process. b. Pain sensitivity decreases with age. c. If patients do not complain, they do not have pain. d. Opioid analgesics are often the best treatment for persistent pain.

ANS: A, D

Pain is not a normal aging process. Something pathological is usually causing the pain. Pain sensitivity does not decrease with age. Some patients have a variety of reactions to pain; many are stoic and refuse to give in to their pain. Opioid analgesics are beneficial for moderate to severe persistent pain.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 239 MSC: Physiological Integrity

3. Which of the following pain sensations are associated with neuropathic pain? (Select all that

apply.) a. Infection b. Obstruction c. Inflammation d. Postamputation

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: D

Neuropathic involves a pathophysiological process of peripheral or central nervous system.

Infection, obstruction, and inflammation are considered nociceptive pain sensations that are associated with injury to skin, mucosa, muscle, or bone.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 237 MSC: Physiological Integrity

4. An older aphasic client has severe osteoarthritis, bilateral contractures of the lower

extremities, and a stage IV pressure ulcer. The nurse practitioner prescribes analgesic medications to be administered around the clock, with as-needed doses to be administered as appropriate. What observation by the nurse would indicate that the pain regimen is effective?

(Select all that apply.) a. The client slept throughout the night. b. The client winces only when turned and repositioned. c. The client slept during dressing change. d. The client cooperative during morning care. e. The client ate 80% of breakfast, 70% of lunch, and 100% of dinner.

ANS: A, C, D, E

Pain cues presented by this client is the wincing when being turned, indicating that this intervention is pain producing. The remaining observations are concurrent with effective pain management.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 239

TOP: Teaching and Learning

Mpairment who recently had hip surgery.

5. A nurse is caring f or an old erNaU d uRltSwIitN hG coTgB n i. t ivCeOim The nurse assesses the client for pain. The nurse would suspect that the client is in pain when the client demonstrates which of the following? (Select all that apply.) a. The client ate all of her meals. b. The client pushes caregivers away when they attempt to change the dressing on her hip. c. The client rocks back and forth repetitively when sitting in a chair. d. The client sleeps soundly throughout the night. e. The client cries out repeatedly when anyone approaches her.

ANS: B, C, E

Pain cues in people with communication difficulties involve changes in behavior including restlessness, resistance to care, repetitive movements, and vocalizations. Other cues including sleeplessness and a decreased appetite.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 239

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 19: Diseases Affecting Vision and Hearing Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following diseases affects the eyesight of an older adult by damaging the central

part of the retina? a. Glaucoma b. Presbyopia c. Cataract d. Macular degeneration ANS: D

Macular degeneration is a disease characterized by damage to the central part of the retina that leaves the outer edges of the visual field intact. Presbyopia, a gradual decline in the flexibility of the lens, makes close-up focusing more difficult and is a common age-related change but not a disease. Glaucoma, a disease marked by increased pressure within the eye that potentially leads to optic nerve damage, is the most common cause of blindness in those 65 years of age and older. A cataract is a disease marked by clouding and blurring of the lens.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 254 MSC: Physiological Integrity

2. Which of the following is used to treat the most common cause of impairment to an older

person’s hearing? a. Hearing aids b. Cochlear implants c. Ear canal irrigation d. Sign language

NURSINGTB.COM

ANS: C

Irrigation is used to dissolve and remove impacted cerumen, the most common cause of impaired hearing in older adults. Hearing aids are useful for sensorineural hearing loss, but the most common cause impairing the hearing of older persons is cerumen impaction. Cochlear implants are useful for profound sensorineural deafness, but the most common cause impairing the hearing of older persons is cerumen impaction. Sign language has been used primarily by those who become deaf in childhood or at birth, but it is not considered a treatment.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 259

TOP: Nursing Process: Planning

3. A medical illustration shows a man with the blunt end of a tuning fork pressed to the center of

his forehead. The man is being tested for which of the following? a. Sensorineural hearing loss b. Presbycusis c. Tinnitus d. Unilateral conductive hearing loss

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: D

Weber’s test, in which a vibrating tuning fork is placed on the center of the forehead, detects the differences in hearing between one ear and the other caused by poor sound conduction.

During testing, the patient is asked to describe the sensation felt when the tuning fork is activated and then placed on the forehead. If the patient’s hearing by conduction is intact, then he or she will feel vibrations conducted through the bones of the skull from the tuning fork.

Weber’s test with the tuning fork is used to detect conductive hearing loss. Presbycusis affects both ears and has a sensorineural origin. The tuning fork test is used to detect conductive hearing loss in one ear. Tinnitus is a hearing sensation not caused by an actual sound. The tuning fork test is used to detect hearing loss caused by poor sound conduction.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 262 MSC: Physiological Integrity

4. Persons with normal age-related sensory changes are likely to have the most difficulty

distinguishing which of the following? a. Spoken pairs of phrases such as “she’s praised” and “fees raised” b. Orange towel hanging on a beige wall c. “Go” and “to” in lowercase letters in fine print d. Spoken word pairs like “cupful” and “capful” ANS: A

A person with presbycusis has trouble hearing the higher frequencies, where most of the differences between consonant sounds occur. The contrast between a vivid color such as orange and a pale color such as beige can help an older person distinguish objects. The details of the letters may be poorly focused, but their overall shape, relative to the line around them, helps distinguish them. Age-related hearing impairments affect the hearing of consonants N R I G B.Cuble M d istinguishing “cupf ul” and “couple.” more than vowels. A person woUuldShavNe mTore troO PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 258 MSC: Physiological Integrity

5. Which of the following interventions should the nurse use when communicating with a

hearing impaired older patient? a. Stand beside the patient’s chair when speaking. b. Always clearly identify yourself and others with you. c. Exaggerate your voice, depending on the cause of the hearing loss. d. Select colors for paint, furniture, and pictures with rich intensity.

ANS: B

Always speak promptly, and clearly identify yourself and others who are with you. State when you are leaving to ensure that the person is aware of your departure. Get down to the person’s level and face him or her when speaking. Speak normally but not from a distance; do not raise or lower your voice and continue to use gestures if doing so is natural to your communication.

Selecting colors for paint, furniture, and pictures with rich intensity is for the visually impaired, not those with a hearing impairment.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 262

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 6. The nurse plans the care of an older female resident of a nursing home who has experienced a

sudden deterioration in visual acuity. Which intervention should the nurse complete first? a. Prevent behavioral and social decline. b. Tell her to hold onto the rails during ambulation. c. Examine her mood and functional status. d. Use problem solving involving the resident.

ANS: C

The most important intervention for the nurse to complete first is to assess the impact of the visual impairment on the resident’s quality of life, mood, and functional ability. The resulting assessment data will provide the basis for solving new problems caused by the loss of vision and finding compensatory mechanisms for the resident. Preventing decline can be a goal in the overall plan of care for this resident, but that cannot be determined until the assessment is complete. Telling her to hold onto rails during ambulation is a potential nursing intervention for patient teaching; however, in problem solving, a different compensatory solution can be developed, based on the assessment. Problem solving takes place after a complete assessment.

PTS: 1 DIF: Analyze MSC: Physiological Integrity

REF: p. 256

TOP: Nursing Process: Planning

7. An older man who has tinnitus complains to the nurse that it is very annoying. Which should

the nurse implement to alleviate the stress he is experiencing from tinnitus? a. Irrigate the bilateral eustachian tubes. b. Assess for modifiable risk factors. c. Propose a hearing aid and a masker. d. Use white noise to override the tinnitus.

ANS:

B

NURSINGTB.COM

The nurse assesses the patient for risk factors potentially contributing to tinnitus that can be altered such as smoking cigarettes, consuming caffeine, drinking alcohol, experiencing fatigue, and taking medications that carry a high risk of causing tinnitus. Removing these potential offenders can help give the patient a sense of control, as well as provide potential relief from tinnitus. The nurse irrigates the external auditory canal for impacted cerumen to decrease the risk of tinnitus. Although a hearing aid and a masker have the potential to alleviate tinnitus, introducing them can also serve as a potential source of additional stress, depending on the financial and functional status of the individual. Although white noise has the potential to alleviate tinnitus, it can be ineffective or serve as a potential source of additional stress.

PTS: 1 DIF: Apply MSC: Psychosocial Integrity

REF: p. 262

TOP: Nursing Process: Planning

8. An older adult complains about experiencing dry eyes daily. Which of the following should

the nurse assess to help determine the cause of the patient’s complaint? a. Vitamin B deficiency b. Use of a humidifier at home c. History of diabetes mellitus d. Prescription antihistamine use ANS: D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Medications can cause dry eye, especially antihistamines, diuretic agents, beta blockers, and some sleeping pills. Vitamin A deficiency is a risk factor, not vitamin B deficiency. The use of a humidifier should help with dry eyes, not cause it. Diabetes mellitus is an endocrine disorder, and dry eyes are an exocrine disorder.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 256 MSC: Physiological Integrity

9. A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma. The

nurse bases the response on the knowledge that the increase in intraocular pressure is a result of a. the exact etiology of glaucoma is variable and often unknown. b. spasms of the orbicular muscle. c. changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves. d. bits of broken coalesced vitreous from the peripheral or central part of the retina.

ANS: A

The etiology of glaucoma is variable and often unknown. However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. Spasms of the orbicular muscle can cause the lower eyelid to turn inward. If it stays this way, it is called entropion. The changes described contribute to decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters.

PTS: 1 DIF: Remember REF: p. 251 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

10. An old er nursing home resid N enU t rR epSoI rtsNtG hT at B he.r C hO eaM ring loss is getting worse. What is the f irst

action of the nurse? a. Refer the resident for an evaluation for a hearing aid. b. Raise her voice in when speaking to the resident. c. Examine the resident’s ears for cerumen impaction. d. Teach the resident to read lips.

ANS: C

When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing loss. Raising one’s voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.

PTS: 1 DIF: Analyze REF: p. 259 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of

sensorineural hearing loss include (Select all that apply.) a. tumors of the middle ear. b. cerumen impaction.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank c. infections of the external and middle ear. d. age-related hearing impairment. e. excessive and loud noise.

ANS: D, E

Age-related hearing impairment (presbycusis) is a form of sensorineural hearing loss.

Excessive and loud noise can cause noise-induced hearing loss, which is also a common type of sensorineural hearing loss. The other options are associated with conductive hearing loss.

PTS: 1 DIF: Remember REF: p. 258 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

2. Which population groups are most at risk for developing macular degeneration? (Select all

that apply.) a. African American b. Asian American c. Caucasian d. Hispanic ANS: B, C

Individuals who are white or Asian American are most at risk for developing macular degeneration than are African Americans or Hispanics.

PTS: 1 DIF: Understand REF: p. 254 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. When preparing a patient teaching session on diabetic retinopathy, the nurse should include

which interventions when d isNcusR singItreatm G en B.tsCforMslowing the progression of the d isease?

(Select all that apply.) a. Glucose control b. Blood pressure control c. Laser therapy d. Cornea transplant

U S N T

ANS: A, B, C

Better control of glucose, blood pressure, and cholesterol can assist in halting the progression of diabetic retinopathy. Laser therapy is also a treatment. A cornea transplant is not an option.

PTS: 1 DIF: Understand REF: p. 253 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

4. The nurse recognized which of the following as symptoms of wet age-related macular

degeneration (AMD)? (Select all that apply.) a. Rarely causes severe visual impairment b. Yellow deposits under the retina c. Decrease in central vision d. Visual distortion ANS: C, D

Patients with wet AMD experience a decrease in central vision and visual distortion. Wet AMD leads to blindness. With distortion, edges or lines become wavy. Dry AMD rarely causes severe visual impairment, and yellow deposits under the retina are a classic sign.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 20: Metabolic Disorders Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following statements is true about diabetes mellitus? a. Type 2 diabetes is the result of the failure of the pancreas to produce insulin. b. Diabetes is diagnosed after two fasting plasma glucose readings over 125 mg/dL. c. Non–insulin-dependent diabetes mellitus is another name for type 1 diabetes. d. The incidence of diabetes mellitus does not increase with age.

ANS: B

Whereas a fasting plasma glucose reading of over 125 mg/dL is considered diabetes, a level between 110 mg/dL and 125 mg/dL is considered to be impaired fasting glucose. Type 2 diabetes is present when insulin is produced but does not lower the blood glucose level. Type 1 diabetes was formerly called insulin-dependent diabetes mellitus, and type 2 diabetes was formerly called non–insulin-dependent diabetes mellitus.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 267 MSC: Physiological Integrity

2. Which laboratory results are goals for reducing a person’s risk for diabetes and heart disease? a. Triglyceride value greater than 150 mg/dL b. Cholesterol value 250 mg/dL c. High-density lipoprotein (HDL) level greater than 40 mg/dL

R I anG1T5B .C/d L d. Fasting blood glucose valN uU e lesSs thN 0 mgO ANS: C

To reduce the risk for diabetes and heart disease, the serum triglycerides value should be less than 150 mg/dL. The cholesterol value should be less than 200 mg/dL to reduce the risk for heart disease and diabetes. The HDL level should be greater than 40 mg/dL to reduce the risk for heart disease and diabetes. The fasting blood glucose value should be less than 126 mg/dL. PTS: 1 DIF: Remember MSC: Physiological Integrity

REF: p. 270

TOP: Nursing Process: Planning

3. When teaching a patient about foods that do not increase blood glucose, which should the

nurse include? a. White bread b. Baked beans c. Broccoli d. Corn ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Broccoli does not raise blood glucose levels. White bread quickly breaks down to glucose and therefore tends to cause a rapid, brief rise in the blood sugar level. Whole grains provide a more sustained release of glucose and are a better source of carbohydrates. The blood glucose level increases after eating baked beans, but the increase occurs more slowly, reaching a lower level of hyperglycemia and remaining for a longer period. Corn is a starchy vegetable and raises the blood glucose level almost as much as sugar itself.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 273 MSC: Physiological Integrity

4. An older man with diabetes mellitus complains to the nurse that his feet feel like they are

burning. Which of the following interventions should the nurse recommend to this older adult to reduce his discomfort? a. Wear well-fitting leather shoes. b. Wear knee-high nylon stockings. c. Soak his feet in warm water. d. Apply antifungal powder on his feet.

ANS: A

The older adult is potentially experiencing a peripheral neuropathy from peripheral nerve damage from hyperglycemia. To prevent trauma to his feet, the nurse instructs him to wear comfortable, well-fitting, tie-on shoes with a broad toe space and low heels for protection.

Nylon stockings for men tend to have restrictive ends that can inhibit tissue perfusion; because this patient is at risk for peripheral tissue damage, the constricted area can break down. The nurse also instructs him to avoid sitting with one leg crossed over the other or with both legs crossed at the knee; these positions restrict blood flow to the feet. Foot soaks can potentially cause excessive dryness. To maintain skin integrity, feet should be washed daily NU R SIsuN but not soaked . I rritating chem icals chGaT s B.C antif uO ngal powd er and corn or wart preparations should not be used on the feet of individuals with diabetes.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 272

TOP: Teaching and Learning

5. The older adult who has type 2 diabetes mellitus has a sensory impairment and unstable blood

sugar levels. Which of the following alterations in sensory function does the nurse address in the plan of care for stabilizing the blood sugar? a. Requires reading glasses at 2.0 strength b. Has difficulty hearing in crowded rooms c. Enjoys spicy food more than bland food d. Awakens with periodic left-foot numbness ANS: B

The nurse focuses on the hearing impairment to plan care for stabilizing this patient’s blood glucose level; hearing impairment is a factor that affects blood glucose control in older adults with diabetes mellitus. Reading glasses at 2.0 are medium-strength glasses, and the need for such glasses is common and not considered a visual impairment. A preference for spicy food does not indicate an impaired sense of taste. Although numbness is a sensory impairment, episodic numbness associated with sleeping is more likely to be caused by a poorly positioned extremity.

PTS: 1

DIF: Apply

REF: p. 272

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank MSC: Physiological Integrity 6. Which comorbidity commonly associated with type 2 diabetes mellitus enhances the

development of the microvascular complications of diabetes mellitus? a. Hyperlipidemia b. Hypothyroidism c. Venous insufficiency d. Chronic constipation ANS: A

Hyperlipidemia, a condition commonly associated with type 2 diabetes mellitus, accelerates the development of microvascular complications of diabetes mellitus because high serum, low-density lipoproteins contribute to the formation of atherosclerotic plaque. The plaque first accumulates in the smallest arteries, causing complications of diabetes mellitus, including peripheral arterial disease, retinopathy, and nephropathy. Hypothyroidism, venous insufficiency, and chronic constipation are not associated with type 2 diabetes mellitus.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 268 MSC: Physiological Integrity

7. The nurse assists an older man who has type 2 diabetes mellitus to improve his glucose

control. Which of the following instructions does the nurse give to this individual when he plans to walk more than usual in 1 day? a. Omit antidiabetic medication. b. Wear sturdy open-toed shoes. c. Supplement caloric intake. d. Prepare to administer insulin. I G B.C M ANS: C

N UR S N T

O

Diabetes mellitus is controlled by balancing exercise, calories, and hypoglycemic medication; if one element of therapy is altered, then one or both of the remaining elements must be adjusted. When the patient’s activity is going to metabolize more calories, the medication has to be reduced or the calories have to increase. For a patient with type 2 diabetes mellitus, adjusting the medication can be difficult; therefore, the nurse instructs this older adult to supplement his caloric intake, which can be accomplished by eating snacks during the walk or by increasing the glycemic load before walking. The patient ensures glucose control during these activities by testing his blood sugar levels. The nurse cannot tell the patient to omit medication because doing so is not within a nurse’s scope of practice. The nurse instructs the older adult to wear closed, well-fitting leather shoes to protect the feet from trauma. Although many individuals with type 2 diabetes mellitus periodically take insulin, insulin is administered to induce hypoglycemia. Because the individual plans to walk more than usual, more calories are needed to prevent hypoglycemia.

PTS: 1 DIF: Apply REF: p. 273 TOP: Nursing Process: Implementation MSC: Physiological Integrity 8. Which is the best goal when planning nursing care for an older patient with diabetes mellitus? a. Stabilize the serum glucose. b. Prevent disease progression. c. Set walking distance goals. d. Plan for consistent exercise.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

ANS: B

The most important goal for planning nursing care for a patient with diabetes mellitus is to prevent disease progression. Stabilizing the serum glucose, managing hyperlipidemia, controlling the blood pressure, preventing infection, maintaining a normal weight (if applicable), and obtaining regular medical evaluation will accomplish this goal. Stabilizing the serum glucose is a part of preventing disease progression. Setting goals for walking is part of a consistent walking regimen. Planning for consistent exercise is part of stabilizing the serum glucose.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 271

TOP: Nursing Process: Planning

9. An older, non-Hispanic white man has a fasting blood sugar level above 130 mg/dL. Which

patient assessment does the nurse use to confirm a high risk for diabetes mellitus in this man? a. 68 years of age b. 120/80 mm Hg c. Palpable peripheral pulses d. Total cholesterol 198 mg/dL ANS: A

Diabetes is significantly more prevalent among older Americans. This man’s blood pressure is normal. Palpable peripheral pulses are a normal finding. A total cholesterol level below 200 mg/dL is normal and highly desirable for a man at risk for diabetes.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 268

TOP: Nursing Process: Diagnosis

N R I G B.C M

10. Which is the most likely reasonUt haSt tyN pe 2Td iabeteOs mellitus is of ten d if ficult to d iagnose in

older adults? a. Presenting symptoms occur very quickly. b. The disease rarely occurs in older adults. c. The classic symptoms may not be present in older adults. d. There are no recognizable symptoms; it is a “silent killer.”

ANS: C

The symptoms are also often masked by normal aging changes and conditions common in older adults. Polydipsia often does not occur because of the decreased thirst mechanism in older adults, polyphagia is often not recognized because of normal appetite declines associated with aging, and polyuria is often not recognized because of frequent urinary tract infections in older adults. Presenting symptoms usually occur very slowly. Type 2 diabetes mellitus is very common in older adults. There are symptoms of diabetes mellitus in older adults; however, they may be different than in younger adults.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 268

TOP: Teaching and Learning

11. A nurse is caring for an older adult who is diagnosed with type 2 diabetes. The patient is

prescribed oral medication for diabetes. The nurse can expect that which of the following medications is prescribed as a first line therapy? a. Insulin b. Sulfonureas

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank c. Metformin d. Chlorpropamide ANS: C

Metformin (Glucophage) is commonly prescribed as first-line therapy; it does not cause hypoglycemia or weight gain. Sulfonylureas were used for many years as first-line agents for all persons with type 2 diabetes. However, they are associated with hypoglycemia and can only be used in persons who can either be aware of the signs themselves or who have a caregiver capable of doing so; therefore, metformin is considered the first line of therapy.

Insulin is used for individuals with type 2 diabetes, however, is not first-line therapy.

Chlorpropamide is contraindicated because of its long half-life and because it can cause prolonged hypoglycemia.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 273

TOP: Teaching and Learning

12. An older adult with type 2 diabetes who is being treated with insulin wants to increase his

activity level and begin a walking program. What recommendations should the nurse provide to this patient? a. A walking program is not recommended for an older adult with diabetes. b. The walking regimen needs to be done on a regularly scheduled basis. c. Regular exercise should not exceed 30 minutes three times a week. d. Insulin can most probably be discontinued if the individual adheres to the walking program.

