TEST BANK ANDERSON’S CARING FOR OLDER ADULTS HOLISTICALLY 6TH EDITION TAMARA R. DAHLKEMPER
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Test Bank: Anderson’s Caring for Older Adults Holistically, 6th Edition, Tamara R. Dahlkemper Chapter Contents: I. Foundations of Care for the Older Adult Chapter 1. Holistic Caring Chapter 2. The Aging Experience Chapter 3. Supporting Life Transitions and Spirituality in the Elderly Chapter 4. The Use of the Nursing Process and Nursing Diagnosis in the Care of the Older Adult Chapter 5. Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter 6. Promoting Wellness Chapter 7. Safety NEW! Chapter 8. Nutrition for Older Adults Chapter 9. Culturally Specific Care Chapter 10. Activity, Rest, and Sleep as Criteria for Health Chapter 11. End -of-Life Issues in Older Adults Chapter 12. Environments of Care Chapter 13. Management and Leadership Role of the Licensed Practical / Vocational Nurse II. Clinical Practice Chapter 14. Infection Chapter 15. Common Medical Diagnoses Chapter 16. Physiological Assessment Chapter 17. Common Clinical Problems: Physiological Chapter 18. Psychological Assessment Chapter 19. Common Clinical Problems: Psychological Chapter 20. Rehabilitation and Restorative Care Chapter 21. Pharmacology and its Significance for Older Adults Chapter 22. Laboratory Values and the Older Adult
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 1: Holistic Caring Multiple Choice Identify the choice that best completes the statement or answers the question. 1. According to the 2010 U.S. Census, approximately how many Americans are older than age 65? 1) 2% 2) 5% 3) 13% 4) 20% 2. What is the average life expectancy today? 1) 70.2 years 2) 75 years 3) 81.1 years for women and 76.3 years for men 4) Longer for men than for women 3. Which statement is NOT true about holistic nursing? 1) Holistic nursing focuses on the specific disease or disorder a person has in order to treat it effectively. 2) Holistic nursing aims to treat the whole person, not just a specific disease or disorder the person may have. 3) Holistic nursing focuses on the individual patient and uses many techniques, such as empathetic listening, music, and imagery, as well as specific clinical skills. 4) Holistic nursing weaves the technical skills of nursing with the social science skills that enhance communication and rapport between the nurse and the person receiving care. 4. The Science of Human Caring theory was developed by 1) Florence Nightingale 2) Clara Barton 3) Jean Watson 4) Savage and Money 5. Which is NOT emphasized in The Science of Human Caring? 1) Providing transpersonal caring 2) Focusing on the person while you are with him or her 3) Ensuring that all nonessential tasks, such as bathing, are given according to a strict schedule 4) Reaching out to the patient, making eye contact, touching if appropriate, speaking softly 6. Which of the following is included as a basic concept of holistic nursing? 1) Using your developed clinical expertise 2) Developing a close relationship with the patient’s family members and significant others 3) Remembering the personal intuition and creativity of patients in your nursing plan 4) All of the above 7. Most elderly people having a heart attack have 1) Pain diffused over the entire chest area 2) No pain 3) Crushing sternal pain
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Pain on the left side of the chest and pain that radiates down the left arm 8. Compared with the doses of medication given to a young adult, the doses given to an old-old person are usually 1) Smaller 2) Larger, because the old-old person is probably sicker 3) The same 4) Minimal, because the person is very old and probably near death 9. What communication technique has been developed specifically for dealing with demented elderly persons? 1) Cognitive therapy 2) Validation therapy 3) Geriatric Depression Scale 4) Mini-Mental Status Examination (MMSE) 10. An 82-year-old patient is diagnosed with liver cancer and has long-standing cardiovascular problems. The patient begins screaming and pushes his meal tray away. What would be an appropriate response? 1) Take the meal tray and leave the room without saying anything. 2) Tell him to stop screaming in a loud voice. 3) Calmly ask him what he is upset about and listen carefully to him. 4) Call your supervisor. 11. The nurse is overhead addressing an 87-year-old patient as “honey.” What is this an example of? 1) Beneficence 2) Paternalism 3) Caring 4) Malfeasance 12. The term “elite-old” is used for people 1) 65 to 74 years old 2) 75 to 84 years old 3) 85 to 100 years old 4) Older than 100 years 13. Which is a key concept in holistic nursing? 1) Following physician instructions and follow-up with the physician 2) Developing a relationship with family members of the patient 3) Using what you have learned—your clinical experience 4) All of the above 14. How should the nursing instructor explain the term “gerontology” to a new class of students? 1) It means the use of older medications to treat illnesses. 2) It comes from a Greek word that means “related to old age.” 3) It focuses on the housing needs of people who are underserved. 4) It is a way of explaining health problems of people over age 50. 15. Which term should the nurse use when explaining medical care that an older patient requires? 1) Genetics 2) Geriatrics 3) Gerontology 4) Gentrification
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
16. During lunch a nursing colleague states that she never wants to be assigned to care for an older patient. What behavior is this nurse demonstrating? 1) Ageism 2) Stereotyping 3) Ethnocentricity 4) Personal preference 17. How should a nursing instructor explain the term “baby boomers” to new students? 1) People who have large families 2) People who advocate for the care of infants 3) People who have decided not to have large families 4) People born between 1946 and 1965 after World War II 18. What explains the decline in the elderly black population since 1980? 1) Diabetes 2) Homicides 3) Hypertension 4) Heart disease 19. Why are older people more likely to participate in exercise programs? 1) They have more time to exercise. 2) They are trying to avoid boredom. 3) They initiated the fitness movement. 4) They want to spend time with their grandchildren. 20. What information would be helpful when explaining Social Security to a group of new nursing students? 1) It is a federal and state supported process that provides health care to financially disadvantaged people. 2) It is federal regulation providing health care for individuals older than age 65 or individuals who are permanently disabled. 3) It is a federal benefit check paid to persons older than age 65 or persons with disabilities who are unable to work. 4) It is a federal benefit check paid to retired workers of a specific age, disabled workers of any age, and spouses and minor children of deceased workers. 21. What should be used to describe a nursing philosophy to a new nursing student? 1) It is a personal concept. 2) It defines goals and aspirations. 3) It outlines steps to a successful career. 4) It recognizes the importance of education. 22. Which behavior demonstrates that a nurse is developing a healing relationship with a patient? 1) Answering a call light using the intercom system 2) Telling a patient that there is no time to try something new 3) Sitting down in the patient’s room to discuss the plan of care 4) Reminding a patient that other patients are waiting for the nurse 23. Which skill is essential to promote holistic nursing? 1) Critical thinking 2) Active listening 3) Time management
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Care coordination 24. Who should the nurse identify as being members of the holistic health-care team for an older patient? 1) The nurse, doctor, and pharmacist 2) The nurse, dietician, and discharge planner 3) Those who will help meet the patient’s needs 4) The social worker, physical therapist, and nurse 25. Which action demonstrates a safe environment? 1) Telephoning a patient prior to arriving for a home visit 2) Mounting grab bars near the commode and in the shower 3) Ensuring that a patient receives a requested daily newspaper 4) Making sure that the television in the room has adequate volume 26. What action should a nurse take who desires to become a more caring nurse? 1) Become a caring person. 2) Ensure adequate daily rest. 3) Set aside time for personal activities. 4) Consume nutritious meals and exercise. 27. An older patient with heart failure refuses any diagnostic tests and does not want to take any medication because of having limited health insurance. Which action should the nurse take that demonstrates caring? 1) Recommend that the patient be discharged home as soon as possible. 2) Ask family members if they are willing to help pay for the patient’s care. 3) Contact a social worker to talk with the patient about health insurance coverage. 4) Find out if the patient has any resources that can be liquidated to pay for the care. 28. During a home visit, an older patient is planning to have dinner with a close friend and then see a movie. What does this behavior indicate to the nurse? 1) Industry 2) Self-absorption 3) Identity diffusion 4) Gerotranscendence Multiple Response Identify one or more choices that best complete the statement or answer the question. 29. The home health nurse is completing an admission assessment of an older patient. Which health problems should the nurse identify as being leading chronic diseases of older adults? Select all that apply. 1) Cancer 2) Diabetes 3) Heart disease 4) Hypertension 5) Multiple sclerosis 30. What should be identified as reasons for the increased number of older adults in today’s society? Select all that apply. 1) Better nutrition 2) Earlier retirement 3) Increased exercise
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Improved health care 5) Consistent sanitation 31. What should the instructor emphasize as being essential elements of a nursing philosophy with beginning students? Select all that apply. 1) Simple 2) Popular 3) Specific 4) Meaningful 5) Inexpensive
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 1: Holistic Caring Answer Section MULTIPLE CHOICE 1. ANS: 3 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 2. Discuss the current demographics of people older than age 65 years. Chapter page reference: 7 Heading: Demographics of Aging Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Economics Difficulty: Easy Feedback 1 Individuals 65 years of age or older make up more than 2% of the population. 2 Individuals 65 years of age or older make up more than 5% of the population. 3 Based on the most recent U.S. census completed in 2010, individuals 65 years of age and older make up 13% of the population. There were 23 million women and 17 million men older than age 65. 4 Individuals 65 years of age or older do not make up 20% of the population. PTS: 1 CON: Economics 2. ANS: 3 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 2. Discuss the current demographics of people older than age 65 years. Chapter page reference: 7 Heading: Point of Interest Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Economics Difficulty: Easy Feedback 1 The average life expectancy is greater than 70.2 years. 2 The average life expectancy is greater than 75 years. 3 The average life expectancy has increased dramatically in the last 75 years—from 59.7 years in 1930 to 81.1 years for women and 76.3 years for men, according to the latest census information. 4 Women live longer than men. PTS: 1 CON: Economics 3. ANS: 1 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 4. Define the word holism as it relates to gerontological nursing.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 9 Heading: Holistic Nursing Integrated Processes: Caring Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Nursing Roles Difficulty: Moderate Feedback 1 The word “holism” is derived from the Anglo-Saxon root “hal,” which means “whole” or “to heal.” Holistic nursing focuses on the whole person, not the person’s specific disease or disorder. 2 Holistic nursing treats the whole person and not just a disease or disorder. 3 Holistic nursing uses techniques such as empathetic listening, music, and imagery, as well as specific clinical skills. 4 Holistic nursing uses technical skills in combination with those that enhance communication and rapport. PTS: 1 CON: Nursing Roles 4. ANS: 3 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 5. Discuss the theory “The Science of Human Caring” by Dr. Jean Watson as it relates to clinical practice. Chapter page reference: 11 Heading: Human Caring Integrated Processes: Caring Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Nursing Roles Difficulty: Easy Feedback 1 Florence Nightingale, known as the Mother of Modern Nursing, practiced holistic nursing long before the term was even used. 2 Clara Barton served as an exemplary nurse during the Civil War. 3 The Science of Human Caring is a nursing philosophy developed by Dr. Jean Watson of the University of Colorado. This philosophy is taught worldwide and serves as the basis for teaching and caregiving. 4 Savage and Money have written on the concepts of holistic nursing. PTS: 1 CON: Nursing Roles 5. ANS: 3 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 5. Discuss the theory “The Science of Human Caring” by Dr. Jean Watson as it relates to clinical practice. Chapter page reference: 12 Heading: Human Caring Integrated Processes: Caring Client Need: Safe and Effective Care Environment: Coordinated Care
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Comprehension [Understanding] Concept: Nursing Roles Difficulty: Moderate Feedback 1 Transpersonal caring is the human-to-human relationship, which is a part of The Science of Human Caring. 2 The person is the focus in The Science of Human Caring. 3 It is important that essential tasks, such as giving medications, be done according to schedule, but if a patient is in distress, needs to talk, or needs answers, there should be some flexibility for nonessential tasks. The nurse needs to treat the whole person, not just give out drugs and see to it that certain grooming tasks are performed routinely. 4 Personal contact, eye contact, and speaking softly are parts of The Science of Human Caring. PTS: 1 CON: Nursing Roles 6. ANS: 4 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 4. Define the word holism as it relates to gerontological nursing. Chapter page reference: 12 Heading: Basic Concepts of Holistic Care Integrated Processes: Caring Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Nursing Roles Difficulty: Easy Feedback 1 The practice of holistic nursing uses clinical expertise. 2 A close relationship is developed with family members and significant others in holistic nursing. 3 Holistic nursing uses personal intuition and creativity when planning patient care. 4 The practice of holistic nursing includes following physicians’ orders, using your clinical expertise, respecting and drawing on a person’s knowledge of and intuition of his or her own body, and integrating significant others in the patient’s life into his or her care. PTS: 1 CON: Nursing Roles 7. ANS: 2 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 4. Define the word holism as it relates to gerontological nursing. Chapter page reference: 6 Heading: Gerontological Nursing Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Comfort; Perfusion; Nursing Difficulty: Easy Feedback 1 Pain over the chest area is a symptom often found in younger people.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
Most elderly people who have a heart attack are less likely to have chest pain. Crushing sternal pain is a symptom often found in younger people. Pain over the left side of the chest radiating down the left arm is a symptom often found in younger people.
PTS: 1 CON: Comfort | Perfusion | Nursing 8. ANS: 1 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 4. Define the word holism as it relates to gerontological nursing. Chapter page reference: 7 Heading: Gerontological Nursing Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication; Nursing Difficulty: Easy Feedback 1 Medication doses for a young or middle-aged person may overwhelm the systems of an elderly person with devastating results. As people age, their metabolism often slows, and there are many changes in body systems that can affect a drug’s absorption and excretion. Older people often require smaller drug dosages. 2 Medication doses are not larger because the patient is sicker. 3 Medication doses are not the same. 4 Medication doses are not being withheld because the patient is old and possibly near death, which is an uncaring belief. PTS: 1 CON: Medication | Nursing 9. ANS: 2 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 1. Define gerontological nursing. Chapter page reference: 6 Heading: Gerontological Nursing Integrated Processes: Communication and Documentation Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 Cognitive therapy, also known as cognitive behavioral therapy, is a method of treating many emotional and psychological problems, including anxiety, depression, and phobias. 2 Validation therapy is a communication technique that has been developed specifically for dealing with demented elderly persons (including persons with Alzheimer’s disease). It focuses on accepting the person’s view of reality and age-appropriate behavior and can be used to calm a pacing, agitated older person. 3 The Geriatric Depression Scale is a tool used in neurological and psychological assessment. 4 The MMSE is a tool used in neurological and psychological assessment.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Cognition 10. ANS: 3 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 6. Describe five examples of how you, as a novice nurse, can use Watson’s theory as you give nursing care to older adults. Chapter page reference: 15 Heading: Expanding the Concept of the Science of Human Caring Integrated Processes: Communication and Documentation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Caring Difficulty: Moderate
1 2 3
4
Feedback Removing the meal try and leaving the room is uncaring and insulting to the patient. Telling the patient to stop screaming in a loud voice is responding with anger and does not determine the cause of the outburst. The nurse should try to find out what is bothering him and ask specific questions. Remember that the patient has been given a very serious and probably terminal diagnosis, and anger is understandable. There is a reason for every behavior, and the nurse has the responsibility to learn the reason before reacting. If the patient becomes unruly assistance should be obtained, but first try to determine the reason for the outburst and provide comfort if possible.
PTS: 1 CON: Caring 11. ANS: 2 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 6. Describe five examples of how you, as a novice nurse, can use Watson’s theory as you give nursing care to older adults. Chapter page reference: 14 Heading: Point of Interest Integrated Processes: Communication and Documentation Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Nursing; Communication Difficulty: Easy Feedback 1 Beneficence is an ethical principle in nursing. Beneficence is to be aimed for. 2 Speaking to patients as if they are children is a form of paternalism. Elderly people should be addressed with respect, usually by Mr. or Mrs., unless they specifically ask you to use their first name. 3 Caring includes respect, and paternalism is not respectful to an older adult. 4 Malfeasance is not an ethical principle in nursing. Malfeasance is to be avoided. PTS: 1 12. ANS: 4
CON: Nursing | Communication
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 2. Discuss the current demographics of people older than age 65 years. Chapter page reference: 7 Heading: Point of Interest Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Nursing: Economics Difficulty: Easy Feedback 1 The term “young-old” is used for people 65 to 74 years old. 2 The term “middle-old” is used for people 75 to 84 years old. 3 The term “old-old” is used for people 85 to 100 years old. 4 The increased numbers of elderly people in the United States has resulted in new definitions. The term “elite-old” is used for people older than 100 years. PTS: 1 CON: Economics 13. ANS: 4 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 4. Define the word holism as it relates to gerontological nursing. Chapter page reference: 10 Heading: Basic Concepts of Holistic Care Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Nursing Roles Difficulty: Moderate Feedback 1 A key concept in holistic nursing is following the physician’s instructions and following up with the physician. 2 A key concept in holistic nursing is developing a relationship with family members of the patient. 3 A key concept in holistic nursing is using clinical experience. 4 Key concepts in holistic nursing include following the physician’s instructions and communicating with the physician; using clinical experience; respecting the ideas the elderly patient has about his or her own body and how to make it well and incorporating those ideas into the nursing plan, if possible; and involving family members in the care of the elderly patient. PTS: 1 CON: Nursing Roles 14. ANS: 2 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 1. Define gerontological nursing. Chapter page reference: 4 Heading: Gerontological Nursing Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Application [Applying] Concept: Nursing Roles Difficulty: Moderate Feedback 1 Gerontology is not the use of older medications to treat illnesses. 2 Gerontology comes from a Greek word that means “related to old age.” 3 Gerontology does not focus on the housing needs of people who are underserved. 4 Gerontology is not a way of explaining health problems of people over age 50. PTS: 1 CON: Nursing Roles 15. ANS: 2 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 1. Define gerontological nursing. Chapter page reference: 5 Heading: Gerontological Nursing Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Nursing Difficulty: Moderate Feedback 1 Genetics is the study of heredity. 2 Geriatrics refers to the medical specialty that deals with the diagnosis and treatment of elderly adults. 3 Gerontology refers to the study of human aging. 4 Gentrification is the purchase of properties in communities for the purpose of renovation. PTS: 1 CON: Nursing 16. ANS: 1 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 2. Discuss the current demographics of people older than age 65 years. Chapter page reference: 6 Heading: Gerontological Nursing Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Diversity; Nursing Difficulty: Moderate Feedback 1 Ageism is being prejudiced against older adults. 2 Stereotyping is saying that all members of a group have the same behaviors and characteristics. 3 Ethnocentricity believes that one cultural group is superior to another. 4 Personal preference is selecting one thing over another. PTS: 1 17. ANS: 4
CON: Diversity | Nursing
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 2. Discuss the current demographics of people older than age 65 years. Chapter page reference: 7 Heading: Demographics of Aging Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Nursing Roles Difficulty: Moderate Feedback 1 Baby boomers are not individuals who have large families. 2 Baby boomers are not individuals who advocate for the care of infants. 3 Baby boomers are not individuals who have decided not to have large families. 4 Baby boomers are people born between 1946 and 1965 after World War II. PTS: 1 CON: Nursing Roles 18. ANS: 2 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 2. Discuss the current demographics of people older than age 65 years. Chapter page reference: 8 Heading: Demographics of Aging Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity; Nursing Roles Difficulty: Easy Feedback 1 Diabetes is a leading chronic disease affecting people older than age 65 years. 2 Since the 1980s to the present, the gap in life expectancy between white and black elders has widened because the elderly black population has declined. This decline is attributed to death by homicide. 3 Hypertension is a leading chronic disease affecting people older than age 65 years. 4 Heart disease is a leading chronic disease affecting people older than age 65 years. PTS: 1 CON: Diversity | Nursing Roles 19. ANS: 3 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 2. Discuss the current demographics of people older than age 65 years. Chapter page reference: 8 Heading: Demographics of Aging Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing Roles Difficulty: Easy Feedback 1 Older people are not more likely to participate in exercise programs because they have
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
more time to exercise. Older people are not more likely to participate in exercise programs because they are trying to avoid boredom. Older people are more likely to participate in exercise programs because they initiated the fitness movement. Older people are not more likely to participate in exercise programs because they want to spend more time with their grandchildren.
PTS: 1 CON: Nursing Roles 20. ANS: 4 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 2. Discuss the current demographics of people older than age 65 years. Chapter page reference: 8 Heading: Point of Interest Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Economics Difficulty: Easy Feedback 1 Medicaid is a federal and state supported process that provides health care to financially disadvantaged people. 2 Medicare is a federal regulation providing health care for individuals older than age 65 or individuals who are permanently disabled. 3 Supplemental Social Security is a federal benefit check paid to persons older than age 65 or persons with disabilities who are unable to work. 4 Social Security is a federal benefit check paid to retired workers of a specific age, disabled workers of any age, and spouses and minor children of deceased workers. PTS: 1 CON: Economics 21. ANS: 1 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 3. Write a one-sentence nursing philosophy. Chapter page reference: 8 Heading: Nursing Philosophy Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Nursing Roles Difficulty: Easy Feedback 1 A nursing philosophy is a personal concept that has to come from within. 2 A nursing philosophy does not define goals and aspirations. 3 A nursing philosophy does not outline steps to a successful career. 4 A nursing philosophy is not used to recognize the importance of education. PTS: 1
CON: Nursing Roles
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
22. ANS: 3 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 4. Define the word holism as it relates to gerontological nursing. Chapter page reference: 10 Heading: Basic Concepts of Holistic Care Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Nursing Roles Difficulty: Moderate Feedback 1 Answering a call light using the intercom system does not demonstrate a nurse who is unrushed and truly wants to develop a relationship with the patient. 2 Telling a patient that there is no time to try something new does not demonstrate a healing relationship with the patient. 3 Sitting with a patient to discuss the plan of care indicates an interest in developing a healing relationship with the patient. 4 Reminding a patient that others are waiting for the nurse does not indicate an interest in developing a healing relationship with the patient. PTS: 1 CON: Nursing Roles 23. ANS: 2 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 4. Define the word holism as it relates to gerontological nursing. Chapter page reference: 10 Heading: Basic Concepts of Holistic Care Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Knowledge [Understanding] Concept: Nursing Roles Difficulty: Easy Feedback 1 Critical thinking is not critical to promote holistic care. 2 Listening is critical to promote holistic care. 3 Time management is not critical to promote holistic care. 4 Care coordination is not critical to promote holistic care. PTS: 1 CON: Nursing Roles 24. ANS: 3 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 4. Define the word holism as it relates to gerontological nursing. Chapter page reference: 10 Heading: Holistic Care Is Based on Teamwork Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Nursing; Nursing Roles
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Moderate Feedback 1 Members of the holistic health-care team may or may not include the doctor and pharmacist. 2 Members of the holistic health-care team may or may not include the dietician and discharge planner. 3 Members of the holistic health-care team include those who will help meet the patient’s needs. 4 Members of the holistic health-care team may or may not include the social worker and physical therapist. PTS: 1 CON: Nursing | Nursing Roles 25. ANS: 2 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 5. Discuss the theory “The Science of Human Caring” by Dr. Jean Watson as it relates to clinical practice. Chapter page reference: 13 Heading: Human Caring Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Comprehension [Understanding] Concept: Nursing; Safety Difficulty: Moderate Feedback 1 Telephoning prior to making a home visit respects the patient’s privacy. 2 Mounting grab bars near the commode and in the shower demonstrates environmental safety. 3 Ensuring the delivery of a daily newspaper provides for stimulation. 4 Ensuring adequate volume on the television provides for stimulation. PTS: 1 CON: Nursing | Safety 26. ANS: 1 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 5. Discuss the theory “The Science of Human Caring” by Dr. Jean Watson as it relates to clinical practice. Chapter page reference: 14 Heading: Expanding the Concept of the Science of Human Caring Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Nursing Roles Difficulty: Easy Feedback 1 To become a more caring nurse, the nurse should become a caring person. 2 Adequate rest is not identified as an action to become a more caring nurse. 3 Setting aside time for personal activities is not identified as an action to become a more caring nurse.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
Consuming nutritious meals and exercising are not identified as actions to become a more caring nurse.
PTS: 1 CON: Nursing Roles 27. ANS: 3 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 6. Describe five examples of how you, as a novice nurse, can use Watson’s theory as you give nursing care to older adults. Chapter page reference: 11 Heading: Expanding the Concept of the Science of Human Caring Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Nursing Roles Difficulty: Moderate Feedback 1 Recommending that the patient be discharged home as soon as possible does not demonstrate caring or meet the patient’s health needs. 2 Asking family members if they are willing to help pay for the patient’s care violates the patient’s privacy. 3 Contacting a social worker to talk with the patient about health insurance coverage demonstrates caring and addresses the patient’s concerns. 4 Finding out if the patient has any resources that can be liquidated to pay for the care violates the patient’s privacy and does not demonstrate caring or meet the patient’s health needs. PTS: 1 CON: Nursing Roles 28. ANS: 4 Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 7. Define the concept of “gerotranscendence.” Chapter page reference: 14 Heading: Gerotranscendence Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Nursing Roles Difficulty: Moderate Feedback 1 Industry is a developmental task of middle childhood. 2 Self-absorption is a part of the adult middle age developmental task. 3 Identity diffusion is a part of the adolescent developmental task. 4 Gerotranscendence means that the older person is satisfied with life and looks forward to living a full life for the rest of his or her days. PTS: 1
CON: Nursing Roles
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
MULTIPLE RESPONSE 29. ANS: 2, 3, 4 Feedback 1. Cancer is not identified as being a leading chronic disease of older adults. 2. Diabetes is identified as being a leading chronic disease of older adults. 3. Heart disease is identified as being a leading chronic disease of older adults. 4. Hypertension is identified as being a leading chronic disease of older adults. 5. Multiple sclerosis is not identified as being a leading chronic disease of older adults. Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 2. Discuss the current demographics of people older than age 65 years. Chapter page reference: 7 Heading: Point of Interest Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Assessment; Nursing Difficulty: Moderate PTS: 1 CON: Assessment | Nursing 30. ANS: 1, 4, 5 Feedback 1. Reasons for the increased number of older persons in our society include better nutrition. 2. Reasons for the increased number of older persons in our society do not include early retirement. 3. Reasons for the increased number of older persons in our society do not include increased exercise. 4. Reasons for the increased number of older persons in our society include improved health care. 5. Reasons for the increased number of older persons in our society include consistent sanitation. Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 2. Discuss the current demographics of people older than age 65 years. Chapter page reference: 7 Heading: Demographics of Aging Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Assessment; Nursing Difficulty: Easy PTS: 1 CON: Assessment | Nursing 31. ANS: 1, 3, 4 Feedback 1. A characteristic of a valuable nursing philosophy is that it is simple. 2. Popularity is not a characteristic of a valuable nursing philosophy. 3. A characteristic of a valuable nursing philosophy is that it is specific.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4. 5.
A characteristic of a valuable nursing philosophy is that it is meaningful. Cost is not a characteristic of a meaningful nursing philosophy.
Chapter number and title: Chapter 1 Holistic Care Chapter/learning objective: 3. Write a one-sentence nursing philosophy. Chapter page reference: 8 Heading: Nursing Philosophy Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Nursing; Nursing Roles Difficulty: Easy PTS: 1
CON: Nursing | Nursing Roles
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 2: The Aging Experience Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The fastest growing segment of the population in the United States is 1) Teenagers 2) Babies 3) People older than 85 years of age 4) People between the ages of 20 and 40
2. An 88-year-old retired school principal who lives alone has neighbors who believe his home is dark, dirty, smelly, and without modern conveniences. The neighborhood children think he is a “crazy old man.” What does this describe? 1) Racism 2) Sexism 3) Ageism 4) Patriotism
3. Which statement reflects respect for people who are older? 1) Getting old is a hopeless downward spiral toward death. 2) As people get older, they become very self-centered. 3) Older people maintain unique and individual characteristics. 4) Older people become very rigid and are unable to learn new things.
4. Normal physiological aging is 1) A predictable and uniform process 2) Reflective of individual diversity 3) Accompanied by extreme mood swings and predictable depression 4) Primarily related to chronic disease processes
5. What is LEAST likely to affect the aging process? 1) Life experiences 2) Financial resources 3) Stress management style 4) Social support system
6. The normal aging process is accompanied by 1) Potential problems in functional ability 2) Chronic disease processes 3) Regression from previous social activities 4) A characteristic depression related to multiple losses
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
7. The leading cause of death in older adults is 1) Stroke 2) Heart disorders 3) Cancer 4) Pneumonia
8. Which theory is NOT considered to be a psychological theory of aging? 1) Subcultural theory 2) Wear and tear theory 3) Developmental tasks theory 4) Continuity theory 9. According to Erik Erikson’s eight stages of life theory, the task of old age is 1) Integrity vs. Despair 2) Industry vs. Inferiority 3) Identity vs. Role Confusion 4) Generativist vs. Stagnation
10. Which is NOT a characteristic of physiological theories of aging? 1) Genetics 2) Nutrition 3) Personality 4) Wear and tear of the body
11. What is considered normal aging of the cardiovascular system? 1) Strengthened heart contractions 2) Decreased cardiac output 3) Flaccid and thinned heart valves 4) Dilation of blood vessels
12. What determines an older adult’s ability to function? 1) Driving a car 2) Quality of life 3) Working, driving, shopping, and exercising as usual 4) Performance of activities of daily living (ADLs), instrumental ADLs, and quality of life
13. Which does NOT contribute to increased residual lung volume in an older patient? 1) Kyphosis 2) Decreased elastic recoil 3) Decreased number of functioning alveoli 4) Decreased efficiency of gas exchange in the alveoli
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
14. One of the best ways for the nurse to promote normal respiratory function with older adults is to 1) Encourage daily walks. 2) Encourage frequent naps and rest periods. 3) Discourage strenuous lifting and physical activity. 4) Teach the use of inhalers in case of respiratory emergencies.
15. Which is NOT an expected age-related change affecting the respiratory status of an older patient? 1) Weakened abdominal muscles 2) Elongation of the thoracic spine 3) Increased rigidity of the rib cage 4) Increased thickness of the alveolus capillary membrane
16. Which is NOT considered a common complication of inactivity in an older adult? 1) Decreased energy 2) Decreased bone mass 3) Decreased muscle mass 4) Decreased joint range of motion
17. What effect do age-related changes of the skin have on an older patient? 1) Effects joint mobility 2) Alters temperature regulation 3) Impacts the ability to ambulate 4) Influences clothing style choices
18. Which is one of the most effective ways to minimize the aging changes of the skin? 1) Wash the skin daily with soap. 2) Avoid excessive sun exposure. 3) Use a vitamin E-fortified lotion every day. 4) Use rose milk lotion on the skin every day.
19. What can slow musculoskeletal changes in an older adult? 1) Exercising 2) Restricting calcium intake 3) Napping throughout the day 4) Eating a diet high in carbohydrates
20. What is the best advice for an older person who complains of never being hungry? 1) Try eating six small meals throughout the day. 2) Force yourself to eat at least three meals a day. 3) As people get older, they may need to eat only one meal a day.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Avoid eating roughage and drinking large amounts of fluid.
21. Which body system is most highly influenced by previous life patterns and environmental conditions? 1) Circulatory 2) Integumentary 3) Respiratory 4) Gastrointestinal
22. Which statement is most true about enlargement of the prostate gland in older men? 1) It is a normal aging change. 2) It indicates the presence of cancer. 3) It is related to a high incidence of impotence for older men. 4) It decreases the incidence of urinary incontinence for older men.
23. Incontinence is a problem for many older women. The normal aging change that contributes to stress incontinence for older women is 1) Decreased bladder capacity 2) Decreased renal blood flow 3) Reduced glomerular filtration rate 4) Loss of mass and strength of perineal muscles
24. Painful intercourse and vaginal infections can be associated with 1) Loss of pubic hair 2) Urinary incontinence 3) Decreased vaginal secretions 4) Decreased perineal muscle mass
25. What sleep pattern change is most stressful to older adults? 1) Frequent wakening 2) Shorter sleeping time at night 3) Inability to nap during the day 4) Feeling of being less rested after sleeping all night
26. Which are the most common gastrointestinal problems for older adults? 1) Indigestion, diarrhea, and anorexia 2) Constipation, bulimia, and indigestion 3) Indigestion, constipation, and anorexia 4) Flatulence, diarrhea, and intestinal cramps
27. How do older adults adapt to their slowed response time? 1) Giving up activities such as driving
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Increasing accuracy of their responses 3) Avoiding situations that require quick responses 4) Using ambulation aids to decrease the chance of falling
28. Decreased tearing of the eyes increases the incidence of 1) Glaucoma 2) Eye infections 3) Corneal abrasions 4) Cataract formation
29. Which is an age-related change in hearing for older adults? 1) Loss of low-frequency tones 2) Loss of high-frequency tones 3) Generalized loss of all frequencies 4) Loss of high-frequency and low-frequency tones
30. What should the nurse do to help an older patient improve hearing? 1) Speak loudly. 2) Speak slowly in a normal tone. 3) Speak slowly with an increased pitch. 4) Mouth words slowly so that the older adult can read lips.
31. Which are the preferred colors to use for signs, curb markings, and stair edgings for older adults? 1) Red and green 2) Blue and green 3) Yellow and red 4) Blue and yellow
32. Which change in the aging eye increases risk of falling? 1) Decreased tearing 2) Yellowing of the lens 3) Increased sensitivity to glare 4) Decreased dark and light accommodation
33. A 78-year-old patient has both ears impacted with cerumen. Why is the incidence of cerumen impaction increased for older adults? 1) Increased keratin in cerumen 2) Increased production of cerumen 3) Decreased bathing because of skin dryness, so ears do not get cleaned as often 4) Older adults are less likely to be in the habit of using cotton-tipped applicators to clean out their ears
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
34. An 84-year-old patient is experiencing decreased reaction time while driving and some dizziness when getting out of his car. What should the nurse realize about this patient’s symptoms? 1) Secondary to diet 2) Indicative of senile dementia 3) Part of the normal aging process 4) Indicative of decreased mental capabilities
35. Which is NOT included during the assessment of ADLs? 1) Eating 2) Moving 3) Cooking 4) Dressing
36. Which would NOT be included when assessing instrumental activities of daily living (IADLs)? 1) Toileting 2) Cleaning 3) Managing finances 4) Taking medications
37. Which are NOT considered to be signs of wear and tear on the body as the result of aging? 1) Slow gait 2) Replaced knees 3) Use of a walker 4) Chronic diseases
38. What information does NOT need to be collected when first interviewing an elderly patient? 1) Nutrition 2) Family history 3) Chronic diseases 4) Number of friends
39. Why is it common for an older adult to feel colder and have decreased diaphoresis, even with an elevated body temperature? 1) Increased body fluid 2) Alterations in appetite 3) Decreased subcutaneous fat 4) Difficulty with bowel elimination
40. An older patient is experiencing skin breakdown. What should the nurse identify as the reason for this health problem? 1) Clustering of melanocytes
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Decreased sweat production 3) Decreased subcutaneous fat 4) Dryness and reduced skin elasticity
41. What should the nurse realize is the reason for an older patient to have an increase in blood pressure? 1) Reduced blood volume 2) Increased rigidity of heart valves 3) Increased rigidity of vascular walls 4) Diminished strength of cardiac muscle
42. An older patient is experiencing a drop in blood volume. What should the nurse realize is the age-related reason for this? 1) Decreased physical activity 2) Increased daily urine output 3) Reduced oral intake of fluids 4) Decreased amount of total body water
43. What should the nurse identify as the reason for an older patient to have a decrease in hematocrit and hemoglobin levels? 1) Increased oral fluid intake 2) Decreased rigidity of heart valves 3) Increased rigidity of blood vessels 4) Reduced bone marrow production
44. The nurse is preparing to assess the respiratory status of an older patient. What should the nurse realize about this status in relation to cardiovascular functioning? 1) The degree of changes within both systems will be minimal. 2) The changes within both systems appear suddenly, causing acute health problems. 3) Changes in the respiratory system are gradual and the older patient will compensate. 4) Changes in the cardiovascular system are gradual and the older patient will compensate.
45. An older patient has osteoporosis. What effect should the nurse expect this health problem to have on the patient’s respiratory status? 1) Improved cough reflex 2) Improved lung capacity 3) Reduced lung space and air flow 4) No change to the respiratory status
46. What impact do good nutrition, exercise, and stress control have on longevity according to the genetic theory of aging? 1) Experiencing an early death 2) Adding 15 years to life expectancy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Reducing risk factors for chronic disease 4) Prolonging or improving the quality of life
47. What concept is used to describe today’s nursing homes? 1) Hospice care 2) Palliative care 3) Custodial care 4) Rehabilitative care
48. Which nursing statement takes the concept of ageism into consideration when caring for an 85-year-old patient with renal failure? 1) “Mr. Martin, how are you doing this morning?” 2) “Now, you know you shouldn’t do that, baby doll.” 3) “Hon, how would you like your eggs in the morning?” 4) “You are doing such a good job with dialysis, sweetie.”
49. The nurse is caring for an 80-year-old patient with lung disease. Which action indicates that the nurse understands the wear and tear theory of aging when caring for this patient? 1) Reviews the importance of a daily intake of adequate calcium 2) Asks the patient at what age the patient’s mother and father passed away 3) Stops and rests for a few seconds when walking with the patient down the hall 4) Suggests that the patient use a wheelchair to reduce the time needed to get to physical therapy
50. An older patient used to be a teacher but after being diagnosed with a health problem the patient began to write educational materials. Which theory explains this patient’s actions? 1) Continuity 2) Subculture 3) Wear and tear 4) Developmental tasks
51. Which statement can be used to define health for an older adult? 1) Expecting to enjoy perfect health until death 2) Realizing that no one leaves this life alive and death occurs to us all 3) Understanding that the body wears out and nothing can be done about it 4) Functioning at the highest potential in the presence of age-related changes
Multiple Response Identify one or more choices that best complete the statement or answer the question. 52. The nurse suspects that an older patient is having difficulty with the developmental task of integrity vs. despair. Which behaviors caused the nurse to make this clinical determination? Select all that apply.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1) 2) 3) 4) 5)
Anger Depression Reading the newspaper Feelings of inadequacy Laughing with grandchildren
53. What should the nurse realize about the normal aging process? Select all that apply. 1) Normal aging does not indicate decline. 2) People become more diverse as they age. 3) Age-related changes are the same in everyone. 4) Normal aging and disease cannot be separated. 5) Adapting to the aging process is accomplished by many adults.
