TEST BANK for Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition by The by StudyGuide

Chapter 01: Introduction to Healthy Aging Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition

MULTIPLE CHOICE 1. A man is terminally ill with end-stage prostate cancer. What is the best statement about

this man’s wellness? a. Wellness is possible, even if the patient uses medication to assist in management of his medical care. b. Wellness is unfortunately not a real option for the patient. c. Wellness is the same thing as faith healing, and if the patient were more receptive, he could be back at work in a few weeks. d. Nursing interventions can help empower a patient to achieve a higher level of wellness. ANS: D Feedback A B C D

Incorrect. An individual must work hard to achieve wellness, just as in a job. Incorrect. All persons, regardless of age or life–health situation, can be helped to achieve a higher level of wellness. Incorrect. Biomedical approaches and other treatments and techniques are used to achieve realistic improvements in wellness. Correct. A nurse can foster wellness at all levels of the needs hierarchy.

DIF: Application REF: 8 OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 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 behaviours. b. The concept of wellness was rarely or never considered by previous generations. c. Wellness and self-actualization develop through learning and compromise. d. It is impossible to have wellness when one’s health is compromised. ANS: A Feedback A B C D

Correct. Holistically, health includes wellness, which involves one’s whole being. Incorrect. Throughout history, basic self-care requirements have been recognized. Incorrect. As basic needs are met, higher level needs can be satisfied in turn, with ever-deepening richness to life. Incorrect. Even with chronic illness, with multiple disabilities, or in dying, movement toward higher wellness is possible.

DIF: Comprehension

REF: 4

OBJ: 2

TOP: NCLEX: Health Promotion and Maintenance 3. Which province or territory is predicted to have the fastest growing older-person

population in Canada between the years 2006 and 2031? a. Ontario b. British Columbia c. Yukon d. Newfoundland ANS: C Feedback A

Incorrect. As shown in Figure 1-1 in your text, the older-person population of Ontario does not rise as rapidly as the older-person population of Yukon between 2006 and 2031. Incorrect. As shown in Figure 1-1 in your text, the older-person population of British Columbia does not rise as rapidly as the older-person population of Yukon between 2006 and 2031. Correct. As shown in Figure 1-1 in your text, the older-person population of Yukon rises faster than any of the other provinces and territories between 2006 and 2031. Incorrect. As shown in Figure 1-1 in your text, the older-person population of Newfoundland does not rise as rapidly as the older-person population of Yukon between 2006 and 2031.

DIF: Knowledge REF: 3 (Figure 1-1) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 3

4. Historical influences that have shaped the lives of the majority of the middle-old in

Canada today include which of the following? a. Influenza epidemic of 1918 b. Immigration from Communist Europe c. Child-rearing during the Depression d. World War II ANS: D Feedback A B C D

Incorrect. A person who survived the influenza epidemic would be at least 93 years old in 2011 and therefore be considered old-old, or centenarian. Incorrect. Those who are middle-old in 2011 were born between 1920 and 1930, before Communism swept Europe. Incorrect. Most of those who are middle-old in 2011 had not reached childbearing age by the end of the Depression. Correct. Those who are middle-old in 2011 were in their teens and twenties during the war; in particular, the men were very likely to have fought in it.

DIF: Comprehension REF: 2 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 3

5. A nurse prepares for the arrival of older persons evacuated from a forest fire in northern

Manitoba to a shelter for short-term care. Which of the following is the priority nursing intervention? a. Demonstrate that the staff is prepared to meet their needs. b. Use individual medical records to develop a medication plan. c. Help older persons to display family photos and memorabilia. d. Help older persons to teach one another a new skill in the shelter. ANS: B Feedback A

Incorrect. Providing safety and security from the fire is evident and implied, as the older persons have been evacuated from danger. The priority nursing intervention is caring for any health concerns; e.g., medication or treatments that were left behind. Correct. The nurse prepares for short-term care by prioritizing the needs of the older persons, and this intervention helps to maintain the therapeutic plan, thereby addressing the need for physiological integrity. Furthermore, the nurse maintains continuity of care by preparing a medication schedule to prevent missed doses of medication. Incorrect. In emergency conditions, the nurse provides basic care relating to safety, security, and physical well-being. Maintaining a sense of belonging is important, but not in emergency conditions. Incorrect. A state of emergency is not the time to develop self-esteem because meeting safety, security, and physical needs is more important.

DIF: Analysis REF: 6-7 OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment 6. According to researchers, which characteristic will most centenarians share in the future? a. Being female b. Having dementia c. Being malnourished d. Being wheelchair-bound ANS: A Feedback A B C D

Correct. Researchers expect women to comprise the majority of centenarians in the future. Incorrect. Gerontologists expect dementia to be common among older persons, but they are not predicting most centenarians will have dementia. Incorrect. Malnutrition is common among older persons, but researchers have not predicted that most centenarians will be malnourished. Incorrect. Decreased mobility is common among older persons, but researchers have not predicted that most centenarians will be confined to a wheelchair.

DIF: Knowledge REF: 2 OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 7. Which statement describes aging in developing countries?

a. Many developing countries have historically had many members live to be

centenarians. b. The biggest problem for older persons will be lack of food. c. Most of the world’s older persons are likely to reside in developing countries. d. Like fertility, life expectancy is increasing, although at a different rate. ANS: C Feedback A B C D

Incorrect. Historically only 2% of the world’s population was defined as old. Incorrect. The biggest problem of the world’s oldest persons is most likely to be lack of regular income. Correct. Developing countries contain 62% of the world’s older persons already. Incorrect. Life expectancy is increasing, but fertility is decreasing worldwide.

DIF: Knowledge REF: 4 OBJ: 3 TOP: NCLEX: Health Promotion and Wellness 8. The nurse develops a community program to promote exercise for older persons. Which of

the following should the nurse include in the exercise program? a. Reinforce the ease of exercising every day. b. Use exercise to relax any dietary restrictions. c. Describe ways to resume exercise after lapses. d. Teach participants that exercise achieves wellness. ANS: C Feedback A

Incorrect. The nurse tells the participants that achieving wellness takes work and regular effort. Instead of offering false hope, the nurse shares practical advice about how to incorporate exercise into everyday life. Incorrect. The nurse avoids suggesting that older persons can look forward to relaxing dietary or medical restrictions by using a single method because it is unethical to offer false hope, the plan can be ineffective, and the plan can have adverse effects. Correct. Because the path to wellness includes progression as well as regression, the nurse shares information to help participants anticipate these events. The nurse encourages participants by telling them to expect periods of regression, that progress made up to that point is not lost, and how to approach resumption in progress toward wellness with exercise. Incorrect. The nurse avoids instructing older persons to rely on one method of achieving wellness because wellness is achieved by balancing emotional, spiritual, social, cultural, and physical processes.

DIF: Application REF: 7 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 9. Determinants of health are the underlying causes of illness and wellness. Which of the

following describes the older person who is likely to experience the best overall health and well-being? a. Resides in assisted-living facility, watches television alone, uses herbal remedies,

is underweight b. Resides alone, was moved to a new city recently by the family for their convenience, has osteoarthritis c. Has prostate cancer with metastasis to the lungs, is receiving radiation therapy, is wealthy, has a large family d. Uses a wheelchair, has peripheral arterial disease, attends weekly baseball games with three friends ANS: D Feedback A

Incorrect. This older person is not thriving in an assisted-living facility, despite having other people in the facility, as evidenced by television viewing habits and weight, both potential indicators of depression. Various aspects of this person’s life are unbalanced, thus inhibiting progress on the path to optimal health and wellness. In addition, the use of herbal remedies can be aggravating or precipitating the problems. Incorrect. After a move to a new region, an older person, especially one who lives alone and is moved to a new area for the family’s convenience, is likely to experience loneliness and isolation until a new social network is established. Thus, although this person has a less-acute health problem, the social isolation is likely to create significant disruption on the path to health and wellness. Incorrect. Although this older person’s financial resources are plentiful, the existence of a large family does not ensure any type of psychosocial support. Most likely, this person faces a grim prognosis because the prostate cancer has crossed the diaphragm, thus reducing the likelihood of a prolonged life. Correct. Despite a serious chronic illness and mobility restrictions, this person has a social network and planned activities with friends. Further, this older person overcomes mobility issues to pursue personal interests; thus, this person is most likely to experience the best health and well-being because of an optimal functional status.

DIF: Analysis REF: 6 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 10. Which of the following nursing interventions represent a holistic approach to caring for an

older person? a. Performs glucose testing during the weekly worship service b. Wheels ambulatory adults to exercise when running late c. Assigns female nurses to older female persons who are Muslim d. Allows older persons in a nursing home to eat meals alone ANS: C Feedback A

Incorrect. Interrupting an older person’s worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older person’s life by testing for glucose before the service begins. Incorrect. In transporting the older persons to the exercise program in a

wheelchair to save time, the nurse disregards the need for self-esteem and exercise, important aspects of physical well-being. Ambulatory older persons can walk, with assistance if needed, to exercise programs and benefit from the additional activity and independence. Correct. The nurse uses a holistic approach to the care of an older female person who is Muslim because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture. Incorrect. The nurse can be tempted to allow an older person to eat meals alone in his or her room if this will motivate the person to eat or if the older person has dysphagia and is embarrassed. However, while focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being.

DIF: Comprehension REF: 4 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 4

11. An older-person male who resides in a nursing home has very high cholesterol levels.

Which nursing intervention is most likely to assist this man in achieving his highest level of wellness? a. Instruct him about increasing dietary fibre. b. Ask the health care provider for a low-fat diet. c. Schedule a consultation for him with the dietitian. d. Review a menu with him to choose suitable foods. ANS: D Feedback A

Incorrect. Informing the older person about dietary fibre offers no control to the older person because he is not part of the decision. Nursing interventions developed with the older person’s collaboration are most likely to help him achieve health and wellness. Incorrect. Collaborating with the health care provider for a low-fat diet is a reasonable approach to help this man with dyslipidemia achieve health and wellness. However, the older person is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has some control. Incorrect. This is a reasonable approach for an older person with dyslipidemia and is a part of a multifaceted approach to optimizing his health. However, he is more likely to engage in a regimen over which he has input. Correct. The nurse collaborates with the older person to choose suitable foods. This is likely to be an effective nursing intervention to help an older person with dyslipidemia achieve optimal health and well-being because it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol.

DIF: Analysis REF: 7-8 OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 12. An older-person male living in an adult community becomes a widower one month after

retirement. Two months later, he has not resumed a weekly outing with his fishing club. Which of the following should the nurse implement? a. Ask the older person why he is not fishing.

b. Have club members visit him at home. c. Meet with him to assess his interests. d. Enroll him in a weekly card game. ANS: C Feedback A

Incorrect. The nurse avoids confronting the older person, even in a gentle manner. “Why” questions can be interpreted as confrontational, and the man may be unable or unwilling to articulate a reason. Incorrect. The nurse avoids asking club members to visit him because it removes the older person from the decision making. Although this effort can be well-meaning, it can be misinterpreted as an invasion of privacy. Correct. The nurse meets with the older person to determine how and when to establish new relationships and social activities in light of his wife’s death. Even though the man engaged in fishing beforehand, the nurse respects the older person’s wishes and needs as he transitions to a different life. Incorrect. The older person is much more likely to participate in an activity in which he has input. In addition, the nurse’s action can be misinterpreted as disrespectful because an adult has the right to control his own life.

DIF: Application REF: 7-8 TOP: NCLEX: Psychosocial Integrity

OBJ: 2

13. The nurse plans activities for female older persons born between 1930 and 1940 who

reside in an assisted-living facility. Which is the best intervention for the nurse to implement? a. Have them bake cookies twice a week. b. Conduct interviews for specific interests. c. Arrange dog and cat visits from volunteers. d. Take them to the library for guest speakers. ANS: B Feedback A

Incorrect. The nurse incorrectly presumes to know what activities they will enjoy because most of these women are in their 80s, and women born between 1930 and 1940 generally spent their lives as homemakers. Correct. The nurse conducts individual interviews with the older persons to determine their interests and avoids generalizing, because as people live longer, they become more and more unique. Incorrect. The nurse should avoid arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older person to a pet visit. Incorrect. Unless it is done on a voluntary basis, the nurse should avoid arranging visits by guest speakers. In addition, the nurse assesses each older person before outside visits, to avoid embarrassing events related to incontinence and hearing and vision problems.

DIF: Analysis

REF: 8

OBJ: 1

TOP: NCLEX: Health Promotion and Maintenance 14. The nurse plans care for an older male adult who lives on Old Age Security pension and a

small pension after retirement, and has type 2 diabetes mellitus. Which aspect of this man’s life should the nurse integrate into a positive approach to his health and well-being? a. He practises effective glucose control. b. He lives alone in a high-rise apartment. c. He lacks low-cost, reliable transportation. d. He attends weekly lunches at his local diner. ANS: A Feedback A

Correct. Practising effective glucose control demonstrates this man’s resilience and capacity to effectively manage the challenges associated with a chronic illness, and thus is a strength the nurse uses in a positive approach toward his health and well-being. Incorrect. Living alone is not ideal for an older person, especially one with diabetes, because of the potential for loneliness and complications from diabetes such as hypoglycemia. This is a negative aspect of this man’s life and one which has to be resolved for his safety and well-being. Incorrect. The nurse cannot include this man’s transportation issues into a positive plan because it is a problem to overcome, not a strength on which to capitalize. Incorrect. Going out to lunch is a positive approach to maintaining good mental health, although eating at a local diner may not be the best approach for controlling his diabetes mellitus.

DIF: Analysis REF: 7-8 OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 15. Mrs. McCloud, 70 years old, lives in Attawapiskat and speaks mostly Cree. She is

transferred to a hospital in a larger city in Ontario for hemodialysis. While Mrs. M. is in hospital, what should the nurse take into account when developing nursing interventions based on health promotion? a. Instruct the older person to monitor her fluid intake on an hourly basis. b. Demonstrate, through pictures, how to eat a healthy, well-balanced diet. c. Ask the older person about her home and how she accesses health care. d. Ask the older person why she did not seek help sooner, to prevent the need for hemodialysis. ANS: C Feedback A

Incorrect. The nurse avoids instructing older persons to monitor their own health, because patients are more likely to engage if they are asked if they are able or want to do so. Incorrect. Even though pictures might be a creative way to engage someone who speaks another language, in isolated communities it is often challenging and expensive to eat a healthy, well-balanced diet. Correct. When the nurse asks the older person about her home, the nurse creates

a personal connection with the older person. Finding out about accessibility to health care is important, because services for older persons are limited in rural and remote regions. Incorrect. Asking clients “why” questions can be construed as measuring, evaluating, or confronting, and the older person may not be able to articulate a reason.

DIF: Analysis REF: 7 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 16. Mr. Levesque, 65 years old, has been living on the street and in homeless shelters for the

last three years after having lost his job as a maintenance attendant at a local store. He suffers from alcoholism and appears malnourished upon arrival at the hospital, after falling on the sidewalk and injuring his left shoulder. When implementing a primary health care approach, what is the main principle the nurse should consider with this older person? a. Health promotion b. Accessibility c. Primary care d. Public participation ANS: A Feedback A

Correct. Health promotion is the process of enabling people to increase control over and improve their health. Health promotion addresses the determinants of health. It includes health education, public education, nutrition, sanitation, and prevention and control of diseases. Incorrect. Accessibility looks solely at access to health care services and how they can be made more accessible; arriving at hospital indicates that accessibility is not necessarily an issue for Mr. Levesque. Incorrect. Primary care is not a principle of primary health care. Primary care is the first contact people have with the health care system. Principles of primary health care include accessibility, public participation, health promotion, appropriate technology, and intersectoral collaboration. Incorrect. Public participation implies that older persons are active partners in making decisions about their health care and the health of their communities. It is difficult to determine if this patient is able to make decisions at this time about becoming an active participant in the health needs of the community.

DIF: Application REF: 7 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 17. To help meet the needs of an increasingly ethnoculturally diverse older-person population,

which of the following should be done? a. Hire more male nurses. b. Offer more second-language courses in nursing schools. c. Provide more reading material in various languages. d. Increase the number of health care providers from various cultures. ANS: D

Feedback A B C D

Incorrect. Gender specific hiring would not address changes in ethnocultural needs. Incorrect. Offering courses in languages other than English would not ensure various cultural needs have been met. Incorrect. Reading materials are not often well utilized for teaching purposes and also would not serve to meet a variety of ethnocultural needs. Correct. Having more HCPs from various cultures would help address the variety of cultures represented in the older-person age group and increase understanding as well as comfort levels.

DIF: Knowledge REF: 7 OBJ: 3 TOP: NCLEX: Safe and Effective Care Environment

Chapter 02: Gerontological Nursing History, Education, and Roles Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following statements best identifies gerontological nursing? a. Nurses have only recently become involved in the care of the older person. b. Gerontological care, while important, is the smallest specialty group within the

Canadian Nurses Association (CNA). c. The purposes of gerontological nursing include promotion of health and support

for maximal function. d. Canadian Nurses Association certification is available only for gerontological

nurses in research positions. ANS: C Feedback A B C

Incorrect. Nurses have always cared for older-person patients. Incorrect. Gerontological care is the largest specialty group within the Canadian Nurses Association. Correct. Promoting health and fostering independence are purposes of the practice, as reflected, for example, in the Canadian Gerontological Nursing Association’s Standards of Practice. Incorrect. The CNA certification program includes a variety of positions, such as nurse practitioners, clinical specialists, researchers, and administrators.

DIF: Knowledge REF: 17-18 OBJ: 1 TOP: NCLEX: Health Promotion and Maintenance 2. Which one of the following Canadian Gerontological Nursing Association Standards of

Practice recognizes that certain behaviours are not necessarily related to pathology, but instead may be related to the circumstances within the physical or social environment surrounding older persons? a. Physiological health b. Relationship care c. Responsive care d. Health system ANS: C Feedback A

B C

Incorrect. Physiological health assists clients to maintain homeostatic regulation through assessment and management of physiological care to minimize adverse events associated with medications, diagnostic or therapeutic procedures, health care–associated infections, or environmental stressors. Incorrect. Relationship care occurs when gerontological nurses develop and preserve therapeutic relationship care. Correct. The responsive care approach recognizes that certain behaviours are not

necessarily related solely to pathology, but instead may be related to circumstances within the physical or social environment surrounding well older persons and those with dementia, and may be an expression of unmet need. Incorrect. Health system focuses on the economic and political influences that provide or facilitate care that supports access to and benefit from the health care delivery system.

DIF: Knowledge REF: 16 (Box 2-5) OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 3. Which of the following is an accurate statement regarding gerontological nursing

education? a. Gerontological nursing content has long been integrated into the curriculum of the typical school of nursing. b. Undergraduate nursing programs cover gerontological nursing extensively in dedicated courses, comparable to the coverage of psychiatric nursing. c. Issues most lacking in gerontological nursing education include faculty not being supportive and students lacking interest in this area of nursing. d. Accreditation of a nursing program guarantees that appropriate amounts of gerontological nursing content are included in the curriculum. ANS: C Feedback A B C

Incorrect. Only recently has gerontological nursing content begun to appear in nursing school curricula. Incorrect. Most nursing schools still do not have courses dedicated to gerontological nursing. Correct. The most evident issues that are most lacking in gerontological nursing education are lack of expertise in nursing faculty, nonsupportive nursing faculty, the belief that gerontological nursing content is integrated throughout the nursing program, and students’ lack of interest in this area of nursing. Incorrect. At present, there are no minimum requirements for coverage of care of older persons.

DIF: Knowledge REF: 19-20 OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance 4. What was the first formal action taken by the Canadian Gerontological Nursing

Association (CGNA) in relation to gerontological nursing? a. The CGNA established the first provincial gerontological nursing association. b. The CGNA established gerontological nursing standards. c. The CGNA created the Canadian Association of Older Adults. d. The CGNA formed the Canadian Association of Gerontology. ANS: B Feedback A B

Incorrect. In Canada, the first provincial gerontological nursing association was formed in Ontario in 1974, prior to the establishment of the CGNA in 1983. Correct. In 1987, gerontological nursing standards were established by the

C D

CGNA. Incorrect. The Canadian Association of Older Adults does not exist. Incorrect. The Canadian Association of Gerontology was founded in 1971, 14 years before the Canadian Gerontological Nursing Association (CGNA) was founded.

DIF: Knowledge REF: 14 OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 5. A male older person is transferred to a hospice facility with end-stage disease. Which of

the following is a suitable nursing intervention for this older person and his family, according to the Canadian Gerontological Nursing Association’s Standards of Practice? 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 Feedback A

Incorrect. To promote comfort, the gerontological nurse administers medication as prescribed and avoids restricting analgesia to patients regardless of the setting or the nurse’s personal views. Incorrect. Although fostering independence is within the scope of gerontological nursing practice, the nurse should assess the older person and family before assuming the older person will want or be able to perform self-care. Incorrect. Although hospice can have regular visiting hours, the older person 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 person’s needs. Correct. To promote dignity, the nurse facilitates enactment of family wishes, rituals, or religious practices related to death and dying. This nursing action relates to Standard III: Responsive care, and Standard IV: Relationship care.

DIF: Application REF: 16 OBJ: 2 TOP: NCLEX: Safe and Effective Care Environment 6. A nursing home executive interviews RNs to fill a full-time position for direct patient care,

to maintain the standards of older-person care. Which nurse should the nursing home hire? a. A nurse from a certified university b. A certified gerontological nurse c. A nurse with 15 years of experience d. A gerontological nurse practitioner ANS: B Feedback A B

Incorrect. A nurse educated in a certified university does not necessarily have specialty education and training in gerontology. Correct. A certified gerontological nurse receives education and training to care

C D

for older persons, assuring the nursing home and the public that the nurse has mastered the specialized skills and knowledge to care for older persons according to gerontological nursing standards. Incorrect. A nurse with 15 years’ experience might have no experience with gerontology and offers no proof of specialized knowledge or skills. Incorrect. Although a gerontological nurse practitioner receives specialized education and training in gerontology, the nurse being hired provides primary care in a nursing home.

DIF: Application REF: 18 OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment 7. The gerontological nurse collaborates with the wound care team about an older person

who has an ulcer. How is this nurse demonstrating leadership in the care of an older person? a. The nurse is screening and assessing older persons effectively. b. The nurse is facilitating access to older person care programs. c. The nurse is coordinating members of the health care team. d. The nurse is empowering older persons to manage chronic illness. ANS: C Feedback A B C

Incorrect. Screening and assessing are only indirectly related to collaboration. Incorrect. In this case, the nurse’s collaborative efforts are unrelated to facilitating access to a program. Correct. The nurse demonstrates leadership in the care of older persons by initiating and coordinating collaboration with the wound care team to improve the health of an older person. This action is congruent with Standard IV: Relationship care of the CGNA’s Standards of Practice. Incorrect. Thus far, the nurse has not educated or trained this client in wound care.

DIF: Application REF: 18 OBJ: 5 TOP: NCLEX: Safe and Effective Care Environment 8. Gerontological nurses may be generalists or specialists. In order to prepare a nurse

generalist, which of the following nursing practices experience would be the most meaningful and helpful? a. Working with older persons experiencing chronic health conditions found in acute care settings b. Working with older persons across the continuum of care c. Working with older persons in long-term care facilities, because this is where most older persons reside d. Working with older persons in home care, because the goal is to keep them in their homes as long as possible ANS: B Feedback A

Incorrect. Working with older persons experiencing chronic health conditions

C D

found in acute care settings is important, but it is only one aspect of caring for older persons. Correct. To prepare nurse generalists, it is important to provide nursing practice experiences with older persons across the continuum of care, not just in acute and long-term care settings. Incorrect. Working with older persons in long-term care facilities is important, but it is only one area of caring for older persons. Incorrect. Working with older persons in home care is important, and it is important to keep older persons in their familiar environment as long as they are safe and can be effectively cared for in their homes, but it is only one area of caring for older persons.

DIF: Comprehension REF: 22 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 6

9. Mrs. Jaciuk, 70 years of age, was admitted to the hospital after a recent fall in her home.

Her left cheek is bruised and she complains that her left leg is very sore. After assessment and undergoing a CT scan of her head and an X-ray of her left leg, the physician is ready to discharge her home because there is no evidence of a fracture. Mrs. Jaciuk starts to cry when the nurse enters the room and she begs the nurse to allow her to stay, because she has no one at home and she fears she may fall again. What should the nurse consider when addressing Mrs. Jaciuk? a. Allow Mrs. Jaciuk to express her feelings. b. Understand that hospitals are dangerous places for older persons. c. Speak with the physician and request that Mrs. Jaciuk be allowed to stay another day. d. Instruct Mrs. Jaciuk about fall prevention, based on the Registered Nurses’ Association (RNAO) Best Practice Guideline. ANS: B Feedback A

C D

Incorrect. Encouraging Mrs. Jaciuk to express her feelings is important, but this will not address the underlying issue of hospitals being a dangerous place for older persons. Correct. Hospitals are dangerous places for older persons: 34% experience functional decline and iatrogenic complications (29% to 38%), a rate three to five times higher than the rate for younger patients. Incorrect. Requesting that Mrs. Jaciuk be allowed to stay one more day does not address the issue that older persons’ hospital stay should be as brief as possible. Incorrect. While providing Mrs. Jaciuk with evidence-informed practice information related to falls is valuable, it does not address the potential complications older persons are susceptible to if they stay in hospital.

DIF: Analysis REF: 18 OBJ: 5 TOP: NCLEX: Safe and Effective Care Environment

10. Leadership in long-term care settings requires balancing the needs of the residents with the

well-being of the staff. The turnover rate of Health Care Aides (HCAs) in long-term care facilities is almost 100%. You are working in a long-term care facility and have identified that whenever a particular HCA is unhappy with an assignment, the entire unit has a bad day. Which action should the unit nurse take first to correct this situation? a. Meet with the HCA to find out why the HCA is so unhappy. b. Place the HCA on probation for the negative behaviour. c. Discuss with the HCA the perceived attitude and the way it affects the unit. d. Suspend the HCA until the behaviour improves. ANS: C Feedback A B C

Incorrect. Meeting with the HCA to find out why she is so unhappy may lead to a long, drawn out, unproductive meeting. Incorrect. Placing the HCA on probation may only exacerbate the negative behaviour and does not address the behaviour. Correct. The first step is an informal meeting with the HCA to discuss the HCA’s attitude and how it affects the staff. The manager should document the conversation. Incorrect. Suspension may only create more disharmony among the other HCAs, even if the individual behaving badly has been removed. The unit nurse must remember that turnover rate is approaching 100% and does not serve the residents well.

DIF: Analysis REF: 20 OBJ: 5 TOP: NCLEX: Health Promotion and Maintenance

Chapter 03: Communicating with Older Persons Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following is a true statement concerning communication with an older person

who has aphasia? a. Communication should be simplified, using very basic words. b. The older person should be exposed to a variety of different staff members to stimulate rehabilitation. c. A nurse should pay attention to what speech and word recognition patterns the patient uses. d. Alternative or augmentative tools exist for only a few types of aphasia. ANS: C Feedback A B

Incorrect. In most cases of aphasia, the person retains normal intellectual ability and could easily understand complex language. Incorrect. Having a small number of staff members consistently care for the patient is most helpful, so that they can learn to understand how the person is attempting to communicate. Correct. Nurses are responsible for accurately observing and recording the speech and word recognition patterns of the client and for implementing the speech pathologist’s recommendations. Incorrect. Tools exist for every imaginable type of language disorder.

DIF: Knowledge REF: 36 (Box 3-7) OBJ: 3 TOP: NCLEX: Physiological Integrity 2. Dysarthria is defined by which of the following descriptions? a. Dysarthria is difficulty in coming up with the correct word. b. Dysarthria is difficulty in physically producing the sounds of speech. c. Dysarthria is difficulty in speaking when the person is thinking about what to say. d. Dysarthria is difficulty in understanding speech. ANS: B Feedback A B C

Incorrect. Difficulty in coming up with the correct word is anomia or anomic aphasia. Correct. Dysarthria is caused by a weakness or incoordination of the speech muscles, interfering with the clarity of speech and pronunciation. Incorrect. Difficulty in speaking when one is thinking about what to say is usually a result of verbal apraxia, which does not interfere when the older person is not thinking about the words. Incorrect. Dysarthria interferes only with the production of speech sounds. Difficulty in understanding speech is encountered in fluent or global aphasia.

DIF: Knowledge REF: 35 TOP: NCLEX: Physiological Integrity

OBJ: 6

3. Which of the following strategies is most useful for communicating with an older person

who is experiencing cognitive impairment? a. Speak normally, because the older person can understand what you are saying. b. Communicate infrequently with the older person, to diminish frustration. c. Correct the older person and repeat until you are understood. d. Use multiple ways of communicating, such as by gesture and touch, as well as speech. ANS: D Feedback A B C D

Incorrect. Speaking slowly and allowing time for response are useful strategies for simplifying the communication. Incorrect. Communicate frequently with the older person to diminish frustration and provide reassurance. Incorrect. The implementation of correction is not a useful strategy for encouraging communication and supporting a sense of personhood. Correct. Gesture and touch play an important role in communicating in an encouraging manner.

DIF: Knowledge REF: 36 TOP: NCLEX: Physiological Integrity

OBJ: 6

4. A patient says, “Peace wing we uh meng meng.” What is your response? a. “I’m sorry, that doesn’t make any sense.” b. “Please try to speak more clearly.” c. “Excuse me, I didn’t understand that.” d. “What would you like me to bring you?” ANS: D Feedback A B C

Incorrect. The nurse must believe that the patient is trying to communicate something important enough for the nurse to make the effort to understand it. Incorrect. The patient is speaking as clearly as he or she can. Incorrect. An open-ended reply is likely to frustrate the patient, who will probably answer by simply repeating the original utterance, no more comprehensibly. Correct. The patient is most likely saying, “Please bring me a…” This response focuses on the one part of the sentence that you did not understand.

DIF: Application REF: 36 TOP: NCLEX: Psychosocial Integrity

OBJ: 6

5. Which of the following statements is true about forming a group with older persons? a. Leaders must be prepared for members to fail to show up as a result of illness,

death, or other reasons.

b. Groups should include persons with diverse levels of cognitive ability. c. A group leader who is prone to depression will be better able to empathize with the

depression and losses suffered by group members. d. The evening is a good time for a group to meet. ANS: A Feedback A B C D

Correct. There must be a clear plan for recognition of absent members; an absence does not by itself mean that a member has died. Incorrect. Mixing very different levels of ability can lead to anxiety in both the more impaired and the less impaired members, for different reasons. Incorrect. The leader should be able to discuss the sadness and losses of the other group members without falling into depression. Incorrect. Some older people may be tired by the evening, and people living outside the facility may have transportation difficulties at that time of day.

DIF: Knowledge REF: 41 OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 6. Which of the following is a good strategy to use for teaching older-person learners? a. Use printed materials in soft colours. b. Provide extra time for the learner to respond. c. Use a pleasant soprano voice in audio materials. d. Cover a diverse range of topics in each session. ANS: B Feedback A B C D

Incorrect. Visual materials should have high contrast, such as black on white, and frequently use techniques other than printed text. Correct. An older person’s reaction time may be longer than a younger person’s. Incorrect. Older persons commonly have more difficulty hearing higher pitches. Incorrect. Focusing on a single topic helps the learner concentrate.

DIF: Knowledge REF: 42 OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 7. An older person living in long-term care begins to forget where activities occur, so the

nurse engages her in reminiscence. Which goal of reminiscence is the most relevant to improve the nurse’s communication with this older person? a. Reminiscence provides cognitive stimulation. b. Reminiscence helps to obtain information about fears. c. Reminiscence offers a pleasurable experience. d. Reminiscence can improve depressive symptoms. ANS: A Feedback A

Correct. The nurse uses reminiscence to provide cognitive stimulation, which functions to slow or prevent further deterioration in the older person’s cognitive

B C

functioning and restore and maintain the optimal level of communication for her enjoyment, safety, and self-esteem. Incorrect. This is a reasonable goal for using reminiscence; however, older persons’ fears are not relevant to this resident. Incorrect. Reminiscence is usually a pleasant experience for older persons, but this nurse hopes to use it to stimulate cognitive functioning because the resident is forgetting the location of activities. Incorrect. Relieving depressive symptoms is not relevant to this older person.

DIF: Application REF: 42 OBJ: 5 TOP: NCLEX: Health Promotion and Maintenance 8. The nurse has to teach an 85-year-old male and his family about a new medication. Which

of the following interventions should the nurse implement to enhance patient teaching? a. Display the medication close to the family while teaching. b. Tell the family members they will need to administer the medication. c. Speak slowly, use repetition, and paraphrase for the patient. d. Face the patient directly and speak clearly in a quiet place. ANS: D Feedback A

C D

Incorrect. The nurse should avoid using elderspeak and thus holds the medication closest to the patient. The family can view the medication after the patient does. Incorrect. The patient should receive the teaching while the family observes. Speaking to the family conveys disrespect for the older person and, in this case, implies the older person is incompetent. Incorrect. These are aspects of elderspeak that the nurse should avoid in teaching an older person. Correct. The nurse demonstrates respect and concern for the patient by addressing him directly; the best way to communicate with an older person is to face him directly, in a quiet place so ambient noise does not interfere with communication.

DIF: Application REF: 37 (Box 3-9) OBJ: 6 TOP: NCLEX: Psychosocial Integrity 9. The nurse asks an older female person, “Which countries were your favourite travelling

destinations?” Which strategy is the most important for the nurse to incorporate into communicating with this older person? a. Maintain a sharp focus on the older person. b. Allocate more time for answering. c. Seek validation of understanding. d. Avoid judgement of the responses. ANS: B Feedback A

Incorrect. This is a reasonable strategy to use during communication but not the

C D

most important for this older person. Correct. Because the nurse asked the older person an open-ended question, this is the most important strategy for the nurse to employ; it can take older persons more time to scan their lives and gather thoughts. Incorrect. Seeking validation demonstrates interest in what the older person says; however, this is not the most important strategy. Incorrect. This is a reasonable strategy to employ in some situations, but because the nurse asked an open-ended question, the most important strategy is to allow more time for answering.

DIF: Analysis REF: 37 (Box 3-9) OBJ: 3 TOP: NCLEX: Psychosocial Integrity 10. The nurse needs to obtain information from an older person who has dysarthria. If the

nurse experiences difficulty in understanding the older person, which one of the following actions would be the nurse’s best response? a. Allow for several brief conversations. b. Repeat a part that is not understood. c. Ask questions using very simple terms. d. Provide a questionnaire with large type. ANS: B Feedback A B C D

Incorrect. The nurse allows more time for conversations and does not need to break up the conversation. Correct. The nurse repeats the part of the message that is not understood so the older person does not have to repeat the whole statement. Incorrect. Dysarthria does not affect an older person’s intelligence. Incorrect. Large type will not facilitate communication with an older person who has dysarthria because vision impairment is not the issue.