ANS: B

If the person is using insulin, exercise needs to be done on a regular rather than an erratic basis. Exercise is an importanNt U paRrtSoI fN d iG abTetBes.sC elf management. I n some cases, exercise in O-M conjunction with an appropriate diet may be sufficient to maintain blood glucose levels within normal levels; however, it is not likely that insulin will be able to be discontinued.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 273

TOP: Teaching and Learning

13. Hyperglycemia is harder to detect in older adults because of which of the following? a. There is a higher tolerance for elevated levels of circulating glucose in older

adults. b. Older adults tend to metabolize glucose at a faster rate than younger adults. c. Fingerstick glucose monitoring is inaccurate in older adults. d. The classic signs of elevated glucose levels, polyuria, polyphagia, and polydipsia

are rarely present in older adults.

ANS: A

Hyperglycemia in older adults is harder to detect than in a younger adult. With aging, there is a higher tolerance for elevated levels of circulating glucose. It is not unusual to find persons with fasting glucose levels of 200 to 600 mg/dL or higher. It is not true that older adults metabolize glucose at a faster rate than younger adults or that fingerstick glucose monitoring is inaccurate in older adults. Although it is true that older adults usually do not have the classic symptoms of elevated glucose levels, this does not explain why hyperglycemia is harder to detect in older adults.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 270

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. The nurse teaches an older adult who has diabetes mellitus and takes metoprolol (Lopressor)

to recognize clinical indicators of hypoglycemia. Which clinical indicators of hypoglycemia does the nurse include in patient teaching as the indicators this man is most likely to detect?

(Select all that apply.) a. Shaking b. Dizziness c. Weakness d. Diaphoresis e. Tachycardia f. Impaired vision ANS: B, C, F

Dizziness is a clinical indicator of moderate hypoglycemia. It is unlikely to be masked by the effects of metoprolol, a beta-adrenergic blocker, because beta blockers effectively mask the early signs of hypoglycemia. Weakness is a clinical indicator of moderate hypoglycemia and is unlikely to be masked by the effects of metoprolol. Impaired vision is a clinical indicator of moderate hypoglycemia and is unlikely to be masked by the effects of metoprolol. Shaking is an early clinical indicator of hypoglycemia and likely to be masked by the action of a beta-adrenergic blocker such as metoprolol; beta blockers oppose the surge of epinephrine in early hypoglycemia. Diaphoresis is an early clinical indicator of hypoglycemia, and it is likely to be masked by the action of a beta-adrenergic blocker such as metoprolol. Increased heart rate is an early clinical ind icaN toUr R ofShI ypNoG glyc mC i aOaM nd is likely to be masked by the action of a TBe. beta-adrenergic blocker such as metoprolol.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 270

TOP: Teaching and Learning

2. The nurse recognizes which of the following signs and symptoms as an indication of

hypothyroidism? (Select all that apply.) a. Decline in cognitive function b. Decrease in functional status c. Decrease in thyroid-stimulating hormone (TSH) and thyroxine (T4 ) d. Heat intolerance ANS: A, B, D

A decline in cognitive function, functional status, and heat intolerance are all indicative of hypothyroidism. An elevated TSH and decrease in T4 indicates hypothyroidism.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 266 MSC: Physiological Integrity

3. The nurse is caring for a patient diagnosed with hyperthyroidism. Which signs and symptoms

indicate hyperthyroidism? (Select all that apply.) a. Atrial fibrillation b. Heart failure c. Constipation

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank d. Heat intolerance ANS: A, B, C

Compared with hypothyroidism, the onset of hyperthyroidism may be quite sudden. The signs and symptoms in older adults include unexplained atrial fibrillation, heart failure, constipation, anorexia, muscle weakness, and other vague complaints. Symptoms of heart failure or angina may cloud the clinical presentation and prevent the correct diagnosis. The person may be misdiagnosed as being depressed or having dementia. On examination, the person is likely to have tachycardia, tremors, and weight loss. Heat intolerance is attributed to hyperthyroidism.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 266 MSC: Physiological Integrity

4. An older patient asks a nurse: “I went to my diabetes doctor and everything was stable. The

nurse practitioner spent the entire time teaching me about decreasing my risks of heart disease. It seemed odd that she did not focus on teaching me how to better control my diabetes. Do you know why?” The nurse formulates a response based on the understanding that (Select all that apply.) a. promoting cardiovascular health has the potential to minimize the complications of diabetes. b. there is little evidence that demonstrates that the course of diabetes can be altered in an older adult. c. the benefits of better control of blood pressure and lipid levels are seen much quicker than the benefits of better glycemic control. d. older adults are less receptive to teaching about diabetes than they are to teaching about cardiovascular disease.

N RS ING T B.CO M e. d iabetes is not a common cU hronic cond ition in old er ad ults.

ANS: A, C

Although glycemic control is important, more emphasis is now on the prevention and treatment of cardiovascular diseases. Research has indicated that although it may take 8 years of glycemic control before benefits are seen, the benefits of better control of blood pressure and lipids are seen as early as 2 to 3 years. Promoting cardiovascular health has the potential to be the most efficacious in the minimization of complications in the persons with diabetes.

Education on self-management of diabetes is important for patients of all ages. Diabetes is a common chronic condition in older adults.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 270

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 254 MSC: Health Promotion and Maintenance

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Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 21: Bone and Joint Problems Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following is a true statement about osteoporosis (OA)? a. OA is indicative of an underlying health problem. b. The most common site for OA fractures is in long bones. c. African American women have the highest risk for OA. d. A high risk of death follows an OA-related fracture.

ANS: D

One-third of all persons who have an OA-related fracture die within 1 year. OA can be a naturally occurring consequence of aging. The vertebrae, pelvis, and wrist are the most frequent sites for OA fractures. The risk of OA is much lower for African American women than it is for those of other races. Thin women of northern European descent are at the highest risk.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 277 MSC: Physiological Integrity

2. Which is a healthy practice recommended for a person at risk for osteoporosis? a. Milk and orange juice at breakfast; cheese pizza at lunch; spaghetti served with

spinach covered with melted cheese for dinner; and ice cream for dessert

b. Long-term estrogen administration as adjunct therapy c. A bisphosphonat e med icaNtiU onRtS akIenNG wT ithBa.snCaOck just bef ore bed time d. Coffee, raisin bran and milk, and sausage at breakfast; a can of cola and a hot dog

on a high-fiber bun at lunch; cocktails before dinner; steak with brown rice, celery, and red wine for dinner ANS: A

These foods in these quantities supply 1204 mg of calcium. Administering estrogen can increase the risk of cancer and heart disease. Because of the seriousness of the risk for esophageal erosion, bisphosphonates must be taken with a full glass of water on an empty stomach after awakening. Afterward, the patient must sit upright and refrain from eating or drinking for 30 minutes. Whereas alcohol and high amounts of protein and salt inhibit calcium uptake, caffeine, excess fiber, and phosphorus (in the cola) promote calcium excretion.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 278 MSC: Physiological Integrity

3. Which of the following is a true statement about joints in older adults? a. Osteoarthritis (OA) is an inflammatory joint disorder. b. Surgical joint replacement can cure OA. c. Joint damage in OA is reversed with medication. d. Very old patients should avoid joint replacement surgery.

ANS: B

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Surgical joint replacement can cure OA and is the only cure for the disease. Whereas OA is a degenerative joint disease, rheumatoid arthritis is an inflammatory process. Medications are used to control the pain of OA. The joint damage cannot be reversed except through joint replacement surgery. Surgical joint replacements are recommended even for those who are very old.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 280 MSC: Physiological Integrity

4. Which of the following statements is true about rheumatoid arthritis (RA)? a. RA strikes unilaterally. b. RA affects more men than women. c. RA can affect body systems other than the joints. d. Morning stiffness in RA lasts less than 30 minutes.

ANS: C

RA can affect body systems other than joints. Women are affected more often than men. RA strikes the same parts of the body on both sides and affects joints in a symmetrical pattern.

Patients with RA can have remissions and exacerbations. Unlike OA, however, RA has a highly variable course, which may include remissions, as well as exacerbations. RA can affect body systems other than joints and can cause general fatigue and malaise and attack systems other than joints. Morning stiffness in OA last less than 30 minutes, but in RA, it lasts longer than 30 minutes.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 281 MSC: Physiological Integrity

5. Which of the f ollowing nursiN ngUiR ntS erI veNnG t ioTnB s . areCO suM itable f or a patient who has gout? a. Nonsteroidal anti-inflammatory drugs (NSAIDs) b. Liquid paraffin hand baths c. Colchicine (Colsalide) by mouth d. Hyaluronic acid injections ANS: C

Colchicine is indicated in the treatment of an acute gout attack. NSAIDs can be used in pain management in all forms of arthritis. Liquid paraffin hand baths can be used to relieve pain in osteoarthritis (OA) and rheumatoid arthritis. Hyaluronic acid injections are used by some to relieve the pain of OA in the knee. Salicylates should not be used in gout because they can exacerbate an attack.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 282 MSC: Physiological Integrity

6. An older woman seeks advice from the nurse about preventing further bone loss after being

diagnosed with osteopenia. To achieve the woman’s goal, which of the following patient teachings should the nurse provide to enhance the activity of the osteoblasts? a. Limit sodium intake. b. Refrain from alcohol use. c. Eat high-fiber foods. d. Exercise with weights.

ANS: D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank In osteopenia, bone metabolism is unbalanced because the action of osteoclasts is greater than the action of osteoblasts. To treat osteopenia effectively, the balance between the activities of the bone cells must be shifted to more osteoblast (bone-building) activity; increasing osteoblast activity helps reduce bone loss and, at the same time, helps gain bone density.

Lifting weights stimulates osteoblasts to build bone through the application of opposing forces on the bone and helps achieve the woman’s goal by increasing physical activity (to stem bone loss) and by generating more bone (to gain bone density). Sodium impairs calcium absorption; therefore, the nurse instructs her to limit sodium intake to reduce bone loss. Alcohol impairs calcium absorption; therefore, the nurse instructs her to avoid alcoholic beverages. Fiber inhibits calcium absorption.

PTS: 1 DIF: Analyze MSC: Physiological Integrity

REF: p. 277

TOP: Nursing Process: Planning

7. After living with osteoporosis for 2 years, an older woman’s bone density scan shows no

improvement, despite consistent bisphosphonate therapy. Which intervention should the nurse implement to reduce bone loss for this older adult? a. Add Tai Chi or yoga exercises. b. Instruct her to drink fortified milk. c. Increase weight-bearing exercises. d. Review her daily nutritional habits.

ANS: D

Reviewing the older adult’s nutritional habits can reveal clues about potential dietary contributors to bone loss from excessive sodium, alcohol, caffeine, or carbonated beverage intake. In addition, the nurse also confirms that the patient avoids smoking and a sedentary lifestyle that contribute to bone loss. Doing Tai Chi or yoga, drinking fortified milk, and Ncise RSs I Gl help B.CinOcrease bone d ensity. increasing weight-bearing exerU caN n alT PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 279

TOP: Nursing Process: Planning

8. Which assessment is typical for a patient with osteoarthritis (OA)? a. Narrow joint spaces with crepitus b. Effects in symmetrical joints c. Morning stiffness for at least an hour d. Swelling from excess synovial fluid ANS: A

The joint of an older adult with OA is narrower than a normal joint, and as the disease advances, crepitus is palpable over the joint. The joint narrows as it degenerates, and crepitus occurs as the articulating surfaces of the bone abnormally move against each other. Disease in symmetrical joints is characteristic of rheumatoid arthritis (RA). Morning stiffness lasting for 1 hour or more is characteristic of polymyalgia rheumatica. Swelling from excessive synovial fluid is characteristic of RA. PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 279 MSC: Physiological Integrity

9. The nurse prepares an older man who has osteoarthritis (OA) for discharge. Which instruction

does the nurse include in patient teaching to maintain safety for this man?

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank a. b. c. d.

Take ibuprofen (Motrin) rather than opioid analgesics.

Increase rest periods to slow disease progression.

Report joint instability to the health care provider.

Avoid stretching the affected joint during exercise.

ANS: C

As OA progresses, the joint deteriorates and can become unstable, thereby increasing the risk of falls. The joint stability will not improve without physical therapy or surgery; therefore, the patient needs to report instability to the health care provider. Although ibuprofen is much less likely to cause dizziness, hypotension, or sedation, nonsteroidal anti-inflammatory agents such as ibuprofen are poor analgesic choices for older adults; they can aggravate hypertension and impair renal blood flow. The nurse avoids recommending increased rest because rest contributes to stiffness. Stretching is an important form of exercise for older adults with OA; it helps maintain joint flexibility and range of motion.

PTS: 1 DIF: Apply REF: p. 280 MSC: Safe, Effective Care Environment

TOP: Teaching and Learning

10. The nurse sees an older woman with osteoarthritis (OA) and a low-grade fever. The patient

tells the nurse that her pain is changing; it is worse at night and in her shoulder muscles.

Which of the following does the nurse perform to prevent complications of this patient’s condition? a. Assess her joints for swelling and redness. b. Obtain blood specimens for blood cultures. c. Direct her to report temporal or scalp pain. d. Tell her to apply moist heat for 20 minutes.

ANS:

C

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The older adult exhibits clinical indicators of polymyalgia rheumatica (PMR), and a serious complication of PMR is giant cell arteritis (GCA). The nurse instructs the patient to report scalp and temporal pain because they are early indicators of GCA. As a complication of PMR, the patient exhibits clinical indicators of PMR that include severe pain and stiffness of muscles, including the back, buttocks, and thighs. PMR is not a disease that affects the joints.

Blood cultures are not indicated for PMR because it is not an infection. Because PMR is an autoimmune, inflammatory disorder, applying heat is more likely to aggravate the patient’s condition. Effective treatment for PMR includes low-dose steroids. However, low-dose steroids are unrelated to preventing complications of PMR. PTS: 1 DIF: Apply REF: p. 281 TOP: Nursing Process: Implementation MSC: Physiological Integrity 11. Which of the following characteristics of RA are unlike those of osteoarthritis (OA)? a. Myalgia and stiffness b. Joint pain that is curable c. Crepitus and instability d. Systemic and symmetrical ANS: D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank OA is not a systemic disease, nor does it affect joints symmetrically. Myalgia and stiffness are characteristics of polymyalgia rheumatica (PMR); however, myalgia is uncharacteristic of rheumatoid arthritis (RA) and OA. Joint pain is characteristic of both RA and OA, but only OA is curable through joint replacement. RA is a systemic disease and affects joints symmetrically; therefore, these are clinical indicators of OA, not RA. PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 281 MSC: Physiological Integrity

12. A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the

following should the nurse include in the teaching? a. Avoid foods high in purine. b. Encourage the patient to take in 1 L of fluid daily. c. Consume one glass of red wine daily. d. Recommend that the patient eat 12 to 16 oz of foods high in protein such as red meat.

ANS: A

A person who is having an acute attack of gout should avoid foods that are high in purine, take in 2 L of fluid daily, avoid alcohol, and only have 4 to 6 oz of foods high in protein daily.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 282

TOP: Teaching and Learning

13. A nurse plans for the discharge of a 75-year-old patient who has the diagnosis of osteoporosis.

Which of these actions would the nurse consider first? a. Avoid stressful situations.

Metry (DEXA) scan. b. Sched ule an annual d ual N enU erR gySI x-rNaG yT abBso.rpCt O iom c. Remove clutter from the floors of the home. d. Encourage consumption of a high-protein diet.

ANS: C

Individuals with osteoporosis are very high risk for falls. The most serious health complication of osteoporosis is the morbidity and mortality associated with falls. There is no evidence that stress impacts osteoporosis. The recommendation for a DEXA scan is every 2 years. There is no evidence that a high-protein diet is important for an individual with osteoporosis.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 278

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. The nurse identifies which risk factors for osteoarthritis (OA)? (Select all that apply.) a. Men b. African Americans c. Old age d. Steroid use ANS: C, D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Older adults and steroid use have been identified as risk factors for the development of OA. Women are more prone. Whites and Asian Americans are more at risk.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 279 MSC: Physiological Integrity

2. The nurse is educating an older woman on foods high in calcium. Which foods should the

nurse include? (Select all that apply.) a. Chinese cabbage b. Soy milk c. Cheese pizza d. Whole wheat ANS: A, B, C

Chinese cabbage, soy milk, and cheese pizza have all been identified as foods that are high in calcium. Whole wheat bread contains calcium; however, it is not a calcium-rich food.

PTS: 1 DIF: Understand REF: p. 278 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

3. A nursing student is preparing a presentation on arthritis. The nursing student knows that

differences between osteoarthritis (OA) and rheumatoid arthritis (RA) include (Select all that apply.) a. both OA and RA have an acute onset in older adults. b. OA is a localized process, but RA may be systemic. c. OA usually impacts distal interphalangeal joints, but RA impacts proximal interphalangeal joints. d. both OA and RA present N wU ithRS joiIntNsG tifTfnBe. ssClaOsM t ing 20 to 30 minutes af ter rest. e. initial treatment of both OA and RA is usually nonpharmacologic using heat or exercise.

ANS: B, C

Whereas OA has an insidious presentation, RA has an acute presentation. OA presents with joint stiffness, which resolves in less than 20 minutes; RA presents with joint stiffness that lasts more than 20 to 30 minutes. OA is initially treated with nonpharmacologic treatments such as heat or exercise; RA is treated with medications (disease-modifying antirheumatic drugs) immediately after diagnosis.

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 279

TOP: Teaching and Learning

4. A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the

following instructions should the nurse include in the teaching? (Select all that apply.) a. Rest the joint during the acute gout attack. b. Take ASA to relieve pain. c. Increase fluid intake to 2 L/day. d. Avoid foods high in purine. e. Avoid alcoholic beverages.

ANS: A, C, D, E

Individuals who are having an acute attack of gout should not take salicylates for pain; ASA is a salicylate.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 281

NURSINGTB.COM

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 22: Cardiovascular and Respiratory Disorders Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following is a true statement about heart disease in older adults? a. Myocardial infarction (MI) has many of the same symptoms in older patients as in

middle-aged persons. b. Both excessive urination at night and decreased urination can be signs of heart

failure (HF). c. Any exertion on the part of an older adult patient with heart disease can bring on another heart attack. d. A person with HF is likely to have trouble breathing, except when lying down.

ANS: B

Because the heart is an ineffective pump in HF, both excessive urination at night and decreased urination can occur when older adults have an MI. Nocturia occurs in HF when the heart is unable to maintain adequate renal blood flow in the performance of daily activities; then during the night when the patient’s lower extremities are elevated for sleep, the heart is able to perfuse the kidneys with the assistance of increased venous return owing to the elevated extremities. Inadequate urine production is caused by inadequate perfusion from an ineffective pump. The classic presentation of angina pectoris in older patients is often absent in what is known as a silent MI, with only mild discomfort, perhaps even limited to nausea or “heartburn” as the only symptom. Failure to engage in cardiac rehabilitation exercises is more likely to result in another MI Nor bRe aI n agG graB va. t ioCn oM f HF than ord inary exertion. A person U S N T O with HF is more likely to have difficulty breathing except when the trunk is upright (orthopnea).

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 288 MSC: Physiological Integrity

2. An older man in a cardiac rehabilitation exercise class refuses to participate in the cool-down

phase of the activity; consequently, 2 minutes later, he passes out but quickly regains consciousness. Which instruction does the nurse include in patient teaching to reinforce the importance of cooling down after exercising to this man? a. Cardiac output diminishes with age. b. Mobility capacity decreases with age. c. Baroreceptor function diminishes with age. d. Sensory perception diminishes with age.

ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank During exercise, the body shunts blood to the skeletal muscles to supply enough oxygen to meet the increased metabolic demands of the muscles. If the exercise is suddenly withdrawn, however, the blood temporarily pools in the skeletal muscles, and the older adult loses consciousness from transient hypotension. Baroreceptor responsiveness declines with age; therefore, the body does not respond as readily to the need for changes in blood pressure. The cool-down period compensates for this effect. An acute problem such as losing consciousness as a result of decreased cardiac output should appear during the “real” exercise. The man is mobile enough to participate in the exercise program. Gradual sensory alteration does not account for the acute episode.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 291

TOP: Teaching and Learning

3. Which of the following is a true statement about heart disease in older men and women? a. More women than men die from MIs. b. Cardiac care for men and women is equally aggressive. c. Cardiac medications have been tested on men and women equally. d. Women generally receive less aggressive treatment than men do.

ANS: D

Women generally receive less aggressive treatment than men; this stereotype has led to a relative neglect of women’s cardiac problems. Men usually receive more aggressive treatment. Testing in the past has focused on male patients. Women receive less aggressive treatment and less effective instruction for cardiac disease, which is potentially due to the atypical presentations women have for cardiac disease and MIs. REF: p. 287 PTS: 1 DIF: Remember G N R TOP: Nursing Process: AssessmU ent S N MTSB C. : C PhO ysiological In tegrity 4. Which condition is a chronic obstructive pulmonary disease (COPD)? a. Bronchial asthma b. Histoplasmosis c. Bacterial pneumonia d. Mycobacterium tuberculosis ANS: A

COPD includes asthma, chronic bronchitis, and emphysema. Pneumonia, an acute pulmonary infection, is not a chronic obstructive lung disorder.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 291 MSC: Physiological Integrity

5. An older woman who has chronic obstructive pulmonary disease (COPD) wants to perform

self-care activities. Which instruction should the nurse include in patient teaching to help her achieve this goal? a. Bathe and eat slowly with periodic rest. b. Walk short distances without oxygen. c. Perform all activities of daily living (ADLs) and then rest. d. Bathe right after eating, and then rest.