54. An older patient is experiencing shortness of breath with household activities. Which respiratory changes with aging could explain this patient’s symptoms? Select all that apply. 1) Loss of lung elastic recoil 2) Larger and thinner alveoli 3) Increased surface area for gas exchange 4) Thickening of the alveolar-capillary membrane 5) Reduction in the number of functioning alveoli
55. The nurse is concerned that an older patient is experiencing age-related changes to the gastrointestinal system. What findings caused the nurse to have this concern? Select all that apply. 1) Loose teeth 2) Poor appetite 3) Feeling thirsty 4) Weak gag reflex 5) Feeling of fullness
56. An older patient is experiencing functional changes caused by decreased bladder capacity. What should the nurse assess for in this patient? Select all that apply. 1) Nocturia 2) Frequency 3) Incontinence 4) Renal calculi 5) Urinary retention
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 2: The Aging Experience Answer Section MULTIPLE CHOICE 1. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 1. Define the term ageism. Chapter page reference: 21 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Diversity; Nursing Difficulty: Easy Feedback 1 Teenagers are not the fastest growing segment of the U.S. population. 2 Babies are not the fastest growing segment of the U.S. population. 3 People older than 85 years of age are the fastest growing segment of the U.S. population. 4 People between the ages of 20 and 40 are not the fastest growing segment of the U.S. population.
PTS: 1
CON: Diversity | Nursing
2. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 1. Define the term ageism. Chapter page reference: 23 Heading: Ageism Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Diversity; Nursing Difficulty: Moderate Feedback 1 Racism is believing that one race is superior to another. 2 Sexism is believing that one gender is superior to another. 3 Ageism is a systematic stereotyping of and discrimination against people simply because they are old. 4 Patriotism is upholding the rights and responsibilities of being a citizen of a country.
PTS: 1
CON: Diversity | Nursing
3. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 1. Define the term ageism.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 24 Heading: Ageism Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Diversity; Nursing Difficulty: Easy Feedback 1 Getting older is not a hopeless spiral toward death. This statement does not respect older people. 2 Believing that older people are self-centered does not respect older people. 3 Older people do have unique and individual characteristics. This statement respects older people. 4 Older people are not rigid and unable to learn new things. This statement does not respect older people.
PTS: 1
CON: Diversity | Nursing
4. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging. Chapter page reference: 25 Heading: Normal Aging Process Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing Difficulty: Easy Feedback 1 Individuals age in different ways. 2 Although aging is a universal experience, each individual older person represents a different pattern of aging. 3 Older adults may experience depression, but this is not a normal aging experience. 4 Older adults may experience chronic diseases, but these are not normal aging experiences.
PTS: 1
CON: Nursing
5. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging. Chapter page reference: 25 Heading: Physiological Theories of Aging Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Stress; Nursing Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Feedback How a person ages depends on life experiences. Aging is not dependent on a person’s financial resources. How a person ages depends on stress management style. How a person ages depends on social support systems.
PTS: 1
CON: Nursing
6. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in body systems. Chapter page reference: 27 Heading: Normal Physiological Changes According to Body Systems Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing Difficulty: Easy Feedback 1 Changes in functional ability, or the ability of the older adult to perform activities of daily living, can be influenced by normal aging changes. 2 Many older adults have chronic disease processes, but disease processes are not a normal consequence of aging. 3 Aging is often viewed as a series of losses. The process is gradual, and older adults generally adapt well and maintain their social activities. 4 Older adults are not generally depressed by the aging process.
PTS: 1
CON: Nursing
7. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems. Cardiovascular Chapter page reference: 28 Heading: Normal Physiological Changes According to Body Systems Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Cellular Regulation Difficulty: Easy Feedback 1 Cardiovascular diseases leading to strokes used to be a leading cause of death among older adults, but older people have learned to take better care of themselves. 2 Cardiovascular diseases leading to heart disorders used to be a leading cause of death among older adults, but older people have learned to take better care of themselves. 3 Cancer is now the leading cause of death among older adults. 4 Pneumonia is not a leading cause of death, however, it is a serious concern in older adults.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Cellular Regulation
8. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging. Chapter page reference: 26 Heading: Psychological Theories Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing Difficulty: Easy Feedback 1 The subculture theory of aging describes aging as being a subculture complete with cultural norms, standards, beliefs, and expectations. 2 The wear and tear theory is a physiological theory of aging. 3 Erikson developed the developmental stages theory, which states that people work through various stages of development through life. 4 The continuity theory states that as people age, their basic personalities do not.
PTS: 1
CON: Nursing
9. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging. Chapter page reference: 26 Heading: Psychological Theories Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Development; Nursing Difficulty: Easy Feedback 1 The task for old age, according to Erikson, is integrity vs. despair. If older adults can find meaning in the life they have lived and are living, they will have the ego integrity to adjust to the process of aging. 2 Industry vs. inferiority is a task for a school-age person. 3 Identity vs. role confusion is a task for adolescence. 4 Generativity vs. stagnation is a task for a middle-aged adult.
PTS: 1
CON: Development | Nursing
10. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging. Chapter page reference: 24
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Physiological Theories of Aging Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing Difficulty: Easy Feedback 1 One physiological theory of aging focuses on genetics, stating that people are born with a genetic program that predetermines life span. 2 One physiological theory of aging focuses on a person’s nutrition during his or her life span. 3 Personality does not relate to a physiological theory of aging. 4 One physiological theory of aging focuses on the fact that bodies are all fine-tuned machinery and that body parts wear out or become less effective as they are repeatedly used.
PTS: 1
CON: Nursing
11. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Cardiovascular Chapter page reference: 28 Heading: Cardiovascular System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Perfusion Difficulty: Easy Feedback 1 The aging heart is slower and weaker. 2 Cardiac output is decreased as a result of the slowed heart rate and weaker cardiac contractions. This is not usually a noticeable problem unless older persons are exposed to stressors that exceed their reserves. 3 Heart valves in the aging heart are thicker and more rigid. 4 Blood vessels in the aging cardiovascular system thicken and become less elastic.
PTS: 1
CON: Nursing | Perfusion
12. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes to the body systems. Chapter page reference: 28 Heading: Normal Physiological Changes According to Body Systems Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Promoting Health Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Feedback Driving a car might be an instrumental activity of daily living, however, function is more than performing this one function. Quality of life is one aspect of functioning. The level of functioning may not be as it was when the person was younger. The definition of function is the ability to perform ADLs and instrumental ADLs, taking into consideration quality of life.
PTS: 1
CON: Nursing | Promoting Health
13. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Respiratory Chapter page reference: 29 Heading: Respiratory System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Oxygenation Difficulty: Easy Feedback 1 Kyphosis is a normal change in aging that increases residual lung volume in an older patient. 2 Decreased elastic recoil is a normal change in aging that increases residual lung volume in an older patient. 3 A decreased number of functioning alveoli is a normal change in aging that increases residual lung volume in an older patient. 4 Decreased efficiency of gas exchange in the alveoli affects the efficiency of oxygen availability.
PTS: 1
CON: Nursing | Oxygenation
14. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Respiratory Chapter page reference: 29 Heading: Respiratory System Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Nursing; Oxygenation Difficulty: Moderate Feedback 1 Exercise and activity are necessary to promote respiratory health. 2 Frequent naps and rest periods discourage physical activity. 3 Avoiding strenuous lifting and physical activity does not promote respiratory health. 4 The use of inhalers is not a routine intervention to promote respiratory health in an
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
older adult.
PTS: 1
CON: Nursing | Oxygenation
15. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Respiratory Chapter page reference: 29 Heading: Respiratory System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Oxygenation Difficulty: Moderate Feedback 1 In the normal aging process, abdominal muscles weaken, decreasing inspiratory and expiratory efforts. 2 With aging the thoracic spine shortens. 3 In the normal aging process, the rib cage becomes rigid because of calcification of cartilage. 4 In the normal aging process, alveolus capillary membranes thicken, decreasing the surface area for gas exchange
PTS: 1
CON: Nursing | Oxygenation
16. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Musculoskeletal Chapter page reference: 29 Heading: Musculoskeletal System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Mobility Difficulty: Moderate
1 2 3 4
Feedback Exercise would increase an older adult’s energy level, but inactivity does not cause decreased energy. Inactivity decreases bone mass. Inactivity decreases muscle mass. Inactivity decreases joint range of motion.
PTS: 1
CON: Nursing | Mobility
17. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 3. Identify age-related changes in the following body systems: Integumentary Chapter page reference: 30 Heading: Integumentary System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Thermo-Regulation Difficulty: Moderate Feedback 1 This is a musculoskeletal system change. 2 The decrease in sweat production and loss of the insulating fat layer underlying the skin makes an older adult prone to hyperthermia and hypothermia. 3 This is a musculoskeletal system change. 4 Some older adults who are self-conscious of age spots on their arms may choose not to wear short-sleeved or sleeveless shirts. Older adults may find that because of changes in their muscle mass and fat distribution, their clothing does not fit as well.
PTS: 1
CON: Nursing | Thermo-regulation
18. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Integumentary Chapter page reference: 30 Heading: Integumentary System Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Nursing; Skin Integrity Difficulty: Moderate Feedback 1 Washing the skin daily with soap will not guarantee that age changes of the skin will be less. 2 Sun exposure intensifies the normal aging changes and increases an older adult’s risk of developing skin cancer. 3 Using vitamin-E fortified lotion daily will not guarantee that age changes of the skin will be less. 4 Using rose milk lotion daily will not guarantee that age changes of the skin will be less.
PTS: 1
CON: Nursing | Skin Integrity
19. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Musculoskeletal Chapter page reference: 30 Heading: Musculoskeletal System Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Nursing; Mobility Difficulty: Moderate Feedback 1 Exercise assists in increasing endurance and muscle strength, which affects functional ability. 2 Calcium supplements help prevent porous, brittle bones that are susceptible to fractures; this assists in functional ability. 3 Napping encourages inactivity, which does not contribute to maintaining a healthy musculoskeletal system. 4 A diet rich in carbohydrates would cause weight gain, placing greater strain on joints and bones.
PTS: 1
CON: Nursing | Mobility
20. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Gastrointestinal Chapter page reference: 31 Heading: Gastrointestinal System Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Nursing; Digestion Difficulty: Moderate Feedback 1 Slowed gastric emptying may cause an older person to have feelings of fullness and a lack of appetite. Eating smaller, more frequent meals may decrease this discomfort. 2 Forcing oneself to eat is not good nutritional advice. 3 Eating one meal a day is not good nutritional advice. 4 Roughage and fluid are important to promote bowel function.
PTS: 1
CON: Nursing | Digestion
21. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Integumentary Chapter page reference: 30 Heading: Integumentary System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Skin Integrity Difficulty: Moderate Feedback 1 The circulatory system is not the most influenced by previous life patterns and environmental conditions. 2 Exposure to sun, earlier health practices regarding diet, grooming, physical activity,
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
genetic factors, and biochemical and environmental factors affect the integumentary system. The respiratory system is not the most influenced by previous life patterns and environmental conditions. The gastrointestinal system is not the most influenced by previous life patterns and environmental conditions.
PTS: 1
CON: Nursing | Skin Integrity
22. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Genitourinary Chapter page reference: 31 Heading: Genitourinary System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Urinary Elimination Difficulty: Easy Feedback 1 Benign enlargement of the prostate is a normal aging change. 2 Prostate enlargement is not always related to the presence of cancer. 3 Prostate enlargement is not related to impotence. 4 Enlargement of the prostate can cause urethral obstruction and is the primary cause of overflow incontinence and urinary dribbling.
PTS: 1
CON: Nursing | Urinary Elimination
23. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Genitourinary Chapter page reference: 31 Heading: Genitourinary System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Urinary Elimination Difficulty: Easy Feedback 1 Decreased bladder capacity is a normal age-related change of the urinary system, but it does not affect stress incontinence. 2 Decreased renal blood flow is a normal age-related change of the urinary system, but it does not affect stress incontinence. 3 Reduced glomerular filtration rate is a normal age-related change of the urinary system, but it does not affect stress incontinence. 4 Stress incontinence, or loss of urine when intra-abdominal pressure is increased, can be increased with weak pelvic floor muscles.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Nursing | Urinary Elimination
24. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Genitourinary Chapter page reference: 32 Heading: Genitourinary System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Female Reproduction Difficulty: Easy Feedback 1 Loss of pubic hair is not related to painful intercourse and vaginal infections. 2 Urinary incontinence can increase the incidence of vaginal infections. 3 Decreased vaginal secretions decrease the natural lubrication of the vagina, which can cause painful intercourse and increase the potential for vaginal infections. 4 Decreased perineal muscle mass is not related to painful intercourse and vaginal infections.
PTS: 1
CON: Nursing | Female Reproduction
25. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Neurological Chapter page reference: 32 Heading: Nervous System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Nursing; Neurological Regulation Difficulty: Moderate Feedback 1 Frequent wakening is annoying, but not the most stressful to older adults. 2 Shorter sleeping time at night is annoying, but not the most stressful to older adults. 3 Older adults rarely complain of not being able to nap during the day. 4 Waking in the morning and still feeling tired is related to the decrease in REM and stage IV sleep.
PTS: 1
CON: Nursing | Neurological Regulation
26. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Gastrointestinal Chapter page reference: 31 Heading: Gastrointestinal System
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Digestion Difficulty: Easy Feedback 1 Diarrhea is not a common gastrointestinal problem for an older adult. 2 Bulimia is not a common gastrointestinal problem for an older adult. 3 Decreased peristalsis, caused by the decrease in smooth muscle tone, delays gastric emptying, leading to indigestion and decreased appetite. Decreased peristalsis also allows more water absorption in the large intestine, creating constipation. 4 Flatulence, diarrhea, and intestinal cramps are not common gastrointestinal problems for older adults.
PTS: 1
CON: Nursing | Digestion
27. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Neurological Chapter page reference: 32 Heading: Nervous System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Neurological Regulation Difficulty: Easy Feedback 1 Older adults may choose to quit driving, but this is not a general reaction to increased reaction time. 2 Studies have shown that older adults compensate for increased reaction times by increasing the accuracy of their responses. 3 Older adults may avoid situations that require quick responses, but this is not a general reaction to increased reaction time. 4 Older adults may use ambulation aids to decrease the risk of falling, but this is not a general reaction to increased reaction time.
PTS: 1
CON: Nursing | Neurological Regulation
28. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Special senses Chapter page reference: 33 Heading: Special Sense Organs Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Sensory Perception Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Feedback Glaucoma is not related to eye dryness. Dryness of the eyes can lead to irritation and eye infections. Eye dryness is usually not severe enough to cause corneal abrasions. The development of cataracts is not related to eye dryness.
PTS: 1
CON: Nursing | Sensory Perception
29. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Special senses Chapter page reference: 33 Heading: Special Sense Organs Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Sensory Perception Difficulty: Easy Feedback 1 The loss of low-frequency tones is not an age-related change in hearing. 2 Presbycusis, or loss of high-frequency tones, is the characteristic hearing loss of normal aging. 3 Generalized loss of hearing in all frequencies is not an age-related change in hearing. 4 Loss of high and low-frequency tones is not an age-related change in hearing.
PTS: 1
CON: Nursing | Sensory Perception
30. ANS: 2 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Special senses Chapter page reference: 33 Heading: Special Sense Organs Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Sensory Perception Difficulty: Easy Feedback 1 Speaking loudly raises the frequency to a level that the older patient may not be able to hear. 2 Older adults can hear a normally pitched, clearly articulated voice. 3 Increasing the pitch moves the voice into the high-frequency range that is difficult for an older adult to hear. 4 Mouthing words so the patient reads lips is an inappropriate strategy.
PTS: 1
CON: Nursing | Sensory Perception
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
31. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Special senses Chapter page reference: 33 Heading: Special Sense Organs Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Comprehension [Understanding] Concept: Nursing; Sensory Perception Difficulty: Easy Feedback 1 Older adults have difficulty seeing the color green because of yellowing of the eye lens. 2 Older adults have difficulty seeing the colors blue and green because of yellowing of the eye lens. 3 Because of yellowing of the lens of the eye with normal aging, older adults have difficulty seeing and differentiating low tone colors, such as blue, green, purple, and brown. Yellow and red are the colors of choice for signs and safety markings. 4 Older adults have difficulty seeing the color blue because of yellowing of the eye lens.
PTS: 1
CON: Nursing | Sensory Perception
32. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Special senses Chapter page reference: 33 Heading: Special Sense Organs Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Comprehension [Understanding] Concept: Nursing; Sensory Perception Difficulty: Easy Feedback 1 Decreased tearing does not increase the risk of falling in an older adult. 2 Yellowing of the lens does not increase the risk of falling in an older adult. 3 Increased sensitivity to glare does not increase the risk of falling in an older adult. 4 The change in accommodation to light and dark takes longer and increases the incidence of falls for older adults.
PTS: 1
CON: Nursing | Sensory Perception
33. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Special senses Chapter page reference: 33 Heading: Special Sense Organs Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Comprehension [Understanding] Concept: Nursing; Sensory Perception Difficulty: Easy Feedback 1 The increased keratin in the cerumen makes it drier and increases the likelihood of it impacting in the ear canal. 2 There is no documentation of an increased cerumen production with aging. 3 Bathing and washing the external canal does not affect the production of cerumen or prevent the development of cerumen impaction. 4 Older adults frequently use cotton-tipped applicators. This practice is not advisable because there is a tendency to push impacted cerumen deeper into the ear canal.
PTS: 1
CON: Nursing | Sensory Perception
34. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Neurological Chapter page reference: 32 Heading: Nervous System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Neurological Regulation Difficulty: Moderate Feedback 1 The diet does not reduce reaction time while driving or create dizziness when getting out of a car. 2 Senile dementia does not reduce reaction time while driving or create dizziness when getting out of a car. 3 As motor neurons work less efficiently, reaction time and the ability to respond to stimuli decrease. Older adults frequently have the potential for hypotensive episodes, with position change secondary to decreased blood volume. 4 Decreased mental capabilities do not reduce reaction time while driving or create dizziness when getting out of a car.
PTS: 1
CON: Nursing | Neurological Regulation
35. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Neurological Chapter page reference: 29 Heading: Normal Physiological Changes According to Body Systems Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Mobility Difficulty: Easy Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Eating is a basic personal need included in ADLs. Moving is a basic personal need included in ADLs. Cooking requires a greater level of independence. Dressing is a basic personal need included in ADLs.
PTS: 1
CON: Nursing | Mobility
36. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Neurological Chapter page reference: 29 Heading: Normal Physiological Changes According to Body Systems Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Mobility Difficulty: Easy Feedback 1 Toileting is a basic task. 2 IADLs are the ability to live independently in the community. Cleaning requires a greater level of independence. 3 IADLs are the ability to live independently in the community. Managing finances requires a greater level of independence. 4 IADLs are the ability to live independently in the community. Taking medication requires a greater level of independence.
PTS: 1
CON: Nursing | Mobility
37. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging. Chapter page reference: 25 Heading: Physiological Theories of Aging Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension {Understanding] Concept: Nursing; Mobility Difficulty: Easy Feedback 1 As part of the normal aging process, the body shows signs of use—wear and tear. Among these signs is slower movement. 2 As part of the normal aging process, the body shows signs of use—wear and tear. Among these signs is decreased cartilage, causing the need for knee replacement. 3 As part of the normal aging process, the body shows signs of use—wear and tear. Among these signs is possible use of a walker because of decreased bone mass and reduced muscle strength. 4 Many older people do not have chronic diseases and chronic diseases are not inevitable
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
with age.
PTS: 1
CON: Nursing | Mobility
38. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging. Chapter page reference: 25 Heading: Physiological Theories of Aging Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Assessment; Nursing Difficulty: Easy Feedback 1 The nutritional status of the person can play a role in the development of certain diseases and in life span. 2 Family history can play a role in the development of certain diseases and in life span 3 The presence of any chronic diseases can play a role in the development of certain diseases and in life span. 4 The number of friends may or may not play a role in the development of certain diseases and life span.
PTS: 1
CON: Assessment | Nursing
39. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Integumentary Chapter page reference: 30 Heading: Integumentary System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Thermo-Regulation Difficulty: Easy Feedback 1 Increased body fluid does not cause an older person to feel colder or have decreased diaphoresis with an elevated body temperature. 2 Alterations in appetite do not cause an older person to feel colder or have decreased diaphoresis with an elevated body temperature. 3 A normal age-related change is a reduction in subcutaneous fat, often leading an older adult to feel cold and ask for sweaters. This reduction in subcutaneous fat and decreased sweat production may also cause an older adult not to exhibit diaphoresis even with a fever. 4 Difficulty with bowel elimination does not cause an older person to feel colder or have decreased diaphoresis with an elevated body temperature.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Nursing | Thermo-regulation
40. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Integumentary Chapter page reference: 30 Heading: Integumentary System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Nursing; Skin Integrity Difficulty: Moderate Feedback 1 Clustering of melanocytes contributes to the development of age spots. 2 Decreased sweat production causes an older person to not experience diaphoresis with a fever. 3 A decrease in subcutaneous fat causes an older person to feel cold. 4 Age-related skin dryness and decreased elasticity increase the risk of skin breakdown and skin tears, leading to increased potential for injury and infection.
PTS: 1
CON: Nursing | Skin Integrity
41. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems. Cardiovascular Chapter page reference: 28 Heading: Normal Physiological Changes According to Body Systems Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Perfusion; Nursing Difficulty: Easy Feedback 1 Reduced blood volume would cause a drop in blood pressure. 2 Increased rigidity of heart valves contributes to changes in cardiac output and the development of heart murmurs. 3 During the aging process, the walls of the blood vessels thicken and become less elastic, often leading to increases in blood pressure. 4 Decreased strength of cardiac muscle contributes to changes in cardiac output.
PTS: 1
CON: Perfusion | Nursing
42. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems. Cardiovascular Chapter page reference: 28 Heading: Normal Physiological Changes According to Body Systems Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Perfusion; Nursing Difficulty: Easy Feedback 1 Decreased blood volume with aging is not caused by decreased physical activity. 2 Decreased blood volume with aging is not caused by increased daily urine output. 3 Decreased blood volume with aging is not caused by reduced oral intake of fluids. 4 Blood volume is decreased in an older adult because of decreased total body water.
PTS: 1
CON: Perfusion | Nursing
43. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems. Cardiovascular Chapter page reference: 28 Heading: Normal Physiological Changes According to Body Systems Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Perfusion; Nursing Difficulty: Moderate Feedback 1 Decreased hemoglobin and hematocrit levels in an older person are not because of increased oral fluid intake. 2 Decreased hemoglobin and hematocrit levels in an older person are not because of decreased rigidity of heart valves. 3 Decreased hemoglobin and hematocrit levels in an older person are not because of increased rigidity of blood vessels. 4 Red blood cells (RBCs) carrying hemoglobin are produced in the bone marrow; a decrease in bone marrow production frequently leads to a decrease in levels of RBCs, hemoglobin, and hematocrit.
PTS: 1
CON: Perfusion | Nursing
44. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Respiratory Chapter page reference: 29 Heading: Respiratory System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Nursing; Oxygenation Difficulty: Moderate Feedback 1 The degree of changes within both systems cannot be predicted.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
Changes appear slower in the respiratory system than the cardiovascular system. The age-related changes affecting the respiratory system are so gradual that most older adults compensate well. Changes in the cardiovascular system are more sudden than those appearing in the respiratory system.
PTS: 1
CON: Nursing | Oxygenation
45. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Respiratory Chapter page reference: 29 Heading: Respiratory System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Nursing; Oxygenation Difficulty: Moderate Feedback 1 Osteoporosis will not improve the patient’s cough reflex. 2 Osteoporosis will not improve the patient’s lung capacity. 3 Osteoporosis often causes compression of the vertebral column, leading to a bent-over or stooped posture. This posture allows less space for lung expansion and air flow. 4 Osteoporosis leads to a stooped posture, which reduces lung space for expansion and air flow.
PTS: 1
CON: Nursing | Oxygenation
46. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging. Chapter page reference: 25 Heading: Physiological Theories of Aging Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Stress; Nursing Difficulty: Moderate Feedback 1 Good nutrition, exercise, and stress control will not cause an early death. 2 There is no way to predict the number of years that can be added to a person’s life if good nutrition, exercise, and stress control are practiced. 3 Although it is believed that good nutrition, exercise, and stress control can impact chronic illnesses, there is no way of knowing if these approaches will reduce the risk factors for chronic disease. 4 Although the genetic theory of aging claims that humans are born with a genetic program that predetermines their life span, a healthy diet, exercise, and stress control
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
support a higher quality of life, if not adding to longevity.
PTS: 1
CON: Nursing
47. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 1. Define the term ageism. Chapter page reference: 24 Heading: Ageism Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Nursing Difficulty: Easy Feedback 1 Hospice care is provided to a person with a terminal illness with 6 months or less time to live. 2 Palliative care is given to a person to ensure comfort while managing a chronic illness. 3 Custodial care is given to maintain a person’s life without impacting chronic illnesses or improving the health status. 4 Today’s nursing home is characterized by a concept of rehabilitative, not custodial, care. Rehabilitative care supports the highest possible level of independence despite physical and cognitive limitations.
PTS: 1
CON: Nursing
48. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 1. Define the term ageism. Chapter page reference: 24 Heading: Ageism Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Diversity; Nursing Difficulty: Moderate Feedback 1 Addressing the older patient with respect honors the uniqueness of the older individual. 2 Calling an older patient “baby doll” is demeaning and fosters dependence. 3 Calling an older patient “hon” is demeaning. 4 Calling an older patient “sweetie” is demeaning.
PTS: 1
CON: Diversity | Nursing
49. ANS: 3 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 25 Heading: Wear and Tear Integrated Processes: Nursing Process: Evaluation Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Analysis [Analyzing] Concept: Nursing Difficulty: Moderate Feedback 1 Reviewing the intake of calcium is focusing on the nutrient theory of aging. 2 Asking about the death of parents focuses on the genetic theory of aging. 3 By stopping and resting for a few seconds while ambulating an older patient the nurse understands that the patient’s body parts might be worn out. With lung disease, the need to rest while walking would be necessary. 4 Suggesting that the patient use a wheelchair to reduce the time to get somewhere is not taking the wear and tear theory of aging into consideration.
PTS: 1
CON: Nursing
50. ANS: 1 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging. Chapter page reference: 26 Heading: Psychological Theories Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Self; Nursing Difficulty: Easy Feedback 1 The continuity theory states that as people change, their basic personalities and behavioral patterns do not change. Because the older patient was unable to teach, writing was the other avenue used to continue to instruct others. 2 According to the subculture theory older people have their own cultural norms and standards. This does not explain the patient’s actions. 3 The wear and tear theory explains the effect of living on the human body parts and organs. 4 Developmental task theory states that older people have the task to achieve integrity vs. despair in old age. This does not explain the actions of this older patient.
PTS: 1
CON: Self | Nursing
51. ANS: 4 Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes to the body systems. Chapter page reference: 28 Heading: Normal Aging Process Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Comprehension [Understanding] Concept: Nursing; Health Promotion Difficulty: Easy
1 2 3 4
Feedback Expecting to enjoy perfect health until death would be everyone’s wish, but is not being realistic. Realizing that everyone dies is a negative view of health for an older adult. Understanding that the body wears out and that nothing can be done about it is a negative view of health. Health for older adults might be defined as the ability to function at an individual’s highest potential despite the presence of age-related changes and risk factors.
PTS: 1
CON: Nursing | Health Promotion
MULTIPLE RESPONSE 52. ANS: 1, 2, 4 Feedback 1. The task for old age, according to Erikson, is integrity vs. despair. If older people can find meaning in the life lived, then they will have the ego integrity to adjust and manage the process of aging. If they do not have integrity, they will be angry. 2. The task for old age, according to Erikson, is integrity vs. despair. If older people can find meaning in the life lived, then they will have the ego integrity to adjust and manage the process of aging. If they do not have integrity, they will be depressed. 3. Reading the newspaper does not indicate that the older patient is having difficulty with the developmental task of integrity vs. despair. 4. The task for old age, according to Erikson, is integrity vs. despair. If older people can find meaning in the life lived, then they will have the ego integrity to adjust and manage the process of aging. If they do not have integrity, they will feel despair. 5. Laughing with grandchildren indicates ego integrity to adjust to aging. Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 2. Discuss six common theories of aging. Chapter page reference: 26 Heading: Psychological Theories Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Nursing; Development Difficulty: Moderate PTS: 1
CON: Nursing | Development
53. ANS: 1, 2, 5 Feedback 1. Normal aging includes gains and losses and does not indicate decline. 2. As individuals age they become more diverse and not alike.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3. 4. 5.
Age-related changes develop in each individual in a unique way. Normal aging and disease are separate entities. Successful adaptation to the aging process is accomplished by most older adults.
Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes to the body systems. Chapter page reference: 28 Heading: Normal Aging Process Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Health Promotion Difficulty: Easy PTS: 1
CON: Nursing | Health Promotion
54. ANS: 1, 2, 4, 5 Feedback 1. Lung elastic recoil is progressively lost with advancing age. 2. Alveoli enlarge and become thin with aging. 3. The surface area for gas exchange is reduced. 4. The alveolus-capillary membrane thickens. 5. The number of functioning alveoli decreases overall. Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Respiratory Chapter page reference: 29 Heading: Respiratory System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Oxygenation; Nursing Difficulty: Moderate PTS: 1
CON: Oxygenation | Nursing
55. ANS: 1, 2, 4, 5 Feedback 1. An age-related change in the oral cavity is loose teeth. 2. Delayed gastric emptying time can reduce the appetite. 3. Feelings of thirst are not age-related changes of the gastrointestinal system. 4. A weak gag reflex is an age-related change in the older person’s esophagus. 5. Feeling full is caused by delayed gastric emptying. Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Gastrointestinal Chapter page reference: 31 Heading: Gastrointestinal System Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Analysis [Analyzing] Concept: Digestion; Nursing Difficulty: Moderate PTS: 1
CON: Digestion | Nursing
56. ANS: 1, 2, 3, 5 Feedback 1. Functional impairments caused by decreased bladder capacity can lead to nocturia. 2. Functional impairments caused by decreased bladder capacity can lead to frequency. 3. Functional impairments caused by decreased bladder capacity can lead to incontinence. 4. Renal calculi is not identified as being caused by functional impairments in bladder capacity. 5. Functional impairments caused by decreased bladder capacity can lead to urinary retention. Chapter number and title: Chapter 2 The Aging Experience Chapter/learning objective: 3. Identify age-related changes in the following body systems: Genitourinary Chapter page reference: 31 Heading: Genitourinary System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Urinary Elimination; Nursing Difficulty: Moderate PTS: 1
CON: Urinary Elimination | Nursing
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which statement is LEAST true about life transitions? 1)
A person usually experiences only one transition in a lifetime.
2)
Sometimes there is more than one transition occurring at the same time in a person’s life.
3)
Challenging experiences that accompany aging may require life transitions.
4)
Each loss or change requires transitional effort from the person experiencing it.
2. A 76-year-old patient recovering from hip replacement surgery is upset and does not feel at peace because of her inability to attend church as a result of the injury. What is the best response by the nurse? 1)
Encourage her to read a book, magazine, or newspaper.
2)
Suggest that she watch television to keep her mind distracted.
3)
Offer to call the hospital’s chaplain or clergyman to come pray with her.
4)
Tell her to sleep so that her body can heal and return to a state of peacefulness.
3. Which would NOT be considered a transitional event? 1)
Marriage
2)
Losing a job
3)
Moving to a new home
4)
Visiting an amusement park
4. Which is NOT an identified feature of a transition? 1)
A stage of denial
2)
A phase of turmoil
3)
An altered time perspective
4)
A disturbance in body function
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
5. The nurse respects an older patient’s decision and right to refuse treatment and returns at a later time to offer previously refused medication. Which factor influencing transitional outcomes applies to this patient’s situation? 1)
Degree of choice
2)
Perception of change
3)
Preparation for the change
4)
Extent or degree of change
6. Which action would LEAST likely support the degree of change that an older person has to make when preparing to move? 1)
Selecting a home that meets the physical needs of the person
2)
Ensuring the new home is located near a senior citizen’s center
3)
Choosing a smaller apartment so the person has fewer items to move
4)
Finding a home with a grocery store within walking distance
7. Which approach is LEAST appropriate when helping patients prepare for transitions? 1)
Avoid discussing difficult topics with patients.
2)
Repeat all necessary information about the transition.
3)
Involve family members when discussing future transitions.
4)
Talk to patients and residents about changes to be anticipated.
8. Which characteristics should be considered when a person is transitioning? 1)
Gender
2)
Vital signs
3)
Past experiences
4)
Height and weight
9. What aspects of the environment in a hospital room would most likely allow for smooth transitioning?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1)
Warm and dark
2)
Clean and colorful
3)
Restrictive and demanding
4)
Cheerful and relaxing
10. Which is NOT a common transition for an older adult? 1)
Marriage
2)
Health changes
3)
Family role changes
4)
Job changes and retirement
11. A 68-year-old patient has just been admitted to the oncology unit with a new diagnosis of lung cancer. This is the patient’s first hospital admission and she knows very little about the diagnosis. Which action should the nurse take to make this patient’s transition easier? 1)
Administer an antianxiety agent to keep her calm.
2)
Leave a printout about lung cancer at her bedside.
3)
Talk with her about her fears, questions, or concerns.
4)
Tell her a physician will be in to explain what is going on.
12. Spirituality is defined as 1)
The service and worship of God or the supernatural
2)
The organized practice of one’s belief in a higher power
3)
Formal worship involving prescribed actions or practices
4)
A feeling from within that communicates a higher power at work
13. Which is the LEAST likely way to assess a patient’s spiritual needs? 1)
Looking for any religious books in the patient’s room
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2)
Identifying the patient’s religious preference from the chart
3)
Asking the patient’s neighbor if he or she has heard the patient praying
4)
Looking for identifying jewelry or artifacts in the patient’s personal belongings
14. A 73-year-old patient recovering from coronary artery bypass surgery is depressed and is continuously asking, “Why is God doing this to me?” The best response by the nurse is to 1)
Ask the patient if he has any specific spiritual needs to be addressed.
2)
Call for a psychiatric consultation to screen the patient for depression.
3)
Reassure the patient that he did nothing wrong and everything is okay.
4)
Tell the patient that sadness usually occurs after undergoing heart surgery.
15. A patient asks the nurse to pray with her, however, the nurse does not usually pray. Which approach would be the LEAST supportive of the patient’s needs? 1)
Hold the patient’s hands while she prays.
2)
Sit near the patient and be reverent during the prayer.
3)
Tell the patient to find someone else who will pray with her.
4)
Find a coworker who would be willing to pray with the patient.
16. Achieving gerotranscendence allows for an older person to 1)
Live life without regret and die well.
2)
Withdraw and disengage from life’s many hardships.
3)
Become more involved with the self rather than others.
4)
Reach a state of wealth and superfluous social interaction.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
17. Which is the LEAST likely reason to perform a life review? 1)
To reflect on all the great accomplishments of one’s life
2)
To identify strengths that can assist with current transitions
3)
To assist older people to review their lives and appreciate them
4)
To help older people prepare for life insurance and funeral expenses
18. One of the purposes of a creating a life story is to 1)
Ensure the patient’s memory is intact.
2)
Publish it as a book and sell it for profit.
3)
Keep the patient busy for long periods of time.
4)
Share the life story with children and grandchildren.
19. When working with older people it is important for the nurse to employ holistic nursing care by embracing the body, mind, and spirit of the patient. Which action does NOT represent embracing the body, mind, or spirit? 1)
Meeting spiritual needs
2)
Following the medical plan of care
3)
Addressing transitional stress needs
4)
Delivering a mechanistic form of care
20. What role does spirituality have with transitions? 1)
Estimates the number of transitions to expect in the future
2)
Summarizes approaches to speed up the transition process
3)
Helps explain how long the transition will take to complete
4)
Provides a method to understand the losses being experienced
21. Which phrase best describes a transitional moment?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1)
Stress provoked by the change
2)
Letting go of previous practices
3)
Realizing that a change has to occur
4)
Accepting new ways of doing things
22. A nursing instructor has spinal fusion surgery and learns afterward that performing cardiopulmonary resuscitation and walking for long periods of time will be contraindicated in the future after recovery. What is the transitional moment for this instructor? 1)
Having surgery
2)
Recovering from surgery
3)
Teaching nursing students
4)
Learning that certain activities are not permitted to be performed
23. What is interconnected with a transition? 1)
Cost
2)
Growth
3)
Relocation
4)
Change in vocation
24. A middle-aged adult is having difficulty with losing one parent and then the other 5 months later. What should the nurse do to help this adult with the transition of losing both parents in a short period of time? 1)
Remind the person that the parents had long lives.
2)
Assure the person that the parents are in a better place now.
3)
Encourage the person to move forward and resume routine activities.
4)
Ask how the transition of losing a spouse a few years ago was handled.
25. What is the average length of a transitional period? 1)
Decades
2)
A few days
3)
A few hours
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4)
Weeks to months
26. One member of an older couple is unable to walk independently and needs hemodialysis treatments three times a week. The couple is discussing the need for an extended care facility. What should be done to facilitate the ill spouse’s free choice with a transition? 1)
Identify the facilities with hemodialysis treatment centers.
2)
Explain how it is safer for an extended care facility admission to occur.
3)
Remind the couple that as they age they should expect health problems
4)
Review the importance of receiving quality care to improve physical status.
27. What strategy should be used to learn how an older person perceives a transition? 1)
Listen to the person talk.
2)
Observe how the person lives.
3)
Plan to share a meal with the person.
4)
Analyze the person’s living situation and clothing.
28. What is the major premise of the progressively lowered stress threshold? 1)
Identify the cause of stress.
2)
Strategize approaches to limit distractions.
3)
Reduce the number of decisions a person has to make.
4)
Provide the individual with as much control as possible.
29. The aging parents of a middle-aged adult have both recently passed away. What transition will the middleaged adult be facing? 1)
Role crisis
2)
Loss of identity
3)
Change in employment
4)
Unpreparedness for the future
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
30. An older adult is having difficulty adjusting to needing a cane to safely ambulate. With which transitions is the person having difficulty? 1)
Role crisis
2)
Body image
3)
Loss of identity
4)
Lack of social interaction
31. During a home visit, the adult daughter of an aging couple asks her father to not tell the story about “the time you were in the war and had to use sheets to cover a wound” again. What should the nurse realize that the older parent is demonstrating? 1)
Delirium
2)
Dementia
3)
Confusion
4)
Life review
32. An older married couple spent a few weeks going through all photos and placing them in albums to present to their adult children. What behavior did the older couple demonstrate? 1)
Creativity
2)
Motivation
3)
Life review
4)
Storytelling
33. During a community picnic, the nurse observes a middle-aged adult sitting alone on a bench. This adult is reflecting on the times spent with parents and friends and does not want to forget the memories. What should the nurse suggest to this person? 1)
Write a life story.
2)
Learn a new hobby.
3)
Spend less time alone.
4)
Share the memories with children.