DIF: Application REF: 37 (Box 3-8) OBJ: 6 TOP: NCLEX: Physiological Integrity 11. Which chronic condition is the most common sensory impairment in Canadians over the

age of 60? a. Hearing loss b. Hypertension c. Visual impairment d. Type 2 diabetes mellitus ANS: A Feedback A B C

Correct. Hearing loss affects 47% of this age group. Incorrect. Hypertension is not the third most common chronic condition of older persons in Canada. Incorrect. Visual impairment is not the third most common chronic condition of older persons in Canada.

Incorrect. Type 2 diabetes mellitus, although increasing in prevalence, is not the third most common chronic condition of older persons in Canada.

DIF: Knowledge REF: 28 TOP: NCLEX: Physiological Integrity

OBJ: 6

12. Which type of question should the nurse avoid when communicating with an older person

who has aphasia? a. The nurse should avoid questions that validate understanding. b. The nurse should avoid questions that have open-ended answers. c. The nurse should avoid questions that require a yes or no answer. d. The nurse should avoid asking several questions in a series. ANS: B Feedback A B

Incorrect. The nurse validates the part of the message that is misunderstood for understanding. Correct. The nurse complicates communication with an older person who has aphasia by asking open-ended questions, because they can require a lengthy response that can be difficult for the older person to formulate. Incorrect. The nurse facilitates effective communication by presenting yes or no or single-word response questions to the older person, because it makes the older person’s response easier to formulate. Incorrect. The nurse simplifies communication with an older person by asking one question at a time, waiting for a response, and asking additional questions as needed.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 34

OBJ: 6

13. An older male person who wears a hearing aid waits in the radiology department. The

department is busy and noisy, so the nurse asks the patient if he wants to wait or reschedule the appointment. Which of the following is the most important strategy for the nurse to implement for effective communication with this man? a. Face the man while sitting at his level. b. Speak with him in a private, quiet setting. c. Verify that the information is understood. d. Ask if hearing is better in one ear or another. ANS: B Feedback A

Incorrect. This is a reasonable strategy to use and should facilitate communication with this man; however, the nurse’s position can be irrelevant if the noise level is too high and the message is difficult to hear. Correct. Although the older person wears a hearing aid, the nurse needs to speak with him in a quiet location. Reducing ambient noise facilitates communication because it can interfere with the hearing of a person with a hearing loss. In addition, some hearing aids function poorly with high levels of ambient noise. Incorrect. Verifying information is a reasonable strategy for a person with a

hearing impairment, but if the older person simply cannot hear the message, the nurse fails in communicating effectively. Incorrect. This is also a reasonable strategy for an older person with a hearing impairment, but not the most important one for this person.

DIF: Analysis REF: 29-31 TOP: NCLEX: Psychosocial Integrity

OBJ: 6

14. The vision of a female patient is deteriorating, and she is depressed about her condition.

Which of the following nursing interventions is most likely to address both conditions? a. Provide adequate lighting without glare. b. Maintain a consistent room arrangement. c. Train her with low-vision assistive devices. d. Offer your arm when ambulating in the hall. ANS: C Feedback A B C

Incorrect. This intervention addresses only the visual impairment. Incorrect. This intervention addresses only the visual impairment. Correct. Training the patient to use low-vision assistive devices can help to boost her self-esteem and promote self-confidence and independence. In addition, low-vision assistive devices can relieve boredom and provide needed diversions. Incorrect. This intervention only addresses the visual impairment.

DIF: Application REF: 32 TOP: NCLEX: Physiological Integrity

OBJ: 6

15. An older person receives speech therapy for dysarthria. Which advice should the nurse

offer the older person to enhance the speech therapist’s work? a. Speak quietly in a quiet location. b. Articulate several words in a row. c. Practise facial exercises regularly. d. Restrict the mouth from opening too far. ANS: C Feedback A B C D

Incorrect. The nurse encourages the older person to speak loudly and slowly in a quiet place. Incorrect. The nurse encourages the older person to focus on articulating one word at a time. Correct. The nurse encourages approved facial exercises to strengthen speaking muscles. Incorrect. The nurse encourages the older person to open the mouth widely and to exaggerate tongue movement to facilitate speaking.

DIF: Application REF: 37 (Box 3-8) OBJ: 6 TOP: NCLEX: Physiological Integrity

Chapter 04: Culture, Ethnicity, and Aging Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following statements is true about gerontological nursing for patients of

different races and ethnic backgrounds? a. The fact that a nurse is white has no bearing on the nurse’s ability to care for patients who are members of a minority group. b. An encyclopedic accumulation of details of a particular culture is the best preparation for caring for persons from that culture. c. A nurse who works in Toronto does not need to be as concerned about sensitivity to multiple cultures as a nurse who works in Vancouver. d. Facial expressions, body language, posture, and touch are important elements of communication between a nurse and a patient from different ethnicities. ANS: D Feedback A

B C D

Incorrect. A white person is more likely to have had opportunities and freedoms, and take them for granted, that a member of a minority group has never experienced and regards as a special privilege. Incorrect. Knowledge of cultural details can be useful, but it can also lead to stereotypes that obscure the differences between individual persons. Incorrect. Toronto and Vancouver are the two cities with the greatest numbers of immigrant older persons in Canada. Correct. These means of communication become more important as language barriers limit the effectiveness of verbal exchanges. They also have different meanings in different cultures.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 56 (Box 4-3) OBJ: 4

2. Which of the following statements is true about differing health belief systems? a. Personalistic or magicoreligious beliefs have been replaced in Western minds by

biomedical principles. b. In most cultures, older persons are likely to treat themselves using traditional methods before turning to biomedical professionals. c. Ayurvedic medicine is another name for traditional Aboriginal medicine. d. The belief that health depends on maintaining a balance among opposite qualities is characteristic of a magicoreligious belief system. ANS: B Feedback A B

Incorrect. Even in Canada, it is not uncommon for older persons to pray for cures or wonder what they did to incur an illness as punishment. Correct. Older persons in most cultures have usually had experience with

C D

traditional methods that have worked as well as expected. After these treatments fail, older persons turn to the formal health care system. Incorrect. The Ayurvedic system is a naturalistic health belief system practised in India and some neighbouring countries. Incorrect. This belief is characteristic of a holistic or naturalistic approach.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 57-58

OBJ: 3

3. When working with an interpreter, which of the following principles should the nurse

understand? a. If the nurse speaks the same language as the patient, then an interpreter is not required. b. When working with interpreters, the nurse should use technical terms or metaphors in order to help the patient fully understand what is being communicated. c. A patient’s young granddaughter who speaks English fluently would make the best interpreter because she is familiar with and loves the patient. d. The nurse should face the patient, rather than the interpreter. ANS: D Feedback A B C D

Incorrect. There may be cultural reasons that prevent the patient from speaking directly to a nurse. Incorrect. Technical terms and metaphors may be difficult or impossible to translate. Incorrect. Cultural restrictions may prevent some topics from being spoken of to a grandparent or child. Correct. This statement is true, because the intent is to converse with the patient, not with a third party about the patient.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 56 (Box 4-3) OBJ: 4

4. A resident in a nursing home insists that a priest hear his confession. The resident is very

anxious, and the nursing home does not have a Roman Catholic chaplain. Which one of the following interventions should the nurse implement? a. A rabbi is coming to visit the home this evening. Arrange an appointment for the resident. b. Report the resident’s change in behaviour in detail so that the attending physician can prescribe medication appropriately. c. Refer the resident to the staff psychologist to address the underlying cause of the patient’s anxiety. d. Contact a Roman Catholic church, and request that the priest visit the resident. ANS: D Feedback A

Incorrect. The two belief systems are not the same, and the resident is unlikely to experience the rabbi’s efforts as satisfactory.

C D

Incorrect. The resident’s wish can be understood entirely within the resident’s belief system and need not reflect a medical problem, particularly if a visit by a priest relieves the resident’s anxiety. Incorrect. This approach is an attempt to change the resident’s belief system. Correct. The nurse should respect the resident’s beliefs and practices and accommodate them when they are not harmful. Receiving the sacrament can potentially relieve much of the resident’s anxiety.

DIF: Application REF: 57 (Box 4-5) OBJ: 4 TOP: NCLEX: Psychosocial Integrity 5. An older person who is a Chinese man of traditional beliefs has a blood pressure of 80/54

mm Hg and refuses to remain in bed. Which intervention should the nurse use to promote and maintain his health? a. Have the health care provider speak to him. b. Use principles of the holistic health system. c. Ask about his perceptions and treatment ideas. d. Consult with a practitioner of Chinese medicine. ANS: C Feedback A B C

Incorrect. It is premature to speak with the health care provider until the assessment is complete. Incorrect. Unless he accepts the beliefs, principles of the holistic health system can be potentially unsuitable and insulting for this patient. Correct. Using the LEARN model, the nurse gathers information from the patient about cultural beliefs concerning health care and avoids stereotyping the patient. In the assessment, the nurse determines what the patient believes about caregiving, decision making, treatment, and other pertinent health-related information. Incorrect. Unless he accepts the treatments, consulting with a practitioner of Chinese medicine can be unsuitable and insulting for this patient.

DIF: Application REF: 57 (Box 4-5) OBJ: 4 TOP: NCLEX: Psychosocial Integrity 6. The nurse prepares a female older person, who is Polish, for discharge through an

interpreter and notes that the older person becomes tense during the instructions about elimination. Which of the following interventions should the nurse implement? a. Move on to the discussion about medication. b. Ask the older person how she feels about this topic. c. Instruct the interpreter to repeat the instructions. d. Have the older person repeat the instructions for clarity. ANS: B Feedback A

Incorrect. Because the nurse notices her tension, the nurse suspends the preparation temporarily to validate her assessment. If the nurse proceeds and the older person is uncomfortable discussing elimination, important instructions can

C D

be missed, leading to adverse effects for the older person. Correct. When working with an interpreter, the nurse watches the older person closely for nonverbal communication and emotion regarding a specific topic and, therefore, validates her assessment about the older person’s tension before proceeding. Incorrect. Repeating the instructions can aggravate the older person’s discomfort. Incorrect. Instructing the older person to repeat the nurse’s instruction ignores the patient’s needs.

DIF: Application REF: 55 TOP: NCLEX: Psychosocial Integrity

OBJ: 5

7. The nurse uses knowledge about and experience with cultures to care for older persons

within the context of a culture. Which one of the following is the best method of providing culturally competent nursing care? a. Apply assessment and cultural data. b. Support the older person’s cultural patterns. c. Increase specific cultural knowledge. d. Assess any strengths and weaknesses. ANS: A Feedback A

B C D

Correct. To provide culturally competent care, the nurse gathers data about the culture, the older person, and the specific culture’s impact on the older person, organizes the data, and applies the information by planning, implementing, and evaluating nursing care. Incorrect. Planning includes supporting cultural patterns. Incorrect. Assessing includes increasing cultural knowledge. Incorrect. The nurse assesses strengths and weaknesses of the older person in a context of the older person’s culture and uses the information to plan care.

DIF: Analysis REF: 57 (Box 4-4) OBJ: 4 TOP: NCLEX: Psychosocial Integrity 8. The health care provider discusses the need for surgery with an older person and her

family. Which information about the older person’s culture is important for the nurse to collect before this discussion to facilitate the process of informed consent? a. Attitudes about caregiving b. Process of decision making c. Rituals for death and dying d. Experience with discomfort ANS: B Feedback A B

Incorrect. Caregiving is unrelated to the process of informed consent. Correct. The nurse uses knowledge of the culture’s influence on the older person in relation to decision making to avoid unnecessary tension and

C D

misunderstanding and thus to facilitate the process of informed consent. The nurse uses the information about decision making by sharing the cultural information with the health care provider and by addressing the culturally suitable member of the family for informed consent. Incorrect. Death and dying, although potentially relevant, are unrelated to informed consent. Incorrect. Relevant to surgical procedures, older-person and family experiences with pain and discomfort are important to the pain management plan.

DIF: Application REF: 53 TOP: NCLEX: Psychosocial Integrity

OBJ: 5

9. The nurse plans care for an older person who follows the beliefs of the personalistic or

magicoreligious system. Which of the following should the nurse consider when planning care? a. The older person may attribute his illness to voodoo or a hex. b. Invite the hospital chaplain to speak with the older person. c. Maintain blood pressure below 120/70 mm Hg. d. Review principles of the magicoreligious system. ANS: A Feedback A B

Correct. If the older person practises and believes in the magicoreligious system, his spiritual beliefs may influence his attitudes toward Western health care. Incorrect. Inviting the hospital chaplain to speak with the older person may be a positive social interaction for the older person but it will not address the person’s belief that his illness is because of voodoo or a hex. Incorrect. Maintaining his blood pressure at or below the current recommendation is an important consideration but it will not address the older person’s belief that his illness is because of voodoo or a hex. Incorrect. Reviewing principles of the magicoreligious system is an important consideration but it will not address the older person’s belief that his illness is because of voodoo or a hex.

DIF: Application REF: 54 TOP: NCLEX: Psychosocial Integrity

OBJ: 5

10. Which health belief system uses treatments to repair a body part? a. Holistic b. Biomedical c. Personalistic d. Magicoreligious ANS: B Feedback A B

Incorrect. The holistic system holds that health is attained through balance. Correct. Because disease is thought to be caused by dysfunction or structural abnormalities, the biomedical system believes in repairing the structural

C D

abnormality. Incorrect. The personalistic system uses treatments such as meditation, fasting, and praying. Incorrect. The magicoreligious system is the same as the personalistic system.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 54

OBJ: 3

11. The nurse is assessing an older person from a culture different from the nurse’s by asking

questions from the Explanatory Model for Culturally Sensitive Assessment. In keeping with this model, which question should the nurse ask? a. “How can we negotiate to solve the problem?” b. “What treatment can improve your condition?” c. “Should we try my plan first to see if it helps?” d. “Can we discuss differences in our plans now?” ANS: B Feedback A B C D

Incorrect. This question is based on the LEARN Model. Correct. Asking about potential therapies is a question from the Explanatory Model and asks what the individual feels will help to clear up the problem. Incorrect. This question is from the LEARN Model. Incorrect. This question is from the LEARN Model.

DIF: Application REF: 57 (Box 4-4) OBJ: 4 TOP: NCLEX: Psychosocial Integrity 12. The phenomenon known as “healthy migrant effect” states that recent immigrants tend to

have better health than long-term immigrants or nonimmigrants, because of: a. Better access to education. b. More economic supports/resources. c. Healthier childhoods. d. Canadian immigration policies. ANS: D

A B C

Feedback Incorrect. Immigrants come from various countries and their education therefore varies. Incorrect. Although there are policies in place that supports economic well-being of immigrants, this cannot be guaranteed. Incorrect. Childhood health is dependent on many individual factors, including the health care system that the child grew up in. This would vary for immigrants depending on where they are immigrating from. Correct. Canadian immigration policies, especially those from the last few decades, do more to support immigrant health than any other factor.

DIF: Knowledge REF: 50 TOP: NCLEX: Psychosocial Integrity

OBJ: 2

Chapter 05: Nursing Documentation Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following is a primary reason that documentation is important when caring

for an older person? a. Documentation enables the team to provide care to meet the older person’s individual needs. b. Documentation helps defend the nurse in the event of a possible lawsuit. c. Documentation enables the older person to access valuable information about the care he is receiving. d. Documentation is the basis for reimbursement to the older person after discharge home. ANS: A Feedback A

C D

Correct. This is a primary reason, because documentation is necessary to ensure that the team has accurate and complete information about the older person’s specific conditions. Incorrect. This should not be the primary motive for the nurse to keep good documentation. However, accurate and thorough documentation is the best defence in the event of legal action against anyone involved in an older person’s care. Incorrect. Documentation enables nurses, not the older person, to identify, monitor, and evaluate treatment or interventions. Incorrect. Documentation often serves as a basis to justify funding for the nursing care, not for reimbursement to the older person after discharge home.

DIF: Comprehension REF: 64 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 1

2. What is a SOAP note? a. This is a record of supplies used in patient hygiene. b. This is a record of an event during a patient’s stay, formatted according to the

Simple Object Access Protocol (SOAP), so that it can be easily transmitted between computers. c. This is a form of bar code. d. This is a record of patient data listing the patient’s subjective complaint, objective data recorded by the nurse, the nurse’s assessment of the situation, and the nurse’s plan of action. ANS: D Feedback A

Incorrect. A SOAP note is a record of an event in which a patient makes a subjective complaint and the nurse observes objective data, makes an assessment

B C D

on the basis of the complaint and the data, and makes a plan for interventions based on the assessment. Incorrect. SOAP stands for subjective (patient complaint), objective (observed data), assessment, and plan. Incorrect. A SOAP note is a record in human language describing a problem, its assessment, and planned interventions. Correct. SOAP stands for subjective, objective, assessment, and plan.

DIF: Knowledge REF: 65 OBJ: 1 TOP: NCLEX: Safe and Effective Care Environment 3. Which of the following is a true statement about documentation? a. Nurses should keep records of patients’ wishes. b. Patients do not have access to their own medical records. c. The DARE approach is a complete record of the health status of a patient. d. The nurse is responsible for completing all of the Minimum Data Set (MDS). ANS: A Feedback A B

C D

Correct. Entering patients’ expressed wishes in the medical or clinical record helps ensure that the interdisciplinary team respects those wishes. Incorrect. According to regulations following the Personal Health Information Protection Act (PHIPA), the patient has access to his or her own medical records and may designate others to have access. Incorrect. The DARE approach or FOCUS charting integrates narrative notes with the plan of care. Incorrect. The MDS should be completed jointly by all members of the interdisciplinary team.

DIF: Comprehension REF: 64 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 1

4. Which documentation tool does the nurse use in extended care and long-term care settings

to gather definitive information on the resident’s functioning? a. Narrative patient progress notes b. Problem-oriented documentation c. Resource Utilization Group (RUG) d. Resident Assessment Instrument (RAI) ANS: D Feedback A B

C D

Incorrect. Narrative progress notes are used in nursing homes to describe events that are unsuitable for other forms of documentation in the medical record. Incorrect. Problem-oriented documentation identifies resident problems, the plan of care to resolve the problem, and the outcome of the problem or response to treatment. Incorrect. The RUG is the reimbursement tool in the RAI. Correct. Mandated by the federal government to improve the quality of care for

nursing home residents, the RAI is used by the nurse to help residents in nursing homes achieve optimal functional status. The RAI includes identification of issues with the Minimum Data Set, a comprehensive assessment from Resident Assessment Protocols, and the foundation for reimbursement using the Resource Utilization Group. DIF: Comprehension REF: 66 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 1

5. Using the Resident Assessment Instrument (RAI), the nurse identifies a trigger from the

Minimum Data Set (MDS) for an older person in a nursing home who requires an indwelling urinary catheter. Which should the nurse do next? a. The nurse should develop a patient-centred plan of care. b. The nurse should assign suitable nursing interventions. c. The nurse should use the Resident Assessment Protocols (RAPs). d. The nurse should institute agency-approved catheter care. ANS: C Feedback A B C

Incorrect. The nurse develops the care plan after completing the RAPs. Incorrect. The nurse assigns suitable nursing interventions to the plan of care. Correct. The nurse uses the RAPs to assess triggers identified from the MDS. To help the resident achieve optimal functional status by determining his strengths, needs, and preferences, RAPs provide an organized framework used by the health care team for additional assessment of the trigger. Incorrect. The nurse uses agency-approved policies to provide care as assigned in the plan of care.

DIF: Analysis REF: 66 OBJ: 2 TOP: NCLEX: Safe and Effective Care Environment 6. The nurse must inform an older person whose first language is French and who does not

speak any English about patient rights. The nurse also has to have the older person sign the document about information access. Which intervention should the nurse use to maintain the confidentiality of this older person? a. The nurse should present the older person with a French version of the information access document. b. The nurse should have an English-speaking family member explain the document to the older person. c. The nurse should explain the document to the older person using an interpreter to ensure understanding. d. The nurse should instruct an interpreter to read the information access document to the older person privately. ANS: C Feedback A B

Incorrect. The nurse cannot ensure that the older person understands without discussing the document with the older person, using an interpreter. Incorrect. The nurse cannot delegate a nursing responsibility to a family member

because the nurse does not have the right to release the health information to anyone. Correct. To ensure that the older person understands, the nurse explains a patient’s rights about information access to the older person with the assistance of an interpreter. The nurse is responsible for the older person understanding and thus cannot relinquish this task to another person. When understanding is reached about the rights associated with access to information, the older person can make an informed decision about releasing health care information and thus maintain privacy. Incorrect. The nurse cannot delegate this task to another person, in private or public.

DIF: Application REF: 67 OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment 7. The same nursing documentation record is used in every unit of a hospital. Why does a

hospital use a standardized form for nursing documentation? a. Standardized documentation helps to provide continuity of care. b. Standardized documentation assists in maintaining confidentiality. c. Standardized documentation reduces the number of medication errors. d. Standardized documentation guarantees excellence of care between units. ANS: A Feedback A

Correct. An institution uses the same nursing documentation record because it helps to provide continuity of care across various settings by providing organized, pertinent, and thorough health care data on a specific individual. Other units in the hospital and other health care settings have an easier time locating relevant data. Incorrect. Nurses must restrict access to a standardized documentation record or any other type of patient record such as laboratory reports, narrative or progress notes, and other documents. Incorrect. A standardized nursing documentation record can reduce a specific type of documentation error but is unlikely to affect the rate of medication errors. Incorrect. The standardized documentation record allows for hospital-wide quality evaluations and sets the stage for excellence in patient care but does not guarantee excellence of care.

DIF: Application REF: 64-65 OBJ: 2 TOP: NCLEX: Safe and Effective Care Environment 8. Mrs. Smadu, who is 80 years of age, was recently admitted to a long-term care setting.

Over the past month, Mrs. Smadu appears to be deteriorating. She does not wish to eat, sleeps all the time, and is not able to participate in any of her activities of daily living. Which of the following assessment tools will help inform and guide comprehensive care and planning for this older person? a. Clinical Assessment Protocols (CAPs) b. Continuing Care Reporting System (CCRS)

c. Resident Assessment Instrument (RAI) d. Utilization Guide (UG) ANS: C Feedback A

Incorrect. Clinical Assessment Protocols (CAPs), developed by interRAI, are used for documenting assessment and inform and guide comprehensive care and service planning in the home care setting. These CAPs are intended as a companion resource for the RAI-Home Care (2008). Incorrect. The Continuing Care Reporting System (CCRS) is a database for ease of analysis and communication of patient profiles to the Canadian Institute for Health Information (CIHI). Correct. The Resident Assessment Instrument (RAI) is used in extended care and long-term care settings. The RAI process is dynamic and solution-oriented. It is used to gather definitive information on the resident’s functioning. Incorrect. A trigger found in the Rapid Assessment Protocol (RAP) prompts the nurse to conduct a more detailed assessment, following utilization guidelines (UGs).

DIF: Comprehension REF: 66 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 2

9. A 75-year-old adult has been admitted to the surgical unit. You are not assigned to admit

the older person; however, you overhear two nurses standing beside the mobile computer in the hallway discussing the admission. Which one of the following outlines rules ensuring privacy for this older person? a. The Continuing Care Reporting System (CCRS) b. Personal Health Information Protection Act (PHIPA) c. Health Insurance Portability and Accountability Act (HIPAA) d. The Canadian Nurses Association’s Code of Ethics ANS: B Feedback A

Incorrect. The Continuing Care Reporting System (CCRS) is a database for ease of analysis and communication of patient profiles to the Canadian Institute for Health Information (CIHI). Correct. The Personal Health Information Protection Act (PHIPA) outlines the rules in the collection, use, and disclosure of personal health information. PHIPA also requires that all personal health information be kept confidential and secure. Incorrect. The Health Insurance Portability and Accountability Act (HIPAA) is the first comprehensive federal government protection for the privacy of personal health information in the United States. Incorrect. The Canadian Nurses Association’s Code of Ethics is a statement of the ethical values of nurses and of nurses’ commitments to persons with health care needs and persons receiving care.

DIF: Comprehension REF: 67 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 4

10. In Canada, advance directives (advanced care planning) falls under which jurisdiction? a. Federal b. Provincial/territorial c. Municipal d. Health care agency/provider ANS: B Feedback A B

C D

Incorrect. Advance directives are not federal jurisdiction. Correct. In Canada, advance directives (also known as advanced care planning) fall under provincial and territorial jurisdictions and are documented in the health record. Incorrect. Advance directives are not a municipality’s authority. Incorrect. Advance directives do not fall under the jurisdiction of the health care agency/health care provider authority.

DIF: Knowledge REF: 64 OBJ: 1 TOP: NCLEX: Safe and Effective Care Environment

Chapter 06: Biological Theories and Physical Changes of Aging Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which theory of aging suggests that the adverse physical effects of aging result from gradual loss of control mechanisms in the pituitary and hypothalamus? a. Free radical theory b. Programmed theory c. Stochastic theory d. Neuroendocrine theory ANS: D Feedback A B C D

Incorrect. The free radical theory attributes aging to the accumulation of destructive products of metabolic oxidation. Incorrect. The programmed theory attributes aging to cells’ exhausting a predetermined number of replications. Incorrect. A stochastic theory attributes aging to the accumulation of random damage to DNA and other molecules. Correct. The neuroendocrine theory attributes aging to gradual changes in or loss of the mechanisms that control the organs through chemical signals.

DIF: Knowledge REF: 70-71 TOP: NCLEX: Physiological Integrity

OBJ: 1

2. Decreased functioning of which physical structure is likely to result in decreased metabolism in older persons? a. Kidney b. Thyroid gland c. Brain d. Skeleton ANS: B Feedback A B

C D

DIF:

Incorrect. Decreased kidney function leads to a decreased glomerular filtration rate and the ability of the kidneys to concentrate urine and clear waste. Correct. Secretion of thyroid hormones tends to decrease with age, resulting in a greater likelihood of a slower metabolism, hypothyroidism, and thinning hair and nails. Incorrect. Decreasing brain function tends to result in decreased cognitive functioning. Incorrect. Osteoclastic activity tends to decrease with age, increasing the risk for osteopenia and osteoporosis. Comprehension

REF: 78

OBJ: 1

TOP: NCLEX: Physiological Integrity 3. An older person is reading a large-print magazine and states that reading is difficult for her in the evening. Which following intervention should the nurse implement? a. Put a high-intensity lamp at the head of her bed. b. Explain to her that the grey-yellow ring around her cornea, arcus senilis, is interfering with visual acuity. c. Put more powerful tubes in the fluorescent room lights. d. Examine her retinas for signs of damage. ANS: A Feedback A

B C D

Correct. The pupil becomes gradually smaller with age, so the eye requires three times as much light. A high-intensity light on the object of interest is more effective than increasing overall room illumination. Incorrect. Arcus senilis does not affect vision. Incorrect. A high-intensity light on the object of interest is more effective than increasing overall room illumination. Incorrect. The patient is describing a gradual overall change, not the more localized or sudden effects of macular degeneration or retinal detachment.

DIF: Application REF: 82 (Box 6-7) TOP: NCLEX: Physiological Integrity

OBJ: 1

4. Which change in the skin is abnormal in an older person? a. Thinner and more fragile skin b. A tear in the skin after being assisted with transferring from the bed c. Mottled pigmentation and greater number of freckles d. Loss of hair on the extremities ANS: B Feedback A B

C D

Incorrect. This change is normal as ridges in the skin are lost. Correct. Although the skin of an older person may require 48 to 72 hours to mount an initial inflammatory response to a wound, increasing redness after that time, particularly with purulent discharge, is a sign of infection. Incorrect. Melanin distribution becomes more uneven with age. Incorrect. Hair is commonly lost from the legs and other areas of older persons. Hair loss from the legs is not a sign of peripheral vascular disease.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 71-72

OBJ: 2

5. The nurse designs a group exercise program at an older-person centre. Which room should the nurse choose for the program? a. A room with a beautiful hardwood floor tastefully appointed with throw rugs b. A spacious room with no windows but with fluorescent lighting and a natural stone floor

c. A room with an old hardwood floor and large windows overlooking a garden area d. An end room with a linoleum floor and a fan for ventilation to compensate for the room’s broken air conditioner ANS: C Feedback A B C D

Incorrect. Throw rugs can slide underfoot and lead to a fall, particularly when sense of balance has declined with age. Incorrect. The fluorescent lighting can lead to a glare problem, and the irregularities of the natural stone floor can lead to a fall. Correct. The hardwood floor provides an even surface. If the daylight from the large windows causes a glare problem, curtains may be used. Incorrect. The linoleum floor presents a glare problem, and there is a risk for overheating in older persons with reduced sweat-gland response to heat.

DIF: Application REF: 82 (Box 6-7) TOP: NCLEX: Safe and Effective Care Environment

OBJ: 3

6. During a nursing assessment, an older person tells the nurse about increasing loss of balance. Which patient teaching should the nurse implement to address musculoskeletal reasons for the loss of balance? a. Exercise with light weights. b. Stand on one foot at a time. c. Train with the use of sit-ups. d. Work out in a swimming pool. ANS: B Feedback A B

C D

Incorrect. Lifting weights helps to increase muscle strength. Correct. Loss of balance from a musculoskeletal perspective is usually due to loss of core muscle strength, thus the nurse suggests standing on one foot at a time, while holding on to a chair back if necessary, and working to increase the duration of the exercise. Incorrect. Sit-ups are contraindicated for older persons because they put tremendous amounts of stress on the lumbar spine. Incorrect. Low-impact aerobic exercise helps to improve conditioning and endurance.

DIF: Application REF: 74 (Box 6-3) TOP: NCLEX: Physiological Integrity

OBJ: 3

7. The nurse cares for an older person who appears to be malnourished and short of breath and has an infection in a large wound on his coccyx. Which intervention is the nurse’s priority? a. Monitor temperature and leukocytes. b. Provide assistance with meal planning. c. Provide high-quality protein in the diet. d. Maintain oxygen saturation above 95%.

ANS: D Feedback A

B C

Incorrect. This is important to implement for anyone with an infection but is not as important as breathing and circulation. Besides, fever is an unreliable indicator of infection in an older person. Incorrect. Providing assistance with meal planning is a reasonable nursing intervention but is not as important as breathing and circulation. Incorrect. The nurse provides high-quality protein in this individual’s diet because of the malnutrition, but this teaching is not as important as breathing and circulation. Correct. The nurse’s priority is to maintain oxygen saturation above 95% to help provide oxygen that the heart is unable to provide. This older person’s heart is less able to respond to increased oxygen demands from infection because of age-related changes in the myocardium. Further, because this older person is malnourished and thus likely to have anemia, any capacity to meet increased oxygen demands is stymied. Along with airway, breathing and circulation are two of the three most basic needs.

DIF: Analysis REF: 75 TOP: NCLEX: Physiological Integrity

OBJ: 3

8. An older-person male who spray-paints houses for a living has had a myocardial infarction (MI). Which intervention should the nurse implement to prevent adverse health effects from his occupational history? a. Provide low-cholesterol diet meals. b. Avoid substances that are hepatotoxic. c. Promote coughing and deep breathing. d. Analyze the electrocardiogram’s rhythm. ANS: C Feedback A

DIF:

Incorrect. Hypercholesterolemia is a common comorbidity with coronary artery disease; if his total cholesterol is greater than 5.2 mmol/L, the nurse should provide a low-cholesterol diet. Incorrect. Inhalation of paint vapour over a long period has adverse effects, primarily on the lungs. However, some hepatotoxic substances are used in health care, such as immunosuppressants and aminoglycoside antibiotics, and must be given to this individual with caution. Correct. The nurse implements coughing and deep breathing because he has a history of exposure to environmental toxins from the paint vapour. Therefore, to promote oxygenation and ventilation, and to prevent atelectasis and pneumonia, the nurse instructs him to cough and deep breathe at regular intervals. Incorrect. Because he had an MI, the nurse monitors the heart’s rhythm closely to detect ventricular dysrhythmias, tachycardia, and other potentially harmful rhythms, but this is unlikely to be directly related to his occupational history. Application

REF: 77 (Box 6-5)

OBJ: 2

TOP: NCLEX: Physiological Integrity 9. The nurse administers an antibiotic and naproxen, an anti-inflammatory medication, to an older female adult. Which laboratory test result should the nurse monitor to gauge if this older person’s kidneys are able to metabolize the medication? a. Urine creatinine b. Indirect bilirubin c. Serum creatinine d. White blood cells ANS: A Feedback A

B C D

Correct. Antibiotics and nonsteroidal anti-inflammatory agents like naproxen can cause kidney damage from various mechanisms; thus the nurse monitors the urine creatinine because it reflects the system’s ability to clear waste products and is especially important for gauging appropriate medication administration. Incorrect. Unconjugated (indirect) bilirubin reflects the liver’s ability to conjugate serum bilirubin. Incorrect. Serum creatinine, also a reflection of renal function, usually remains stable throughout life. Incorrect. White blood cells can reflect the degree of infection or inflammation in the body; however, the ability of an older person to respond to infection can be diminished, thus this can be a misleading indicator.

DIF: Application REF: 77 TOP: NCLEX: Physiological Integrity

OBJ: 3

10. An older person who recently had surgery complains of pain at a level of 3 out of 10 and constipation during the postoperative primary care visit. Which intervention should the nurse implement to first facilitate elimination in this older person? a. Encourage use of a laxative. b. Review medication list. c. Promote fibre in the diet. d. Suggest added fluid intake. ANS: B Feedback A B

C D

Incorrect. Use of a laxative can be contraindicated and is the therapy of last resort for constipation caused by factors other than opioid analgesics. Correct. The nurse begins by reviewing the medication list to find substances that are likely to cause constipation, such as opioid analgesics, antidepressants, and others. If the patient is taking an opioid analgesic, and because the patient rates the pain as 3 out of 10, a change in pain medication can help to relieve constipation. Incorrect. Promoting fibre in the diet is a reasonable intervention, but can be made unnecessary by omitting the opioid analgesic. Incorrect. Increasing fluid intake is a reasonable nursing intervention for older persons with and without constipation, but can be unnecessary for this older

person. DIF: Analysis REF: 80 TOP: NCLEX: Physiological Integrity

OBJ: 3

11. Which age-related change contributes to anorexia and weight loss in the older person? a. Excessive saliva b. Fewer taste buds c. Wearing dentures d. Softened tooth enamel ANS: B Feedback A B

Incorrect. Saliva production tends to decrease with age. Correct. The number of taste buds declines with age and can decrease the enjoyment of food. This can result in less motivation to eat and a resulting weight loss or loss of appetite. Incorrect. As long as dentures fit properly and the wearer practises good oral hygiene, wearing dentures does not necessarily contribute to anorexia and weight loss. Incorrect. Older persons tend to lose enamel.