ANS: A

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank A person with COPD can perform self-care tasks if allowed plenty of time to accomplish them and to take breaks for rest. The patient can potentially benefit more from longer periods of exercise supplemented with oxygen than from short excursions without oxygen. A plan to rest in the future after the self-care task of performing ADLs or bathing after eating is accomplished does not compensate for the deprivation of rest when she needs it.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 294

TOP: Teaching and Learning

6. Which of the following statements is true about cardiopulmonary disease in older adults? a. Chronic obstructive pulmonary disease (COPD) can be reversed with proper

treatment. b. Chest radiographic studies are a reliable indicator of whether pneumonia is present

in an older patient. c. Persons older than 65 years should receive Pneumovax annually. d. Mouth hygiene is essential to prevent and treat pneumonia.

ANS: D

Bacteria from the mouth can migrate into the lower respiratory tract and cause infection.

COPD cannot be reversed. For a debilitated person at the beginning of the course of infection or in dehydration, the chest x-ray study results are often falsely negative. Although the Pneumovax vaccine is most often a one-time dose, the older adult’s health care provider may recommend a second dose at a later time.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 295 MSC: Physiological Integrity

7. A 58-year-old African AmerN icaUnRmSaI n N inGgT ooBd .hC eaO lthM has a blood pressure at 120/73 mm Hg at

his annual physical examination. Which of the following is the best goal for the nurse to use to assist him in maintaining his health and wellness into older age? a. Alter modifiable risk factors. b. Prevent cardiovascular disease. c. Recognize disease in early stage. d. Maintain tight glycemic control.

ANS: B

The nurse assists this adult in maintaining health and wellness by helping him prevent cardiovascular disease; as an older African American man, he has a high risk of stroke, hypertension, and diabetes mellitus. Furthermore, he is more likely to die of a stroke or heart attack than other people in the United States. To help him prevent cardiovascular disease, the nurse assists him with lifestyle modifications. Specific recommendations the nurse can make include getting regular exercise; learning the warning signs of heart attack and stroke; maintaining a normal weight; controlling blood pressure; eating a well-balanced, low-fat, no-added-salt diet; and avoiding smoking. Altering modifiable risk factors is a subgoal to preventing cardiovascular disease. Learning the early warning signs of disease is a subgoal to preventing cardiovascular disease. Although he has no clinical indicators of hyperglycemia, he is at risk for developing diabetes mellitus, which is an important subgoal of preventing cardiovascular disease for an African American man.

PTS: 1 DIF: Analyze REF: p. 287 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

8. Which classic sign of an acute myocardial infarction (AMI) can be absent in an older man

with an AMI? a. Vague complaints b. Epigastric burning c. Crushing chest pain d. Dyspnea and fatigue ANS: C

Gripping chest pain radiating to the shoulder is typically seen in younger adults but not always in older adults. Instead, an older adult may be experiencing a silent MI. Older adults with an AMI express vague complaints such as fatigue, weakness, and dyspnea. Older adults with an AMI are seen with atypical complaints such as epigastric burning or pain.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 288 MSC: Physiological Integrity

9. Which of the following is the most important goal in the nursing plan of care to decrease the

frequency of hospitalizations for acute exacerbations of HF in older adults who have HF? a. Control fluid balance. b. Control blood pressure. c. Prevent deconditioning. d. Maintain patient safety.

ANS: A

The most important goal for keeping a patient who has HF out of the hospital is to control total body fluid; hypervolemia aggravates HF by increasing the blood volume and making the heart work hard er. ControllinN g toR fluBid.aC lsoM helps prevent d yspnea and hypertension, U talSbIodNyGT maintain physical activity, improve rest and sleep, and promote nutrition for optimal health and wellness. Controlling the blood pressure is an important part of HF therapy; however, fluid volume status is implicated more often in those hospitalized with HF. Preventing deconditioning is an important yet challenging goal for patients with HF, but it is not frequently implicated in those hospitalized with HF. Maintaining patient safety is an important goal for any patient, but it is not commonly implicated as a cause of hospitalization for those with HF. PTS: 1 DIF: Understand REF: p. 289 MSC: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

10. After an acute exacerbation of chronic obstructive pulmonary disease (COPD), the nurse

prepares an older adult for discharge to home. Which is the most important patient teaching for the nurse to include for the prevention of hospitalizations for exacerbations of COPD? a. Ease breathing by sitting upright. b. Use low-flow oxygen for dyspnea. c. Avoid sick people and wash hands. d. Eat nutrient- and calorie-dense foods.

ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank The nurse helps the patient with COPD maintain health and wellness by preventing infection.

To accomplish this, the nurse instructs the patient to avoid people with contagious illnesses to reduce exposure to communicable diseases and to wash hands frequently to reduce exposure to microorganisms as potential pathogens. Following these instructions will help the patient avoid hospitalizations for COPD; a pulmonary infection can have a devastating impact on a patient who has compromised pulmonary reserves. Fluid and exudates accumulate in the lungs to decrease oxygenation and ventilation, and patients with COPD are less able to cough and expel sputum. The nurse teaches the patient to sit upright to ease breathing for transient dyspnea that occurs after exertion or while eating. This technique, however, is unlikely to prevent a hospitalization for patients with exacerbations of COPD. Patient with COPD regularly use oxygen for dyspnea as prescribed. Oxygen provides symptomatic relief of dyspnea but does not prevent hospitalizations for exacerbated COPD. Eating nutrient- and calorie-dense food is also important. Patients with COPD work very hard at breathing; therefore, the patient needs the calories and nutrition to supply fuel for the work of breathing.

In addition, patients with COPD should eat these foods because eating them in sufficient quantities to meet their needs is often difficult; therefore, the food they do eat must contain many calories and nutrients. Nutritional issues are not the most important aspect of preventive therapy for patients with COPD; an infection is more likely to cause a more devastating problem.

PTS: 1 DIF: Analyze REF: p. 294 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

11. The nurse notices that an older female nursing home resident is not eating and that her heart

rate is faster than usual. Which should the nurse do to determine if pneumonia is a potential cause of the change in her status? a. Obtain a specimen f or aeN roU biR cS blI ooNd GcT ultBur.esC.OM b. Promptly send the resident for a chest x-ray examination. c. Analyze sputum for color, texture, and volume. d. Compare tympanic temperature with the baseline.

ANS: C

Sputum cultures are indicated to assess a resident for pneumonia. Sputum is a sensitive and specific clinical indicator of pneumonia for older adults in nursing homes. If pneumonia is causing this resident’s anorexia and tachycardia, then her sputum should be cloudy, colored, and thick, especially if the resident is dehydrated, which indicates an infection. Blood cultures are likely to show no growth unless the resident has severe sepsis. A chest x-ray study is a nonsensitive, nonspecific diagnostic tool for determining the presence of pneumonia in an older adult. Fever can be a late indicator of infection for an older adult.

PTS: 1 DIF: Apply REF: p. 292 TOP: Nursing Process: Implementation MSC: Physiological Integrity 12. A nurse measures an older adult’s blood pressure on the right arm and notes a reading of

150/100 mm Hg. The nurse waits 5 minutes and measures the blood pressure again in the right arm and obtains a reading of 152/100 mm Hg. What is the next action by the nurse? a. Immediately contact the medical provider. b. Measure the blood pressure in the left arm. c. Measure the blood pressure in sitting and standing positions. d. Document the findings in the medical record; elevated blood pressures are normal

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank in older adults.

ANS: B

When an abnormal blood pressure reading is obtained, it is necessary to do two measurements, 5 minutes apart, confirmed in the contralateral arm. Doing orthostatic measurements is not indicated in this situation. A blood pressure reading above 140/90 mm Hg is considered abnormal for the general population. However, a systolic reading up to 150 mm Hg is now acceptable for those at least 65 years of age, except for those with diabetes (James et al., 2014).

PTS: 1 DIF: Understand MSC: Physiological Integrity

REF: p. 287

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. Which are potential results of end-organ damage from chronic hypertension? (Select all that

apply.) a. Carotid stenosis b. Diabetes mellitus c. Renal insufficiency d. Coronary artery disease e. Isolated systolic hypertension f. Familial hypercholesterolemia ANS: A, C, D

Carotid stenosis refers to the occlusion of the carotid artery from atherosclerotic plaque and can be a result of chronic hypertension. Older adults with carotid stenosis are at high risk for N R I oem G Tbolic B.CeO strokes because of the risk of aUthroSmbN vent f rom the plaque. Renal d ysfunction can occur as a result of chronic hypertension; the intimal lining of the renal arteries is damaged over time, which leads to renal artery stenosis and decreased renal perfusion. Coronary artery disease is a common result of chronic hypertension. Diabetes is not a result of end -organ damage from chronic hypertension; however, when it accompanies hypertension, diabetes accelerates the process of end-organ damage and greatly increases the risk of cardiovascular disease. Isolated systolic hypertension is a common consequence of aging but not a result of end-organ damage. Genetic factors determine familial hypercholesterolemia and cannot be caused by end-organ damage.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 287 MSC: Physiological Integrity

2. An older man who has heart failure (HF) complains of increasing dyspnea over 2 days. Which

of the following should the nurse assess to help determine whether the patient has adhered to his therapy? (Select all that apply.) a. Check for peripheral edema. b. Ask about his bowel pattern. c. Auscultate the lungs bilaterally. d. Compare his weight with baseline. e. Determine coughing frequency. f. Assess his diet over the past 48 hours.

ANS: A, C, D, F

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Standard HF therapy includes taking medications as prescribed with a low-sodium diet to control total body fluids. Usually, dyspnea in a patient with HF is caused by hypervolemia, which occurs after a lapse in adherence to the standard HF therapy. The nurse checks the patient’s extremities for edema because peripheral edema is a clinical indicator of hypervolemia. If the patient is nonadherent with therapy, then the nurse is more likely to find peripheral edema than with an adherent patient. Hypervolemia can also be caused by worsening HF. The nurse listens to the patient’s lungs to assess for pulmonary edema as a cause of the patient’s dyspnea. Pulmonary edema can be caused by hypervolemia from nonadherence to therapy or from worsening HF. The nurse compares the patient’s weight with his baseline to determine whether the patient has experienced a sudden weight gain, which would be indicative of hypervolemia. Assessing the patient’s diet over the past 48 hours can provide clues about a potential cause of the patient’s dyspnea. If the patient increases the dietary sodium by eating pizza, pickles, and processed food, among others, he is likely to experience a sudden increase in total body fluid, which can cause dyspnea. Although older adults with HF complain of anorexia, bowel habits are not as likely to be affected by hypervolemia as is the appetite. Coughing is a nonspecific, nonsensitive indicator of pulmonary edema.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 289 MSC: Health Promotion and Maintenance

3. The nurse understands that heart disease risk factors are which of the following? (Select all

that apply.) a. Age b. Hypertension c. Diabetes d. Macular degeneration

NURSINGTB.COM

ANS: A, B, C

Age, hypertension, cigarette smoking, obesity, inactivity, dyslipidemia, and diabetes are all risk factors for the development of heart disease. Macular degeneration is a disease.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 288 MSC: Health Promotion and Maintenance

4. The nurse should instruct a patient on which of the following modifiable risk factors for

essential hypertension? (Select all that apply.) a. Tobacco use b. Alcohol c. Stress management d. Adequate rest ANS: A, B, C

Tobacco use, alcohol, and stress management are modifiable risk factors. Although adequate rest helps with general health and wellness, it has not been identified as a modifiable risk factor for essential hypertension.

PTS: 1 DIF: Understand REF: p. 287 MSC: Health Promotion and Maintenance

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 5. A nurse is involved in primary prevention activities related to the promotion of respiratory

health. The nurse is involved in which of the following activities? (Select all that apply.) a. Organizing an influenza vaccination clinic b. Promoting a smoking cessation program in the community c. Referring individuals with respiratory disease to the pulmonology clinic at the hospital d. Visiting a congressman representative to advocate for legislation on clean air e. Teaching individuals with chronic obstructive pulmonary disease measures to maximize lung function ANS: A, B, D

Primary prevention includes activities such as promoting or conducting smoking cessation programs and community intervention, including organizational efforts to promote and administer preventive vaccinations such as that for influenza and pneumonia. Primary prevention includes political activism with industry leaders and environmental agencies to push for clean air and water. Neither referrals to specialists of teaching individuals who already have respiratory illness are part of primary prevention.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 295

TOP: Teaching and Learning

6. A nurse is educating a group of older adults on the impact of lifestyle changes on

hypertension. The nurse includes which of the following in the education? (Select all that apply.) a. Learning how to read and interpret food labels b. The sodium content of commonly consumed foods c. Techniques to incorporate more physical activity into the daily routine d. The actions of calcium chNaU nnR eS l bI loNckG eT r B m e.d C icO ations on hypertension e. The importance of adhering to pharmacologic regimens for treatment of hypertension ANS: A, B, C

Knowing how to read and interpret food labels, knowing about sodium content, and incorporating physical activity into the daily routine are all lifestyle changes to control hypertension. The other options are related to pharmacologic treatment of hypertension.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 287

TOP: Teaching and Learning

OTHER 1. The exercise tolerance of an older adult is impaired after a myocardial infarction because of a

low ejection fraction. Rank the following interventions that the nurse should use to assist this individual to restore baseline functional status in order of importance, beginning with the first intervention. a. Provide a well-balanced diet. b. Assist with range of motion. c. Sit in chair four times daily. d. Keep arterial oxygen saturation (SaO 2 ) above 95%.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS:

D, A, B, C The nurse first helps the patient maintain myocardial oxygenation by keeping the patient’s SaO 2 above 95%; if it drops below that level, then the arterial blood lacks sufficient oxygen to meet tissue oxygen demands. Second, the nurse provides a well-balanced diet for tissue building and repair. The patient has little hope of resuming baseline functioning without adequate food for fuel and maintaining muscle bulk. Third, to help maintain muscle bulk and joint flexibility, the nurse helps the patient perform range-of-motion exercises in preparation for more strenuous physical activity. Last, before ambulation, the nurse ensures that the patient is able to sit in the chair four times a day as progress toward restoring baseline functioning.

PTS: 1 DIF: Analyze REF: p. 290 MSC: Health Promotion and Maintenance

NURSINGTB.COM

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 23: Neurological Disorders Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following statements is true about Parkinson’s disease (PD)? a. Drinking large amounts of alcohol can relieve symptoms of essential tremor. b. Motor tremors and slow movement accompany severe cognitive impairment. c. Lewy body dementia (LBD) is the most common form of dementia. d. Older adults taking levodopa–carbidopa (Sinemet) must take it on an empty

stomach.

ANS: D

Older adults taking Sinemet must take it on an empty stomach; (i.e., 30 to 60 minutes before a meal or 45 to 60 minutes after a meal) for it to be effective. It is given on a set schedule to prevent fluctuation in symptoms. Drinking small amounts of alcohol can relieve symptoms of essential tremor, although heavy drinking should be avoided. The majority of persons with PD remain alert and intelligent, but motor difficulties in facial expression and speech can give a false impression of cognitive impairment. LBD, which can occur in some patients with PD symptoms, is the second most common form of dementia. It accounts for 15% to 20% of all dementias.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 303 MSC: Physiological Integrity

N R I G B.C M

2. An old er man comes to the emeUrgeS ncyNd epTartmenO t after falling at home, and he reports that he

cannot walk without losing his balance. Which steps should the nurse implement for this patient? a. Arrange to transfer him immediately to the radiology department. b. Determine symptom onset or when he fell at home. c. Organize the reperfusion recombinant tissue plasminogen activator (rt-PA) infusion. d. Perform a comprehensive neurological assessment.

ANS: B

The nurse determines when the symptoms first appeared or the time of the fall to determine whether sufficient time is left to administer reperfusion rt-PA; if indicated, rt-PA must be administered within 3 hours of symptom onset. A patient with clinical indicators of a stroke will need a computed tomography scan to differentiate between a thrombotic stroke and a hemorrhagic stroke; the type of stroke will determine the therapeutic course. The time of symptom onset is a vital piece of information that must be determined before the patient is referred to the radiology department because rt-PA is usually administered in the radiology suite. Administering rt-PA can be contraindicated for this patient; therefore, the preparation of this infusion is delayed until the type of stroke and the plan of care are determined. The nurse will not have enough time to complete a comprehensive assessment and thus will perform a focused assessment in preparation for the trip to radiology.

PTS: 1 DIF: Apply REF: p. 304 TOP: Nursing Process: Implementation MSC: Physiological Integrity

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

3. Which of the following statements is true about dysarthria? a. Does not affect intelligence b. Stems from severe rheumatoid arthritis c. Physical therapy can be beneficial d. Can affect the balance ANS: A

Dysarthria is a speech disorder caused by a weakness or incoordination of the speech muscles.

It occurs as a result of central or peripheral neuromuscular disorders that interfere with the clarity of speech and pronunciation; it does not affect intelligence. It does not stem from rheumatoid arthritis. Occupational therapy can help. Dysarthria does not affect balance.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 306 MSC: Physiological Integrity

4. A new nurse in a long-term care facility is caring for a patient with Parkinson’s disease (PD).

The nurse should note which one of the following actions related to PD that is observed during the assessment? a. Tremors during sleep b. Cogwheel rigidity c. Frequent blinking d. Fast movements ANS: B

Patients with PD display slow movement, infrequent blinking, masked facies, and cogwheel rigidity. Patients with PD exhibit tremors at rest in their hands, arms, legs, feet, and jaw.

N R I G B.C M

U S N REF: T p. O DIF: Understand 302 PTS: 1 TOP: Nursing Process: Assessment MSC: Physiological Integrity 5. An older adult arrives at the emergency department with a probable diagnosis of a

hemorrhagic stroke. The nurse understands, based on the patient’s age, that the most likely cause is which one of the following? a. Intracranial hemorrhage b. Decreased cardiac output c. Thrombosis d. Uncontrolled hypertension ANS: D

Hemorrhagic strokes are primarily caused by uncontrolled hypertension and less often by malformations of the blood vessels (e.g., aneurysms). Although the exact mechanism is not fully understood, it appears that chronic hypertension causes a thickening of the vessel wall, microaneurysms, and necrosis. When enough damage to the vessel accumulates, it is at risk for rupture. The spontaneous rupture may be large and acute or small with a slow leak of blood into the adjacent brain tissue. In many cases, blood ruptures or seeps into the ventricular system of the brain with damage to the affected tissue through necrosis or death of brain tissue. Hemorrhagic strokes are more life threatening but occur less frequently than ischemic strokes. Decreased cardiac output does not cause this type of hemorrhage. A thrombosis is not related to this type of hemorrhage.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 299 MSC: Physiological Integrity

6. After completing an admission assessment on a patient who recently had a stroke, the nurse

should choose which of the following nursing diagnoses as a priority? a. Risk for injury b. Altered thought process c. Altered cerebral perfusion d. Decreased mobility ANS: C

Altered cerebral perfusion is the priority diagnosis. Altered cerebral perfusion may be caused by an interruption in blood flow such as occlusive disorder, hemorrhage, cerebral vasospasm, or cerebral edema. It is important for the nurse to monitor cognitive status and vitals for patients experiencing altered cerebral perfusion. The patient is at risk for injury because of the effects of the stroke; however, it is not the priority diagnosis. This patient may have altered thought processes because of cerebral damage from the stroke; however, this is not the priority diagnosis. This patient may experience a decrease in mobility such as hemiparesis; however, it is not the priority diagnosis.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 298 MSC: Physiological Integrity

7. A home health nurse is completing an admission on a patient who recently experienced a

transient ischemic attack (TIA). During the assessment, the patient begins to complain of a severe headache and numbness in his left arm. Which action should the nurse take next? a. Instruct the patient to take Tylenol. b. Ask whether patient suff eN rsUfR roS mIm a inBe.hC eaOdM aches.

NigGrT c. Reschedule the visit. d. Call 9-1-1.

ANS: D

The home health nurse should immediately call 9-1-1. A TIA is ischemic but clinically different from a stroke in that all of the neurologically associated symptoms begin to resolve within minutes. About one-third of persons who have a TIA and do not receive treatment are likely to have a major stroke within 1 year; 10% to 15% of these persons will have a major stroke within 3 months (Centers for Disease Control and Prevention, 2013). Tylenol would not be advised. The nurse should not leave the patient until the patient is en route to the emergency department.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 299 MSC: Physiological Integrity

8. The nurse in a rehabilitation center is caring for a patient who has new-onset stroke with

right-side hemiparesis. Which intervention should the nurse implement when caring for this patient? a. Orders a two-person assist with a transfer b. May need to incorporate repetition c. Gives the patient a dry erase board d. Raises all four side rails

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 24: Mental Health Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. An older woman recently lost her brother, provides care for her husband who has health

needs, and must move to a new location after 35 years in the same home. When she comes to the primary care facility with clinical indicators of influenza, the nurse recognizes which of the following? a. She is exhibiting attention-seeking behaviors. b. Crises and stressors can impair physical health. c. Her greatest need is respite care for her husband. d. Crisis leads to a lower functional status for the victim.