Multiple Response Identify one or more choices that best complete the statement or answer the question. 34. What characteristics should be considered when assisting an older person with a transition? Select all that apply.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1)
Finances
2)
Nutrition
3)
Personality
4)
Coping skills
5)
Past experiences
35. What behaviors indicate that an older person is experiencing unresolved stress? Select all that apply. 1)
Punching an orderly
2)
Criticizing the meals
3)
Sitting in a dark room
4)
Arguing with the staff
5)
Yelling at a family member
36. What should be identified as potentially causing stress in an older patient? Select all that apply. 1)
Waiting over an hour for a pain pill
2)
Watching a horror movie on television
3)
Having a different nurse scheduled for the day shift
4)
Hearing a jackhammer breaking up concrete on the street
5)
Being awakened every 2 hours during the night for blood work
37. Which observation indicates that a recently retired older person is having difficulty with the transition? Select all that apply. 1)
Losing weight
2)
Meeting with friends
3)
Downloading ebooks
4)
Babysitting grandchildren
5)
Skipping medication doses
Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Answer Section MULTIPLE CHOICE
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 1. Discuss the significance of transitions and spirituality in the lives of elderly people. Chapter page reference: 39 Heading: Significance of Transitions and Spirituality Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Self; Nursing Difficulty: Easy Feedback 1
Life is full of transitions. A person does not experience just one transition during a lifetime.
2
More than one transition can be occurring at the same time.
3
Experiences of aging may be challenging and may require life transitions.
4
A loss or change does require transitional effort for the person experiencing it.
PTS: 1
CON: Self | Nursing
2. ANS: 3 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 1. Discuss the significance of transitions and spirituality in the lives of elderly people. Chapter page reference: 39 Heading: Significance of Transitions and Spirituality Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Spirituality Difficulty: Moderate Feedback 1
This is a distraction and does not resolve the patient’s underlying spiritual need.
2
This is a distraction and does not resolve the patient’s underlying spiritual need.
3
Calling the hospital’s chaplain or clergyman to pray with the patient would help meet
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
spiritual needs and aid in recovery and healing. 4
PTS: 1
Sleep is an important component of recovery, but it does not replace the power of spirituality.
CON: Spirituality
3. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 2. Describe what a transition is and the impact it has on people. Chapter page reference: 39 Heading: Understanding Transitions Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Self; Nursing Difficulty: Easy Feedback 1
Marriage marks the beginning of a new phase of life.
2
Losing a job marks the end of a phase of life.
3
Moving to a new home marks the beginning of a new phase of life.
4
Visiting an amusement park is entertainment and not a transitional event.
PTS: 1
CON: Self | Nursing
4. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 2. Describe what a transition is and the impact it has on people. Chapter page reference: 41 Heading: Understanding Transitions Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Self; Nursing Difficulty: Easy Feedback 1
A stage of denial is not a common feature of transitions.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2
A phase of turmoil is a common feature of transitions.
3
An altered time perspective is a common feature of transitions.
4
A disturbance in body function is a common feature of transitions.
PTS: 1
CON: Self | Nursing
5. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 3. List four to six activities the nurse can perform that will facilitate a successful transitional outcome. Chapter page reference: 41 Heading: How to Influence a Transitional Outcome Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Self; Nursing; Nursing Roles Difficulty: Easy Feedback 1
People who believe they have chosen the transition are more likely to embrace the transition, and this represents degree of choice.
2
This is a factor that influences transitional outcomes but does not explain this patient’s situation.
3
This is a factor that influences transitional outcomes but would not apply to this patient’s situation.
4
This is a factor that influences transitional outcomes but would not explain this patient’s situation.
PTS: 1
CON: Self | Nursing | Nursing Roles
6. ANS: 3 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 3. List four to six activities the nurse can perform that will facilitate a successful transitional outcome. Chapter page reference: 43 Heading: How to Influence a Transitional Outcome
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Self; Nursing; Nursing Roles Difficulty: Easy Feedback 1
This is a humanistic approach to caring and would make the transition of moving into a new home easier.
2
This is a humanistic approach to caring and would make the transition of moving into a new home easier.
3
This is a mechanistic approach to caring and would require the person to discard items that may be desired. This would make the transition more difficult.
4
This is a humanistic approach and demonstrates caring to make the transition of moving into a new home easier.
PTS: 1
CON: Self | Nursing | Nursing Roles
7. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 3. List four to six activities the nurse can perform that will facilitate a successful transitional outcome. Chapter page reference: 43 Heading: How to Influence a Transitional Outcome Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Self; Nursing; Nursing Roles Difficulty: Easy Feedback 1
Avoiding the discussion of difficult topics fails to prepare patients for future transitions.
2
Repeating all necessary information about the transition is a technique to prepare for a future transition.
3
Involving family members when discussing future transitions is an appropriate technique.
4
Talking to patients and residents about changes to be anticipated is an appropriate
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
technique when preparing for a transition.
PTS: 1
CON: Self | Nursing | Nursing Roles
8. ANS: 3 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 3. List four to six activities the nurse can perform that will facilitate a successful transitional outcome. Chapter page reference: 43 Heading: How to Influence a Transitional Outcome Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Self; Nursing; Nursing Roles Difficulty: Easy Feedback 1
Gender does not characterize the person’s ability to transition.
2
Vital signs do not characterize the person’s ability to transition.
3
A person’s personality, past experiences, and coping skills all are important factors to consider for transitioning.
4
Height and weight do not characterize the person’s ability to transition.
PTS: 1
CON: Self | Nursing | Nursing Roles
9. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 3. List four to six activities the nurse can perform that will facilitate a successful transitional outcome. Chapter page reference: 44 Heading: How to Influence a Transitional Outcome Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Self; Nursing; Nursing Roles Difficulty: Easy Feedback 1
Warm and dark environments may hinder transitioning.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2
Clean and comfortable environments may play a role in healing, but not necessarily ensure satisfactory transitioning.
3
Restrictive and demanding environments may hinder transitioning.
4
Environments that are cheerful, relaxed, nurturing, and respectful allow for proper healing.
PTS: 1
CON: Self | Nursing | Nursing Roles
10. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 5. Recommend three transitions common to older adults. Chapter page reference: 47 Heading: Common Transitions for Older Adults Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Self; Nursing; Nursing Roles Difficulty: Easy Feedback 1
Although marriage is considered to be a transition, it is most often seen in early to middle adulthood.
2
Health changes are common transitions for an older adult because of the frequency of their occurrence during the aging process.
3
Family role changes are common transitions for an older adult because of the frequency of their occurrence during the aging process.
4
Job changes and retirement are common transitions for an older adult because of the frequency of their occurrence during the aging process.
PTS: 1
CON: Self | Nursing | Nursing Roles
11. ANS: 3 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 5. Recommend three transitions common to older adults. Chapter page reference: 48 Heading: Common Transitions for Older Adults
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Self; Nursing; Nursing Roles Difficulty: Moderate Feedback 1
An antianxiety agent may help the patient remain calm but does not resolve underlying concerns.
2
This may provide supplemental information about the health problem but does not replace the role of the nurse to listen and address the patient’s concerns.
3
Talking with the patient about fears and concerns is a critical aspect of giving caring and holistic nursing care.
4
The physician may be able to provide information about the health problem but does not help the patient with cares and concerns.
PTS: 1
CON: Self | Nursing | Nursing Roles
12. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 49 Heading: Significance of Spirituality Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive level: Remembering [Knowledge] Concept: Spirituality Difficulty: Easy Feedback 1
The service and worship of God or the supernatural explains religion.
2
The organized practice of one’s belief in a higher power is a definition of religion.
3
Formal worship involving prescribed actions or practices is a characteristic of religion.
4
Spirituality is a feeling from within.
PTS: 1
CON: Spirituality
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
13. ANS: 3 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 49 Heading: Significance of Spirituality Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Spirituality; Assessment Difficulty: Easy Feedback 1
Looking for religious books is one way to assess for spiritual needs.
2
Identifying the patient’s religious preference from the chart is one way to assess for spiritual needs.
3
Involving the patient’s neighbor may be a violation of the patient’s right to privacy.
4
Looking for identifying jewelry or artifacts in the patient’s personal belongings is one way to assess for spiritual needs.
PTS: 1
CON: Spirituality | Assessment
14. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 50 Heading: Significance of Spirituality Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Spirituality Difficulty: Moderate Feedback 1
Feelings of sadness or depression and comments of despair are expressions of unmet spiritual needs or spiritual distress.
2
Calling for a psychiatric consultation to screen the patient for depression might be considered after the nurse addresses any unmet spiritual needs.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3
Reassuring the patient that he did nothing wrong and everything is okay is an inappropriate response.
4
Telling the patient that sadness usually occurs after undergoing heart surgery is not correct information.
PTS: 1
CON: Spirituality
15. ANS: 3 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 50 Heading: Significance of Spirituality Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Spirituality Difficulty: Moderate Feedback 1
Holding the patient’s hands while she prays will meet the patient’s needs.
2
Sitting near the patient and being reverent during the prayer will meet the patient’s needs.
3
It is the nurse’s role to support a person with unmet spiritual needs so the patient can achieve management of the illness or problems being faced. Telling the patient to find someone else to pray with does not meet the patient’s needs.
4
Finding a coworker who would be willing to pray with the patient will meet the patient’s needs.
PTS: 1
CON: Spirituality
16. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 51 Heading: Resolving Transitional Problems Integrated Processes: Nursing Process: Planning
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Development; Nursing Difficulty: Easy Feedback 1
Gerotranscendence allows an older person to have no regrets and die well.
2
Withdrawing and disengaging from life’s many hardships is the opposite of gerotranscendence.
3
Becoming more involved with the self rather than others is the opposite of gerotranscendence.
4
Reaching a state of wealth and superfluous social interaction is the opposite of gerotranscendence.
PTS: 1
CON: Development | Nursing
17. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 51 Heading: Resolving Transitional Problems Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Development; Nursing Difficulty: Easy Feedback 1
A life review allows for older people to reflect on accomplishments throughout life.
2
A life review allows for older people to identify strengths to help with current transitions.
3
A life review allows for older people to review their lives and appreciate them.
4
A life review is not done to prepare for life insurance and funeral expenses.
PTS: 1
CON: Development | Nursing
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
18. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 52 Heading: Resolving Transitional Problems Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Development; Nursing Difficulty: Easy Feedback 1
Creating a life story is not done to ensure the patient’s memory is intact.
2
Creating a life story is not done to publish it as a book and sell it for profit.
3
Creating a life story is not done to keep the patient busy for long periods of time.
4
A copy of a life story could be shared with children, grandchildren, friends, family members, and staff members so that they could get to know the patient better.
PTS: 1
CON: Development | Nursing
19. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 53 Heading: Resolving Transitional Problems Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Nursing; Nursing Roles Difficulty: Moderate Feedback 1
Meeting spiritual needs embraces the spirit.
2
Following the medical plan of care embraces the body.
3
Addressing transitional stress needs embraces the mind.
4
Holistic nursing care involves a humanistic approach, not simply mechanistic care.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Development | Nursing
20. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 1. Discuss the significance of transitions and spirituality in the lives of elderly people. Chapter page reference: 49 Heading: Significance of Transitions and Spirituality Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Spirituality Difficulty: Easy Feedback 1
Spirituality does not help estimate the number of transitions to expect in the future.
2
Spirituality does not provide approaches to speed up the transition process.
3
Spirituality does not help explain how long the transition will take to complete.
4
Spirituality is comforting and can provide many people with a method for understanding the losses that are being experienced.
PTS: 1
CON: Spirituality
21. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 1. Discuss the significance of transitions and spirituality in the lives of elderly people. Chapter page reference: 41 Heading: Significance of Transitions and Spirituality Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Stress Difficulty: Easy Feedback 1
The time of the unknown, which is usually marked by the stress provoked by the change, is the transitional moment.
2
Letting go of previous practices is not the transitional moment.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3
Realizing that a change has to occur is not the transitional moment.
4
Accepting new ways of doing things is not the transitional moment.
PTS: 1
CON: Stress
22. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 1. Discuss the significance of transitions and spirituality in the lives of elderly people. Chapter page reference: 41 Heading: Significance of Transitions and Spirituality Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Stress Difficulty: Moderate Feedback 1
Although surgery is stressful, this is not the transitional moment.
2
Although recovering from surgery can be stressful, this is not the transitional moment.
3
Although teaching nursing students can be stressful, this is not the transitional moment.
4
Learning that certain activities can no longer be performed creates stress, which is the transitional moment.
PTS: 1
CON: Stress
23. ANS: 2 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 2. Describe what a transition is and the impact it has on people. Chapter page reference: 40 Heading: Understanding Transitions Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge; Remembering Concept: Development; Stress Difficulty: Easy Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1
Cost is not necessarily interconnected with a transition.
2
Transitions are interconnected with the growth of the person.
3
Relocation is not necessarily interconnected with a transition.
4
Change in vocation is not necessarily interconnected with a transition.
PTS: 1
CON: Development | Stress
24. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 2. Describe what a transition is and the impact it has on people. Chapter page reference: 40 Heading: Understanding Transitions Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Development; Stress Difficulty: Moderate Feedback 1
Reminding the person that the parents had long lives will not help the adult deal with the transition of losing both parents within a short period of time.
2
Assuring the person that the parents are in a better place will not help the adult deal with the transition of losing both parents within a short period of time.
3
Encouraging the person to move forward and resume routine activities will not help the adult deal with the transition of losing both parents within a short period of time.
4
Most people have experienced a critical transition. By helping the person remember the behaviors that were helpful in the past, these same behaviors can be used to help with the current transition.
PTS: 1
CON: Development | Stress
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
25. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 2. Describe what a transition is and the impact it has on people. Chapter page reference: 41 Heading: Understanding Transitions Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Development; Stress Difficulty: Easy Feedback 1
A transitional period is not identified as lasting decades.
2
A transitional period will be longer than a few days.
3
A transitional period will be longer than a few hours.
4
A transitional period can last weeks or months.
PTS: 1
CON: Development | Stress
26. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 3. List four to six activities the nurse can perform that will facilitate a successful transitional outcome. Chapter page reference: 42 Heading: How to Influence a Transitional Outcome Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Development; Stress Difficulty: Moderate Feedback 1
People who think they have freely chosen the transition are more likely to embrace it or own it. Providing a list of facilities with hemodialysis treatment centers will offer the couple, and specifically the ill member, an opportunity to choose where to be admitted for care and treatment.
2
Explaining safety issues does not provide the ill member with a choice.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3
Reminding the couple that they are older in age and should expect health problems does not provide either of them with a choice.
4
Reviewing the importance of receiving quality care to improve physical status does not address free choice.
PTS: 1
CON: Development | Stress
27. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 3. List four to six activities the nurse can perform that will facilitate a successful transitional outcome. Chapter page reference: 43 Heading: How to Influence a Transitional Outcome Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Development; Stress Difficulty: Moderate Feedback 1
Communication skills should be used to listen to how a person perceives a transition and gain insight into the unique meanings that are attached to it for the person.
2
Observing how a person lives will not necessarily determine how the person will perceive a transition.
3
Sharing a meal with a person will not necessarily determine how the person will perceive a transition.
4
Analyzing the living situation and clothing will not necessarily determine how the person will perceive a transition.
PTS: 1
CON: Development | Stress
28. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 4. Define how the “progressively lowered stress threshold” concept can assist in the management of negative behaviors in older adults. Chapter page reference: 44 Heading: Progressively Lowered Stress Threshold
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Stress Difficulty: Easy Feedback 1
Identifying the cause of stress is not the major premise of the progressively lowered stress threshold.
2
Strategizing approaches to limit distractions is not the major premise of the progressively lowered stress threshold.
3
Reducing the number of decisions a person has to make could encourage stress.
4
The major premise of the progressively lowered stress threshold is that personal freedom and control are threatened.
PTS: 1
CON: Stress
29. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 5. Recommend three transitions common to older adults. Chapter page reference: 48 Heading: Common Transitions for Older Adults Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback 1
A person who is a member of the sandwich generation may experience role crisis after the individuals for whom the person is caring for have left or died.
2
Loss of identity is associated with job change or retirement.
3
Change in employment is associated with job change or retirement.
4
Unpreparedness for the future is associated with job change or retirement.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Stress
30. ANS: 2 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 5. Recommend three transitions common to older adults. Chapter page reference: 48 Heading: Common Transitions for Older Adults Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback 1
A role crisis occurs when the person’s place in the family and expectations have changed.
2
The use of a cane may cause the older person to have an altered self-image or lowered selfesteem.
3
Loss of identity is associated with job change and retirement.
4
Lack of social interaction is associated with job change and retirement.
PTS: 1
CON: Stress
31. ANS: 4 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 51 Heading: Resolving Transitional Problems Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Development Difficulty: Easy Feedback 1
Repeating the same story is not demonstrating delirium.
2
Repeating the same story is not demonstrating dementia.
3
Repeating the same story is not demonstrating confusion.
4
Storytelling is essential for the older person to
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
achieve integrity and should be supported and encouraged.
PTS: 1
CON: Development
32. ANS: 3 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 52 Heading: Resolving Transitional Problems Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Development Difficulty: Easy Feedback 1
Coordinating photographs is not necessarily demonstrating creativity.
2
The older couple may have needed to be motivated to perform the task.
3
Collecting and organizing photographs is a form of a life review.
4
Storytelling is verbally reviewing or reliving events in one’s life as a method of validation and integrity.
PTS: 1
CON: Development
33. ANS: 1 Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 6. Compare and contrast spirituality and religion. Chapter page reference: 52 Heading: Resolving Transitional Problems Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Development Difficulty: Easy Feedback 1
Writing a life story is a method of recording life events for the purpose of sharing or having a personal record.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2
Learning a new hobby does not support the person’s need to store the memories.
3
Spending less time alone does not support the person’s need to store the memories.
4
Sharing the memories with children may not be sufficient. The children may forget the stories and the memories will be lost in the years ahead.
PTS: 1
CON: Development
MULTIPLE RESPONSE 34. ANS: 2, 3, 4, 5 Feedback 1.
Finances are not important to consider when helping a person through a transition.
2.
Adequate nutrition is an important factor to consider when helping a person through a transition.
3.
A person’s personality is an important factor to consider when helping a person through a transition.
4.
A person’s coping skills are important factors to consider when helping a person through a transition.
5.
A person’s past experiences are important factors to consider when helping a person through a transition.
Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 3. List four to six activities the nurse can perform that will facilitate a successful transitional outcome. Chapter page reference: 43 Heading: How to Influence a Transitional Outcome Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Development; Stress Difficulty: Easy PTS: 1
CON: Development | Stress
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
35. ANS: 1, 2, 4, 5 Feedback 1.
Unresolved stress can include hitting.
2.
Unresolved stress can include criticizing the environment.
3.
Sitting in a dark room is a characteristic of depression.
4.
Unresolved stress can include raising one’s voice.
5.
Unresolved stress can include criticizing people in the environment.
Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 4. Define how the “progressively lowered stress threshold” concept can assist in the management of negative behaviors in older adults. Chapter page reference: 44 Heading: Progressively Lowered Stress Threshold Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Development; Stress Difficulty: Easy PTS: 1
CON: Development | Stress
36. ANS: 1, 3, 4, 5 Feedback 1.
Waiting over an hour for a pain pill may cause stress.
2.
Watching a horror movie on television is a personal choice that can be changed by turning off the television.
3.
Having a different nurse for the day shift is a change in caregiver and may cause stress.
4.
Hearing a jackhammer break up concrete is inappropriate stimuli and may cause stress.
5.
Being awakened every 2 hours for blood work can lead to fatigue, which may cause stress.
Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 4. Define how the “progressively lowered stress threshold” concept can assist in the management of negative behaviors in older adults. Chapter page reference: 45
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Progressively Lowered Stress Threshold Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Development; Stress Difficulty: Moderate PTS: 1
CON: Development | Stress
37. ANS: 1, 5 Feedback 1.
Losing weight could indicate that the older person has insufficient income to purchase food after retirement.
2.
Meeting with friends indicates social interaction is being maintained.
3.
Downloading ebooks indicates maintaining interests and hobbies.
4.
Babysitting grandchildren indicates spending time with family.
5.
Skipping medication doses could indicate that the older person has insufficient income to purchase needed medications.
Chapter number and title: Chapter 3: Supporting Life Transitions and Spirituality in the Elderly Chapter/learning objective: 5. Recommend three transitions common to older adults. Chapter page reference: 47 Heading: Common Transitions for Older Adults Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Development; Stress Difficulty: Moderate PTS: 1
CON: Development | Stress
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which statement defines the nursing process? 1) A problem-solving approach 2) A standardized care-planning method 3) An intuitive approach to planning nursing care 4) A structured and inflexible way to approach problems
2. Which phrase LEAST describes the nursing process? 1) Planned care 2) Patient-centered 3) Adaptable to change 4) Organized according to medical diagnosis
3. Which is NOT a step in the nursing process? 1) Planning 2) Assessment 3) Physician orders 4) Nursing diagnosis
4. In which step of the nursing process does the nurse complete the minimum data set (MDS)? 1) Planning 2) Diagnosis 3) Assessment 4) Physician orders
5. Which is an example of assessment data? 1) Altered nutrition 2) Monitoring the resident’s oral intake 3) Resident will walk 100 feet each afternoon 4) Resident is complaining of difficulty swallowing
6. Which statement best explains the MDS? 1) Refers care providers to standardized plans of care 2) Focuses on care required for specific medical diagnoses 3) Dictates the nursing care that should be provided to every nursing home resident 4) Refers care providers to problem areas that must be addressed in the plan of care
7. Which is a nursing diagnosis?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1) 2) 3) 4)
Osteoporosis related to menopause Congestive heart failure related to history of hypertension Non–insulin-dependent diabetes mellitus related to obesity Alteration in thought process related to Alzheimer’s disease
8. What does the development of a nursing diagnosis depend on? 1) Medical diagnoses 2) Chronic disease processes 3) Goals for the resident’s care 4) Data collected in the comprehensive assessment
9. Which statement describes the process of identifying a nursing diagnosis? 1) Setting goals for nursing care 2) Identifying the patient’s strengths and weaknesses 3) Reviewing medical-surgical nursing texts for patterns of disease processes 4) Selecting a nursing diagnosis from a list approved by the North American Nursing Diagnosis Association (NANDA)
10. How frequently are goals in long-term care measured? 1) Yearly 2) Weekly 3) Bimonthly 4) Every 30 or 90 days
11. Which best describes goals? 1) Resident-focused 2) Nurses providing ordered care 3) Priorities of the nursing facility 4) Priorities set by the physician’s orders
12. Which is a measurable goal for an older person? 1) The resident will feel better. 2) The resident will feel less nauseated. 3) The resident’s appetite will improve. 4) The resident will eat more than 80% of each meal for the next week.
13. An 80-year-old patient has the nursing diagnosis of impaired skin integrity related to stasis ulcer on the left ankle. Which would be a goal for this nursing diagnosis? 1) The resident will not have any more leg ulcers. 2) The nurse will change the wound dressing b.i.d. until healed. 3) The nurse will chart any wound drainage and report it to the physician. 4) Stasis ulcer will have decreased redness and granulation tissue evident in 2 weeks.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
14. A 68-year-old resident has an elevated blood pressure. What would be a goal for this resident’s care? 1) The resident’s blood pressure will be normal. 2) The resident’s blood pressure will not be elevated. 3) The resident’s blood pressure will be monitored t.i.d. for 1 week. 4) The resident’s blood pressure will be less than 160/90 mm Hg in 1 week.
15. Which is an appropriate goal for a resident who has a history of falling? 1) The resident will have no falls in the next 90 days. 2) The resident will be toileted q2h for the next week to prevent falls. 3) The resident will be walked by the physical therapy assistant two times a day. 4) The resident will be assessed for complaints of dizziness or unsteadiness for the next 90 days.
16. Which health-care provider implements the resident care plan? 1) The entire nursing team 2) The registered nurse (RN) 3) The licensed practical nurse (LPN) and the certified nursing assistant (CNA) 4) The RN and the CNA
17. What is NOT a part of assessment documentation? 1) Blood pressure 2) What the resident said 3) The nurse’s observation 4) Phone calls to the physician
18. After the care plan is completed on a new admission what must be done? 1) Notify the physician so that he or she may make changes. 2) File it in the drawer; it is not a useful tool for the ongoing care of the patient. 3) Re-evaluate and update the plan of care continually based on the patient’s needs. 4) Inform the family that the plan of care is complete for the duration of the patient’s stay.
19. Based on Maslow’s hierarchy of needs, which represents the most appropriate list of priorities? 1) Nutrition less than body requirements; constipation; self-care deficit; confusion 2) Constipation; self-care deficit; confusion; nutrition less than body requirements 3) Nutrition less than body requirements; self-care deficit; confusion, constipation 4) Self-care deficit; confusion; constipation; nutrition less than body requirements
20. Which care provider performs nursing interventions? 1) RN 2) LPN
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) CNA 4) All members
21. Which statement best describes the nursing process? 1) A step-by-step linear plan 2) A step-by-step circular plan 3) A standardized plan of care for specific diseases or disorders 4) A plan of care designed by the physician according to the medical diagnosis
22. How does a nursing diagnosis differ from a medical diagnosis? 1) It is identified by a physician. 2) It identifies specific signs and symptoms. 3) It identifies a specific disease process affecting a specific body system. 4) It describes the impact a specific disease has on a patient’s day-to-day activities.
23. How should the nurse explain the minimum data set (MDS) to a new nursing student? 1) Highlights the major issues for each resident 2) Lists specific issues according to each resident 3) Outlines the specific care needed for every resident 4) Identifies standardized information for every resident
24. When should the MDS be completed? 1) On the day of admission 2) Within the first month of admission 3) Within the first 7 days of admission 4) Prior to discharge from the facility
25. What is embedded within the MDS responses? 1) Care area triggers 2) Care area assessment 3) Resident assessment protocols 4) Resident assessment instrument 26. What is missing from the goal “the resident will walk down the hall every day?” 1) Specificity 2) Timeliness 3) Attainability 4) Measurability
27. Why is it important for all disciplines to participate in the planning of a resident’s care? 1) Reduces duplication of effort
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Ensures that everyone is working 3) Speeds up the process of providing care 4) Ensures enough time to document at the end of the shift 28. Why should CNAs help in the development of nursing interventions for a resident’s plan of care? 1) They are nicer to the resident. 2) They spend the most time with the resident. 3) They have the most theory-based knowledge. 4) They are better received by the family members.
29. What should be done with the plan of care for a resident who is discharged back home? 1) Discard it. 2) Provide a copy to the family. 3) Keep it with the medical record. 4) Send it to the resident’s physician.
30. The nurse provides a resident with medication to aid with constipation. What should be included when documenting this intervention? 1) Resident’s response 2) Number of pills remaining 3) Number of residents needing the medication 4) Resident’s location when the medication was given
31. What should the nurse consult when documenting care provided to a resident in a nursing facility? 1) Physician’s progress note 2) Medical-surgical textbook 3) CNAs’ flow sheet information 4) Medication administration record
Multiple Response Identify one or more choices that best complete the statement or answer the question. 32. The nurse is reviewing information received from an acute care facility for a patient being transferred to the nursing home. What information should the nurse expect regarding the patient’s functional ability? Select all that apply. 1) Need for oxygen 2) Integrity of the skin 3) How the patient bathes 4) Assistance needed to eat 5) How the patient transfers
33. What is included in an admission assessment? Select all that apply.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1) 2) 3) 4) 5)
Nursing history Physical examination Interview with the resident Review of laboratory values Previous facility nurse’s notes
34. What is included in the resident assessment instrument (RAI)? Select all that apply. 1) Minimum data set (MDS) 2) Care area assessment (CAA) 3) Medication reconciliation form 4) Medicare and Medicaid conditions of participation 5) RAI utilization guidelines
35. Which are care area triggers? Select all that apply. 1) Falls 2) Delirium 3) Activities 4) Dental care 5) Arrhythmia
36. What is included in the planning phase of the nursing process? Select all that apply. 1) Setting priorities 2) Identifying goals 3) Designing interventions 4) Evaluating outcomes of care 5) Identifying outcomes of care
37. Why is a written plan of care created for all residents of a nursing facility? Select all that apply. 1) Required by federal regulations 2) Required by states for nursing licensure 3) Required by standards of nursing practice 4) Required by the nursing home administrator 5) Required by continuing education organizations
38. What is included in the nursing plan of care? Select all that apply. 1) Problems 2) Goals to be achieved 3) Time the action is to occur 4) Actions to address problems 5) Person to address the actions
39. Which actions facilitate that a resident’s plan of care will be followed by CNAs? Select all that apply.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1) 2) 3) 4) 5)
Assigning CNAs to pass linen Giving the CNAs written assignments Scheduling CNAs to do the same tasks Discussing the plan of care with the CNAs Using primary CNAs with steady assignments
40. What is the purpose of the evaluation phase of the nursing process? Select all that apply. 1) Determine if goals are met. 2) Assess the outcomes of care. 3) Make the next day’s assignments. 4) Ensure the resident is charged for all care. 5) Validate information to bill the insurance company.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Answer Section MULTIPLE CHOICE 1. ANS: 1 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 62 Heading: Nursing Process Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy Feedback 1 The nursing process is a problem-solving approach that describes what nurses do. 2 The nursing process is changeable. 3 The nursing process is individualized for each person and provides a planned framework for providing care. 4 The nursing process is flexible.
PTS: 1
CON: Critical Thinking
2. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 62 Heading: Nursing Process Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy Feedback 1 The nursing process is based on planned care. 2 The nursing process is patient-centered. 3 The nursing process is individualized for each person and provides a planned framework for providing care. 4 The nursing process is not organized according to medical diagnoses.
PTS: 1
CON: Critical Thinking
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3. ANS: 3 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 63 Heading: Nursing Process Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy Feedback 1 After problems are identified, the plan is developed. 2 The nursing process starts with assessment. 3 Physician orders are considered in the plan of care but are not a step in the nursing process. 4 During assessment, the information regarding the patient is collected and then organized according to patient-centered problems and nursing diagnoses.
PTS: 1
CON: Critical Thinking
4. ANS: 3 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 63 Heading: Assessment Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy Feedback 1 The MDS is not done during the planning step of the nursing process. 2 The MDS is not part of the diagnosis step of the nursing process. 3 The MDS is part of the assessment step in the nursing process. 4 Physician orders are not a part of the nursing process.
PTS: 1
CON: Critical Thinking
5. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 63
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Assessment Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Assessment; Critical Thinking Difficulty: Moderate Feedback 1 Altered nutrition is a nursing diagnosis. 2 Monitoring the resident’s oral intake is a nursing intervention. 3 Resident will walk 100 feet each afternoon is a patient goal. 4 Resident complaining of difficulty swallowing is assessment data.
PTS: 1
CON: Assessment | Critical Thinking
6. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 64 Heading: Minimum Data Set (MDS) Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Assessment; Critical Thinking Difficulty: Easy Feedback 1 The MDS is not based on standardized care plans. 2 The MDS is not based on medical diagnoses. 3 The MDS and resident assessment protocols provide guidelines designed to individualize the patient’s plan of care. 4 The MDS is part of the comprehensive assessment and has accompanying resident assessment protocols that provide the nurse with guidelines for care planning.
PTS: 1
CON: Assessment | Critical Thinking
7. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 65 Heading: Nursing Diagnosis and Medical Diagnosis Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Assessment; Critical Thinking Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Feedback This is a medical diagnosis. Naming a medical problem is not a nursing diagnosis. Combining medical problems is not a nursing diagnosis. This describes a patient problem that nursing care can address.
PTS: 1
CON: Assessment | Critical Thinking
8. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 64 Heading: Nursing Diagnosis Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Assessment; Critical Thinking Difficulty: Easy Feedback 1 Medical diagnoses are part of the comprehensive assessment but are not what nursing diagnoses are based on. 2 Chronic disease processes are part of the comprehensive assessment but are not what nursing diagnoses are based on. 3 Goals for the resident’s care will depend on the nursing diagnosis. 4 The nursing diagnosis results from the organization of assessment data into problem areas.
PTS: 1
CON: Assessment | Critical Thinking
9. ANS: 2 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 64 Heading: Nursing Diagnosis Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Assessment; Critical Thinking Difficulty: Easy Feedback 1 Setting goals follows identification of the nursing diagnosis. 2 The process of identifying a nursing diagnosis starts with evaluating a patient’s strengths and weaknesses.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
Reviewing medical-surgical texts assists the nurse in understanding responses to disease and assists in designing care plans but does not identify nursing diagnoses. The NANDA-approved list provides diagnostic labels for the patient’s strengths and weaknesses.
PTS: 1
CON: Assessment | Critical Thinking
10. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 68 Heading: Goal Setting or Identifying Outcomes Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Critical Thinking Difficulty: Easy Feedback 1 Goals can be reviewed yearly, however, are not used because of the lack of framework for reviews at this interval. 2 Goals can be reviewed weekly, however, are not used because of the lack of framework for reviews at this interval. 3 Goals can be reviewed bimonthly, however, are not used because of the lack of framework for reviews at this interval. 4 Omnibus Reconciliation Act (OBRA) guidelines mandate a 30-day review after recent admission and a quarterly (90-day) interdisciplinary team review. These time frames provide measurable time markers for goals.
PTS: 1
CON: Critical Thinking
11. ANS: 1 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 68 Heading: Goal Setting or Identifying Outcomes Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Critical Thinking Difficulty: Easy Feedback 1 Goals are resident-focused and based on priorities identified for the resident. 2 Goals are not nurses providing ordered care because this is not resident-focused. 3 Goals are not priorities of the nursing facility because these would not be resident-
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
focused. Goals are not priorities set by the physician’s orders because they may not be residentfocused.
PTS: 1
CON: Critical Thinking
12. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 68 Heading: Goal Setting or Identifying Outcomes Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Critical Thinking Difficulty: Easy Feedback 1 This is not a measurable goal. 2 This may be difficult to measure. 3 This may be difficult to measure objectively. 4 Goals are measurable, realistic, specific, time-related, and attainable.
PTS: 1
CON: Critical Thinking
13. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 68 Heading: Goal Setting or Identifying Outcomes Integrated Processes: Nursing Process: Diagnosis Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Critical Thinking Difficulty: Moderate Feedback 1 Even though this is a goal, it is not specific or timely. 2 This is a nursing intervention. 3 This is a nursing action. 4 This is a measurable, realistic, specific, time-related, and attainable goal.
PTS: 1 14. ANS: 4
CON: Critical Thinking
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 68 Heading: Goal Setting or Identifying Outcomes Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Critical Thinking Difficulty: Moderate Feedback 1 This goal is not measurable. 2 This goal is not specific. 3 This is a nursing intervention. 4 This is a measurable, timely, patient-specific, realistic, and attainable goal.
PTS: 1
CON: Critical Thinking
15. ANS: 1 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 68 Heading: Goal Setting or Identifying Outcomes Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Critical Thinking Difficulty: Moderate Feedback 1 This goal is measurable, realistic, specific, time-related, and attainable. 2 This is a nursing intervention. 3 This is a physical therapy intervention. 4 This is a nursing action.
PTS: 1
CON: Critical Thinking
16. ANS: 1 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 70 Heading: Goal Setting or Identifying Outcomes Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Application [Applying] Concept: Critical Thinking Difficulty: Moderate Feedback 1 The entire nursing team is responsible for implementing the plan of care. 2 The RN is identified as head of the nursing team. 3 The LPN manages the care given by the CNA and passes medications, does dressings, and provides other care within the LPN domain of practice. 4 The CNA often gives the personal care to the resident under the supervision of the LPN.
PTS: 1
CON: Critical Thinking
17. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 71 Heading: Implementation Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Critical Thinking; Communication Difficulty: Easy Feedback 1 Objective measurements are part of assessment documentation. 2 What the resident said is part of assessment documentation. 3 The nurse’s observation is part of assessment documentation. 4 Phoning the physician is part of the plan when documenting using the AssessmentAction-Plan approach.
PTS: 1
CON: Critical Thinking | Communication
18. ANS: 3 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 71 Heading: Evaluation Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Critical Thinking Difficulty: Easy Feedback 1 The physician may have input into the care plan but does not have the right to make changes unilaterally, unless by virtue of changed orders.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
The care plan is a valuable communication, planning, and evaluation tool and should not be stored in a drawer. Care planning and the nursing process are ongoing processes that are never completed as long as the patient is in the health-care environment. The care plan is reviewed and revised in interdisciplinary team meetings and at other times deemed necessary by changes in patient status.
PTS: 1
CON: Critical Thinking
19. ANS: 1 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 67 Heading: Setting Priorities Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Critical Thinking Difficulty: Moderate Feedback 1 Maslow places life-sustaining needs highest (nutrition, constipation), followed by safety and security (self-care deficit), love and belonging, self-esteem (confusion), and self-actualization. 2 Nutrition would be a priority with constipation in this list. 3 Constipation should appear after nutrition in this list. 4 Nutrition and constipation should begin this list, followed by self-care deficit and confusion.
PTS: 1
CON: Critical Thinking
20. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 70 Heading: Implementation Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy Feedback 1 The RN, in addition to all team members, performs nursing interventions. 2 The LPN, in addition to all team members, performs nursing interventions. 3 The CNA, in addition to all team members, performs nursing interventions.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
All team members perform nursing interventions.
PTS: 1
CON: Critical Thinking
21. ANS: 2 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 63 Heading: Nursing Process Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy Feedback 1 The nursing process is not a linear approach to care. 2 The nursing process includes the steps of assessment, nursing diagnosis, planning, intervention, and evaluation. It is an ongoing process that takes into account changes in the patient’s condition and responses to interventions, which lead to a need for reassessment—or a return to the first step, as in a circular path. 3 The nursing process is not a standardized plan of care for specific diseases or disorders. 4 The nursing process is not a plan of care designed by the physician according to the medical diagnosis.
PTS: 1
CON: Critical Thinking
22. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 66 Heading: Nursing Diagnosis and Medical Diagnosis Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Critical Thinking Difficulty: Easy Feedback 1 A medical diagnosis is identified by a physician. 2 A medical diagnosis identifies signs and symptoms. 3 A medical diagnosis identifies a disease process affecting a body system. 4 A nursing diagnosis is specific to the patient’s nursing care needs and relates to the areas in which the individual has difficulty functioning.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Critical Thinking
23. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 64 Heading: Minimum Data Set (MDS) Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Assessment, Critical Thinking Difficulty: Moderate Feedback 1 The MDS does not highlight the major issues for each resident. 2 The MDS does not list specific issues according to each resident. 3 The MDS does not outline the specific care needed for every resident. 4 The MDS is standardized so the same information is collected on every resident.
PTS: 1
CON: Assessment | Critical Thinking
24. ANS: 3 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 64 Heading: Minimum Data Set (MDS) Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Assessment, Critical Thinking Difficulty: Easy Feedback 1 The MDS does not need to be completed on the day of admission. 2 The MDS must be completed within the first 7 days of admission. 3 The MDS must be completed within the first 7 days of admission. 4 The MDS must be completed within the first 7 days of admission.
PTS: 1
CON: Assessment | Critical Thinking
25. ANS: 1 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 64
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Care Area Assessment (CAA) Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Assessment, Critical Thinking Difficulty: Easy Feedback 1 Embedded within the MDS responses are care area triggers (CATs), which indicate the need for further assessment. 2 When the MDS is completed, it provides a comprehensive assessment as well as indicators of risk for the resident. This is called the care area assessment (CAA). 3 CAAs have replaced resident assessment protocols. 4 The resident assessment instrument includes the MDS, the CAA, and the resident assessment instrument utilization guidelines.