DIF: Knowledge REF: 79 TOP: NCLEX: Physiological Integrity

OBJ: 1

12. An older person has been diagnosed with a nutrition imbalance. Which age-associated intestinal problem should the nurse be aware of when planning goals and interventions to improve this older person’s nutritional status? a. Older persons have less intrinsic factor secretion. b. Older persons have short, broad, small intestinal villi. c. Older persons have decreased gastric smooth muscle. d. Older persons have decreased large intestinal motility. ANS: B Feedback A B

C D

Incorrect. Decreased intrinsic factor secretion leads to pernicious anemia due to inability to absorb vitamin B12 in the stomach. Correct. Villi of the small intestine shorten and widen with age and, as a result, become less functional. This contributes to malabsorption of nutrients despite a healthy diet because nutrients are absorbed primarily in the small intestine. The concept of malabsorption is what the nurse uses to plan care, because this nursing diagnosis refers to the inability of the body to absorb nutrients due to biological factors. Incorrect. Gastric smooth muscle is not present in the intestines. Incorrect. Decreased large intestine motility is an age-associated problem; however, this should have no impact on absorption in the small intestine.

DIF: Application REF: 80 TOP: NCLEX: Physiological Integrity

OBJ: 1

13. Common health promotion advice for older persons is to not smoke, or to stop smoking. What other health teaching should the nurse provide to promote healthy lungs in an older person? a. Obtain annual influenza immunization. b. Maintain adequate intake of fluids. c. Ensure regular intake of vitamin D. d. Maintain a healthy weight. ANS: A Feedback A

C D

Correct. The nurse should recommend that the older person obtain an annual influenza immunization. The lack of basilar inflation, an ineffective cough response, and a less efficient immune system pose potential problems for older persons who are sedentary. Incorrect. Maintaining adequate intake of fluids is important in preventing constipation and promoting healthy digestion but is unrelated to maintaining healthy lungs. Incorrect. Ensuring regular intake of vitamin D ensures promotion of healthy bones and muscles but is unrelated to healthy lungs. Incorrect. Maintaining a healthy weight promotes a healthy heart but is unrelated to healthy lungs.

DIF: Knowledge REF: 77 (Box 6-5) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 3

Chapter 07: Social, Psychological, Spiritual, and Cognitive Aspects of Aging Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following statements is true about sociological theories of aging? a. Disengagement theory, activity theory, and continuity theory are supported by

data. b. Everyone should be able to achieve the three tasks of Peck’s model of integrity. c. The exercising of rights is not a task of aging in Kelly’s model. d. A person may choose to avoid pursuing inner discovery in old age. ANS: D Feedback A B

C D

Incorrect. None of these theories is clearly supported by data. Incorrect. Peck’s tasks of ego differentiation, body transcendence, and ego transcendence demand a great deal of courage and energy that not everyone possesses. Incorrect. Tasks of aging in Kelly’s model are accepting reality, fulfilling responsibility, and exercising rights. Correct. Some persons do not value inner psychological exploration and remain action oriented even in old age, while others are still subject to the same demands of daily living as they were in middle age.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 94

OBJ: 1

2. Which statement is true about the social, emotional, and spiritual well-being of older

persons? a. Contemporary society has strong norms for the behaviour of adults older than 80 years. b. The transition to old age entails a declining level of contribution to others as one becomes increasingly dependent on them. c. Computers and the Internet have little to contribute to older persons in their need for social support. d. Nurses are often significant sources of social and emotional support for older persons. ANS: D Feedback A B C

Incorrect. The diversity of cultures and individuals in a society like Canada’s means that norms are almost nonexistent for persons older than 80 years. Incorrect. Older persons have a great deal to contribute in wisdom and by example. Incorrect. E-mail and social networking sites are a means of contact and social support for many older persons.

Correct. Nurses are often important confidants and providers of social support in the lives of older persons.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 100

OBJ: 1

3. Which alterations in roles are most likely to have a significant effect on the type of aging

process experienced by the older person? a. Being a grandparent and church member b. Losing employment or a spouse c. Being a friend and patient d. Being a parent and volunteer ANS: B Feedback A

C D

Incorrect. Alterations in these roles are not usually as challenging as loss of employment and loss of a spouse. Grandparenting and church membership can offer the potential for enhanced social experiences for an older person; however, adults can age well without them when more basic needs are met. Correct. The loss of employment or a spouse are likely to be devastating for an older person for economic and biopsychosocial reasons. Losing a job not only includes the loss of income and benefits, most notably health insurance, but can include the loss of lifestyle, identity, and sense of importance or purpose in life. When an older person loses a spouse, the loss can include economic security, especially for women, and societal roles. Incorrect. Alterations in these roles are not always as acutely demanding as loss of a spouse or retirement. Incorrect. Alterations in these roles usually call for little or gradual adjustment.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 95 (Box 7-2) OBJ: 2

4. In which context are members of a cohort described when using the age-stratification

theory to explain the effect of similar events, conditions, and circumstances? a. Historical context b. Biological context c. Sociological context d. Chronological context ANS: A Feedback A

B C

Correct. In the age-stratification theory, historical context is used to understand members of a cohort in terms of similar events, conditions, and circumstances and the effect these things have on the group as a whole. A good example of such a cohort is older persons who lived through World War II. Incorrect. Biological context is not important in considering the age-stratification theory. Incorrect. The age-stratification theory is a sociological theory of aging that uses historical context to describe cohorts.

Incorrect. Chronological context of a cohort will span a range, but historical context is what describes the cohort.

DIF: Knowledge REF: 92 TOP: NCLEX: Psychosocial Integrity

OBJ: 2

5. An older male adult with severe knee pain tells the nurse how he lost his job and his home

after starting a new business when he was 48 years old. Now he lives alone and relies on welfare. Using Jung’s theory, what in this individual’s life is the most pivotal in his personality development? a. Living alone b. Meagre income c. Severe knee pain d. Job loss and home loss ANS: D Feedback A B C

Incorrect. Living alone is a situation that is the result of many factors coalescing in an individual’s life. Incorrect. A meagre income can be a result of the individual’s life work and other individual choices and events. Incorrect. Personality can affect how an individual deals with pain, and the pain can affect an individual’s personality; however, the reader does not know if the pain is old or new and thus cannot make the determination. Correct. Jung theorizes that the personality forms, in part, after crisis, as an individual moves from extroversion to introversion in aging.

DIF: Analysis REF: 94 TOP: NCLEX: Psychosocial Integrity

OBJ: 1

6. The nurse plans care for older persons who are in good health but isolated from their

families. If the nurse’s goal is to move the adults toward gerotranscendence, which of the following interventions should the nurse use in the plan of care? a. Give a daily tea party for the group. b. Call each family to encourage visiting. c. Encourage each person to focus on individual activities. d. Assist them to resume midlife patterns. ANS: C Feedback A B C

Incorrect. Individual activities or self-selected activities are satisfactory. Incorrect. Solitude is satisfactory. Correct. In Tornstam’s theory, aging offers the potential for gerotranscendence, a culmination of an individual’s life, wisdom, and spiritual growth that allows the older person to live contentedly with and without social activities. An older person spends more time on meditation and solitude, and less time on materialism and self-consciousness about body image. Incorrect. Midlife patterns are no longer relevant to contentment.

DIF: Application REF: 95 TOP: NCLEX: Psychosocial Integrity

OBJ: 1

7. The nurse observes older female adults learning advanced knitting techniques. The nurse

concludes that this is a suitable learning activity for these women because it accomplishes which goal? a. It helps to maintain joint flexibility. b. It improves the group’s cohesiveness. c. It provides a needed social opportunity. d. It adds to their existing knowledge base. ANS: D Feedback A B C D

Incorrect. Joint flexibility is a physical activity and not necessarily a learning activity. Incorrect. The members share enjoyment of knitting; other than being female and older, the group does not necessarily have a special bond on which to build. Incorrect. The need for socializing is not evident. Correct. Learning advanced techniques is a suitable activity for older persons because it builds on knowledge they have already; further, it is suitable because it is concrete and practical for experienced knitters to develop advanced skills.

DIF: Application REF: 100-101 OBJ: 5 TOP: NCLEX: Health Promotion and Maintenance 8. The nurse at a nursing home wants to help decrease the risk of Alzheimer’s disease among

the residents. Which of the following should the nurse do to implement this goal? a. Assist residents with ambulation to meals. b. Offer beads for the residents to string on yarn. c. Show movies that the residents choose. d. Keep the curtains open in the residents’ rooms. ANS: A Feedback A B

C D

Correct. Engaging in physical activity and social interaction are associated with a lower risk for Alzheimer’s disease. Incorrect. This is unlikely to decrease the risk for Alzheimer’s disease because stringing beads is a passive, sedentary activity; physical activity is associated with a lower risk for Alzheimer’s disease. Incorrect. Watching movies is a sedentary but not mentally stimulating activity for an adult with normal intelligence. Incorrect. Social interaction is associated with a lower risk for Alzheimer’s disease. Keeping the curtains open can make the resident’s room more pleasant but is likely to be counterproductive in lowering the risk because brightening the room can entice the resident to stay in the room and decrease social interaction.

DIF: Application REF: 91 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance

9. Which physiological change in the brain is the reason the nurse allows more time for older

persons to answer questions? a. Increased secretion of acetylcholine b. Decreased secretion of neurotransmitters such as dopamine c. Loss of brainstem neurons d. Atrophy of dendrites in the cerebral cortex ANS: D Feedback A B C D

Incorrect. The secretion of cholinesterase, the enzyme that inactivates acetylcholine in the synapse, does not increase with aging. Incorrect. Changes in the transmission of neurotransmitters are associated with the atrophy of dendrites. Incorrect. It is the cerebral cortex that loses neurons with age. Correct. Dendrites are the receiving end of neurons (receiving electrochemical signals) and the branched ends extending from the cell body. The atrophy of dendrites contributes to slower thought processes with aging because the synapses are impaired; this changes the transmission of neurotransmitters that are vital in the transmission of an electrical impulse from neuron to neuron.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 98

OBJ: 4

10. The nurse provides opportunities for nursing home residents to read aloud to others.

Which cognitive skill is this nursing intervention most likely to improve? a. Verbal fluency b. Logical analysis c. Object naming d. Visuospatial skills ANS: A Feedback A B C D

Correct. Allowing residents to read aloud helps to improve and maintain verbal fluency because it provides an opportunity to practise those skills. Incorrect. Reading aloud does not usually require analysis. Incorrect. Reading aloud is unlikely to improve object recall unless displaying objects is part of the reading. Incorrect. Visuospatial skill is the ability to perceive the relationship of objects in terms of the space each object occupies; reading aloud is unlikely to improve this skill.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 99

OBJ: 5

11. Crystallized intelligence consists of: a. Memories created more than 20 years ago. b. Knowledge and abilities that the person acquires through education and life. c. Skills that are biologically determined.

d. Education acquired through post-secondary education. ANS: B Feedback A B C D

Incorrect. Memory is not the sole factor in types of intelligence. Correct. Crystallized intelligence is developed throughout life and consists of both formal education and life experience. Incorrect. This is the definition of fluid intelligence. Incorrect. Although formal education plays a part in crystallized intelligence, it does not have to be post-secondary.

DIF: Knowledge REF: 99 TOP: NCLEX: Physiological Integrity

OBJ: 5

Chapter 08: Nutritional Needs Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. When providing health teaching to an older person, which of the following nutrition

information guidelines should be recommended for the older person’s daily diet? a. A daily fibre intake of 15 g b. No more than 1500 mg/day sodium intake c. Five servings of meat per day d. Vitamin D intake of 600 to 800 IU/daily ANS: B Feedback A B C D

Incorrect. Older persons require 20 to 35 g of fibre each day. Correct. No more than 1500 mg/day of sodium is recommended for older persons. Incorrect. Older persons should consume two to three servings of meat per day. Incorrect. 400 IU is the recommended daily intake of vitamin D.

DIF: Comprehension REF: 109 TOP: NCLEX: Integrity NCLEX: Physiological

OBJ: 1

2. Which one of the following is a potential mechanical risk factor that may potentiate

malnutrition in older persons? a. Memory loss b. Removal from usual cultural patterns c. Decreased or diminished vision or blindness d. Loneliness, isolation, or living alone ANS: C Feedback A B C D

Incorrect. Memory loss is a psychosocial risk factor. Incorrect. Removal from usual cultural patterns is a psychosocial risk factor. Correct. Decreased or diminished vision or blindness is a mechanical risk factor. Incorrect. Loneliness, isolation, or living alone is a psychosocial risk factor.

DIF: Knowledge REF: 111 (Box 8-2) TOP: NCLEX: Physiological Integrity

OBJ: 1

3. Which of the following is a true statement about nutrition for older persons? a. The older person should be encouraged to practise strict controls on cholesterol

intake to ensure protection against heart disease. b. Transportation can be a critical factor in nutritional insufficiency in older persons. c. Ethnic cooking is a major concern for older persons, because it makes balanced

nutrition difficult to maintain. d. There are no government programs to promote congregate dining among older

persons. ANS: B Feedback A B

C D

Incorrect. Cholesterol phobia, or excessive concern over cholesterol control, can contribute to malnutrition in older persons. Correct. Older persons often have difficulty in obtaining adequate transportation to remote supermarkets and may choose lighter weight but less nutritious food items rather than heavy fresh fruits and vegetables. Incorrect. Every culture has some particular foods and ways of preparing food that can bring great comfort for a person raised in that culture. Incorrect. The United Way and other charitable organizations provide funding for outreach centres that serve social meals open to all older persons, regardless of their ability to pay.

DIF: Comprehension REF: 111 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 2

4. Which of the following is a true statement about dental health in older persons? a. Most people can expect to lose most of their teeth by old age. b. Excessive saliva production is a common problem among older persons. c. Functional and cognitive limitations may contribute to poor oral hygiene. d. A little blood on the toothbrush is normal. ANS: C Feedback A B C

Incorrect. Older persons can lose teeth, but more adults are retaining their teeth into old age. Tooth loss is most often a result of periodontal disease. Incorrect. Inadequate saliva production (xerostomia) is a common problem for older persons. Correct. Older persons may not have had the advantages of preventive treatment, and those with functional and cognitive limitations may be unable to perform oral hygiene. Incorrect. Bleeding from the gums is a sign of periodontal disease.

DIF: Comprehension REF: 112 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 5

5. Bowel function in the older person can be a source of concern, and potentially serious

problems may develop. What mechanical factors may contribute to constipation in the older person? a. Inadequate toileting b. Abscess or ulcer of the anal sphincter c. Altered cognitive status d. Irregular defecation habits ANS: B Feedback

A B C D

Incorrect. Inadequate toileting is a functional factor contributing to constipation in the older person. Correct. Abscess or ulcer of the anal sphincter is a mechanical factor contributing to constipation in the older person. Incorrect. Altered cognitive status is considered a psychological factor contributing to constipation in the older person. Incorrect. Irregular defecation habit is a functional factor contributing to constipation in the older person.

DIF: Knowledge REF: 109 (Box 8-1) TOP: NCLEX: Physiological Integrity

OBJ: 6

6. The nurse is trying to improve the nutritional status of older persons in a nursing home.

Which one of the following recommendations should the nurse implement? a. Develop a seating chart for the main dining room, based on unit, to facilitate a more organized and efficient meal delivery. b. Replace the fluorescent lighting with candles at every table, to create a cozier, restaurant-like atmosphere. c. Provide nutritious food according to the older persons’ expressed food preferences, with liberal use of seasonings. d. Distribute “nutritional liquid supplements” such as Ensure. ANS: C Feedback A B C

Incorrect. This action is not for the benefit of the residents but for the benefit of management and degrades the dignity of the residents. Incorrect. Older persons require greater amounts of light to see; candlelight can be too dim to allow them to see. Correct. Only nutritious food that is actually eaten can enhance a person’s nutritional status. They are more likely to eat food they like, and seasonings can make food more palatable. Incorrect. These supplements are costly and often are not consumed as ordered.

DIF: Comprehension REF: 124 (Box 8-10) OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 7. The nurse instructs the health care aide to feed an older person. If the nurse is unable to

observe feeding directly, which action should the nurse use to assess the older person’s risk for aspiration immediately following feeding? a. Note the food volume eaten by the older person. b. Observe the older person’s skin colour. c. Inspect for pocketing. d. Monitor the older person for bradypnea. ANS: C Feedback A

Incorrect. The amount of food consumed by an older person is unrelated to the risk of aspiration, so noting the amount of food eaten is unsuitable for detecting

a risk for aspiration. Incorrect. An alteration in circulation as evidenced by a change in skin colour can be a late indicator of aspiration. Thus, a change in skin colour can indicate the presence of aspiration, but the older person with a change in skin colour is not necessarily at risk for aspiration. Correct. The nurse is able to assess the risk for aspiration by assessing the older person for pocketing, residual accumulations of pockets of food in the mouth, which the older person can aspirate after the meal is complete. If food is found in the mouth, the nurse removes it and evaluates the current plan of care. Incorrect. The nurse monitors for tachypnea as an indicator of aspiration; however, tachypnea does not indicate a risk for aspiration.

DIF: Application REF: 118 (Box 8-7) TOP: NCLEX: Physiological Integrity

OBJ: 4

8. An older person who has difficulty using the dominant hand also has a gastrostomy tube.

What should the nurse provide to prevent complications of the gastrostomy tube? a. Use foam swabs to brush teeth. b. Provide oral care every four hours. c. Supply a soft toothbrush and floss. d. Position the older person at 90 degrees for tube feedings. ANS: B Feedback A B

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

DIF: Application REF: 116 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 9. The health care aides working at a long-term care facility need help to properly feed

residents who require assistance with feeding. Which of the following plans should the nurse implement to ensure that the residents are fed properly? a. Instruct the health care aides 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. Feed the residents at different times (e.g., feed one group lunch at 1100 hours, and feed a second group lunch at 1200 hours). ANS: B Feedback

A B

C D

Incorrect. The nurse avoids assigning more than three residents to the aides for feeding; four residents are too many to assist safely. Correct. 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. Incorrect. If a resident needs assistance with feeding, it can be dangerous, humiliating, and frustrating for a resident to attempt self-feeding. Incorrect. If there are insufficient health care aides to assist with all of the feedings at one time, then the residents will potentially have to wait for long periods before being fed. Since the time required to implement feeding assistance is 38 minutes, a lengthy delay can result in adverse effects or injury for the resident, increase the risk of errors for the health care aides, and lead to frustration with the residents. Some of the health care aides will also have to attend to the first group for toileting, etc., and this will again cause a shortage to assist with feeding the second group.

DIF: Application REF: 123 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 10. An older person who has iron deficiency anemia complains of abdominal pain, fullness,

and diarrhea over a period of 24 hours. Which patient data potentially indicate a systemic cause of this individual’s constipation? a. Abdominal pain b. Feeling of fullness c. Loose, watery stools d. Iron deficiency anemia ANS: A Feedback A B C

Correct. Abdominal pain is a potential indicator of an underlying pathological gastrointestinal condition that can manifest as constipation. Incorrect. Feeling full does not cause constipation but can be a nonsystemic indicator of constipation. Incorrect. Diarrhea is not a systemic indicator for constipation, although it can occur simultaneously with constipation since the watery stool leaks around the hard stool. Incorrect. Iron deficiency anemia is an unlikely cause of constipation unless the older person is taking iron supplements; however, the supplements would contribute to a mechanical or pharmacological cause for constipation.

DIF: Application REF: 112 TOP: NCLEX: Physiological Integrity

OBJ: 8

11. An older female adult with alterations in her cognitive status has an increased temperature,

poor appetite, and almost fell beside her bed. What should the nurse consider when caring for this older person? a. The older person may be experiencing loneliness. b. The older person may be demonstrating signs of constipation.

c. The older person may be hungry and feeling weak. d. The older person has a fever and is delirious. ANS: B Feedback A

Incorrect. It is important to note that alterations in cognitive status, incontinence, increased temperature, poor appetite, or unexplained falls may be the only clinical symptoms of constipation in the cognitively impaired or frail older person. Correct. It is important to note that alterations in cognitive status, incontinence, increased temperature, poor appetite, or unexplained falls may be the only clinical symptoms of constipation in the cognitively impaired or frail older person. Incorrect. It is important to note that alterations in cognitive status, incontinence, increased temperature, poor appetite, or unexplained falls may be the only clinical symptoms of constipation in the cognitively impaired or frail older person. Incorrect. It is important to note that alterations in cognitive status, incontinence, increased temperature, poor appetite, or unexplained falls may be the only clinical symptoms of constipation in the cognitively impaired or frail older person.

DIF: Analysis REF: 120 (Table 8-2) TOP: NCLEX: Physiological Integrity

OBJ: 7

12. Which of the following recommendations for daily food intake is correct for older persons

according to Eating Well with Canada’s Food Guide? a. Seven servings of fruits and vegetables b. Five servings of meat and alternatives c. Four servings of milk and alternatives d. Ten servings of grain products ANS: A Feedback A B C D

Correct. The food guide recommends seven servings of fruit and vegetables. Incorrect. The food guide recommends two servings of meat and alternatives. Incorrect. The food guide recommends three servings of milk and alternatives. Incorrect. The food guide recommends six servings of grain products.

DIF: Comprehension REF: 107 (Figure 8-1) OBJ: 1 TOP: NCLEX: Physiological Integrity 13. The following nursing interventions represent the four steps of a nutritional assessment.

Which one would be the final step in the nutritional assessment? a. Measure the midpoint of the upper arm. b. Obtain blood for biochemical serum examination. c. Examine the lips, gums, oral cavity, and skin turgor. d. Obtain a detailed weight history.

ANS: B Feedback A B C D

Incorrect. This assessment includes anthropomorphic measurements such as the height, weight, mid-arm circumference, and triceps skinfold thickness. Correct. The biochemical examination is the final step and includes the serum albumin, transferrin, hemoglobin, and cholesterol levels. Incorrect. The physical examination gathers data about the older person’s current state of health. Incorrect. The first step in a nutritional assessment is to interview the older person to obtain a health and nutritional history and an overview of daily food habits and resources for obtaining food.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 126

OBJ: 8

Chapter 09: Hydration and Continence Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following is a true statement about dehydration in an older person? a. Urine flow gradually decreases in an older person. b. Older persons 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

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

dehydration than middle-aged persons or children. ANS: D Feedback A B C D

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

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 134

OBJ: 1

2. Which one of the following increases the risk for chronic dehydration in older persons? a. Overuse of diuretics b. Poor cognitive function c. Dry mucous membranes d. Fluid loss from vomiting ANS: B Feedback A B

C D

Incorrect. Overuse of diuretics is more likely to cause acute dehydration. Correct. Poor cognitive function, dependence with ambulation, residence in a residential facility, and having four chronic illnesses are factors that increase the risk of chronic dehydration. Incorrect. Dry mucous membranes are reliable indicators of chronic dehydration. Incorrect. Fluid loss from vomiting leads to acute dehydration.

DIF: Knowledge REF: 134 TOP: NCLEX: Physiological Integrity

OBJ: 1

3. Which of the following statements is true about fluid intake for older persons? a. An older person’s daily total volume should be 1000 to 1500 mL. b. Coffee is a suitable beverage for maintaining hydration. c. Sports drinks should not be consumed, because they contain too much sugar. d. The amount of fluid offered with medication administration should be standardized

(at least 100 mL) for an older person. ANS: D Feedback A B C D

Incorrect. Daily total volume should be a minimum of 1500 mL. Incorrect. Caffeine increases urine production and therefore aggravates dehydration rather than relieving it. Incorrect. Sports drinks can be easily absorbed and they help restore electrolyte balance. Correct. Standardizing the amount of fluid offered is one way of consistently providing fluids throughout the day when the older person is awake.

DIF: Comprehension REF: 137 (Box 9-2) OBJ: 2 TOP: NCLEX: Physiological Integrity 4. The most important aspect of care for the nurse to maintain when assisting an older person

with urinary incontinence is which one of the following? a. Ensure the availability of protective rubber garments. b. Use indwelling urinary catheters. c. Use smooth muscle relaxants. d. Maintain a respectful and positive attitude about resolving the underlying problem. ANS: D Feedback A B C D

Incorrect. Rubber garments, in particular, are hot and can cause skin irritation. Incorrect. Internal catheters should be used only for a short time and under limited circumstances. Incorrect. Smooth muscle relaxant use is indicated only for urge incontinence and overactive bladder. Correct. The nurse recognizes that incontinence is a sign of an underlying problem and that it is 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.

DIF: Comprehension REF: 142 (Box 9-5) OBJ: 4 TOP: NCLEX: Physiological Integrity 5. Which one of the following is part of a program for addressing bowel incontinence in an

older person? a. Place the older person on the toilet or commode first thing upon wakening. b. Provide a diet containing 2 g of fibre and 1000 mL of water each day. c. Expect a rapid and full recovery of continence of the bowel. d. Provide patient teaching about exercises to strengthen abdominal and pelvic floor muscles.

ANS: D Feedback A

B C D

Incorrect. The best time for the older person to have a bowel movement depends on the older person’s schedule; usually 20 to 40 minutes after a regularly scheduled meal is when the gastrocolic reflex is active. Incorrect. These amounts of fibre and fluid are less than required to ensure more solid and controllable stool and to protect against dehydration. Incorrect. Unrealistic expectations of rapid and full recovery should not be imposed on the patient. Correct. These exercises can help regain control of elimination function.

DIF: Knowledge REF: 145-47 OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance 6. An older person who is on bedrest has tachycardia and dry mucous membranes, and

decreased urinary output after surgery. Which of the following situations is the nurse’s priority for preventive care because of the patient’s fluid volume status? a. Bowel obstruction b. Delirious behaviour c. Thromboembolic events d. Delayed wound healing ANS: C Feedback A

B C

Incorrect. Dehydration can lead to constipation and in extreme cases a bowel obstruction; however, this is not the nurse’s priority because circulation issues take precedence over a potential gastrointestinal issue. Incorrect. Dehydration increases the risk of delirium, especially in a hospitalized patient, but this has a lower priority than a circulation issue. Correct. This older person is at high risk for a thromboembolic event as a result of bedrest and dehydration. The nurse’s priority is to prevent a thromboembolic event, including deep venous thrombosis and pulmonary embolism, because it is a potentially life-threatening situation. The patient is likely to have low circulating blood volume as evidenced by tachycardia, a compensatory mechanism when the tissues receive inadequate oxygenation. In addition, compensatory mechanisms that help to restore fluid balance are limited in an older person. This results in poorer tissue perfusion and an increased risk for thrombus formation for a patient who is on bedrest, because a lack of skeletal muscle action promotes pooling of blood in the extremities. Incorrect. Dehydration increases the risk of delayed wound healing because optimum wound healing occurs in a moist environment. However, this is a secondary concern until the nurse manages the circulation issue.

DIF: Analysis REF: 134 TOP: NCLEX: Physiological Integrity

OBJ: 1

7. The nurse assesses an older 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 the resident’s oral fluid intake. b. Provide scheduled (timed) toileting. c. Apply an absorbent undergarment. d. Encourage frequent rest periods. ANS: B Feedback A

B C D

Incorrect. The nurse avoids limiting oral fluid intake because older persons, especially those living in residential facilities, are at higher risk for dehydration than younger people. Correct. The nurse provides regular toileting to promote voiding and prevent incontinence for a resident with a potential cognitive impairment. Incorrect. Using absorbent undergarments may be unnecessary if the incontinence can be controlled with regular toileting. Incorrect. 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.

DIF: Application REF: 140 OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance 8. Which type of incontinence is characterized by a large residual urine volume? a. Urge incontinence b. Stress incontinence c. Overflow incontinence d. Functional incontinence ANS: C Feedback A B C D

Incorrect. Urge incontinence is associated with a small residual urine volume. Incorrect. Stress incontinence is associated with a small residual urine volume. Correct. Overflow incontinence is characterized by dribbling, hesitancy, and a large residual urine volume. Incorrect. Functional incontinence is not associated with residual urine volume.

DIF: Knowledge REF: 139 TOP: NCLEX: Physiological Integrity

OBJ: 5

9. The nurse wants to begin helping an older person who is overweight and has urinary

incontinence, with healthy bladder behaviour skills. Which intervention should the nurse implement? a. Begin low-calorie diet for weight management. b. Schedule voiding at two- to four-hour intervals. c. Instruct the older person to practise abdominal exercises. d. Reduce the time between an urge to void and voiding.

ANS: B Feedback A B C D

Incorrect. This can be a reasonable approach to urinary incontinence, but the nurse applies low-cost behavioural techniques first. Correct. Healthy bladder behaviour skills include scheduling voiding at two- to four-hour intervals for residents, either independently or with prompting. Incorrect. It is pelvic floor exercises that help to control urinary incontinence. Incorrect. Bladder training involves increasing the time between the urge to void and voiding.

DIF: Application REF: 140 OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance 10. An older female adult 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 use of caffeinated beverages. b. Coordinate a family conference with the older person. c. Recommend exercises to strengthen the pelvic floor. d. Schedule voiding for every two hours around the clock. ANS: C Feedback A B

Incorrect. Stress incontinence is usually due to weakened pelvic floor muscles, so eliminating caffeinated beverages can be ineffective treatment. Incorrect. Arranging a family conference is premature and potentially embarrassing for the older person. Many therapies are available to decrease this older person’s incontinence. Correct. 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. Incorrect. Scheduled voiding is recommended at two- to four-hour intervals during the day and four-hour intervals at night.

DIF: Application REF: 140 (Box 9-4) TOP: NCLEX: Physiological Integrity

OBJ: 6

11. Which one of the following signs and symptoms is characteristic of a urinary tract

infection (UTI) in an older person? a. Fever b. Dysuria c. Anorexia d. Flank pain ANS: C Feedback A B

Incorrect. Fever is an unreliable indicator of a UTI in an older person. Incorrect. Dysuria is an unreliable indicator of a UTI in an older person.

C D

Correct. Anorexia is a more reliable indicator of a UTI in an older person. Incorrect. Flank pain is an unreliable indicator of a UTI in an older person.

DIF: Knowledge REF: 144 TOP: NCLEX: Physiological Integrity

OBJ: 1

12. The nurse evaluates the urinalysis (UA) of an older female patient who has an indwelling

urinary catheter. The UA report shows gross contamination of the urine. Which one of the following actions should the nurse implement first? a. Provide perineal hygiene. b. Provide urinary catheter care. c. Check the duration of catheterization. d. Obtain a urine specimen from a sterile port. ANS: C Feedback A

Incorrect. This would be the third intervention, where the nurse progresses to perineal care. This follows catheter care because of the principle of asepsis regarding working from the least contaminated to the most contaminated area. Incorrect. This would be the second intervention, which is providing catheter care. Regardless of the cause of the specimen contamination, catheter care is a suitable nursing intervention because it decreases the colony count on the catheter. Correct. This would be the first intervention. Gross contamination of a urine specimen is a costly error because the contaminated urine is unsuitable for evaluation. The nurse responds to the report of contamination by determining how long the catheter has been in place because an increased duration increases the risk of a urinary tract infection from fecal contamination and can affect subsequent nursing interventions. Incorrect. This would be the fourth intervention, which occurs when the nurse obtains another urine specimen from a sterile port. Although the catheter has been washed, the nurse rubs the port with alcohol and withdraws urine with a sterile needle and syringe to prevent the introduction of contaminants into the specimen.

DIF: Analysis REF: 143-44 TOP: NCLEX: Physiological Integrity

OBJ: 5

Chapter 10: Rest, Sleep, and Activity Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following statements is true about sleep in older persons? 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 increases with age. d. The amount of stage III sleep increases steadily throughout life. ANS: A Feedback A

B C D

Correct. Older persons tend to spend less time asleep than younger persons, even though they spend more time in bed. This is because sleep takes longer to arrive and is more fragmented. Incorrect. Leg movements during sleep often tend to increase with age. Incorrect. REM sleep decreases with age. Incorrect. Stage III sleep decreases with age and virtually disappears in older persons.

DIF: Knowledge REF: 151 TOP: NCLEX: Physiological Integrity

OBJ: 1

2. Which factor contributes to sleep problems in older persons? a. Excessive napping b. Daily exercise c. Lethargy d. Rapid eye movement (REM) ANS: A Feedback A B C D

Correct. Excessive daytime napping contributes to changes in sleep during the night. Incorrect. Daily exercise aids in promoting nighttime sleep. Incorrect. Lethargy is conducive to daytime napping, which contributes to changes in sleep during the night. Incorrect. Rapid eye movement (REM) is the period of deep, more restful sleep, and this period decreases in older persons.

DIF: Knowledge REF: 152 (Box 10-3) TOP: NCLEX: Physiological Integrity

OBJ: 1

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 older man’s duration of sleep? a. Instruct the wife to increase her husband’s daily physical activity.

b. Collaborate with the health care provider to administer a hypnotic. c. Teach the wife how to apply a vest restraint during sleep. d. Help the wife plan daily periods for napping and activity. ANS: A Feedback A B

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

DIF: Application REF: 152 (Box 10-3) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 4

4. Which of the following is important to include in the initial assessment for older persons

who are frail and are beginning an exercise program? a. Exercise tolerance testing (ETT) b. The older person’s financial ability to pay for training sessions c. A medical history and physical examination d. Pulmonary function tests (PFTs) ANS: C Feedback A

B C

Incorrect. Fitness tests such as the ETT are warranted in older persons who are beginning a moderately intense or vigorous exercise program. The ETT is not recommended for the frail older person. Incorrect. Expensive training programs are not usually needed. Correct. Any aspect of the older person’s current and past physical and psychological condition can be important in designing an exercise program to suit the individual. Incorrect. Although aerobic capability must be carefully observed, PFTs specifically are not necessary unless pulmonary function is a parameter that the therapeutic program is targeting for improvement.

DIF: Comprehension REF: 160 (Box 10-11) OBJ: 3 TOP: NCLEX: Physiological Integrity 5. During the night, an older female adult complains to the nurse that she has not slept more

than two hours since her admission to the hospital. Which intervention should the nurse implement to increase the duration of this woman’s sleep? a. Inquire about the 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 her a book or suggest she watch a movie. ANS: A Feedback A

B C

Correct. Hospitalization often disrupts normal sleeping patterns, so re-establishing those patterns is the best first step to improving the quality of sleep in the hospital. Incorrect. This is a reasonable approach to complaints of sleeplessness, but it may not be this woman’s problem. Incorrect. Sleep is increasingly fragmented in older persons; however, understanding that issue may or may not help this woman sleep for longer periods. Incorrect. A book or movie can help some people become drowsy, but that will not usually increase the quality or duration of their sleep. In fact, books and movies can be stimulating and decrease the ability to fall asleep.

DIF: Application REF: 155 OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 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 Feedback A B C D

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

DIF: Knowledge REF: 151 TOP: NCLEX: Physiological Integrity

OBJ: 2

7. An older female adult 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 habits. d. Propose volunteer work at a thrift shop. ANS: C Feedback

A B C

Incorrect. Preparing for sleep is a reasonable intervention to propose after completing an assessment. Incorrect. Sipping warm milk is a reasonable intervention to suggest after completing an assessment. Correct. 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. Incorrect. Engaging in meaningful activities can improve the quality of sleep and is a reasonable intervention to propose after the assessment.