ANS: B

Her resistance to disease is likely to be lower as a result of the effects of heavy stresses acting simultaneously. She may be seeking attention, but that does not make the stress and illness any less real. Her greatest need at this moment is to be treated for influenza. Respite care may be necessary, but it is not sufficient. Successful coping with a crisis may lead to a higher level of functioning.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 309 MSC: Psychological Integrity

2. Which of the following statements is true about the mental health of older adults?

R I GegB .C a. Nurses should d iscourageNdU eniaSl anNd rT ressioOn so old er ad ults can d irectly f ace

underlying causes of anxiety. b. Anxiety is easily distinguished from depression, dementia, and the effects of

disease or medication. c. Compulsive rituals surrounding toileting and sleep are signs of a serious mental

disorder. d. The nurse avoids antianxiety medications without an assessment for factors

associated with anxiety.

ANS: D

Without an adequate assessment, medications can exacerbate a problem. Denial and regression may be necessary to enable an older person to cope with underlying stressors.

Depression, dementia, disease, and medications can produce anxious behavior, and the resultant anxiety can be manifested in a similar manner, regardless of the cause. Compulsive rituals can be a way of coping with challenges leading to anxiety.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 313 MSC: Psychological Integrity

3. An older female resident lowers her voice and tells the nurse that another female resident is

looking at her behind her back and is going to make her move tonight with a male staff member. Which ideas should the nurse include in the response to this individual? a. The staff receives training in ethics. b. Validate the woman’s impression.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank c. Avoid suspicious, paranoid thinking. d. Use the call bell if she becomes frightened.

ANS: D

Telling the resident to use the call bell if she becomes frightened offers assurances to the patient that she will be protected, but it neither confirms her suspicions nor makes a promise that cannot be kept. Replying that the staff receives training in ethics sounds as if the nurse is arguing in defense of the male staff member and does not help alleviate the resident’s fear, which can lead her to suspect that the nurse is also a part of the plot. Validating the woman’s impression contributes to the resident’s suspicions; in addition, the nurse increases professional liability risks by speaking about another resident in a negative manner. Telling the resident to avoid suspicious, paranoid thinking only aggravates the struggle for control.

PTS: 1 DIF: Apply MSC: Psychological Integrity 4.

REF: p. 320

TOP: Nursing Process: Planning

Which of the following is a true statement about psychotic behavior in older adults? a. Usually, hallucinations in older patients are the result of psychological conflicts. b. Illusion, delusion, and hallucination are different terms for the same phenomenon. c. An older adult with psychotic behavior should be assessed for a variety of causes. d. Regardless of the cause, dissimilar hallucinations are treated with similar therapies.

ANS: C

The nurse assesses an older adult who is exhibiting psychotic behavior by searching for a reason from a wide variety of potential causes for the behavior. For example, neuroleptic medications can cause extrapyramidal side effects, which can result in movement disorders that are similar to psychotic behavior. Hallucinations in older patients are usually the result of physical d isord ers, d ementiasN, U orRsS enI soNryGfTunBc. t ioCnOloMss. A d elusion is a belief that is maintained, although facts can prove that it is incorrect. A hallucination or illusion is the sensory perception of a stimulus that does not exist in the external world. Treatments for hallucinatory states vary according to the cause.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment 5.

REF: p. 319 MSC: Psychological Integrity

Which of the following is a true statement concerning suicide among older adults? a. Older adults and younger adults manifest a suicidal intent in a similar manner. b. Older African American women have the highest risk of suicide among older adults. c. Ethics require that the nurse respects a person’s intent to terminate his or her own life. d. A major crisis experienced by the patient can contribute to the risk of suicide.

ANS: D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Major crises or transitions, such as retirement or relocation to an assisted living or nursing facility, can contribute to the risk of suicide. Putting personal affairs in order, distributing possessions; making a will; or saying something similar to, “I won’t be around much longer” can indicate a risk for suicide in a young person but can be a rational and mature act in older age. Men in all countries have a higher suicide rate, and white men are more likely to evaluate their worth solely in terms of their present economic productivity. Chinese American women aged 65 years and older have the highest suicide rate of all women older than the age of 65 years in the United States (National Alliance on Mental Illness, 2011). Health care professionals are obligated to prevent the destruction of life as a permanent solution to what may be a temporary problem.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 326 MSC: Psychological Integrity

6. You are evaluating the plan of care for an older adult who is alcohol dependent. Which patient

documentation indicates the need for follow-up nursing interventions by the nurse? a. Patient states that he intends to decrease his alcohol consumption. b. Patient arrives at his group session on time and well-groomed. c. Patient states, “I am an alcoholic because I drink 10 beers a day.” d. Patient states that he understands that he needs continued treatment.

ANS: A

When the patient states that he or she intends to decrease alcohol consumption, this response indicates that the patient continues to believe that his or her alcohol consumption is under his or her control. If the patient arrives at a group session on time and is well-groomed; taking pride in his or her appearance and participating in a group activity are positive signs.

Acknowledging that he or she has a problem is a positive sign; older adults cannot be helped NUged RS G Twled B.C until the problem is acknowled .I AcNkno giO ng the need f or continuing treatment is a positive sign.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 330

TOP: Nursing Process: Evaluation

7. Which assessment finding of an older adult living in an assisted-living facility indicates the

highest risk for suicide? a. Liver failure is due to alcohol abuse; older adult is popular at meals b. Older adult declines company; is preoccupied with lethal weapons c. Refuses to allow a large, extended family to help him d. Older adult had an overdose of acetaminophen 20 years ago; is in a sewing group ANS: B

The older adult who prefers to be alone and is preoccupied with lethal weapons has two risk factors for suicide. This individual warrants close observation for additional risk factors and verbalization and indicators of future suicide attempts. The nurse should also increase the frequency of observations and account for his whereabouts at all times. The individual who has a serious illness and a history of alcohol abuse has two risk factors for suicide. However, this older adult also relishes social interaction, which is an indication that suicide is less likely to be imminent or even in the individual’s thoughts. The older adult who will not accept help from the family exhibits a potential risk factor for suicide or is an exceedingly proud individual who wants to be self-sufficient. History of a suicide attempt is a risk factor for suicide; however, the acetaminophen overdose could have been accidental.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 327 MSC: Psychological Integrity

8. An older man who had radical surgery for oral cancer is refusing to see visitors and is losing

weight despite aggressive nutrition therapy. The nurse assesses this man for ineffective coping related to dysfunctional grieving. Which of the following patient outcomes of nursing care is the most important to implement in response to his mental health status? a. Is able to discuss how his coping mechanisms are overwhelmed b. Performs daily self-feedings through a gastrostomy tube c. Effectively uses nonverbal forms of communication d. Exhibits self-confidence in regaining a sense of control ANS: D

The most important element of the nursing plan of care for this older adult is to create and strengthen self-confidence to improve his sense of control; doing so is likely to help him effectively manage the other aspects of his health care. The nurse helps create and improve this self-confidence by observing for strengths and integrating them into his daily care and by responding with empathy and encouragement to his expressions of fears, emotions, and desirable goals. Helping this patient gain self-confidence is the most important outcome because this man has clinical indicators for depression—social isolation and weight loss.

Before this patient can benefit from discussing his stressors or from patient teaching, the nurse must establish a trusting, caring relationship and build some self-confidence because, at this point, this individual feels hopeless and believes that he has no control. The patient displays a lack of readiness for expressions about emotions, coping, or his stressors; by enhancing his self-confidence, the nurse prepares him to discuss coping mechanisms and stressors. This patient also displays a lack of readiness for learning a new psychomotor activity. Performing N Ue RthS GTimport B.CO M as the d ay f or d ischarge approaches. d aily self -f eed ing is an outcom atIgN ains ance Effectively using nonverbal forms of communication is important for basic communication; however, he displays a lack of readiness for receiving help to achieve this outcome.

PTS: 1 DIF: Analyze MSC: Psychological Integrity

REF: p. 309

TOP: Nursing Process: Planning

9. Which older adult is most likely to have normal mental health? a. An older adult who grieves over the loss of a spouse for 2 years but is traveling

again b. An older adult who exhibits long periods of depression with occasional manic

episodes c. An older adult who has lost two friends in a war, has had three failed marriages, and is bankrupt d. An older adult who has been treated for chronic depression and whose brother killed himself 1 year ago ANS: A

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank An older adult who grieves after suffering a major loss for 2 years, which is a length of time for grief that is within normal limits, is beginning to enjoy life again. This individual is most likely to have normal mental health because he or she has worked through the grief and has had the strength to resume normal activities. An older adult who exhibits long periods of depression with occasional manic episodes has clinical indicators of bipolar disorder. An older adult who has lost two friends in a war, has had three failed marriages, and is bankrupt is unlikely to enjoy normal mental health; this older adult’s life displays an inability to cope effectively with tragedy, relationships, and personal matters. An older adult who has been treated for chronic depression and whose brother killed himself 1 year ago is at risk for suicide and is unlikely to have normal mental health.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 309 MSC: Psychological Integrity

10. Although the older man who was forced to retire from law enforcement has multiple physical

complaints, the primary care health care provider finds nothing abnormal. After the man tells the nurse that his girlfriend just left him, which of the following is the priority nursing intervention to complete before the older adult leaves? a. Ask him how he plans to cope with his loss. b. Use direct questions about access to firearms. c. Collaborate with his provider for antidepressants. d. Allow him to express himself by intently listening.

ANS: B

The nurse’s priority intervention is to ask him directly about his access to firearms; he has familiarity with guns, and the risk factors for suicide in older adults include male gender, physical complaints of unknown causes, and having suffered a recent loss. Asking him how INnab GTle B.C M he plans to cope with his lossNisUaRrS easo interO vention f or the nurse to includ e in the plan of care for this older adult in light of his risk factors for suicide. Collaborating with his provider for antidepressants is a reasonable intervention for the nurse to include after a comprehensive assessment of this older adult. Allowing him to express himself by intently listening is a reasonable intervention for the nurse to include because it helps the nurse establish a trusting, caring relationship with this older adult.

PTS: 1 DIF: Analyze REF: p. 327 TOP: Nursing Process: Implementation MSC: Psychological Integrity 11. An older adult says to the nurse, “I don’t know why I can’t handle booze like I used to when I

was younger.” The nurse’s response is based on the knowledge that a. older adults develop higher blood alcohol levels because of age-related changes in the neurological system. b. older adults develop higher blood alcohol levels because of age-related changes that alter absorption and distribution of alcohol. c. older adults develop higher blood alcohol levels because of slowed reaction times. d. older adults develop higher blood alcohol levels because of cognitive changes.

ANS: B

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Age-related changes such as increased body fat, decreased lean muscle mass, and decreased total body water content alter absorption and distribution of alcohol, increasing blood alcohol levels. Age-related neurologic changes do not impact blood alcohol levels. Slowed reaction time does not impact blood alcohol levels. Cognitive changes do not impact blood alcohol levels; furthermore, not all older adults experience cognitive changes.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 329

TOP: Teaching and Learning

12. How should the nurse respond when an older adult asks, “How much alcohol is good for

you?” a. “Alcohol isn’t good for you, so avoid it as a general rule.” b. “Experts in the field recommend only one regular sized drink a day.” c. “It’s been said that red wine has health benefits, but that doesn’t mean you should drink a whole bottle.” d. “If you are only drinking on special occasions, limit yourself to two drinks.”

ANS: B

Clinically significant adverse effects can occur in some individuals consuming as little as two to three drinks per day over an extended period. Because of the increased risk of adverse effects from alcohol use, the National Institute on Alcohol Abuse and Alcoholism defines “at-risk drinking” for men and women aged 65 years and older as more than one drink per day. The other options do not address the patient’s question.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 329

TOP: Teaching and Learning

B.t eC 13. An old er patient in an ad ult dN ayUcRarSeIpN roG grT am llO s tM he nurse that, “I ’m very stressed because another neighbor passed away.” The most therapeutic response by the nurse is: a. “What do you mean by ‘stressed’?” b. “Tell me what you did when your other neighbor passed away.” c. “Are you worrying about your own death?” d. “Let’s get involved in some activities and not think about sad things.”

ANS: B

Application of what one has learned from previous situations can help dissipate the intensity of stress. Denial of the stressful event and focusing on blessings or happiness will not lessen the stress and may in turn intensify it. Although it is appropriate to ask the patient to clarify what he or she is saying, it does not help in this situation. This is not necessarily the time to initiate a conversation about the patient’s feelings about death because doing so is likely to increase the level of stress.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 310

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. Which of the following are true statements about depression or depression therapy? (Select all

that apply.) a. An older adult who lived through the Great Depression is unlikely to develop depression.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank b. Complaining and not complaining can be symptomatic of depression. c. Serotonin reuptake inhibitors are rarely used to resolve depression in 2 weeks. d. The nurse should avoid trying to bolster a depressed person’s mood.

ANS: B, D

An older adult can complain because of having no positive feelings, or an older adult may not bother complaining because of having no hope. The nurse should not deny the older adult’s depressed feelings or grief. Older adults who have endured the horrors of the mid-20th century (e.g., the Great Depression, the Holocaust, and World War II) are as prone to depression as other older adults, but they can consider it shameful to acknowledge depressive feelings. Serotonin reuptake inhibitors, usually the drug of choice for depression, can be unsuitable for a specific individual. All antidepressant medications must be closely monitored for side effects and therapeutic response. Only about one-third of depressed older adults achieve remission with any single agent (McGovern et al., 2014).

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 321 MSC: Psychological Integrity

2. Which factors interfere with the mental health of older adults because of the effect on

adaptation? (Select all that apply.) a. Culture b. Life events c. Physical illness d. Substance abuse e. Cognitive impairment f. Developmental transitions ANS: B, C, E, F

NURSINGTB.COM

A life event can interfere with the mental health of an older adult because the experience can interfere with the older adult’s ability to adapt to the situation. Physical illness can interfere with the mental health of an older adult because the illness can interfere with the individual’s adaptive ability. A cognitive impairment can interfere with the mental health of an older adult because this impairment can destroy the older adult’s ability to adapt to new situations.

Development transitions can interfere with the mental health of an older adult because the individual can lack the suitable skills necessary for adaptation through the transitional period.

Culture is likely to influence the mental health of an older adult and influence how the individual adapts but does not necessarily interfere with adaptation. Substance abuse is likely to interfere with the mental health of an older adult but has a variable impact on the ability of the older adult to adapt.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 309 MSC: Psychological Integrity

3. When planning care for a patient that has a history of alcohol abuse, the nurse recognizes

which of the following medications will interact with alcohol? (Select all that apply.) a. Analgesics b. Antibiotics c. Antidepressants d. Antipyretics ANS: A, B, C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Many drugs that older adults use for chronic illnesses cause adverse effects when combined with alcohol (Box 24-17). Medications that interact with alcohol include analgesics, antibiotics, antidepressants, antipsychotics, benzodiazepines, H2-receptor antagonists, nonsteroidal anti-inflammatory drugs, and herbal medications (e.g., Echinacea valerian).

Acetaminophen taken on a regular basis, when combined with alcohol, may lead to liver failure. Alcohol diminishes the effects of oral hypoglycemics, anticoagulants, and anticonvulsants. All older people should be given precise instructions regarding the interaction of alcohol with their medications.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 329

TOP: Nursing Process: Planning

4. Alcohol diminishes the effects of what types of medications? (Select all that apply.) a. Oral hypoglycemic b. Anticoagulant c. Anticonvulsants d. Tricyclic antidepressants ANS: A, B, C

Alcohol diminishes the effects of oral hypoglycemics, anticoagulants, and anticonvulsants.

Alcohol increases the effect of tricyclic antidepressants.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 329

TOP: Nursing Process: Planning

5. When discussing electroconvulsive therapy (ECT) with an older chronically depressed adult

and his family, which statement will the nurse use to support this intervention? (Select all that

NURSINGTB.COM apply.) a. “This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications.” b. “ECT has been found to be more effective in older adults than in younger adults.” c. “ECT is a safe intervention for those with psychotic ideation.” d. “Although there may be some short-term memory loss, most individuals find that their memory comes back within a few days.” e. “ECT results in a more immediate response to symptoms.”

ANS: A, D, E

ECT has been found to be effective in individuals who have psychotic depression and those who do not respond to antidepressant medications. ECT is equally effective in older adults as in younger adults. It is used for individuals with depression, not psychotic ideation. There is some short-term memory loss associated with ECT; however, it does resolve within a short time frame. ECT provides a more immediate response to symptoms than does medication.

PTS: 1 DIF: Understand REF: p. 326 MSC: Psychological/Psychosocial Integrity OTHER

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 1. An older woman fell at home while trying to get to the bathroom in time to prevent urinary

leakage. Rank the following suitable nursing interventions in order according to the ability of each intervention to prevent patient injury at home in the future. Start with the intervention that is most likely to prevent injury in the home. a. Discharge to home while attending an alcohol prevention program. b. Perform home safety inspection to identify modifiable safety hazards. c. Instruct the older woman on pelvic floor exercises and other incontinence strategies. d. Explore depression, alcohol abuse, and physiological contributors to falls.

ANS:

D, C, B, A The nurse begins planning for home injury prevention by assessing the older adult for risk factors for alcohol abuse and for contributors to alcohol abuse or falls. Assessment data help identify areas for intervention; falling and incontinence, especially in women, are risk factors for alcohol abuse. Second, the nurse helps this woman improve incontinence by teaching her strategies to use to improve bladder control. Alcohol abuse increases the risk of incontinence by relaxing the bladder’s muscle tone and by increasing an older adult’s instability or mobility impairment; therefore, the nurse includes plans to control alcohol intake. Next, before discharge, the woman’s home is inspected for potential safety hazards to prevent future falls and injury and to remove a safety hazard as a contributor to falls. Finally, an alcohol prevention program can be a suitable intervention for this older adult if alcohol abuse is a contributing factor. Depending on the assessment data, the willingness to avoid alcohol can determine whether she has the capacity to live at home or should be in a residential facility to maintain safety.

B:.pC. 32M8 PTS: 1 DIF: AN n alyR ze I GREF U S N T MSC: Safe and Effective Care Environment

TOP: Nursing Process: Planning

2. An older adult who has Alzheimer’s disease exhibits new behaviors, including shouting in the

hallways and hallucinations. Rank the following nursing interventions in order, beginning with the first intervention the nurse should implement in response to the new behavior. a. Review the medication list for potential causes. b. Plan nursing care to promote a trusting relationship. c. Look for the likely causes for psychotic manifestations. d. Consult with her health care provider about medications.

ANS:

C, A, B, D The nurse’s first task is to identify the likely causes of psychotic behaviors to provide a framework for planning suitable nursing interventions. Second, as a potential cause of the new behaviors, the nurse reviews the medication list and looks for new medications, missed or increased doses, polypharmacy, and medications likely to cause psychotic behavior. Third, after identifying possible pharmacological reasons, the nurse consults with the health care provider to consider adjustments to the pharmacotherapy. Finally, to supplement the removal of offending medications, the nurse promotes a trusting relationship with the older adult by expressing respect and concern.

PTS: 1

DIF: Apply

REF: p. 318

TOP: Nursing Process: Planning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank MSC: Psychological Integrity

NURSINGTB.COM

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: C

Right-side hemiparesis involves a left-side brain injury. The left side of the brain controls speaking and language. By giving the patient a dry erase board, he or she can communicate easier initially after the stroke. People who have this type of hemiparesis experience difficulty talking. With only one side affected; the nurse should be able to transfer the patient alone.

Patients with left-side hemiparesis have short-term memory loss, so often repetition must be incorporated into patient care. The raising of all four side rails up would be considered a restraint.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 299 MSC: Physiological Integrity

9. The nurse is caring for a patient who has had a stroke. The nurse is concerned the patient will

develop contractures. Which intervention should the nurse implement? a. Use tennis shoes while in bed. b. Turn the patient onto the affected side, resting on the shoulder. c. Use paraffin wax for hand soaks. d. Conduct passive range-of-motion movements to the affected extremities.

ANS: D

Conducting passive range-of-motion movements will help decrease the risk of contractures.

Using tennis shoes in bed helps decrease foot drop. Turning the patient on the affected side, resting on the shoulder, can cause pain. Paraffin wax soaks are often used for patients with arthritis.

PTS: 1 DIF: Analyze TOP: Nursing Process: Assessment

REF: p. 299 MSC: Physiological Integrity

NURSINGTB.COM

MULTIPLE RESPONSE 1. Which of the following behavior modifications should the nurse instruct a patient to

accomplish to help reduce the risk factors for an occurrence of a stroke? (Select all that apply.) a. Increase the intake of green, leafy vegetables. b. Stop smoking. c. Control blood pressure. d. Increase physical activity.

ANS: B, C, D

Stopping smoking, keeping blood pressure under control, and incorporating physical activities are all modifiable risk factors. Increasing the intake of green leafy vegetables does not in itself decrease the risk of stroke; however, they are part of a healthy diet if the patient is not taking an anticoagulant medication.