PTS: 1
CON: Assessment | Critical Thinking
26. ANS: 4 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 68 Heading: Goal Setting or Identifying Outcomes Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Critical Thinking Difficulty: Easy Feedback 1 The goal identifies the action of walking. 2 The goal identifies that something is to be done every day. 3 The goal is written as attainable. 4 The goal cannot be measured. How far is the resident supposed to walk every day? How many feet? How many times?
PTS: 1
CON: Critical Thinking
27. ANS: 1 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 68 Heading: Designing and Documenting the Plan of Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Critical Thinking Difficulty: Easy Feedback 1 A coordinated approach among all disciplines enhances the effectiveness of the care given to the resident and minimizes duplication of efforts. 2 A coordinated approach among all disciplines is not done to ensure that everyone is working. 3 A coordinated approach among all disciplines is not done to speed up the process of providing care. 4 A coordinated approach among all disciplines is not done to ensure that there is enough time at the end of the shift to document.
PTS: 1
CON: Critical Thinking
28. ANS: 2 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 69 Heading: Designing and Documenting the Plan of Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Critical Thinking Difficulty: Moderate Feedback 1 CNAs are not necessarily nicer to the residents. 2 Nursing interventions must be developed with input from CNAs because they spend more time with residents in nursing facilities than any other member of the interdisciplinary team. 3 CNAs do not have the most theory-based knowledge. The RN and LPN will have this knowledge. 4 CNAs are not necessarily better received by the family members.
PTS: 1
CON: Critical Thinking
29. ANS: 3 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 70 Heading: Designing and Documenting the Plan of Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Critical Thinking
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Moderate Feedback 1 The plan of care should not be discarded. 2 The plan of care does not need to be provided to the family. 3 The plan of care is a permanent part of the resident’s medical record. 4 The plan of care does not need to be sent to the physician.
PTS: 1
CON: Critical Thinking
30. ANS: 1 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 71 Heading: Implementation Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Critical Thinking Difficulty: Moderate Feedback 1 Documentation of interventions includes the resident’s response to the intervention. 2 The number of pills is not documented. 3 The number of residents needing the medication is not documented. 4 The resident’s location when the medication was given is not documented.
PTS: 1
CON: Critical Thinking
31. ANS: 3 Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 71 Heading: Implementation Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Critical Thinking Difficulty: Moderate Feedback 1 Physician’s progress notes do not need to be consulted when documenting care. 2 Medical-surgical textbooks do not need to be consulted when documenting care. 3 Results and trends from the flow sheets can be incorporated into the LPN’s regular progress charting. 4 The medication administration record does not need to be consulted when documenting
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
care.
PTS: 1
CON: Critical Thinking
MULTIPLE RESPONSE 32. ANS: 3, 4, 5 Feedback 1. The need for oxygen would be identified under equipment needs. 2. Skin integrity would be included under special needs. 3. Bathing would be provided under functional ability. 4. Feeding would be included under functional ability. 5 Transferring would be included under functional ability. Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 63 Heading: Assessment Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Assessment; Critical Thinking Difficulty: Moderate PTS: 1
CON: Assessment | Critical Thinking
33. ANS: 1, 2, 3, 4 Feedback 1. The admission assessment includes a nursing history. 2. The admission assessment includes a physical examination. 3. The admission assessment includes an interview with the older adult. 4. The admission assessment includes a review of laboratory values. 5 The previous facility’s nurse’s notes are not part of the admission assessment. Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 63 Heading: Assessment Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Assessment; Critical Thinking Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Assessment | Critical Thinking
34. ANS: 1, 2, 5 Feedback 1. The RAI includes the MDS. 2. The RAI includes the CAA. 3. The RAI does not include medication reconciliation forms. 4. The RAI does not include Medicare and Medicaid conditions of participation. 5 The RAI includes the RAI utilization guidelines. Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 64 Heading: Resident Assessment Instrument (RAI) Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Assessment; Critical Thinking Difficulty: Easy PTS: 1
CON: Assessment | Critical Thinking
35. ANS: 1, 2, 3, 4 Feedback 1. Falls are identified as a problem area from the MDS. 2. Delirium is identified as a problem area from the MDS. 3. Activities are identified as a problem area from the MDS. 4. Dental care is identified as a problem area from the MDS. 5 Arrhythmias are not identified as a problem area from the MDS. Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 2. Identify the use of the nursing process minimum data set (MDS) and care area assessments (CAAs) in developing nursing care plans for residents in nursing facilities. Chapter page reference: 65 Heading: Problem Areas Identified From the Minimum Data Set Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Assessment; Critical Thinking Difficulty: Easy PTS: 1
CON: Assessment | Critical Thinking
36. ANS: 1, 2, 3, 5 Feedback 1. The planning portion of the nursing process includes setting priorities.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2. 3. 4. 5
The planning portion of the nursing process includes identifying goals. The planning portion of the nursing process includes designing interventions. The evaluation phase of the nursing process includes evaluating outcomes of care. The planning portion of the nursing process includes identifying outcomes of care.
Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 67 Heading: Planning Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy PTS: 1
CON: Critical Thinking
37. ANS: 1, 3 1. 2. 3. 4. 5
Feedback Federal regulations require that each resident have a written, comprehensive, and interdisciplinary plan of care. A written plan of care is not required by states for nursing licensure. Standards of nursing practice require that each resident have a written, comprehensive, and interdisciplinary plan of care. A written plan of care is not required by the nursing home administrator. A written plan of care is not required by continuing education organizations.
Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 68 Heading: Designing and Documenting the Plan of Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy PTS: 1
CON: Critical Thinking
38. ANS: 1, 2, 4, 5 Feedback 1. The plan of care includes the problem or potential problem to be identified. 2. The plan of care includes the goals to be achieved. 3. The plan of care does not include the time the action is to occur. 4. The plan of care includes the actions or interventions to be taken to address the problem.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
5
The plan of care includes the person or discipline responsible for each action.
Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 68 Heading: Designing and Documenting the Plan of Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy PTS: 1
CON: Critical Thinking
39. ANS: 2, 4, 5 Feedback 1. Assigning CNAs to pass linen will not ensure that a plan of care will be followed. Giving each CNA written assignments with information on the plan of care ensures the 2. implementation of the plan of care. Scheduling CNAs to perform the same tasks will not ensure that a plan of care will be 3. followed. Meeting regularly with CNAs to discuss the plan of care ensures the implementation of the 4. plan of care. Using primary CNAs who care for the same residents each day ensures the implementation of 5 the plan of care. Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 70 Heading: Implementation Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Critical Thinking Difficulty: Medium PTS: 1
CON: Critical Thinking
40. ANS: 1, 2 1. 2. 3. 4. 5
Feedback The main purpose of evaluation is to decide if the resident has met the identified goals. The main purpose of evaluation is to assess the outcomes of the nursing care provided. The main purpose of evaluation is not to make the next day’s assignments. The main purpose of evaluation is not to ensure that the resident is charged for all care. The main purpose of evaluation is not to validate information to bill the insurance company.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 4: The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults Chapter/learning objective: 1. Describe the nursing process as a problem-solving technique in the context of assessment of the older adult, plan of care, nursing interventions, and nursing documentation. Chapter page reference: 71 Heading: Evaluation Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Critical Thinking Difficulty: Easy PTS: 1
CON: Critical Thinking
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1.
Which situation could cause an ethical/legal issue? 1) Allowing a resident to refuse care 2) Deciding whether to pass pills first or do a dressing change 3) Deciding whether to include the resident in planning care 4) Reporting a nursing assistant for not answering a resident’s call light
2.
Which situation could be a legal dilemma for nurses caring for older adults? 1) The resident requests not to be bathed. 2) The nurse passes the medications to all of the residents on time. 3) The resident signs out of the nursing facility and does not tell the staff where he or she is going. 4) The nurse gives the resident only half of the ordered dose of a medication because of side effects that the resident is experiencing.
3.
Which best describes ethics? 1) Legal aspects of health 2) Consequence evaluation 3) Values and moral concepts 4) Right and wrong behaviors
4.
Which is true about ethical decision making? 1) It is governed by the law. 2) It is beyond the legal scope of the practical nurse. 3) It is the use of personal values and beliefs to solve problems. 4) It is unnecessary if there are comprehensive physician orders.
5.
What is the Patient Care Partnership designed to do? 1) Protect the nurse from unfounded lawsuits. 2) Identify the individual’s ability to make decisions. 3) Support the choices of an individual who is able to read and write. 4) Protect the individual’s right to make informed choices relating to his or her health care.
6.
Which is true regarding laws governing health care and health-care delivery? 1) They are consistent with values systems. 2) They are fair and benefit most of the population. 3) They are man-made and capable of being changed. 4) They are developed with the rights of residents as the central theme.
7.
A licensed practical nurse (LPN) finds a resident unresponsive, calls for help, and instructs the staff to call 911 and bring emergency supplies while she sets up oxygen for the resident. What is this nurse guilty of doing? 1) The LPN should have called 911. 2) The LPN did not document the event. 3) The LPN functioned within the scope of practice. 4) The LPN should have requested a physician’s order for the oxygen.
8.
A non-intravenous (IV) certified LPN starts an IV infusion in a resident during an emergency situation. What is this nurse guilty of doing? 1) Doing someone else’s job 2) Adhering to the Nurse Practice Act 3) Being negligent because of not being IV-certified 4) Skipping resident consent for the IV insertion
9.
If a non-IV certified LPN starts an IV infusion what should the judge determine if this situation is reviewed in court? 1) Was the physician in attendance?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) 3) 4)
Who was responsible for the resident’s care? Did the resident give permission for the IV? Would another LPN do the same thing?
10. What does the failure to notify the physician or nursing supervisor when a resident’s heart rate decreases to less than 48 describe? 1) Libel 2) Omission 3) Negligence 4) Unprofessional behavior
11.
An 84-year-old patient experiencing severe cancer pain is restless and refuses pain medication. Which is an ethical approach to this problem? 1) Discuss with the patient feelings about the pain and the medication. 2) Call the family to ensure that the resident’s choice is in the living will. 3) Withhold the medication, because all residents have the right to refuse care. 4) Give the medication, because the resident’s decision may be related to delirium.
12. What is a positive result of a restraint-free environment? 1) Use of more medications 2) Fewer incidents of resident falls 3) Increased nursing assistant staffing 4) Development of more creative care strategies
13. What may an LPN be required to do when providing ethical nursing care? 1) Examine personal beliefs and values. 2) Practice outside of the facility’s policies and procedures. 3) Practice outside of the legal scope of practical nursing practice. 4) Compromise the rights of residents as outlined in the Patient Care Partnership.
14. What does NOT legally define the practice of the LPN? 1) Facility procedure outlines 2) The State Nurse Practice Act 3) Facility nursing care policies 4) Experience in providing nursing care
15. Which is an example of omission? 1) Forgetting to unclamp a catheter 2) Changing a resident’s diet to increase fiber 3) Refusing to sign off on a medication that was not given 4) Adjusting a dosage schedule of an antibiotic that the pharmacy delivered late
16. Why are other nurses often used as expert witnesses in lawsuits involving nurses? 1) They can review the usual job description of nurses. 2) They can learn about the Nurse Practice Act standards. 3) They can establish the definition of safe and prudent care. 4) They can validate the credentials of the nurse being charged.
17. What is the most important factor in successfully initiating a restraint-free environment? 1) Discussing safer methods of restraining residents 2) Educating the residents and families regarding restraint-free principles 3) Providing in-service training of nursing staff about restraint policies and procedures 4) Reviewing the Patient Care Partnership with the whole staff so that they understand the right of the resident to choose to be unrestrained
18. What does informed consent mean? 1) The resident has the right to refuse treatment. 2) The resident must sign a release statement before all treatments.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) 4)
The care personnel are exempt from any lawsuit if something goes wrong during a procedure. The resident has the right to know all of the information regarding procedures before consenting to treatment.
19. What is the role of the LPN when elder abuse is suspected? 1) Review the care of other residents. 2) Document and investigate the incident. 3) Report the incident to the local, county, or state authorities. 4) Discuss suspicions at the next interdisciplinary team meeting.
20. Who are the abusers in most cases of elder abuse? 1) Privately paid caregivers 2) Long-term care facility employees 3) Anyone who cares for an older adult 4) Family members who are living with the older adult
21. What is a major barrier to reporting of elder abuse? 1) Reporting involves too much paperwork. 2) It is not a felony to abuse a competent adult. 3) Elders are reluctant to report incidents of abuse. 4) Families of elderly abuse victims seldom believe that they are abusing the elder.
22. The wife of a married couple in a facility requests to be moved into a different room. How should the nurse respond to this request? 1) “Don’t you think your husband will miss you?” 2) “This must have been a difficult decision for you to make.” 3) “We will have to get your husband’s permission for you to move.” 4) “This is against the facility policy, which encourages couples to be in the same room.”
23. What statement best describes a resident’s rights for sexual expression? 1) The right to use touch to express sexual feelings. 2) The right to have access to opportunities for sexual expression. 3) The right to engage in sexual relationships with other residents. 4) The right to express sexual feelings in socially appropriate ways.
24. Which statement is NOT true about physical restraints? 1) They may include bed rails. 2) They restrict access to one’s body. 3) They can be removed by the resident. 4) They include anything attached to the individual that cannot be removed easily.
25. A certified nursing assistant (CNA) uses soft restraints to protect a resident from falling out of bed even though there was no order for their usage. On rounds several hours later, the resident is found not breathing, tangled, with her restraints around her neck. What is the responsibility of the LPN? 1) Guilty of omission 2) Guilty of negligence 3) Not at fault because of being unaware of the restraints being used 4) Not concerned because the resident has a do not resuscitate (DNR) order
26. A primary care provider orders short-term restraints for an elderly patient. Which is NOT a responsibility of the nurse regarding these restraints? 1) Remove the restraints periodically. 2) Assist with range-of-motion exercises. 3) Observe and care for the skin periodically. 4) Delay following the physician’s instructions and contact the interdisciplinary team (IDT).
27. Which law was specifically designed to protect and regulate patient privacy? 1) Patient Care Partnership 2) Patient Self-Determination Act 3) Omnibus Budget Reconciliation Act (OBRA)
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4)
Health Insurance Portability and Accountability Act (HIPAA)
28. What has research been unable to prove regarding the use of restraints? 1) Care based on the patient’s individual needs 2) A reduction in the person’s functional capacity 3) Injuries to the patient who tries to get free from the restraints 4) Problems with many body systems often resulting from immobility
29. The nurse lives in Erie, Pennsylvania, but sees home care patients in New York, Pennsylvania, and Ohio. Which state licensure requirements should the nurse follow? 1) Ohio 2) New York 3) Pennsylvania 4) All of the states
30. The nurse is concerned about an unsafe situation with a resident. With whom should the nurse discuss this situation first? 1) The CNAs 2) The physician 3) The charge nurse 4) The administrator
31. While making afternoon rounds the charge nurse sees a resident sitting in a geriatric chair with a tray. What should the nurse do? 1) Do nothing. 2) Remove the tray. 3) Assist with ambulation. 4) Transfer to another chair.
32. A resident of a nursing facility demonstrates occasional delirium. From whom should the nurse obtain consent for an invasive procedure? 1) The resident 2) The physician 3) Family attorney 4) Medical power of attorney
33. What is the primary objective of an advance directive? 1) Reduce the cost of care. 2) Restrict the utilization of resources. 3) Follow the resident’s wishes for care. 4) Calm the family’s fears and concerns.
34. What is the most extreme expression of ageism? 1) Negligence 2) Malpractice 3) Elder abuse 4) False imprisonment
35. During morning care an older male resident begins to masturbate. What should the CNA do? 1) Ignore the action and complete the bath. 2) Ask the resident to stop until the bath is over. 3) Leave the resident to complete the action in private. 4) Stand and wait for the resident to complete the action.
36. The nurse overhears several CNAs discussing a resident’s health problems in the lunch room. What should the nurse do? 1) Do nothing. 2) Participate in the discussion. 3) Listen to what they have to say. 4) Remind them that the information is confidential.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Multiple Response Identify one or more choices that best complete the statement or answer the question. 37. What information should the nurse expect to find within the Patient Care Partnership? Select all that apply. 1) Billing and collection policies 2) Access to health care and coverage 3) Acceptable nurse-resident staffing ratios 4) Intolerance of racial and ethnic disparities 5) Partnership with health-care decisions and delivery
38. Which actions should the nurse take when enforcing the Patient Self-Determination Act of 1990 with a newly admitted resident of a nursing facility? Select all that apply. 1) Ask if the resident has a living will. 2) Ask if the resident has advance directives. 3) Ask if the executor of the will has been identified. 4) Ask if the resident has a durable power of attorney. 5) Ask if the resident will sign the consent to treatment form.
39. The Director of Nursing is concerned that one staff nurse is at risk for liability issues when providing resident care. What did the director observe to make this decision? Select all that apply. 1) The nurse changed a medication dosage. 2) The nurse worked 32 hours over the last 2 days. 3) The nurse documented the status of a resident’s pressure ulcer. 4) The nurse did not have supplies to change a wound-vac draining system. 5) The nurse did not obtain consent before sending a resident for a surgical procedure.
40. The nurse is identifying tasks to delegate to CNAs. What should the nurse use as a guide when making these decisions? Select all that apply. 1) Age of the CNAs 2) Skill level of the CNAs 3) Experience of the CNAs 4) Certification of the CNAs 5) Shift the CNAs are working
41. What are the characteristics of a prudent, responsible nurse? Select all that apply. 1) Attends seminars 2) Thinks through actions 3) Applies for re-licensure 4) Reads nursing magazines 5) Carefully considers options
42.
What can be used in place of restraints to monitor residents who have a tendency to wander? Select all that apply. 1) Sitters hired to stay with the resident 2) Alarm doors 3) Bed alarm pads 4) Room door locks 5) Wristband alarms
43.
A resident is having a health-care proxy created. What should be included in this document? Select all that apply. 1) Use of feeding tubes 2) Types of medications 3) Plans for resuscitation 4) Location of will in the home 5) Desire for mechanical ventilation
44. Which parts of Medicare are associated with monthly premiums? Select all that apply. 1) A
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) 3) 4) 5)
B C D E
45. What should the nurse explain to a resident of a nursing facility about Medicaid? Select all that apply. 1) It includes acute care. 2) It includes long-term care. 3) It has a monthly premium. 4) It has substantial co-payments. 5) It is the largest payer for skilled care.
46. How did the Affordable Care Act (ACA) impact Medicare? Select all that apply. 1) Increased co-payments 2) Added deductibles for office visits 3) Included more preventive services 4) Reduced the cost of prescription drugs 5) Limited the number of skilled care days
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Answer Section MULTIPLE CHOICE 1.
ANS: 1 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 1. Compare and contrast the terms legal and ethical. Chapter page reference: 92 Heading: The Law Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Ethics; Legal Difficulty: Easy Feedback Refusal of care often goes against what we know as right or best for a resident, which would define it as ethical in 1 nature. However, according to the law the resident has the right to refuse care. 2 This is a nursing decision. 3 The nursing process is individualized for each person and provides a planned framework for providing care. 4 This could lead to a resident safety issue.
PTS: 2.
Ethics | Legal
1
CON:
Ethics | Legal
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 1. Compare and contrast the terms legal and ethical. Chapter page reference: 90 Heading: Ethics Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Ethics; Legal Difficulty: Easy Feedback 1 Legal aspects of health do not describe ethics. 2 Consequence evaluation does not describe ethics. 3 Ethics in nursing is the study of values and moral concepts as they relate to providing nursing care. 4 Right and wrong behaviors are defined by the laws governing nursing practice.
PTS: 4.
CON:
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 95 Heading: Acts of Negligence, Malpractice, and Omission Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Ethics; Legal Difficulty: Easy Feedback 1 The resident has the right to refuse care. 2 This is a nursing responsibility and no ethical issue is present. 3 This could be an ethical issue because the facility needs to be concerned with the safety of all residents. It is ethical to support a resident’s right to be free from side effects. Legally, however, the physician has ordered the 4 medication to be given.
PTS: 3.
1
1
CON:
Ethics | Legal
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 1. Compare and contrast the terms legal and ethical. Chapter page reference: 91
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Ethics Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Ethics; Legal Difficulty: Easy Feedback 1 Ethics are not governed by the law. 2 Ethics are not beyond the scope of the practical nurse. 3 Values and beliefs are used to influence ethical decision making. 4 Ethics are necessary, regardless of the presence of comprehensive physician orders.
PTS: 5.
Ethics | Legal
1
CON:
Ethics | Legal
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 1. Compare and contrast the terms legal and ethical. Chapter page reference: 91 Heading: The Law Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Legal Difficulty: Easy Feedback 1 Laws are not necessarily consistent with a person’s value system. 2 Laws are not always fair and beneficial to most of the population. The legal system is based on rules and regulations that guide society in a formal and binding manner. These regulations 3 are human-made rules capable of being changed by the legislative and judiciary systems of the United States. 4 Laws are not necessarily developed with the rights of residents as a central theme.
PTS: 7.
CON:
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 1. Compare and contrast the terms legal and ethical. Chapter page reference: 91 Heading: Patient Care Partnership Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Ethics; Legal Difficulty: Easy Feedback 1 The Patient Care Partnership was not designed to protect the nurse from lawsuits. 2 The Patient Care Partnership was not designed to identify an individual’s ability to make decisions. The Patient Care Partnership was not designed to support the choices of a literate individual; it was designed to protect 3 all individuals in health-care facilities. 4 The Patient Care Partnership supports informed choices for individual health.
PTS: 6.
1
1
CON:
Legal
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 94 Heading: Acts of Negligence, Malpractice, and Omission Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Legal Difficulty: Moderate Feedback 1 The LPN delegated the calling of 911 to a staff member, which was within the scope of practice. 2 It is unknown if the LPN did not document the event.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
PTS: 8.
CON:
Legal
1
CON:
Legal
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 94 Heading: Acts of Negligence, Malpractice, and Omission Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Legal Difficulty: Moderate Feedback 1 The judge is not investigating the physician’s actions. 2 The person responsible for the resident’s care is not an issue. The resident most likely signed a Consent to Treatment form on admission, which would cover the insertion of an IV 3 during an emergency situation. 4 In a court of law, a judge must assess this one issue—would another LPN do the same thing under the same circumstances? This is the measure of safe and prudent care. As long as the answer is always yes, the LPN’s actions are safe.
PTS: 10.
1
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 94 Heading: Acts of Negligence, Malpractice, and Omission Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Legal Difficulty: Moderate Feedback 1 Doing someone else’s job would not be illegal. 2 Starting an IV when not IV-certified is not adhering to the Nurse Practice Act. If an LPN starts an IV procedure, even in an emergency situation, and is not IV-certified, the law has been broken as 3 outlined in the Nurse Practice Act and the LPN is liable for this behavior even if there is a good outcome from the action. The resident’s signature on the Consent for Treatment form on admission to the facility most likely covered emergency 4 procedures.
PTS: 9.
The LPN functioned within the scope of practice, most likely followed facility guidelines, and delegated direction appropriately. It is unknown if the resident was provided with oxygen. The LPN was setting it up.
1
CON:
Legal
ANS: 2 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 95 Heading: Acts of Negligence, Malpractice, and Omission Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Legal Difficulty: Moderate Feedback 1 Libel does not relate to this situation. 2 Omission is not doing something that is ordered or normally expected as part of nursing care. 3 Negligence is not doing what another professional would do in a similar situation. 4 Unprofessional behavior does not relate to this situation.
PTS:
1
CON:
Legal
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
11.
ANS: 1 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 91 Heading: Ethics Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Ethics Difficulty: Moderate Feedback Ethically, before making a decision about the resident’s care, the nurse needs to assess the resident’s reasoning for the 1 choice to refuse medication. 2 Calling the family should not be done before discussing the decision with the resident. The choice to refuse medication could cause the resident more pain. The nurse needs to do something else besides 3 withholding the medication. 4 Giving the medication when the resident clearly refused is unethical and could be breaking the law.
PTS: 12.
Ethics
1
CON:
Safety
ANS: 1 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 1. Compare and contrast the terms legal and ethical. Chapter page reference: 91 Heading: Ethics Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Ethics Difficulty: Moderate Feedback 1 Ethics and ethical care require that the nurse explore values and beliefs that are self-important. 2 Ethical care is not practicing outside of the facility’s policies and procedures. 3 Ethical care is not practicing outside of the legal scope of practical nursing practice. 4 Ethical care is not compromising the rights of residents.
PTS: 14.
CON:
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 3. Define the guiding principles of a restraint-free environment. Chapter page reference: 96 Heading: Use of Restraints Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Safety Difficulty: Moderate Feedback 1 Use of more medications would mean that the environment might not be free of chemical restraints. 2 Evidence never did support that falls are prevented by restraints. 3 Needing more staff in restraint-free environments has not been proven. 4 Without the option of restraints, nurses are often more creative in their approaches to patient care.
PTS: 13.
1
1
CON:
Ethics
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 92 Heading: The Law Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Legal Difficulty: Easy Feedback 1 Facility procedure outlines legally define the practice of the LPN. 2 The State Nurse Practice Act legally defines the practice of the LPN. 3 Facility nursing care policies legally define the practice of the LPN. 4 Experience is not a legal justification for practice.
PTS: 15.
Legal
1
CON:
Legal
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 94 Heading: Acts of Negligence, Malpractice, and Omission Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Legal Difficulty: Easy Feedback 1 Job descriptions are guidelines that assist the expert witness in defining care. 2 The Nurse Practice Act is a guideline that assists the expert witness in defining care. 3 Nurses who are expert witnesses define safe and prudent care. 4 The nurse’s credentials are guidelines that assists the expert witness in defining care.
PTS: 17.
CON:
ANS: 1 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 95 Heading: Acts of Negligence, Malpractice, and Omission Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Legal Difficulty: Easy Feedback Omission is not doing something that is ordered or normally expected as part of nursing care, such as unclamping a 1 catheter. 2 Changing a resident’s diet to increase fiber is not an act of omission. 3 Refusing to sign off on a medication that was not given is not an act of omission. 4 Adjusting a dosage schedule of an antibiotic that the pharmacy delivered late is not an act of omission.
PTS: 16.
1
1
CON:
Legal
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 3. Define the guiding principles of a restraint-free environment. Chapter page reference: 96 Heading: Use of Restraints Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Legal; Safety Difficulty: Moderate Feedback Discussing safer methods of restraining residents is a component of initiating change but is less successful if the staff, 1 residents, and families do not understand the underlying philosophy of restraint-free environments. 2 Educating the residents and families regarding restraint-free principles is a component of initiating change but is less successful if the staff, residents, and families do not understand the underlying philosophy of restraint-free environments. 3 Providing in-service training of nursing staff about restraint policies and procedures is a component of initiating change
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
PTS: 18.
Legal | Safety
1
CON:
Legal | Safety
1
CON:
Violence | Legal | Safety
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 4. Outline the role of the licensed practical nurse (LPN) in using advanced directives and informed consent. Chapter page reference: 98 Heading: Elder Abuse Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Violence; Legal; Safety Difficulty: Easy Feedback 1 Privately paid caregivers are not the abusers in most cases of elder abuse. 2 Long-term care facility employees are not the abusers in most cases of elder abuse. 3 Anyone who cares for an older adult is the abuser in most cases of elder abuse. 4 Family members who are living with the older adult are not the abusers in most cases of elder abuse.
PTS: 21.
CON:
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 4. Outline the role of the licensed practical nurse (LPN) in using advanced directives and informed consent. Chapter page reference: 98 Heading: Elder Abuse Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Violence; Legal; Safety Difficulty: Easy Feedback 1 Reviewing the care of other residents may be required by the facility. 2 Documenting and investigating the incident may be required by the facility. 3 Elder abuse must be reported whenever it is suspected. 4 Discussing suspicions at the next interdisciplinary team meeting may be required by the facility.
PTS: 20.
1
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 4. Outline the role of the licensed practical nurse (LPN) in using advanced directives and informed consent. Chapter page reference: 96 Heading: Informed Consent Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Legal; Safety Difficulty: Easy Feedback 1 The resident’s right to refuse treatment is part of the Patient Care Partnership. 2 Signing a release before all treatments may be required by individual facilities. 3 Exempting personnel from lawsuits if something goes wrong during a procedure is not a part of informed consent. Informed consent implies that the resident has all of the information necessary to make informed decisions regarding his 4 or her care.
PTS: 19.
but is less successful if the staff, residents, and families do not understand the underlying philosophy of restraint-free environments. Education is important to support the staff’s understanding of the philosophy behind releasing restraints.
1
CON:
Violence | Legal | Safety
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 4. Outline the role of the licensed practical nurse (LPN) in using advanced directives and informed consent.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 98 Heading: Elder Abuse Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Violence; Legal; Safety Difficulty: Easy Feedback 1 This is not a reason why elder abuse is not reported. 2 It is a felony to abuse a competent adult. 3 Individuals are often unwilling or unable to report their abuse to the authorities or family members. 4 Families of elderly abuse victims are aware that their actions are inappropriate.
PTS: 22.
Violence | Legal | Safety
1
CON:
Sexuality
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 5. Express an understanding of the ethical responsibility of working with older adults in meeting their sexual needs. Chapter page reference: 100 Heading: Providing for Intimacy Needs Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback The right to use touch to express sexual feelings may be appropriate statements if the rights of all residents and 1 employees are considered. The right to have access to opportunities for sexual expression may be appropriate statements if the rights of all residents 2 and employees are considered. The right to engage in sexual relationships with other residents may be appropriate statements if the rights of all 3 residents and employees are considered. 4 Sexuality and sexual expression are appropriate if they do not infringe on the rights of others.
PTS: 24.
CON:
ANS: 2 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 5. Express an understanding of the ethical responsibility of working with older adults in meeting their sexual needs. Chapter page reference: 100 Heading: Providing for Intimacy Needs Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback 1 Asking if the husband will miss the wife is a prejudiced response. Recognizing that this was a difficult decision for the resident to make is the only one that acknowledges the resident’s 2 right to choose what she believes would be best for her care. 3 Asking the husband for permission is a prejudiced response. Saying that this is against facility policy does not acknowledge that situations could arise that would make it difficult for 4 them to room together.
PTS: 23.
1
1
CON:
Sexuality
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 3. Define the guiding principles of a restraint-free environment. Chapter page reference: 95 Heading: Use of Restraints Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Legal; Safety
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Easy Feedback 1 Physical restraints include leg restraints, hand mitts, bed rails, or soft ties. 2 They restrict free movement and restrict access to one’s body. 3 By definition, physical restraints cannot be removed easily by the resident. 4 They include anything attached to the body that cannot be easily removed by the person.
PTS: 25.
Legal | Safety
1
CON:
Legal | Safety
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 3. Define the guiding principles of a restraint-free environment. Chapter page reference: 95 Heading: Use of Restraints Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Legal; Safety Difficulty: Moderate Feedback 1 While the restraints are on the patient, the nurse must remove the restraints periodically. 2 While the restraints are on the patient, the nurse must assist with range-of-motion exercises. 3 While the restraints are on the patient, the nurse must monitor the patient closely and observe for skin irritations. The nurse cannot refuse to obey the physician’s orders. After placing the restraints on the patient as ordered, the nurse 4 may discuss the situation with the supervisor or IDT if he or she seriously disagrees with the physician’s assessment.
PTS: 27.
CON:
ANS: 2 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 3. Define the guiding principles of a restraint-free environment. Chapter page reference: 94 Heading: Acts of Negligence, Malpractice, and Omission Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Legal; Safety Difficulty: Moderate Feedback 1 Nothing was omitted in the care of the resident. 2 The LPN was negligent in not assessing the resident more frequently. The CNA was guilty of imprisoning a patient. 3 The LPN should have been aware of everything going on with an assigned resident. 4 A DNR order has nothing to do with this situation.
PTS: 26.
1
1
CON:
Legal | Safety
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 6. Explain the HIPAA law and the significance it has for your nursing practice. Chapter page reference: 100 Heading: Confidentiality Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Legal Difficulty: Easy Feedback 1 The Patient Care Partnership summarizes the rights of a patient, but is not specifically aimed at guarding privacy. The Patient Self-Determination Act requires that patients be asked if they have living wills, have given someone durable 2 power of attorney, or have advance directives in place. 3 OBRA monitors many aspects of care, including the use of restraints. HIPAA, enacted in April 2003, includes regulations specifically focused on patient privacy. It is a federal law binding in 4 all states.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 28.
PTS:
1
CON:
Legal | Safety
Feedback The nurse needs to adhere to the licensure requirements for New York and Pennsylvania in addition to Ohio. The nurse needs to adhere to the licensure requirements for Ohio and Pennsylvania in addition to New York. The nurse needs to adhere to the licensure requirements for Ohio and New York in addition to Pennsylvania. Nurse practice acts differ from state to state, so if practicing in more than one state, the nurse needs to know the differences.
1
CON:
Legal
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 93 Heading: The Law Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Application [Applying] Concept: Legal Difficulty: Moderate Feedback 1 The CNA is not a member of the chain of command. 2 The physician is not identified as being a member of the chain of command. If any situation is present that could cause a medical or nursing error the nurse needs to work through the chain of 3 command until the problem is solved. This means starting with the charge nurse. If the situation is not resolved, the nurse should see the nurse manager and then finally the administrator. The 4 administrator is not contacted first.
PTS: 31.
Legal
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 1. Compare and contrast the terms legal and ethical. Chapter page reference: 92 Heading: The Law Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Legal Difficulty: Moderate
1 2 3 4
30.
CON:
ANS: 1 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 3. Define the guiding principles of a restraint-free environment. Chapter page reference: 96 Heading: Use of Restraints Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Legal; Safety Difficulty: Easy Feedback 1 Restraints tend to depersonalize care and result in a paternalistic or controlling attitude toward the patient. 2 Restraints often reduce functional capacity. 3 Restraints can result in injuries when trying to get free of the restraint. 4 Restraints can cause problems with body systems because of immobility.
PTS: 29.
1
1
CON:
Legal
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 3. Define the guiding principles of a restraint-free environment. Chapter page reference: 95
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Use of Restraints Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Application [Applying] Concept: Legal Difficulty: Moderate Feedback 1 Anything restricting a person’s movement is considered a restraint. 2 Removing the tray is not sufficient. The geriatric chair is considered a restraint. 3 There is not enough information to determine if the resident is able to be ambulated. 4 The legal system considers the use of restraints, as well as the threat of using restraints, as unlawful imprisonment. Anything that restricts a person’s movement is considered a restraint. These items include wheelchairs with trays and geriatric chairs. The resident should be transferred to another chair.
PTS: 32.
Legal
1
CON:
Legal
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 4. Outline the role of the licensed practical nurse (LPN) in using advanced directives and informed consent. Chapter page reference: 97 Heading: Informed Consent and Advance Directives Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Knowledge [Remembering] Concept: Legal Difficulty: Easy Feedback 1 The primary objective of the advance directive is not to reduce the cost of care. 2 The primary objective of the advance directive is not to restrict the utilization of resources. 3 The primary objective of the advance directive is to follow the wishes of the person who wrote it. 4 The primary objective of the advance directive is not to calm the family’s fears and concerns.
PTS: 34.
CON:
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 4. Outline the role of the licensed practical nurse (LPN) in using advanced directives and informed consent. Chapter page reference: 97 Heading: Informed Consent and Advance Directives Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Application [Applying] Concept: Legal Difficulty: Moderate Feedback 1 The resident has occasional delirium and may not recall or remember information to obtain a legal consent. 2 The physician cannot sign a consent form for a resident’s procedure. 3 The family attorney cannot sign a consent form for a resident unless the attorney is the medical power of attorney. Some older adults have a medical power of attorney entrusted to a family member or friend. If so, that is the person who 4 should understand the procedure and sign the consent form.
PTS: 33.
1
1
CON:
Legal
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 4. Outline the role of the licensed practical nurse (LPN) in using advanced directives and informed consent. Chapter page reference: 98 Heading: Elder Abuse Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Knowledge [Remembering] Concept: Legal Difficulty: Easy Feedback 1 Negligence is not the most extreme expression of ageism.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
PTS: 35.
1
CON:
Legal
ANS: 3 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 5. Express an understanding of the ethical responsibility of working with older adults in meeting their sexual needs. Chapter page reference: 99 Heading: Providing for Intimacy Needs Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback 1 Ignoring the action and completing the bath does not provide for the resident’s privacy. 2 Asking the resident to stop the action implies that the action is inappropriate, which it is not. 3 Leaving the resident to complete the action in private is appropriate. Standing and waiting for the resident to complete the action is inappropriate and does not provide for the resident’s 4 privacy.
PTS: 36.
Malpractice is not the most extreme expression of ageism. Elder abuse is the most extreme and destructive form of ageism that can be demonstrated. False imprisonment, something that can occur with the use of restraints, is not the most extreme expression of ageism.
1
CON:
Sexuality
ANS: 4 Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 6. Explain the HIPAA law and the significance it has for your nursing practice. Chapter page reference: 100 Heading: Confidentiality Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Legal Difficulty: Moderate Feedback 1 Doing nothing promotes violations of the resident’s privacy. 2 Participating in the discussion promotes a violation of the resident’s privacy. 3 Listening to what they have to say promotes a violation of the resident’s privacy. 4 Reminding them that the information is confidential is adhering to the HIPAA law.
PTS:
1
CON:
Legal
MULTIPLE RESPONSE 37.
ANS: 1. 2. 3. 4. 5.
1, 2, 4, 5 Feedback The Patient Care Partnership document covers billing and collection policies. The Patient Care Partnership document stresses access to health care and coverage. The Patient Care Partnership document does not address staffing ratios. The Patient Care Partnership document is clear in not allowing racial or ethnic disparities. The Patient Care Partnership document defines the right of every person to be a partner in health-care decisions and delivery.
Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 1. Compare and contrast the terms legal and ethical. Chapter page reference: 91 Heading: Patient Care Partnership Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Legal Difficulty: Easy PTS:
1
CON:
Legal
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
38.
ANS: 1. 2. 3. 4. 5.
1, 2, 4 Feedback The Patient Self-Determination Act of 1990 requires asking people if they have living wills. The Patient Self-Determination Act of 1990 requires asking people if they have advance directives. The Patient Self-Determination Act of 1990 does not require asking people if they have an executor of their will identified. The Patient Self-Determination Act of 1990 requires asking people if they have a durable power of attorney. The Patient Self-Determination Act of 1990 does not require asking if the resident will sign the consent to treatment form.
Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 1. Compare and contrast the terms legal and ethical. Chapter page reference: 93 Heading: The Law Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Legal Difficulty: Moderate
39.
PTS:
1
ANS:
1, 2, 4, 5 Feedback The risk of liability increases when practicing beyond the scope of the Nurse Practice Act. The risk of liability increases when working when physically or emotionally exhausted. The risk of liability is not increased when documenting assessment findings. The risk of liability increases when not having the necessary equipment available to meet resident needs. The risk of liability increases when not following the policies and procedures of the facility.