DIF: Application REF: 155 OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 8. An older person who is overweight and hypertensive awakens abruptly during the night

with gasping and choking. Which action should the nurse implement to manage this patient’s signs and symptoms? a. Obtain a 12-lead electrocardiogram (ECG). b. Administer an anti-anxiety medication. c. Raise the head of the patient’s bed to 30 degrees. d. Offer a cool cloth and refresh the patient’s bed linens. ANS: C Feedback A

Incorrect. A 12-lead ECG can be a reasonable response if the patient experiences chest pain or pressure, if the nurse suspects myocardial ischemia, or if the nurse finds evidence of ECG changes suggesting myocardial ischemia or injury. Incorrect. A sedative or hypnotic is not indicated, and it is premature to administer one; in addition, for this individual, anti-anxiety medications can aggravate the problem. Correct. The older person is experiencing obstructive sleep apnea (OSA), with symptoms that may include gasping, choking on awakening, morning headache, poor memory, irritability, and personality changes. Often the patient is overweight, smokes, and is hypertensive. Raising the head of the bed allows the patient’s airway to open and thoracic cage to expand. Incorrect. After the head of the bed is elevated and the patient stabilizes, fresh linens and a cool cloth can help to soothe the patient and facilitate rest and sleep.

DIF: Application REF: 154 (Box 10-5) TOP: NCLEX: Physiological Integrity

OBJ: 4

9. The nurse at an assisted-living facility uses the Exercise and Screening for You (EASY)

tool to plan an exercise program for an older-person resident who is in good health except that her height has decreased 1.5 cm. 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 exercises.

ANS: B Feedback A

Incorrect. Red, warm, swollen joints are usually due to gout or rheumatoid arthritis, and the resident does not have these health problems. This is a good recommendation for anyone who exercises. Correct. The nurse needs more information because the resident’s height decreased and the nurse does not know why this happened. Thus, 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 discs, compression fractures, or changes in the curvature of the spine, any of which can be aggravated by exercising incorrectly. With a complete assessment, the nurse can plan a suitable exercise program for the resident. Incorrect. Evaluating an individual’s surroundings when exercising does not alert the nurse who is considering an exercise plan for this resident; this is a good, general recommendation for anyone who exercises. Incorrect. This is a good recommendation for anyone who exercises.

DIF: Application REF: 158 OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 10. The older-person residents of an assisted-living facility are preparing for a 14-day trip to

Europe. Which of the following is the most important exercise for the nurse to recommend for the group? a. Practise standing on one foot for 30 seconds. b. Move light weights in a rowing motion eight times. c. Stretch the hips by pulling the knee to the chest. d. Swim laps in the pool for ten minutes continuously. ANS: D Feedback A

Incorrect. This is a reasonable exercise to recommend because balance tends to decrease with age; however, the cornerstone of the group’s exercise must be endurance. Incorrect. This is a reasonable exercise to recommend because muscle bulk tends to decrease with age; however, the cornerstone of the group’s exercise must be endurance. Incorrect. This is a reasonable exercise to recommend because joint flexibility tends to decrease with age; however, the cornerstone of the group’s exercise must be endurance. Correct. The nurse should recommend endurance exercises for the group, to improve cardiovascular and respiratory conditioning. Endurance training is suitable to prepare the residents to withstand the rigours of travel.

DIF: Analysis REF: 158 TOP: NCLEX: Physiological Integrity

OBJ: 4

11. Which of the following should the nurse recommend as a moderate-intensity exercise for

older persons who are ambulatory and in good health?

a. b. c. d.

Walk 5 to 6 km in 60 minutes. Work in the garden for 50 minutes. Participate in endurance exercises and increase time gradually. Wash and wax the car for 75 minutes.

ANS: C Feedback A

B C

Incorrect. The nurse can safely recommend walking 2.5 km in 30 minutes, but recommending that the older persons walk 5 to 6 km for 60 minutes would be excessive. Incorrect. Older persons should limit gardening to 35 to 40 minutes at a time. Correct. Older persons who are in good health should engage in exercise that moves large muscle groups (e.g., walking briskly, tennis, dancing) and should increase their endurance gradually. Incorrect. The older person can wash and wax a car for a combined 45 to 60 minutes.

DIF: Knowledge REF: 158 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 12. Which of the following are benefits of exercise for nonambulatory older persons? a. Muscle weakness and atrophy may be reversed. b. Incontinence problems will be resolved. c. Memory issues may improve. d. Ambulation will develop. ANS: A Feedback A B C D

Correct. Both muscle weakness and atrophy are functionally relevant and reversible aspects to exercise in nonambulatory older persons. Incorrect. Continence has not been shown to be effected by exercise in the nonambulatory older person. Incorrect. Although functioning and increased satisfaction may occur, there is no research to show improved memory. Incorrect. Exercise in the nonambulatory older person will improve atrophy and weakness, but does not guarantee mobility and ambulation.

DIF: Knowledge REF: 158 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance

Chapter 11: Promoting Healthy Skin and Feet Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following is an important consideration regarding the skin of an older

person? a. Generous amounts of soap should be used for cleansing. b. Sweat glands increase in activity. c. The skin becomes more vulnerable to damage. d. The skin becomes darker in unexposed areas. ANS: C Feedback A

B C D

Incorrect. Because moisture is lost more rapidly from the skin of an older person, excessive use of soap tends to dehydrate the skin more severely than in a younger person. Incorrect. Sweat gland activity does not increase in old age, but moisture is lost more rapidly because the skin is thinner and sebum secretion is reduced. Correct. Thinner skin, reduced sebaceous protection, vascular insufficiency, and longer periods in stationary positions promote skin damage for older persons. Incorrect. Changes of skin colour in areas exposed to the sun are of more concern than those in unexposed areas.

DIF: Knowledge REF: 164 TOP: NCLEX: Physiological Integrity

OBJ: 1

2. Which skin lesion on an older person should be evaluated promptly by a dermatologist? a. A circumscribed, raised area resembling a blob of brown wax b. A multicoloured, raised lesion with an irregular border c. A rough, scaly, pink to reddish-brown lesion d. A brown spot on the skin with no raised area ANS: B Feedback A B C D

Incorrect. This lesion reflects seborrheic keratosis. Correct. This lesion is malignant melanoma. Incorrect. This lesion is an actinic keratosis. Incorrect. This lesion is lentigo.

DIF: Comprehension REF: 168 (Box 11-3) OBJ: 2 TOP: NCLEX: Physiological Integrity 3. Which of the following topical agents is safe to apply? a. Corn starch, to absorb moisture in the groin area b. Betadine, to disinfect a healing pressure ulcer c. An over-the-counter preparation, to dissolve a corn

d. Zinc oxide ointment to an area of excoriation ANS: D Feedback A B C D

Incorrect. Corn starch is a substance that promotes fungal growth. Incorrect. Betadine, hydrogen peroxide, alcohol, and some soaps are damaging to newly formed skin. Incorrect. Corn preparations dissolve healthy tissue along with the corn. Correct. Zinc oxide is designed to coat the skin and replace the skin’s natural oil barrier.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 165

OBJ: 4

4. A 70-year-old woman complains of dry skin and asks for advice. Which advice should the

nurse offer to this older person for improving her dry skin? a. Add oil to bath water to keep skin soft. b. Keep bath water at a tepid temperature. c. Move to a climate with lower humidity. d. Dry the skin vigorously with a rough towel after bathing. ANS: B Feedback A

B C D

Incorrect. 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. Correct. Tepid bath water minimizes moisture loss from skin. Incorrect. Humidity should be maintained at about 60%. The person may not be able to move to another location. Incorrect. Vigorous, rough towel drying increases skin irritation.

DIF: Application REF: 165 (Box 11-2) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 4

5. Which of the following statements is true about impaired skin integrity? a. A stage III pressure ulcer can regress to stage II as the subcutaneous tissues

regenerate. b. Stasis ulcer is another term for pressure ulcer. c. An unstageable wound presents with redness and blistering. d. Anemia and poor nutritional status correlate with poor healing of pressure ulcers. ANS: D Feedback A

Incorrect. Because subcutaneous tissues such as muscle and fat are not regenerated but simply replaced by granular tissue, staging of pressure ulcers is never reversed. Incorrect. Stasis ulcers result from 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. Incorrect. An unstageable wound is covered with eschar or slough, preventing visualization of the wound. The skin requires debriding before the wound can be staged. Correct. Anemia and poor nutritional status correlate with poor healing of pressure ulcers.

DIF: Knowledge REF: 171 TOP: NCLEX: Physiological Integrity

OBJ: 2

6. An older-person female patient with mild peripheral vascular disease complains of foot

pain from a corn. After assessing the patient’s feet, which intervention should the nurse implement to safely alleviate her discomfort? a. Cut out an oval corn pad to make a U shape. b. Use a corn pad slightly larger than the corn. c. Gently remove the corn with a sterile razor blade. d. Tape the toe with the corn to the other toes. ANS: A Feedback A B

C D

Correct. A corn pad that is altered in this way surrounds the corn without adding pressure over it. Incorrect. If an oval corn pad is used without being cut to a U shape, it aggravates pressure over the corn and can reduce circulation to the covered tissue. Incorrect. For surgical removal of a corn, the patient should be referred to a foot care specialist. Incorrect. Taping the toes replaces pressure from the shoe with pressure from the tape.

DIF: Application REF: 177 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 7. Which of the following statements is true about foot care for older persons with diabetes? a. A health care aide is qualified to care for the feet of a diabetic patient, including

trimming the patient’s nails. b. Onychomycosis is eradicated quickly with antifungal creams or powders. c. Toenails should be cut to give a smooth, rounded edge. d. Tinea pedis is treated with topical application of antifungal powders. ANS: D Feedback A B C

Incorrect. Diabetic foot care should be performed only by a nurse with special training, a nurse practitioner, or a podiatrist. Incorrect. Treatment of onychomycosis is very difficult because of the limited blood supply to the nails. Oral medications are expensive and toxic. Incorrect. A toenail should be cut flat across. Rounding can lead to ingrown toenails.

Correct. Tinea pedis is treated similarly to any other fungal infections. Feet, especially between the toes, should be kept dry and clean and should be regularly exposed to sun and air. Topical application of antifungal powders, in addition to the hygiene measures already noted, is the usual treatment.

DIF: Knowledge REF: 178 TOP: NCLEX: Physiological Integrity

OBJ: 2

8. The nurse plans care to protect the skin covering an immobile older person’s greater

trochanter. What is the nurse’s priority intervention when the older person is positioned on the side? a. Turn the patient at least once every hour. b. Place a cushion between the patient’s knees. c. Keep the patient’s skin clean and dry. d. Use the Sims’ position. ANS: A Feedback A

C D

Correct. The most important nursing intervention when an older person is positioned on the side is to relieve pressure on the head of the femur, the greater trochanter, because it is the most prominent bony projection on the side of a body. By turning the older person at one-hour intervals or more frequently, the nurse helps to maintain tissue perfusion, thus providing oxygenation to tissues and allowing the removal of waste from vulnerable skin. Incorrect. The nurse places a pillow between the knees to help maintain physiological body alignment and prevent strain on the hips and spine, and if positioned properly, the pillow can help to 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. Incorrect. The nurse keeps the skin clean and dry to help maintain skin integrity, but this is not as important as maintaining tissue oxygenation. Incorrect. The nurse uses the Sims’ position to supplement turning, because in Sims’ position, the patient is on the side but rotated slightly forward, allowing the chest and abdomen to fall forward and relieve some of the pressure on the patient’s side.

DIF: Analysis REF: 172 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 9. An older person has a vitamin C deficiency. Which of the following does the nurse

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

Feedback A B C D

Incorrect. Carrots sticks are a good source of beta carotene, fibre, and vitamin A, important in the formation of epithelial tissue. Incorrect. Milk provides calcium for bone strength and protein for tissue repair, but these do not address a vitamin deficiency. Correct. Orange slices provide vitamin C, which is important for healthy tissues and gums, tissue repair and healing, and maintenance of blood vessels. Incorrect. Unsalted nuts provide healthy fats, fibre, and other nutrients, but not vitamins.

DIF: Application REF: 175 TOP: NCLEX: Physiological Integrity

OBJ: 4

10. The nurse monitors for which of the following clinical indicators when an older person

complains of pruritus? a. Dry, flaky skin b. Brown macule c. Brownish skin d. Regional edema ANS: A Feedback A

B C D

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

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 164

OBJ: 2

11. The nurse cares for an older male adult 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 application of sunscreen at his neighbourhood health fair. c. Tell him to schedule all outdoor activities after 1600 hours daily. d. Instruct him to wear sun-protective clothing and a hat at all times. ANS: D Feedback A B C

Incorrect. Placing posters is an intervention for a community nurse. Incorrect. Promoting sunscreen at a health fair is an intervention for a community nurse. Incorrect. Scheduling activities after a specific time can be impractical or impossible.

Correct. The nurse caring for an older person instructs him to wear sun-protective garments at all times as well as an effective sunscreen to protect his skin against ultraviolet light to help prevent additional skin cancers.

DIF: Application REF: 168 (Box 11-4) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 4

12. Which infection-control practice should the nurse implement when caring for an older

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

B C D

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

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 166

OBJ: 4

13. An older person sleeps in a recliner with his cool, greyish-coloured feet on the floor. What

should the nurse investigate to assess the vascular status of this older person? a. Ability to stand during activities of daily living b. Lateral ulcerations with brownish discoloration c. Complaints of dull aching and peripheral edema d. History of dyslipidemia and hypertension ANS: D Feedback A

B C D

Incorrect. To assess an older person with signs of arterial insufficiency, the nurse examines the distance the adult can walk without pain. The older person with peripheral arterial disease can stand without pain because dependent positioning of the feet helps to perfuse hypoxic tissues. Incorrect. Lateral ulcerations are clinical indicators of venous insufficiency. Incorrect. Dull aching and peripheral edema are clinical indicators of venous insufficiency. Correct. The nurse examines the older person’s history of a dyslipidemia and

hypertension to help determine the vascular status because histories of these disorders are risk factors for peripheral arterial disease. DIF: Application REF: 169 TOP: NCLEX: Physiological Integrity

OBJ: 2

14. An older male adult has peripheral edema and brownish skin below the knees bilaterally.

Which goal does the nurse use specifically in this older person’s plan of care, to manage his condition? a. Promote perfusion to the periphery. b. Maintain dependent positioning. c. Protect skin from ultraviolet rays. d. Promote lower extremity compression. ANS: D Feedback A B

C D

Incorrect. Perfusion to the peripheral tissues is not this older person’s problem. Incorrect. Dependent positioning uses gravity to pull fluid from higher to lower places; for this patient, the nursing care needs to counteract the gravity pull of fluids, so dependent positioning is contraindicated. Incorrect. Protecting skin from the sun is suitable care for all skin and not specifically related to his condition. Correct. An older person with brownish skin and peripheral edema has clinical indicators of venous insufficiency; therefore, the basis of nursing care for this older person is compression because compression helps to prevent venous pooling and fluid accumulation in dependent interstitial spaces and, thus, prevent edema. The nurse should request that a referral be made to a vascular surgeon.

DIF: Application REF: 169 TOP: NCLEX: Physiological Integrity

OBJ: 4

15. Which nursing intervention is most likely to prevent the creation of an environment that is

conducive to fungal growth? a. Provide oral care with soft-bristled brush. b. Apply nystatin powder to reddened tissue. c. Use mild skin cleansing agents and blot dry. d. Apply gauze soaked with antifungal lotion. ANS: C Feedback A

B C

Incorrect. 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. Incorrect. Reddened tissue can be infected already; nonetheless, applying an antifungal agent is an indicated treatment for a fungal infection. Correct. 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, and all skin, clean and dry and to prevent tissue irritation from harsh drying.

Incorrect. Applying antifungal lotion and keeping an area moist can contribute to fungal overgrowth.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 170-71

OBJ: 4

Chapter 12: Maintaining Mobility and Environmental Safety Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following statements is true about mobility and safety for older persons? 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 Braden Scale provides a measure of a patient’s energy and initiative. d. Lowering the bed and using night lights are interventions to increase patient safety. ANS: D Feedback A B C D

Incorrect. Restraints have not been shown to increase safety and may contribute to morbidity and mortality. Incorrect. Even if a fall does not cause injury, it can contribute to fear of falling, inhibiting activities of daily living. Incorrect. The Braden Scale is used for predicting pressure sore risk. Correct. Adjusting bed height to match the length of a patient’s lower leg and using night lights in rooms and bathrooms are some of many possible interventions to improve patient safety.

DIF: Comprehension REF: 189-90 (Table 12-3) OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 2. The nurse can place an older person into one of four patient rooms. Which one of the

following is a suitable room for an older person? a. A brightly lit, blue room with cozy throw rugs. b. A room with orange carpeting and soft lighting. c. A brightly lit, blue room with waxed vinyl floors. d. A room for television and crafts. ANS: B Feedback A B C D

Incorrect. Throw rugs easily slip, and older persons can trip on them, resulting in injury. Correct. 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. Incorrect. The patient’s feet should not be able to glide easily across the floor, and if the surface becomes wet, a waxed floor can be very slippery. Incorrect. The patient may stumble over children and crafts.

DIF: Application REF: 189-90 (Table 12-3) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 3

3. Which statement is true about assistive devices to aid older persons with impaired

mobility?

a. When using a walker, armless chairs provide more ease when moving from sitting

to standing. b. Assistive devices do not contribute to falls and injuries. c. Older persons should receive assistance in learning how to use the assistive device

from a specialist in occupational or physiotherapy. d. A walker is most useful for unilateral disabilities, but not for bilateral problems. ANS: C Feedback A B C D

Incorrect. Chairs with arms help to push upward to standing from sitting. Incorrect. Improperly selected or improperly used assistive devices can be risk factors for falls and injuries. Correct. Professionals trained in how to fit and use assistive devices are the best people to help the older person using one for the first time. Incorrect. Walkers can relieve stress on arthritic joints bilaterally.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 194

OBJ: 3

4. The overall temperature in your gerontological unit is 17°C (62°F) during the evening

shift. In documenting this concern to administration, which factor is the most important for the health and well-being of older persons? a. It is not fair for older persons to have to deal with an uncomfortable environment. b. Some of the residents are wearing blankets around their shoulders to keep warm. c. An ambient temperature of 17°C (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 Feedback A B C

Incorrect. The issue is not one of fairness but a more fundamental issue of safety. Incorrect. Some of the residents wearing blankets may represent individual temperature preferences. Correct. Under no circumstances should the temperature drop below 18°C, because older persons are at risk for hypothermia. Furthermore, frail older persons will need the temperature to be considerably higher. Incorrect. The purpose is to make the point that the residents are vulnerable to low temperatures, not to make veiled accusations against the administrators.

DIF: Application REF: 196 TOP: NCLEX: Physiological Integrity

OBJ: 5

5. After assessing an older male adult 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, saying he tried to get out of bed but felt dizzy What is the most important intervention the nurse should have implemented to prevent this event? a. Call for someone to bring the sign. b. Show him how to use the call bell. c. Provide a urinal and drinking water.

d. Assess for postural hypotension. ANS: D Feedback A B

C D

Incorrect. This is a reasonable approach to communicating the risk of falls, but it cannot take the place of instructing the patient directly about prevention. Incorrect. The needs of an older person can contribute to the risk of falls as an individual leans and reaches for something; thus, call bell instructions are a reasonable approach for preventing falls. However, before providing the call bell instructions, the nurse needed to tell him to call for help. Incorrect. A urinal and drinking water are common items older persons need, but reaching for them can contribute to falls. Correct. Postural hypotension and cardiovascular disorders should be assessed for and treated as per RNAO guidelines.

DIF: Analysis REF: 194 OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 6. An older male adult was oriented and responded correctly in the hospital, but he is

disoriented and confused in his home after discharge. Which is the first issue the home nurse should examine to determine if an environmental issue is contributing to the patient’s condition at home? a. Complaints of shivering b. Temperature of the household c. Types of food preparation d. Patient indicators of injury ANS: B Feedback A

Incorrect. Asking about shivering can be ineffective with an older person who is confused and disoriented because the response can be incorrect. However, to display respect, the nurse should ask the question. Correct. Older persons are at higher risk of hypothermia in the community because hypothermia is difficult to detect and because, as hypothermia sets in, the older person can respond to a lower temperature. This man has clinical indicators of hypothermia, so the home care nurse assesses the ambient temperature first for a baseline determination because the household temperature should have the most profound impact on his body temperature. Incorrect. The type of food preparation can offer additional clues about the older person’s hypothermia and mental status because eating cold foods like sandwiches and yogurt can contribute to the problem unwittingly. Incorrect. The nurse assesses the older person who is disoriented and confused for injury as a likely cause of a change in mental status. However, because the older person was not confused and was oriented in the hospital, the nurse looks at environmental factors for clinical indicators.

DIF: Analysis REF: 196 OBJ: 5 TOP: NCLEX: Safe and Effective Care Environment

7. The nurse assesses the quality of which patient characteristic 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 Feedback A B C

Incorrect. Stride is not assessed specifically in this test, although it is an aspect of gait and can be a factor in balance. Incorrect. The older person’s speed is not assessed in this test. Correct. Using the Get Up and Go test, the quality of the older person’s movements are assessed: the nurse instructs the individual to rise from a chair, walk, and return to the chair and be seated. Incorrect. Flexibility is not assessed specifically in this test, although it can be an important factor in balance.

DIF: Comprehension REF: 186 (Figure 12-1) OBJ: 3 TOP: NCLEX: Physiological Integrity 8. An older female adult who receives intravenous (IV) fluids is making wide gesticulations

with her arms and insulting the nursing staff loudly. 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. Use a temporary air splint to prevent elbow and wrist flexion. ANS: D Feedback A

Incorrect. 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, padding the arm is a better preventive measure because the padding allows for some movement and prevents the patient from manipulating the IV site. Incorrect. Administration of an antipsychotic agent can be justified for agitation but is not in this case because less intrusive measures are available for initial protective measures. Incorrect. 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. Correct. To help maintain the patient’s independence and permit the administration of IV fluids yet provide safe, effective care, the nurse protects the IV insertion site with an air splint from occupational therapy. This will prevent flexion at the elbow and wrist but allow free movement at the shoulder. Also, padding the IV site protects it against bumps from her movements and prevents

manipulation of the IV by her other hand. DIF: Analysis REF: 193 (Box 12-5) TOP: NCLEX: Safe and Effective Care Environment

OBJ: 4

9. The nurse determines that an older person who has chronic bronchitis is at high risk for

falls, but he repeatedly tries to ambulate without assistance. Which alternative measure to restraints is contraindicated for this older person? a. Inform staff about his risk for falls. b. Place a concave mattress on the bed. c. Provide frequent walks in the hallway. d. Help him learn to use an assistive device. ANS: B Feedback A

C D

Incorrect. Communicating the risk for falls is a suitable alternative measure to restraints for him because it employs multiple people to observe, manage, and lower his fall risk. Correct. A concave mattress is a restraint alternative, but it is contraindicated for this patient who has chronic bronchitis because lowering the relative position of his torso in relationship to the head and lower extremities puts extra pressure on the diaphragm and restricts chest expansion. This makes the work of breathing much more difficult for him and is contraindicated because chronic bronchitis is an obstructive breathing disorder. Incorrect. Providing frequent walks can be an effective restraint alternative for this older person if he is restless or bored. Incorrect. The nurse helps him to learn how to use an assistive device to help avoid the use of restraints.

DIF: Application REF: 193 (Box 12-4) TOP: NCLEX: Safe and Effective Care Environment

OBJ: 4

10. The nurse wants to encourage an older female adult who lost her balance and fell to

include daily exercise as a means of improving her balance and strength. What recommendation and intervention according to the RNAO Best Practice Guideline (BPG): Prevention of Falls and Fall Injuries in the Older Adult is appropriate for the older person? a. Tell the older person to use an assistive device until her balance and strength improve. b. Implement a multifactorial fall prevention intervention to prevent future falls. c. Help the older person to learn how to exercise the core group of muscles. d. Instruct the older person to enroll in an exercise program for eight weeks. ANS: B Feedback A B

Incorrect. Using an assistive device can help to prevent falls; however, assistive devices are not part of an exercise program. Correct. The BPG recommends that multifactorial components—staff education, environmental modifications, exercise, mobility aids, medication review, hip

protectors, and post-fall problem solving—should be incorporated to prevent future falls. Incorrect. Though the BPG states that, while the relationship between exercise and reducing the risk for falls is strong, exercise alone imparts no protective benefit against falls. Incorrect. Though the BPG states that, while the relationship between exercise and reducing the risk for falls is strong, exercise alone imparts no protective benefit against falls.

DIF: Application REF: 192 OBJ: 3 TOP: NCLEX: Safe and Effective Care Environment 11. The nurse is discharging an older female adult who is using a walker from rehabilitative

care. Which observation does the nurse use to determine that this patient is prepared for discharge? a. The patient holds the front of the walker. b. The patient has a walker with four wheels. c. The patient takes four steps into the walker. d. The patient takes the walker to the elevator. ANS: D Feedback A B C D

Incorrect. Older persons should use the arms of a walker for stability. Incorrect. 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. Incorrect. To use a walker correctly, she should take two steps at a time into the walker. Correct. The older person 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.

DIF: Application REF: 194 OBJ: 6 TOP: NCLEX: Safe and Effective Care Environment 12. Driving cessation has been associated with which of the following? a. Decreased social integration b. Decreased income c. Increase in falls d. More prescription medications ANS: A Feedback A

B C D

Correct. Driving cessation has been associated with decreased social integration, decreased out-of-home activities, increased depressive and anxiety symptoms, decreased quality of life, and increased risk of nursing home placement. Incorrect. No correlation between income and driving cessation has been made. Incorrect. Falls risks do not increase with driving cessation. Incorrect. Having your license taken away does not directly correlate with being

prescribed more medications. DIF: Knowledge REF: 199 TOP: NCLEX: Psychosocial Integrity

OBJ: 6

13. The nurse is assessing an older person in order to plan for fall screening prevention. What

information should the nurse gather for the plan of care? a. Information about the environment in hospital and at home b. The patient’s emotional status c. The patient’s financial status d. The patient’s occupational history ANS: A Feedback A

B C D

Correct. The nurse uses information about lighting, flooring, apparel, and other issues from the environmental assessment of an older person to plan individualized fall prevention measures. Incorrect. The nurse may examine the emotional status to find out if the older person is able to cope with physical changes that may cause falls. Incorrect. Financial issues are not related directly to a risk for falls. Incorrect. Occupational history is not related directly to a risk for falls.

DIF: Knowledge REF: 190 (Table 12-3) TOP: NCLEX: Safe and Effective Care Environment

OBJ: 7

Chapter 13: Assessment Tools in Gerontological Nursing Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following should the nurse include in the psychosocial assessment of an older patient? a. Comorbid diseases b. Joint pain c. Genetics d. Family relationships ANS: D Feedback A B C D

Incorrect. Comorbid diseases are part of a medical history. Incorrect. Pain is an important influence on both the patient’s current well-being and the patient’s response to future stress. Incorrect. Genetic factors provide important clues about an older person’s medical risks. Correct. Information about family relationships is important for the integration of the older person’s life: it provides important clues about sources of stress, support, food, companionship, and other issues. The Family APGAR assessment tool should be used.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 206

OBJ: 5

2. Which type of assessment tool gives the most reliable results for an older person? a. Medical history b. Self-report c. Observational d. Report-by-proxy ANS: C Feedback A

B C

Incorrect. The medical history provides information about the physical status of an older person in the past, but can provide little information about past psychosocial, environmental, and other issues pertinent to the health and wellness of older persons. Incorrect. A self-report tends to overestimate the person’s abilities and health. Correct. An observational tool gives objective results based on the nurse’s observation and the older person’s complaints as told to the nurse. The nurse uses information obtained from subsequent reassessment and compares the new data to the baseline data to identify trends and constants. Incorrect. Report-by-proxy, used primarily when the person is cognitively impaired, tends to underestimate the person’s actual abilities.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 205

OBJ: 2

3. The FANCAPES model represents Fluids, Aeration, Nutrition, Communication, Activity, Pain, Elimination, and Socialization. When would this tool be used to assess an older person? a. To determine functional performance b. To determine mental status c. To determine physical assistance d. To determine caregiver burden ANS: A Feedback A B C D

Correct. FANCAPES emphasizes the determination of basic needs and the individual’s functional ability to meet these needs independently. Incorrect. Mental status assessment is determined with the Mini-Mental State Exam (MMSE). Incorrect. Physical assistance is determined with the use of the Barthel Index. Incorrect. Caregiver burden is determined by the Caregiver Strain Index.

DIF: Knowledge | Application REF: 207 (Table 13-1) OBJ: 3 TOP: NCLEX: Psychosocial Integrity 4. Which tool is used to assess an older person’s functional capability? a. ADL b. MMSE c. OBRA d. FIM ANS: D Feedback A

B C D

Incorrect. Tools such as the Katz Index are used to measure the patient’s ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Incorrect. The Mini-Mental State Exam (MMSE) is a tool for assessment of cognitive function. Incorrect. The Omnibus Budget Reconciliation Act (OBRA) is the 1987 law that mandated nursing home reform in the United States. Correct. The Functional Independence Measure (FIM) is the most comprehensive functional assessment tool for rehabilitation settings.

DIF: Knowledge REF: 208 TOP: NCLEX: Psychosocial Integrity

OBJ: 3

5. Which question or command is a part of the Geriatric Depression Scale (GDS)? a. “Do you have the coordination, balance, and strength to participate in day-to-day life?”

b. “How often does your family provide support for you?” c. “Do you prefer to stay at home rather than go out and do things?” d. “Please repeat the three words I asked you to remember.” ANS: C Feedback A B C D

Incorrect. This is part of the FANCAPES questionnaire under the Activity section. Incorrect. This is part of the Family APGAR, which assesses a family’s capability for adaptation, partnership, growth, affection, and resolution. Correct. A “yes” answer to this question, which is part of the Geriatric Depression Scale (GDS), contributes to an assessment of depression. Incorrect. This is part of the Mini-Mental State Exam (MMSE).

DIF: Comprehension REF: 213 (Figure 13-1) OBJ: 3 TOP: NCLEX: Psychosocial Integrity 6. Which one of the following categories is not found in the Fulmer SPICES assessment tool? a. Pain b. Confusion c. Falling d. Incontinence ANS: A Feedback A B C D

Correct. Pain is not one of the SPICES categories; the P in SPICES stands for “problems with eating or feeding.” Incorrect. Confusion is the C in SPICES. Incorrect. Evidence of falling is the E in SPICES. Incorrect. Incontinence is the I in SPICES.

DIF: Knowledge REF: 216 TOP: NCLEX: Psychosocial Integrity

OBJ: 3

7. Which assessment tool is the most comprehensive exam of an older person’s functional status? a. Katz Index b. Fulmer SPICES c. The Functional APGAR Evaluation Tool d. The Older Americans Resources and Services (OARS) instrument ANS: D Feedback A B

Incorrect. The Katz Index is a basic assessment tool that evaluates most measures of activities of daily living. Incorrect. The Fulmer SPICES assessment tool is shorter than the OARS and

C D

less comprehensive. Incorrect. The Functional APGAR Evaluation Tool does not exist. There is a Family APGAR tool, which addresses a family’s functional abilities. Correct. The OARS tool evaluates an older person’s ability, disability, and capacity in terms of social resources, economic resources, physical health, mental health, and ability to perform activities of daily living.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 215

OBJ: 4

8. Which of the following does the nurse do when preparing to perform a skilled and detailed assessment of an older person that is not usually required when assessing a younger individual? a. Provide for adequate privacy. b. Allow more time for assessing. c. Gather all needed supplies. d. Complete the evaluation in one sitting. ANS: B Feedback A B

C D

Incorrect. The nurse provides adequate privacy when assessing anyone. Correct. To assess an older person, the nurse allows for more time because there is more information to collect and the response time of an older person can be longer than that of a younger individual. Incorrect. The nurse gathers all supplies required during the assessment beforehand when assessing anyone. Incorrect. The nurse prepares to complete the assessment in more than one sitting, if necessary, and with the help of a team, in many sittings.

DIF: Comprehension REF: 205 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 5

9. Why should a new nurse use a standardized assessment tool? a. It allows for electronic data collection and analysis. b. It increases the likelihood of collecting the most accurate data. c. It is a substitute for possessing refined interviewing skills. d. It provides an automated means of choosing nursing diagnoses. ANS: B Feedback A B

Incorrect. Standardized assessment tools are not necessarily electronic. Correct. By learning how to use an assessment tool and following some basic rules, the new nurse can collect reasonably reliable assessment data without using advanced interviewing skills. Incorrect. A standardized tool is only as good as the nurse administering the tool; as the nurse’s skill level for assessing an older person increases, the data collected will increase in comprehensiveness and reliability.

Incorrect. After data collection, the new nurse must analyze the data to determine suitable nursing diagnoses; most assessment tools do not perform the analysis in place of the nurse’s judgement.

DIF: Comprehension REF: 205 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 1

10. The nurse assesses an older female adult in midmorning and, in a normal-toned voice, asks her, “Do you walk to the library to borrow books?” How should this nurse improve an assessment of an older person? a. Assess her earlier in the day. b. Get this data from the family. c. Use a soft voice for questions. d. Ask her how she obtains books. ANS: D Feedback A B

Incorrect. Midmorning is a good time to interview older persons because they are likely to be more alert at this time and not as likely to be awaiting a meal. Incorrect. Report-by-proxy data is not as reliable as data collected by the nurse’s observations because this type of report tends to underestimate the person’s abilities. Incorrect. The nurse does not have to use a soft voice when asking questions about borrowing books because it is not a sensitive topic such as sexual practices or how someone obtains food. Correct. While interviewing for an assessment, the nurse avoids directing the conversation or the older person’s responses in any manner and thus uses open-ended questions as much as possible.

DIF: Analysis REF: 205 OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment 11. Which functional assessment tool asks about the mechanical and psychological factors affecting an older person’s ability to maintain an adequate diet? a. Katz Index b. FANCAPES c. Functional Independence Measure d. Older Americans Resources and Services ANS: B Feedback A B

Incorrect. The Katz Index assigns a score to an older person’s level of dependence in performing activities of daily living (ADLs). Correct. FANCAPES is a prioritized and comprehensive functional assessment tool used to evaluate basic needs and the older person’s ability to meet those needs; it asks pointed questions about fluids, aeration, nutrition, communication, activity, pain, elimination, and socialization. Incorrect. The Functional Independence Measure is the most comprehensive

assessment for the rehabilitation setting and includes the evaluation of ADLs, mobility, cognition, and social functioning. Incorrect. The OARS tool examines an older person’s ability, disability, and capacity to function in five categories.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 206

OBJ: 6

12. Which of the following is considered a functional activity needed for independent living (an instrumental activity of daily living, or IADL)? a. Feeding b. Dressing c. Washing clothes d. Getting out of bed ANS: C Feedback A B C D

Incorrect. Feeding is an activity of daily living, or ADL. Incorrect. Dressing is an ADL. Correct. Washing and hanging up clothes is an IADL, needed for independent living. Incorrect. Getting out of bed is an ADL.