PTS: 1 DIF: Apply MSC: Physiological Integrity

REF: p. 301

TOP: Nursing Process: Planning

2. Which of the following are common side effects of Parkinson’s disease (PD) and the

medications used to treat it? (Select all that apply.) a. Skin irritation b. Dyskinesias

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank c. Dystonia d. Nausea ANS: B, C

Medication therapy is complicated and must be closely supervised. Hypotension, dyskinesias (involuntary movements), dystonia (lack of control of movement), hallucinations, sleep disorders, and depression are common side effects of both the disease and the medications used to treat it. Nausea is not a side effect of PD. PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 303 MSC: Physiological Integrity

3. An older adult is diagnosed with Alzheimer’s disease (AD). The nurse knows that this

diagnosis is made on the presence of which of the following? (Select all that apply.) a. A decline from a previous level of functioning b. Fluctuation of symptoms over the course of a 24-hour period c. An insidious onset d. A gradual decline in cognitive abilities e. The cognitive changes worsen in the evening hours ANS: A, C, D

A diagnosis of a neurocognitive disease attributable to AD requires (1) a decline from a previous level of functioning, (2) that the onset was insidious, and (3) that there has been gradual decline in cognitive abilities. Of important note is that the changes are “greater than expected for the person’s age and educational background,” and these changes can be documented with standardized neuropsychological testing. The other options are indicative of delirium.

NURSINGTB.COM REF: p. 303

PTS: 1 DIF: Understand MSC: Physiological Integrity

TOP: Teaching and Learning

SHORT ANSWER 1.

is the result of a lesion in the part of the brain adjacent to the primary auditory cortex (Wernicke area).

ANS:

Fluent aphasia Fluent aphasia is also known as sensory, posterior, or Wernicke aphasia. The person speaks easily with many long runs of words, but the content does not make sense. He or she has problems finding the correct word and often substitutes an incorrect word. The speech sounds are similar to what is sometimes referred to as jabberwocky, with unrelated words strung together or syllables repeated.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment 2. Persons with

minimal number of words.

REF: p. 305 MSC: Physiological Integrity

usually understand others but speak very slowly and use a

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS:

nonfluent aphasia Patients often struggle to articulate a word and seem to have lost the ability to voluntarily control the movements of speech. Difficulties are experienced in communicating orally and in writing.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment 3.

REF: p. 305 MSC: Physiological Integrity

is a motor speech disorder that affects the ability to plan and sequence voluntary muscle movements.

ANS:

Verbal apraxia The muscles of speech are not paralyzed; rather, a disruption occurs in the brain’s transmission of signals to the muscles. When thinking about what to say, the person may be unable to speak at all or may struggle to say any words. In contrast, the person may be able to say many words or sentences correctly when not thinking about the words. Apraxia frequently occurs with aphasia.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 305 MSC: Physiological Integrity

NURSINGTB.COM

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 25: Care of Individuals With Neurocognitive Disorders Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following statements is true about cognitive impairments in older adults? a. Loss or interruption of sleep can lead to delirium. b. Confusion is a normal and unavoidable consequence of aging. c. Older patients who are agitated often have a lower cognitive status than those who

are quietly sitting. d. The Mini-Mental State Exam-2 (MMSE-2) should be administered on admission

to detect delirium.

ANS: D

The MMSE-2 or a similar instrument should be administered to a patient at admission to ascertain the patient’s baseline cognitive status. The loss or interruption of sleep, in of itself, does not often lead to delirium. It can potentiate delirium in the presence of other factors.

Confusion or delirium is not a normal consequence of aging but an indicator of a potentially underlying problem. The hypoactive subtype of delirium can be associated with a worse prognosis than with the hyperactive subtype; it is easily overlooked.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 341 MSC: Psychological Integrity

2. At 10 PM, an old er male resiN d entRatteImpGts t oBc.liC mbM over the bed rails. Which intervention

should the nurse implement f irsUt? S N T a. Talk to the resident about his behavior. b. Call the physician, and ask for a sedative. c. Apply a vest restraint on the resident. d. Get a companion to keep him in the bed.

O

ANS: A

The resident is expressing a need that the nurse can potentially determine with gentle questioning. Pharmacologic intervention can be necessary but should not replace careful evaluation and management of the underlying cause. Simply restraining the patient will not address the underlying problem, and the imposition of restraints can trigger delirium.

Applying a restraint is the last resort, and the nurse must consider the problems that accompany the application of restraints before doing so. Placing a companion in the room can be an effective method of keeping the resident safe if the companion can determine and meet the resident’s needs.

PTS: 1 DIF: Analyze REF: p. 344 TOP: Nursing Process: Implementation MSC: Psychological Integrity 3. A definitive diagnosis of Alzheimer’s disease (AD) can be made by detecting or using which

one of the following methods? a. Clinical observation of dementia b. Inability to speak with relevance c. Development of neurofibrillary tangles

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank d. Computed tomography (CT) scan ANS: C

Confirming the development of neurofibrillary tangles is the only accurate method for diagnosing AD. Patients with AD can be observed for dementia and delirium, but these indicators are nonspecific for the disease. The inability to speak with relevance is a feature of dementia; if other causes of dementia are ruled out, then it may be dementia of the Alzheimer type. A CT scan is the most useful means for diagnosing a stroke.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 344 MSC: Physiological Integrity

4. Which assessment parameter should the nurse use to differentiate between delirium and

depression in an older adult? a. Orientation b. Activity c. Course over the morning hours d. Psychomotor activity ANS: A

Qualities about the patient’s orientation are a good method for the nurse to use for distinguishing between delirium and depression; in delirium, orientation is usually impaired, and in depression, orientation is normal. Activity can vary throughout the day and is not a good indicator. Delirium tends to be worse at night, and depression tends to be worse in the morning. The nurse avoids using qualities about the patient’s psychomotor activities to distinguish between delirium and depression in an older adult; psychomotor activities in both disorders are highly variable and make distinctions difficult.

NURSINGTB.COM REF: p. 338

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

MSC: Psychological Integrity

5. The nurse recognizes which of the following displays may indicate hyperactive delirium? a. Lethargy b. Withdrawn behavior c. Nonpurposeful repetitive movements d. Decreased psychoactive activity ANS: C

Patients with hyperactive delirium often wander and have nonpurposeful repetitive movements. Lethargy and withdrawn behavior are both indicative of hypoactive delirium.

Patients with hyperactive delirium have increased psychoactive activity, not decreased.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 339 MSC: Psychological Integrity

6. Which of the following approaches to hygienic care is beneficial for a patient with dementia? a. Schedule the patient’s full shower at 7 AM, three mornings every week. b. Have a team give the bath with each member washing a different body area. c. Wash the perineal region first to remove potentially infectious material. d. Explain each step as you go and keep the patient covered as much as possible

while bathing.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: D

A person with dementia can interpret undressing for bathing as an assault. It should be performed in a way that minimizes the intrusive and exposing aspects and maintains trust between the person and only one caregiver. From the point of view of the well-being of the patient, bathing is rarely an emergency that it must be performed at a time when the patient is not receptive. Stimulation should be kept simple and focused, and alarming the patient should be avoided. The most sensitive and intimate areas should be washed last, after trust has been established between the patient and the nurse, which may have to be done anew at every encounter. From an infection-control standpoint, washing occurs from clean to dirty areas.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 346 MSC: Psychological Integrity

7. An older client diagnosed with dementia resides with his daughter. When the home care nurse

visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, “I don’t know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him.” How will the nurse respond to the client’s daughter? a. “Let’s think about what you may have done to anger your father.” b. “Let’s try to figure out what your father was trying to say with his behavior.” c. “Scratching is usually a sign of untreated pain. Do you think your father is in pain?” d. “Maybe you should consider having a home health provide your father’s physical care.”

ANS: B

Dementia often interferes with the person’s communication and the ability to understand and N UR I usGnTeed B.C express thoughts and f eelings. T heSfocN s toObe on what the person is attempting to communicate through behavior. Behavioral manifestations are not necessarily signs of anger in persons with dementia. Although behavioral manifestations frequently are seen in persons with untreated pain, this is not always true. The issue here is not necessarily the individual who is providing the care but perhaps the care activity itself. It is appropriate for the daughter to provide care for her father.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 343

TOP: Teaching and Learning

8. An older woman is recovering from a bowel resection in the intensive care unit (ICU) but

remains intubated and on a mechanical ventilator. Which of the following should the nurse implement to help prevent delirium in this woman? a. Assess cognition with the Mini-Mental State Examination, 2nd edition (MMSE-2). b. Provide uninterrupted periods of rest and sleep. c. Maintain adequate sedation and pain management. d. Cover the patient’s eyes with protective ophthalmic ointment.

ANS: B

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Providing uninterrupted periods of rest and sleep is a challenge for the nurse in the ICU. Because of the nature of the patients’ illnesses, nurses administer medications and treatments and perform invasive procedures on a 24-hour basis, leaving patients little time for rest. Many patients become delirious in the ICU because the noise, activity, brightness, and disturbance tend to persist around the clock, which contribute to delirium. Patients lose their sources for maintaining orientation and stability; that is, bright lighting at all times, as well as unfamiliar and abrupt increases in noise, can lead to a disruption in the circadian rhythm. In addition, patients in the ICU are more likely to receive multiple medications, and medications that are potentially harmful can aggravate the patient’s cognitive difficulties. Because this patient is intubated and on mechanical ventilation, the nurse cannot apply the MMSE-2; the patient is unable to perform adequately. Besides, assessing for dementia is not a prophylactic measure.

Sedation and pain management, although often needed in the ICU, can contribute to delirium.

Covering the eyes of a patient in the ICU with ointment can be necessary to prevent corneal damage; however, it is likely to contribute to delirium because the patient will be unable to see clearly.

PTS: 1 DIF: Apply REF: p. 342 TOP: Nursing Process: Implementation MSC: Psychological Integrity 9. Which of the following should the nurse use to assess a nonverbal older adult for delirium? a. Cranial nerves (CNs) XI and XII b. Confusion Assessment Method (CAM) c. MMSE-2 d. Controlled Word Association Test ANS: B

The CAM is a tool for measuring delirium in patients who are intubated or nonverbal.

GTglossal B.CO(CN XII ) CNs provid es clues about the Assessing the accessory (CN N XUI) RaS ndIhNypo patient’s ability to swallow. The nurse uses the Controlled Word Association Test to assess for a neurologic cause of an older adult’s cognitive dysfunction. This tool is an index of frontal lobe functioning and provides an assessment of executive function, including the patient’s frontal lobe functioning and his or her ability to refrain from distraction and perseveration. The MMSE-2 is a valid and reliable tool to assess cognitive function; however, it is unable to pinpoint discrete areas of neurologic dysfunction.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 341 MSC: Psychological Integrity

10. An older woman has a wound infection 5 days after a below-the-knee amputation brought

about by diabetes mellitus. Which of the following is the nurse’s priority intervention to prevent cognitive dysfunction and postoperative complications in this older adult? a. Remove invasive devices as soon as possible. b. Minimize the administration of opioid analgesics. c. Allow for self-care and independent activities. d. Administer short-acting benzodiazepines as needed.

ANS: A

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank To help prevent cognitive dysfunction, postoperative complications, and an increased risk of morbidity and mortality, the nurse recognizes that the risk factors this older adult has for delirium include stressors, infection, and surgery; therefore, to prevent cognitive decline and additional postoperative complications, the nurse promptly removes invasive devices such as intravenous infusions, urinary catheters, and wound drains. Removing these devices not only reduces the risk of infection, thromboembolic events, blood loss, injury, and fluid imbalance, but they also serve to promote mobility, promote a sense of control for the patient, and reduce the types of situations that can frighten the patient or that the patient can misinterpret. Poor pain management can contribute to delirium in older patients. A patient with multiple stressors and risk factors for delirium needs additional nursing care and attention to provide a calming, caring therapeutic environment. The nurse must assess the patient’s functional status before allowing self-care and independent activities. In addition, this older adult is likely to need extensive physical therapy to maintain mobility. Benzodiazepines are a poor pharmacologic choice for older adults for sedation or sleep; they can contribute to delirium, are highly addictive, and can cause rebound insomnia if suddenly withdrawn.

PTS: 1 DIF: Analyze MSC: Physiological Integrity

REF: p. 338

TOP: Nursing Process: Planning

11. When differentiating the characteristics of depression, delirium, and dementia, the nurse

recognized which of the following as an indicator of delirium? a. Sudden onset b. Recent loss c. Insidious d. Life change ANS: A

NURSINGTB.COM

Delirium can occur suddenly. Recent loss or life changes can precipitate depression. Dementia can be insidious and slow and occur over the course of several years.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 338 MSC: Physiological Integrity

12. An older woman with dementia exhibits new behaviors including crying and repeatedly

verbalizing the same phrase; furthermore, the behavior has increased over 2 days. Which intervention should the nurse implement in response to this behavior? a. Tell her you will remember what she says if she stops crying. b. Attribute these findings to a deterioration in cognitive function. c. Check the medication administration record for missed doses. d. Present probing questions to the patient about her behavior.

ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 26: Relationships, Roles, and Transitions Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following statements is not true of older adult relationships? a. After 50 years of marriage, a couple can face new and severe challenges to their

relationship. b. Older adults often hold their families together by arranging get-togethers and

documenting the family’s history and rituals. c. Losing a brother or sister brings an older adult face to face with his or her own death. d. For older adults, friends can never take the place of family.

ANS: D

Friendships can provide the commitment and support that is sometimes lacking in family relationships. Physical and psychosocial changes related to aging, such as declining health, reduced income, and mismatched needs, may cause a severe strain even for a couple who has been together for 50 years or more. A person who holds his or her family together by arranging get-togethers and documenting the family’s history and rituals is known as a kin keeper. The impact of the loss of a brother or sister, not only at the time of the death but also when a younger survivor reaches the age at which the lost sibling died, can be quite disruptive.

GREFB:.pC. 36M3 UenS TOP: Nursing Process: Assessm t N MTSC: Psychosocial Integrity PTS: 1

DIF: UnderR stanI d

2. Which of the following statements is true about the role of grandparents? a. The usefulness of grandparents declined with the advent of the industrial age. b. Today many grandparents are the primary caregivers of their grandchildren. c. The value of grandparents is to provide gifts to younger family members. d. Traditionally, parents are subordinate to the grandparents in caregiving.

ANS: B

Grandparents have always had an important role to play and have become more important than ever in recent decades. An increasing number of parents have been unable to provide necessary care for their children as a result of personal problems; often, grandparents fill the gaps. Grandparents provide continuity, family tradition, and accumulated wisdom. Parents are still expected to be the primary caregivers.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 368 MSC: Psychosocial Integrity

3. Which disease has become known as the “great imitator?” a. Human immunodeficiency virus (HIV) b. Acquired immunodeficiency syndrome (AIDS) c. Alzheimer’s disease (AD) d. Schizophrenia

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: A

The compromised immune system of an older individual makes him or her more susceptible to HIV or AIDS than a younger person. AIDS in older adults has been called the “great imitator”; many of the symptoms, such as fatigue, weakness, weight loss, and anorexia, are common to other disease conditions and may be attributed to normal aging. AD and schizophrenia are not known as the “great imitator.”

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 360 MSC: Psychosocial Integrity

4. Which is the most important element for older adults to have for enhancing the transition into

retirement? a. Good health b. Private pension c. 401k retirement plan d. Preretirement planning ANS: D

Good health is always a desirable state; however, if an older adult in poor health plans for retirement, then the transition to the changes of retirement can be smoother if the planning accounts for health challenges. With preretirement planning, private pensions are not obligatory. With preretirement planning, 401k retirement plans are not obligatory; however, these plans are effective saving plans for retirement; they allow employees to save pretax dollars. Preretirement planning is the most important aspect of a smooth transition into retirement because it affords the individual a chance to prepare for losses associated with retirement such as income, interpersonal communication, health insurance, status, influence, and other issues. Health, social, and f inancial planning help the old er ad ult ad apt to expected or sudden retirement.

N R I G B .C M U S N T O

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 361 MSC: Safe and Effective Care Environment

5. Which one of the following older adults is most likely to need preretirement counseling to

avoid significant concerns in retirement? a. African American woman who is a certified public accountant b. Mexican American woman who receives cash for cleaning services c. Middle-aged man who has a history of type 1 diabetes mellitus d. Older male clerk who works for the Department of Homeland Security ANS: B

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Older adults with the most need for retirement planning are usually the same people who are least likely to receive it. The Mexican American woman will most likely need preretirement counseling to avoid significant problems in retirement. She has three characteristics indicating a need for retirement planning: (1) her sex is female, (2) her job implies a lack of education or training, and (3) she does not pay into Social Security or federal taxes. Thus, she can potentially fail to pay into the federal system for a sufficient length of time to be eligible for Social Security and Medicare benefits in retirement. In addition, her job is unlikely to offer a 401k plan. Although the African American woman is a member of a minority group, she is a professional and likely to earn a significant income in a finance-related business. Her occupation and education places her well to receive significant retirement planning. The middle-aged man has one factor potentially associated with the need for retirement planning—poor health. The older clerk has one factor potentially associated with the need for retirement planning—he is likely to be a low-level employee.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 361 MSC: Safe and Effective Care Environment

6. The community health nurse delivers a program to middle-aged adults about retirement

planning and wants to them to choose the year of their retirement. Which is the most important area on which the participants should focus to ease the transition to retirement? a. Kind of legacy they want to leave behind b. Type of setting for their personal residence c. Location of convenient health care services d. Ability to maintain a stable standard of living ANS: D

The most significant factors contributing to a smooth transition into retirement are health, NUt;RthSere IN GT income, and social involvemen f ore , B.C the nuO rse helps the participants f ocus on f inancial issues to begin retirement planning, thereby establishing the future retiree’s ability to maintain health, income, and social involvement. By choosing a year for retirement, individuals can estimate their retirement income and consult specialists in retirement planning, such as the employee’s human resources department, to determine retirement benefits. Defining the kind of legacy is a secondary factor and less likely to contribute to a smooth transition into retirement. The location of retirement and the location of health care services are also less likely to contribute to a smooth transition into retirement.

PTS: 1 DIF: Analyze REF: p. 361 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 7. Which one of the following older adults has the highest economic risk in retirement at the

beginning of retirement? a. Divorced woman who has lived in this country for 3 years b. Male veteran who had an above-the-knee amputation and was a teacher c. Female widow who is a primary care nurse practitioner d. Man who immigrated from China and designs computer software ANS: A

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank The older divorced woman who has lived in this country for 3 years has three factors associated with economic risk in retirement: (1) female sex, (2) divorced, and (3) immigrant with inadequate time to be eligible for government-sponsored retirement benefits. The older male veteran who had an above-the-knee amputation was a teacher and has one risk factor— disability. The older female widow and primary care nurse practitioner has two risk factors: (1) female gender and (2) widowhood. The older man who emigrated from China anddesigns computer software has one risk factor—immigrant.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 361 MSC: Safe and Effective Care Environment

8. As the wife of a university president, an older woman met exciting people and traveled

extensively until her husband died. Besides losing an intimate partner, the nurse identifies that this woman is most likely to grieve for the loss of which area of her life? a. Self-confidence b. Economic security c. Status in community d. Intellectual stimulation ANS: C

After the loss of her husband, this woman will most likely mourn the loss of her status in the community; no longer is she a wife or the wife of a community leader. After her husband’s death, the opportunities for university-related travel and social occasions will most likely disappear from her life. After extensive travel and sophisticated social stimulation, this woman is likely to be self-confident and to have acquired life skills from her experiences. The president of a university is likely to have planned for retirement and is likely to have left his survivors with an adequate estate. This woman will most likely to be able to provide N R lifIeN Ghough B.CtO intellectual stimulation in her oUwnS , alt T he stimulation f rom the university-related activities will likely decrease.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 362 MSC: Psychosocial Integrity

9. The children of an older woman ask the nurse for advice about helping their mother heal after

her husband’s (their father’s) death. Which strategy should the nurse share with the family? a. Appoint one family member to take her on outings. b. Coordinate family expressions of care and concern. c. Have each child plan a long trip with her assistance. d. Take her to community events to meet other people.

ANS: B

The nurse suggests that the family work together to provide extended expressions of caring and concern for their mother; many small expressions of concern and caring from several sources help bereaved individuals gain the strength and confidence needed to survive a huge loss. Multiple small gestures are more likely to help build strength and confidence than a few large gestures. One person is unlikely to provide enough support for bereaved individuals, and this strategy can potentially imply that only one person is concerned. Helping a widow meet new people can be unsuitable; she may be uninterested or unwilling to attend events for meeting new people. In addition, she may believe that the family is trying to find a replacement for the deceased to ease the family’s burden. However, the family can offer to accompany her to such events.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Apply MSC: Psychosocial Integrity

REF: p. 363

TOP: Nursing Process: Planning

10. Which of the following statements is true about relationships of older adults? a. Loneliness is evidence of self-centeredness and an unwillingness to love. b. A person may be lonely even when surrounded by other people. c. Hostile behavior indicates that a person prefers to be left alone. d. A pet cannot substitute for human attention.

ANS: B

The mere presence of other people, without significant personal exchange, does not prevent or alleviate loneliness. Loneliness is evidence of the capacity to love. Hostile behavior can be a sign of loneliness. Pets can provide comfort, touch, affection, and an opportunity to care for another being.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 362 MSC: Psychosocial Integrity

11. Which of the following questions will best assess the ability of a lesbian, gay, bisexual, or

transgender older couple to successfully adjust to the challenges of aging? a. “How long have you been in this relationship?” b. “Have you experienced prejudice and discrimination in your life?” c. “As a couple are you financially secure?” d. “Do you as a couple share similar religious beliefs?”