1. 2. 3. 4. 5.
CON:
Legal
Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 93 Heading: Legal Liability Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Analysis [Analyzing] Concept: Legal; Safety Difficulty: Moderate
40.
PTS:
1
ANS:
2, 3, 4 Feedback Age of the CNAs is not information to consider when delegating. It is important to delegate only those tasks that an individual has the knowledge to perform. It is important to delegate only those tasks that an individual has the knowledge to perform. It is important to delegate only those tasks that an individual has the license or certification to perform. The shift that the CNAs are working is not information to consider when delegating.
1. 2. 3. 4. 5.
CON:
Legal |Safety
Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 93 Heading: Legal Liability Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Application [Applying] Concept: Legal; Safety Difficulty: Moderate
41.
PTS:
1
ANS:
1, 2, 4, 5 Feedback A prudent, responsible nurse is a professional who renews nursing knowledge by attending seminars and workshops. A prudent, responsible nurse is someone who is wise about his or her actions. Applying for re-licensure is not a characteristic of a prudent, responsible nurse. A prudent, responsible nurse is a professional who renews nursing knowledge by reading.
1. 2. 3. 4.
CON:
Legal |Safety
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
5.
A prudent, responsible nurse is someone who is careful about his or her actions.
Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 2. Define the term liability and discuss the impact it can have on your career. Chapter page reference: 94 Heading: Acts of Negligence, Malpractice, and Omission Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Comprehension [Understanding] Concept: Legal; Safety Difficulty: Easy
42.
PTS:
1
ANS:
2, 3, 5 Feedback Hiring sitters is not identified as a method to monitor residents who have a tendency to wander. There are numerous devices available to assist with the problem of resident wandering, including alarmed doors. There are numerous devices available to assist with the problem of resident wandering, including bed alarm pads. Locking the resident’s room door is a form of imprisonment and inappropriate for the resident who has a tendency to wander. There are numerous devices available to assist with the problem of resident wandering, including wristband alarms.
1. 2. 3. 4. 5.
CON:
Legal |Safety
Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 3. Define the guiding principles of a restraint-free environment. Chapter page reference: 96 Heading: Use of Restraints Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Comprehension [Understanding] Concept: Legal; Safety Difficulty: Easy
43.
PTS:
1
ANS:
1, 2, 3, 5 Feedback A health-care proxy is a written document prepared by a competent person giving permission for someone to make health decisions on his or her behalf under certain conditions. This document should include clear instructions about the patient’s wishes regarding feeding tubes. A health-care proxy is a written document prepared by a competent person giving permission for someone to make health decisions on his or her behalf under certain conditions. This document should include clear instructions about the patient’s wishes regarding medications. A health-care proxy is a written document prepared by a competent person giving permission for someone to make health decisions on his or her behalf under certain conditions. This document should include clear instructions about the patient’s wishes regarding resuscitation. A health-care proxy is a written document prepared by a competent person giving permission for someone to make health decisions on his or her behalf under certain conditions. It does not identify the location of the resident’s will in the home. A health-care proxy is a written document prepared by a competent person giving permission for someone to make health decisions on his or her behalf under certain conditions. This document should include clear instructions about the patient’s wishes regarding mechanical ventilation.
1.
2.
3.
4. 5
CON:
Legal |Safety
Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 4. Outline the role of the licensed practical nurse (LPN) in using advanced directives and informed consent. Chapter page reference: 97 Heading: Informed Consent and Advance Directives Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Legal Difficulty: Easy
44.
PTS:
1
ANS:
2, 3, 4 Feedback There are no premiums for Part A and coverage is automatic for anyone age 65 or older who is eligible for Social Security retirement benefits. Seniors may choose to join Part B and must pay monthly premiums to be enrolled.
1. 2.
CON:
Legal
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3.
Part C offers seniors a choice. If they wish, they can join a private health maintenance organization (HMO) or other managed care plan (called a Medicare Advantage plan) that replaces the other three parts. Many seniors have chosen to do this because they feel the Advantage plans offer better coverage at lower premiums. Those who wish to enroll in Part D must pay monthly premiums. Medicare does not have a Part E.
4. 5
Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 7. Compare and contrast Medicare and Medicaid. Chapter page reference: 101 Heading: Financial Considerations Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Economics Difficulty: Easy
45.
PTS:
1
ANS:
1, 2, 5 Feedback Medicaid includes acute care. Medicaid includes long-term care. Medicaid does not have a monthly premium. Medicaid does not have substantial co-payments. Medicaid is the largest payer for skilled care.
1. 2. 3. 4. 5
CON:
Economics
Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 7. Compare and contrast Medicare and Medicaid. Chapter page reference: 101 Heading: Financial Considerations Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Economics Difficulty: Moderate
46.
PTS:
1
ANS:
3, 4
CON:
Economics
Feedback Co-payments were not increased because of the ACA. Deductibles for office visits were not added because of the ACA. More preventive services were added with the ACA. The cost of prescription drugs was reduced with the ACA. The number of skilled care days was not limited because of the ACA.
1. 2. 3. 4. 5
Chapter number and title: Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults Chapter/learning objective: 7. Compare and contrast Medicare and Medicaid. Chapter page reference: 101 Heading: Financial Considerations Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Economics Difficulty: Easy PTS:
1
CON:
Economics
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 6: Promoting Wellness Multiple Choice Identify the choice that best completes the statement or answers the question. 1. What is the popular standard by which health is being defined for older people? 1) The maintenance of independence 2) The absence of debilitating diseases 3) The ability to pay for needed health service 4) The ability to participate in aerobic exercises
2. Which is NOT a goal when treating chronic diseases? 1) Symptom management 2) Prevention of disabling side effects 3) Maximizing the individual’s strengths 4) Focusing on curing the disease process
3. Arthritis is a chronic disease process that affects the health of many older people. What is the best description of health promotion for individuals with arthritis? 1) Activity restrictions to minimize joint pain 2) Pain management to enhance normal physical activity 3) Referral of the person to herbalists and massage therapists to seek potential disease cures 4) Use of walkers and wheelchairs early in the disease process so that the older person is better able to use these aids when he or she is totally debilitated
4. “One does not have to be free of disease to experience the benefits of wellness and the positive side of living.” What does this statement mean in relationship to the health of older people? 1) Illness is not a good excuse for being inactive. 2) People’s needs are important, even if they are ill. 3) A good attitude makes aging a positive learning experience. 4) Individuals do not have to limit their experience of health simply because they have an illness.
5. Society is becoming very focused on health promotion. Which purpose statement would most likely appeal to older people selecting a health-promotion program? 1) Focus on extension of life. 2) Focus on prevention of aging. 3) Focus on enhancing the quality of life. 4) Focus on prevention of chronic disease processes.
6. Which statement best describes the role of the gerontological nurse in developing treatment strategies for people experiencing a chronic disease process? 1) Administering ordered treatments to minimize debilitating symptoms
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Assessing elderly clients and identifying treatable causes of pain and discomfort 3) Setting goals for elderly clients that consider the individual and the chronic disease process 4) Evaluating the impact of the disease process and treatment on individuals and their functional abilities
7. What does compliance with a health-promotion program for an elderly person depend on? 1) The older person’s motivation 2) The time of day that the activity takes place 3) The older person’s recognition of a health problem 4) The disabling characteristics of the older person’s disease process
8. What percentage of people older than 65 years reside in nursing homes? 1) 3% 2) 5% 3) 10% 4) 15%
9. Which is NOT an environmental factor that affects the nutritional habits of older people? 1) Food storage 2) Transportation 3) Readability of food labels 4) Lack of nutritional knowledge
10. Which program is designed to meet the nutritional and social needs of older people? 1) Food stamps 2) Meals on Wheels 3) Senior center–based meal programs 4) U.S. Department of Agriculture (USDA) commodities
11. Which is an appropriate exercise program goal for a frail older adult? 1) Prevent pressure ulcers. 2) Regain strength to ambulate. 3) Maintain and increase functional ability. 4) Increase strength for transfers and physical stamina.
12. What does aerobic exercise strengthen or increase? 1) Strength 2) Flexibility 3) Endurance 4) Relaxation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
13. Why is slow and gradual stretching of muscles important? 1) Increases muscle endurance 2) Reduces the risk of muscle injury 3) Is not part of a usual exercise program 4) Increases the strength and the bulk of muscles
14. What is reduced by improving stress-management skills for older adults? 1) Functional disability 2) Many of the losses related to aging 3) The occurrence of stress-related events 4) Worsening of stress-related disease processes
15. What should the nurse keep in mind when asking an older adult to keep a stress log or journal? 1) It can be too stressful for older adults. 2) It is usually an effective stress-management technique. 3) It is difficult because of the long-term nature of most stress for older adults. 4) It helps older adults recognize the stressful events in their lives and their responses to stress.
16. Which should NOT be suggested to a patient as a quick relaxer to promote sleep? 1) Imagery 2) Life review 3) Roll breathing 4) Progressive muscle relaxation
17. A 78-year-old patient having difficulty driving has been allowing his grandchildren to use his car if they agree to drive him to the senior center, grocery store, and other activities. The patient is upset because the grandchildren have not washed the interior or exterior of the car since they started using it and have been late to pick up the patient 4 days in a row. Which is a long-term stress-management skill that may help the patient deal with this stress? 1) Walk to the senior center to get physical exercise. 2) Use roll breathing when the grandchildren are late. 3) Take the car back to reduce the worry about the car. 4) Alter the stressor; establish rules for continued use of the car.
18. What should the nurse keep in mind about alcohol or drug abuse in an older adult? 1) It is a serious social problem. 2) Symptoms are easily recognizable. 3) It negatively affects functional ability. 4) It is less dangerous and more socially acceptable.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
19. What is the most common health problem of older adults? 1) Acute disease 2) Chronic disease 3) Medication management 4) Repeated hospitalizations
20. What is one of the commonly occurring changes in the aging body that directly affects nutrition? 1) Most elderly people have dentures. 2) Most elderly people live under the poverty level and cannot afford nutritious food. 3) There is no one left to eat with because of death of spouse or children leaving home. 4) The body’s rate of metabolism slows and the body no longer needs the same amount of food to do the same amount of work.
21. What do health promotion activities emphasize? 1) Exercise 2) Weight loss 3) Illness management 4) Wellness management
22. How should the nurse explain motivation to a group of nursing assistants? 1) It is the same for everyone. 2) It is being forced to make a change. 3) It is usually caused by something external. 4) It is the incentive or drive to make a change.
23. What number of chronic diseases do 50% of older people over the age of 60 have? 1) One 2) Two 3) Four 4) Eight
24. A group of senior citizens enjoy attending daily swimming lessons but complain that the instructor does not talk loud enough. What is the issue with the design of this health-promotion activity? 1) It is not accessible. 2) It is not reasonable. 3) It is not enjoyable and social. 4) It is not sensitive to the needs of the older adult.
25. What strategies should the nurse emphasize to prevent osteoporosis in an older adult? 1) Take insulin 2) Add calcium to the diet, exercise, and avoid alcohol 3) Add calcium to the diet, avoid smoking, and take aspirin
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Add calcium to the diet, take insulin, and decrease fat intake
26. An 80-year-old patient is unable to leave the house but has good mobility in the home. What should the visiting nurse teach this patient to increase exercise? 1) Do deep knee bends. 2) Do 15 push-ups two times a day. 3) Do a range of motion with a can of soup. 4) Do nothing because the patient is 80 years old.
27. Which is considered to be a part of the normal aging process? 1) Obesity 2) Diabetes 3) Osteoporosis 4) Loss of muscle elasticity and thickening of tissue around joints
28. Twice a day an older patient sits in a favorite chair, closes his eyes, takes two deep breaths, and imagines being on the beach in Hawaii. What is occurring with this patient? 1) Exercising 2) Suffering from dementia 3) Decreasing his stress with a quick relaxer 4) Developing a long-term method to reduce stress
29. The nurse is planning care for an older person experiencing expected body changes associated with aging. What should the nurse identify as an appropriate goal for this patient? 1) Improve physical endurance. 2) Avoid the onset of chronic illnesses. 3) Implement actions to reverse the aging process. 4) Achieve harmony between the body, mind, and spirit.
30. A newly hired community nurse is identifying health-promotion activities available for aging members of the neighborhood. What action should the nurse take to learn what is currently available for these community members? 1) Count the number of older community members who have a disability. 2) Survey the community members to find out what activities they prefer. 3) Go to the community center to find out what activities are designed for older people. 4) Plan an afternoon hike and note the number of older community members who participate.
31. During a home visit, the nurse learns that an older patient recovering from total knee replacement surgery has not been performing daily exercises as prescribed. What action should the nurse take first? 1) Cancel the physical therapy sessions. 2) Reinforce the safe use of the walker for ambulation. 3) Find out why the patient is not motivated to do the exercises.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Document that the patient is noncompliant with the prescribed medical plan. 32. During a focused interview, the nurse learns that an older person likes to walk but doesn’t do it regularly because she finds the activity lonely and boring. What should the nurse suggest to this patient? 1) “Listen to a book on tape while you walk.” 2) “Consider walking with the Mall Walkers.” 3) “Do it anyway because it is good for your health.” 4) “Wear ear buds and listen to music while you walk.”
33. An older patient who used to bowl but has not been able to do so because of arthritis in the shoulder and elbow misses playing with others and socializing. What should the nurse suggest to support this patient’s interest and encourage socialization? 1) Join the library sewing circle. 2) Learn to play shuffle board instead. 3) Find out if a computer bowling game can be installed in the community center. 4) Participate with the group that takes bird-watching walks once a week in the summer.
34. An older patient wants to grocery shop, do laundry, cook, and perform routine household chores. Which function should the nurse identify as being a priority for this patient? 1) Relaxation 2) Amusement 3) Socialization 4) Independence
35. An older person likes to swim but will not use the pool in the local gymnasium. What information should help the nurse understand why the person will not engage in this activity? 1) The pool is open from 6:00 am to midnight. 2) There are always children and young adults in the pool. 3) The pool has lifeguards seated on each side of the pool. 4) The pool is heated and has showers and lockers for use.
36. The nurse observes an older person order an extra value meal in a fast food restaurant and wrap half of the meal in a napkin to take home. What might this behavior suggest to the nurse? 1) The older person does not like to waste food. 2) The older person is going to feed a pet with the leftovers. 3) The older person didn’t want to throw the food out in the restaurant. 4) The older person has limited income and the extra value meal provides food for later.
37. The nurse notes that activities planned for a community day are limited for older people or those with physical limitations. Which activity should the nurse suggest be added to engage the older adults in physical activity? 1) Tennis
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Volleyball 3) Nature walk 4) Chair aerobics
38. During a routine health visit, an older patient states that he has never had a tetanus booster vaccination. What should the nurse instruct this patient about this immunization? 1) It has to be obtained every 5 years. 2) It should be obtained every 10 years. 3) It is something to think about getting in the years ahead. 4) It should be obtained yearly with the influenza vaccination.
39. The nurse notes that an older patient has been losing weight despite having dentures and adequate financial resources to purchase food. What should the nurse ask the patient to gain more information? 1) “Are you having problems swallowing? 2) “When was your last dental examination?” 3) “How often do you clean your dentures?” 4) “Are you having problems with cooking?”
40. An older person says that he sees no reason to have medical treatment for arthritis. What should the nurse respond to this statement? 1) “A doctor can help you cure the arthritis.” 2) “Medical care can help you manage the disorder.” 3) “It’s important to see a doctor to make sure it isn’t spreading.” 4) “There is no cure for the disease, so in many ways you are right.”
41. During an assessment, the nurse notes that an older person has +2 pitting edema of both feet and ankles. Which information should the nurse use to help determine the reason for this patient’s fluid retention? 1) Adding extra salt to all foods 2) Sipping on water throughout the day 3) Drinking 8 ounces of water with all medication doses 4) Having 2 cups of hot tea in the evening after dinner
42. An older patient asks what can be done to reduce the feelings of fatigue during the day. What should the nurse suggest to this patient? 1) Take a walk. 2) Sleep an hour longer each night. 3) Take frequent naps during the day. 4) Spend more time outside in the sun.
Multiple Response Identify one or more choices that best complete the statement or answer the question.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
43. What should wellness activities for an older adult include? Select all that apply. 1) Exercise 2) Self-care 3) Finances 4) Nutrition 5) Relationships
44. What would be incentives for a 79-year-old man with severe arthritis in the knees to attend biweekly aerobics class? Select all that apply. 1) Having fun 2) Preventing growing old 3) Helping to stay healthy 4) Preventing chronic diseases 5) Enjoying being with other people
45. What can inactivity cause? Select all that apply. 1) Diabetes 2) Weak bones 3) Heart disease 4) Muscle wasting 5) Poor circulation
46. An older patient on medication for hypertension, arrhythmias, and glaucoma takes over-the-counter medications for allergy symptoms and pain relief. Recently, the patient has had difficulty sleeping and has one to two glasses of wine nightly to help with relaxation. What is this patient at risk for experiencing? Select all that apply. 1) Sleep apnea 2) Joint stiffness 3) Increased falls 4) Increased depression 5) A toxic or lethal drug interaction
47. The nurse is preparing a seminar on healthy aging for a group of community members. What should the nurse include as contributing to longer lives for older people? Select all that apply. 1) Food preservatives 2) Targeted treatments 3) Advances in surgery 4) Improved medications 5) Technology for diagnosis
48. The nurse determines that a 68-year-old patient is experiencing normal changes associated with aging. What assessment findings did the nurse use to come to this conclusion? Select all that apply. 1) +1 bilateral ankle edema
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) 3) 4) 5)
New onset of right knee stiffness Weight increase of 3 lb over 6 months Difficulty hearing high pitched tones Need to start wearing reading glasses
49. At the conclusion of a physical assessment the nurse determines that an older patient is experiencing the most chronic conditions of an older person. What did the nurse assess to come to this conclusion? Select all that apply. 1) Hard of hearing 2) Heart rate 72 and irregular 3) Blood pressure 168/90 mm Hg 4) Bilateral hip and knee pain with movement 5) Skin tags over upper extremities and the back
50. The nurse determines that an older patient is experiencing environmental stress. What information did the nurse obtain to make this clinical determination? Select all that apply. 1) Woke up four times during the night 2) Road construction blocking routine driving routes 3) Living alone after the death of the patient’s spouse 4) Snow and ice on the sidewalks and steps leading to the house 5) Having to wait for an adult daughter to pick the patient up for a doctor’s appointment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 6: Promoting Wellness Answer Section MULTIPLE CHOICE 1. ANS: 1 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 1. Recognize aging as a normal process of living rather than a disease process. Chapter page reference: 107 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Promoting Health Difficulty: Easy Feedback 1 The maintenance of independence in self-care is the best answer. 2 Throughout the chapter and in related readings and references, the definition of health is referred to as more than just the absence of disease. 3 Financial security can positively affect one’s ability to access health-promotion services, but it is not a discriminating factor for defining health. 4 This addresses only one aspect of health promotion and is not a standard that measures health.
PTS: 1
CON: Nursing | Promoting Health
2. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 109 Heading: Chronic Disease Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing; Promoting Health Difficulty: Easy Feedback 1 Treatment of chronic disease includes symptom management. 2 Treatment of chronic disease includes prevention of disabling side effects. 3 Treatment of chronic disease includes maximizing the individual’s strengths. 4 Chronic diseases cannot be cured, but are managed for symptom control, prevention of side effects, and promotion of the highest level of self-care and function.
PTS: 1 3. ANS: 2
CON: Nursing | Promoting Health
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 111 Heading: Chronic Disease Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Mobility; Nursing; Promoting Health Difficulty: Easy Feedback 1 Activity restrictions to minimize joint pain would have a negative effect on self-care and self-esteem. 2 Maintaining physical activity has the positive effect of increasing bone mass, promoting muscle tone, preventing disability, promoting independence, and fostering emotional health. 3 The use of alternatives to medical care often has a positive effect on the symptoms of chronic diseases, but these alternatives would not cure the person of the chronic disease. 4 Using walkers and wheelchairs early in the disease process would have a negative effect on self-care and self-esteem.
PTS: 1
CON: Mobility | Nursing | Promoting Health
4. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 1. Recognize aging as a normal process of living rather than a disease process. Chapter page reference: 107 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Promoting Health Difficulty: Moderate Feedback 1 Illness is not a good excuse for being inactive may be true, however, it does not explain the intention for older people. 2 People’s needs are important, even if they are ill may be true, however, it does not explain the intention for older people. 3 A good attitude makes aging a positive learning experience may be true, however, it does not explain the intention for older people. 4 Health and health promotion can address the vitality and independence of older people, even if they have a chronic disease. The experience of health is not reserved for only persons who do not have an illness.
PTS: 1 5. ANS: 3
CON: Nursing | Promoting Health
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 109 Heading: Health-Promotion Activities Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Promoting Health Difficulty: Easy Feedback 1 Focusing on extension of life is a youth-based purpose for health promotion. 2 Focusing on the prevention of aging is a youth-based purpose for health promotion. 3 Programs designed for the purpose of enhancing one’s life would be the most appealing. 4 Focusing on prevention of chronic disease processes is a youth-based purpose for health promotion.
PTS: 1
CON: Nursing | Promoting Health
6. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 111 Heading: Treatment Strategies Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Promoting Health Difficulty: Easy Feedback 1 Administering ordered treatments to minimize debilitating symptoms addresses parts of the nurse’s responsibilities but does not consider the individuality of the older person. 2 Assessing elderly clients and identifying treatable causes of pain and discomfort addresses parts of the nurse’s responsibilities but does not consider the individuality of the older person. 3 Setting goals for elderly clients that consider the individual and the chronic disease process addresses parts of the nurse’s responsibilities but does not consider the individuality of the older person. 4 The gerontological nurse must constantly question and evaluate nursing care. Does the nursing care build on the older person’s strengths or does it foster dependency?
PTS: 1
CON: Nursing | Promoting Health
7. ANS: 1 Chapter number and title: Chapter 6: Promoting Wellness
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 4. Examine the importance motivation plays in an older person’s ability to participate in health-promotion and disease-prevention activities. Chapter page reference: 108 Heading: Motivation Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nursing; Promoting Health Difficulty: Easy Feedback 1 Motivation is the driving force behind compliance with any prescribed or individually developed health-promotion program. 2 An elderly patient often cites time of day as an obstacle to following through with a health-promotion activity. 3 Simple recognition of a problem does not provide incentive or motivation to participate in a health-promotion program. 4 An elderly patient often cites illness as an obstacle to following through with a healthpromotion activity.
PTS: 1
CON: Nursing | Promoting Health
8. ANS: 2 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 1. Recognize aging as a normal process of living rather than a disease process. Chapter page reference: 106 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Remembering [Knowledge] Concept: Nursing Difficulty: Easy Feedback 1 More than 3% of people age 65 or older reside in nursing homes. 2 Only 5% of people 65 years old or older reside in nursing homes. 3 Less than 10% of people age 65 or older reside in nursing homes. 4 Less than 15% of people age 65 or older reside in nursing homes.
PTS: 1
CON: Nursing
9. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 112 Heading: Nutrition Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Remembering [Knowledge]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Nutrition Difficulty: Easy Feedback 1 Food storage is an environmental factor that can affect an older person’s nutritional habits. 2 Transportation is an environmental factor that can affect an older person’s nutritional habits. 3 Readability of food labels is an environmental factor that can affect an older person’s nutritional habits. 4 Lack of nutritional knowledge is a personal barrier that affects nutrition.
PTS: 1
CON: Nutrition
10. ANS: 3 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 112 Heading: Nutrition Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Nutrition Difficulty: Easy Feedback 1 The food stamps program is state and federally funded. It provides food vouchers for low-income people of all ages. 2 Meals on Wheels delivers meals to older adults, but does not provide social contact. 3 Senior centers across the United States provide activities for older adults, and most serve a meal once a day during the week while groups of seniors are at the centers. 4 The USDA distributes food commodities, such as butter and cheese, to older adults and low-income families, but does not provide social contact.
PTS: 1
CON: Nutrition
11. ANS: 3 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 113 Heading: Exercise and Fitness Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Mobility Difficulty: Moderate Feedback 1 This assumes that the older adult is bedbound.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
This assumes that the older adult is unable to ambulate. Activities that assist older adults in preserving their ability to function independently would be appropriate for frail older adults. Increased strength for transfers and physical stamina may be appropriate but does not address the necessity of relating strength and stamina to function.
PTS: 1
CON: Mobility
12. ANS: 3 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 115 Heading: Endurance Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Mobility Difficulty: Easy Feedback 1 Strengthening requires movement against resistance. 2 Flexibility requires stretching. 3 Aerobic exercise increases endurance through improving the functions of the heart, lungs, and blood vessels. 4 Relaxation uses deep or rhythmic breathing to relax muscles and relieve stress.
PTS: 1
CON: Mobility
13. ANS: 2 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 114 Heading: Flexibility Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Mobility Difficulty: Easy Feedback 1 Stretching muscles increases functional range of motion, but does not increase muscle endurance. 2 Stretching of all muscle groups increases flexibility and range of motion and assists in preventing muscle injury. 3 Stretching is viewed as an important part of all exercise programs. 4 Stretching muscles increases functional range of motion, but does not increase muscle strength.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Mobility
14. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 116 Heading: Stress Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Stress Difficulty: Easy Feedback 1 Older people can be immobilized by stress but the functional disability is usually associated with a stress-related disease process. 2 Stress-management techniques do not reduce the amount of stress related to aging. 3 Stress-management techniques do not reduce the occurrence of stress-related events. 4 Stress is related to worsening of many disease processes.
PTS: 1
CON: Stress
15. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 116 Heading: Stress Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1 Stress logs assist with increasing an older adult’s awareness of stress. 2 Keeping a stress log is not a stress-management technique. 3 Older adults have the potential to identify and adjust effectively to stressors in their lives. 4 A log or journal is one way to assist older adults in identifying stress in their lives.
PTS: 1
CON: Stress
16. ANS: 2 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 116 Heading: Stress Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1 Imagery is a stress-management strategy that enhances relaxation and promotes sleep. 2 Life review is a structured and time-consuming exercise. Life review often produces stress. 3 Roll breathing is a stress-management strategy that enhances relaxation and promotes sleep. 4 Progressive muscle relaxation is a stress-management strategy that enhances relaxation and promotes sleep.
PTS: 1
CON: Stress
17. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 116 Heading: Stress Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1 Exercise is a good stress reliever and the patient would not have to deal with the worry and stress related to the condition of his car and his lack of transportation, however, this is not appropriate for the patient’s health status. 2 Roll breathing is a good stress-management strategy, but it is a quick technique and does not change the stressor. 3 Taking the car back would cause stress of being unable to go to the senior center and shopping. 4 Altering the stressor by making rules for the car use would change the stress at its source.
PTS: 1
CON: Stress
18. ANS: 3 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 117 Heading: Alcohol, Drugs, and Aging
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Addiction Difficulty: Easy Feedback 1 The negative physical effects of alcohol and drugs can increase potential for injury and disability. 2 Alcoholism and drug abuse are often missed in reviewing the problems of older adults. 3 Alcohol and drug abuse are serious problems for many older adults. The physical effects and social isolation associated with alcohol and drug abuse are serious threats to the functional independence of older adults. 4 Alcohol or drug abuse are not socially accepted, but rather are socially ignored.
PTS: 1
CON: Addiction
19. ANS: 2 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 110 Heading: Chronic Disease Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing Difficulty: Easy Feedback 1 Acute diseases are not the most common problem for older adults. 2 The most common health problem in older adults is chronic diseases. 3 Medication management is not a health problem. 4 Repeated hospitalizations are not a health problem.
PTS: 1
CON: Nursing
20. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 112 Heading: Nutrition Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nutrition Difficulty: Easy Feedback 1 More and more elderly people have their own teeth because of modern dentistry
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
techniques. This is not a commonly occurring change in the aging body. This is not a commonly occurring change in the aging body. With aging the metabolism rate slows.
PTS: 1
CON: Nutrition
21. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 109 Heading: Health-Promotion Activities Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 Exercise may be a component of wellness management. 2 Weight loss may be a component of wellness management. 3 Traditional medicine focuses on the illness end of a continuum. 4 Health promotion focuses on wellness management.
PTS: 1
CON: Promoting Health
22. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 4. Examine the importance motivation plays in an older person’s ability to participate in health-promotion and disease-prevention activities. Chapter page reference: 108 Heading: Motivation Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Motivation is different for everyone. 2 Motivation is not being forced to make a change. 3 Motivation can be caused by internal or external factors. 4 Motivation is an individualized desire to make a change.
PTS: 1 23. ANS: 2
CON: Promoting Health
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 110 Heading: Chronic Disease Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing Difficulty: Easy Feedback 1 50% of older people over the age of 60 have more than one chronic disease. 2 50% of older people over the age of 60 have two chronic diseases. 3 50% of older people over the age of 60 do not have four chronic diseases. 4 50% of older people over the age of 60 do not have eight chronic diseases.
PTS: 1
CON: Nursing
24. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 110 Heading: Health-Promotion Activities Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Promoting Health Difficulty: Moderate Feedback 1 The program is accessible because the senior citizens attend it every day. 2 It is reasonable because it is the right activity for the correct reason. 3 It is enjoyable and social because the people attend together 4 It is not sensitive to the hearing issues of the older adult.
PTS: 1
CON: Promoting Health
25. ANS: 2 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 112 Heading: Nutrition Integrated Processes: Nursing Process: Implementation; Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Feedback Taking insulin is for people with diabetes, with a physician’s orders only. Adding calcium to the diet, exercising, and avoiding alcohol are key strategies to prevent osteoporosis. Taking aspirin has no impact on the development of osteoporosis. Decreasing fat intake has no impact on the development of osteoporosis.
PTS: 1
CON: Promoting Health | Nursing Roles
26. ANS: 3 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 114 Heading: Exercise and Fitness Integrated Processes: Nursing Process: Implementation; Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 Deep knee bends may be a little aggressive for an older adult who is home alone. 2 Push-ups may be a little aggressive for an older adult who is home alone. 3 Simple exercises with a small can assist an older adult in strength building. 4 Exercise, when appropriately planned, can be done with all ages—regardless of circumstances.
PTS: 1
CON: Promoting Health | Nursing Roles
27. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 114 Heading: Flexibility Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Mobility; Promoting Health; Nursing Difficulty: Easy Feedback 1 Obesity is not part of the normal aging process. 2 Diabetes is not part of the normal aging process. 3 Osteoporosis is not part of the normal aging process. 4 Loss of muscle elasticity and thickening of tissue around joints are a part of the normal aging process.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Mobility | Promoting Health | Nursing
28. ANS: 3 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 116 Heading: Stress Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Stress; Promoting Health Difficulty: Moderate Feedback 1 This action is not exercise. 2 The patient does not have dementia. 3 Imagining a pleasant place or situation is a quick technique to relax and counteract distress. 4 This tool is not for long-term stress management.
PTS: 1
CON: Stress | Promoting Health
29. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 1. Recognize aging as a normal process of living rather than a disease process. Chapter page reference: 107 Heading: Introduction Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health; Nursing Difficulty: Moderate Feedback 1 The objective is not to run a marathon. 2 The objective is not to never experience illness. 3 The fountain of youth does not exist. 4 Harmony between the body, mind, and spirit can occur if individuals strive for gerotranscendence as they age. When aging individuals achieve this developmental stage, they are able to accept the naturally occurring losses of the aging experience.
PTS: 1
CON: Promoting Health | Nursing
30. ANS: 3 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 1. Recognize aging as a normal process of living rather than a disease process. Chapter page reference: 107 Heading: Priority Setting 6.1
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health; Nursing Difficulty: Moderate Feedback 1 Counting the number of older community members with a disability will not help the nurse learn what health-promotion activities are currently available for aging community members. 2 Surveying the community members to find out what activities they prefer will not help the nurse learn what health-promotion activities are currently available for aging community members. 3 The nurse should visit the local senior citizens’ center and become familiar with what they offer. The center can refer the nurse to other organizations that assist elderly people to be healthy. 4 Planning an afternoon hike and noting the number of older community members who participate will not help the nurse learn what health-promotion activities are currently available for aging community members.
PTS: 1
CON: Promoting Health | Nursing
31. ANS: 3 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 4. Examine the importance motivation plays in an older person’s ability to participate in health-promotion and disease-prevention activities. Chapter page reference: 109 Heading: Motivation Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health; Nursing Difficulty: Moderate Feedback 1 2 3 4
It is premature to cancel the patient’s physical therapy sessions. Reinforcing the safe use of a walker is a nursing action for safety, however, it does not help identify why the patient does not want to do the exercises. The nursing challenge is to assist older adults in identifying their own incentives for participation in health-promotion and disease-prevention activities. The nurse needs to find out why the patient is noncompliant and not just document this as a finding.
PTS: 1
CON: Promoting Health | Nursing
32. ANS: 2 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 4. Examine the importance motivation plays in an older person’s ability to participate in health-promotion and disease-prevention activities.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 109 Heading: Incentives Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Listening to a book on tape will not remove the feelings of loneliness and boredom. 2 The patient finds walking alone lonesome and boring. The nurse should suggest that the patient walk with the Mall Walkers to help with socialization. 3 The patient needs to be motivated beyond walking as being good for health. 4 Listening to music will not help remove the feelings of loneliness and boredom.
PTS: 1
CON: Promoting Health
33. ANS: 3 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 4. Examine the importance motivation plays in an older person’s ability to participate in health-promotion and disease-prevention activities. Chapter page reference: 109 Heading: Incentives Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Sewing is not a physical activity. 2 Shuffle board has not been identified as a sport that the patient likes to perform. 3 There are computer games that simulate sports. Finding out if this game can be installed in the community center would support the patient’s need for participating in a sport that she loves while encouraging the socialization of bowling with other people. 4 Bird watching is not an activity that the patient identified as something of interest.
PTS: 1
CON: Promoting Health
34. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 4. Examine the importance motivation plays in an older person’s ability to participate in health-promotion and disease-prevention activities. Chapter page reference: 109 Heading: Incentives Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Promoting Health Difficulty: Moderate
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Feedback Shopping, laundry, cooking, and household chores would not be relaxing. Shopping, laundry, cooking, and household chores would not be done for amusement. Shopping, laundry, cooking, and household chores are usually done as solo activities and not in a group for socialization. The patient is identifying activities that support independent living.
PTS: 1
CON: Promoting Health
35. ANS: 2 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 109 Heading: Health-Promotion Activities Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Promoting Health Difficulty: Moderate Feedback 1 The pool’s hours of operation should not be an issue. 2 The emphasis on young and healthy-appearing people might be intimidating to the older person. 3 Lifeguards would be a safety feature. 4 Heated water and shower and locker facilities would be positive features.
PTS: 1
CON: Promoting Health
36. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 109 Heading: Health-Promotion Activities Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Promoting Health Difficulty: Moderate Feedback 1 It is unlikely that the older person is going to waste the food. 2 It is unlikely that the older person is going to feed a pet with the fast food obtained. 3 It is unlikely that the older person is concerned about throwing food away in the restaurant. 4 Self-responsibility for health might be limited based on personal circumstances. By ordering the extra value meal the person is getting more food for less money. The extra
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
food can be saved for later.
PTS: 1
CON: Promoting Health
37. ANS: 4 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 109 Heading: Health-Promotion Activities Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Mobility; Promoting Health Difficulty: Moderate Feedback 1 Tennis would not be appropriate for older people with physical limitations. 2 Volleyball would not be appropriate for older people with physical limitations. 3 A nature walk would not be appropriate for older people with physical limitations. 4 Chair aerobics would be appropriate for older people with physical limitations.
PTS: 1
CON: Mobility | Promoting Health
38. ANS: 2 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 110 Heading: Regular Examinations Integrated Processes: Nursing Process: Implementation; Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 2 3 4
A tetanus booster is not needed every 5 years. A tetanus booster is needed every 10 years. A tetanus booster is not something to consider in the years ahead. A tetanus booster is not needed annually.
PTS: 1
CON: Promoting Health | Nursing Roles
39. ANS: 2 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 110 Heading: Regular Examinations Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Asking if the patient is having problems swallowing could be assessed if the patient has been having routine dental examinations. 2 Even with dentures the patient should have routine dental examinations to check for denture fit, mouth soreness, or oral cancer. This could be why the patient is losing weight despite having adequate teeth and resources to purchase food. 3 Cleaning the dentures most likely is not contributing to the patient’s weight loss. 4 Asking about cooking could be assessed after determining if the patient is having routine dental examinations and is able to safely swallow.
PTS: 1
CON: Promoting Health
40. ANS: 2 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 110 Heading: Chronic Disease Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Chronic diseases do not have a cure. 2 Chronic diseases can and do need to be managed. 3 Arthritis is not a disease that “spreads.” 4 Saying that the patient is correct is not an appropriate health-promotion response.
PTS: 1
CON: Promoting Health
41. ANS: 1 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 112 Heading: Nutrition Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Nutrition; Perfusion; Promoting Health
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Moderate Feedback 1 The sense of taste and smell change with aging. The additional salt on foods is contributing to the excess fluid in the patient’s feet and ankles. 2 Sipping water throughout the day will not cause edema of the feet and ankles. 3 Drinking 8 ounces of water with each medication dose will not cause edema of the feet and ankles. 4 Hot tea will not cause edema of the feet and ankles.
PTS: 1
CON: Nutrition | Perfusion | Promoting Health
42. ANS: 1 Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 115 Heading: Endurance Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 The patient is having an issue with endurance. An endurance-building activity is walking. 2 Sleeping longer each night will not build endurance. 3 Taking frequent naps throughout the day will not build endurance. 4 Spending more time outside in the sun will not build endurance.
PTS: 1
CON: Promoting Health | Nursing Roles
MULTIPLE RESPONSE 43. ANS: 1, 2, 4, 5 Feedback 1. Health promotion for older adults should include exercise. 2. Health promotion for older adults should include self-care. 3. Health promotion for older adults does not include finances. 4. Health promotion for older adults should include nutrition. 5. Health promotion for older adults should include relationships. Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 1. Recognize aging as a normal process of living rather than a disease process. Chapter page reference: 107 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Knowledge [Remembering] Concept: Nursing; Promoting Health Difficulty: Easy PTS: 1
CON: Nursing | Promoting Health
44. ANS: 1, 3, 5 Feedback 1. Incentives for older adults to participate in classes or group activities include having fun. 2. Prevention of growing old is unrealistic and most likely not a motivating factor. 3. Incentives for older adults to participate in classes or group activities include staying healthy. 4. Preventing chronic illnesses is unrealistic. The patient already has arthritis, a chronic disease. 5. Incentives for older adults to participate in classes or group activities include socializing. Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 4. Examine the importance motivation plays in an older person’s ability to participate in health-promotion and disease-prevention activities. Chapter page reference: 108 Heading: Motivation Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Nursing; Promoting Health Difficulty: Moderate PTS: 1
CON: Nursing | Promoting Health
45. ANS: 2, 4 1. 2. 3. 4. 5.
Feedback Inactivity does not cause diabetes. Inactivity leads to weak bones. Inactivity does not cause heart disease. Inactivity leads to muscle wasting. Inactivity does not cause poor circulation. Poor circulation can lead to inactivity.
Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 113 Heading: Exercise and Fitness Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy PTS: 1 46. ANS: 3, 4, 5
CON: Promoting Health
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1. 2. 3. 4. 5.
Feedback Combining alcohol, over-the-counter medications, and prescription drugs is not identified as causing sleep apnea. Combining alcohol, over-the-counter medications, and prescription drugs is not identified as causing joint stiffness. Combining alcohol, over-the-counter medications, and prescription drugs can lead to an increase in falls secondary to impairment. Combining alcohol, over-the-counter medications, and prescription drugs can lead to an exacerbation of depression. Combining alcohol, over-the-counter medications, and prescription drugs can lead to a toxic or lethal drug reaction.
Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 3. Recommend key health-promotion and disease-prevention activities appropriate for older people. Chapter page reference: 118 Heading: Alcohol, Drugs, and Aging Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Addiction; Safety Difficulty: Moderate PTS: 1
CON: Addiction | Safety
47. ANS: 2, 3, 4, 5 Feedback 1. Food preservatives have not contributed to prolonging the life of older people. 2. The remarkable advances in treatments have made tremendous contributions to the prolonging of life for older people. 3. The remarkable advances in surgery have made tremendous contributions to the prolonging of life for older people. 4. The remarkable advances in pharmacology have made tremendous contributions to the prolonging of life for older people. 5. The remarkable advances in diagnosis have made tremendous contributions to the prolonging of life for older people. Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 1. Recognize aging as a normal process of living rather than a disease process. Chapter page reference: 107 Heading: Introduction Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate PTS: 1 48. ANS: 2, 3, 4, 5
CON: Promoting Health | Nursing Roles
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1. 2. 3. 4. 5.
Feedback Lower extremity edema is not a normal process of aging. Normal processes of aging include some decrease in joint mobility from arthritis. Normal processes of aging may include some weight gain. Normal processes of aging include some decrease in hearing. Normal processes of aging include some decrease in vision.
Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 1. Recognize aging as a normal process of living rather than a disease process. Chapter page reference: 107 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Nursing Difficulty: Moderate PTS: 1
CON: Nursing
49. ANS: 1, 2, 3, 4 Feedback The most common health problems of older adults are associated with chronic diseases. The 1. most frequent chronic conditions include hearing impairments. The most common health problems of older adults are associated with chronic diseases. The 2. most frequent chronic conditions include heart conditions. The most common health problems of older adults are associated with chronic diseases. The 3. most frequent chronic conditions include hypertension. The most common health problems of older adults are associated with chronic diseases. The 4. most frequent chronic conditions include arthritis. 5. Skin tags are not identified as being a chronic health problem. Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 110 Heading: Chronic Disease Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Nursing Difficulty: Moderate PTS: 1
CON: Nursing
50. ANS: 2, 4, 5 Feedback 1. Lack of sleep contributes to body stress. 2. Road construction contributes to environmental stress. 3. Living alone contributes to mind stress.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4. 5.
Inclement weather contributes to environmental stress. Waiting for someone else contributes to environmental stress.
Chapter number and title: Chapter 6: Promoting Wellness Chapter/learning objective: 2. Describe the role nurses play in health-promotion and disease-prevention activities for older people. Chapter page reference: 116 Heading: Stress Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Stress; Nursing Difficulty: Moderate PTS: 1
CON: Stress | Nursing
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT
Chapter 7 Safety and Risk Management
1 2 3
CHAPTER 7
Introduction
The primary means by which we prevent accidents in wildland fire operations is through aggressive risk management. Our safety philosophy acknowledges that 6 while the ideal level of risk may be zero, a hazard free work environment is not 7 a reasonable or achievable goal in fire operations. Through organized, 8 comprehensive, and systematic risk management, we will determine the 9 acceptable level of risk that allows us to provide for safety yet still achieve fire 10 operations objectives. Risk management is intended to minimize the number of 11 injuries or fatalities experienced by wildland firefighters. 4 5
12
Policy
Firefighter and public safety is our first priority. All Fire Management Plans and activities must reflect this commitment. The commitment to and accountability 15 for safety is a joint responsibility of all firefighters, managers, and 16 administrators. Every supervisor, employee, and volunteer is responsible for 17 following safe work practices and procedures, as well as identifying and 18 reporting unsafe conditions. 13 14
Agency-specific Safety Policy Documents: BLM – BLM Handbook 1112-1, DOI Occupational Safety and Health 21 Program – Field Manual 22 NPS – DO-50 and RM-50 Loss Control Management Guideline 23 FWS – Service Manual 240 FW 1 Safety Program Management, 241 FW7, 24 Firefighting, 241 FW 4, Risk Management 25 FS – FSM 5100 and chapters, FSH-6709.11 Health and Safety Code 26 Handbook 19 20
For additional safety guidance, refer to: Wildland Fire Incident Management Field Guide (PMS 210) 29 Incident Response Pocket Guide (IRPG) (PMS 461, NFES 1077) 30 ○ FS – USDA Forest Service website for Risk Management at 31 https://www.fs.fed.us/managing-land/fire/safety. 27 28
32
Guiding Principles
The primary means by which we implement command decisions and maintain unity of action is through the use of common principles of operations. These 35 principles guide our fundamental wildland fire management practices, 36 behaviors, and customs, and are mutually understood at every level of 37 command. They include Risk Management, Standard Firefighting Orders and 38 Watch Out Situations, LCES and the Downhill Line Construction Checklist. 39 These principles are fundamental to how we perform fire operations, and are 40 intended to improve decision making and firefighter safety. They are not 41 absolute rules. They require judgment in application. 33 34
Release Date: January 2021
163
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7 1
SAFETY AND RISK MANAGEMENT
Goal
The goal of the fire safety program is to provide direction and guidance for safe and effective management in all activities. Safety is the responsibility of 4 everyone assigned to wildland fire, and must be practiced at all operational 5 levels from the national fire director, state/regional director, and unit manager to 6 employees in the field. Agency Administrators need to stress that firefighter and 7 public safety always takes precedence over property and resource loss. 8 Coordination between the fire management staff and unit safety officer(s) is 9 essential in achieving this objective. 2 3
10
Definitions
11
Safety: A measure of the degree of freedom from risk or conditions that can cause death, physical harm, or equipment or property damage.
12 13 14 15 16
Hazard: A condition or situation that exists within the working environment capable of causing physical harm, injury, or damage. Risk: The likelihood or possibility of hazardous consequences in terms of severity or probability.
18
Risk Management: The process whereby management decisions are made and actions taken concerning control of hazards and acceptance of remaining risk.
19
Risk Management Process
17
Fire operations risk management is outlined in the NWCG Incident Response Pocket Guide (IRPG). The five step process provides firefighters and fire 22 managers a simple, universal, and consistent way to practice risk management 23 by: 24 Establishing situation awareness by identifying hazards. 25 Assessing hazard potential. 26 Developing hazard controls and making risk management decisions. 27 Implementing hazard controls. 28 Supervising implementation and evaluating effectiveness. 20 21
29
Job Hazard Analysis (JHA)/Risk Assessment (RA)
A completed JHA/RA is required for: Jobs or work practices that have potential hazards. 32 New, non-routine, or hazardous tasks to be performed where potential 33 hazards exist. 34 Jobs that may require the employee to use non-standard personal protective 35 equipment (PPE). 36 Changes in equipment, work environment, conditions, policies, or materials. 30 31
Supervisors and appropriate line managers must ensure that established JHAs/RAs are reviewed and signed prior to any non-routine task or at the 39 beginning of the fire season. 37 38
164
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT 1
2 3 4 5 6 7 8 9 10 11
CHAPTER 7
BLM – Additional RA information can be obtained at https://doimspp.sharepoint.com/sites/blm-wo-700/SitePages/Home.aspx. FWS – See also 240 FW 1, Exhibit 1, Job Hazard Assessment. FS – JHAs must include a description of the emergency medical procedures, identification of key individuals, and actions that will be taken to ensure prompt and effective medical care and evacuation. See FSH 6709.11, section 21.1 for more information. The FS Operational Risk Management Guide, process and forms for conducting a RA can be found on the USDA Forest Service website for Risk Management at https://www.fs.fed.us/managing-land/fire/safety.
Work/Rest
To mitigate fatigue, Agency Administrators, fire managers, supervisors, Incident Commanders, and individual firefighters should plan for and ensure that all 14 personnel are provided a minimum 2:1 work/rest ratio (for every 2 hours of 15 work or travel, provide 1 hour of sleep and/or rest). Work shifts that exceed 16 16 hours and/or consecutive days that do not meet the 2:1 work/rest ratio should be 17 the exception. When this occurs, the following actions are required: 18 Personnel will resume 2:1 work/rest ratio as quickly as possible. 19 The Incident Commander or Agency Administrator will justify work shifts 20 that exceed 16 hours and/or consecutive days that do not meet 2:1 work to 21 rest ratio. Justification will be documented in the daily incident records, 22 made available to the employee by the Finance Section/local unit, and must 23 include mitigation measures used to reduce fatigue. 24 The Time Officer’s/Unit Leader’s approval of the Emergency Firefighter 25 Time Report (OF-288), or other agency pay document, certifies that the 26 required documentation is on file and no further documentation is required 27 for pay purposes. 12 13
The work/rest guidelines do not apply to aircraft pilots assigned to an incident. Pilots must abide by applicable Federal Aviation Administration (FAA) 30 guidelines, or agency policy if more restrictive. 28 29
31
Length of Assignment
Assignment Definition An assignment is defined as the time period (days) between the first full 34 operational period at the first incident or reporting location on the original 35 resource order and the last day worked prior to commencement of return travel 36 to the home unit. 32 33
Length of Assignment Standard assignment length is 14 days, exclusive of travel from and to home 39 unit, with possible extensions identified below. Time spent in staging and 40 preposition status counts toward the 14-day limit, regardless of pay status, for all 41 personnel, including incident management teams. 37 38
Release Date: January 2021
165
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7 1
SAFETY AND RISK MANAGEMENT
14-Day Scenario
2
Days Off To assist in mitigating fatigue, days off are allowed during and after 5 assignments. Agency Administrators (incident host or home unit) may authorize 6 time off supplementary to mandatory days off requirements. 3 4
7 8
The authority to grant a day off with pay lies within 5 U.S.C. 6104, 5 CFR 610.301-306, and 56 Comp. Gen. Decision 393 (1977).
After completion of a 14-day assignment and return to the home unit, two mandatory days off will be provided (2 after 14). Days off must occur on the 11 calendar days immediately following the return travel in order to be charged to 12 the incident (See Section 12.1-2) (5 U.S.C. 6104, 5 CFR 610.301-306, and 56 13 Comp. Gen. Decision 393 (1977). If the next day(s) upon return from an 14 incident is/are a regular work day(s), a paid day(s) off will be authorized. 15 Regulations may preclude authorizing this for non-NWCG and state/local 16 employees. 9
10
Pay entitlement, including administrative leave, for a paid day(s) off cannot be authorized on the individual’s regular day(s) off at their home unit. Agencies 19 will apply holiday pay regulations, as appropriate. A paid day off is recorded on 20 home unit time records according to agency requirements. Casuals (AD) are not 21 entitled to paid day(s) off upon release from the incident or at their point of hire. 17 18
Contract resources are not entitled to paid day(s) off upon release from the incident or at their point of hire. 24 BLM/FWS – After completion of a 14-day assignment and return travel, 25 the mandatory days off will be charged to Administrative Leave if they fall 26 on a regularly-scheduled work day. 22 23
Home unit Agency Administrators may authorize additional day(s) off with compensation to further mitigate fatigue. If authorized, home unit program funds 29 will be used. All length of assignment rules apply to aviation resources, 30 including aircraft pilots, notwithstanding the FAA and agency day off 31 regulations. 27 28
Assignment Extension Prior to assigning incident personnel to back-to-back assignments, their health, 34 readiness, and capability must be considered. The health and safety of incident 35 personnel and resources will not be compromised under any circumstance. 32 33
Assignments may be extended when: Life and property are imminently threatened. 38 Suppression objectives are close to being met. 39 A military battalion is assigned. 36 37
166
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT 1
CHAPTER 7
Replacement resources are unavailable, or have not yet arrived.
Upon completion of the standard 14-day assignment, an extension of up to an additional 14 days may be allowed (for a total of up to 30 days, inclusive of 4 mandatory days off, and exclusive of travel). 2 3
5
21-Day Scenario
6
A 21-day assignment is exclusive of travel from and to home unit. Time spent in staging and preposition status counts toward the 21-day assignment, regardless 9 of pay status, for all personnel, including incident management teams. 7 8
10
30-Day Scenario
11
An assignment longer than 22 days is exclusive of travel from and to home unit. Time spent in staging and preposition status counts toward the assignment, 14 regardless of pay status, for all personnel, including Incident Management 15 Teams. For an assignment exceeding 21 days, two mandatory days off will be 16 provided prior to the 22nd day of the assignment. 12 13
Contracts, Incident Blanket Purchase Agreements (I-BPA), and Emergency Equipment Rental Agreements (EERA) should be reviewed for appropriate pay 19 requirements and length of assignment. If the contract, I-BPA, or EERA do not 20 address this, the incident Finance/Administration Section Chief or the 21 procurement official should be consulted as to whether compensation for a day 22 off is appropriate. 17 18
Single Resource/Kind Extensions The section chief or Incident Commander will identify the need for assignment 25 extension and will obtain the affected resource’s concurrence. The section chief 26 and affected resource will acquire and document the home unit supervisor’s 27 approval. 23 24
The Incident Commander approves the extension. If a convened Geographic or National Multi-Agency Coordinating Group (GMAC/NMAC) directs, the 30 Incident Commander approves only after GMAC/NMAC concurrence. 28 29
If the potential exists for reassignment to another incident during the extension, the home unit supervisor and the affected resource will be advised and must 33 concur prior to reassignment. 31 32
Release Date: January 2021
167
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7
SAFETY AND RISK MANAGEMENT
Incident Management Team Extensions Incident management team extensions are to be negotiated between the incident 3 Agency Administrator, the Incident Commander, and the GMAC/NMAC (if 4 directed). 1 2
Maximum Consecutive Days Worked – Home Unit During extended periods of activity at the home unit, personnel will have a 7 minimum of 1 day off in any 21-day period. 5 6
8
Driving Standard
All employees driving motor vehicles are responsible for the proper care, operation, maintenance, and protection of the vehicle, and to obey all federal 11 and state laws. 9
10
12 13
The use of government-owned, rented, or leased motor vehicles is for official business only. Unauthorized use is prohibited.
General Driving Policy Employees must have a valid state driver’s license in their possession for 16 the appropriate vehicle class before operating the vehicle. Operating a 17 government-owned or rental vehicle without a valid state driver’s license is 18 prohibited. 19 All drivers whose job duties require the use of a motor vehicle will receive 20 initial defensive driver training within three months of entering on duty and 21 refresher driver training every three years thereafter. 22 ○ BLM/FS – Driver training is required prior to operating a vehicle for 23 official purposes. 24 All traffic violations or parking tickets will be the operator’s responsibility. 25 All driving requiring a CDL will be performed in accordance with 26 applicable Department of Transportation regulations. 27 Drivers and all passengers are required to use provided seat belts at all times 28 when the motor vehicle is in motion. 14 15
Employees operating a motor vehicle that meets any of the following criteria must possess a valid Commercial Driver’s License (CDL) with all of the 31 applicable endorsements: 32 Has a gross combination weight rating or gross combination weight of 33 26,001 pounds or more, whichever is greater, inclusive of a towed unit(s) 34 with a gross vehicle weight rating or gross vehicle weight of more than 35 10,000 pounds, whichever is greater; or 36 Has a gross vehicle weight rating or gross vehicle weight of 26,001 pounds 37 or more, whichever is greater; or 38 Is designed to transport 16 or more passengers, including the driver; or 39 Is of any size and is used in the transportation of hazardous materials. 40 Hazardous materials means any material that has been designated as 41 hazardous under 49 U.S.C. 5103 and is required to be placarded under 29 30
168
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45
CHAPTER 7
subpart F of 49 CFR part 172 or any quantity of a material listed as a select agent or toxin in 42 CFR part 73. ○ BLM – BLM Form 1112-11 will be used to document every fire and aviation employee’s authorization to drive government vehicles or to drive private or rental vehicles for government business. BLM Form 1112-11 replaces form OF-345, form DI-131, and any equivalent form that has been created for local or state level use. Employees are required to self-certify their physical ability to operate vehicles which they are authorized to use. Drivers of vehicles that require a Commercial Driver’s License may be required to have additional driver, medical, and fitness testing as required by local and/or state laws. Employees will immediately inform their supervisor and update BLM Form 1112-11 if a change in medical condition impedes their driving ability or if a state driving privilege is restricted for any reason. Supervisors will review the updated form and take appropriate action as necessary. BLM Form 1112-11 is available at https://doimspp.sharepoint.com/sites/blmoc/dbs/eForms%20Library/Forms/Safety.aspx. ○ DOI – Employees under the age of 21 that possess a CDL may operate Commercial Motor Vehicles (CMV) across state lines for Interstate Commerce purposes under the following conditions: Drivers with a CDL may operate a Commercial Motor Vehicle (CMV) in accordance with the issuing authority (i.e., the State) that issued the CDL and must comply with the issuing authority’s CMV operational requirements and any special requirements and endorsements applicable to the CMV license classification of the CDL holder; and Supervisors must annually establish and document that those drivers have a valid driver’s license (i.e., that the license has not been suspended, revoked, canceled, or that he/she has not been otherwise disqualified from holding a license – 485 DM 16.3D (1)), have the ability to operate the vehicle(s) safely in the operational environment assigned (485 DM 16.3B (2)), and review and validate the employee’s driving record (485 DM 16.3D (4)). ○ BLM/NPS/FWS – Employees, volunteers, and contractors (for BLM, this includes cooperators) are prohibited from using any mobile voice/data communication or electronic data retrieval device while operating a government owned, leased, or rented vehicle or while operating a personally-owned vehicle for official government business, and are further prohibited from using any government-owned mobile communication or data retrieval device while operating a personallyowned vehicle. Government purchased two-way radios are exempt from this requirement. The use of any of these devices during an emergency situation (immediate threat to life) is limited to the extent necessary to convey vital information. When there is a passenger in the vehicle and Release Date: January 2021
169
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7 1 2
○
3 4 5
○
6 7 8 9
○
10 11 12 13 14 15 16
SAFETY AND RISK MANAGEMENT
the vehicle is in motion, the passenger shall manage communications to prevent driver distraction. NPS – For NPS employees engaged in activities other than wildfire or prescribed fire, refer to the current NPS Official Travel Driving Policy for restrictions. FS – Policy requires all operators of government owned, or leased vehicles to have a Forest Service issued Operator’s Identification Card (OF-346) indicating the type of vehicles or equipment the holder is authorized and qualified to operate. FS – Drivers shall not engage in cellular phone or mobile radio communications while the vehicle is in motion unless actively engaged in an emergency such as wildland firefighting. During non-emergency situations, the driver shall identify a safe location to stop the vehicle and then engage in cellular phone or mobile radio communications. These restrictions apply whether or not hands-free technology is available.
Non-Incident Operations Driving Refer to the current driving standards for each individual agency. 19 BIA – Per Indian Affairs Manual (IAM), Part 25, Chapter 4: employees 20 will not exceed eight hours of driving time (behind the wheel), to include 21 use of specialized equipment, during a 16-hour duty day. 17 18
Mobilization and Demobilization To manage fatigue, every effort should be made to avoid off unit (excluding IA 24 response) mobilization and demobilization travel between 2200 hours and 0500 25 hours. 22 23
Incident Operations Driving This policy addresses driving by personnel actively engaged in wildland fire or 28 all-hazard activities; this includes driving while in support, mobilization, and 29 demobilization to an assigned incident, or during initial attack fire response 30 (includes time required to control the fire and travel to a rest location). 31 Agency resources assigned to an incident or engaged in initial attack fire 32 response will adhere to the current agency work/rest policy for determining 33 length of duty day. 34 No driver will drive more than 10 hours (behind the wheel) within any duty35 day. 36 Multiple drivers in a single vehicle may drive up to the duty-day limitation 37 provided no driver exceeds the individual driving (behind the wheel) time 38 limitation of 10 hours. 39 A driver shall drive only if they have had at least 8 consecutive hours off 40 duty before beginning a shift. Exception to the minimum off-duty hour 41 requirement is allowed when essential to: 42 ○ Accomplish immediate and critical suppression objectives. 43 ○ Address immediate and critical firefighter or public safety issues. 26 27
170
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT 1 2 3 4 5
CHAPTER 7
As stated in the current agency work/rest policy, documentation of mitigation measures used to reduce fatigue is required for drivers who exceed 16 hour work shifts. This is required regardless of whether the driver was still compliant with the 10 hour individual (behind the wheel) driving time limitations.
Fire Vehicle Operation Standards Operators of all vehicles must abide by state traffic regulations. Operation of all 8 vehicles will be conducted within the limits specified by the manufacturer. 9 Limitations based on tire maximum speed ratings and GVWR restrictions must 10 be followed. It is the vehicle operator’s responsibility to ensure vehicles abide 11 by these and any other limitations specified by agency or state regulations. 6 7
12
Management Controls to Mitigate Risks to Responders
Management controls, engineering controls, equipment guards, and administrative procedures are the first line of defense against exposing an 15 employee to a hazard. Personal protective equipment (PPE) will be used to 16 protect employees against hazards that exist after all management controls are 17 exhausted. 13 14
18
Wildland Fire Field Attire
Polyester, polypropylene, and nylon materials are not to be worn, because most synthetic fibers melt when exposed to flame or extreme radiant heat. Personnel 21 should wear only undergarments made of 100 percent or the highest possible 22 content of natural fibers, aramid, or other flame-resistant materials. 19 20
23
Personal Protective Equipment (PPE)
All personnel are required to use personal protective equipment (PPE) appropriate for their duties and/or as identified in JHAs/RAs. Employees must 26 be trained to use safety equipment effectively. 24 25
Flame resistant clothing should be cleaned or replaced whenever soiled, especially when soiled with petroleum products. Flame resistant clothing will be 29 replaced when the fabric is so worn as to reduce the protection capability of the 30 garment or is so faded as to significantly reduce the desired visibility qualities. 27 28
Any modification to personal protective equipment that reduces its protection capability such as iron-on logos, and stagging of pants, is an unacceptable 33 practice and will not be allowed on fires. 31 32
Required Fireline PPE Wildland fire boots 36 Fire shelter (M-2002) 37 Helmet with chinstrap 38 Goggles/safety glasses (as identified by JHAs/RAs) 39 Ear plugs/hearing protection 34 35
Release Date: January 2021
171
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7 1
2 3 4
5 6 7 8
9 10 11 12
SAFETY AND RISK MANAGEMENT
National Fire Protection Association (NFPA) 1977 compliant long-sleeved flame resistant shirt (yellow recommended) NFPA 1977 compliant flame resistant trousers Leather or leather/flame resistant combination gloves. Flame resistant flight gloves or NFPA 1977 compliant Driving Gloves can be used by heavy equipment operators, drivers and fireline supervisors when not using fireline hand tools. Additional PPE as identified by local conditions, Safety Data Sheet (SDS), or JHA/RA ○ FS – Shirt, trousers, and gloves used by USFS personnel must meet Forest Service specification 5100-91 (shirt), 5100-92 (trousers), 61705 (gloves), or be NFPA 1977 compliant.
Wildland Fire Boot Standard Personnel assigned to wildland fires must wear a minimum of 8-inch high, lace15 type exterior leather work boots with lug melt-resistant soles. The 8-inch height 16 requirement is measured from the bottom of the boot’s heel to the top of the 17 boot. Alaska is exempt from the lug sole requirement. 13 14
All boots that meet the wildland fire boot standard as described above are required for firefighting and fireline visits, considered non-specialized PPE, and 20 will be purchased by the employee (including AD/EFF) prior to employment. 18 19
21 22
The agencies have authorized payment of a boot stipend. See agency specific guidance for implementation.
Fire Shelters New Generation Fire Shelters (M-2002, Forest Service Specification 5100-606) 25 are required for all wildland firefighters. For more information, refer to 26 https://www.nwcg.gov/committees/fire-shelter-and-personal-protective27 equipment-subcommittee. 23 24
Training in inspection and deployment of fire shelters will be provided prior to issuance. Fire shelters do not have a shelf life; serviceability depends on the 30 shelter’s condition. Firefighters will inspect their shelter at the beginning of each 31 fire season and periodically throughout the year to ensure they are serviceable. 32 Inspection criteria can be found at 33 https://www.fs.fed.us/t-d/php/library_card.php?p_num=1151%202301P. 28
29
Training shelters will be deployed at required RT-130, Wildland Fire Safety Training Annual Refresher. No live fire exercises for the purpose of fire shelter 36 deployment training will be conducted. 34 35
Fire shelters will be carried in a readily accessible manner by all line personnel. The deployment of shelters will not be used as a tactical tool. Supervisors and 39 firefighters must never rely on fire shelters instead of using well-defined escape 40 routes and safety zones. When deployed on a fire, fire shelters will be left in 41 place if it is safe to do so and not be removed pending approval of authorized 37 38
172
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT 1 2
CHAPTER 7
investigators. Firefighters must report the shelter deployment incident to their supervisor as soon as possible.
Head Protection Personnel must be equipped with helmets and wear them at all times while in the 5 fire area. Helmets must be equipped with a chinstrap, which must be fastened 6 while riding in, or in the vicinity of, helicopters. Acceptable helmets for fireline 7 use must meet NFPA 1977 Standard on Protective Clothing and Equipment for 8 Wildland Fire Fighting requirements. 9 BLM – Helmets and hats used for protection from impact of falling and 10 flying objects and from limited electric shock and burn must meet the 11 specifications of American National Standards Institute Z89.1-2009. 12 Equivalent helmet meeting ANSI Z89.1-2009 Type 1, Class G or NFPA 13 1977. 3 4
Helmets consist of the shell and the suspension, which work together as a system. Both components require frequent inspection and maintenance. Detailed 16 helmet inspection procedures can be found at 17 https://www.nwcg.gov/committees/fire-shelter-and-personal-protective18 equipment-subcommittee. 14 15
Eye and Face Protection The following positions require the wearing of eye protection (meets ANSI 21 Z87.1 Standards): 22 Nozzle operator 23 Chainsaw operator/faller 24 ○ The ANSI Z87.1 eye and face protection will be worn during all 25 chainsaw operations involving cleaning and fueling. Steel mesh safety 26 goggles are allowed only during falling and bucking chainsaw/crosscut 27 saw operations. 28 ○ Steel mesh glasses are not allowed for any chainsaw operations. 29 Helibase and ramp personnel 30 Wildland fire chemical mixing personnel 31 Other duties may require eye protection as identified in a specific JHA/RA 19 20
Full-face protection in the form of a face shield in compliance with ANSI Z87.1 shall be worn when working in any position where face protection has been 34 identified as required in the job-specific JHA/RA: Batch Mixing for Terra35 Torch®, power sharpener operators, etc. 32 33
Hearing Protection Personnel who are exposed to a noise level in excess of 85db must be provided 38 with, and wear, hearing protection. This includes, but is not limited to: 39 Chainsaw operators/fallers 40 Pump operators 41 Helibase and aircraft ramp personnel 42 Wildland fire chemical mixing personnel 36 37
Release Date: January 2021
173
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7 1
SAFETY AND RISK MANAGEMENT
Other duties may require hearing protection as identified in a specific JHA/RA.
Employees may be required to be placed under a hearing conservation program as required by 29 CFR 1910.95. Consult with local safety and health personnel 4 for specifics regarding unit hearing conservation programs. 2 3
Neck Protection Face and neck shrouds are not required PPE. The use of shrouds is not required 7 and should be as a result of onsite risk analysis. If used, face and neck shrouds 8 shall meet the requirements of FS specification 5100-601 or NFPA 1977 9 Standard on Protective Clothing and Equipment for Wildland Fire Fighting. 5 6
Shrouds should be positioned in a manner that allows for immediate use. For additional information see MTDC Tech Tip Improved Face and Neck Shroud 12 for Wildland Firefighters, 2004 (0451-2323-MTDC) at 13 https://www.fs.fed.us/t-d/pubs/htmlpubs/htm04512323/index.htm. 10 11
Leg Protection All chainsaw operators will wear chainsaw chaps meeting the United States 16 Forest Service Specification 6170-4F or 4G. Swampers should wear chaps when 17 the need is demonstrated by a risk analysis considering proximity to the sawyer, 18 slope, fuel type, etc. All previous Forest Service specification chainsaw chaps 19 must be removed from service. Chainsaw chaps shall be maintained in 20 accordance with MTDC Publication, Inspecting and Repairing Your Chainsaw 21 Chaps – User Instructions (0567-2816-MTDC) available at 22 https://www.fs.fed.us/t-d/pubs/htmlpubs/htm05672816/page01.htm. 14 15
Respiratory Protection Respiratory protection should only be implemented once engineering and 25 administrative controls are exhausted. The need for respiratory protection during 26 wildland fire operations must be determined by each agency. The requirements 27 for respirator use are found in 29 CFR Part 1910.134. 23 24
Only NIOSH-approved respirators shall be used. Several respiratory-type products are marketed to wildland firefighters but are not NIOSH-approved 30 (e.g., shrouds with filtration devices). 28 29
Managers and supervisors will not knowingly place wildland firefighters in positions where exposure to toxic gases or chemicals that cannot be mitigated 33 and would require the use of self-contained breathing apparatus. 31 32
Managers will not sign cooperative fire protection agreements that would commit wildland firefighters to situations where exposure to toxic gases or 36 chemicals would require the use of self-contained breathing apparatus. 37 FS – FSM 5130, Self-Contained Breathing Apparatus – Wildland 38 firefighters may use only SCBA which are compliant with NFPA 1981, 39 Standard on Open-Circuit Self-Contained Breathing Apparatus (SCBA) for 40 Emergency Services. SCBA may only be used when contaminants from 41 vehicle, dump, structure, or other non-wildland fuel fire cannot be avoided 34 35
174
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT 1 2 3 4 5 6 7 8 9
CHAPTER 7
while meeting wildland fire suppression objectives (29 CFR 1910.134, Respiratory Protection). If such an apparatus is not available, avoid exposure to smoke from these sources. The acquisition, training, proper use, employee health surveillance programs, inspection, storage, and maintenance of respiratory protection equipment must comply with applicable National Fire Protection Association standards and 29 CFR 1910.134, and be justified by a Job Hazard Analysis or Risk Assessment (RA). Where the acquisition and use of an SCBA is approved, it may be carried only on a fire engine and its use must be consistent with FSM 5130.
Specialized or Non-Standard Personal Protective Equipment (PPE) Specialized PPE not routinely supplied by the agency (e.g., prescription safety 12 glasses, static-resistant clothing, cold weather flame resistant outerwear, etc.) 13 required to perform a task safely must be procured in accordance with agency 14 direction, and supported by a JHA/Risk Assessment. 10 11
A JHA/Risk Assessment must be completed and reviewed by the Unit Safety Officer and the supervisor’s approval is required. Items must meet agency and 17 industry standards for specific intended use. Cold weather flame resistant 18 outerwear shall be in compliance with NFPA 1977, Standard on Protective 19 Clothing and Equipment for Wildland Fire Fighting. All cold weather inner 20 wear should be composed of 100% or the highest possible content of natural 21 fibers (cotton, wool or silk) or other flame resistant material such as aramid. 15 16
High Visibility Vests In order to meet 23 CFR 634, high visibility apparel should be worn whenever a 24 firefighter is working on or in the right of way of a public roadway. 22 23
25 26
Employees must wear high visibility safety apparel that meets ANSI/ISEA 1072004, Class 2 or 3, or ANSI/ISEA 207-2006.
Exceptions The high visibility safety apparel should not be worn if: 29 There is a reasonable chance that the employee may be exposed to flames, 30 high heat, or hazardous materials. 31 The high visibility garment hinders an employee’s ability to do their job 32 because it prevents necessary motion or because it limits access to 33 necessary equipment such as radios or fire shelters. 27 28
Additional information is available in the Missoula Technology and Development Center (MTDC) report, High-Visibility Garments and Worker 36 Safety on Roadways (1251-2818P-MTDC) at 37 https://www.fs.fed.us/t-d/pubs/pdfpubs/pdf12512818/pdf12512818Pdpi300.pdf. 34 35
Release Date: January 2021
175
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7 1
SAFETY AND RISK MANAGEMENT
Fireline Safety
Incident Briefings Fire managers must ensure that safety briefings are occurring throughout the fire 4 organization, and that safety factors are addressed through the IC or their 5 designee and communicated to all incident personnel at operational briefings. 6 The identification and location of escape routes and safety zones must be 7 stressed. A briefing checklist can be found in the Incident Response Pocket 8 Guide (IRPG). 2 3
LCES – A System for Operational Safety LCES will be used in all operational briefings and tactical operations as per the 11 Incident Response Pocket Guide (IRPG). 12 L – Lookout(s) 13 C – Communication(s) 14 E – Escape Route(s) 15 S – Safety Zone(s) 9
10
Right to Refuse Risk Every individual has the right to turn down unsafe assignments. When an 18 individual feels an assignment is unsafe, they also have the obligation to 19 identify, to the degree possible, safety alternatives for completing that 20 assignment. The IRPG contains a process for properly refusing risk. 16 17
Aerial Drop Safety Considerations Maintain prompt communications with aerial resources. Prioritize air-to23 ground as appropriate. 24 Establish a designated monitor for air-to-ground communications. Specific 25 drops may not be accomplished unless communications are maintained and 26 clearance is assured. Keep informed of the aerial firefighting objectives, 27 tempo and aircraft type. 28 Anticipate when line clearance may be requested. Tempo can change very 29 quickly as aerial resources become available. Anticipate the clearance 30 requirement based on the volume of delivery. 31 Evaluate the environment for gravity hazards (tree limbs, rocks, logs and 32 dispensed retardant/water). Broken trees and tree limbs, rolling rocks and 33 logs all move with gravity. If clearance is downhill of the drop, heightened 34 awareness is warranted. 35 If clearance is impractical, where fuels and/or terrain obstruct lateral 36 clearance, notify aerial supervisor or the initial attack resource immediately. 37 If escape is not possible, lie face-down with head toward incoming aircraft 38 with hardhat in place. Hold hand tool away from your body, and if possible, 39 grasp something firm to prevent being carried or rolled about by the 40 dropped liquid. 21 22
176
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT
CHAPTER 7
Smoke and Carbon Monoxide It is important to note that smoke is just one of the potential risks faced by 3 wildland firefighters. Site-specific hazards and mitigations need to be identified 4 (using JHA/RA) to reduce firefighter exposure to smoke and potential carbon 5 monoxide which includes evaluating and balancing all the risks associated with 6 the operational objectives. 1 2
From an incident management perspective, smoke impacts need to be analyzed and a risk assessment completed using the ICS-215A, Incident Action Plan 9 Safety Analysis worksheet. For additional information, reference NWCG 10 memorandum EB-M-12-006, Monitoring and Mitigating Exposure to Carbon 11 Monoxide and Particulates at Incident Base Camps at 12 https://www.nwcg.gov/executive-board/correspondence. Ordering Air Resource 13 Advisors should be considered when smoke impacts are of concern in the ICS14 215A. 7 8
Location of Fire Camps and Plans to Remain in Place Fire camps should be located in areas that will service the incident for the long 17 term without having to relocate. Due to such factors as extreme fire behavior, 18 fire camp locations might be compromised. Incident Commanders are to be 19 especially vigilant to quickly identify situations that may put their fire camp(s) 20 or any other adjacent fire camps in jeopardy. As such, planning for evacuation 21 and/ or remain in place actions should be considered. Evacuation plans at a 22 minimum shall include: 23 Documented risk assessment 24 Trigger points 25 Egress routes 26 Transportation for all personnel 27 Accountability for all personnel 28 Those individuals not meeting PMS 310-1 qualifications will be considered 29 escorted visitors as addressed elsewhere in this chapter. 30 ○ FS – At a minimum, plans shall also include: 31 ICP protection strategy referenced in the IAP. 32 Live-ability considerations including air quality index guidelines, 33 functionality of location and facilities, and safety factors for post 34 burn conditions. 15 16
Standard Safety Flagging The following flagging is recommended for wildland fire activities: 37 Hot-pink flagging marked “Escape Route” (NFES 0566). Crews with 38 colorblind members may wish to carry and utilize fluorescent chartreuse 39 flagging (NFES 2396). 40 Hazards. Yellow with black diagonal stripes, 1-inch wide (NFES 0267). If 41 the above recommendation is not utilized on an incident, the incident will 42 need to identify the selected color and make it known to all firefighters. 35 36
Release Date: January 2021
177
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7 1
SAFETY AND RISK MANAGEMENT
Emergency Medical Planning and Services
To provide for quick and effective response, all units (including dispatch centers) will develop and implement plans that specify emergency procedures, 4 actions, and roles/responsibilities to ensure injured personnel are provided 5 prompt and effective medical care and evacuation. 2 3
Incident Medical Emergency Management Planning In 2010, NWCG approved the standardized incident emergency protocol 8 developed by the Dutch Creek Serious Accident Task Team, and issued 9 direction that these emergency medical procedures be adopted by all IMTs 10 during daily operations. 11 Although some of the procedures are specific to larger Type 1 and Type 2 12 incidents when key unit leader positions are filled, these same procedures 13 and protocols can be adapted for local unit use when managing Type 5, 4, 14 and 3 incidents as well as during normal field operations. Local unit 15 emergency medical plans must take into account all types and management 16 levels of incidents. 17 All IMTs will use the standard Medical Incident Report in their Medical 18 Plan and Communication protocols. It is found in the IRPG under 19 Emergency Medical Care Guidelines (red pages) and with the Medical Plan 20 (ICS-206-WF) form available at https://www.nwcg.gov/publications/ics21 forms. 6 7
To achieve successful medical response, Agency Administrators will ensure that their units have completed the following items prior to each field season: 24 A Medical Emergency Plan that identifies medical evacuation options, 25 local/county/state/federal resource capabilities, capacities, ordering 26 procedures, cooperative agreements, role of dispatch centers, and key 27 contacts or liaisons. 28 Standardized incident and communication center protocols identified in the 29 Medical Incident Report section of the IRPG. 30 For incidents that require the preparation of an IAP, Form ICS-206-WF will 31 be used. This form is available at 32 https://www.nwcg.gov/publications/ics-forms. 22 23
Air Ambulance Coordination Unit and state/regional-level fire program managers should ensure that 35 procedures, processes, and/or agreements for use of local and regional air 36 ambulance services are stated in writing and effectively coordinated between the 37 fire programs, the dispatch/logistics centers, and the service providers. These 38 procedures, processes, and/or agreements should address contact frequencies, 39 coordinate format requirements, and capabilities/limitations of the air ambulance 40 (e.g., night flying, unimproved helispots, and weather restrictions). 33 34
178
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT
CHAPTER 7
Incident Emergency Medical Services Incident medical information can be found on the NWCG Emergency Medical 3 Committee website at https://www.nwcg.gov/committees/emergency-medical4 committee. 1 2
NWCG has published Clinical Treatment Guidelines for Wildland Fire Medical Units (PMS 551). These guidelines establish a national approach for medical 7 care during large incidents that expand the typical emergency management 8 services (EMS) scope of practice to include the mission of managing and 9 maintaining the health and wellness of wildland fire personnel. These guidelines 10 are available at https://www.nwcg.gov/committees/emergency-medical11 committee under “Guides and Agency Policies.” 5 6
Home units that choose to utilize and support higher level medical responders to provide medical support for internal agency medical emergencies (beyond basic 14 first aid/CPR) may do so; however, certification and credentialing must follow 15 respective state laws and protocols unless there is other agency direction. 12 13
16
Required Treatment for Burn Injuries
17
The following standards will be used when any firefighter sustains burn injuries, regardless of agency jurisdiction.