DIF: Knowledge REF: 208 TOP: NCLEX: Physiological Integrity

OBJ: 4

13. The nurse assesses an older male adult who has Alzheimer’s disease and his caregiver. Which information from the caregiver warrants further investigation by the nurse to assess the caregiver for strain? a. The patient wants to stay home. b. The patient sleeps on two pillows. c. The patient sits in the chair all day. d. The patient does not like to be alone. ANS: D Feedback A B C D

Incorrect. Wanting to stay home can be managed, as long as the older person can be left alone safely or the caregiver has someone to stay with him. Incorrect. Sleeping on two pillows can be a preference or a requirement for living with heart failure, but it should not create undue stress. Incorrect. Sitting in a chair all day can be managed as long as he is willing to make trips to the bathroom, go to bed at night, and so on. Correct. The nurse investigates the older person’s preference for continuous company because providing companionship for another person can become a source of stress. After completing an assessment of caregiver strain, the nurse can offer suggestions and provide resources for relief for the caregiver.

DIF: Application REF: 214 (Figure 13-2) TOP: NCLEX: Psychosocial Integrity

OBJ: 4

Chapter 14: Safe Medication Use for Older Persons Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian 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 Feedback A

C D

Correct. 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 persons can also decrease intestinal motility, thereby complicating the titration of medications or introducing new adverse effects through drug–drug interactions. Incorrect. 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. Incorrect. Reduced liver mass and hepatic dysfunction can impair oxidative metabolism, which can lead to an accumulation of toxic levels of a drug. Incorrect. Impaired renal function can impair excretion of drugs through the kidney.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 220

OBJ: 1

2. Which of the following processes is not increased in the early morning? a. Fibrinolytic activity b. Osteoarthritis pain c. Asthma symptoms d. Rheumatoid arthritis pain ANS: D Feedback A B C D

Incorrect. Fibrinolytic activity is increased in the early morning. Incorrect. Pain from osteoarthritis is more severe in the morning. Incorrect. Asthma symptoms peak about 0400 to 0500 hours. Correct. Pain from rheumatoid arthritis is more severe in the late afternoon.

DIF: Knowledge

REF: 225 (Table 14-2)

OBJ: 1

TOP: NCLEX: Physiological Integrity 3. Which of the following medications correctly matches the older-person condition given,

according to current medical knowledge? a. Alprazolam (Xanax) for depression at bedtime b. Buspirone (BuSpar) for chronic anxiety states c. Amitriptyline (Elavil) for depression in the morning d. Haloperidol (Haldol) long-term for psychotic behavior ANS: B Feedback A

Incorrect. Alprazolam (Xanax) is associated with rapid addiction, prolonged sedation effects, and potential for confusion and falling, and is considered inappropriate for an older person. Correct. Buspirone (BuSpar) is safer for older persons than benzodiazepines for anxiety. Because it can take up to five to seven days for the therapeutic benefit to be felt, it should be used only for chronic anxiety. Incorrect. Tricyclic antidepressants such as amitriptyline (Elavil) are contraindicated for use with older persons because of the risk for anticholinergic and sedative effects. Tricyclic antidepressants have been replaced with selective serotonin reuptake inhibitors (SSRIs), which are more effective at lower doses with fewer side effects. Incorrect. Antipsychotic agents such as haloperidol (Haldol) can cause extrapyramidal effects, especially in older persons. For long-term administration, they should be used only after a thorough psychiatric evaluation.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 234

OBJ: 3

4. In speaking with an older person, 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 Feedback A

B C D

Incorrect. This question 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.” Incorrect. Although this question is meant to elicit the reason for nonadherence, it has an accusatory tone that is likely to make the patient defensive. Correct. This question is worded to put the patient at ease and elicit information in a matter-of-fact way. Incorrect. This question can be interpreted as judgemental.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 228

OBJ: 4

5. An older person who has an albumin level of 25 g/L takes aspirin and phenytoin (Dilantin)

by mouth daily. Which adverse effect of these medications does the nurse expect because of the older person’s nutritional status? a. Depressed mood b. Clay-coloured stools c. Increased heart rate d. Gingival hyperplasia ANS: B Feedback A B

C D

Incorrect. Depression is a common adverse effect of antiseizure medication, especially phenytoin, but is unrelated to hypoalbuminemia. Correct. Serum albumin at 25 g/L is below normal, indicating that the older person has hypoproteinemia. The medication is partially inactivated after absorption because a percentage of it binds with serum proteins, especially albumin. If the older person does not have an adequate serum albumin level, a greater percentage of active medication circulates in the bloodstream, since an insufficient amount of albumin is available for binding; thus, toxic levels can develop. When aspirin is taken, the inactivated form is excreted by the kidneys, and the liver metabolizes the active compound. However, an older person with hypoalbuminemia exposes the liver to potentially toxic levels of aspirin that can lead to hepatotoxicity as evidenced by clay-coloured stools. Incorrect. Tachycardia is not a commonly associated adverse effect of aspirin or phenytoin. Incorrect. Gingival hyperplasia is a common adverse effect of phenytoin, but it does not indicate toxicity, and it is unrelated to hypoalbuminemia.

DIF: Analysis REF: 221 (Figure 14-1) TOP: NCLEX: Physiological Integrity

OBJ: 3

6. The nurse prepares to administer vancomycin (Vancocin) to an older person. Which

laboratory test should the nurse review before administering this medication? a. Stool culture b. Serum potassium c. Creatinine clearance d. Alkaline phosphatase ANS: C Feedback A B

Incorrect. The pathogen is already identified, though some value can be obtained from subsequent stool cultures to determine if the infection is eradicated. Incorrect. Serum potassium is a reasonable parameter to check in an older person; however, if used as a measure of renal function, the creatinine clearance is a better choice. Correct. Antibiotics as a group of drugs are hard on the kidneys; thus, the nurse should check the creatinine clearance of this individual. Although about 30% of absorbed vancomycin is protein bound, it is cleared by the kidneys, and

creatinine clearance is the best index of renal function available. Because approximately 70% of vancomycin circulates in the bloodstream in the active form, when the older person has renal dysfunction, the dosage must be reduced or the dosing intervals increased to maintain the desired drug level and prevent toxicity. Incorrect. Alkaline phosphatase is a measure of hepatic function. It is a reasonable parameter to check when administering medications because hepatic clearance is important in the metabolism of many medications.

DIF: Application REF: 222 TOP: NCLEX: Physiological Integrity

OBJ: 3

7. The nurse provides instruction about medication safety to older persons. Which of the

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

C D

Incorrect. 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. Incorrect. Keeping medication at the bedside is dangerous for anyone and can be especially dangerous for older persons taking anti-anxiety agents, hypnotic agents, and opioid analgesics because these and other medications can cause respiratory depression with and without excessive dosing. If sleepy or lethargic, an older person can inadvertently take more than the correct dose and suffer serious consequences as a result. Correct. Older persons should ask the health care provider for the purpose of each medication and record the information. Incorrect. These are suitable instructions for many medications; however, many medications that are likely to cause nausea are taken with food. The nurse should instruct older persons to keep a record of the recommended method of administration.

DIF: Comprehension REF: 230 (Box 14-2) OBJ: 5 TOP: NCLEX: Safe and Effective Care Environment 8. The relationship of biological rhythms to variations in the body’s response to drugs is

known as chronopharmacology. When caring for an older person with asthma, what information would help guide the nurse in planning the time to administer medication to the patient? a. The asthma is most distressing before bedtime. b. The asthma is most distressing at midday. c. The asthma is most distressing between 0400 and 0500 hours. d. The asthma is most distressing after performing activities of daily living.

ANS: C Feedback A B C

Incorrect. The greatest respiratory distress occurs overnight (during sleeping), with symptoms peaking in early morning (0400 to 0500 hours). Incorrect. The greatest respiratory distress occurs overnight (during sleeping), with symptoms peaking in early morning (0400 to 0500 hours). Correct. The greatest respiratory distress is overnight (during sleeping), with symptoms peaking in early morning (0400 to 0500 hours). The body’s normal biorhythms and the differences in these rhythms in men and women can also affect pharmacokinetics and pharmacodynamics. Therefore, when planning care for an older person with asthma, knowing when the greatest distress occurs will help in planning the time to administer medication to the patient. Incorrect. The greatest respiratory distress occurs overnight (during sleeping), with symptoms peaking in early morning (0400 to 0500 hours).

DIF: Comprehension | Application REF: 225 (Table 14-2) OBJ: 2 TOP: NCLEX: Physiological Integrity 9. Mr. Perrault, 75 years of age, was diagnosed with Parkinson’s disease two years ago. Over

the last 24 hours, he appears to have become more confused and agitated. Which of the following should the nurse consider as a possible cause of these symptoms, knowing that Mr. Perrault is receiving medication to alleviate some of his Parkinson’s disease symptoms? a. Delirium and dementia b. Adverse drug reaction and delirium c. Dementia and adverse drug reaction d. Worsening of dementia ANS: B Feedback A

B C D

Incorrect. Too often delirium goes unrecognized as an adverse drug reaction (ADR) and instead is viewed as a worsening of pre-existing dementia, or even new-onset dementia. Correct. One of the most troublesome ADRs for the older person is drug-induced delirium and confusion. Incorrect. Too often delirium goes unrecognized as an ADR and instead is viewed as a worsening of pre-existing dementia, or even new-onset dementia. Incorrect. Too often delirium goes unrecognized as an ADR and instead is viewed as a worsening of pre-existing dementia, or even new-onset dementia.

DIF: Comprehension | Application TOP: NCLEX: Physiological Integrity

REF: 226

OBJ: 7

10. Polypharmacy may include which one of the following definitions? a. 10 or more prescribed medications b. Adverse drug reactions c. More than 3 prescribers of medications for one client d. Use of medications that are duplicated or unnecessary

ANS: D Feedback A B C D

Incorrect. There is no specific number of medications that make up polypharmacy. Incorrect. Adverse drug reactions may occur as a result of polypharmacy, but does not define it. Incorrect. The number of prescribers does not define polypharmacy. Correct. This is one of the accepted definitions of polypharmacy.

DIF: Comprehension | Application TOP: NCLEX: Physiological Integrity

REF: 225

OBJ: 3

Chapter 15: Living with Chronic Illness Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. An older female adult is diagnosed with a chronic illness. Which principle should the

nurse apply when answering her questions? a. The most prevalent form of disease in Canada 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 persons cope successfully with chronic disease by learning about the disease. ANS: C Feedback A B C D

Incorrect. The most prevalent form of disease in Canada at this time is chronic illness. Incorrect. The effect on the family, as on the patient, can be profound. Correct. Chronic illnesses are enduring and necessitate lifetime adaptations. Uncertainty exacerbates the impact of a chronic disease. Incorrect. There are no guarantees. Knowledge requires effort on the part of all concerned to apply it.

DIF: Application REF: 252 (Box 15-7) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 1

2. Which one 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. Focus on potential rather than on limitations. c. Suggest that the patient accept eventual death to reduce burdens on the patient’s family. d. Encourage the patient to minimize the utilization of services to control costs. ANS: B Feedback A B C D

Incorrect. Chronic illnesses are long-term problems, and cures are not usually available. Correct. 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. Incorrect. If a patient has an incurable illness, the nurse provides a caring environment to facilitate implementation of the patient’s and family’s wishes. Incorrect. 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.

DIF: Comprehension REF: 248 (Box 15-4) OBJ: 6 TOP: NCLEX: Safe and Effective Care Environment 3. Which statement is true about rehabilitation and restorative care for older persons? a. The purpose is to regain specific abilities lost because of a condition. b. Rehabilitation consists primarily of regular physiotherapy sessions. c. A person can learn skills and gain abilities that enable functioning. d. The patient’s capabilities are recognized at the time of admission. ANS: C Feedback A

B C D

Incorrect. The purpose of rehabilitation is to enable the person to regain function but not necessarily specific abilities; this can involve the development of compensating abilities (e.g., driving a motorized wheelchair) rather than recovery of original abilities (e.g., walking). Incorrect. Rehabilitation consists of activities involving the entire day, not merely those within an allotted time period. Correct. A patient with a severe stroke, for example, may not be able to walk again but may recover mobility by learning to drive a motorized wheelchair. Incorrect. On admission, the patient is in crisis and his or her actual abilities may not be evident.

DIF: Knowledge REF: 250 OBJ: 5 TOP: NCLEX: Health Promotion and Maintenance 4. Which statement is the most suitable for establishing goals when teaching an older person

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 caregiver, so goals should be set collaboratively. b. The patient will be able to make needed changes in his life if you provide accurate, written instructions. c. Psychological functioning is usually impaired only to a small extent in a patient with a chronic illness. d. The patient’s values, culture, and beliefs will have little to do with the types of changes he will be able to make. ANS: A Feedback A B C D

Correct. The patient must remain involved in decision making; the patient and caregiver may have different priorities. Incorrect. Instructions by themselves are not sufficient. Incorrect. Psychological functioning may be more impaired than physical functioning. Incorrect. The person’s values, culture, and beliefs profoundly shape his or her response to chronic illness and therapeutic interventions.

DIF: Comprehension REF: 248 (Box 15-4) OBJ: 5 TOP: NCLEX: Health Promotion and Maintenance

5. An older female adult has gastritis, occasional migraine headaches, and severe

osteoporosis in the long bones, with impaired mobility and chronic pain. In the trajectory phase, what health teaching should the nurse offer to the older person? a. Regular exercise (at least 30 minutes daily) will increase bone density. b. Daily intake of vitamin C 500 mg will reverse osteoporosis over time. c. Rest periods of one to two hours throughout the day will prevent osteoporotic pain in long bones. d. Taking nonsteroidal anti-inflammatory agents (NSAIDs) every two hours will reduce pain. ANS: A Feedback A B C

Correct. Regular exercise will increase bone density and reduce osteoporotic changes. Incorrect. Vitamin C will provide help in tissue repair, but does not affect bone density. Incorrect. Resting is important, but one to two hours of rest throughout the day will create other problems, such as inability to sleep at night, and while rest is important, exercise is much more valuable for increasing bone density. Incorrect. NSAIDs should not be taken by older persons who have gastritis as regular use can lead to ulceration of the stomach.

DIF: Analysis REF: 246 (Table 15-1) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 5

6. An older male adult 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 the right arm. b. Collaborate with occupational therapy. c. Promote plaque-reversing strategies. d. Support effective coping mechanisms. ANS: B Feedback A B

Incorrect. This goal should be included in the man’s plan of care because a flaccid extremity is at risk for skin breakdown, but it is not the first priority. Correct. 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 occupational therapy (OT) is the most important goal for this older person because the greatest factor in establishing wellness is adaptation, and OT can assist this man with adaptive tools, skills, and abilities to manage living with a flaccid dominant hand and arm. Incorrect. Plaque-reversing strategies, including diet and antilipid medication, should be part of this man’s plan of care. It is not the most important goal for him, however, because adaptation is the most important factor in establishing health and wellness.

Incorrect. This goal should be included in the 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 work effectively. Supporting effective coping mechanisms can help to enhance the work of the OT.

DIF: Analysis REF: 249 (Box 15-5) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 5

7. An older female adult has diabetes mellitus. Which of the following validates the nurse’s

conclusion that this patient’s illness is in the foreground perspective of the Shifting Perspectives Model of Chronic Illness? a. The older person has an amputation of two toes. b. The older person lives at home with her husband. c. The older person self-checks blood sugar frequently. d. The older person changes the battery in her glucometer. ANS: A Feedback A

B C D

Correct. An older person thinks and acts about diabetes mellitus in the foreground perspective when signs of disease progression occur. This is evidenced by the need for the amputations because hyperglycemia damages the lining of vessels and can lead to peripheral artery disease. The perfusion to this woman’s toes has deteriorated to the extent that the tissue has died; the dead tissue must be removed to avoid infection. Incorrect. Living at home indicates that she has a functional status that is sufficient to maintain independent living. Incorrect. This woman is able to monitor her blood sugar independently. Incorrect. This woman retains enough functional ability to change a battery.

DIF: Application REF: 245 TOP: NCLEX: Psychosocial Integrity

OBJ: 3

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 Feedback A B C D

Incorrect. The nurse with compassion has sensitivity to the needs of others in general. Incorrect. The desire to help others lead a healthy life is admirable; however, to provide caring, the nurse should not impose personal beliefs on patients. Incorrect. A nurse can provide caring by dedicating herself or himself to nursing as a lifelong commitment and not just as a means to provide a living. Correct. Along with competence, compassion, conscience, and commitment, to

provide caring, the nurse must be able to inspire confidence in the nursing care. DIF: Comprehension REF: 248 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 6

9. An older male adult who has osteoarthritis tells the nurse that he has experienced fatigue

for the past two weeks. Which nursing intervention should the nurse implement to help him manage fatigue? a. Recommend an antidepressant. b. Help him plan exercise and rest. c. Plan two or three naps every day. d. Tell him the fatigue is due to osteoarthritis. ANS: B Feedback A B

Incorrect. This older person has no indicators of depression except for fatigue. Correct. With no clues about the cause of the fatigue, the nurse helps this older person balance exercise and rest to help alleviate fatigue. The fatigue can be due to decreased physical activity that in turn is due to pain from osteoarthritis (OA), in which case a balance of exercise and rest should help to attenuate the effects of pain from OA. Incorrect. Decreasing physical exercise is likely to contribute to fatigue and deconditioning. He should pace activities by planning for rest and activity; however, planning for two or three naps every day may lead to confusion and deconditioning in the older person. Incorrect. Fatigue is an unusual characteristic of OA.

DIF: Application REF: 249 OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance 10. Which one of the following descriptors represents a phase of the chronic illness trajectory

(CIT)? a. Caring b. Stable c. Bargaining d. Rehabilitation ANS: B Feedback A B C D

Incorrect. The CIT does not include a caring phase. Correct. The CIT includes a stable phase. Incorrect. The CIT does not include a bargaining phase. Incorrect. The CIT does not include a rehabilitation phase.

DIF: Knowledge REF: 246 (Table 15-1) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 3

Chapter 16: Pain and Comfort Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Compared with acute pain, which of the following statements is true of persistent pain? a. It leads to markedly altered vital signs. b. It is usually described as a burning pain. c. It is generally gone within four months. d. It can bring about changes in lifestyle. ANS: D Feedback A B C D

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

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 257

OBJ: 2

2. The nurse admits an older male patient who had abdominal surgery. Admission vital signs

are P 73, R 20, 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, R 26, BP 164/90 mm Hg, and he denies pain. Which intervention should the nurse implement? a. Administer an opioid medication by IV route. b. Check the surgical dressing for bleeding. c. Report the vital signs to the health care provider. d. Ask him about discomfort at the surgical site. ANS: D Feedback A B C D

Incorrect. This is unethical; the nurse should avoid administering medication for pain without the patient’s request. Incorrect. The patient shows signs of pain rather than blood loss. Incorrect. It is premature for the nurse to report the vital signs because the patient’s pain assessment is not complete. Correct. The patient’s heart rate, respiratory rate, and blood pressure increased significantly since the admission vital signs and indicate the potential for pain or discomfort from the surgical incision. The patient could be misunderstanding the nurse’s question about pain or be barred from saying yes by cultural patterns. Such miscommunication is common, so the nurse rewords the question using another term for pain such as discomfort, burning, or pressure.

DIF: Application

REF: 260 (Box 16-2)

OBJ: 3

TOP: NCLEX: Health Promotion and Maintenance 3. An older female adult had surgery one day ago, and the nurse thinks that the woman also

has dementia. While assessing the patient, what indication would the nurse use to determine that the older person is experiencing pain? a. The patient holds her abdomen tightly. b. The patient has stable vital signs. c. The patient is not verbalizing. d. The patient moves during sleep. ANS: A Feedback A

B C

Correct. Because this older person has a potential cognitive impairment and thus is likely to self-report pain unreliably, the nurse uses additional clinical indicators to detect whether she’s experiencing pain. Muscle rigidity and guarding are clinical indicators of pain for a postoperative older person, regardless of a cognitive impairment. Incorrect. An individual experiencing pain is unlikely to have stable vital signs. Incorrect. Not verbalizing can indicate a sensory impairment and warrants further investigation by the nurse. Nonetheless, this older person’s verbalizations are potentially unreliable indicators of pain. Incorrect. Older persons normally move during sleep to adjust their position in bed, and this is not an indicator of pain unless the movements are agitated or restless in nature.

DIF: Application REF: 264 (Box 16-3) TOP: NCLEX: Physiological Integrity 4.

OBJ: 3

Which statement is true about analgesic medications for older persons? 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 persons. ANS: B Feedback A B

C D

Incorrect. Because of changes in metabolism with aging, opioids have a greater and longer-lasting analgesic effect in older patients. Correct. Opioids often cause constipation and necessitate bowel stimulation to prevent constipation. A bowel regimen should be instituted at the same time as opioid treatment. Incorrect. NSAIDs can cause gastrointestinal bleeding, kidney and liver damage, and drug interactions with potentially fatal results. Incorrect. The maximum daily dose of acetaminophen is 4,000 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.

DIF: Knowledge

REF: 266

OBJ: 6

TOP: NCLEX: Physiological Integrity 5. Which one of the following interventions would provide comfort, reduce anxiety and

distress, and alleviate pain? a. Acupuncture treatments b. Adjuvant therapy c. Transcutaneous electrical nerve stimulation d. Touch ANS: D Feedback A B

C D

Incorrect. Acupuncture is a nonpharmacological treatment that helps reduce the perception of pain. Incorrect. 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. Incorrect. Transcutaneous electrical nerve stimulation is a nonpharmacological treatment for pain relief. Correct. Touch is a nonpharmacological means of providing comfort and alleviating pain and distress.

DIF: Knowledge REF: 264 TOP: NCLEX: Psychosocial Integrity

OBJ: 4

6. An older person 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 prescribed. c. Tell the patient it is too soon for pain medication. d. Talk the patient into alternative comfort measures. ANS: B Feedback A

Incorrect. 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. However, the nurse should use assessment data to support withholding of pain medication in the presence of over-sedation or another assessment that would potentially be aggravated by pain medication administration. Correct. The nurse should administer the opioid pain medication as prescribed because the patient requested 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, so 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. Incorrect. 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 that the patient is not having pain and is exhibiting drug-seeking behaviour, the nurse must administer the medication. Since the patient knows the timing of his pain medication, the nurse could be subject to legal and ethical ramifications of this statement. Incorrect. The nurse must administer the pain medication as requested and can use comfort measures to enhance the therapeutic effect of the medication.

DIF: Application REF: 266 TOP: NCLEX: Physiological Integrity

OBJ: 4

7. The nurse administers an opioid analgesic to an older male adult postoperative patient on a

surgical unit. Which is the most important intervention for the nurse to implement before leaving the patient’s room? a. Place the call bell within reach. 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 Feedback A B C

Incorrect. Placing the call bell within reach is a good supplementary intervention to instructing the patient about calling for help. Incorrect. Comfortable positioning is a good supplemental intervention after pain medication administration. Incorrect. Offering toileting and hydration is a reasonable intervention to implement after pain medication administration, but it does not offer the same degree of safety as instructing the patient to call for help. Correct. The most important intervention for fall and injury prevention is for the nurse to instruct the older person to ask for help before getting up after receiving an opioid medication. This is important because the medication can cause sedation and dizziness; so the nurse instructs him to ask for help to prevent a fall or injury.

DIF: Analysis REF: 266 OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment 8. The older person is at higher risk for acute psychological pain compared to a younger adult

because of which of the following statements about older persons? a. Older persons have less tolerance for pain. b. Older persons possess fewer assets. c. Older persons experience more loss. d. Older persons live with impairments. ANS: C Feedback A

Incorrect. Older persons tend to have more illnesses than younger adults and illness can trigger depression. The older person may have a greater tolerance for pain owing to adjustment to inadequate relief of long-standing pain. Incorrect. The lack of assets of younger and older persons is unlikely to be

related to acute psychological distress unless the person experiences a sudden loss of a large asset. Correct. Older persons 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. Incorrect. Older persons do not necessarily live with impairments, and, if impairment causes psychological distress, the acute phase is likely to occur at the onset rather than in day-to-day activities.

DIF: Knowledge REF: 257 TOP: NCLEX: Psychological Integrity

OBJ: 1

9. An older male adult who had a gastric resection states that he wants to ambulate, but the

osteoarthritis (OA) in his knees causes too much pain. Which intervention should the nurse implement to increase the amount of walking he can perform? a. Encourage pain medication around the clock. b. Instruct him to rest until the pain disappears. c. Suggest taking pain medication before walking. d. Collaborate with the health care provider to get him a walker. ANS: C Feedback A

B C

Incorrect. Around-the-clock medication can be necessary; however, if the patient can sleep uninterrupted by pain, awakening to take pain medication is unnecessary. Long-acting pain medication or twice-daily administration of selected analgesics can offer an effective pain-management strategy. Incorrect. Inactivity tends to exacerbate the pain of OA; instead, the nurse recommends a balance of rest and exercise. Correct. The nurse suggests taking the pain medication before walking to provide relief during the time when the pain occurs. In addition, if the patient premedicates, the analgesic effect is likely to last long enough to benefit the patient for any pain after walking. Incorrect. A walker is not indicated and will not alleviate any pain in the knees because it is intended to provide stability for ambulation.

DIF: Application REF: 260 OBJ: 5 TOP: NCLEX: Health Promotion and Maintenance 10. An older male adult who does not understand or speak English very well denies having

pain, but he had knee replacement surgery two days before. Which is the best pain assessment tool for the nurse to apply when assessing the older person’s pain? a. Numeric Rating Scale b. Verbal Descriptor Scale c. PAINAD assessment tool d. Visual Analogue Scale ANS: D Feedback A

Incorrect. The Numeric Rating Scale is valid and reliable, but older persons who

B C D

are unable to communicate well prefer using the Visual Analogue Scale. Incorrect. The Verbal Descriptor Scale is valid and reliable, but older persons who are unable to communicate well prefer using the Visual Analogue Scale. Incorrect. The PAINAD assessment tool is used specifically to assess pain in older persons with cognitive impairments. Correct. The nurse uses the Visual Analogue Scale to validate the patient report because the postoperative period in knee replacement surgery is very painful, and this makes the nurse think he is likely to have pain.

DIF: Application REF: 264 (Box 16-3) TOP: NCLEX: Health Promotion and Integrity

OBJ: 3

11. The nurse uses comfort measures to enhance an older person’s pharmacological pain

management. Which should the nurse use to identify relationships between comfort measures, pharmacotherapy, and the older person’s pain level? a. Older person’s self-report b. Older person’s pain diary c. Visual Analogue Scale d. Pain medication frequency ANS: B Feedback A B

C D

Incorrect. Self-report is one parameter used to evaluate pain, but it is still necessary to draw a relationship between the pain level and another factor. Correct. The nurse instructs the older person to maintain a pain diary to help achieve some control over the pain experience. The diary is then used to identify trends or the timing of pain and relationships between the pain level and comfort measures, activity, and pain medications. Many older persons report feeling useful and having some control over the pain, or at least the pain management program, through maintaining a pain diary. Incorrect. The Visual Analogue Scale is a reliable pain assessment tool, but the task remains to link the pain rating to other factors. Incorrect. The frequency of medication administration provides a clue about the patient’s pain level.

DIF: Application REF: 260 TOP: NCLEX: Psychosocial Integrity

OBJ: 3

12. Which one of the following pain management techniques is an example of a cognitive

behavioural approach? a. Biofeedback b. Opioid medication c. Massage d. Anxiety medication ANS: A Feedback A

Correct. An individual can learn voluntary control over some body processes and

B C D

alter them by changing the physiological correlates appropriate to them. Incorrect. Medications would be a pharmacological intervention not a behavioural one. Incorrect. Massage is a physical approach to pain management. Incorrect. Medication would be a pharmacological approach.

DIF: Knowledge REF: 265 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance

Chapter 17: Diabetes Mellitus Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following is a true statement about diabetes mellitus? a. Type 2 diabetes results from a failure of the pancreas to produce insulin. b. Diabetes is diagnosed after two fasting plasma glucose readings over 4.4–6.1

mmol/L (82–110 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 Feedback A B C

Incorrect. Type 2 diabetes is present when insulin is produced but does not lower the blood glucose level. Correct. Fasting plasma glucose over 4.4–6.1 mmol/L (82–110 mg/dL) is considered diabetes. Incorrect. Type 1 diabetes was formerly called insulin-dependent diabetes mellitus (IDDM), whereas type 2 diabetes was formerly called non– insulin-dependent diabetes mellitus (NIDDM). Incorrect. Two percent of Canadians (1.1 million out of 21.2 million) aged 20 to 64 have diabetes; 21.3% of Canadians aged 65 and older have been diagnosed with diabetes.

DIF: Knowledge REF: 272 TOP: NCLEX: Physiological Integrity

OBJ: 3

2. Which of the following laboratory results is a goal for reducing a person’s risk for diabetes

and heart disease? a. Triglycerides over 1.69 mmol/L (150 mg/dL) b. Cholesterol over 5.18 mmol/L (200 mg/dL) c. High-density lipoprotein under 1.03 mmol/L (40 mg/dL) d. Fasting blood glucose under 7.0 mmol/L (126 mg/dL) ANS: D Feedback A B C D

Incorrect. To reduce the risk for diabetes and heart disease, the serum triglycerides value should be under 1.69 mmol/L (150 mg/dL). Incorrect. The cholesterol value should be under 5.18 mmol/L (200 mg/dL) to reduce the risk for heart disease and diabetes. Incorrect. The HDL level should be over 1.03 mmol/L (40 mg/dL) to reduce the risk for heart disease and diabetes. Correct. The fasting blood glucose value should be under 7.0 mmol/L (126 mg/dL).

DIF: Knowledge REF: 273 TOP: NCLEX: Physiological Integrity

OBJ: 3

3. An older male adult with diabetes mellitus complains to the nurse that his feet feel like

they are burning. What should the nurse recommend to this older person to improve his discomfort? a. Well-fitting leather shoes b. Knee-high nylon stockings c. Soaking feet in warm water d. Antifungal powder on feet ANS: A Feedback A

C D

Correct. The older person is potentially experiencing a peripheral neuropathy from peripheral nerve damage caused by hyperglycemia. To prevent trauma to the feet, the nurse instructs him to wear comfortable, well-fitting, tie-on shoes with a broad toe space and low heels for protection. Incorrect. Nylon stockings for older persons tend to have restrictive ends that can inhibit tissue perfusion, and because the older person is at risk for peripheral tissue damage, the constricted area can break down. The nurse also instructs the older person to avoid sitting with one leg crossed over the other or with both legs crossed at the knee, because these positions restrict blood flow to the feet. Incorrect. Foot soaks potentially cause excessive dryness. To maintain skin integrity, feet should be washed daily but not soaked daily. Incorrect. Irritating chemicals such as antifungal powder and corn or wart preparations should not be used on the feet of diabetic individuals.

DIF: Application REF: 274 OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance 4. An older female adult who has diabetes mellitus takes Glitazone (a thiazolidinedione

medication) and tells the nurse that her blood sugars have been higher than normal since she began using a vaginal cream for hot flashes. Which one of the following interventions is the best one for the nurse to implement? a. Ask if she had a fever or infection recently. b. Verify the expiration date of the medication. c. Review her diet for increased carbohydrates. d. Ascertain if the vaginal cream contains estrogen. ANS: D Feedback A

B C

Incorrect. This is a reasonable task to implement because infection increases the blood sugar of an individual with diabetes mellitus; however, because this woman associated the hyperglycemia with the vaginal cream, the most likely contributor to the problem is the vaginal cream, and it is a good place to start the investigation. Incorrect. This is a reasonable task to implement; however, ineffective medication would not have the desired hypoglycemic effect. Incorrect. This is a reasonable task to implement; however, a glucose load will

increase the blood sugar. Correct. Vaginal cream prescribed for hot flashes potentially contains estrogen as an active ingredient, because estrogen is an effective therapy to reduce hot flashes. Unfortunately, estrogen impairs the hypoglycemic effect of sulfonylurea hypoglycemic medications. If the estrogen therapy continues, the nurse should assist this individual in adjusting her diet and exercise regimen in coordination with her antidiabetic medication to maintain stable blood sugar levels.

DIF: Analysis REF: 277 (Box 17-4) TOP: NCLEX: Physiological Integrity

OBJ: 3

5. An older person with type 2 diabetes mellitus has a sensory impairment and unstable blood

sugars. Which alteration in sensory function does the nurse address in the plan of care for stabilizing his blood sugar? a. The older person requires reading glasses at 2.0 strength. b. The older person has difficulty hearing in crowded rooms. c. The older person enjoys spicy food more than bland food. d. The older person awakens with periodic left-foot numbness. ANS: B Feedback A B

C D

Incorrect. Reading glasses at 2.0 are medium-strength glasses, and the need for such glasses is very common and not considered a visual impairment. Correct. The nurse focuses on the hearing impairment to plan care for stabilizing his blood glucose, because a hearing impairment is a factor affecting blood glucose control in older persons with diabetes mellitus. Incorrect. A preference for spicy food does not indicate an impaired sense of taste. Incorrect. Although numbness is a sensory impairment, episodic numbness associated with sleeping is more likely to be due to a poorly positioned extremity.

DIF: Application REF: 275 (Box 17-3) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 6

6. An older male adult comes to a primary care setting, and his reason for seeking health care

is to get a prescription for sildenafil (Viagra). Which laboratory report can help to explain why this individual needs sildenafil? a. Serum potassium 4.5 mEq/L b. Prothrombin time 13 seconds c. Hemoglobin 140–180 g/L (14.0–18.0 g/dL) d. Glycosylated hemoglobin (Hgb A1c) over 8% ANS: D Feedback A B C

Incorrect. The potassium level is within normal limits. Incorrect. The prothrombin time is within normal limits. Incorrect. Hemoglobin 140–180 g/L (14.0–18.0 g/dL) is within normal limits.

Correct. The Hgb A1c is an indicator of serum glucose control over the last 90 days. An Hgb A1c level over 8% indicates that this older person had poor glucose control in that time frame. As a reliable indicator of hyperglycemia, it can indicate the reason this older-person experiences erectile dysfunction, because hyperglycemia is associated with peripheral arterial disease. An erection occurs as the penile shaft becomes engorged with blood. This process can be impaired if the vessels are damaged from hyperglycemia because hyperglycemia damages the lining of blood vessels and leads to progressive occlusion of the damaged vessels. Many of the vessels involved in causing an erection are fine vessels and are among the first occluded in arterial disease.