ANS: B

Some research has suggestedNthaR t thiI s poGpulB ati.onC mM ay ad apt more successfully to old age as a U S N T result of successful coping over a lifetime with discrimination and prejudice.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 367

TOP: Teaching and Learning

12. Which of the following reactions to the loss of a spouse or long-term partner is a unique

example of older adult male bereavement? a. Withdrawing from friends and family b. Remarrying within months of the loss c. Focusing on “doing” rather than “feeling” d. Experiencing moderate to severe depression ANS: B

Bereaved men may be more socially and emotionally vulnerable. Widowers adapt more slowly than widows to the loss of a spouse and often remarry quickly. The remaining options reflect reactions that are typically seem in both grieving men and women.

PTS: 1 DIF: Apply MSC: Psychological Integrity MULTIPLE RESPONSE

REF: p. 362

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank 1. In a retirement planning program, the community health nurse wants to help participants

avoid disappointment in retirement. The nurse’s program emphasizes which of the following elements that must be adequate to meet postretirement expectations? (Select all that apply.) a. Financial planning b. Company-sponsored benefits c. Company-sponsored health care d. Government-sponsored benefits e. Ability to maintain a personal residence f. Safety and security of a personal residence ANS: A, B, C, D

Overall financial planning is important to provide a stable source of income for retirement if individuals want to fulfill their retirement expectations. Company-sponsored benefits must be sufficient in retirement to avoid large, unplanned expenses. Health care expenses in retirement are more likely to be significant; therefore, retirement health care must be adequate to avoid huge, unexpected expenses. If government-sponsored benefits are inadequate for retirement, then the individual must plan to fill the gaps with preretirement planning. The ability to maintain a residence is not essential to fulfill retirement expectations. Safety and security of the personal residence is also not essential to fulfill retirement expectations.

PTS: 1 DIF: Remember REF: p. 361 MSC: Safe and Effective Care Environment

TOP: Nursing Process: Planning

2. The nurse should suggest which of the following to a spouse of a patient with dementia who

has displayed inappropriate sexual behavior to decrease the occurrence? (Select all that apply.) a. Intimate relations NURSINGTB.COM b. Hug c. Kiss d. Touch ANS: B, C, D

Inappropriate sexual behavior may be triggered by unmet intimacy needs or may be symptoms of an underlying physical problem, such as a urinary tract or vaginal infection. Encouraging family and friends to touch, hug, kiss, and hold hands when visiting may help meet the patient’s touch and intimacy needs and decrease inappropriate sexual behavior.

PTS: 1 DIF: Understand MSC: Psychosocial Integrity

REF: p. 379

TOP: Nursing Process: Planning

3. Which populations are most at risk for developing HIV? (Select all that apply.) a. Those older than the age of 50 years b. Women c. Those who are cognitively impaired d. Those who are sexually active ANS: A, B, D

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Older adults who are sexually active are at risk for HIV, AIDS, and other sexually transmitted diseases. People older than 50 years of age are approximately one sixth as likely to use condoms during sex. Older women who are sexually active are at high risk for HIV, AIDS, and other sexually transmitted infections from an infected partner, resulting, in part, from normal age changes of the vaginal tissue—a thinner, drier, friable vaginal lining that makes viral entry more efficient. Being cognitively impaired does not put one at high risk.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 379 MSC: Physiological Integrity

4. Which statements made by a couple who have recently retired support the nurse’s evaluation

that the transition to retirement has been a successful one? (Select all that apply.) a. “I’m afraid we can’t make it that weekend; we’ll be visiting the grandchildren.” b. “I’m not accustomed to sharing my kitchen with anyone else.” c. “One week I was working 50 hours, and the next I didn’t have to get up until noon.” d. “I often wonder if my buddies from the plant miss me.” e. “We have found a few painless ways to reduce our monthly expenses.”

ANS: A, E

The correct options demonstrate a sense of purpose and adjustment to the realities of retirement and so that the transition has been a successful one. The remaining options suggest that the couple is not adjusting well to having each other around so much and involved in activities they previously used as being theirs alone. Feeling lonely or abandoned is also a sign of ineffective adjustment. A transition into a retirement rather than an abrupt one is also a barrier to a successful adjustment into retirement.

PTS: 1 DIF: ApNpU lyRSINGRT EB F:.pC. O 3 6M2 MSC: Psychological Integrity

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank New behaviors with increasing frequency warrant further investigation by the nurse to ensure that effective nursing care can be planned and implemented. Crying and repeated verbalizations from a patient with dementia can indicate anxiety, but the cognitive disorder makes anxiety difficult to detect. In addition to checking for missed doses, the nurse checks the medication record for medications that are likely to cause anxiety, such as beta-adrenergic agonists, which are used to reverse bronchoconstriction. The nurse should also check for risk factors for anxiety and perform a comprehensive assessment to identify potential causes. The nurse should avoid making a veiled threat to the patient. Giving the patient the incentive to stop crying can be suitable. However, the incentive should never be attention; the duty of the nurse is to pay close attention to the patient. The new behavior can be deteriorating cognitive function, but the nurse must first assess the patient further before making that determination.

One aspect of the assessment is to question the patient. Depending on the stage of dementia, the patient can be an unreliable source of information about herself.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 338

TOP: Nursing Process: Planning

MULTIPLE RESPONSE 1. The nurse working in a long-term care facility completes her morning assessment on a new

postoperative patient and notes a change in cognitive status from the previous day? The nurse recognizes which of the following as a precipitating factor for delirium? (Select all that apply.) a. Major medical treatment b. Poor sleep habits c. Ad mission to long-term care N R I G B.C M d. Pharmacological agents U S N T O ANS: A, C, D

Major medical treatment, admission to long-term care, and pharmacologic agents are all precipitating factors for delirium. Changes in surroundings often precipitate delirium. The development of delirium is a result of complex interactions among multiple causes. Delirium can result from the interaction of predisposing factors—vulnerability on the part of the individual as a result of predisposing conditions, such as cognitive impairment, severe illness, and sensory impairment; delirium can also result from precipitating factors and insults— medications, procedures, restraints, and iatrogenic events. Although a single factor (e.g., infection) can trigger an episode of delirium, several coexisting factors are also likely tobe present. A highly vulnerable older individual requires a lesser amount of precipitating factors to develop delirium. Poor sleep habits is not a contributing factor in of itself.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 339 MSC: Physiological Integrity

2. Which intervention to manage wandering in clients in a long-term care facility should be

implemented? (Select all that apply.) a. Camouflaging doorways b. Close observation to identify the person’s individual patterns c. Engaging the person in social interactions d. Using physical restraints to prevent wandering to maintain safety e. Providing enclosed pathways for walking

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

ANS: A, B, C, E

Restraints are not an effective intervention for wandering. Although they might physically prevent the person from wandering, restraints have many potential negative consequences and patient harm associated with their use. Environmental modifications such as camouflaging doorways and providing enclosed pathways, close observation to identify the person’s individual patterns, and engaging the person in social interactions are all interventions that are effective strategies to manage wandering.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 353

TOP: Teaching and Learning

3. Which information will the nurse manager include when discussing the major differentiation

between delirium and dementia with novice nurses? (Select all that apply.) a. The delirious client learns to make up answers to hide their confusion. b. Delirium requires increased monitoring at night. c. The client diagnosed with dementia generally looks frightened. d. Dementia results in a steady decline in cognitive abilities. e. Delirium is characterized by fluctuations in alertness.

ANS: B, D, E

The correct options accurately describe the conditions of delirium and dementia. The other statements are false; it is the client experiencing dementia who will over the course of the illness learn to confabulate to cover up their memory losses, and the delirious client is more likely to show fear through facial expressions.

PTS: 1 DIF: Apply MSC: Psychological Integrity N R

REF: p. 337

U SINGTB.COM

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 27: Caregiving Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. A widowed grandmother is about to assume the role of custodial parent for her 6-year-old

grandchild. Which intervention has priority when preparing the grandmother for long-term success in this new role? a. Reviewing the developmental milestones of childhood b. Identifying local sources of child counseling services c. Discussing the common challenges of parenting a 6-year-old child d. Teaching stress management and relaxation techniques ANS: D

Grandmothers raising grandchildren reported the most stress, intrafamily strain, and perceived problems in family functioning with the stress increasing over time. The introduction of the skills identified in the correct option will serve to improve and maintain the family’s quality of life. Although the remaining options are appropriate, they lack attention to the long-term, fundamental barrier to a successful transition into this new role.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 389

TOP: Teaching and Learning

2. An older man is being abused by his daughter, a single working mother of four children, with

whom he lives. The nurse investigates and learns that the abuse is due to situational stress.

N nR I hou GTldB.C Which of the f ollowing interveU tioS ns sN the nO urse implement to ad d ress the short-term crisis? a. Immediately remove him from his daughter’s home. b. Encourage the daughter to work with social services. c. Arrange respite care or day care for the patient. d. Place the patient in a long-term care facility.

ANS: C

By relieving the daughter of some responsibilities, respite care is likely to be beneficial for the older adult and his daughter; it can help reduce tension. Unlike children, abused older adults cannot be removed from their situations without their permission. Helping the daughter manage the situational stress would be more effective. Encouraging the daughter to work with social services can help teach her more effective and harmless ways of solving problems, but it does not address the short-term crisis. Placing the patient in a long-term care facility may eventually be necessary, but improving the living situation within the patient’s family would be better.

PTS: 1 DIF: Apply REF: p. 392 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 3. Which of the following statements is true about caregiving? a. Dementia in an older adult can cause grief in the caregiver, comparable with the

grief from the older adult’s death. b. Middle-aged adults and older parents reverse lifelong caregiving roles with

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 27: Caregiving Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. A widowed grandmother is about to assume the role of custodial parent for her 6-year-old

grandchild. Which intervention has priority when preparing the grandmother for long-term success in this new role? a. Reviewing the developmental milestones of childhood b. Identifying local sources of child counseling services c. Discussing the common challenges of parenting a 6-year-old child d. Teaching stress management and relaxation techniques ANS: D

Grandmothers raising grandchildren reported the most stress, intrafamily strain, and perceived problems in family functioning with the stress increasing over time. The introduction of the skills identified in the correct option will serve to improve and maintain the family’s quality of life. Although the remaining options are appropriate, they lack attention to the long-term, fundamental barrier to a successful transition into this new role.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 389

TOP: Teaching and Learning

2. An older man is being abused by his daughter, a single working mother of four children, with

whom he lives. The nurse investigates and learns that the abuse is due to situational stress.

N nR I hou GTldB.C Which of the f ollowing interveU tioS ns sN the nO urse implement to ad d ress the short-term crisis? a. Immediately remove him from his daughter’s home. b. Encourage the daughter to work with social services. c. Arrange respite care or day care for the patient. d. Place the patient in a long-term care facility.

ANS: C

By relieving the daughter of some responsibilities, respite care is likely to be beneficial for the older adult and his daughter; it can help reduce tension. Unlike children, abused older adults cannot be removed from their situations without their permission. Helping the daughter manage the situational stress would be more effective. Encouraging the daughter to work with social services can help teach her more effective and harmless ways of solving problems, but it does not address the short-term crisis. Placing the patient in a long-term care facility may eventually be necessary, but improving the living situation within the patient’s family would be better.

PTS: 1 DIF: Apply REF: p. 392 TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment 3. Which of the following statements is true about caregiving? a. Dementia in an older adult can cause grief in the caregiver, comparable with the

grief from the older adult’s death. b. Middle-aged adults and older parents reverse lifelong caregiving roles with

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank increasing age. c. Older adults should relocate to the caregiver’s home when long distances separate

the two. d. Increasing numbers of adult children who are developmentally disabled become

caregivers for their older parents.

ANS: A

As the dementia progresses, the patient may cease to recognize a spouse or child. The parent still remains the parent, and the idea that the parent somehow becomes a child again is demeaning. The older person may have significant support in the community where he or she lives. Older parents often remain the caregivers for disabled children, which is a serious burden.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 389 MSC: Psychosocial Integrity

4. The home health care nurse observes that an older male patient is confined by his

daughter-in-law to his room. When the nurse suggests that he walk to the living room and join the family, he says, “I’m in everyone’s way; my daughter-in-law needs me to stay here.” The most important action for the nurse to take is to a. suggest appropriate resources to the patient and daughter-in-law, such as respite care and a senior citizens’ center. b. suggest to the patient and daughter-in-law that they consider a nursing home for the patient. c. say nothing because it is best for the nurse to remain neutral and wait to be asked for help. d. say to the d aughter-in-law, “Confining your father-in-law to his room is inhuman.”

N R I G B.C M ANS: A

U S N T

O

Assisting patients and families to become aware of available community support systems is a role and responsibility of the nurse. Suggesting committing the patient to a nursing home is a premature action on the nurse’s part. Observing that the patient has begun to be confined to his room makes it necessary for the nurse to intervene legally and ethically. Telling the daughter-in-law that the confinement is inhuman is both incorrect and judgmental.

PTS: 1 DIF: Apply REF: p. 391 TOP: Safe and Effective Care Environment

MSC: Psychological Integrity

5. Which of the following statements is not true about respite care? a. Respite care allows the caregiver to take a break from caregiving for various

periods of time. b. Respite care may be provided in institutions, in the home, or in other community

settings. c. Respite care services are used frequently in the course of caregiving. d. Respite care services are used very late in the course of caregiving.

ANS: B

Linking caregivers to community resources, such as respite care, adult day programs, and financial support resources, is important. These community services, when available, can alleviate much of the stress of caregiving but are used infrequently or very late in the course of caregiving in the United States (Mast, 2013).

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 391 MSC: Psychological Integrity

6. The home health care nurse suspects that a patient’s spouse is experiencing caregiver burden.

The nurse assesses for this condition by a. referring the family to a social services agency. b. waiting for the caregiver to talk about the stress. c. obtaining feedback from the patient about the caregiver. d. gathering assessment data from the caregiver and the patient.

ANS: D

Although caregiving is a means to “give back” to a loved one and can be a source of joy, it is also stressful. Caregiver burden can occur when a patient is significantly dependent on the caregiver for personal and health care needs. The nurse gathers data from the patient and the caregiver to determine the caregiver’s stressors and coping abilities and withholds making any referrals until the assessment is complete and the plan of care is in place. Because the nurse suspects caregiver burden, the nurse fulfills the duty to the patient and family by approaching the family with the concern, gathering assessment data, and planning care. The nurse does not expect the patient to assess the coping abilities of the caregiver, because assessment is part of the nursing process and should not be delegated.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 387 MSC: Safe and Effective Care Environment

7. While working in the emergency department, the nurse is conducting an interview with a

victim of spousal abuse. Which step should the nurse take first? a. Contact the appropriate leNgU alRseSrI vicNeG s .TB.COM b. Ensure privacy for interviewing the victim away from the abuser. c. Establish a rapport with the victim and the abuser. d. Request the presence of a security guard.

ANS: B

Privacy, away from the abuser, is important. This allows the victim to discuss the problem freely, without fear of reprisal from the abuser (especially if the patient decides to return to the abusive situation). In most states and U.S. jurisdictions, licensed nurses are “mandatory reporters,” that is, persons who are required to report suspicions of abuse to the state, usually to a group called Adult Protective Services (National Adult Protective Services Associations, 2014). The standard for reporting is one of reasonable belief; that is, the nurse must have a reasonable belief that a vulnerable person either has been or is likely to be abused, neglected, or exploited. Although the nurse would want to establish rapport with the victim, her initial concern would not be to establish rapport with the abuser. The situation does not describe the abuser as currently violent or under the influence of substances; therefore, requesting a security presence is inappropriate at this time.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 394 MSC: Safe and Effective Care Environment

8. What makes nursing support of caregivers so important for health care in the United States? a. Family members providing care in the home are the best caregivers. b. Eighty percent of caregiving takes place in the home of older adults.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank c. The health care system reimburses families for caregiving from Medicare. d. Informal caregiving saves the health care system enormous sums of money.

ANS: D

The value of caregiving is estimated at $257 billion; therefore, informal caregiving is a huge savings for the health care system that it might potentially be unable to provide in the event that it was called to do so. Although family members can be the most convenient and are the least expensive, they do not necessarily make the best caregivers. Family members provide 80% of the caregiving for older adults. Caregiving is not an expense for which Medicare reimburses the family.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 386 MSC: Safe and Effective Care Environment

9. An older woman is admitted to the emergency department with a fractured arm. She explains

to the nurse that her injury resulted when she provoked her drunken husband, who then pushed her. Which of the following best describes the nurse’s understanding of the patient’s explanation? a. The patient’s explanation is appropriate acceptance of her responsibility. b. The patient’s explanation is an atypical reaction of an abused woman. c. The patient’s explanation is evidence that the woman may be an abuser as well as a victim. d. The patient’s explanation is a typical response of a victim accepting blame for the abuser.

ANS: D

Self-blame is a common psychological response for a woman who is a victim of abuse. In this situation, the message that viN olU enRceS I ocN cuGrrT edBb.eC caOuM se the woman provoked the abuser is accepted and owned by the victim; however, the victim is not responsible for the violence.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 392 MSC: Safe and Effective Care Environment

10. The nurse is providing an educational session to new staff employees, and the topic is abuse

of the older patient. Which patient is most typically a victim of abuse? a. A 69-year-old man who has newly diagnosed cataracts b. A 90-year-old woman who has advanced Parkinson’s disease c. A 70-year-old woman who has early diagnosed Lyme disease d. A 74-year-old man who has moderate hypertension ANS: B

Elder mistreatment is a complex phenomenon that includes elder abuse and neglect. Elder abuse includes physical, sexual, or psychological abuse; misuse of property; and violation of rights. The typical abuse victim is a woman of advanced age with few social contacts and at least one physical or mental impairment that limits her ability to perform activities of daily living. In addition, the patient usually lives alone or with the abuser and depends on the abuser for care.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 392

TOP: Teaching and Learning

11. Which situation would the nurse identify as placing a client at high risk for caregiver abuse?

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank a. An adult child quits her job to move in and care for a parent with severe dementia. b. An elderly man with severe heart disease resides in a personal care home and is

visited frequently by his adult child. c. An elderly parent with limited mobility lives alone and receives help from several

adult children. d. An elderly woman who cares for her husband who is in early stages of

Alzheimer’s disease and has a network of available support persons.

ANS: A

In this situation, the adult child has given up her usual role as well as moved her place of residence to care for her parent. Caring for someone with severe dementia is very stressful, requiring almost 24-hour vigilance to ensure safety and meet needs. This situation places the caregiver at high risk for stress and abuse.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 392

TOP: Nursing Process: Diagnosis

12. Which nursing intervention best addresses the need for social support demonstrated by an

older adult couple who will be assuming responsibility for the raising of two grandchildren? a. Facilitating a support group for children being raised by grandparents b. Helping the grandparents express their feeling regarding this unexpected role change c. Offering a monthly parenting class for this cohort of grandparents d. Suggesting couple’s therapy to assist in managing any new stress on their marriage ANS: C

Primary care grandparents with a network of social support seem to experience fewer negative consequences, but instrumentNalUsR upSpI orN tsGsuc TBh.asCaOssMistance with child rearing are of ten lacking. Education and training programs and support groups are valuable resources and nurses can be instrumental in developing and conducting these types of interventions.

Although the remaining options are appropriate, they do not focus on the needs that are identified as currently unaddressed.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 389

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. Which nursing assessment findings are specific signs of sexual abuse of an older adult?

(Select all that apply.) a. Bruises or scratches in the genital area b. Torn undergarments or presence of blood c. Unexplained lacerations in various stages of healing d. Fractures inconsistent with functional ability e. Bruises or scratches in the breast area ANS: A, B, E

Bruises or scratches in the genital area, torn undergarments or presence of blood, and bruises or scratches in the breast area are all indications that a female older adult has been the victim of sexual abuse. The remaining options are signs of physical abuse of an older adult, not sexual abuse.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Understand REF: p. 394 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment, Physiological Integrity 2. Which of the following statements are true about caregivers or caregiving? (Select all that

apply.) a. Approximately 75% of all caregivers are male with an average age of 49 years. b. Family caregivers are children, spouses, and other family and friends. c. Caregiving can have serious negative effects on mental and physical health. d. The average duration of a caregiver’s role is 10 years. e. Hispanic (non-white, non–African American) caregivers have the lowest reported prevalence of caregiving. f . Caregiving can present financial burdens. g. Women who are family caregivers are 2.5 times more likely than noncaregivers to live in poverty.

ANS: B, C, F, G

The most common caregiver arrangement is that of a woman providing care to her mother (Messecar, 2012), with approximately 75% of all caregivers being female. Family caregivers include children, spouses, and other family and friends. Caregiving can have serious negative effects with approximately 40% to 70% of caregivers having clinically significant symptoms of depression. The average duration of a caregiver’s role is 4 years. Hispanic (nonwhite, non– African American) caregivers have the highest reported prevalence of caregiving at 21%.

Caregiver prevalence rates among other racial/ethnic groups are Asian-American, 20.3%; African American, 19.7%; and white, 16.9%. Financial burdens are also found with caregiving.

NURSINGTB.COM

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 386 MSC: Psychological Integrity

3. Which information will the nurse include when discussing tips for reducing caregiver stress

with family caregivers? (Select all that apply.) a. Attend to your own needs. b. Set long-term goals. c. Limit tapping your social resources for assistance. d. Use community resources. e. Take time to relax and exercise. f. Educate yourself about the disease or medical condition.