18
After on-site medical response, initial medical stabilization, and evaluation are completed, the Agency Administrator or designee having jurisdiction for the 21 incident and/or firefighter representative (e.g., Crew Boss, Medical Unit Leader, 22 Compensations for Injury Specialist, etc.) should discuss and coordinate with the 23 attending physician to ensure that a firefighter whose burn injuries meet any of 24 the following burn injury criteria is appropriately referred to the nearest regional 25 burn center. Burn injuries are often difficult to evaluate and may take 72 hours 26 to manifest themselves. When there is any doubt as to the severity of or if 27 criteria are met for a burn injury, the recommended action is to work closely 28 with the treating physician to facilitate either a digital picture or telemedicine 29 consult with a burn center or the referral and transport of the burned employee to 30 the nearest burn center. It should be kept in mind, however, that not all burns 31 require referral to a burn center. Special consideration should be given to 32 referring a burned firefighter to a burn center if there is poor pain control during 33 care at the medical facility. The following criteria from the American Burn 34 Association (ABA) are meant to help guide the patient referral decision process. 19 20
The decision to refer a firefighter not meeting the following criteria to a regional burn center is made directly by the attending physician or may be requested of 37 the physician by the Agency Administrator or designee having jurisdiction 38 and/or firefighter representative after discussing medical follow-up beyond the 39 ER. A possible solution is a referral to a burn center out-patient clinic for 40 follow-up care after the ER visit. 35 36
41 42
After initial medical stabilization and evaluation are completed in a medical facility, the decision to refer the employee to a specialty care physician/facility Release Date: January 2021
179
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7
SAFETY AND RISK MANAGEMENT
is made only by the attending physician. Workers’ compensation benefits may be denied in the event the employee is transported to a specialty care 3 physician/facility without a referral from the attending physician after already 4 being seen by a medical provider. A report prepared by a Physicians’ Assistant 5 must be countersigned by a physician to be accepted as medical evidence. A 6 definition of “physician” can be found at 7 https://www.dol.gov/owcp/dfec/regs/compliance/DFECfolio/FECA8 PT3/#301003. 1 2
The Agency Administrator or designee for the incident will coordinate with the employee’s home unit to identify a workers’ compensation liaison to assist the 11 injured employee with workers’ compensation claims and procedures. 9
10
During these rare events, close consultation must occur between the attending physician, the firefighter, the Agency Administrator or designee and/or 14 firefighter representative, the firefighter’s physician (if they have one), and the 15 burn center to assure that the best possible care for the burn injuries is provided. 12 13
ABA Burn Injury Criteria Partial thickness burns (second degree) involving greater than 10% Total 18 Body Surface Area (TBSA). 19 Burns (second degree) involving the face, hands, foot, genitalia, perineum, 20 or major joints. 21 Third-degree burns of any size are present. 22 Electrical burns, including lightning injury, or chemical burns are present. 23 Inhalation injury is suspected. 24 Burn injury in someone with preexisting medical disorders that could 25 complicate management, prolong recovery or affect mortality (e.g., 26 diabetes). 27 Any patient with burns and concomitant trauma (such as fractures) in which 28 the burn injury poses the greatest risk of morbidity or mortality. In such 29 cases, if the trauma poses the greater immediate risk, the patient may be 30 initially stabilized in a trauma center before being transferred to a burn unit. 31 Physician judgment will be necessary in such situations and should be in 32 concert with the regional medical control plan and triage protocols. 33 Burn injury in someone who will require special social, emotional or 34 rehabilitative intervention (PTSD, severe anxiety, etc.). 16 17
Severity Determination First Degree (Superficial) – Red, sometimes painful. 37 Second Degree (Partial Thickness) – Skin may be red, blistered, swollen, 38 and painful to very painful. 35 36
180
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT 1 2
CHAPTER 7
Third Degree (Full Thickness) – Whitish, charred, or translucent, no pin prick sensation in burned area.
Percentage Total Body Surface Area (TBSA) – Rule of 9s or Rule of Palms Rule of 9s (pictures on previous page): The body is divided into sections of 9 5 percent, or multiples of 9 percent, each as per the drawing. 3 4
Rule of Palms: Patient’s palm equals 1% of their body surface. Estimate how many times the patient’s palm could be placed over the burned areas to estimate 8 the percentage of body that has been burned. 6 7
9
A map as well as a search engine of burn care facilities can be found at
10 http://ameriburn.org/public-resources/find-a-burn-center/. 11
For additional NWCG incident emergency medical information see
12 https://www.nwcg.gov/committees/emergency-medical-committee under 13
“Guides and Agency Policies.”
14
Explosives, Munitions, and Unexploded Ordnance
When encountering explosives, munitions, unexploded ordnance (UXO), or suspected UXO, never pick up, handle, uncover, or touch suspected explosives 17 or military munitions. Retreat and secure the area from entry. Immediately 18 notify the local dispatch office, and gather as much information as possible from 19 a safe distance. 15 16
Gather the following information and provide it to the dispatch center: Location of the explosive/munitions using a map, GPS coordinates, or 22 landmarks (use of a GPS receiver is acceptable because it is a receive-only 23 device). 24 Picture of the explosive if it can be obtained from a safe distance. 25 Who discovered the explosive/munitions and how they can be contacted. 26 Condition of the explosive/munitions (e.g., buried, partially exposed, fully 27 exposed, deteriorated, or punctured). 20 21
Release Date: January 2021
181
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7 1
2 3 4 5
6 7
SAFETY AND RISK MANAGEMENT
Number and type of explosive/munitions visible (e.g., blasting caps, dynamite, bomb, grenade, etc.). Estimated size of explosive/munitions (e.g., length and diameter). Distinctive features of explosive/munitions (e.g., shape, color, markings). Nearby structures, if any (so inhabitants can be contacted and evacuated if necessary). Public access to the vicinity (i.e., open or closed to motor vehicles).
Never spend more time near munitions, suspected explosives, or UXO than is absolutely necessary. Only collect the above information as long as it is safe to 10 do so from a distance. Never compromise safety to collect information. 8 9
Notifications Local dispatch centers are responsible for notifying: 13 Agency law enforcement; 14 Unit safety officer; 15 Agency Administrator; and 16 Local law enforcement. 11 12
Discovery of Explosives/Munitions/UXO Associated with Former Defense Sites 19 The military retains liability and responsibility for munitions removal and for 20 remedial actions on all lands transferred (or transferring) from the military to the 21 land management agencies, and is responsible for explosives safety at former 22 defense sites. The military must be notified for all UXO on these lands. 17 18
Local law enforcement is responsible for contacting the appropriate military authority. If the responsible military unit is unknown, then local law 25 enforcement should contact the U.S. Army Forces Command (FORSCOM), 26 52nd Ordnance Group (EOD), at its 24-hour emergency response number, (931) 27 431-3824. 23 24
28
For additional UXO safety information, see the current IRPG.
29
Industrial and Naturally Occurring Hazardous Materials Exposure
Firefighters can potentially be exposed to hazards in the wildland fire environment. Encountered hazards can be both human and environmentally 32 borne. 30 31
This section provides information and mitigations for most commonly encountered industrial and naturally occurring potential exposures. Recognizing 35 there may be unique/area specific hazardous exposures (e.g., fungus causing 36 valley fever, erionite, coal seams), the following standards apply to all hazards: 37 Identifying unit-specific environmental hazards; 38 Develop Risk Assessments/Job Hazard Analyses (RA/JHAs) for those 39 hazards; 40 Develop and provide specific training and standard operating procedures 41 (SOPs); 33 34
182
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT 1 2 3
CHAPTER 7
Provide briefings/training for those who may be exposed; If exposure is suspected, immediately disengage and leave the area; and Seek immediate medical attention if exposure symptoms occur.
Hazardous Materials Response Hazardous materials response or control is not a functional responsibility of 6 wildland fire suppression resources. These incidents have tremendous potential 7 to cause significant health and life safety issues. In order to protect the health 8 and safety of agency personnel, no employee shall be directed, or dispatched 9 (including self-dispatching) to an incident involving hazardous materials unless 10 they are provided with the required personal protective equipment and the 11 appropriate certification level. Agency personnel on incidents involving 12 hazardous material will limit their actions to those emergency services necessary 13 for the immediate protection of themselves and the public and the prompt 14 notification of appropriate public safety agencies. All wildland firefighters who 15 are likely to witness or discover hazardous substances are required to complete 16 their agency’s First Responder Awareness (Level I) program. 4 5
Dump and Spill Sites Employees that discover any unauthorized waste dump or spill site that contains 19 indicators of potential hazardous substances (e.g., containers of unknown 20 substances, pools of unidentifiable liquids, piles of unknown solid materials, 21 unusual odors, or any materials out of place or not associated with an authorized 22 activity) should take the following precautions: 23 Follow the procedures in the IRPG; 24 Treat each site as if it contains harmful materials; 25 Do not handle, move, or open any container, breathe vapors, or make 26 contact with the material; 27 Move a safe distance upwind from the site; 28 Contact appropriate personnel. Generally, this is the Hazardous Materials 29 Coordinator for the local office; and 30 Firefighters need to immediately report hydrogen sulfide (H2S) or potential 31 exposure and seek immediate medical care. 32 ○ BLM/NPS/FWS – Agencies require that all field personnel complete 33 First Responder Awareness training. Firefighters are required to take 34 an annual refresher for Hazardous Material protocol. 17 18
The following general safety rules shall be observed when working with chemicals: 37 Read and understand the Safety Data Sheets. 38 Keep the work area clean and orderly. 39 Use the necessary safety equipment. 40 Label every container with the identity of its contents and appropriate 41 hazard warnings. 42 Store incompatible chemicals in separate areas. 43 Substitute less toxic materials whenever possible. 35 36
Release Date: January 2021
183
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7 1
2 3
4
SAFETY AND RISK MANAGEMENT
Limit the volume of volatile or flammable material to the minimum needed for short operation periods. Provide means of containing the material if equipment or containers should break or spill their contents.
Wildland Fires In or Near Oil/Gas Operations For units with oil and gas operations within their jurisdiction, the following are 7 the minimum standard operating procedures to help ensure the health and safety 8 of wildland firefighters: 9 Firefighters shall receive annual oil and gas hazard recognition and 10 mitigation training; 11 Local unit shall complete a JHA/RA for wildland fire activities in oil and 12 gas areas and provide a copy with a briefing to all local and incoming 13 resources; 14 Establish Response Protocols and proper decontamination procedures to 15 minimize exposure to additional employees, equipment, and facilities. 16 Protocols will include notification procedures to respective oil and gas 17 company(s); 18 Ensure oil and gas resource advisors are consulted; 19 Ensure that at least one member of each squad or engine crew is 20 knowledgeable in the use and data interpretation of the H2S gas monitor. 21 Training on the device will include at a minimum: 22 ○ Equipment charging and maintenance of sensors; 23 ○ Startup, zeroing, calibration, and bump testing procedures as 24 recommended by the manufacturer; and 25 ○ How the monitor elicits a warning alarm (visual, auditory, vibration). 26 Understand Peak Reading, Short Term Exposure Limits (STEL), and Time 27 Weighted Averages; 28 ○ Understand how to set the monitors alarm threshold. 29 The monitor’s alarm shall be set at the current American Conference on 30 Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (10 31 PPM 2008) and STEL (15 PPM 2008); 32 If H2S gas is encountered, immediately disengage and leave area; and 33 Do not establish incident base camps or staging areas in or near oil and gas 34 operations. 5 6
The following websites provide additional information and training resources: https://www.nifc.gov/video/HazMat.wmv 37 https://www.wildfirelessons.net/irdb 38 https://www.nfpa.org/ 39 A template for briefing Incident Management Teams is available in the 40 “Additional Resources” section of the NIFC Safety website at 41 https://www.nifc.gov. 35 36
184
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT
CHAPTER 7
Wildland Fires In or Near Radioactive Locations Abandoned uranium mines and other potential radioactive sites exist in many 3 areas of public lands. When these areas are identified, local management should 4 provide information and direction on operations to be used. General knowledge 5 and understanding of potential radiation exposure is necessary for wildland fire 6 program management to make valid risk management decisions in these areas. 1 2
7
The following website provides information and general guidelines.
8 https://www.nifc.gov/standards/guides/red-book
Wildland Fires In or Near Coal Seams Coal is naturally occurring black or brownish rock usually located in rock strata 11 in layers or veins, coal beds or coal seams. Exposed coal seams are abundant 12 through southeast and central Montana, western North Dakota, South Dakota, 13 and Alaska. A coal seam fire is the smoldering of an exposed or underground 14 coal deposit. 9
10
Risks: Coal seam fires pose a serious problem that can be a hazard to firefighter’s health and safety. Coal seam fires can emit toxic gases, including 17 carbon monoxide, sulfur dioxide and other potentially hazardous gases. 15 16
Carbon Monoxide is a colorless, odorless and tasteless gas that can be highly toxic. Sulfur Dioxide is a colorless gas with a characteristic of an irritating, 20 pungent odor and is also highly toxic. Some symptoms of exposure to these 21 gases may include headaches, nausea, dizziness, fatigue, shortness of breath, 22 coughing and eye irritation. 18 19
Because of the variances in symptoms and exposure levels, seek medical attention for a complete diagnosis if firefighters have been exposed to toxic 25 gases from coal seam fires and symptoms persist. Additionally firefighters 26 exposed to coal ash, smoke or vapor should trade in their PPE for fresh PPE. 27 Individually bag PPE that has been contaminated. 23 24
Required Actions/Precautions: Firefighters are typically not equipped or trained for coal seam fires and should not attempt to extinguish such fires with hand 30 tools and engines. 28 29
Putting water on coal seam fires is normally useless. Mitigation crews will need to excavate the burning coal seam and mix the hot material with soil and water 33 to cool. The area can be reclaimed by backfilling the seam and re-vegetating the 34 disturbed area. 31 32
Signs of a coal seam fire may include a rotten egg smell, smoking white ash and continuous or non-continuous lines of what appears to be smoldering black rock 37 (coal) where the flame may or may not be visible. Avoid low lying terrain in 38 known coal seam fire areas especially early morning when air temps are cool. 39 Gas tends to sink when air is cool and will accumulate in low lying areas. 35 36
40 41
Do not depend on sense of smell to detect coal seam fires. At high concentrations the sense of smell will be almost immediately overwhelmed or Release Date: January 2021
185
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7
SAFETY AND RISK MANAGEMENT
become numb. At lower levels, the sense of smell will slowly deteriorate as levels build in the blood stream. Do not stand downwind of coal smoke under 3 any conditions especially during suppression operations. 1 2
Report the location of all coal seam fires to the incident commander or supervisor. ICs should notify agency representatives of locations of coal seam 6 fires. Agencies should have resource advisors notify incoming incident 7 command teams and firefighting resources of known locations of exposed coal 8 seams, coal mines or abandoned coal mines adjacent to ongoing incidents and 9 the risks and precautions to take when working around coal seam fires. 4 5
Hazardous Water Sources Many water sources used during wildland fire operations may appear harmless, 12 but contain hazardous materials (e.g., hydraulic fracturing fluid, cyanide, 13 sewage, corrosives). These hazardous water sources may pose threats to 14 personnel health and firefighting equipment. Indicators that a water source may 15 be hazardous include proximity to active or inactive mining operations, gas/oil 16 wells, water treatment facilities, or other industrial operations. In many cases, 17 these hazardous water sources may not be fenced and no warning signs may be 18 present. 10 11
Fire personnel should evaluate water sources to ensure they do not contain potentially hazardous materials. If unsure of the contents of a water source, 21 personnel should not utilize the water source until its contents can be verified. 22 Dispatch centers, Resource Advisors, or on-scene personnel can assist with 23 verification of safe water sources. Information about known hazardous water 24 sources should be included in operational briefings. 19 20
Hydrogen Cyanide (HCN) Exposure Synthetic materials such as plastics, nylon, Styrofoam®, and polyurethane can 27 produce HCN. HCN exposure can disrupt the body’s ability to use oxygen, 28 cause asphyxia, and cause carbon monoxide poisoning. Common items such as 29 sofas, carpeting, vehicles, and other products routinely found in the wildland can 30 produce smoke with HCN. 25 26
Symptoms of HCN poisoning include bitter almond odor on breath, burning taste in mouth, stiffness of lower jaw, feeling of numbness or constriction in 33 throat, weakness, and headache. 31 32
Follow hazardous materials protocols contained in the IRPG to mitigate exposure to HCN. If personnel may have been exposed to HCN, immediate 36 referral to a health care facility capable of toxicology testing and treatment of 37 HCN exposure is required. 34 35
38
Safety for Personnel Visiting Fires
A wide variety of personnel such as Agency Administrators, other agency personnel, dignitaries, members of the news media, etc., may visit incidents. The 41 following standards apply to all visitors. 39 40
186
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT
CHAPTER 7
Visits to Incident Base Camps or Non-Fireline Field Locations Recommended field attire includes: 3 Lace-up, closed toe shoes/boots with traction soles and ankle support. 4 Trousers. 5 Long-sleeve shirt. 6 For agency personnel, the field uniform is appropriate. 1 2
Fireline Logistical Support Personnel performing fireline logistical support duties (e.g., bus drivers, supply 9 delivery/retrieval, incident drivers, non-tactical water delivery, etc.) must meet 10 the following requirements: 11 Complete fire shelter training. 12 Required Fireline PPE as referenced in the personal protective equipment 13 section of this chapter. 14 Receive an incident briefing. 15 Ensure adequate communications are established. 16 Other requirements (if any) established by the Incident Commander. 17 A Work Capacity Test (WCT) is not required unless required for a specific 18 position defined in the PMS 310-1. 7 8
Minimum Requirements for Visits to the Fireline/RX Burns Visits (such as media visits or political/administrative tours) to hazardous areas 21 of the fire or areas that pose a fire behavior threat will be managed by meeting 22 the requirements below: 23 Visits to the fireline must have the approval of the IC/Burn Boss. 24 Visitors must maintain communications with the DIVS or appropriate 25 fireline supervisor of the area they are visiting. 26 Required fireline PPE as referenced in the personal protective equipment 27 section of this chapter. 28 Required field attire: 29 ○ Undergarments made of 100 percent or the highest possible content of 30 natural fibers or flame-resistant materials. 31 Required equipment/supplies: 32 ○ Hand tool 33 ○ Water canteen 19 20
34 35
Visitors to the fireline/RX burns may be “Non-Escorted” or “Escorted” depending on the following requirements:
Non-Escorted Visits Visitors must have an incident qualification with a minimum physical fitness 38 level of “light” to visit the fireline unescorted. 39 Must have adequate communications and radio training. 40 Completed the following training: 41 ○ Introduction to Fire Behavior (S-190) 42 ○ Firefighter Training (S-130) 36 37
Release Date: January 2021
187
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7
○
1 2 3
SAFETY AND RISK MANAGEMENT
4
Wildland Fire Safety Training Annual Refresher (RT-130), including fire shelter training Deviation from these requirements must be approved by the IC or Burn Boss.
Escorted Visits All visitors lacking the above training and physical requirements must be 7 escorted while on the fireline. 8 Visitors must receive training in the proper use of fireline PPE. 9 Requirement for hand tool and water to be determined by escort. 10 Visitors must be able to walk in mountainous terrain and be in good 11 physical condition with no known limiting conditions. 12 Escorts must be minimally qualified as Single Resource Boss. 13 Deviation from these requirements must be approved by the IC or Burn 14 Boss. 5 6
Helicopter Observation Flights Visitors who take helicopter flights to observe fires must receive approval from 17 the Incident Commander, a passenger briefing, and meet the following 18 requirements: 19 Required PPE: 20 ○ Flight helmet 21 ○ Leather boots 22 ○ Flame-resistant clothing 23 ○ All leather or leather and aramid gloves 15 16
24 25
Occasional passengers/visitors have no training requirement, but a qualified flight manager must supervise loading and unloading of passengers.
Fixed-Wing Observation Flights No PPE is required for visitors and agency personnel who take fixed-wing 28 flights to observe fires. However, a passenger briefing is required, and the flight 29 level must not drop below 500 feet AGL. 26 27
30
6 Minutes for Safety Training
It is recommended that daily 6 Minutes for Safety training be conducted that focuses on high-risk, low frequency activities that fire personnel may encounter 33 during a fire season. A daily national 6 Minutes for Safety briefing can be found 34 at https://www.nwcg.gov/committees/6-Minutes-for-safety or within the 35 National Incident Management Situation Report. 31 32
36
SAFENET
SAFENET is a form, process, and method for reporting and resolving safety concerns encountered in any aspect (e.g., preparedness, training, etc.) of 39 wildland fire or all hazard incident management. The information provided on 40 the form will provide important, safety-related data to the National Interagency 41 Fire Center, and determine long-term trends and problem areas. 37 38
188
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT
CHAPTER 7
The objectives of the form and process are: To provide immediate reporting and correction of unsafe situations or close 3 calls in wildland fire. 4 To provide a means of sharing safety information throughout the fire 5 community. 6 To provide long-term data that will assist in identifying trends. 7 Primarily intended for wildfire and prescribed fire situations, however, 8 SAFENET can be used for training and all hazard events. 1 2
Individuals who observe or who are involved in an unsafe situation shall initiate corrective actions if possible, and then report the occurrence using SAFENET. 11 You are encouraged, but not required, to put your name on the report. 9
10
Prompt replies to the originator (if name provided), timely action to correct the problem, and discussion of filed SAFENETs at local level meetings encourage 14 program participation and active reporting. 12 13
SAFENET is not the only way to correct a safety-related concern and it does not replace accident reporting or any other valid agency reporting method. It is an 17 efficient way to report a safety concern. It is also a way for front line firefighters 18 to be involved in the daily job of being safe and keeping others safe, by 19 documenting and helping to resolve safety issues. SAFENETs may be filed: 20 Electronically at https://safenet.nifc.gov; 21 Verbally by telephone at 1-888-670-3938; or 22 By SAFENET Field Card. 15 16
The SAFENET Field Card can be used by wildland fire personnel to immediately identify and report unsafe situations or close calls that should 25 receive immediate resolution/mitigation. If the situation cannot be resolved at 26 the local/incident level, the reporting individual is encouraged to follow the 27 formal SAFENET submission process stated above. SAFENET Field Cards are 28 available at https://safenet.nifc.gov. 23 24
29
Safety Alert System
The Safety Alert system is intended as another mechanism to provide safety related information to the field. The expectation is that the messages will 32 continue to be forwarded within the fire community, and that they will receive a 33 wide distribution in a relatively short period of time. There are three levels of 34 Safety Alert: 35 Safety Warning – A warning of a safety hazard that poses an imminent 36 threat to life or property. 37 Safety Advisory – An advisory on safety information that isn’t related to 38 imminent or potential threats of injury. 39 Safety Bulletin – A factual confirmation of a serious accident, incident or 40 fatality within the fire community. 30 31
41
A database of all bulletins can be found at https://www.nwcg.gov/alerts. Release Date: January 2021
189
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7 1
SAFETY AND RISK MANAGEMENT
Accident/Injury Reporting
The Occupational Safety and Health Administration (OSHA) mandates that all accidents and injuries be reported in a timely manner. This is important for the 4 following reasons: 5 To protect and compensate employees for incidents that occur on-the-job. 6 To assist supervisors and safety managers in taking corrective actions and 7 establish safer work procedures. 8 To determine if administrative controls or personal protective equipment are 9 needed to prevent a future incident of the same or similar type. 10 To provide a means for trend analysis. 2 3
Agency Reporting Requirements Employees are required to immediately report to their supervisor every job13 related accident. Managers and supervisors shall ensure that an appropriate level 14 of investigation is conducted for each accident and record all personal injuries 15 and property damage. Coordinate with your human resources office or 16 administrative personnel to complete appropriate Office of Workers’ 17 Compensation (OWCP) forms. Reporting is the responsibility of the injured 18 employee’s home unit regardless of where the accident or injury occurred. 19 BLM/NPS/FWS – Employees will report accidents using the Safety 20 Management Information System (SMIS) at https://www.smis.doi.gov. 21 Supervisors shall complete SMIS report within six working days after the 22 accident/injury. 23 FS – Employees will use the eSafety system through the Forest Service 24 Dashboard at 25 http://fsweb.asc.fs.fed.us/HRM/owcp/WorkersComp_index.php//. 26 BIA – In addition to reporting accidents using the Safety Management 27 Information System (SMIS), Fire Management Officers will complete the 28 Early Alert at https://www.bia.gov/bia/ots/dfwfm/bwfm/safety, and submit to 29 Regional Fire Management Officers within 24 hours after the 30 accident/injury. 11 12
OSHA Reporting Requirements For accidents/injuries meeting the Serious Accident criteria (found in Chapter 33 18), OSHA must be notified within 8 hours. 31 32
For other work-related accidents/injuries requiring in-patient hospitalizations, amputations, or loss of an eye, OSHA must be notified within 24 hours. In36 patient hospitalization is defined as formal admission to the in-patient service of 37 a hospital or clinic for care or treatment (does not include admission for 38 observation or diagnostic testing only). 34 35
Supervisors will coordinate with the unit safety manager where the accident/injury occurred to ensure notifications are made to the appropriate 41 OSHA regional office. 39 40
190
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper SAFETY AND RISK MANAGEMENT 1
CHAPTER 7
OSHA reporting information is available at
2 https://www.osha.gov/recordkeeping2014/index.html. 3
Critical Incident Management
The NWCG has published the Agency Administrator’s Guide to Critical Incident Management (PMS 926). This guide is designed as a working tool to 6 assist Agency Administrators with the chronological steps in managing a critical 7 incident. This document includes a series of checklists, which outline Agency 8 Administrator’s and other functional area’s oversight and responsibilities. The 9 guide is not intended to replace local emergency plans or other specific guidance 10 that may be available, but should be used in conjunction with existing agency 11 policy, line of duty death (LODD)/loss of human life (LOHL) handbooks, or 12 other critical incident guidance. Local units should complete the guide or 13 equivalent, and review and update at least annually. 4 5
14
Critical Incident Stress Management (CISM)
CISM is a comprehensive, integrated, systematic, and multicomponent crisis intervention program that was developed to manage traumatic experiences. It is 17 a package of tactics that are designed to mitigate the impact of a traumatic event, 18 facilitate normal recovery processes, restore adaptive function, and identify 19 people who would benefit from additional support services. CISM interventions 20 services can be applied to wildland fire, law enforcement, or other emergency 21 responses. CISM interventions should never be used for grief counseling, 22 mediation or a replacement for mental health care professionals. The Agency 23 Administrator is responsible for identifying an event as a critical incident. 24 BLM – Refer to FA IM-2020-003, Critical Incident Stress Management 25 Program Policy. https://doimspp.sharepoint.com/sites/blm26 fa/Directives/Forms/AllItems.aspx?id=%2Fsites%2Fblm%2Dfa%2FDirecti 27 ves%2F2020IM%2FFA%2DIM%2D2020%2D003%2Epdf&parent=%2Fsit 28 es%2Fblm%2Dfa%2FDirectives%2F2020IM 15 16
Critical Incident Peer Support (CIPS) Critical Incident Peer Support (CIPS) is an intervention tactic designed for 31 colleagues or people of “mutual respect” to help each other through difficult 32 situations. It is the foundation of the interagency wildland fire CISM program 33 since peers understand the unique traumas, fears, job related stresses, and offer 34 instant trust, respect, credibility, and empathy. Camaraderie among peers has 35 credibility that academic training cannot create. 29 30
Critical Incident Peer Support Groups CIPS Groups are assembled at the time of request and can be ordered through 38 the dispatch/coordination system. For more information go to 39 https://gacc.nifc.gov/cism/. 36 37
Release Date: January 2021
191
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper CHAPTER 7
SAFETY AND RISK MANAGEMENT
(This page intentionally left blank.)
192
Release Date: January 2021
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 8 Nutrition for Older Adults Test Bank for Anderson’s Caring for Older Adults Holistically, 6th Edition, Tamara R. Dahlkemper
Amount of water needed determined by? Age, gender, chronic disease, physical activity, heat exposure
A deficiency of vitamin K can result in? Hemorrhaging, a sign of which is very dark and bloody stools.
Define minerals Inorganic substances found in nature and human body
Difference between simple and complex carbs? Complex carbs break down over a longer period of time and are more nutritious
Simple carbs are easier to digest and are used as a quick source of energy
Effect of Too Much Pork Bacon Excess fat may lead to a change in the body's hormonal system that can suppress the immune system and leave the person at risk for an infection.
Electrolytes include? [Hint: there's 6] Calcium, potassium, phosphorus, magnesium, sodium, chloride
Electrolytes: Must be maintained in a state of Moved through body by neutrality
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
fluids
Essential proteins Body cannot make; must come from food
Importance of calcium Bones and teeth, blood clotting, muscle and nerve activity, digestion, maintenance of blood pressure
Importance of Iron Carries oxygen (ensures adequate tissue oxygenation), aiding in metabolism
Importance of Potassium Building muscle, metabolic activities, electrical activity of the heart, acid-base balance regulation
Importance of Zinc Wound healing
Lab Tests to Assess Nutritional Status: BUN Why use it? when excess body tissue is broken down (the liver produces urea in the urea cycle as a waste product of the digestion of protein)
Monitoring weight effective how? In assessing nutritional status
Nonessential The body can make
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Nutrition Amount of food needed to maintain health changes over life span
A Nutritional Assessment may vary depending on? The facility
Nutrition identifies.. Identifies physical changes related to aging that affect nutrition.
Proteins assists in? Building and repairing body tissue
Proteins come from? Plants and animals ex. animal sources, soy, quinoa, buckwheat, hemp-seed and chia are plant based complete proteins
Reasons for food Intake Changes? > Loss of appetite > Chronic diseases > Normal changes in the digestive tract > Adverse reactions to medications taken
Sodium maintains? Fluid balance
T/F? Metabolism slows as a person ages.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
TRUE
Three critical food groups found in various foods? Carbohydrates, Proteins, Fats
Various diet plans exist such as... Regular Modified Clear liquid Full liquid Soft
Vitamin A is used for what? Vision, growth, and immune system function Excess vitamin A causes a yellowish-orange skin color
Vitamin B complex use Nervous system, healthy tissue, prevent dementia, metabolism, production of hemoglobin, formation of body cells; alcoholics are deficient in B vitamins
Vitamin C is used for what? Build and repair body tissue and bones, keep teeth and gums healthy
Vitamin D is used for what? Absorption of calcium and phosphorus for maintenance of bone tissue and other body functions; get from the sun
Vitamin E is used for what? Prevents breakdown of red blood cells, aids in wound healing
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Vitamin K is used for what? Blood clotting, bone development
Vitamins are extracted from... Foods or supplements
What do fats do? > Support and protection of internal organs > Sustain body temperature > Assist with absorption of vitamins A, D, E, and K > Fats come from plants, plant oils, meat, fish, and eggs
What is nitrogen balance? a measure of nitrogen input minus nitrogen output.
Negative nitrogen balance is associated with burns, serious tissue injuries, fevers, hyperthyroidism, wasting diseases, malnourishment and during periods of fasting. This means that the amount of nitrogen excreted from the body is greater than the amount of nitrogen ingested. A negative nitrogen balance can be used as part of a clinical evaluation of malnutrition.[
What is the basis for proteins? Amino acids
When do nutritional needs change? With age, physical activity, and health status.
Which assessment could indicate that the patient may need interventions related to nutrition?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
A. Regularly eating with friends and family B. The ability to shop and cook for themselves C. The frequent use of alcoholic beverages D. Weight loss of 5 pounds in the past 6 months C. The frequent use of alcoholic beverages
Which mineral is important for wound healing? Zinc
Which mineral plays an important role in cardiac functioning? Potassium
Which nutrient is an essential building block for body tissues? Proteins
Which type of diet contains foods that are liquid at room temperature? Full Liquid Diet
Which vitamin is essential for blood clotting? Vitamin K
Which vitamin is important for wound healing? Vitamin E
Which vitamins are fat-soluble? A, D, E, and K a fat-soluble vitamin needs fat to absorb and utilize the vitamin in body tissue
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Which vitamins are water-soluble? B&C
You assess for what nutritional risks? > Illness that may have impact on nutrition > Difficulty chewing or swallowing: observe while eating > Weight gain or loss > Regular eating habits > Types of food normally eaten > Resources to purchase food > Ability to shop for and prepare meals: method of cooking and food storage > Medications > Monitor and have patient keep food journal of what and how much is eaten
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 9: Culturally Specific Care Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which is NOT considered an aspect of culture? 1) Religion 2) Stories from grandparents 3) Non-physical inherited traits 4) Physical traits such as hair and eye color
2. Based on census data and predictions about changes in the U.S. population, which is a true statement? 1) The number of Asians living in the United States will decrease. 2) The population of the United States will become more diverse and older. 3) The population of the United States will probably become younger and more assimilated. 4) The percentage of blacks living in the United States will increase more than any other ethnic group.
3. What health issue increases in black men between the ages of 15 to 34? 1) AIDS 2) Stroke 3) Cancer 4) Unintentional injury
4. A black woman is experiencing fever and severe pain in her lower back and legs after flying a long distance the previous day. Test results indicate anemia. What should the nurse consider that this patient is experiencing? 1) Infection 2) Sickle cell anemia 3) Deep venous thrombosis 4) Transient ischemic attack
5. Which are the two leading causes of death among Native Americans? 1) Suicide and AIDS 2) Cirrhosis and stroke 3) Heart disease and cancer 4) Unintentional injuries and diabetes
6. What might the nurse expect to see when entering the hospital room of an ill Native American? 1) Cups being applied to the patient’s back 2) The patient and family facing east and praying to Allah 3) A shaman performing a healing “sing” with family members 4) The eldest member of the patient’s family asking questions and taking notes
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
7. Which ethnic group has the lowest cancer survival rate? 1) Blacks 2) Hispanics 3) Europeans 4) Native Americans
8. With which ethnic group are the practices of acupuncture and acupressure most closely associated? 1) Asians 2) Blacks 3) Hispanics 4) Europeans
9. The nurse is caring for a male Asian patient and needs permission for certain procedures to be performed. How should the nurse approach the family members? 1) Ask a translator to obtain permission from the wife. 2) Go directly to the patient’s father and act in a very friendly manner. 3) Explain the patient’s condition to his wife and ask her permission for the procedures to be done. 4) Acknowledge the wife but speak directly and formally to the patient’s father and mother who are present.
10. What do many Europeans believe about health care? 1) It is an unnecessary expense. 2) It is to be avoided at all costs. 3) It is the responsibility of the government. 4) It is the responsibility of the patient and the family.
11. A 75-year-old Jewish patient sends a meal tray back with much food uneaten. How should the nurse respond? 1) Ask the family about the patient’s eating habits. 2) Explain that the food must be eaten to aid in healing and recuperation. 3) Tell the dietitian to send a kosher diet without saying anything to the patient. 4) Remark that minimal intake is being noted and ask if a kosher diet is followed.
12. A middle-aged Hispanic woman does not want to take penicillin for diarrhea caused by an infection. What is a likely explanation for this refusal? 1) The patient does not believe in the use of antibiotics. 2) The patient thinks penicillin would interfere with the herbs and spices routinely taken. 3) The patient considers penicillin a “hot” medication and diarrhea a “hot” disease and believes that penicillin should not be used. 4) The patient considers penicillin a “hot” medication and diarrhea a “cold” disease and believes that penicillin should not be used.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
13. An elderly Hispanic patient leaves after waiting for 45 minutes for an appointment that was scheduled for an hour and a half earlier. Even though the patient is annoyed, what should the nurse respond to this situation? 1) Reschedule the appointment. 2) Suggest that another physician be chosen. 3) Say that the patient must be on time for the appointment and must wait if necessary. 4) Recognize the difference in time perception and gently explain the need to be on time for appointments to receive the needed care.
14. What should the nurse keep in mind when doing an initial assessment of a Native American? 1) Native Americans like to relate their personal history. 2) Many Native Americans find the personal questions asked during an initial assessment and history offensive. 3) Many Native Americans rely solely on the Indian Health Care Services for health care. 4) Native Americans who speak English are completely comfortable with the U.S. healthcare system.
15. A group of nurses is reviewing the care needed by a newly admitted older patient. Which statement represents an ethnocentric view of this patient’s culture and ethnicity? 1) “Remember to check his dietary preferences before submitting each day’s menu.” 2) “I think the way he wants some things done is really weird–we don’t do it that way.” 3) “Be sure to let his parish priest know he is here and wants to see him when he makes rounds.” 4) “His spouse and children are coming in later this afternoon to discuss physical therapy plans.”
16. The nurse is caring for an 82-year-old black female patient. What should the nurse recall regarding this patient’s life expectancy? 1) The patient can expect to live another 5 to 10 years. 2) The patient has exceeded the expected life expectancy for black females. 3) The patient has at least 3 more years before reaching the life expectancy for white females. 4) The patient has several years before reaching the expected life expectancy for black females.
17. The nurse is providing care to an older black female. Which statement should the nurse expect that explains this patient’s health beliefs? 1) “It is God’s will.” 2) “My daughter will take care of me.” 3) “I’ll do whatever it takes to get better.” 4) “My doctor knows how to keep me well.”