DIF: Comprehension REF: 271 (Box 17-1) OBJ: 1 TOP: NCLEX: Physiological Integrity 7. Which comorbidity commonly associated with type 2 diabetes mellitus enhances the

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

B C D

Correct. Dyslipidemia, 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 accumulates in the smallest arteries first, causing complications of diabetes mellitus, including peripheral arterial disease, retinopathy, and nephropathy. Incorrect. Hypothyroidism is not associated with type 2 diabetes mellitus. Incorrect. Venous insufficiency is not associated with type 2 diabetes mellitus. Incorrect. Chronic constipation is not associated with type 2 diabetes mellitus.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 272

OBJ: 1

8. The nurse assists an older male adult with type 2 diabetes mellitus to improve his glucose

control. What does the nurse instruct this individual to do when he plans to walk more than usual in one day? a. Omit antidiabetic medication. b. Wear sturdy open-toed shoes. c. Supplement his caloric intake. d. Prepare to administer insulin. ANS: C Feedback A B

Incorrect. The nurse cannot tell the patient to omit medication because this is not within a nurse’s scope of practice. Incorrect. The nurse instructs the older person to wear closed, well-fitting leather

shoes to protect the feet from trauma. Correct. Diabetes mellitus is controlled by balancing exercise, calories, and hypoglycemic medication; if one element of therapy is altered, 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; so the nurse instructs this older person to supplement his caloric intake. This 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 the blood sugar. Incorrect. Although many individuals with type 2 diabetes mellitus take insulin periodically, insulin is administered to induce hypoglycemia. Because the individual plans to walk more than usual, more calories are needed to prevent hypoglycemia.

DIF: Application REF: 275 TOP: NCLEX: Physiological Integrity

OBJ: 4

9. Which one of the following is the most important 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. ANS: B Feedback A B

C D

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

DIF: Comprehension REF: 272 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 6

10. Gerontological nurses have an important educational role in the treatment of diabetes, and

must advocate for and encourage older persons to obtain care that can delay or minimize complications. Hyperosmolar nonketotic syndrome is a metabolic complication of diabetes mellitus (DM). What signs should the nurse be aware of when planning care for an older person who has DM and may develop this syndrome? a. Auditory impairments that can cause difficulty hearing instructions b. A decline in the patient’s visual acuity c. Altered ability to recognize hunger and thirst

d. Changes in hepatic or renal function ANS: C Feedback A B C D

Incorrect. Auditory impairments that can lead to difficulty hearing instructions are an interaction between diabetes and the aging process. Incorrect. A decline in visual acuity is an interaction between diabetes and the aging process. Correct. Altered ability to recognize hunger and thirst may lead to weight loss, dehydration, and increased risk for hyperosmolar nonketotic syndrome. Incorrect. Changes in hepatic or renal function are an interaction between diabetes and the aging process.

DIF: Comprehension REF: 275 (Box 17-3) OBJ: 7 TOP: NCLEX: Physiological Integrity

Chapter 18: Bone and Joint Health Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following statements about osteoporosis is true? a. Osteoporosis is indicative of an underlying health problem. b. The most common site for osteoporosis fractures is in the long bones. c. Women who are of African descent have the highest risk for osteoporosis. d. A high risk of death follows an osteoporosis-related hip fracture. ANS: D Feedback A B C

Incorrect. Osteoporosis can be a naturally occurring consequence of aging. Incorrect. The vertebrae, the pelvis, and the wrist are the most frequent sites for osteoporosis fractures. Incorrect. The risk of osteoporosis is much lower for women of African descent than for women of other ancestry. Thin women of northern European descent are at the highest risk. Correct. One-third of persons who have an osteoporosis-related fracture die within one year. Thirty percent of hip fractures that are related to osteoporosis result in death and 28% of women and 37% of men who fracture their hip die within the year.

DIF: Knowledge REF: 281 TOP: NCLEX: Physiological Integrity

OBJ: 2

2. Which of the following 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. Steak with brown rice, celery, and red wine for dinner d. Coffee, raisin bran and milk, and sausage at breakfast; a can of cola and a hot dog on a high-fibre bun at lunch; and a cocktail before dinner ANS: A Feedback A B C D

Correct. Milk, cheese, spinach, melted cheese, and ice cream are excellent sources of the bone-supportive nutrient, calcium. Incorrect. Administering estrogen can increase the risk of cancer and heart disease. Incorrect. Alcohol and high amounts of protein and salt inhibit calcium uptake. Incorrect. Alcohol and high amounts of protein and salt inhibit calcium uptake, whereas caffeine, excess fibre, and phosphorus (in the cola) promote calcium excretion.

DIF: Comprehension REF: 283 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 4

3. Which statement about joints in older persons is true? a. Osteoarthritis is an inflammatory joint disorder. b. Surgical joint replacement can cure osteoarthritis. c. Joint damage in osteoarthritis is reversed with medication. d. Very old persons should avoid joint replacement surgery. ANS: B Feedback A B C D

Incorrect. Osteoarthritis (OA) is a degenerative joint disease, whereas rheumatoid arthritis is an inflammatory process. Correct. This is the only cure for the disease. Incorrect. Medications are used to control pain from OA. The joint damage cannot be reversed except through joint replacement surgery. Incorrect. Surgical joint replacements are recommended even for very old persons.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 284

OBJ: 7

4. Which statement about rheumatoid arthritis (RA) is true? a. Rheumatoid arthritis strikes different parts of the body unilaterally. b. Patients with rheumatoid arthritis have no remissions and exacerbations. c. Rheumatoid arthritis affects only joints. d. It is considered an autoimmune disease, in which products from the inflamed

lining of the joint invade and destroy the cartilage and bone within the joint. ANS: D Feedback A B C

Incorrect. RA affects joints in a symmetrical pattern. Incorrect. Unlike OA, RA has a highly variable course, which may include remissions as well as exacerbations. Incorrect. RA can cause general fatigue and malaise and attack systems other than joints. Since RA is a systemic disease, the person may feel generalized fatigue and malaise and have occasional fevers. The joints are warm and tender. Weight loss is common. The natural course of RA is highly variable, with good and bad days. Correct. Conventional therapy for RA includes a complex regimen of medications. Glucosamine has not been proven to offer significant relief from RA.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 285

OBJ: 5

5. Which one of the following is a suitable nursing intervention for an older person who has

gout?

a. b. c. d.

Vitamin D 400–1000 international units (IU) Liquid paraffin hand baths and disease-modifying antirheumatic drugs A diet low in purines Aspirin 500 mg daily

ANS: C Feedback A B

C D

Incorrect. Vitamin D 400–1,000 IU is suitable for older persons to build and maintain strong bones and teeth. Incorrect. Liquid paraffin hand baths can be used to relieve pain in OA and RA, whereas disease-modifying antirheumatic drugs are used only in RA and are not beneficial to an older person with gout. Correct. Risk factors for gout include high blood pressure and a diet high in purines. Incorrect. Salicylates should not be used in gout because they can exacerbate an attack.

DIF: Comprehension REF: 286 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 5

6. An osteoporosis-related fall necessitated hip-replacement surgery for an older female adult

who is entering a rehabilitation facility. Which of the following goals is the nurse’s priority during this woman’s rehabilitation? a. Tell the patient to eat whole grains, fruits, and vegetables. b. Recapture the patient’s preoperative mobility status. c. Keep the patient’s surgical wound clean and dry. d. Tell the patient to take two steps into the walker. ANS: B Feedback A

C D

Incorrect. Increasing dietary fibre and nutrient-dense foods is an intervention to help to maintain regular bowel habits and repair and build tissue; it is integral to postoperative and rehabilitative care for an older person, but not the highest priority. Correct. Only 40% of people who have an osteoporosis-related fracture recuperate their pre-fall mobility status, so the most important goal for the nurse is to plan care designed to restore her baseline mobility status. This is a comprehensive goal encompassing nutrition, exercise, rest, and physiotherapy and preventing postoperative complications that can plague older persons, such as atelectasis and pneumonia, impaired skin integrity, constipation, and dehydration. Incorrect. Preventing infection and promoting skin integrity are integral to postoperative and rehabilitative care for an older person. Incorrect. Instructing the older person about using a walker properly is an intervention and part of the primary goal of restoring preoperative mobility.

DIF: Analysis REF: 287 OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance

7. An older female adult seeks advice from the nurse about preventing further bone loss after

being diagnosed with osteopenia. To achieve the woman’s goal, which teaching should the nurse provide to enhance the activity of osteoblasts? a. Limit sodium intake. b. Refrain from alcohol use. c. Eat high-fibre foods. d. Exercise with weights. ANS: D Feedback A B C D

Incorrect. Sodium impairs calcium absorption, so the nurse instructs her to limit sodium to reduce bone loss. Incorrect. Alcohol impairs calcium absorption, so the nurse instructs her to avoid alcoholic beverages. Incorrect. Fibre inhibits calcium absorption. Correct. In osteopenia, bone metabolism is unbalanced because the action of osteoclasts is greater than the action of osteoblasts. To effectively treat osteopenia, the balance between the activities of the bone cells must be shifted to more osteoblast (bone-building) activity because increasing osteoblast activity helps to reduce bone loss and at the same time gain bone density. Lifting weights stimulates osteoblasts to build bone through the application of opposing forces on the bone and helps to achieve the woman’s goal by increasing physical activity (to stem bone loss) and by generating more bone (to gain bone density).

DIF: Analysis REF: 282 (Box 18-1) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 7

8. After living with osteoporosis for two years, an older female adult’s bone density scan

shows no improvement. Which intervention should the nurse implement to reduce bone loss for this older person? a. Add tai chi or yoga exercises. b. Instruct her to drink fortified milk. c. Increase weight-bearing exercise. d. Review her daily nutritional habits. ANS: D Feedback A B C D

Incorrect. These forms of exercise can help to increase bone density. Incorrect. Drinking fortified milk can help to increase bone density. Incorrect. Increasing weight-bearing exercise can help to increase bone density. Correct. Reviewing the older person’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 confirms that the patient avoids smoking and a sedentary lifestyle that contribute to bone loss.

DIF: Application REF: 287 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 9. Which of the following assessments is typical for an older person with osteoarthritis (OA)?

a. b. c. d.

Narrow joint spaces with crepitus Effects occurring in symmetrical joints Morning stiffness for at least an hour Swelling from excess synovial fluid

ANS: A Feedback A

B C D

Correct. The joint of an older person 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 move against each other abnormally. Incorrect. Disease in symmetrical joints is characteristic of rheumatoid arthritis (RA). Incorrect. Morning stiffness lasting for one hour or more is characteristic of polymyalgia rheumatica. Incorrect. Swelling from excessive synovial fluid is characteristic of RA.

DIF: Knowledge REF: 287 OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance 10. The nurse prepares an older male person who has osteoarthritis (OA) for discharge. Which

instruction does the nurse include in patient teaching to maintain safety for this man? a. Take ibuprofen (Motrin) rather than opioid analgesics. b. Increase rest periods to slow disease progression. c. Report joint instability to the health care provider. d. Avoid stretching the affected joint during exercise. ANS: C Feedback A

B C

Incorrect. 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 persons because they can aggravate hypertension and impair renal blood flow. Incorrect. The nurse avoids recommending increased rest because rest contributes to stiffness. Correct. As OA progresses, the joint deteriorates and can become unstable, thereby increasing the risk of falls. The joint stability will not improve without physiotherapy or surgery, so the patient needs to report it to the health care provider. Incorrect. Stretching is a very important form of exercise for older persons with OA because it helps to maintain joint flexibility and range of motion.

DIF: Application REF: 284 OBJ: 6 TOP: NCLEX: Health Promotion and Maintenance 11. An older female adult with osteoarthritis is seen by the nurse. She has a low-grade fever,

and she tells the nurse that her pain is changing: it is worse at night and in her shoulder muscles. What should the nurse do to determine if the older person is now experiencing polymyalgia rheumatica (PMR) rather than an exacerbation of her osteoarthritis?

a. Assess the patient’s joints for swelling and redness. b. Obtain blood specimens for blood cultures. c. Direct the patient to report pain in the neck and upper arms, possibly evolving to

the pelvic and pectoral girdles. d. Tell the patient to apply moist heat for 20 minutes. ANS: C Feedback A

B C

Incorrect. An older person with polymyalgia rheumatica (PMR) would exhibit severe pain and stiffness of muscles including the back, buttocks, and thighs. It is not a disease affecting the joints. Incorrect. Blood cultures are not indicated for PMR because it is not an infection. Correct. PMR may present similarly to OA but does have some distinguishing features, such as pain in the neck, shoulders, and pelvic region versus in joints. PMR can also have an acute onset and should be treated with corticosteroids. Incorrect. 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, this is unrelated to preventing complications of PMR.

DIF: Application REF: 284 TOP: NCLEX: Physiological Integrity

OBJ: 5

12. Which of the following represents characteristics of rheumatoid arthritis (RA) that are

unlike osteoarthritis (OA)? a. RA involves myalgia and stiffness. b. RA involves joint pain, and it is curable. c. RA involves crepitus and instability. d. RA is systemic and symmetrical. ANS: D Feedback A B C D

Incorrect. Myalgia and stiffness are characteristics of polymyalgia rheumatica; however, myalgia is uncharacteristic of RA and OA. Incorrect. Joint pain is characteristic of both RA and OA, but only OA is curable, through joint replacement. Incorrect. These are clinical indicators of OA but not of RA. Correct. OA is not a systemic disease, nor does it affect joints symmetrically.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 285

OBJ: 5

13. An older male adult who has hyperuricemia complains of severe pain in the right ankle.

Which instruction should the nurse include in patient teaching to enhance the action of medication the patient takes for his condition? a. Avoid dehydration by drinking water. b. Take aspirin when joints are red and hot. c. Comply with antihypertensive diuretic regimen.

d. Avoid beef kidneys, asparagus, and alcohol. ANS: D Feedback A

B C

Incorrect. The nurse instructs the patient to drink two litres of water daily to facilitate uric acid excretion and to prevent the crystallization of uric acid in the renal tubules. Incorrect. The nurse instructs this individual to avoid aspirin because it increases the risk of an acute attack and counteracts the benefit of uric acid prophylaxis. Incorrect. Antihypertensive therapy helps to reduce the risk of another attack, but when diuretics are used for antihypertensive therapy, the potential benefit for gout prophylaxis is blunted because diuretics increase the risk of gouty attacks. Correct. Because this individual manifests an acute attack in the ankle from hyperuricemia, the goal of therapy is to prevent another attack. To decrease uric acid production, the prophylactic medication of choice for gouty arthritis is colchicine (Colsalide). To enhance the action of this medication and further reduce this patient’s risk of another attack, the nurse instructs the patient to avoid beef kidney and asparagus, because they contain purine, and to avoid alcohol, because it increases uric acid production.

DIF: Analysis REF: 286 (Box 18-3) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 6

Chapter 19: Visual and Auditory Changes Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which disease creates pressure within the eye and potential optic nerve damage in the

older person? a. Glaucoma b. Presbyopia c. Cataract d. Macular degeneration ANS: A Feedback A

C D

Correct. Glaucoma, a disease marked by increased pressure within the eye that potentially leads to optic nerve damage, is the most common cause of blindness after age 65. Incorrect. 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. Incorrect. A cataract is a disease marked by clouding and blurring of the lens. Incorrect. 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.

DIF: Knowledge REF: 292 TOP: NCLEX: Physiological Integrity

OBJ: 1

2. Which of the following factors may exacerbate tinnitus? a. Hearing aids b. A diet high in calcium c. Alcohol and cigarettes d. History of brain injury ANS: C Feedback A B C D

Incorrect. Hearing aids may be used to treat tinnitus, and do not exacerbate it. Incorrect. There is no link between dietary calcium and tinnitus Correct. Alcohol and cigarettes, as well as caffeine, stress, and fatigue, may make tinnitus worse. Incorrect. Brain injury is not directly related to hearing loss or tinnitus.

DIF: Comprehension REF: 298 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 3

3. Glaucoma is a major public health problem. It is estimated that 250,000 Canadians were

living with glaucoma in 2009. Mr. Gonzalez, 70 years of age, has told the nurse that he is experiencing frequent headaches, poor vision in dimly lit areas, increased sensitivity to glare, “tired eyes,” and some impaired peripheral vision, especially when he is driving. Which type of glaucoma is Mr. Gonzalez experiencing? a. Primary open-angle glaucoma b. Acute angle-closure glaucoma c. Low tension glaucoma d. Normal tension glaucoma ANS: A Feedback A

Correct. Signs of primary open-angle glaucoma include headaches, poor vision in dim lighting, increased sensitivity to glare, “tired eyes,” impaired peripheral vision, a fixed and dilated pupil, and frequent changes in prescriptions for corrective lenses. Incorrect. Acute angle-closure glaucoma is characterized by a rapid rise in intraocular pressure (IOP), accompanied by redness and acute pain in and around the eye, severe headache, nausea, and vomiting, and blurring of vision. If untreated, blindness can occur in two days. Incorrect. Low tension glaucoma signs include IOP that is within normal range (12–22 mm Hg), but there is damage to the optic nerve and narrowing of the visual fields. Incorrect. Normal tension glaucoma is the same as low tension glaucoma; signs include IOP that is within normal range (12–22 mm Hg), but there is damage to the optic nerve and narrowing of the visual fields.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 292

OBJ: 2

4. The etiology of glaucoma is variable and often unknown. Which type of glaucoma in the

older person is the most urgent and requires medical attention? a. Primary open-angle glaucoma b. Acute angle-closure glaucoma c. Low tension glaucoma d. Normal tension glaucoma ANS: B Feedback A

Incorrect. Signs of open-angle glaucoma include headaches, poor vision in dim lighting, increased sensitivity to glare, “tired eyes,” impaired peripheral vision, a fixed and dilated pupil, and frequent changes in prescriptions for corrective lenses. Correct. Acute angle-closure glaucoma is characterized by a rapid rise in intraocular pressure (IOP), accompanied by redness and acute pain in and around the eye, severe headache, nausea and vomiting, and blurring of vision. If untreated, blindness can occur in two days. Incorrect. Low tension glaucoma signs include IOP that is within normal range

(12–22 mm Hg), but there is damage to the optic nerve and narrowing of the visual fields. Incorrect. Normal tension glaucoma is the same as low tension glaucoma; signs include IOP that is within normal range (12–22 mm Hg), but there is damage to the optic nerve and narrowing of the visual fields.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 292

OBJ: 2

5. The nurse plans care for 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 behavioural and social decline. b. Tell the resident to hold rails during ambulation. c. Examine the resident’s mood and functional status. d. Use problem solving involving the resident. ANS: C Feedback A B

Incorrect. 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. Incorrect. This is a potential nursing intervention for patient teaching; however, in problem solving, a different compensatory solution can be developed based on the assessment. Correct. 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 provide the basis for solving new problems caused by the loss of vision and finding compensatory mechanisms for the resident. Incorrect. Problem solving takes place after a complete assessment.

DIF: Analysis REF: 299 OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 6. The most detrimental illness or condition that an older person with prelingual deafness can

experience is which one of the following? a. Aphasia b. Cataracts c. Glaucoma d. Osteoarthritis ANS: B Feedback A

Incorrect. Aphasia has the potential to affect the individual’s life, depending on the type and severity; however, with adequate vision, some means of communication usually remains viable. Correct. Cataracts can have a potentially devastating impact on the life of an individual with prelingual deafness because sign language is the primary source for communication. Without the ability to read signing or lips accurately, the older person who has a cloudy lens is unable to receive communication except

by Braille. Incorrect. Glaucoma would not devastate the individual’s ability to read sign language unless blindness occurred. Effective treatment should help to maintain the individual’s baseline visual acuity. Incorrect. Osteoarthritis can make signing more difficult for an individual with prelingual deafness, but it is not nearly as devastating to the ability to communicate as a cloudy lens from cataracts.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 298

OBJ: 2

7. An older male adult who has tinnitus complains to the nurse that it is very annoying. The

nurse should implement which one of the following to alleviate the stress this patient is experiencing from tinnitus? a. Irrigate bilateral Eustachian tubes. b. Assess for modifiable risk factors. c. Propose a hearing aid and a masker. d. Use white noise to override tinnitus. ANS: B Feedback A B

Incorrect. The nurse irrigates the external auditory canal for impacted cerumen to decrease the risk of tinnitus. Correct. 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 to give the patient a sense of control as well as provide potential relief from tinnitus. Incorrect. Although these devices 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. Incorrect. Although white noise has the potential to alleviate tinnitus, it can be ineffective or serve as a potential source of additional stress.

DIF: Application REF: 298 OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 8. The children of an older male adult feel that his vision may be impaired and they are

worried about him driving a car. Which sign/behaviour has research shown to indicate that there may be vision problems in this patient? a. This older person has complained of squinting and a greater sensitivity to light. b. This older person recently began taking a prescription medication for high blood pressure. c. This older person has decreased his socialization with his bridge group. d. This older person has shown decreased interest in making meals. ANS: A Feedback A

Correct. Squinting and sensitivity to light may indicate vision problems.

B C D

Incorrect. Blood pressure medication is not listed as a symptom of decreased vision. Incorrect. This behaviour change may be an indicator of depression or other mood change, but not decrease in vision. Incorrect. This behaviour change may be an indicator of depression or other mood change, but not decrease in vision.

DIF: Application REF: 293 (Box 19-1) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 2

9. Management of glaucoma involves medications (oral or topical eye drops) to decrease

intraocular pressure (IOP). Which of the following medications would be prescribed to the older person to control and reduce the IOP in acute angle-closure glaucoma? a. Antihistamines b. Vasodilators c. Beta blockers d. Bronchodilators ANS: C Feedback A

C D

Incorrect. Antihistamines, stimulants, vasodilators, clonidine, and bronchodilators (sympathomimetics) are particularly dangerous for patients predisposed to angle-closure glaucoma. Incorrect. Antihistamines, stimulants, vasodilators, clonidine, and bronchodilators (sympathomimetics) are particularly dangerous for patients predisposed to angle-closure glaucoma. Correct. Beta blockers are the first-line therapy for glaucoma. Incorrect. Antihistamines, stimulants, vasodilators, clonidine, and bronchodilators (sympathomimetics) are particularly dangerous for patients predisposed to angle-closure glaucoma.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 294

OBJ: 2

10. According to the Canadian National Institute for the Blind (CNIB), age-related macular

degeneration (AMD) is the leading cause of severe vision loss in older persons in Canada. The CNIB suggests that older persons can change several modifiable risk factors to reduce or prevent AMD. Which of the following demonstrates modification of a risk factor for AMD? a. Consume few or no alcoholic beverages. b. Stop smoking. c. Avoid direct sunlight. d. Consume foods high in vitamin C. ANS: B Feedback A

Incorrect. Consuming alcohol does not appear to be a modifiable risk factor for reducing or preventing AMD

Correct. Smoking is a significant and modifiable risk factor. People who smoke are up to four times more likely to develop AMD, the leading cause of vision loss in Canada. Incorrect. Staying indoors on sunny days is not necessary; however, protecting your eyes and wearing a hat and sunglasses with 98% UV protection are more important and logical actions. Incorrect. Eating brightly coloured vegetables, and fish such as tuna and salmon, is recommended by the CNIB.

DIF: Comprehension REF: 295 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 3

Chapter 20: Cardio-Vascular and Respiratory Disorders Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following statements about heart disease in older persons is true? a. Myocardial infarction has many of the same symptoms in older patients as in

middle-aged persons. b. Excessive urination at night and orthopnea can be signs of heart failure. c. Any exertion on the part of an older-person patient with heart disease can bring on another heart attack. d. A person with heart failure is likely to have trouble breathing, except when lying down. ANS: B Feedback A

C D

Incorrect. In older patients, the classic presentation of angina pectoris is often absent in what is known as a “silent” myocardial infarction (MI), with only mild discomfort, perhaps even limited to nausea or “heartburn.” Correct. Because the heart is an ineffective pump in heart failure (HF), both of these can occur when older persons have an MI. Nocturia occurs in heart failure, 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. The older person may also experience an inability to lie flat without becoming short of breath (orthopnea), waking up at night gasping for air. Incorrect. Failure to engage in cardiac rehabilitation exercise is more likely to result in another MI or aggravation of HF than ordinary exertion. Incorrect. A person with HF is more likely to have difficulty breathing except when the trunk is upright (orthopnea).

DIF: Comprehension REF: 305 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 2

2. An older male adult in a cardiac rehabilitation exercise class refuses to participate in the

cool-down phase of the activity, and two minutes later, he passes out but regains consciousness quickly. Which of the following instructions does the nurse include in patient teaching to reinforce to this older person the importance of cooling down after exercise? 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 Feedback

A B C

Incorrect. An acute problem due to decreased cardiac output should appear during the “real” exercise. Incorrect. The older person is mobile enough to participate in the exercise program. Correct. 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, the blood pools in the skeletal muscles temporarily, and the older person loses consciousness from transient hypotension. This is because baroreceptor responsiveness declines with age, so the body does not respond as readily to the need for changes in blood pressure. The cool-down period compensates for this effect. Incorrect. Gradual sensory alteration does not account for the acute episode.

DIF: Application REF: 307 TOP: NCLEX: Physiological Integrity

OBJ: 2

3. Which of the following statements about heart disease in older persons is true? a. More women than men die from myocardial infarctions. 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 Feedback A B C D

Incorrect. This is a stereotype that has led to a relative neglect of women’s cardiac problems. Incorrect. Men usually receive more aggressive treatment. Incorrect. In the past, testing has focused on male patients. Correct. Women receive less aggressive treatment and less effective instruction for cardiac disease. This is potentially due to the atypical presentations women have for cardiac disease and myocardial infarctions (MIs). Older women often present with weakness or lethargy as a sign of an MI. More often, there are no noticeable signs or symptoms at all, and the event is only noticed at the time of death or when an electrocardiogram (ECG) is performed for some other purpose. Often, these vague symptoms are not brought to the attention of a health care provider.

DIF: Knowledge REF: 305 OBJ: 2 TOP: NCLEX: Safe and Effective Care Environment 4. An older female adult who has chronic obstructive pulmonary disease (COPD) wants to

perform self-care activities. Which instruction should the nurse include in patient teaching to help this older person 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) together, and then rest. d. Bathe right after eating and then rest. ANS: A

Feedback A B C D

Correct. A person with COPD can perform self-care tasks if allowed plenty of time for them as well as breaks for rest. Incorrect. The patient can potentially benefit more from longer periods of exercise supplemented with oxygen than from short excursions without oxygen. Incorrect. A plan to rest after the job is done does not compensate for deprivation of rest when she needs it. Incorrect. A plan to rest after the job is done does not compensate for deprivation of rest when she needs it.

DIF: Application REF: 308 OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 5. The Public Health Agency of Canada and the Canadian Lung Association recommend that

every older person who will be entering a long-term care (LTC) facility as a resident will become part of communal living and must therefore undergo annual testing for tuberculosis (TB). Which of the following statements about TB in older persons is TRUE? a. The principal threat from TB is its highly contagious nature. b. The tuberculin purified protein derivative (PPD) test is a conclusive test for TB. c. Antimicrobial drugs have made TB a thing of the past. d. Older persons who contracted TB in their youth may suffer reactivation of TB. ANS: D Feedback A

C D

Incorrect. TB is not as contagious as formerly supposed, though drug-resistant forms exist and are a serious risk for older persons who are immunocompromised. Incorrect. A PPD test has a false-negative rate of approximately 30%. When the result is positive, the patient receives a sputum culture and chest X-ray exam. A positive sputum culture is necessary to confirm the diagnosis. Incorrect. Although medications such as isoniazid (INH) were thought to have eliminated TB, the organism is present in multidrug-resistant forms. Correct. Older persons who contracted TB before the 1940s may suffer reactivation of the bacterium. Most reported cases of TB among elders are from nursing homes.

DIF: Comprehension REF: 312 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 6

6. Clinical heart failure (HF) is categorized as left-sided, right-sided, or both-sided

(biventricular) failure. Mrs. Poulin, 80 years of age, lives in a long-term care (LTC) facility and has been diagnosed as having Class II mild heart failure. She is comfortable at rest and occasionally dyspneic after completing her own morning care. Which atypical exacerbation of congestive heart failure (CHF) should the nurse be alerted to when caring for Mrs. Poulin? a. Weight gain of 1 kg in one week b. Swelling of lower extremities after sitting for two hours c. Malaise and diminished desire to participate in activities

d. Nonproductive cough ANS: C Feedback A

B C

Incorrect. A weight gain of 1 kg in one week is not of major concern, and could simply indicate that the patient has eaten more and exercised less during the week. Unusual weight gain would be 2 kg in one or two days, but is not an atypical sign. Incorrect. Swelling of lower extremities after sitting for two hours is expected with CHF and not an atypical sign. Correct. Malaise and diminished desire to participate in activities is an atypical sign. The older person may appear confused or delirious, begin falling, or complain of insomnia or urinary frequency at night (nocturia). He or she may complain of dizziness or may have syncope (fainting). Or, more often, the nurse will notice that the person has “droops,” or malaise and a subtle decline in activity tolerance or functional or cognitive abilities. These atypical signs need to be addressed quickly as they become acute problems; they can do so very rapidly, and often necessitate acute hospitalization and intensive treatment followed by rehabilitation. Incorrect. Nonproductive cough is not an atypical sign of CHF.

DIF: Comprehension REF: 305 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 2

7. What is the most important goal in the nursing plan of care to decrease the frequency of

hospitalizations for acute exacerbations of heart failure (HF) in older persons who have HF? a. Control fluid balance. b. Control blood pressure. c. Prevent deconditioning. d. Maintain patient safety. ANS: A Feedback A

Correct. The most important goal for keeping a patient who has heart failure out of the hospital is to control total body fluid, because hypervolemia aggravates heart failure by increasing the blood volume and making the heart work harder. Controlling total body fluid also helps to prevent dyspnea and hypertension, maintain physical activity, improve rest and sleep, and promote nutrition for optimal health and wellness. Incorrect. Controlling the blood pressure is an important part of heart failure therapy; however, fluid volume status is implicated most often in hospitalizations for heart failure. Incorrect. Preventing deconditioning is an important yet challenging goal for patients with heart failure, but it is not implicated frequently in hospitalizations for heart failure. Incorrect. Maintaining patient safety is an important goal for any patient but is not commonly implicated as a cause of hospitalizations for heart failure.

DIF: Comprehension REF: 305 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 3

8. After an older person’s acute exacerbation of chronic obstructive pulmonary disease

(COPD), the nurse prepares the patient for discharge to home. What is the most important patient teaching for the nurse to include for the prevention of hospitalizations for exacerbation 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 food. ANS: C Feedback A

Incorrect. The nurse teaches the patient this technique to ease breathing for transient dyspnea that occurs after exertion or while eating. It is, however, unlikely to prevent a hospitalization for a patient with an exacerbation of COPD. Incorrect. The patient with COPD uses oxygen regularly or for dyspnea as prescribed. Oxygen provides symptomatic relief of dyspnea and does not prevent hospitalizations for exacerbated COPD. Correct. The nurse helps the patient with COPD to 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 micro-organisms as potential pathogens. This helps to avoid hospitalizations for COPD because a pulmonary infection can have a devastating impact on a patient who has compromised pulmonary reserves: fluid and exudates accumulate in the lungs, decreasing oxygenation and ventilation, and the patient with COPD is less able to cough and expel sputum. Incorrect. Eating nutrient- and calorie-dense food is important in COPD because the patient works hard at breathing, so she needs the calories and nutrition to supply fuel for the work of breathing. In addition, she should eat these foods because it is difficult for her to eat in sufficient quantities for her needs; so the food she does eat must contain many calories and nutrients. This is not the most important aspect of preventative therapy for patients with COPD, however, because an infection is more likely to cause a devastating problem faster than are nutritional issues.

DIF: Analysis REF: 311 (Box 20-9) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 3

9. The nurse notices that an older female nursing home resident is not eating and that her

heart rate is faster than usual at 110–120 beats per minute. What should the nurse do to eliminate pneumonia as a potential cause of the change in this resident’s status? a. Obtain a specimen for aerobic blood cultures. b. Send the resident for a chest X-ray exam promptly. c. Analyze sputum for colour, texture, and volume. d. Compare tympanic temperature to the baseline.

ANS: C Feedback A B C

Incorrect. Sputum cultures are indicated to assess a resident for pneumonia; blood cultures are likely to show no growth unless the resident has severe sepsis. Incorrect. A chest X-ray study is a nonsensitive, nonspecific diagnostic tool for determining the presence of pneumonia in an older person. Correct. Sputum is a sensitive and specific clinical indicator of pneumonia for older persons in nursing homes. If pneumonia is causing this resident’s anorexia and tachycardia, the sputum should be cloudy, coloured, and thick, especially if the resident is dehydrated, indicating an infection. Incorrect. Fever can be a late indicator of infection for an older person.

DIF: Application REF: 311 (Box 20-8) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 2

10. The exercise tolerance of an older person is impaired after a myocardial infarction (MI)

because of a low ejection fraction. Which of the following primary interventions should the nurse use to assist this individual to restore baseline functional status? a. Provide a well-balanced diet. b. Assist with range of motion. c. Instruct the older person to sit up in a chair four times daily. d. Keep O2 saturation above 95%. ANS: D Feedback A

Incorrect. This is the second intervention the nurse should consider. The nurse provides a well-balanced diet for tissue building and repair. The older person has little hope of resuming baseline functioning without adequate food for fuel and maintaining muscle bulk. Incorrect. This is the third intervention the nurse should consider. This is to help maintain muscle bulk and joint flexibility; therefore, the nurse helps the older person to perform range-of-motion exercises in preparation for more strenuous physical activity. Incorrect. This is the last intervention the nurse should consider. Before ambulation, the nurse ensures that the patient is up in a chair four times a day as progress toward restoring baseline functioning. Correct. This is the first intervention the nurse should consider. The nurse helps to maintain myocardial oxygenation by keeping the patient’s SaO2 above 95%, because if it drops below that level, the arterial blood lacks sufficient oxygen to meet tissue oxygen demands.

DIF: Analysis REF: 311 (Box 20-9) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 2

11. Pneumonia and influenza are the seventh and eighth leading causes of death for men and

women over the age of 65, respectively, according to Statistics Canada (2015). To prevent pneumonia and influenza in the older person, what is the priority nursing intervention? a. Provide the older person with supplemental oxygen therapy, if and when it is

necessary. b. Administer IV antibiotics and other medications as prescribed. c. Administer the influenza and pneumococcal vaccines. d. Promote maximal functional capacity and encourage older persons to quit

smoking. ANS: C Feedback A

Incorrect. Providing the older person with supplemental oxygen therapy if and when it is necessary is important, but this is a nursing intervention that would be implemented after the older person has contracted pneumonia. Incorrect. Administering IV antibiotics and other medications as prescribed is important, but this is a nursing intervention that occurs after the older person has contracted pneumonia. Correct. Many cases of pneumonia can be either prevented by immunization or treated effectively. The pneumococcal vaccine is a one-time vaccine that can prevent pneumonia and other infections and is recommended for people at high risk, those above 65 years of age, or both. The influenza vaccine remains the cornerstone of prevention. A yearly flu vaccine, if used accordingly, can be expected to prevent 70% of hospitalizations and 80% of deaths due to influenza among older individuals living in the community. Incorrect. Promoting maximal functional capacity and encouraging older persons to quit smoking are important. However, these measures need to be taken prior to contracting influenza or pneumonia.