ANS: A, D, E, F

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Caregiver burden is defined as the negative psychological, economic, and physical effects of caring for a person who is impaired. Whereas not all caregivers experience stress and caregiver burden, the circumstances that are more likely to cause problems with caregiving include competing role responsibilities, advanced age of the caregiver, high-intensity caregiving needs, insufficient resources, financial difficulty, poor self-reported health, living in the same household with care recipient, dementia of the care recipient, length of time caregiving, and prior relational conflicts between the caregiver and care recipient. Taking care of oneself, asking for assistance, and education are ways to reduce caregiver stress. Positive benefits of caregiving may include enhanced self-esteem and well-being, personal growth and satisfaction, and finding or making meaning through caregiving (Sorrell, 2014). The caregiver should set realistic goals, not long-term goals. It is encouraged for caregivers to tap their social resources for assistance.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 388

TOP: Teaching and Learning

4. An older woman is preparing to move in with her daughter following the death of her spouse

of 55 years. The daughter asks a nurse: “I know we are doing the right thing for mom, but I am a bit nervous about this. Do you have any suggestions about things that we should do in preparation?” The nurse responds: (Select all that apply.) a. “Have you chosen an area of the house for your mom to live in?” b. “Have you considered scheduling regular visits for your mom with your sister who lives out of state?” c. “You have every right to be nervous; multigenerational households are usually not successful.” d. “Have you investigated what activities are available at the senior center near your NURSINGTB.COM home?” e. “Since your mom is so computer literate she can stay in touch with her friends when she moves.”

ANS: A, B, D, E

There are some important modifications that may need to be made when adding an older person to the household, which include arranging semi-private living quarters if possible, scheduling regular visits to other relatives to give each family time for respite and privacy, and arranging senior activities for the older person to help keep contact with members of his or her own generation. It is important to consider how the older person will feel about giving up familiar surroundings and friends. There is a growing number of intergenerational families.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 391

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 28: Loss, Death, and Palliative Care Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following statements is true about loss in older adulthood? a. A person experiences each stage of grief once, and then grieving is resolved. b. Antianxiety agents are frequently recommended for reducing the pain of grief. c. The loss response model is concerned with the effect of loss on an individual. d. Referring to the deceased in the past tense can acknowledge the death’s reality.

ANS: D

The widow may say, for example, that her husband “just loved to garden” rather than “just loves to garden.” Although the bereaved person passes through the stages according to the Bowlby model, the person may experience the cycle more than once as different aspects of the loss are encountered. Such medications do not reduce the pain of grief; they only deaden it for a time. The loss response model considers the effect of the loss on the family as a system.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 398 MSC: Psychosocial Integrity

2. The health care provider believes an older woman has approximately 6 weeks to live. After 2

months, the family remains at the bedside but, in the past few days, are becoming increasingly impatient and irritable. This pattern is least indicative of which of the following statements? a. Family is experiencing anticipatory grief for the older adult.

NU R bI G ved B.C M b. Family d esires that the pati ent S e rN elieT of hOer misery. c. Anticipatory grieving can fail to attenuate acute grief upon death. d. Grievers deal more easily with known losses at known times.

ANS: B

The family is not impatient because they want her death to take place and want her to be relieved of her misery; they are impatient because of the emotional fluctuations of waiting.

The remaining three statements are true.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 400 MSC: Psychosocial Integrity

3. After an older adult dies, the brother who has a history of alcohol abuse upsets the family by

going on a drinking binge instead of attending the funeral. Which of the following is the best description of the brother’s behavior? a. Personality disorder b. Disrespectful attitude c. Disenfranchised grief d. Chronic grief ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank When a family is in discord, a grieving member can be unable to or consider him- or herself permitted to express grief by socially acceptable means. The brother’s behavior is most likely a grief reaction, although it could be indicative of a personality disorder. The brother can believe that the most respectful thing he can do for the family members is to stay out of their way. The brother has suffered an acute loss.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 401 MSC: Psychosocial Integrity

4. Which of the following interventions is recommended for an older adult in the final stages of

dying? a. Apply an electric blanket to keep the patient warm. b. Lower the head of the bed and turn the head to the side. c. Decrease the number of visitors. d. Support the preservation of energy.

ANS: D

Conserving energy should be a focus in the care of a patient in the final stage of dying.

Completing only the necessary activities of daily living is an example. An electric blanket should not be used; it can increase the patient’s distress by overheating. Elevating the head of the bed and turning the patient’s head to the side is a recommended intervention to help clear uncomfortable respiratory congestion. Nurses should not withhold visitors; the patient needs to have closure, as well as the family.

PTS: 1 DIF: Understand REF: p. 406 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

Man loses weight because he eats very 5. Af ter the loss and burial of a N beUloRvS edIpNeG t, T anBo. ldC eO rm little. Three months later, he starts to paint pictures of the pet, and his appetite slowly improves. Describe this individual’s mourning for his pet. a. Weight loss from inadequate intake b. Pet’s burial and painting pictures of the pet c. Loss of his appetite resulting in weight loss d. Increased food intake after painting begins ANS: B

This older adult mourns and incorporates into his life the loss of his pet by burying the pet and then by memorializing the pet in pictures he creates. Weight loss from inadequate intake: grief is displayed by a decreased appetite that results in weight loss. The older adult’s response is not weight loss; it is anorexia. Loss of his appetite resulting in weight loss: grief is displayed by a decreased appetite that results in weight loss. The transition from the loss through the burial to painting the pictures is how this man mourns his pet; the improved appetite is a result of effective coping and mourning.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 398 MSC: Psychosocial Integrity

6. When an older woman who is close to death asks the family to leave after short visits and acts

withdrawn in their presence, the family becomes distraught. Which of the following does the nurse include in family teaching to explain the patient’s behavior? a. She is preoccupied with her own death.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank b. She must have unresolved family issues. c. She can be experiencing anticipatory grief. d. Her body prepares for death in this manner.

ANS: C

Anticipatory grief occurs before the death and can be experienced by the patient or the potential survivors. When a patient who is dying experiences anticipatory grief, the individual detaches from the environment into a state sometimes described as psychological death. The person is no longer involved in day-to-day activities and enacts a premature death.

Preoccupation with death is acute grief, but because the death has not occurred, preoccupation cannot describe this patient. The patient might have unresolved issues with the family, but this behavior is an unusual way to express it. The body prepares for death through the deterioration of organ system functioning; for example, the kidneys stop producing urine, the patient stops drinking and eating, and the extremities become cold, among other functions.

PTS: 1 DIF: Apply MSC: Psychosocial Integrity

REF: p. 400

TOP: Teaching and Learning

7. The son of an older adult couple ends his life suddenly and violently. The husband proceeds

with living as usual. After 1 year, the wife remains in seclusion and is hospitalized for dehydration. Which steps should the nurse implement to help improve the wife’s mental health and wellness? a. Encourage additional fluids and social activity. b. Instruct the husband to display empathy for her. c. Establish a trusting, caring relationship with her. d. Ask social services for a survivor’s support group.

ANS:

C

NURSINGTB.COM

This couple is at high risk for chronic grief because of the nature of their son’s death. The nurse can help this older woman work toward better mental health by establishing a trusting and caring relationship with her to encourage expressions about her son. Afterward, the nurse can pose probing questions to determine the best plan of care to help this older adult resolve or reframe enough grief to allow improved functioning. Encouraging fluids can be a reasonable nursing intervention for this woman; however, encouraging social activity without a complete assessment and without being in the environment of a trusting relationship is unlikely to help improve functioning. The husband can be displaying disenfranchised grief and be unable to help until his grief is managed. A survivor’s support group can be helpful to survivors of a loved one’s suicide; however, expecting this older adult to attend such a group is unrealistic until the nurse establishes a trusting relationship with her.

PTS: 1 DIF: Apply REF: p. 400 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 8. A patient loses her husband because of a sudden myocardial infarction, and she blames herself

for not recognizing the warning signs. Which patient outcome associated with her loss should the nurse use to plan care? a. Meets her daily responsibilities b. Expresses feelings of guilt, fear, anger, or sadness c. Assesses the causes of the dysfunctional grieving processes d. Identifies problems connected to anticipatory grief

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: B

The nurse plans care that will help this patient resolve her grief and will work to accomplish this by determining a suitable patient outcome—the ability of the patient to express feelings of guilt, fear, anger, or sadness within 3 months. Being able to express herself in this manner is part of the work of grief. Expecting the patient to meet her daily responsibilities is a nursing intervention suitable for dysfunctional grieving. Assessing the causes of the dysfunctional grieving processes is a nursing intervention suitable for the grieving patient. Identifying problems connected to anticipatory grief is a patient outcome suitable for anticipatory grief.

PTS: 1 DIF: Apply MSC: Psychosocial Integrity

REF: p. 402

TOP: Nursing Process: Planning

9. The actions of the family members of an older adult who just died are chaotic, and they are

unable to decide on a funeral home. Which recommendation should the nurse implement? a. Help them make a list of the problems. b. Provide a list of preferred funeral homes. c. Allow them privacy to work it out alone. d. Suggest they call someone who can help.

ANS: D

A characteristic of a good coper is one who has good communication with others; however, immediately after the older adult’s death, this family is ineffectively coping with the loss. To facilitate the family with decision making, the nurse asks one family member to consider calling another person who will likely help the family face the reality of the death. After making the suggestion, the nurse ensures that the family has enough time for holding behaviors, to prepare the body if they wish, and to express their grief in privacy and in their own way. Effective coping includes a focus on the solutions rather than on the problems. The GT nurse avoid s recommend ing N f uU nR eraSl IhoNme s, B.C whichOcould be a potential conf lict of interest.

The family can be unable to solve the problem alone because of ineffective coping in the immediate mourning period.

PTS: 1 DIF: Apply REF: p. 403 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 10. While awaiting the imminent death of her sister, an older woman makes arrangements to bury

her sister in the survivor’s home state because she cannot reach the other family members.

Which step should the nurse implement? a. Ask questions, including questions about the location of her sister’s family. b. Instruct this woman that this is not her decision to make. c. Try to contact the family to inform them of the decision. d. Question her about holding behaviors that she will want.

ANS: A

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank In a countercoping intervention, the nurse assists the older adult to cope with the loss by collecting information and encouraging her to avoid acting on impulse. The older adult can arrive at a hasty decision when not effectively coping with grief; therefore, the nurse acts to help restore some control for the bereaved and helps avoid a decision that she might regret later. The nurse can ask the woman if she believes that this is her decision to make but avoids informing her that it is not. The nurse avoids acting without the sister’s knowledge; the nurse does not have the right to impose personal feelings on the family or on the patient. At a time when the older adult is acting impulsively, it can be reasonable to have her cool off; however, the woman has made a hasty decision and needs help to resolve that issue. In addition, the nurse can be considered insensitive for asking about this issue before the patient is dead.

PTS: 1 DIF: Apply REF: p. 403 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 11. An older patient who has end-stage pulmonary disease decides to accept care from the

palliative care nurse. This older adult will most likely benefit from the palliative care nurse in which patient needs of Weisman’s six needs for the dying? a. Closure b. Control c. Composure d. Cohesiveness ANS: B

The dying patient is most likely to benefit from the care of the palliative care nurse by affording the patient as much control as possible, providing effective nursing care for symptom control, and providing continuity of care as the palliative care team directs total patient care. In providing control, the nurse asks the patient to determine activities and how Nn R Ictly GTbenef B.CitOthe M patient by provid ing a better quality of time is spent. Palliative care caU inS d ireN life at the end of life, but palliative care does not provide for closure. Nurses use countercoping techniques to help the patient maintain composure. Cohesiveness is not one of the six needs of a patient who is dying.

PTS: 1 DIF: Apply MSC: Psychosocial Integrity

REF: p. 405

TOP: Nursing Process: Evaluation

12. Which of the following is a true statement about loss, dying, and death for older adults? a. Men and women tend to respond similarly to the loss of a spouse. b. Visions on the part of a person who has lost a spouse are not normal grief reactions

and should be regarded as signs of underlying defects. c. The grieving process is not rigidly structured. d. Bereaved persons regain their normal capability approximately 6 months after loss,

and regressive behavior after that time should be discouraged.

ANS: C

Men and women do not always respond similarly to the loss of a spouse. The grieving process is not rigidly structured and is not always predictable. Visions, hallucinations, and an inability to communicate in a logical, sustained manner on the part of a person who has lost a spouse are not normal grief reactions and should be regarded as signs of underlying defects; all of these reactions are common in the first several months of bereavement. A bereaved person ordinarily begins to recover personal control and capabilities after approximately 6 months; at first, recovery is sporadic and interspersed with periods of depression.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 398 MSC: Psychosocial Integrity

13. A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to

eat or drink. He is alert and oriented and states that he has no desire to eat, which is causing the family great distress. To best address the client and family, the nurse a. explains the family’s concern to the client. b. educates the family that this is normal behavior in this situation. c. contacts the physician for an order for enteral feeding. d. contacts the dietitian for feeding supplements.

ANS: B

The nurse should educate the family that this is a normal part of the dying process, and the nurse should not pressure the client, contact the physician for enteral feeding, or contact the dietitian for feeding supplements. Because the patient is expressing a desire not to eat, his wishes should be honored. Essential to the facilitation of self-esteem is the premise that the values of the patient must figure significantly in the decisions that will affect the course of dying. Whenever possible, the nurse can have the person decide when to groom, eat, wake, sleep, and so on.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 406

TOP: Teaching and Learning

14. When working with a bereaved individual, the goal of nursing interventions is to a. assist the individual to go through the stages of grief work in the optimal order. b. assist the individual to attain a healthy adjustment to the loss experience. c. encourage the ind ivid ual N t oUtaRlkSaIbN ouGt T hiB s o.rChO erMfeelings about the d eceased

individual. d. offer support and advice about how to successfully achieve grief work.

ANS: B

The goal of nursing interventions when working with bereaved individuals is to help them adjust in a healthy manner. There is no optimal order in which to experience grief. Not all individuals are able to talk about their feelings, nor is it helpful for everyone. The role of nursing is to offer support but not advice.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 402

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. Which of the following characteristics are associated with acute grief? (Select all that apply.) a. Preoccupation with the loss of a loved one b. Waves of grief or distressing emotion c. Prolonged inability to sleep after a loss d. Exacerbations of grief on specific dates e. Change in attitude toward the future loss f. Inability to perform simple self-care tasks ANS: A, B, F

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank In acute grief, the bereaved is preoccupied with the deceased or the loss in a manner similar to daydreaming combined with a sense of unreality. Specific activities, items, people, or other things can trigger an overwhelming pain in acute grief. The bereaved can be incapacitated by acute grief, making simple tasks such as dressing nearly impossible to complete or taking much longer to complete a task. Chronic grief is characterized by prolonged insomnia and an extended period of inhibited activities and suboptimal performance. Chronic grief is characterized by periods of pain exacerbated on specific dates such as anniversaries, birthdays, and holidays, among others. Anticipatory grief is characterized by a change in attitude toward the individual who is about to die when the death does not occur as planned.

PTS: 1 DIF: Knowledge TOP: Nursing Process: Assessment

REF: p. 400 MSC: Psychosocial Integrity

2. Which of the following indicate a person is effectively coping? (Select all that apply.) a. Avoids avoidance b. Confronts realities c. Focuses on solutions d. Redefines problems ANS: B, C, D

People who cope well confront reality and deal with situations. They focus on the solution and redefine the problem. People who cope well avoid avoidance.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 401 MSC: Psychosocial Integrity

3. Those who cope less effectively may exhibit which of the following? (Select all that apply.) a. b. c. d.

Avoids avoidance Confronts reality Is demanding Is rigid

NURSINGTB.COM

ANS: C, D

Those who cope less effectively have few if any of these abilities listed by Weisman. They tend to be more rigid and pessimistic, are demanding, and are given to emotional extremes.

Those who cope well avoid avoidance and confront reality.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 401 MSC: Psychosocial Integrity

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank increasing age. c. Older adults should relocate to the caregiver’s home when long distances separate

the two. d. Increasing numbers of adult children who are developmentally disabled become

caregivers for their older parents.

ANS: A

As the dementia progresses, the patient may cease to recognize a spouse or child. The parent still remains the parent, and the idea that the parent somehow becomes a child again is demeaning. The older person may have significant support in the community where he or she lives. Older parents often remain the caregivers for disabled children, which is a serious burden.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 389 MSC: Psychosocial Integrity

4. The home health care nurse observes that an older male patient is confined by his

daughter-in-law to his room. When the nurse suggests that he walk to the living room and join the family, he says, “I’m in everyone’s way; my daughter-in-law needs me to stay here.” The most important action for the nurse to take is to a. suggest appropriate resources to the patient and daughter-in-law, such as respite care and a senior citizens’ center. b. suggest to the patient and daughter-in-law that they consider a nursing home for the patient. c. say nothing because it is best for the nurse to remain neutral and wait to be asked for help. d. say to the d aughter-in-law, “Confining your father-in-law to his room is inhuman.”

N R I G B.C M ANS: A

U S N T

O

Assisting patients and families to become aware of available community support systems is a role and responsibility of the nurse. Suggesting committing the patient to a nursing home is a premature action on the nurse’s part. Observing that the patient has begun to be confined to his room makes it necessary for the nurse to intervene legally and ethically. Telling the daughter-in-law that the confinement is inhuman is both incorrect and judgmental.

PTS: 1 DIF: Apply REF: p. 391 TOP: Safe and Effective Care Environment

MSC: Psychological Integrity

5. Which of the following statements is not true about respite care? a. Respite care allows the caregiver to take a break from caregiving for various

periods of time. b. Respite care may be provided in institutions, in the home, or in other community

settings. c. Respite care services are used frequently in the course of caregiving. d. Respite care services are used very late in the course of caregiving.

ANS: B

Linking caregivers to community resources, such as respite care, adult day programs, and financial support resources, is important. These community services, when available, can alleviate much of the stress of caregiving but are used infrequently or very late in the course of caregiving in the United States (Mast, 2013).

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 391 MSC: Psychological Integrity

6. The home health care nurse suspects that a patient’s spouse is experiencing caregiver burden.

The nurse assesses for this condition by a. referring the family to a social services agency. b. waiting for the caregiver to talk about the stress. c. obtaining feedback from the patient about the caregiver. d. gathering assessment data from the caregiver and the patient.

ANS: D

Although caregiving is a means to “give back” to a loved one and can be a source of joy, it is also stressful. Caregiver burden can occur when a patient is significantly dependent on the caregiver for personal and health care needs. The nurse gathers data from the patient and the caregiver to determine the caregiver’s stressors and coping abilities and withholds making any referrals until the assessment is complete and the plan of care is in place. Because the nurse suspects caregiver burden, the nurse fulfills the duty to the patient and family by approaching the family with the concern, gathering assessment data, and planning care. The nurse does not expect the patient to assess the coping abilities of the caregiver, because assessment is part of the nursing process and should not be delegated.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 387 MSC: Safe and Effective Care Environment

7. While working in the emergency department, the nurse is conducting an interview with a

victim of spousal abuse. Which step should the nurse take first? a. Contact the appropriate leNgU alRseSrI vicNeG s .TB.COM b. Ensure privacy for interviewing the victim away from the abuser. c. Establish a rapport with the victim and the abuser. d. Request the presence of a security guard.

ANS: B

Privacy, away from the abuser, is important. This allows the victim to discuss the problem freely, without fear of reprisal from the abuser (especially if the patient decides to return to the abusive situation). In most states and U.S. jurisdictions, licensed nurses are “mandatory reporters,” that is, persons who are required to report suspicions of abuse to the state, usually to a group called Adult Protective Services (National Adult Protective Services Associations, 2014). The standard for reporting is one of reasonable belief; that is, the nurse must have a reasonable belief that a vulnerable person either has been or is likely to be abused, neglected, or exploited. Although the nurse would want to establish rapport with the victim, her initial concern would not be to establish rapport with the abuser. The situation does not describe the abuser as currently violent or under the influence of substances; therefore, requesting a security presence is inappropriate at this time.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 394 MSC: Safe and Effective Care Environment

8. What makes nursing support of caregivers so important for health care in the United States? a. Family members providing care in the home are the best caregivers. b. Eighty percent of caregiving takes place in the home of older adults.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank c. The health care system reimburses families for caregiving from Medicare. d. Informal caregiving saves the health care system enormous sums of money.

ANS: D

The value of caregiving is estimated at $257 billion; therefore, informal caregiving is a huge savings for the health care system that it might potentially be unable to provide in the event that it was called to do so. Although family members can be the most convenient and are the least expensive, they do not necessarily make the best caregivers. Family members provide 80% of the caregiving for older adults. Caregiving is not an expense for which Medicare reimburses the family.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 386 MSC: Safe and Effective Care Environment

9. An older woman is admitted to the emergency department with a fractured arm. She explains

to the nurse that her injury resulted when she provoked her drunken husband, who then pushed her. Which of the following best describes the nurse’s understanding of the patient’s explanation? a. The patient’s explanation is appropriate acceptance of her responsibility. b. The patient’s explanation is an atypical reaction of an abused woman. c. The patient’s explanation is evidence that the woman may be an abuser as well as a victim. d. The patient’s explanation is a typical response of a victim accepting blame for the abuser.