DIF: Application REF: 309 OBJ: 5 TOP: NCLEX: Health Promotion and Maintenance

Chapter 21: Cognitive Impairment and Neurological Disorders Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. At 2200 hours, an older male resident is attempting to climb over the bedrails. Which

intervention should the nurse implement first? a. Gently question the resident about his behaviour. b. Call the physician and ask for sedation. c. Apply a vest restraint to the resident. d. Get a companion to keep the older person in the bed. ANS: A Feedback A B C

Correct. The resident is expressing a need that the nurse can potentially determine with gentle questioning. Incorrect. Pharmacological intervention can be necessary but should not replace careful evaluation and management of the underlying cause. Incorrect. Simply restraining the resident will not address the underlying problem, and 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. Incorrect. 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.

DIF: Analysis REF: 325 (Figure 21-1) TOP: NCLEX: Safe and Effective Care Environment

OBJ: 1

2. Confirming a diagnosis of Alzheimer’s disease in an older person can be achieved by

detecting or utilizing which of the following tests or assessments? a. Clinical observation of dementia and delirium in the older person b. Observing the inability of the older person to speak with relevance and fluency c. Neurofibrillary tangles and beta amyloid plaques observed during autopsy d. Computed axial tomographic scan (CT scan) ANS: C Feedback A

B C D

Incorrect. Patients with Alzheimer’s disease can be observed for dementia and delirium, but these are nonspecific indicators for Alzheimer’s disease and will not confirm a diagnosis of AD. Incorrect. These are features of dementia; if other causes of dementia are ruled out, this may be dementia of the Alzheimer’s type. Correct. This is the only accurate method for diagnosing AD. Incorrect. A CT scan is the most useful means for diagnosing stroke.

DIF: Knowledge REF: 330 TOP: NCLEX: Physiological Integrity

OBJ: 2

3. Which assessment parameter should the nurse avoid using to differentiate between

delirium and depression in an older person? a. Orientation of the older person b. Level of consciousness in the older person c. Course of behaviour of the older person over 24 hours d. Psychomotor activity of the older person ANS: D Feedback A

B C D

Incorrect. Qualities of the patient’s orientation are a good method for the nurse to use for distinguishing between delirium and depression, because with delirium, orientation is usually impaired, whereas with depression, orientation is normal. Incorrect. Consciousness is a good method for distinguishing between delirium and depression because in delirium it is reduced and in depression it is clear. Incorrect. Delirium tends to be worse at night, and depression tends to be worse in the morning. Correct. The nurse avoids using qualities about the patient’s psychomotor activities to distinguish between delirium and depression in an older person, because psychomotor activities in both disorders are highly variable and make distinctions difficult.

DIF: Comprehension REF: 319 (Table 21-1) OBJ: 1 TOP: NCLEX: Health Promotion and Maintenance 4. Classic signs of Parkinson’s disease (PD) in an older person include tremors at rest,

rigidity (stiff muscles), akinesia (poverty of movement), and postural abnormalities. Which of the following is the most conspicuous sign of PD? a. Tremor b. Rigidity c. Akinesia d. Postural abnormalities ANS: A Feedback A

B C

Correct. The most conspicuous sign of PD is the tremor—an asymmetrical, regular, rhythmic, low-amplitude tremor. It disappears briefly during voluntary movement and increases with stress and anxiety. Incorrect. Rigidity, which impedes passive and active movement, is not the most conspicuous sign of PD. Incorrect. Akinesia (absence or poverty or movement) is an often overlooked symptom. All the striated muscles in the extremities, the trunk, the ocular area, and the face are affected, including the muscles of mastication (chewing), deglutition (swallowing), and articulation. However, akinesia is not the most conspicuous sign of PD. Incorrect. Postural abnormalities or instability—difficulty maintaining balance

when walking or standing—are not the most conspicuous signs of PD. DIF: Knowledge REF: 345-346 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 5. Which of the following is a beneficial approach to hygienic care for an older person with

dementia? a. Schedule the older person’s full shower at 0700 hours for three mornings every week. b. Have a team give the older person a bath together, with each member washing a different body area. c. Wash the older person’s perineal region first, to remove potentially infectious material. d. Explain each step as you go, and keep the older-person patient covered as much as possible while bathing. ANS: D Feedback A

B C

Incorrect. From the point of view of the well-being of the older-person patient, bathing is rarely such an emergency that it must be performed at a time when the older person is not receptive. Incorrect. Stimulation should be kept simple and focused, and avoid alarming the older-person patient. Incorrect. The most sensitive and intimate areas should be washed last, after trust has been established between the older-person 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. Correct. Undressing for bathing can be interpreted as assault by an older-person patient with dementia. It should be performed in a way that minimizes the intrusive and exposing aspects and maintains trust between the patient and caregiver.

DIF: Comprehension REF: 338 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 5 | 6

6. An older female adult is recovering in the intensive care unit from a bowel resection, but

remains intubated and on a mechanical ventilator. Using the Hospital Elder Life Program (HELP), what should the nurse implement to help prevent delirium in this older person? a. Assess cognition with Mini-Mental State Exam. b. Provide uninterrupted periods of rest and sleep. c. Maintain adequate sedation and pain management. d. Cover her eyes with protective ophthalmic ointment. ANS: B Feedback A

Incorrect. Because the patient is intubated and on mechanical ventilation, the nurse cannot apply the MMSE because the patient is unable to perform adequately. Besides, assessing for dementia is not a prophylactic measure. Correct. Providing uninterrupted periods of rest and sleep is a challenge for the

C D

nurse in the intensive care unit (ICU). Because of the nature of the patients’ illnesses, nurses administer medication 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. This contributes to delirium as patients lose sources for maintaining orientation and stability (for example, bright lighting at all times, leading to disruption in the circadian rhythm; and unfamiliar, abrupt increases in noise). In addition, patients are more likely to receive multiple medications and medications that are potentially harmful and can aggravate their cognitive difficulties. Incorrect. Sedation and pain management, although often needed in the intensive care unit, can contribute to delirium. Incorrect. Covering the eyes of a patient in intensive care 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.

DIF: Application REF: 323 (Box 21-2) TOP: NCLEX: Safe and Effective Care Environment

OBJ: 7

7. An older female adult has a wound infection five days after having undergone a

below-the-knee amputation brought about by diabetes mellitus. What is the nurse’s priority intervention to prevent cognitive dysfunction and postoperative complications in this older person? a. Remove invasive devices as soon as possible. b. Minimize administration of opioid analgesics. c. Allow for self-care and independent activities. d. Administer short-acting benzodiazepines as needed (PRN). ANS: A Feedback A

B C

Correct. To help prevent cognitive dysfunction, postoperative complications, and an increased risk of morbidity and mortality, the nurse recognizes the risk factors this older person has for delirium, including stressors, infection, and surgery; thus, to prevent cognitive decline and additional postoperative complications, the nurse removes invasive devices promptly 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 it serves to promote mobility and a sense of control for the patient, and to reduce the types of situations that can frighten the patient or that the patient can misinterpret. Incorrect. Poor pain management can contribute to delirium in older patients. Incorrect. 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 person is likely to need extensive physical therapy to maintain mobility. Incorrect. Benzodiazepines are a poor pharmacological choice for older persons for sedation or sleep because they can contribute to delirium, are highly addictive, and can cause rebound insomnia if withdrawn suddenly.

DIF: Analysis REF: 323 (Box 21-3) TOP: NCLEX: Health Promotion and Maintenance

OBJ: 7

8. Pharmacological interventions should not replace thoughtful and careful evaluation and

management of the underlying causes of delirium. Which medication administered for delirium in a controlled environment can reduce the duration and severity of delirium for high-risk patients? a. Haloperidol (Haldol) b. Thioridazine (Mellaril) c. Fluphenazine (Prolixin) d. Chlorpromazine (Thorazine) ANS: A Feedback A

B C D

Correct. Haloperidol administered in low doses helps reduce the severity and duration of delirium for high-risk patients following hip surgery; however, haloperidol therapy does not reduce the incidence of delirium in this group. In addition, atypical antipsychotic medications can also be effective when administered in low doses under controlled circumstances. Incorrect. Thioridazine is a typical antipsychotic and not indicated in the prevention of delirium. Incorrect. Fluphenazine is a typical antipsychotic and not indicated in the prevention of delirium. Incorrect. Chlorpromazine is a typical antipsychotic and not indicated in the prevention of delirium.

DIF: Knowledge REF: 325 (Figure 21-1) TOP: NCLEX: Physiological Integrity

OBJ: 7

9. An older male adult comes to the emergency department after falling at home. He reports

that he cannot walk without losing his balance, and his speech is somewhat slurred. Which one of the following steps should the nurse implement for this patient? a. Arrange to transfer him to radiology immediately. b. Determine symptom onset or when he fell at home. c. Organize the tissue plasminogen activator (tPA) infusion. d. Perform a comprehensive neurological assessment. ANS: B Feedback A

Incorrect. A patient who is seen with clinical indicators of a stroke will need a computed tomography (CT) scan to differentiate between a thrombotic and a hemorrhagic stroke because the type of stroke determines the therapeutic course. Even so, the time of symptom onset is a vital piece of information that must be determined before the trip to radiology because tPA is usually administered in the radiology suite. Correct. The nurse determines when the symptoms appeared first, or the time of the fall, to determine if sufficient time is left to administer tPA; if it is indicated, it must be administered within three hours of symptom onset.

Incorrect. Administration of tPA can be contraindicated for this patient, so preparation of this infusion is delayed until the type of stroke and plan of care are determined. Incorrect. 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.

DIF: Application REF: 343 OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 10. Which type of exercise program is better for improving mood and function in older

persons with Alzheimer’s disease (AD)? a. A program that helps to improve balance b. A program that emphasizes walking c. A self-paced exercise program d. A program that emphasizes wandering ANS: A Feedback A

B C D

Correct. Older persons with Alzheimer’s disease (AD) can benefit from regular exercise, including exercises to improve balance, as demonstrated by more positive affect and mood, improved function, and less disability. Incorrect. Endurance, strength, and balance exercises help to improve patients with AD more than walking does. Incorrect. Self-paced exercises are unlikely to be suitable for a patient with AD, because of cognitive dysfunction. Incorrect. People with dementia who wander may have more visuospatial impairments, anxiety and depression, and a history of a prior active lifestyle. Wandering can lead to falls.

DIF: Comprehension REF: 338 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 8

11. Cerebrovascular disease is manifested as either a stroke (ischemic or hemorrhagic) or a

transient ischemic attack (TIA). Mr. Dickson, 75 years of age, has been admitted to the hospital with an ischemic stroke. Which of the following would be an expected finding in an older person with an ischemic stroke? a. A sudden explosive, unrelenting headache b. Decreased level of consciousness c. Sudden weakness or numbness on one side of the body d. A seizure lasting one to two minutes ANS: C Feedback A

Incorrect. In older persons with subarachnoid hemorrhagic stroke, the headache is not only sudden but also explosive, very severe, and without other neurological manifestations, but this is not a symptom of an ischemic stroke. Incorrect. Older persons with hemorrhagic stroke have more focal neurological changes and a more depressed level of consciousness than those with an

ischemic stroke. If a deep unresponsive state occurs, the older person is unlikely to survive. Correct. Symptoms of a transient ischemic attack or stroke include sudden weakness or numbness on one side of the body (face, arm, or leg), dimness or loss of vision in one eye, slurred speech, loss of speech, difficulty comprehending speech, dizziness, difficulty walking, loss of coordination, loss of balance, a fall, difficulty swallowing, sudden confusion, and nausea and vomiting. Incorrect. Seizures are more common in intracerebral hemorrhage.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 342

OBJ: 3

12. An older person who has had a TIA should be assessed for which of the following? a. Age, race, gender, income b. Vital signs, speech, gender, race c. Age, income, coordination, sensation d. Vital signs, speech, coordination, sensation ANS: D Feedback A B C D

Incorrect. See Table 21-4 in text; these factors are risk for stroke but not a priority assessment following a TIA. Incorrect. See Table 21-4 in text; these factors are risk for stroke but not a priority assessment following a TIA. Incorrect. See Table 21-4 in text; these factors are risk for stroke but not a priority assessment following a TIA. Correct. These factors are priority assessments for a stroke following a TIA.

DIF: Comprehension REF: 345 (Table 21-4) OBJ: 3 TOP: NCLEX: Physiological Integrity

Chapter 22: Economic and Legal Issues Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Under the Canada Health Act, “medically necessary” services are publicly insured,

including primary health care, care in hospitals, and surgical–dental services. How is the term “medically necessary” interpreted by the provinces and the territories? a. There is provincial and territorial variability in terms of how some “medically necessary” services are interpreted. b. All provinces and territories follow the same interpretation, and provide all “medically necessary” services to Canadians. c. Home care, medications outside of hospital, physiotherapy, and optometry services are provided to all Canadians. d. The level of funding provided for all “medically necessary” services is the same throughout Canada. ANS: A Feedback A

B C

Correct. The term “medically necessary” is not explicitly defined within the Canada Health Act, meaning that it is somewhat open to interpretation. This means there is provincial and territorial variability in the provision of some services such as home care, long-term care, medications outside of hospital, physiotherapy, optometry services, etc. Incorrect. The level of funding provided for these services varies among provinces and territories. Incorrect. Home care, medications outside of hospital, physiotherapy, and optometry services are provided to all Canadians, but the level of funding provided for these services varies among provinces and territories. Incorrect. The level of funding provided for these services varies among provinces and territories.

DIF: Knowledge REF: 357 OBJ: 1 TOP: NCLEX: Safe and Effective Care Environment 2. In 2001, the Canadian Health Services Research Foundation (CHSRF) reported that if the

pattern of typical health care service use by older Canadians changes, there could be an impact on overall health care costs for the population. What would cause health care expenditures in Canada to increase? a. As the baby boomer generation ages, older Canadians will be in poor health and require more health care services. b. Healthy older persons will be using more health care services, mainly more physician visits and tests for preventative measures. c. The biggest cost increase in the health care expenditure will be for prescription medication. d. As the population ages, more hospital services will be required, thereby increasing the overall cost of health care.

ANS: B Feedback A

B C

Incorrect. Increased use of services by older persons in poor health accounted for only small portions of the increased health care expenditures for the entire population of older persons. Correct. Healthy older persons will be using more services, mainly more physician visits and tests for preventative measures. Incorrect. The biggest cost increase in the health care expenditure will be for prescription medication, but most of this expense is paid out-of-pocket and by private insurance, not by the government. Incorrect. Increased use of services by older persons in poor health accounted for only small portions of the increased health care expenditures for the entire population of older persons.

DIF: Knowledge REF: 358 OBJ: 2 TOP: NCLEX: Safe and Effective Care Environment 3. Social security retirement income programs are designed to minimize the chances of

retirees and older people living in poverty in Canada. Which of the following individuals over the age of 65 years would encounter the most challenges in accessing the social security retirement income programs, which include Old Age Security (OAS), Guaranteed Income Supplement (GIS), Allowance for the Survivor, and the Canada Pension Plan (CPP)? a. Mrs. Perez, who has been living in Canada for eight years as a sponsored immigrant b. Ms. Soznicki, who has been a common-law partner for ten years c. Mrs. Haas, who is the widow of an old age security pensioner d. Mr. Naipal, who has been a same-sex partner for 15 years ANS: A Feedback A

B C D

Correct. Sponsored immigrants are not eligible for the GIS or the Allowance for the Survivor during the period of their sponsorship (up to ten years), except under limited situations. Incorrect. The Allowance for the Survivor is paid to the spouse or common-law partner of an OAS pensioner. Incorrect. The Allowance for the Survivor is paid to the survivor (widow or widower) of an OAS pensioner. Incorrect. The Canada Pension Plan (CPP) and Quebec Pension Plan (QPP) provide retirement pensions and disability benefits for persons who made contributions to the plans. They also provide survivor benefits for eligible spouses, common-law partners (including same-sex partners), or dependent children when a contributor to the plan dies.

DIF: Knowledge REF: 359 OBJ: 3 TOP: NCLEX: Safe and Effective Care Environment

4. The National Advisory Committee on Aging (NACA) has raised an important issue of

“under-subscription,” that is, people who are eligible for the GIS, the Allowance, Old Age Security (OAS), or the Allowance for the Survivor, but who do not receive it because they have not applied or reapplied for the benefits. Which of the following groups constitutes the majority of those who do not subscribe or apply for OAS benefits? a. Canadians who do not speak English or French, or who have low literacy b. Canadians who live in remote regions c. Canadians who are homeless d. Canadians who are older women ANS: D Feedback A

Incorrect. People who are less likely to apply for the GIS, the Allowance, and the Allowance for the Survivor benefits include those who do not speak English or French, live in remote regions, are physically or mentally impaired, have low literacy, or are homeless (NACA, 2005). But the majority of those who do not apply for OAS are older women, who are at highest risk of living in poverty. Incorrect. People who are less likely to apply for the GIS, the Allowance, and the Allowance for the Survivor benefits include those who do not speak English or French, live in remote regions, are physically or mentally impaired, have low literacy, or are homeless (NACA, 2005). But the majority of those who do not apply for OAS are older women, who are at highest risk of living in poverty. Incorrect. People who are less likely to apply for the GIS, the Allowance, and the Allowance for the Survivor benefits include those who do not speak English or French, live in remote regions, are physically or mentally impaired, have low literacy, or are homeless (NACA, 2005). But the majority of those who do not apply for OAS are older women, who are at highest risk of living in poverty. Correct. A significant number of older Canadians miss out on benefits they are entitled to and need because of late applications or missed renewal application deadlines. However, the majority of those who do not apply for OAS are older women, who are at highest risk of living in poverty.

DIF: Knowledge REF: 361 OBJ: 3 TOP: NCLEX: Safe and Effective Care Environment 5. A health care provider asks the nurse about an older male adult’s power of attorney

because consent is needed for a medically necessary invasive procedure; the patient has end-stage disease, is intubated, and is on mechanical ventilation. Which one of the following steps should the nurse implement? a. Refer to the patient’s advance directive for a name. b. Assist with obtaining informed consent from the patient. c. Use an oral test to measure the patient’s cognitive function. d. Apply the Confusion Assessment Method for critical care. ANS: D Feedback A

Incorrect. If the patient has an advance directive, the attorney-in-fact named in the power of attorney should be on that document. However, because the patient

B C D

has the right to make his own decisions about care, his cognitive status should be established first. Incorrect. Before informed consent can be given, the patient’s cognitive status must be determined. Incorrect. The patient is unable to perform an oral test while he is intubated. Correct. The health care provider assumes the intubated older person lacks the cognitive skill to give consent for treatment. Before the search begins for the power of attorney and to help determine the patient’s cognitive status, the nurse assesses the patient for delirium using the Confusion Assessment Method for the Intensive Care Unit. The nurse implements this valid and reliable tool because, as the patient’s advocate, the nurse wants to give the patient every opportunity to participate in the plan of care and make his own determinations.

DIF: Application REF: 365 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 6. Guardianship for an incapacitated older person may be appointed in which one of the

following situations? a. A dementia patient with a daughter designated as POA b. Needing to make a decision about payment for placement in a LTC home, with no living family or friends c. Undergoing a routine outpatient procedure, with a living spouse d. An emergency situation with a DNR in place ANS: B Feedback A B C D

Incorrect. A power of attorney would make decisions and a guardian would not be needed. Correct. When a person becomes mentally incapable of managing personal or financial affairs and does not have a POA in place, a guardian may be appointed. Incorrect. A living spouse would be able to provide consent for the procedure if needed. Incorrect. A DNR would be a legal document outlining the client wishes, made at a time they were capable, or made by a POA. A guardian would therefore not be needed.

DIF: Application REF: 365 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 7. The nurse distrusts the male caregiver, the son of an older female adult, and collaborates

with social services about potential resources for abused older persons. Which characteristics of the caregiver does the nurse report to social services as indicators of potential elder abuse? a. The caregiver collects unemployment benefits. b. The caregiver keeps his mother isolated from other family members and services. c. The caregiver takes frequent breaks for smoking. d. The caregiver sits at the patient’s bedside for hours daily. ANS: B

Feedback A

B C

Incorrect. Lack of employment is not a characteristic of someone who abuses older persons, although this problem can frustrate the individual; however, financial dependency on the abused is a predictor for abuse. Correct. The male caregiver—and son—of this woman isolates her, which is a risk factor for elder abuse. Incorrect. Although smoking is an unhealthy habit and exposes the older person to unhealthy second-hand smoke, smoking is not a characteristic of an abuser of older persons. Incorrect. This characteristic, in isolation, is not a characteristic of an abuser of older persons because concerned, caring family members keep bedside vigils, too.

DIF: Comprehension REF: 367 (Table 22-2) OBJ: 6 TOP: NCLEX: Psychosocial Integrity 8. Mrs. Bilyea is an 80-year-old widow who lives in a very expensive neighbourhood with

her 55-year-old son. She requires minor assistance with her activities of daily living. She has recently been admitted to hospital with chest pain. The nurse examines the older person and discovers that she has bruises on both of her upper arms. The son states that she was in the shower and fell, and while he was lifting her up, he grabbed both of her arms very tightly because she was wet and he did not want her to fall again. The nurse discusses her observations with other members of the health care team. Which statement by a member of the health care team indicates that more education is required? a. “This could not possibly be older-person abuse. Mrs. Bilyea is white and wealthy; abuse does not happen to ladies like her.” b. “Abuse increases proportionately to the increased time needed to provide care.” c. “We are not sure what has happened so we should report our suspicions.” d. “Most abusers are either adult children or spouses.” ANS: A Feedback A

Correct. This comment suggests that members of the health care team require more education about abuse. An older person’s wealth does not preclude that individual being abused. Most often, older victims are unwilling or afraid to report the problem because of shame, embarrassment, intimidation, or fear of retaliation. Incorrect. This comment indicates an awareness that older persons with cognitive impairment or who are physically dependent are at higher risk for elder abuse. Women are more likely than men to be the victims of reported elder abuse. Incorrect. This comment indicates that the health care team understands the importance of developing a safety plan with potential victims, so that they know how to get help if it is needed and know what resources are available to them. Incorrect. This comment indicates an awareness and understanding that older women are most likely to be abused by their spouse or adult children, and older men are most likely to be abused by adult children or close friends (CAMH, 2008).

DIF: Comprehension REF: 370 (Box 22-4) OBJ: 7 TOP: NCLEX: Psychosocial Integrity 9. An older male adult 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. Which should the nurse implement to address the short-term crisis? a. Remove him from his daughter’s home immediately. 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 Feedback A

B C

Incorrect. Unlike children, abused older persons cannot be removed from situations without their permission. Helping the daughter deal with the situational stress would be more effective. Incorrect. This solution can help the daughter learn more effective and harmless ways of solving problems, but it does not address the short-term crisis. Correct. By relieving the daughter of some responsibilities, respite care is likely to be beneficial for the older person and his daughter because it can help to reduce tension. Incorrect. This measure may eventually be necessary, but it would be better to improve the living situation within the patient’s family.

DIF: Application REF: 371 TOP: NCLEX: Psychosocial Integrity

OBJ: 7

Chapter 23: Relationships, Roles, and Transitions Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following statements about older-person relationships is true? a. After 50 years of marriage, a couple can face new and severe challenges to their

relationship. b. Older persons are usually alienated from their family members and their care is abandoned to institutions. c. Older persons find rewarding relationships by becoming a member of a church. d. For older persons, friends can never take the place of family. ANS: A Feedback A

B C

Correct. Physical and psychosocial changes related to aging, such as declining health, reduced income, and mismatched needs, may cause a severe strain, even in a couple who have been together for 50 years or more. Incorrect. It is a long-standing myth in society that families are alienated from their older family members and abandon their care to institutions. Incorrect. The development of rewarding relationships should have occurred many years prior to a person becoming an older person. If an older person does not already belong to a church, he or she is not likely to join a church in later life. Incorrect. Friendships can provide the commitment and support that is sometimes lacking in family relationships.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 378

OBJ: 2

2. Which of the following statements about the role of grandparents is true? 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 Feedback A B

C D

Incorrect. Grandparents have always had an important role to play in families, and have become more important than ever in recent decades. Correct. An increasing number of parents have been unable to provide necessary care for their children as a result of personal problems, and often grandparents fill the gaps. Incorrect. Grandparents provide continuity, family tradition, and accumulated wisdom. Incorrect. It is still expected that parents will be the primary caregivers.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 380

OBJ: 3

3. Which of the following statements is true about caregiving? a. Dementia in an older person can cause grief in the caregiver, comparable to the

grief from the older person’s death. b. Middle-aged adults and older parents reverse lifelong caregiving roles with

increasing age. c. Older persons 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 Feedback A B C D

Correct. For example, as the dementia progresses, the patient may cease to recognize the caregiver, who is often a spouse or child. Incorrect. The parent still remains the parent, and the notion that the parent somehow becomes a child again is demeaning. Incorrect. The older person may have significant support in the community where he or she lives. Incorrect. Often, the older parents remain caregivers for the disabled children, which is a serious burden.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 388

OBJ: 5

4. What is the most important element for older persons to have to enhance their transition

into retirement? a. Good health b. A private pension c. A registered retirement savings plan (RRSP) d. Preretirement planning ANS: D Feedback A

B C

Incorrect. Good health is always a desirable state; however, if an older person in poor health plans for retirement, the transition to the changes of retirement can be smoother if the planning accounts for health challenges. Incorrect. With preretirement planning, private pensions are not obligatory. Incorrect. With preretirement planning, RRSPs are not obligatory; however, these plans are effective saving plans for retirement because they allow employees to save pretax dollars. Correct. 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 financial planning help in the adaptation to expected or sudden retirement.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 382

OBJ: 4

5. Which following older person is most likely to need preretirement counselling to avoid

significant concerns in retirement? a. A woman who is a certified public accountant b. A woman who receives cash for cleaning services c. A middle-aged male adult who has a history of type 1 diabetes mellitus d. An older male clerk who works for Canada Post ANS: B Feedback A

C D

Incorrect. As a woman, this accountant is a member of a minority group. However, she is a professional and likely to earn a significant income in a finance-related business. Her occupation and education suggest she is well positioned to receive significant retirement planning. Correct. The older persons with the most need for retirement planning are the same people who are least likely to receive it. This woman has three characteristics indicating a need for retirement planning: she is female, her job implies a lack of education or training, and she does not pay into the Canada Pension Plan 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. In addition, her job is unlikely to help her build her RRSPs. Incorrect. This man has only one factor potentially associated with the need for retirement planning: poor health. Incorrect. The older clerk has only one factor potentially associated with the need for retirement planning: a clerk is likely to be a lower-level employee.

DIF: Comprehension REF: 383 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 4

6. The community health nurse delivers a program about retirement planning to middle-aged

adults, and wants to them to choose the year of their retirement. On which of the following areas should participants focus to ease their transition into retirement? a. The kind of legacy they want to leave behind b. The type of setting they prefer for their personal residence c. The location of convenient health care services d. The ability to maintain a stable standard of living ANS: D Feedback A B C D

Incorrect. Defining their legacy is a secondary factor and less likely to contribute to a smooth transition into retirement. Incorrect. Location of retirement is less likely than a stable standard of living to contribute to a smooth transition into retirement. Incorrect. Location of health care services is less likely than a stable standard of living to contribute to a smooth transition into retirement. Correct. The most significant factors contributing to a smooth transition into

retirement are health, income, and social involvement, so the nurse helps the participants focus on financial issues to begin retirement planning, thereby establishing their 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 their human resources department, to determine retirement benefits. DIF: Analysis REF: 382 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 7. Which older person will have the highest economic risk at the beginning of retirement? a. An older divorced female who has lived in this country for eight years b. An older male veteran, who is an above-the-knee amputee, and who was a teacher c. An older female, who is a widow and a primary care nurse practitioner d. An older male, who immigrated from China, and designs computer software ANS: A Feedback A

B C D

Correct. This older female adult has three factors associated with economic risk in retirement: being female, divorced, and an immigrant with inadequate time to be eligible for government-sponsored retirement benefits. Incorrect. The veteran has one risk factor: disability. Incorrect. The nurse has two risk factors: female gender and widowhood. Incorrect. The older person who is an immigrant from China has one risk factor: being an immigrant.

DIF: Comprehension REF: 382 TOP: NCLEX: Health Promotion and Maintenance

OBJ: 4

8. As the wife of a university president, an older female adult met exciting people and

travelled extensively until her husband died. The nurse identifies that, besides grieving an intimate partner, 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 Feedback A

B C

Incorrect. After extensive travel and sophisticated social stimulation, this older person is likely to be self-confident and to have acquired life skills from her experiences. Incorrect. The president of a university is likely to have planned for retirement and has left his survivors with an adequate estate. Correct. After the loss of her husband, this older person is most likely to mourn the loss of her status in the community because she is neither a wife nor the wife of a community leader any longer. After his death, the opportunities for university-related travel and social occasions are most likely to disappear from her life.

Incorrect. This woman is most likely to be able to provide intellectual stimulation in her own life even though the stimulation from the university-related activities is likely to decrease.

DIF: Application REF: 382 TOP: NCLEX: Psychosocial Integrity

OBJ: 4

9. The children of an older female adult ask the nurse for advice about helping their mother

heal after her husband’s death. Which strategy should the nurse share with the family? a. Appoint one family member to take the mother on outings. b. Coordinate family expressions of care and concern. c. Have each child plan a long trip with their mother’s assistance. d. Take the mother to community events to meet other people. ANS: B Feedback A B

C D

Incorrect. One person is unlikely to provide enough support for the bereaved, and this can potentially imply that only one person is concerned. Correct. The nurse suggests that the family work together to provide extended expressions of caring and concern for their mother because many small expressions of concern and caring from several sources help the bereaved to gain the strength and confidence needed to survive a huge loss. Incorrect. Multiple small gestures are more likely to help build strength and confidence than a few large gestures. Incorrect. Helping a widow meet new people can be unsuitable because she can be uninterested or unwilling to attend events for meeting new people. In addition, she can feel that the family is trying to find a replacement for the deceased to ease their burden. However, the family can offer to accompany her to such events.

DIF: Application REF: 386 TOP: NCLEX: Psychosocial Integrity

OBJ: 6

10. Which statement is true about the relationships of older persons? a. Loneliness is evidence of self-centredness and unwillingness to love. b. A person may be lonely even when surrounded by other people. c. Hostile behaviour indicates that a person prefers to be left alone. d. A pet cannot substitute for human attention. ANS: B Feedback A B C D

Incorrect. Loneliness is evidence of the capacity to love. Correct. The mere presence of other persons, without significant personal exchange, does not prevent or alleviate loneliness. Incorrect. Hostile behaviour can be a sign of loneliness. Incorrect. Pets can provide comfort, touch, affection, and an opportunity to care for another being.

DIF: Knowledge

REF: 379

OBJ: 4

TOP: NCLEX: Psychosocial Integrity 11. As older persons’ health begins to deteriorate, caregiving often becomes the responsibility

of their middle-aged children. Of the following people, who is the most likely to provide care for an aging parent? a. A middle-aged son who is married and works full time from his home office b. A middle-aged daughter-in-law who is a stay-at-home mother c. A middle-aged daughter who is married and works part-time d. A middle-aged son who is married and works part-time ANS: C Feedback A B C

Incorrect. The number of male caregivers is increasing, but caregiving still remains a primarily female responsibility. Incorrect. Caregivers are generally adult children (49%) or in-law children (13%), followed by partners or spouses (7%). Correct. The “typical” caregiver is a 45- to 54-year-old woman, married, with a paid job outside the home; 54% of all women will provide care for an older person at some point in their lives. Incorrect. The number of male caregivers is increasing, but caregiving still remains a primarily female responsibility.

DIF: Knowledge REF: 386 TOP: NCLEX: Psychosocial Integrity

OBJ: 5

12. The World Health Organization defines sexual health as a state of physical, emotional,

mental, and social well-being related to sexuality. What is the most common reason for sexual inactivity among older persons who have a partner? a. Sexual prowess and desire wane as the individual ages. b. Sexual inactivity is related to the male partner, who has poor health. c. Sex is not as important as it was when a couple was trying to have children. d. Social and cultural rules determine sexual inactivity in older persons. ANS: B Feedback A B

C D

Incorrect. It is a common myth that sexual prowess and desire wane as the individual ages. Correct. Sexual activity is closely tied to overall health, and people who rate their health as excellent or very good are nearly twice as likely to be sexually active as those who rate their health as being poorer. The most common reason for sexual inactivity among those with a partner relates to the male partner’s health. Incorrect. It is a common myth that sex is not as important in later years as it was when a couple was trying to have children. Incorrect. It is a common myth that social and cultural rules determine sexual inactivity in older persons.

DIF: Knowledge REF: 396 TOP: NCLEX: Psychosocial Integrity

OBJ: 7

Chapter 24: Mental Health and Wellness in Later Life Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. An older female adult lost her brother recently, provides care for her husband who has

health needs, and must move to a new location after having lived for 35 years in the same house. When she arrives for primary care with clinical indicators of influenza, which of the following does the nurse recognize about this older person? a. She is exhibiting attention-seeking behaviours. 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 person. ANS: B Feedback A B C D

Incorrect. She may be seeking attention, but that does not make the stress and illness any less real. Correct. Her resistance to disease is likely to be lower due to the effects of heavy stresses acting simultaneously. Incorrect. Her greatest need at this moment is to be treated for the flu. Respite care may be necessary but is not sufficient. Incorrect. Successful coping with a crisis may lead to a higher level of functioning.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 410

OBJ: 1

2. Which statement is true about the mental health of older persons? a. Nurses should discourage denial and regression so older persons can face

underlying causes of anxiety directly. 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 anti-anxiety medications without an assessment for factors associated with anxiety. ANS: D Feedback A B

Incorrect. Denial and regression may be necessary to enable an older person to cope with underlying stressors. Incorrect. Depression, dementia, disease, and medication can produce anxious behaviour, and the resultant anxiety can be manifested in a similar manner regardless of the cause. Incorrect. Compulsive rituals can be a way of coping with challenges leading to

anxiety. Correct. Without an adequate assessment, medication can exacerbate the problem.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 412

OBJ: 2

3. An older-person 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 of the following ideas should the nurse include in a response to this individual? a. Tell her that the staff receives training in ethics and will not act against another resident’s interests. b. Validate her impression and add additional information about the other resident. c. Advise her to avoid suspicious, paranoid thinking because the staff and residents are trustworthy individuals. d. Tell her that the nurse will look in on her and to use the call bell if she becomes frightened. ANS: D Feedback A

C D

Incorrect. This answer sounds as if the nurse is arguing in defence of the staff member. This does not help to alleviate the resident’s fear and can lead her to suspect that the nurse is a part of the plot, too. Incorrect. This response contributes to the resident’s suspicions; in addition, the nurse increases professional liability risks by speaking about another resident in a negative manner. Incorrect. This type of reproach only aggravates the struggle for control. Correct. This answer offers assurance to the resident that she will be protected, but it neither confirms her suspicions nor makes a promise that cannot be kept.