ANS: D

Self-blame is a common psychological response for a woman who is a victim of abuse. In this situation, the message that viN olU enRceS I ocN cuGrrT edBb.eC caOuM se the woman provoked the abuser is accepted and owned by the victim; however, the victim is not responsible for the violence.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 392 MSC: Safe and Effective Care Environment

10. The nurse is providing an educational session to new staff employees, and the topic is abuse

of the older patient. Which patient is most typically a victim of abuse? a. A 69-year-old man who has newly diagnosed cataracts b. A 90-year-old woman who has advanced Parkinson’s disease c. A 70-year-old woman who has early diagnosed Lyme disease d. A 74-year-old man who has moderate hypertension ANS: B

Elder mistreatment is a complex phenomenon that includes elder abuse and neglect. Elder abuse includes physical, sexual, or psychological abuse; misuse of property; and violation of rights. The typical abuse victim is a woman of advanced age with few social contacts and at least one physical or mental impairment that limits her ability to perform activities of daily living. In addition, the patient usually lives alone or with the abuser and depends on the abuser for care.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 392

TOP: Teaching and Learning

11. Which situation would the nurse identify as placing a client at high risk for caregiver abuse?

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank a. An adult child quits her job to move in and care for a parent with severe dementia. b. An elderly man with severe heart disease resides in a personal care home and is

visited frequently by his adult child. c. An elderly parent with limited mobility lives alone and receives help from several

adult children. d. An elderly woman who cares for her husband who is in early stages of

Alzheimer’s disease and has a network of available support persons.

ANS: A

In this situation, the adult child has given up her usual role as well as moved her place of residence to care for her parent. Caring for someone with severe dementia is very stressful, requiring almost 24-hour vigilance to ensure safety and meet needs. This situation places the caregiver at high risk for stress and abuse.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 392

TOP: Nursing Process: Diagnosis

12. Which nursing intervention best addresses the need for social support demonstrated by an

older adult couple who will be assuming responsibility for the raising of two grandchildren? a. Facilitating a support group for children being raised by grandparents b. Helping the grandparents express their feeling regarding this unexpected role change c. Offering a monthly parenting class for this cohort of grandparents d. Suggesting couple’s therapy to assist in managing any new stress on their marriage ANS: C

Primary care grandparents with a network of social support seem to experience fewer negative consequences, but instrumentNalUsR upSpI orN tsGsuc TBh.asCaOssMistance with child rearing are of ten lacking. Education and training programs and support groups are valuable resources and nurses can be instrumental in developing and conducting these types of interventions.

Although the remaining options are appropriate, they do not focus on the needs that are identified as currently unaddressed.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 389

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. Which nursing assessment findings are specific signs of sexual abuse of an older adult?

(Select all that apply.) a. Bruises or scratches in the genital area b. Torn undergarments or presence of blood c. Unexplained lacerations in various stages of healing d. Fractures inconsistent with functional ability e. Bruises or scratches in the breast area ANS: A, B, E

Bruises or scratches in the genital area, torn undergarments or presence of blood, and bruises or scratches in the breast area are all indications that a female older adult has been the victim of sexual abuse. The remaining options are signs of physical abuse of an older adult, not sexual abuse.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Understand REF: p. 394 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment, Physiological Integrity 2. Which of the following statements are true about caregivers or caregiving? (Select all that

apply.) a. Approximately 75% of all caregivers are male with an average age of 49 years. b. Family caregivers are children, spouses, and other family and friends. c. Caregiving can have serious negative effects on mental and physical health. d. The average duration of a caregiver’s role is 10 years. e. Hispanic (non-white, non–African American) caregivers have the lowest reported prevalence of caregiving. f . Caregiving can present financial burdens. g. Women who are family caregivers are 2.5 times more likely than noncaregivers to live in poverty.

ANS: B, C, F, G

The most common caregiver arrangement is that of a woman providing care to her mother (Messecar, 2012), with approximately 75% of all caregivers being female. Family caregivers include children, spouses, and other family and friends. Caregiving can have serious negative effects with approximately 40% to 70% of caregivers having clinically significant symptoms of depression. The average duration of a caregiver’s role is 4 years. Hispanic (nonwhite, non– African American) caregivers have the highest reported prevalence of caregiving at 21%.

Caregiver prevalence rates among other racial/ethnic groups are Asian-American, 20.3%; African American, 19.7%; and white, 16.9%. Financial burdens are also found with caregiving.

NURSINGTB.COM

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 386 MSC: Psychological Integrity

3. Which information will the nurse include when discussing tips for reducing caregiver stress

with family caregivers? (Select all that apply.) a. Attend to your own needs. b. Set long-term goals. c. Limit tapping your social resources for assistance. d. Use community resources. e. Take time to relax and exercise. f. Educate yourself about the disease or medical condition.

ANS: A, D, E, F

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank Caregiver burden is defined as the negative psychological, economic, and physical effects of caring for a person who is impaired. Whereas not all caregivers experience stress and caregiver burden, the circumstances that are more likely to cause problems with caregiving include competing role responsibilities, advanced age of the caregiver, high-intensity caregiving needs, insufficient resources, financial difficulty, poor self-reported health, living in the same household with care recipient, dementia of the care recipient, length of time caregiving, and prior relational conflicts between the caregiver and care recipient. Taking care of oneself, asking for assistance, and education are ways to reduce caregiver stress. Positive benefits of caregiving may include enhanced self-esteem and well-being, personal growth and satisfaction, and finding or making meaning through caregiving (Sorrell, 2014). The caregiver should set realistic goals, not long-term goals. It is encouraged for caregivers to tap their social resources for assistance.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 388

TOP: Teaching and Learning

4. An older woman is preparing to move in with her daughter following the death of her spouse

of 55 years. The daughter asks a nurse: “I know we are doing the right thing for mom, but I am a bit nervous about this. Do you have any suggestions about things that we should do in preparation?” The nurse responds: (Select all that apply.) a. “Have you chosen an area of the house for your mom to live in?” b. “Have you considered scheduling regular visits for your mom with your sister who lives out of state?” c. “You have every right to be nervous; multigenerational households are usually not successful.” d. “Have you investigated what activities are available at the senior center near your NURSINGTB.COM home?” e. “Since your mom is so computer literate she can stay in touch with her friends when she moves.”

ANS: A, B, D, E

There are some important modifications that may need to be made when adding an older person to the household, which include arranging semi-private living quarters if possible, scheduling regular visits to other relatives to give each family time for respite and privacy, and arranging senior activities for the older person to help keep contact with members of his or her own generation. It is important to consider how the older person will feel about giving up familiar surroundings and friends. There is a growing number of intergenerational families.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 391

TOP: Teaching and Learning

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

Chapter 28: Loss, Death, and Palliative Care Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition MULTIPLE CHOICE 1. Which of the following statements is true about loss in older adulthood? a. A person experiences each stage of grief once, and then grieving is resolved. b. Antianxiety agents are frequently recommended for reducing the pain of grief. c. The loss response model is concerned with the effect of loss on an individual. d. Referring to the deceased in the past tense can acknowledge the death’s reality.

ANS: D

The widow may say, for example, that her husband “just loved to garden” rather than “just loves to garden.” Although the bereaved person passes through the stages according to the Bowlby model, the person may experience the cycle more than once as different aspects of the loss are encountered. Such medications do not reduce the pain of grief; they only deaden it for a time. The loss response model considers the effect of the loss on the family as a system.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 398 MSC: Psychosocial Integrity

2. The health care provider believes an older woman has approximately 6 weeks to live. After 2

months, the family remains at the bedside but, in the past few days, are becoming increasingly impatient and irritable. This pattern is least indicative of which of the following statements? a. Family is experiencing anticipatory grief for the older adult.

NU R bI G ved B.C M b. Family d esires that the pati ent S e rN elieT of hOer misery. c. Anticipatory grieving can fail to attenuate acute grief upon death. d. Grievers deal more easily with known losses at known times.

ANS: B

The family is not impatient because they want her death to take place and want her to be relieved of her misery; they are impatient because of the emotional fluctuations of waiting.

The remaining three statements are true.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 400 MSC: Psychosocial Integrity

3. After an older adult dies, the brother who has a history of alcohol abuse upsets the family by

going on a drinking binge instead of attending the funeral. Which of the following is the best description of the brother’s behavior? a. Personality disorder b. Disrespectful attitude c. Disenfranchised grief d. Chronic grief ANS: C

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank When a family is in discord, a grieving member can be unable to or consider him- or herself permitted to express grief by socially acceptable means. The brother’s behavior is most likely a grief reaction, although it could be indicative of a personality disorder. The brother can believe that the most respectful thing he can do for the family members is to stay out of their way. The brother has suffered an acute loss.

PTS: 1 DIF: Apply TOP: Nursing Process: Assessment

REF: p. 401 MSC: Psychosocial Integrity

4. Which of the following interventions is recommended for an older adult in the final stages of

dying? a. Apply an electric blanket to keep the patient warm. b. Lower the head of the bed and turn the head to the side. c. Decrease the number of visitors. d. Support the preservation of energy.

ANS: D

Conserving energy should be a focus in the care of a patient in the final stage of dying.

Completing only the necessary activities of daily living is an example. An electric blanket should not be used; it can increase the patient’s distress by overheating. Elevating the head of the bed and turning the patient’s head to the side is a recommended intervention to help clear uncomfortable respiratory congestion. Nurses should not withhold visitors; the patient needs to have closure, as well as the family.

PTS: 1 DIF: Understand REF: p. 406 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

Man loses weight because he eats very 5. Af ter the loss and burial of a N beUloRvS edIpNeG t, T anBo. ldC eO rm little. Three months later, he starts to paint pictures of the pet, and his appetite slowly improves. Describe this individual’s mourning for his pet. a. Weight loss from inadequate intake b. Pet’s burial and painting pictures of the pet c. Loss of his appetite resulting in weight loss d. Increased food intake after painting begins ANS: B

This older adult mourns and incorporates into his life the loss of his pet by burying the pet and then by memorializing the pet in pictures he creates. Weight loss from inadequate intake: grief is displayed by a decreased appetite that results in weight loss. The older adult’s response is not weight loss; it is anorexia. Loss of his appetite resulting in weight loss: grief is displayed by a decreased appetite that results in weight loss. The transition from the loss through the burial to painting the pictures is how this man mourns his pet; the improved appetite is a result of effective coping and mourning.

PTS: 1 DIF: Understand TOP: Nursing Process: Assessment

REF: p. 398 MSC: Psychosocial Integrity

6. When an older woman who is close to death asks the family to leave after short visits and acts

withdrawn in their presence, the family becomes distraught. Which of the following does the nurse include in family teaching to explain the patient’s behavior? a. She is preoccupied with her own death.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank b. She must have unresolved family issues. c. She can be experiencing anticipatory grief. d. Her body prepares for death in this manner.

ANS: C

Anticipatory grief occurs before the death and can be experienced by the patient or the potential survivors. When a patient who is dying experiences anticipatory grief, the individual detaches from the environment into a state sometimes described as psychological death. The person is no longer involved in day-to-day activities and enacts a premature death.

Preoccupation with death is acute grief, but because the death has not occurred, preoccupation cannot describe this patient. The patient might have unresolved issues with the family, but this behavior is an unusual way to express it. The body prepares for death through the deterioration of organ system functioning; for example, the kidneys stop producing urine, the patient stops drinking and eating, and the extremities become cold, among other functions.

PTS: 1 DIF: Apply MSC: Psychosocial Integrity

REF: p. 400

TOP: Teaching and Learning

7. The son of an older adult couple ends his life suddenly and violently. The husband proceeds

with living as usual. After 1 year, the wife remains in seclusion and is hospitalized for dehydration. Which steps should the nurse implement to help improve the wife’s mental health and wellness? a. Encourage additional fluids and social activity. b. Instruct the husband to display empathy for her. c. Establish a trusting, caring relationship with her. d. Ask social services for a survivor’s support group.

ANS:

C

NURSINGTB.COM

This couple is at high risk for chronic grief because of the nature of their son’s death. The nurse can help this older woman work toward better mental health by establishing a trusting and caring relationship with her to encourage expressions about her son. Afterward, the nurse can pose probing questions to determine the best plan of care to help this older adult resolve or reframe enough grief to allow improved functioning. Encouraging fluids can be a reasonable nursing intervention for this woman; however, encouraging social activity without a complete assessment and without being in the environment of a trusting relationship is unlikely to help improve functioning. The husband can be displaying disenfranchised grief and be unable to help until his grief is managed. A survivor’s support group can be helpful to survivors of a loved one’s suicide; however, expecting this older adult to attend such a group is unrealistic until the nurse establishes a trusting relationship with her.

PTS: 1 DIF: Apply REF: p. 400 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 8. A patient loses her husband because of a sudden myocardial infarction, and she blames herself

for not recognizing the warning signs. Which patient outcome associated with her loss should the nurse use to plan care? a. Meets her daily responsibilities b. Expresses feelings of guilt, fear, anger, or sadness c. Assesses the causes of the dysfunctional grieving processes d. Identifies problems connected to anticipatory grief

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank ANS: B

The nurse plans care that will help this patient resolve her grief and will work to accomplish this by determining a suitable patient outcome—the ability of the patient to express feelings of guilt, fear, anger, or sadness within 3 months. Being able to express herself in this manner is part of the work of grief. Expecting the patient to meet her daily responsibilities is a nursing intervention suitable for dysfunctional grieving. Assessing the causes of the dysfunctional grieving processes is a nursing intervention suitable for the grieving patient. Identifying problems connected to anticipatory grief is a patient outcome suitable for anticipatory grief.

PTS: 1 DIF: Apply MSC: Psychosocial Integrity

REF: p. 402

TOP: Nursing Process: Planning

9. The actions of the family members of an older adult who just died are chaotic, and they are

unable to decide on a funeral home. Which recommendation should the nurse implement? a. Help them make a list of the problems. b. Provide a list of preferred funeral homes. c. Allow them privacy to work it out alone. d. Suggest they call someone who can help.

ANS: D

A characteristic of a good coper is one who has good communication with others; however, immediately after the older adult’s death, this family is ineffectively coping with the loss. To facilitate the family with decision making, the nurse asks one family member to consider calling another person who will likely help the family face the reality of the death. After making the suggestion, the nurse ensures that the family has enough time for holding behaviors, to prepare the body if they wish, and to express their grief in privacy and in their own way. Effective coping includes a focus on the solutions rather than on the problems. The GT nurse avoid s recommend ing N f uU nR eraSl IhoNme s, B.C whichOcould be a potential conf lict of interest.

The family can be unable to solve the problem alone because of ineffective coping in the immediate mourning period.

PTS: 1 DIF: Apply REF: p. 403 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 10. While awaiting the imminent death of her sister, an older woman makes arrangements to bury

her sister in the survivor’s home state because she cannot reach the other family members.

Which step should the nurse implement? a. Ask questions, including questions about the location of her sister’s family. b. Instruct this woman that this is not her decision to make. c. Try to contact the family to inform them of the decision. d. Question her about holding behaviors that she will want.

ANS: A

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank In a countercoping intervention, the nurse assists the older adult to cope with the loss by collecting information and encouraging her to avoid acting on impulse. The older adult can arrive at a hasty decision when not effectively coping with grief; therefore, the nurse acts to help restore some control for the bereaved and helps avoid a decision that she might regret later. The nurse can ask the woman if she believes that this is her decision to make but avoids informing her that it is not. The nurse avoids acting without the sister’s knowledge; the nurse does not have the right to impose personal feelings on the family or on the patient. At a time when the older adult is acting impulsively, it can be reasonable to have her cool off; however, the woman has made a hasty decision and needs help to resolve that issue. In addition, the nurse can be considered insensitive for asking about this issue before the patient is dead.

PTS: 1 DIF: Apply REF: p. 403 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 11. An older patient who has end-stage pulmonary disease decides to accept care from the

palliative care nurse. This older adult will most likely benefit from the palliative care nurse in which patient needs of Weisman’s six needs for the dying? a. Closure b. Control c. Composure d. Cohesiveness ANS: B

The dying patient is most likely to benefit from the care of the palliative care nurse by affording the patient as much control as possible, providing effective nursing care for symptom control, and providing continuity of care as the palliative care team directs total patient care. In providing control, the nurse asks the patient to determine activities and how Nn R Ictly GTbenef B.CitOthe M patient by provid ing a better quality of time is spent. Palliative care caU inS d ireN life at the end of life, but palliative care does not provide for closure. Nurses use countercoping techniques to help the patient maintain composure. Cohesiveness is not one of the six needs of a patient who is dying.

PTS: 1 DIF: Apply MSC: Psychosocial Integrity

REF: p. 405

TOP: Nursing Process: Evaluation

12. Which of the following is a true statement about loss, dying, and death for older adults? a. Men and women tend to respond similarly to the loss of a spouse. b. Visions on the part of a person who has lost a spouse are not normal grief reactions

and should be regarded as signs of underlying defects. c. The grieving process is not rigidly structured. d. Bereaved persons regain their normal capability approximately 6 months after loss,

and regressive behavior after that time should be discouraged.

ANS: C

Men and women do not always respond similarly to the loss of a spouse. The grieving process is not rigidly structured and is not always predictable. Visions, hallucinations, and an inability to communicate in a logical, sustained manner on the part of a person who has lost a spouse are not normal grief reactions and should be regarded as signs of underlying defects; all of these reactions are common in the first several months of bereavement. A bereaved person ordinarily begins to recover personal control and capabilities after approximately 6 months; at first, recovery is sporadic and interspersed with periods of depression.

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 398 MSC: Psychosocial Integrity

13. A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to

eat or drink. He is alert and oriented and states that he has no desire to eat, which is causing the family great distress. To best address the client and family, the nurse a. explains the family’s concern to the client. b. educates the family that this is normal behavior in this situation. c. contacts the physician for an order for enteral feeding. d. contacts the dietitian for feeding supplements.

ANS: B

The nurse should educate the family that this is a normal part of the dying process, and the nurse should not pressure the client, contact the physician for enteral feeding, or contact the dietitian for feeding supplements. Because the patient is expressing a desire not to eat, his wishes should be honored. Essential to the facilitation of self-esteem is the premise that the values of the patient must figure significantly in the decisions that will affect the course of dying. Whenever possible, the nurse can have the person decide when to groom, eat, wake, sleep, and so on.

PTS: 1 DIF: Apply MSC: Psychological Integrity

REF: p. 406

TOP: Teaching and Learning

14. When working with a bereaved individual, the goal of nursing interventions is to a. assist the individual to go through the stages of grief work in the optimal order. b. assist the individual to attain a healthy adjustment to the loss experience. c. encourage the ind ivid ual N t oUtaRlkSaIbN ouGt T hiB s o.rChO erMfeelings about the d eceased

individual. d. offer support and advice about how to successfully achieve grief work.

ANS: B

The goal of nursing interventions when working with bereaved individuals is to help them adjust in a healthy manner. There is no optimal order in which to experience grief. Not all individuals are able to talk about their feelings, nor is it helpful for everyone. The role of nursing is to offer support but not advice.

PTS: 1 DIF: Understand MSC: Psychological Integrity

REF: p. 402

TOP: Teaching and Learning

MULTIPLE RESPONSE 1. Which of the following characteristics are associated with acute grief? (Select all that apply.) a. Preoccupation with the loss of a loved one b. Waves of grief or distressing emotion c. Prolonged inability to sleep after a loss d. Exacerbations of grief on specific dates e. Change in attitude toward the future loss f. Inability to perform simple self-care tasks ANS: A, B, F

Ebersole and Hess' Gerontological Nursing and Healthy Aging 6th Edition Touhy Test Bank In acute grief, the bereaved is preoccupied with the deceased or the loss in a manner similar to daydreaming combined with a sense of unreality. Specific activities, items, people, or other things can trigger an overwhelming pain in acute grief. The bereaved can be incapacitated by acute grief, making simple tasks such as dressing nearly impossible to complete or taking much longer to complete a task. Chronic grief is characterized by prolonged insomnia and an extended period of inhibited activities and suboptimal performance. Chronic grief is characterized by periods of pain exacerbated on specific dates such as anniversaries, birthdays, and holidays, among others. Anticipatory grief is characterized by a change in attitude toward the individual who is about to die when the death does not occur as planned.

PTS: 1 DIF: Knowledge TOP: Nursing Process: Assessment

REF: p. 400 MSC: Psychosocial Integrity

2. Which of the following indicate a person is effectively coping? (Select all that apply.) a. Avoids avoidance b. Confronts realities c. Focuses on solutions d. Redefines problems ANS: B, C, D

People who cope well confront reality and deal with situations. They focus on the solution and redefine the problem. People who cope well avoid avoidance.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 401 MSC: Psychosocial Integrity

3. Those who cope less effectively may exhibit which of the following? (Select all that apply.) a. b. c. d.

Avoids avoidance Confronts reality Is demanding Is rigid

NURSINGTB.COM

ANS: C, D

Those who cope less effectively have few if any of these abilities listed by Weisman. They tend to be more rigid and pessimistic, are demanding, and are given to emotional extremes.

Those who cope well avoid avoidance and confront reality.

PTS: 1 DIF: Remember TOP: Nursing Process: Assessment

REF: p. 401 MSC: Psychosocial Integrity