DIF: Application REF: 418 TOP: NCLEX: Psychosocial Integrity

OBJ: 2

4. Which of the following statements about psychotic behaviour in older persons is true? 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 person with psychotic behaviour should be assessed for a variety of

causes. d. Regardless of the cause, dissimilar hallucinations are treated with similar therapies. ANS: C Feedback A B

Incorrect. Hallucinations in older patients are usually the result of physical disorders, dementia, or sensory function loss. Incorrect. A delusion is a belief that is maintained even though facts can prove it is incorrect. A hallucination or illusion is the sensory perception of a stimulus that does not exist in the external world.

Correct. The nurse assesses an older person exhibiting psychotic behaviour by searching for a reason from a wide variety of potential causes for the behaviour; for example, neuroleptic medications can cause extrapyramidal side effects resulting in movement disorders that are similar to psychotic behaviour. Incorrect. The treatments for hallucinatory states vary according to the cause.

DIF: Comprehension TOP: NCLEX: Physiological Integrity

REF: 418

OBJ: 1

5. Which of the following statements about suicide among older persons is true? a. Older persons and young adults manifest suicidal intent in similar ways. b. Older female adults have the highest risk of suicide. c. Ethics require that the nurse respect a person’s intent to terminate his or her own

life. d. Depression and other mental health problems contribute to the risk of suicide. ANS: D Feedback A

C D

Incorrect. Putting personal affairs in order, distributing possessions, making a will, or saying something like “I won’t be around much longer” can indicate a risk for suicide in a young person, but can be rational and mature acts in old age. Incorrect. Men in all countries have a higher suicide rate, and white men are more likely to evaluate their worth solely in terms of their current economic productivity. Incorrect. Health care providers are obligated to prevent the destruction of life as a permanent solution to a problem. Correct. Depression and other mental health problems contribute to the risk of suicide.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 425

OBJ: 3

6. You are evaluating the plan of care for an older person who is alcohol-dependent. Which

patient documentation indicates a need for follow-up nursing interventions by the nurse? a. The patient states that he intends to decrease his alcohol consumption. b. The patient arrives at his group session on time and well groomed. c. The patient states, “I am an alcoholic because I drink ten beers a day.” d. The patient states that he understands that he needs continued treatment. ANS: A Feedback A

B C

Correct. This response indicates that the patient continues to feel that his alcohol consumption is under his control. This warrants follow-up nursing interventions because the patient remains at high risk for alcohol abuse. Incorrect. Taking pride in his appearance and participating in group activity are positive signs. Incorrect. Acknowledging that he has a problem is a positive sign because older persons cannot be helped until the problem is acknowledged.

Incorrect. Acknowledging the need for continuing treatment is a positive sign.

DIF: Application REF: 429 OBJ: 4 TOP: NCLEX: Health Promotion and Maintenance 7. An older male adult who has activity intolerance due to pulmonary fibrosis barks orders

and commands at the nursing staff when he cannot help himself. What is the nurse’s priority patient outcome for planning care to resolve these problems? a. The patient verbalizes requests in a calm, respectful, and appreciative manner. b. The patient identifies potential triggers of anger and redirects energy positively. c. The patient expresses an understanding of the need to balance rest and exercise. d. Resolve the pulmonary fibrosis to restore baseline activity tolerance. ANS: C Feedback A

B C

Incorrect. This is not the nurse’s priority patient outcome because the physiological need is more important to resolve; lower basic human needs must be met before higher level needs can be managed effectively. Incorrect. This is not the nurse’s priority because physiological needs must be met first. Correct. This individual becomes frustrated and angry when activity intolerance limits his independence and ability to perform activities of daily living. Even though pulmonary fibrosis cannot be cured, helping this older person to manage his physiological limitations by balancing rest and exercise, along with other strategies, is the nurse’s priority patient outcome because potential behavioural disorders cannot be managed effectively until his physiological needs are met. Incorrect. Pulmonary fibrosis is not curable; the patient will have pulmonary fibrosis until death.

DIF: Analysis REF: 423-24 OBJ: 2 TOP: NCLEX: Health Promotion and Maintenance 8. An older female adult with dementia exhibits new behaviours, including crying and

verbalizing the same phrase repeatedly; furthermore, the behaviour has increased over two days. Which intervention should the nurse implement in response to this behaviour? a. The nurse tells the older person that he will remember what she says if she stops crying. b. The nurse attributes these findings to deterioration in cognitive function. c. The nurse checks the medication administration record for missed doses or drug interactions. d. The nurse presents probing questions to the patient about her behaviour. ANS: C Feedback A

Incorrect. The nurse avoids making a veiled threat to the patient. Giving the older person an incentive to avoid crying can be suitable; however, the incentive should never be attention because the duty the nurse owes to the patient is to pay close attention to her. Incorrect. The new behaviour can be deteriorating cognitive function, but the

nurse must assess the patient further before making that determination. Correct. New behaviours with increasing frequency warrant further investigation by the nurse so 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 used to reverse bronchoconstriction. The nurse should also check for risk factors for anxiety and perform a comprehensive assessment to identify potential causes. Incorrect. 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.

DIF: Application REF: 423-24 OBJ: 2 TOP: NCLEX: Safe and Effective Care Environment 9. Which assessment finding of an older person living in an assisted-living facility indicates

the highest risk for suicide? a. The older person has liver failure due to alcohol abuse but enjoys socializing. b. The older person declines company, and is preoccupied with lethal weapons. c. The older person refuses to allow a large extended family to help him. d. The older person experienced an acetaminophen overdose 20 years ago. ANS: B Feedback A

Incorrect. The individual who has a serious illness and a history of alcohol abuse has two risk factors for suicide; however, this older person also relishes social interaction, which is an indication that suicide is less likely to be imminent or even in the individual’s thoughts. Correct. The older person 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, verbalization, and indicators of future suicide attempts. The nurse should also increase the frequency of observations and account for his whereabouts at all times. Incorrect. The older person who will not accept help from the family exhibits a potential risk factor for suicide but may be an exceedingly proud individual who wants to be self-sufficient. Incorrect. History of a suicide attempt is a risk factor for suicide; however, the acetaminophen overdose could also have been accidental.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 425

OBJ: 3

10. An older male adult who had radical surgery for oral cancer is refusing to see visitors and

is losing weight, despite aggressive nutrition therapy. The nurse assesses this older person and recognizes that he is not coping well and appears to be grieving. What is the most important patient outcome, in light of this nursing assessment? a. The patient discusses how his coping mechanisms are overwhelmed. b. The patient performs self-feedings through gastrostomy tube daily.

c. The patient uses nonverbal forms of communication effectively. d. The patient exhibits self-confidence in regaining a sense of control. ANS: D Feedback A B

C D

Incorrect. The patient displays a lack of readiness for expressions about emotions, coping, or his stressors. Incorrect. This patient displays a lack of readiness for learning a new psychomotor activity. This outcome gains importance as the day for discharge approaches. Incorrect. This outcome is important for basic communication; however, he displays a lack of readiness for receiving help to achieve this outcome. Correct. The most important element for this older person is to create and strengthen self-confidence to improve his sense of control because doing so is likely to help him manage other aspects of his health care effectively. The nurse helps to create and improve this self-confidence by observing for strengths and integrating them into daily care, and by responding with empathy and encouragement to his expressions of fears, emotions, and desirable goals. This is the most important outcome because this man has clinical indicators for depression: social isolation and weight loss. Before he 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 that he has no control.

DIF: Analysis REF: 434 TOP: NCLEX: Psychosocial Integrity

OBJ: 2

11. Which of the following statements made by an older person should a nurse consider as a

signal for a gambling addiction? a. “I have an overwhelming sense of being out of control of my life and destiny.” b. “Someone is stealing my things.” c. “I cannot account for blocks of time in my day.” d. “My wife died six months ago and I have nothing left to live for.” ANS: C Feedback A B

C D

Incorrect. Statements like this are indicative of anxiety or anxiety disorder. Incorrect. Statements like this can be indicative of paranoid behaviour, and can be induced by medications, alcoholism, and hearing impairment. Fear and a lack of trust based in reality may become magnified, especially when the person is isolated from others and does not receive reality feedback. Memory loss and forgetfulness may result in the person being convinced that items are being stolen or that medications are not the correct ones. Correct. Not being able to account for blocks of time in one’s day is one sign of a gambling addiction. Incorrect. This statement could be indicative of a gambling addiction, but is more likely to be indicative of depression and suicidal ideation in the older person.

DIF: Analysis REF: 433 TOP: NCLEX: Psychosocial Integrity

OBJ: 5

12. Although an older male adult 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, what is the priority nursing intervention to complete before this older person leaves? a. Ask him how he plans to cope with his loss. b. Use direct questions about access to firearms. c. Collaborate with the provider for antidepressants. d. Allow him to express himself by intent listening. ANS: B Feedback A

C D

Incorrect. This is a reasonable intervention for the nurse to include in the plan of care for this older person, in light of his risk factors for suicide, but it is not the priority intervention. Correct. The nurse’s priority intervention is to ask him directly about access to firearms because he has familiarity with guns, and risk factors for suicide in older persons include male gender, physical complaints of unknown etiology, and having suffered a recent loss. Incorrect. This is a reasonable intervention for the nurse to include for this older person, after a comprehensive assessment. Incorrect. This is a reasonable intervention for the nurse to include for this older person because it helps the nurse establish a trusting, caring relationship with him, but it is not the priority intervention.

DIF: Analysis REF: 434 TOP: NCLEX: Psychosocial Integrity

OBJ: 3

13. An older female adult fell at home while trying to get to the bathroom in time to prevent

urinary leakage. What is the priority nursing intervention to prevent patient injury at home in the future? a. Discharge the patient to home while she is attending an alcohol prevention program. b. Perform a home safety inspection to identify modifiable safety hazards. c. Instruct the patient on pelvic floor exercises and other incontinence strategies. d. Explore and assess for depression, alcohol abuse, and physiological contributors to falls. ANS: D Feedback A

Incorrect. This would be the fourth nursing intervention. An alcohol prevention program can be a suitable intervention for this older person if alcohol abuse is a contributing factor. Depending on the assessment data, willingness to avoid alcohol can determine if she has the capacity to live at home or should be in a residential facility to maintain safety. Incorrect. This would be the third nursing intervention. Before discharge, the

woman’s home is inspected for potential safety hazards to prevent future falls and injury and to remove any safety hazards as contributors to falls. Incorrect. This would be the second nursing intervention, by which 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 person’s instability or mobility impairment, so the nurse includes plans to control alcohol intake. Correct. The priority nursing intervention is planning for home injury prevention by assessing the older person for risk factors for alcohol abuse and for contributors to alcohol abuse or falls. Assessment data help to identify areas for intervention because falling and incontinence, especially in women, are risk factors for alcohol abuse.

DIF: Analysis REF: 430 OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment

Chapter 25: Loss, Death, and Palliative Care Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. Which of the following statements about loss in older adulthood is true? a. A person experiences each stage of grief once and then grieving is resolved. b. Anti-anxiety 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 Feedback A

B C D

Incorrect. Though the bereaved person passes through those stages according to Worden’s model, the person may experience the cycle more than once, as different aspects of the loss are encountered. Incorrect. Such medications do not reduce the pain of grief; they only deaden it for a time. Incorrect. The Loss Response Model considers the effect of the loss on the family as a system. Correct. A widow may, for example, say that her husband “just loved to garden” rather than “just loves to garden.”

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 440

OBJ: 2

2. The health care provider feels that an older female adult has about six weeks to live. After two months, the family remains at the bedside but, in the last few days, they have become increasingly impatient and irritable. This pattern is least indicative of which of the following statements? a. The family is experiencing anticipatory grief for the older person. b. The family desires that the patient be relieved of her 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 Feedback A B C D

Incorrect. This is a true statement. Correct. The family is not impatient because they want her death to take place, but because of the emotional fluctuations of waiting. Incorrect. This is a true statement. Incorrect. This is a true statement.

DIF: Application REF: 441 TOP: NCLEX: Psychosocial Integrity

OBJ: 2

3. After an older person dies, his brother, who has a history of alcohol abuse, upsets the family by going on a drinking binge instead of attending the funeral. What is the best description of the brother’s behaviour? a. The brother has a personality disorder. b. The brother is displaying a disrespectful attitude. c. The brother is experiencing disenfranchised grief. d. The brother is experiencing chronic grief. ANS: C Feedback A B C D

Incorrect. His behaviour is most likely a grief reaction, although it could be indicative of a personality disorder. Incorrect. The brother may feel that the most respectful thing he can do for the family is to stay out of their way. Correct. With the family is in discord, the grieving brother may be unable to—or consider himself not permitted to—express grief by socially acceptable means. Incorrect. The brother has suffered an acute loss.

DIF: Application REF: 442 TOP: NCLEX: Psychosocial Integrity

OBJ: 2

4. Jean Smithers, 80 years of age, is grieving the loss of her husband, Adam, who died last month at the age of 82. They had been life partners for 60 years. She cries all the time and complains of feeling distracted and restless. She says that deciding what to wear seems too complex a task and she is “at loose ends.” What type of grief is Jean Smithers experiencing? a. Anticipatory grief b. Persistent grief c. Acute grief d. Disenfranchised grief ANS: C Feedback A

Incorrect. Anticipatory grief is the response to a real or perceived loss before it actually occurs. This grief can be observed in preparation for potential loss, such as loss of belongings (e.g., selling of a home), moving (e.g., into a long-term care home), knowing that a body part or function is going to change (e.g., a mastectomy), or in anticipation of the loss of a spouse or oneself, either as a result of dementia or death. Incorrect. Persistent grief may temporarily inhibit some activity, but is considered to be a normal response. The intermittent pain of grief is often exacerbated on anniversary dates (birthdays, holidays, and wedding anniversaries). Correct. Acute grief is a crisis. It has a definite syndrome of somatic and psychological symptoms of distress that occur in waves lasting varying periods of time. These symptoms may occur every time the loss is acknowledged, others are informed of the loss, or another person offers condolences. Incorrect. Disenfranchised grief is an experience of the person whose loss cannot

be openly acknowledged or publicly mourned. The grief is socially disallowed or unsupported and is incongruent with norms of grief in the person’s culture. DIF: Application REF: 442 TOP: NCLEX: Psychosocial Integrity

OBJ: 2

5. Mrs. Palmer, 75 years of age, was admitted to hospital one week ago with end-stage cancer of the breast. This morning, when the nurse assesses Mrs. Palmer, a significant decline in all of her systems is apparent. Mr. Palmer, who is sitting beside her bed, looks at the nurse and states, “I miss her so much, how will I go on without her?” How should the nurse respond? a. “Mr. Palmer, you look very tired. Why don’t you go home and get some rest?” b. “Mr. Palmer, would you like me to bring you some breakfast?” c. “Mr. Palmer, I would really like to hear about your life together.” d. “Mr. Palmer, would you like me to call someone to be here with you?” ANS: C Feedback A

Incorrect. This does demonstrate the nurse’s desire to care for the grieving family member, but this is not an appropriate time to suggest that the spouse leave the bedside, when the death of his wife could occur at any time. Incorrect. This is a very caring suggestion; however, Mr. Palmer is not indicating that he is hungry. He is saying that he does not know how he will continue to live without his spouse, and this needs to be addressed. Correct. Often what is needed most is someone to listen to the “whys” and “hows”—questions that cannot be answered. Nursing interventions, especially when older people are in crisis, begin with the gentle establishment of rapport. Incorrect. This is an important suggestion; however, at this moment the focus needs to be on Mr. Palmer and the comment he has just shared with the nurse.

DIF: Application REF: 444 TOP: NCLEX: Psychosocial Integrity

OBJ: 2

6. Advance care planning is the process of planning for a time when older persons may not have the mental capacity to make decisions about their health care. Mrs. Jaworski, 75 years of age, has designated her daughter as her substitute decision maker if she is unable to speak for herself. Mrs. Jaworski is admitted to hospice care after a lengthy illness. What is the nurse’s role in assisting this patient with advance care planning? a. Require Mrs. Jaworski to complete an advance directive. b. Provide legal information to Mrs. Jaworski and then help complete the advance directive. c. Complete the advance directive and have Mrs. Jaworski sign the document before she loses consciousness. d. Serve as a resource person ready to answer questions Mrs. Jaworski may have about end-of-life decision making. ANS: D Feedback

Incorrect. Advance directives are completely voluntary. Nurses and health care facilities may provide patients with information about advance care planning, but they cannot require patients or residents to complete an advance directive. Incorrect. The nurse cannot provide legal information; however, she or he often serves as a resource person ready to answer many of the questions people have about end-of-life decision making. Incorrect. Nurses and health care facilities may provide patients with information about advance care planning, but they cannot require patients or residents to complete an advance directive. Correct. Nurses can serve as a resource person ready to answer questions that a patient may have about end-of-life decision making.

DIF: Application REF: 454 OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment 7. The primary difference between the Loss Response Model (LRM) and the Worden model of grief is which of the following? a. In the Worden model, those grieving pass through stages in order. b. The LRM uses a systems approach that acts to uphold stability. c. In the Worden model, the system helps to maintain the equilibrium. d. In the LRM model, those grieving transition through several stages. ANS: B Feedback A B

C D

Incorrect. The Worden model describes grieving as a series of evolving tasks not necessarily occurring in a distinct order. Correct. In the LRM, a systems approach is used to explain grieving wherein the system responds to the loss with chaos at first and then works to restore the equilibrium. Incorrect. The Worden model describes grieving as a series of evolving tasks. Incorrect. The LRM uses a systems approach that works to restore the equilibrium.

DIF: Comprehension TOP: NCLEX: Psychosocial Integrity

REF: 440

OBJ: 1

8. When an older female adult who is close to death asks the family to leave after short visits and acts withdrawn in their presence; the family becomes distraught. What does the nurse include in family teaching to explain the patient’s behaviour? a. The patient is preoccupied with her own death. b. The patient must have unresolved family issues. c. The patient can be experiencing anticipatory grief. d. The patient’s body prepares for death in this manner. ANS: C Feedback A

Incorrect. Preoccupation with a death is acute grief, but since the death has not

B C

occurred, this cannot explain the patient’s behaviour. Incorrect. The patient might have unresolved issues with the family, but this is an unusual way to express it. Correct. Anticipatory grief occurs before the death and can be experienced by the patient or the potential survivors. When the 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. Incorrect. 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, the extremities become cold, and so forth.

DIF: Application REF: 441 TOP: NCLEX: Psychosocial Integrity

OBJ: 1

9. The son of an older-person couple ends his life suddenly and violently. The husband proceeds with living as usual. After one year, the wife remains in seclusion and is hospitalized for dehydration. Which step 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 survivors’ support group. ANS: C Feedback A

B C

Incorrect. 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. Incorrect. The husband can be displaying disenfranchised grief and be unable to help until his grief is managed. Correct. This couple is at high risk for chronic grief because of the nature of their son’s death. The nurse can help this older female adult 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 person resolve or reframe enough grief to allow improved functioning. Incorrect. A survivor’s support group can be helpful to survivors of a loved one’s suicide; however, expecting this older person to attend such a group is unrealistic until the nurse establishes a trusting relationship with her.

DIF: Application REF: 442 TOP: NCLEX: Psychosocial Integrity

OBJ: 1

10. Mrs. Cantor, 70 years of age, has been admitted to hospital with chest pain. She has recently lost her husband because of a sudden myocardial infarction, and she blames herself for not recognizing his warning signs. What is the nurse’s priority intervention with Mrs. Cantor? a. Encourage Mrs. Cantor to complete her activities of daily living. b. Encourage Mrs. Cantor to express feelings of guilt, fear, anger, or sadness. c. Assess causes of Mrs. Cantor’s disenfranchised grieving processes. d. Identify Mrs. Cantor’s feelings connected to anticipatory grief. ANS: B Feedback A

Incorrect. This is a suitable nursing intervention; however, the priority intervention is to encourage the patient to express feelings of guilt, anger, fear, and sadness. Correct. The nurse plans care to help this patient resolve her grief by encouraging the older person to express feelings of guilt, fear, anger, or sadness. Being able to express herself in this manner is part of the work of grief. Incorrect. This is a nursing intervention suitable for the grieving patient; however, Mrs. Cantor is not experiencing disenfranchised grief as she is experiencing her loss openly and is able to acknowledge or publicly mourn the loss of her husband. Incorrect. Anticipatory grief is the response to a real or perceived loss before it actually occurs. This grief can be observed in preparation for potential loss. In the case of Mrs. Cantor, the loss of her husband has already occurred; therefore, anticipatory grief is not present.

DIF: Application REF: 445-46 OBJ: 3 TOP: NCLEX: Health Promotion and Maintenance 11. The actions of the family of an older person who just died are chaotic, and the family members are unable to decide on a funeral home. The nurse observes “functional disruption.” 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 Feedback A B C D

Incorrect. Effective coping includes a focus on solutions rather than problems. Incorrect. The nurse avoids a potential conflict of interest that could result from recommending funeral homes. Incorrect. The family may be unable to solve the problem alone because of ineffective coping in the immediate mourning period. Correct. A characteristic of someone who is coping well is good communication with others; however, immediately after the older person’s death, this family is coping ineffectively with the loss. To facilitate the decision making, the nurse asks one family member to consider calling another person who is likely to help

in this situation because this can help the individual to face the reality of the death. DIF: Application REF: 443 OBJ: 1 TOP: NCLEX: Health Promotion and Maintenance 12. Nurses have had strong opinions both for and against medically assisted dying. Considerable confusion exists regarding terminology and interpretation of what effects the nurse’s role may have in end-of-life care or palliative care. Which one of the following might constitute an example of medically assisted dying? a. Relieving patient suffering and improving the person’s quality of living until death. b. Discontinuing tube feeds, but continuing with intravenous fluids. c. The physician providing the patient with sleeping pills and instructions about a lethal dose. d. A patient voluntarily requesting to be helped to die and receiving a lethal injection of pain-relieving medication by their doctor. ANS: D Feedback A B

Incorrect. This is not an example of euthanasia. Incorrect. Many nurses believe that turning off a ventilator, turning off tube feedings, stopping intravenous fluids, or giving as much pain medication as is needed, even as directed by the patient, with death as a side effect, constitutes assisted suicide. Incorrect. This could be an example of physician-assisted suicide; it is considered a form of passive euthanasia because the physician has not administered the dose that results in death. Correct. The person who injects a lethal dose into a patient who voluntarily requested to be helped to die would be medically-assisted dying.

DIF: Application REF: 455 OBJ: 5 TOP: NCLEX: Safe and Effective Care Environment 13. An older patient who has end-stage pulmonary disease decides to accept care from the palliative care nurse. This older person is most likely to benefit from the palliative care nurse in terms of which following patient need of Weisman’s six needs for the dying? a. Closure b. Control c. Composure d. Cohesiveness ANS: B Feedback A B

Incorrect. Palliative care can indirectly benefit the patient by providing a better quality of life at the end of life, but palliative care does not provide for closure. Correct. The palliative care nurse is most likely to help the dying patient by affording the patient as much control as possible, providing effective nursing

C D

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 time is spent. Incorrect. Nurses use countercoping techniques to help the patient maintain composure. Incorrect. Cohesiveness is not one of the six needs of a dying patient.

DIF: Application REF: 443 TOP: NCLEX: Psychosocial Integrity

OBJ: 3

14. Which of the following statements about loss, dying, and death for older persons is TRUE? a. Those at special risk for significantly adverse effects of grief are younger to middle-aged spouses because these partners are at the beginning of their life journey. b. Visions, hallucinations, and an inability to communicate in a logical, sustained manner are not normal grief reactions for someone who has lost a spouse and should be regarded as signs of underlying health issues. c. Pathological grief begins with normal grief responses whose evolution toward adjustment and the re-establishment of equilibrium is blocked by some obstacle. d. Bereaved persons regain their normal capability about six months after loss, and regressive behaviour after that time should be examined by a therapist. ANS: C Feedback A B C

Incorrect. Those at special risk for significantly adverse effects of grief are older spouses, and life partners of any kind. Incorrect. All these reactions are common in the first several months of bereavement. Correct. The memories resist being reframed. Reactions are exaggerated, and memories are experienced as recurrent acute grief, over and over again, months and years later. Incorrect. A bereaved person ordinarily is beginning to recover personal control and capability about this time; at first this is sporadic and interspersed with periods of depression.

DIF: Knowledge REF: 443 TOP: NCLEX: Psychosocial Integrity

OBJ: 2

15. Which of the following characteristics is associated with acute grief? a. Waves of grief or distressing emotion b. Prolonged inability to sleep after a loss c. Exacerbations of grief on specific dates d. Change in attitude toward the future loss ANS: A Feedback A

Correct. Specific activities, items, people, or other things trigger an

B C D

overwhelming pain in acute grief. Incorrect. Chronic grief is characterized by prolonged insomnia and an extended period of inhibited activities and suboptimal performance. Incorrect. Chronic grief is characterized by periods of pain exacerbated on specific dates such as anniversaries, birthdays, holidays, and so forth. Incorrect. 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.

DIF: Knowledge REF: 442 TOP: NCLEX: Psychosocial Integrity

OBJ: 1

Chapter 26: Care Across the Continuum Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition MULTIPLE CHOICE 1. An older female resident in a residential facility keeps a large collection of personal items and photos of her late husband on her bedside table, but the personal support worker (PSW) and the resident argue about this frequently. Why should the nurse intervene between the resident and the PSW? a. The resident is attempting to maintain her sense of personal space. b. The resident needs to accept the reality of her spouse’s death. c. The resident’s argumentative nature can indicate early dementia. d. The clutter from all the personal items is a safety and liability risk. ANS: A Feedback A B C D

Correct. A thoughtful nurse respects and supports the resident’s boundaries. Incorrect. Even if this were true, the resident’s grief process and personal space should be respected. Incorrect. The resident’s behaviour can be understood as a healthy defence of her personal space. Incorrect. This is probably the PSW’s rationale, but the PSW should realize that the resident is entitled to her use of personal space.

DIF: Application REF: 472 TOP: NCLEX: Psychosocial Integrity

OBJ: 5

2. As the nurse admits an older female adult to a long-term care facility from her home of 50 years, the woman mistakes the nurse for her daughter. Which of the following diagnoses should the nurse consider carefully when planning care for this woman? a. Hypoxia due to chronic disease b. Relocation stress syndrome c. Alzheimer’s disease (AD) d. Attention-seeking behaviour ANS: B Feedback A B

Incorrect. Many conditions other than hypoxia can cause altered mental status, including relocation stress. Correct. Research calls into question the validity of a commonly accepted nursing diagnosis, relocation stress syndrome, a catastrophic reaction to relocation. Research suggests that individuals are better able to meet the challenges of relocation if they have a sense of control over the circumstances and the confidence to carry out the needed activities associated with a move. Incorrect. Many conditions other than AD can cause altered mental status, including relocation stress.

Incorrect. There is no evidence to support interpreting her behaviour as anything other than a mistake; alternatively, it can be understood as relocation stress syndrome.

DIF: Application REF: 472 TOP: NCLEX: Psychosocial Integrity

OBJ: 5

3. Residential options for older persons range along a continuum, from remaining in one’s own home; to senior retirement communities; to shared housing with family members, friends, or others; to residential care communities such as assisted living settings. Mrs. Chung is moving into a retirement home in her community. How would you describe Mrs. Chung’s level of residential living? a. Partial to complete dependence b. Independence c. Independence to partial dependence d. Complete dependence to end-of-life care ANS: C Feedback A

Incorrect. Extended care, hospice care, complex continuing care, residential respite care, long-term care homes (special care homes, personal care homes, nursing homes), acute care facilities, and rehabilitation are facilities that provide partially dependent to completely dependent living. Incorrect. Home ownership, single-room occupation (SRO), condominium ownership, apartment dwelling, shared housing/co-housing, adult lifestyle communities, and life lease are all facilities that provide independent care. Correct. Public/subsidized housing, living in residence with one’s family, supportive housing/living, assisted living, residential facilities, and retirement homes/residences/communities are facilities that provide independence to partial dependence. Incorrect. This is usually hospice care.

DIF: Application REF: 461 OBJ: 1 TOP: NCLEX: Safe and Effective Care Environment 4. A family that includes three small children prepares to move an older female parent into their home, knowing that she stays up all night, and the nurse helps the family prepare for this change. Which part of planning should the nurse indicate is the family’s highest priority? a. Sharing household responsibilities b. Preparing the house for her arrival c. Helping her use her skills and talents d. Setting limits on nighttime activities ANS: B Feedback A

Incorrect. Sharing household responsibilities should be part of the preparation; however, safety concerns are more important.

C D

Correct. To reduce the risk of injury and falls, the family’s priority is to prepare the house for an older person’s arrival, including preparation of the older person’s private space, removing hazards, providing adequate lighting, installing handrails where necessary, and other safety measures. In addition, the parents need to prepare mentally for the challenges presented when the children create new safety hazards for an older person, including spills, leaving toys on the floor, and so on. Incorrect. Helping the older person to use her skills and talents provides meaningful activities; however, safety concerns are more important. Incorrect. Setting limits on her nighttime activities is important preparation to avoid conflicts; however, safety concerns are the priority.

DIF: Analysis REF: 464 OBJ: 5 TOP: NCLEX: Safe and Effective Care Environment 5. A resident of a long-term care facility in Ontario has been asking to have the drain in the bathroom sink repaired for two months. The nurse responds by saying that when they move to the new building, the sinks will work very well. Which right of a resident of a long-term care facility has the nurse violated? a. The right to be free of all forms of abuse b. The right to be transferred for appropriate reasons c. The right to voice concerns or recommend changes in policies and services and have them remedied d. The right to information about conditions and treatments ANS: C Feedback A B C

Incorrect. A clogged sink is not abuse. Incorrect. The resident is not going to be transferred; the entire building is moving to a new facility. Correct. The nurse violates the resident’s right to voice a grievance and to have the problem fixed. If the residents were moving into the new building in a few days, the nurse’s response might be suitable; but, without specifying a time limit, the nurse has violated the resident’s right. Incorrect. A resident’s condition or treatments are not mentioned by the resident.

DIF: Application REF: 469 OBJ: 3 TOP: NCLEX: Safe and Effective Care Environment 6. Many long-term care (LTC) homes provide an environment that truly represents the best of caring and quality of life, where there is a focus on person-centred care. Which of the following nursing interventions focuses on person-centred care? a. Maintain consistent resident assignments. b. Provide structured activities for the residents. c. Assign only personal support workers (PSWs) to perform bathing. d. Determine mealtime based on staffing levels. ANS: A

Feedback A

B C D

Correct. As part of a person-centred culture, the nurses should have consistent resident assignments so they can establish rapport with their residents and are familiar with their unique qualities and preferences. Incorrect. Activities structured by the staff are part of the institution-centred culture. Incorrect. Assigning only the PSWs to perform the bathing is part of the institution-centred culture because it focuses on tasks. Incorrect. Schedules are determined for the staff’s convenience as part of the institution-centred culture.

DIF: Application REF: 470 OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment 7. The nurse prepares to transfer an older person to a long-term care facility and calls the facility to give a report. Which nursing actions are the responsibilities of both the transferring nurse and the receiving nurse? a. Incorporating patient goals into the care plan b. Ensuring the patient is stable for transfer c. Supplying patient documents for planning d. Providing continuity of care during transfer ANS: D Feedback A B C D

Incorrect. The receiving nurse incorporates patient goals into the care plan. Incorrect. The sending nurse ensures that the patient is stable for the transfer, to prevent decompensation during the trip or shortly after arrival at the new facility. Incorrect. The sending nurse is responsible for providing clear, comprehensive, and complete patient documentation. Correct. A shared responsibility of the sending and receiving nurses or care team is to regard the transition as a transfer versus a discharge and to provide continuous and consistent nursing care throughout the transfer phase. To accomplish this, the two nurses or groups must have clear, comprehensive communication.

DIF: Comprehension REF: 472 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 5

8. The nurse assesses an older person who was transferred yesterday from an acute care hospital. What should the nurse assess to determine if this individual is under stress from the transfer? a. The nurse should find out the length of the resident’s stay in the acute care facility. b. The nurse should determine the resident’s options and input into relocation. c. The nurse should question the older person about the presence of familiar people throughout the transfer. d. The nurse should determine whether a tour of the new facility was completed shortly after the transfer.

ANS: B Feedback A B

C D

Incorrect. The length of stay in the acute care facility is an unreliable index of stress in a resident who was relocated recently. Correct. To help assess the resident for stress, the nurse reviews the sequence of events that led to the relocation, including whether the resident had relocation options and what those options were before relocation. If the resident played an active role in the choice of facilities and had several available options, the resident is likely to experience less stress upon relocation. Incorrect. The presence of familiar people is an unreliable predictor of relocation stress. Incorrect. Touring the new facility is an unreliable predictor of relocation stress; if the tour is conducted too soon or when the resident is in pain, tired, or distracted, the resident is unlikely to benefit from it.

DIF: Application REF: 472 OBJ: 4 TOP: NCLEX: Safe and Effective Care Environment 9. Nurses are concerned with assessing the impact of relocation on older persons, and determining methods to mitigate any negative reactions. Which characteristic of relocation stress syndrome in a resident being transferred from acute care to a long-term care facility should the nurse be aware of? a. Agitation b. Feelings of loss of control c. Presence of a caring family d. Hallucinations ANS: B Feedback A B C D

Incorrect. Agitation is uncharacteristic of relocation stress syndrome. Correct. Feeling a loss of control is a major defining characteristic of relocation stress syndrome. Incorrect. An inadequate support system is characteristic of this syndrome. Incorrect. Hallucinations are uncharacteristic of this syndrome.

DIF: Knowledge REF: 472 TOP: NCLEX: Psychosocial Integrity

OBJ: 5

10. Architects are designing homes for younger adults that allow these individuals to age safely in their homes. What is this type of design called? a. Aging-in-place b. Residential care c. Transgenerational d. Safe haven homes ANS: C Feedback

A B

C D

Incorrect. Aging-in-place is a certification available to builders who follow guidelines established by the federal government for older persons. Incorrect. Residential care includes living arrangements where groups of unrelated people receive services such as meals, activities, medication, and assistance with activities of daily living. Correct. A home with a universal design that potentially benefits everyone is called a transgenerational design by home builders. Incorrect. Safe haven is unrelated to types of residences for older persons.

DIF: Knowledge REF: 462 OBJ: 1 TOP: NCLEX: Safe and Effective Care Environment 11. A family is touring selected long-term care homes in preparation for their mother’s future. Which qualities of a nursing home should the family include if they decide on a person-centred nursing home? a. Staff members cover all nursing units. b. Residents choose stimulating activities. c. Group activities are scheduled on the hour. d. There is a hospital environment that assures families of excellent care. ANS: B Feedback A B C D

Incorrect. Consistent nursing assignments are characteristic of a person-centred culture. Correct. A characteristic of a person-centred culture is that the residents choose their own activities to suit their interests. Incorrect. Predetermined schedules are characteristic of an institution-centred culture. Incorrect. This option focuses on institutional care rather than on a person-centred culture.

DIF: Comprehension REF: 470 TOP: NCLEX: Safe and Effective Care Environment

OBJ: 4