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
18. An older black female lives alone in a small city apartment and receives $900 a month in Social Security benefits from which she makes Medicare payments and pays rent. How will this income impact the patient’s health? 1) Isolated 2) Overcrowded 3) Could lead to malnutrition 4) Exposed to communicable diseases
19. The nurse notes that a newly admitted older patient is Asian. What should be a priority question when beginning the assessment of this patient? 1) Marital status 2) Country of origin 3) Previous profession 4) Number of children
20. The nurse is caring for an older Asian American female. What should the nurse avoid doing when providing care to this patient? 1) Addressing the patient as Mrs. 2) Discussing health care with the spouse 3) Keeping body parts covered during morning care 4) Telling the patient to stop doing something
21. The nurse is observing the reaction of an older Hispanic patient after learning about a chronic illness. Which response should the nurse expect the patient to make? 1) “I’m having bad luck.” 2) “I should never come to a hospital for care.” 3) “The doctors don’t know what they are doing.” 4) “It’s my husband’s fault I am the way that I am.”
22. An older Hispanic patient will not take a medication because it does not work in sync with the hot infection. What should the nurse do to first help this patient? 1) Document that the patient refused the medication. 2) Ask for clarification on what are the hot and cold illnesses. 3) Explain that the concepts of hot and cold do not apply to infections. 4) Explain that the patient’s illness will get worse if the medication is not taken.
23. An older white patient tells the nurse that the federation supplied all of his medications and paid for doctor visits in his native country. Which cultural group is this patient most likely a member of? 1) Black 2) Asian 3) European 4) American
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
24. What is a defining characteristic of a person from the European culture? 1) Extremely tall and muscular 2) Blond hair and blue eyes 3) Appearance of a typical American 4) Extended family provides health care
25. The nurse notes that a newly admitted older white patient speaks with an accent. What should the nurse do first to plan culturally sensitive care for this patient? 1) Obtain an interpreter. 2) Find out the patient’s country of origin. 3) Ask if a male family member is available to make health-care decisions. 4) Determine which family member plans to take care of the patient after discharge.
26. The nurse is assisting in the distribution of breakfast meal trays in a nursing facility. Which food item should be removed from the tray of a Jewish patient? 1) Toast 2) Bacon 3) Oatmeal 4) Orange juice
27. On Saturday afternoon an older Jewish patient has 15 family members and friends visiting. What should the nurse do to support this patient’s need for a support system? 1) Ask everyone to leave. 2) Enforce the two visitors per patient policy. 3) Suggest that everyone take 15 minutes each with the patient. 4) Invite everyone to the visitor’s lounge and transport the patient to visit there.
28. During a visit to the reservation where an older Native American patient lives, the nurse observes a ceremony being conducted for the patient’s newly diagnosed illness. What should the nurse recall about this culture? 1) The ceremony is to heal the illness. 2) The ceremony is to celebrate the patient’s life. 3) The ceremony is to prepare the patient for death. 4) The ceremony is to bring the family closer together.
29. The leader of a tribe of Sioux Indians is admitted to the hospital for treatment of type 2 diabetes mellitus. The tribal shaman arrives and asks for clean towels and water. What should the nurse do? 1) Provide the towels and water as requested. 2) Explain that the patient is too ill for visitors. 3) Explain that the patient was bathed earlier in the day. 4) Provide the towels but direct the shaman to use the sink for water.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Multiple Response Identify one or more choices that best complete the statement or answer the question. 30. A black Muslim male patient with diabetes is recovering from a stroke. Which would be examples of culturally sensitive nursing care? Select all that apply. 1) Provide a frankfurter instead of hamburger for lunch. 2) Substitute a ham slice with bacon on his breakfast tray. 3) Request that the pharmacy send only non-pork insulin for him. 4) Discuss his diet with him, asking him if he has any special needs. 5) Inform him that while he is in the hospital he must eat whatever is brought to him and take the insulin given to him.
31. What is true about elderly care in traditional Asian families? Select all that apply. 1) They are cared for at home by their family. 2) They are sent to nursing homes routinely when they reach a certain age. 3) They are placed in nursing homes only if they do not have family members to care for them. 4) They are sent to nursing homes only if the older person does not want to be around small children. 5) They are sent to nursing homes as soon as they become infirm or unable to contribute to family life.
32. Which characteristics should the nurse keep in mind that assists Asian Americans to be a healthier cultural group? Select all that apply. 1) Higher income 2) Well-educated 3) Residency status 4) Live with extended family 5) Obtain driver’s license
33. During an assessment, the nurse suspects that an older Hispanic patient is at risk for diseases of poverty. Which health problems should the nurse be concerned that this patient is developing? Select all that apply. 1) Arthritis 2) Diabetes 3) Pneumonia 4) Malnutrition 5) Heart disease
34. The nurse is planning care for an older Jewish patient. What should the nurse keep in mind that this patient will consider as aspects of health? Select all that apply. 1) Good health is a right. 2) The holy book is used to heal the sick. 3) Maintaining good health is an expectation. 4) Prayer is used to make treatment decisions.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
5) The use of modern medicine is encouraged.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 9: Culturally Specific Care Answer Section MULTIPLE CHOICE 1. ANS: 4 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 1. Define the differences between culture and ethnicity. Chapter page reference: 162 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 Religion is often considered a significant aspect of one’s cultural identity. 2 Stories from grandparents are part of non-physical traits which are a part of culture. 3 Non-physical traits are a part of one’s culture. 4 Physical traits such as hair and eye color inherited from parents are part of the person’s ethnicity.
PTS: 1
CON: Diversity
2. ANS: 2 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 1. Define the differences between culture and ethnicity. Chapter page reference: 164 Heading: Ethnicity and Culture as Caring Behaviors Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 It is predicted that the number of Asians in the United States will increase. 2 It is predicted that the population of the United States between now and 2050 will become older and more diverse. 3 The population of the United States will become older. 4 The percentage of blacks in the United States is predicted to remain unchanged.
PTS: 1
CON: Diversity
3. ANS: 4 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 2. Identify health-care needs of black Americans. Chapter page reference: 165
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Black Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity; Violence Difficulty: Easy Feedback 1 AIDS is not increased in black men between the ages of 15 and 34. 2 Stroke is not increased in black men between the ages of 15 and 34. 3 Cancer is not increased in black men between the ages of 15 and 34. 4 Unintentional injury is increased in black men between the ages of 15 and 34.
PTS: 1
CON: Diversity | Violence
4. ANS: 2 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 2. Identify health-care needs of black Americans. Chapter page reference: 165 Heading: Black Americans Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Hematologic Regulation; Diversity Difficulty: Moderate Feedback 1 The patient’s ethnicity, symptoms, and laboratory test results should suggest the possibility of sickle cell anemia more than infection. 2 Sickle cell anemia is a chronic inherited disease in which structurally defective hemoglobin molecules lead to hemolysis, anemia, and pain in areas of the body where the defective red blood cells block normal blood flow. It occurs mostly in blacks and in some people from the Mediterranean region. In people with sickle cell anemia, a crisis may be triggered by changes in altitude, dehydration, and infection. 3 The patient’s ethnicity, symptoms, and laboratory test results should suggest the possibility of sickle cell anemia more than deep venous thrombosis. 4 The patient’s ethnicity, symptoms, and laboratory test results should suggest the possibility of sickle cell anemia more than transient ischemic attack.
PTS: 1
CON: Hematologic Regulation | Diversity
5. ANS: 3 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 7. Identify health-care needs of Native Americans. Chapter page reference: 168 Heading: Native Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge {Remembering] Concept: Diversity
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Easy Feedback 1 Suicide is the seventh leading cause of death among Native Americans. AIDS is not identified as being a leading cause of death. 2 Cirrhosis and stroke are the fifth and sixth leading causes of death, respectively, among Native Americans. 3 Heart disease and cancer are the leading causes of death among Native Americans. 4 Unintentional injuries and diabetes are the third and fourth leading causes of death, respectively, among Native Americans.
PTS: 1
CON: Diversity
6. ANS: 3 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 7. Identify health-care needs of Native Americans. Chapter page reference: 167 Heading: Native Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Diversity Difficulty: Easy Feedback 1 Cups being applied to the patient’s back are more likely to occur with a Hispanic patient. 2 The patient and family facing east and praying to Allah is more likely to occur with a Muslim patient. 3 Many Native American tribes have a medicine man or woman, often called a shaman, who may chant and sing or use incense to help the ill person get well. 4 The eldest member of the patient’s family asking questions and taking notes is more likely to occur with a Japanese patient.
PTS: 1
CON: Diversity
7. ANS: 4 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 7. Identify health-care needs of Native Americans. Chapter page reference: 168 Heading: Native Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 Blacks have a higher cancer survival rate than Native Americans. 2 Hispanics have a higher cancer survival rate than Native Americans.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
Europeans have a higher cancer survival rate than Native Americans. The cancer survival rate among Native Americans is the lowest of any group in the United States.
PTS: 1
CON: Diversity
8. ANS: 1 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 3. Identify health-care needs of Asian Americans. Chapter page reference: 171 Heading: Asian Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 The use of acupuncture and acupressure is most closely associated with Asians. 2 The use of acupuncture and acupressure is not most closely associated with blacks. 3 The use of acupuncture and acupressure is not most closely associated with Hispanics. 4 The use of acupuncture and acupressure is not most closely associated with Europeans.
PTS: 1
CON: Diversity
9. ANS: 4 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 3. Identify health-care needs of Asian Americans. Chapter page reference: 170 Heading: Asian Americans Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Asking a translator to obtain permission from the wife is inappropriate because the family member may ask medical-related or nursing-related questions. The nurse can bring a translator to assist in communication. 2 Going directly to the patient’s father and acting in a very friendly manner is incorrect because it is too informal and the wife should not be ignored. 3 Explaining the patient’s condition to his wife and asking her permission for the procedures to be done is incorrect because the oldest family member makes the decisions. 4 In many Asian cultures the oldest male family member (or if he is dead, the oldest female family member) makes important decisions, such as decisions regarding an adult son’s health. The wife is not to be ignored and the patient’s parents are to be addressed respectfully.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Diversity
10. ANS: 3 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 5. Identify health-care needs of European Americans. Chapter page reference: 171 Heading: European Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 Many Europeans do not believe that health care is an unnecessary expense. 2 Many Europeans do not believe that health care is to be avoided at all costs. 3 Because many European countries have national health-care plans with socialized medicine, there is an expectation that the federal government is responsible for each person’s health care. 4 Health care in the United States is seen as being reliant on family or extended family groups.
PTS: 1
CON: Diversity
11. ANS: 4 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 6. Identify health-care needs of Jewish Americans. Chapter page reference: 175 Heading: Jewish Americans Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Talking with the family is inappropriate and belittling to the patient. 2 Explaining that the food must be eaten to aid in healing and recuperation is inappropriate and insensitive. The patient can be provided the necessary nutrients with a different diet. 3 Telling the dietitian to send a kosher diet without saying anything to the patient does not respect the patient’s wishes. 4 The nurse should tell the patient that it has been noticed that the food is not being eaten and ask about dietary preferences. Inform the patient that if a kosher menu is desired it can be provided.
PTS: 1 12. ANS: 3
CON: Diversity
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 4. Identify health-care needs of Hispanic Americans. Chapter page reference: 174 Heading: Hispanic Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Diversity Difficulty: Moderate Feedback 1 There is no information to support that the patient does not believe in the use of antibiotics. 2 There is no information about the herbs and spices that the patient routinely takes. 3 Many Hispanics believe in “hot” and “cold” ideas about diseases and medications. A “hot” medication, such as penicillin, should not be taken to treat a “hot” disease, such as diarrhea. “Hot” diseases should be treated with “cold” medications and vice versa. 4 This is contrary to the hot-cold belief system.
PTS: 1
CON: Diversity
13. ANS: 4 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 4. Identify health-care needs of Hispanic Americans. Chapter page reference: 174 Heading: Hispanic Americans Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Rescheduling the appointment does not recognize the patient’s cultural differences. 2 Suggesting another physician does not recognize the patient’s cultural differences. 3 Saying that the patient must be on time for the appointment and must wait if necessary does not recognize the patient’s cultural differences. 4 For many Hispanics, time is a relative concept and minimal attention is given to the exact time of day.
PTS: 1
CON: Diversity
14. ANS: 2 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 7. Identify health-care needs of Native Americans. Chapter page reference: 168 Heading: Native Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Diversity Difficulty: Moderate Feedback 1 Although Native Americans are great storytellers, they do not like to reveal much about their personal lives to strangers. 2 Many Native Americans find the questions asked during an initial assessment and history offensive and intrusive. It is sometimes wiser to ask younger members of the family about a patient’s history. 3 Many Native Americans often are “lost” between the Indian Health Care Services and other health-care services available in the United States. 4 Native Americans are often caught in limbo in terms of modern health care. They are caught between their traditions and modern treatment—the shaman and the physician.
PTS: 1
CON: Diversity
15. ANS: 2 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 1. Define the differences between culture and ethnicity. Chapter page reference: 163 Heading: Introduction Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Diversity Difficulty: Moderate Feedback 1 Checking dietary preferences indicates cultural sensitivity. 2 Saying that something is weird because “we don’t do it that way” demonstrates ethnocentrism. 3 Assisting to meet spiritual needs indicates cultural sensitivity. 4 Acknowledging the importance of family indicates cultural sensitivity.
PTS: 1
CON: Diversity
16. ANS: 2 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 2. Identify health-care needs of black Americans. Chapter page reference: 165 Heading: Black Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 Life expectancy for black females in 2010 was 3.3 years lower (78.0 years) than white females (81.3 years). This patient has already outlived expectations.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
The patient has outlived expectations by 4 years. The patient has outlived white female expectations by 4 years. The patient reached expectations for black females at age 78.
PTS: 1
CON: Diversity
17. ANS: 1 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 2. Identify health-care needs of black Americans. Chapter page reference: 165 Heading: Black Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 Members of this group may express the belief that they do not have much control over their health because it is part of a greater plan. 2 Expecting a family member to provide health care does not describe a health belief. 3 Stating that she will do whatever it takes to get better indicates self-control over health. 4 Stating that the doctor knows what to do indicates that health care is the provider’s responsibility.
PTS: 1
CON: Diversity
18. ANS: 3 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 2. Identify health-care needs of black Americans. Chapter page reference: 166 Heading: Black Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Diversity Difficulty: Moderate Feedback 1 It is unlikely that the patient will be isolated in a city apartment. 2 The patient lives alone so overcrowding is not an issue. 3 The patient has limited income, which she is using to pay for health care and rent. That leaves little money for food, medicine, and other essentials. 4 The patient lives alone so exposure to communicable diseases is not likely.
PTS: 1 19. ANS: 2
CON: Diversity
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 3. Identify health-care needs of Asian Americans. Chapter page reference: 169 Heading: Asian Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Marital status is not essential when beginning the assessment of this patient. 2 Country of origin is important for this patient. Asian Americans are from a variety of cultures, each with definite concepts and opinions. 3 Previous profession is not essential when beginning the assessment of this patient. 4 Number of children is not essential when beginning the assessment of this patient.
PTS: 1
CON: Diversity
20. ANS: 4 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 3. Identify health-care needs of Asian Americans. Chapter page reference: 170 Heading: Asian Americans Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 In this culture older people are to be addressed with their formal name. 2 In this culture the oldest male is to be involved in health-care decisions. 3 In this culture maintaining modesty is paramount. 4 In this culture demands should never be made to the older adult because it is an insult.
PTS: 1
CON: Diversity
21. ANS: 1 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 4. Identify health-care needs of Hispanic Americans. Chapter page reference: 172 Heading: Hispanic Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 For older Hispanics, traditional beliefs concerning health do not readily work with
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
modern health-care treatments. Some traditional Hispanics think that good health is “good luck.” When their health is not good, that is simply a mechanism of the “bad luck.” Blaming the hospital is not a traditional belief about health. Blaming the health-care professional is not a traditional belief about health. Blaming the spouse is not a traditional belief about health.
PTS: 1
CON: Diversity
22. ANS: 2 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 4. Identify health-care needs of Hispanic Americans. Chapter page reference: 174 Heading: Hispanic Americans Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Documenting that the patient refused the medication will not help the patient. 2 The only way you will know what is “hot” and “cold” is to ask. Once this is understood the nurse can plan care accordingly. 3 The concepts of “hot” and “cold” do apply to illnesses and treatments. This would be inaccurate information. 4 The patient’s illness might get worse, however, this does not help with the patient’s approach to treatment using the “hot” and “cold” approach.
PTS: 1
CON: Diversity
23. ANS: 3 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 5. Identify health-care needs of European Americans. Chapter page reference: 171 Heading: European Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 Health care in the United States is seen as being reliant on family or extended family groups. This would be consistent with black Americans. 2 Health care in the United States is seen as being reliant on family or extended family groups. This would be consistent with Asian Americans. 3 Because many European countries have national health-care plans with socialized medicine, there is an expectation that the federal government is responsible for each
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
person’s health care. Health care in the United States is seen as being reliant on family or extended family groups.
PTS: 1
CON: Diversity
24. ANS: 3 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 5. Identify health-care needs of European Americans. Chapter page reference: 171 Heading: European Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 European body structure is diverse. 2 There is no typical hair or eye color of a European American. 3 Most European Americans have white skin and are easily mistaken for someone who has lived in the United States throughout his or her life. 4 People from the European culture are used to the government supplying health care.
PTS: 1
CON: Diversity
25. ANS: 2 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 5. Identify health-care needs of European Americans. Chapter page reference: 171 Heading: European Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 The patient speaks with an accent. An interpreter is not necessary. 2 The nurse needs to identify the patient’s country of origin to plan culturally sensitive care for the patient. 3 A male family member being the primary decision maker is not consistent with the European culture. 4 Extended family caring for older persons is not a characteristic of the European culture.
PTS: 1
CON: Diversity
26. ANS: 2 Chapter number and title: Chapter 9: Culturally Specific Care
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 6. Identify health-care needs of Jewish Americans. Chapter page reference: 175 Heading: Jewish Americans Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Toast is not forbidden in a traditional Jewish diet. 2 Traditional Jewish people are forbidden from eating pork. The bacon needs to be removed from the meal tray. 3 Oatmeal is not forbidden in a traditional Jewish diet. 4 Orange juice is not forbidden in a traditional Jewish diet.
PTS: 1
CON: Diversity
27. ANS: 4 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 6. Identify health-care needs of Jewish Americans. Chapter page reference: 175 Heading: Jewish Americans Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Asking everyone to leave does not support this patient’s need for a support system. 2 Enforcing the two visitors per patient policy does not support this patient’s need for a support system. 3 Suggesting that the visits be limited to 15 minutes each does not support this patient’s need for a support system. 4 Finding another area for the patient and family members and friends to visit is the most culturally appropriate way to support this patient’s need for a support system.
PTS: 1
CON: Diversity
28. ANS: 1 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 7. Identify health-care needs of Native Americans. Chapter page reference: 167 Heading: Native Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Feedback Guided by a shaman, a ceremony is used to heal the patient. Ceremonies with ill individuals are not performed to celebrate life. Ceremonies with ill individuals are not done to prepare for the person’s death. Ceremonies with ill individuals are not done to bring the family closer together.
PTS: 1
CON: Diversity
29. ANS: 1 Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 7. Identify health-care needs of Native Americans. Chapter page reference: 167 Heading: Native Americans Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 The shaman is someone who should be welcomed into the room of the person who is ill. It is important for the nurse to obtain any items as requested. 2 Denying the shaman access to the patient does not support the patient’s cultural needs. 3 The towels and water might not be used for bathing. It might be a part of the healing ritual. 4 It is inappropriate to only fulfill one part of the request. The shaman is a guest and is present for a specific purpose to help the patient.
PTS: 1
CON: Diversity
MULTIPLE RESPONSE 30. ANS: 3, 4 1. 2. 3. 4.
5.
Feedback Frankfurters contain pork. A ham slice, like bacon, is a pork product. The pharmacy should be asked to send only non-pork insulin for this patient. Many black Muslims follow the Halal diet, which means they do not eat pork or any pork products. If he tells you that he follows this diet, you should discuss it with the dietitian, who can ensure that he does not receive any pork or pork products. Telling the patient to eat what is provided and take medication as prescribed is not providing culturally sensitive nursing care.
Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 2. Identify health-care needs of black Americans. Chapter page reference: 165 Heading: Black Americans Integrated Processes: Nursing Process: Implementation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate PTS: 1
CON: Diversity
31. ANS: 1, 3, 4 Feedback 1. In traditional Asian families elders are cared for at home by their family. 2. In traditional Asian families elders are not sent to nursing homes routinely when they reach a certain age. 3. In traditional Asian families elders are placed in a nursing home only if they do not have family members to care for them. 4. In traditional Asian families elders are sent to nursing homes only if the older person does not want to be around small children. 5. In traditional Asian families elders are not sent to nursing homes as soon as they become infirm or unable to contribute to family life. Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 3. Identify health-care needs of Asian Americans. Chapter page reference: 169 Heading: Asian Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy PTS: 1
CON: Diversity
32. ANS: 1, 2, 3 Feedback 1. Asian Americans have the highest median income of any foreign-born group. This factor assists them in being healthier people. 2. Asian Americans are well-educated. This factor assists them in being healthier people. 3. Asian Americans obtain residency status. This factor assists them in being healthier people. 4. Obtaining a driver’s license does not assist them in being healthier people. 5. Living with extended family does not assist them in being healthier people. Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 3. Identify health-care needs of Asian Americans. Chapter page reference: 169 Heading: Asian Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Diversity
33. ANS: 2, 4, 5 Feedback 1. Arthritis is not identified as being a disease of poverty for the Hispanic population. 2. Diabetes is identified as being a disease of poverty for the Hispanic population. 3. Pneumonia is not identified as being a disease of poverty for the Hispanic population. 4. Malnutrition is identified as being a disease of poverty for the Hispanic population. 5. Heart disease is identified as being a disease of poverty for the Hispanic population. Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 4. Identify health-care needs of Hispanic Americans. Chapter page reference: 174 Heading: Hispanic Americans Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Diversity Difficulty: Easy PTS: 1
CON: Diversity
34. ANS: 3, 5 1. 2. 3. 4. 5.
Feedback People in the Jewish culture believe that maintaining good health is an expectation, not a right. The holy book is used to teach Jewish people to visit and assist the sick. In the Jewish culture maintaining good health is an expectation. Prayer is used to ask God for improvement of health or healing of the body. In the Jewish culture the use of modern medicine is encouraged.
Chapter number and title: Chapter 9: Culturally Specific Care Chapter/learning objective: 6. Identify health-care needs of Jewish Americans. Chapter page reference: 175 Heading: Jewish Americans Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate PTS: 1
CON: Diversity
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 10: Activity, Rest, and Sleep as Criteria for Health Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which is true about an older adult’s sleep pattern? 1) Go to bed earlier 2) Sleep later in the morning 3) Wake earlier in the morning 4) Take several naps during the day
2. The nurse is assigning tasks to nursing assistants in a nursing home. Which would be the most appropriate instruction to give to the assistant who will care for a frail 80-year-old woman with arthritis? 1) Help her to use a bedpan. 2) Bring her meal trays to the bed. 3) Give her a bed bath, comb her hair, and brush her teeth. 4) Let the patient do as much as she can for mouth and personal care and toileting.
3. Which is NOT a realistic expectation about stress in an older person’s life? 1) It increases with age. 2) It should be managed. 3) It should be eliminated. 4) It can have beneficial results.
4. An older patient with gastroesophageal reflux disease (GERD) and heart failure complains of insomnia and of always feeling tired. What should the nurse suggest to help the patient sleep better? 1) Lie on the left side. 2) Take a long-lasting analgesic before bed. 3) Take antacids before bed to relieve gastric reflux. 4) Raise the head of the bed so that the upper body is elevated.
5. An older male patient with obesity reports feeling tired all of the time, even in the morning. The patient’s spouse says he snores loudly. What disorder should the nurse suspect? 1) GERD 2) Dementia 3) Sleep apnea 4) Nocturnal myoclonus
6. Which is not identified as contributing to disturbed or interrupted sleep? 1) Activity 2) Alcohol 3) Tobacco 4) Sedentary lifestyle
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
7. An older patient states that the most activity he wants to get is walking from the couch to the kitchen table to eat every day. What might be this patient’s philosophy of activity and exercise? 1) Exercise is a luxury. 2) Exercise is not necessary. 3) Exercise is a waste of time. 4) Exercise is for younger people.
8. The nurse notes that an older patient who had been on bedrest for a deep venous thrombosis is reluctant to ambulate and expresses fatigue and disinterest in recovery. How should the nurse respond to this patient? 1) “It is wise to limit ambulation with your health problems.” 2) “That is just a normal part of aging. You will get used to less activity.” 3) “Exercising will help you regain your strength and motivation to get better.” 4) “There are other things that you can do to take your mind off of your health problems.”
9. The nurse is guiding a group of older patients with limited mobility on an exercise to improve strength in the lower legs. What goal is this nurse supporting? 1) Increase the number of older adults with physical mobility issues to walk independently. 2) Increase the number of older adults who are wheelchair-bound to maintain muscle tone and function. 3) Increase the number of older adults with arthritis to experience less pain and improve their quality of life. 4) Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities
10. The nurse is aware of an older patient having difficulty with upper arm mobility. Which activity should the nurse encourage to help this patient? 1) Tie shoes. 2) Comb hair. 3) Put on socks. 4) Flex the ankles.
11. A group of older community members are taking a walk through the neighborhood arboretum. Which type of activity are these individuals engaging in? 1) Endurance 2) Balance training 3) Muscle lengthening 4) Flexibility exercises
12. An older person attends yoga three times a week. Which type of activity is this person participating in? 1) Flexibility 2) Endurance
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Circuit training 4) Muscle building
13. An older person notices that after working in the garden she has to sit and rest for a few minutes. What should the nurse say in response to this patient? 1) “This means that you are not eating enough.” 2) “It might be that the gardening will need to be given up if it is too tiring for you.” 3) “That’s an abnormal behavior that should be investigated by your health-care provider.” 4) “This means you are moderating activity with rest to stay energized throughout the day.”
14. An older patient is observed napping at 10:00 a.m., 1:00 p.m., 3:00 p.m., and again at 7:00 p.m. What action should the nurse take? 1) Nothing, since this is normal behavior. 2) Discuss the need for frequent napping with the patient. 3) Hang a “do not disturb” sign on the patient’s room door. 4) Recommend that the patient stay in bed for most of the day.
15. The nurse observes that an older patient is increasingly irritable, does not want to participate in routine activities, and is frequently napping. What should the nurse do to help this patient? 1) Encourage more napping. 2) Restrict interaction with other people. 3) Reduce the amount of daytime activities. 4) Provide uninterrupted sleep during the night.
16. The nurse notes that an older patient who usually awakens in the morning at 5:00 a.m. is watching television at 1:00 a.m.. What should the nurse consider is occurring with the patient? 1) Off-balance circadian rhythm 2) Mechanism to relieve boredom 3) Not sleepy because of napping throughout the day 4) Attempting to stay awake longer to sleep longer in the morning
17. An older patient tells the nurse that sleep is optional because moving in bed is painful. What should the nurse do first to help this patient? 1) Assess pain level. 2) Provide pain medication. 3) Review the causes of the pain. 4) Discuss pain management strategies.
18. The nursing assistant reports that a newly admitted older patient is confused. What should the nurse find out during morning report about this patient? 1) What is the patient’s routine diet? 2) What time was the patient admitted?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Did the patient sleep through the night? 4) What activities does the patient like to perform?
19. An older patient is experiencing a new onset of ankle edema. What should the nurse include when assessing this patient? 1) Routine oral intake 2) Ability to perform ADLs 3) Feelings after sleeping throughout the night 4) Amount of physical activity performed during the day
20. An older patient desires to increase tolerance for walking but becomes fatigued with short distances. What should the nurse suggest to this patient? 1) Walk in a mall, stopping when necessary to sit. 2) Walk 10 feet to the mailbox several times a day. 3) Walk in the park and stop periodically to sit on a bench. 4) Walk in the grocery store using a cart for stability and support.
21. An older patient reports engaging in physical activity 15 minutes every day. What should the nurse say in response to this patient’s activity level? 1) “That’s all you need!” 2) “You need to increase that to 30 minutes every day.” 3) “Why so much? Fifteen minutes every other day would be better.” 4) “Just 7 more minutes a day and then you will be right on target.”
22. The spouse of an older patient asks the nurse why the patient is shaking the cans of soup so much every day. How should the nurse respond to the spouse? 1) “That’s to keep her arms limber.” 2) “That’s being done to increase elbow flexibility.” 3) “That’s an exercise using a can of soup as a weight.” 4) “That’s to make sure the contents that have settled are dispersed throughout the soup.”
Multiple Response Identify one or more choices that best complete the statement or answer the question. 23. An older patient with chronic obstructive pulmonary disease and degenerative arthritis affecting her lower back and legs is unable to exercise and has someone deliver food and other necessities. Which interventions are appropriate to help improve this patient’s physical status? Select all that apply. 1) Consider moving to an assisted living facility. 2) Discuss family members who can move in to help her. 3) Explain activities such as using a walker for shopping. 4) Encourage getting out of the house to interact with others. 5) Suggest that she accept her limitations and live as best she can.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
24. Which health problems are managed or prevented by activity? Select all that apply. 1) Arthritis 2) Diabetes 3) Osteoporosis 4) Diverticulitis 5) Heart disease
25. During a home visit, the nurse suspects that an older person is participating in routine physical activity. What did the nurse observe to have this conclusion? Select all that apply. 1) Asks a grandson to help him stand up 2) Weight loss of 2 lb over the last month 3) Rests on a walker after moving a few feet 4) Able to bend down to pick up the newspaper 5) Recalls when the next health-care appointment is scheduled
26. The nurse is preparing a community program focusing on the importance of physical activity for older people with chronic health problems. Which health problems should the nurse highlight as being the most common in this age group? Select all that apply. 1) Arthritis 2) Diabetes 3) Hypertension 4) Prostate cancer 5) Urinary incontinence
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 10: Activity, Rest, and Sleep as Criteria for Health Answer Section MULTIPLE CHOICE 1. ANS: 3 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 3. Describe normal rest and sleep patterns for older adults. Chapter page reference: 190 Heading: Sleep Disorders Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Knowledge [Remembering] Concept: Sleep, Rest, and Activity Difficulty: Easy Feedback 1 Going to bed earlier will cause an earlier wake-up time. 2 Often older people try to stay up later in the evening, thinking that this will allow them to sleep later in the morning, but that often does not happen. 3 As people get older, they often awake earlier—sometimes at 4:00 or 5:00 a.m.—even though they do not need to rise that early. 4 Many need a daytime nap, but some try to avoid that, hoping to sleep better at night. Too-frequent daytime naps can disrupt nighttime sleep patterns.
PTS: 1
CON: Sleep, Rest, and Activity
2. ANS: 4 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 1. Express an understanding of the importance of activity for all older adults, including the most disabled. Chapter page reference: 184 Heading: How to Keep Older Adults Active Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate Feedback 1 If possible, the bedpan should not be used. The patient should be assisted to walk to the bathroom. 2 Meals should not be eaten in bed. Sitting up improves digestion and reduces acid reflux. 3 Giving a bath and performing personal care for the patient reduces the patient’s selfesteem and does not promote healthy activity. 4 The “allow people to do as much for themselves as possible” rule should extend to all of the care given people in the nursing home, the hospital, or the home. Activities such as walking to the bathroom, brushing the teeth, and combing the hair provide activity and exercise-related physical benefits, such as improved range of motion, and psychological benefits of improved self-esteem and a sense of accomplishment.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Sleep, Rest, and Activity
3. ANS: 3 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 4. Identify older adults who are most at risk for developing rest and sleep disturbances. Chapter page reference: 188 Heading: Stress Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Stress Difficulty: Easy
1
2 3 4
Feedback Stress may or may not increase with age. It may increase because of pain or difficulty in doing specific things but it may also decrease with lightened professional and family responsibilities. Stress should be managed and used to channel energy and achieve goals. Stress cannot be totally eliminated and perhaps should not be. Life is a series of stressful events. Much of the stress actually enhances our lives. Some stress assists us in achieving our goals and other stress simply makes us feel alive and assists us in avoiding boredom.
PTS: 1
CON: Stress
4. ANS: 4 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 5. Apply nursing interventions to older adults who are experiencing problems with activity, rest, or sleep. Chapter page reference: 190 Heading: Sleep Disorders Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Digestion; Sleep, Rest, and Activity Difficulty: Moderate
1 2 3 4
Feedback Lying on the side may help but is unrealistic as a long-term solution. The patient is not experiencing pain. The health-care provider prescribes the use of antacids. This is beyond the nurse’s scope of practice. Patients with GERD and heart failure should sleep with the head of the bed elevated. The head of the bed can be raised by placing blocks under the head end or by other means.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Digestion | Sleep, Rest, and Activity
5. ANS: 3 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 5. Apply nursing interventions to older adults who are experiencing problems with activity, rest, or sleep. Chapter page reference: 190 Heading: Sleep Disorders Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Oxygenation; Sleep, Rest, and Activity Difficulty: Moderate Feedback 1 GERD is reflux of stomach contents. 2 Dementia would cause wandering. 3 The classic symptom of sleep apnea is fatigue on awakening and throughout the day. People with sleep apnea are very tired all the time. Sleep apnea occurs when the patient’s airway is partially obstructed during sleep. Many people with sleep apnea are overweight. 4 Nocturnal myoclonus is sudden movements of the legs.
PTS: 1
CON: Oxygenation | Sleep, Rest, and Activity
6. ANS: 1 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 3. Describe normal rest and sleep patterns for older adults. Chapter page reference: 191 Heading: Sleep Disorders Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Knowledge [Remembering] Concept: Sleep, Rest, and Activity Difficulty: Easy Feedback 1 Activity, whether it be strenuous exercise or simple walking and completing the activities of daily life (ADLs), improves sleep. 2 Alcohol contributes to disturbed or interrupted sleep. 3 Tobacco contributes to disturbed or interrupted sleep. 4 A sedentary lifestyle contributes to disturbed or interrupted sleep.
PTS: 1
CON: Sleep, Rest, and Activity
7. ANS: 2 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 1. Express an understanding of the importance of activity for all older adults, including the most disabled.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 183 Heading: Activity Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Easy Feedback 1 There is no indication that the patient believes that exercise is a luxury. 2 Stating that the only exercise desired is walking from the couch to the kitchen indicates that the patient believes exercise is not necessary. 3 There is no indication that the patient believes that exercise is a waste of time. 4 There is no indication that the patient believes that exercise is for younger people.
PTS: 1
CON: Sleep, Rest, and Activity | Promoting Health
8. ANS: 3 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 1. Express an understanding of the importance of activity for all older adults, including the most disabled. Chapter page reference: 183 Heading: Advantages and Disadvantages of Exercise Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate Feedback 1 The nurse should encourage the patient to increase activity. 2 Fatigue and disinterest in life is not a normal part of aging. 3 Exercise improves functioning of the musculoskeletal and cardiovascular systems. It also prevents boredom. 4 Suggesting something else to take the patient’s mind off of health problems will not be beneficial to the patient over the long-term.
PTS: 1
CON: Sleep, Rest, and Activity | Promoting Health
9. ANS: 4 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 2. Discuss the significance of activity for people with and without chronic diseases. Chapter page reference: 184 Heading: How to Keep Older Adults Active Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Feedback The nurse is not preparing the older patients to walk independently because this might not be realistic. The nurse might be helping to maintain muscle tone and function, however, this would be an effect of the activity. There is no guarantee that the nurse’s exercises will help patients with arthritis experience less pain and an improved quality of life. This nurse’s actions are supporting the Healthy People 2020 objective to increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities.
PTS: 1
CON: Sleep, Rest, and Activity | Promoting Health
10. ANS: 2 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 2. Discuss the significance of activity for people with and without chronic diseases. Chapter page reference: 184 Heading: How to Keep Older Adults Active Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate Feedback 1 Tying the shoes would help with spine, lower extremity, and finger flexibility. 2 Combing the hair would help with upper arm mobility. 3 Putting on socks would help with spine, lower extremity, and hand/finger flexibility. 4 Flexing the ankles would help with foot flexibility.
PTS: 1
CON: Sleep, Rest, and Activity | Promoting Health
11. ANS: 1 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 2. Discuss the significance of activity for people with and without chronic diseases. Chapter page reference: 184 Heading: How to Keep Older Adults Active Integrated Processes: Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Mobility; Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate Feedback 1 Walking helps with physical endurance. 2 Balance training is done in a standing position, on an uneven surface, and uses muscles to improve joint stability.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
Muscle-lengthening exercises would be stretching. Flexibility exercises include yoga, stretching, and tai chi.
PTS: 1
CON: Mobility | Sleep, Rest, and Activity | Promoting Health
12. ANS: 1 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 2. Discuss the significance of activity for people with and without chronic diseases. Chapter page reference: 185 Heading: How to Keep Older Adults Active Integrated Processes: Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Mobility; Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate Feedback 1 Yoga improves flexibility. 2 Yoga does not improve endurance. 3 Yoga is not building muscle as would be accomplished with circuit training. 4 Yoga is not a muscle-building activity.
PTS: 1
CON: Mobility | Sleep, Rest, and Activity | Promoting Health
13. ANS: 4 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 3. Describe normal rest and sleep patterns for older adults. Chapter page reference: 188 Heading: “All I Do is Rest!” Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity Difficulty: Moderate Feedback 1 There is not a direct correlation between the need for rest and diet or nutrition. 2 This is not appropriate. The nurse needs to support the patient with performing desired activities. 3 This is not an abnormal behavior. This is something that occurs with the aging process. 4 This is accurate because the patient needs to modify activity to what works best for the individual.
PTS: 1
CON: Sleep, Rest, and Activity
14. ANS: 2 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 3. Describe normal rest and sleep patterns for older adults.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 188 Heading: “All I Do is Rest!” Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity Difficulty: Moderate Feedback 1 An older person may normally nap one or two times a day. 2 Oversleeping may be caused by boredom or depression. The napping needs to be discussed with the patient. 3 Hanging a “do not disturb” sign on the door supports the frequent napping. 4 Having the patient stay in bed during the day supports inactivity and further sleeping.
PTS: 1
CON: Sleep, Rest, and Activity
15. ANS: 4 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 3. Describe normal rest and sleep patterns for older adults. Chapter page reference: 189 Heading: Sleep Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity Difficulty: Moderate Feedback 1 Encouraging more napping will hinder the natural circadian rhythm of this patient. 2 Restricting interaction with other people will increase isolation and irritability. 3 Reducing the amount of daytime activities will encourage fatigue and hinder sleep during the night. 4 Providing for uninterrupted sleep during the night will help with restorative sleep to ensure body rest and maximize functioning.
PTS: 1
CON: Sleep, Rest, and Activity
16. ANS: 4 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 3. Describe normal rest and sleep patterns for older adults. Chapter page reference: 189 Heading: Sleep Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Analysis [Analyzing] Concept: Sleep, Rest, and Activity Difficulty: Moderate Feedback 1 The patient’s circadian rhythm supports early morning wakening.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
There is not enough information to determine if the patient is using television to combat boredom. There is no evidence that the patient was napping throughout the day. A normal circadian rhythm change in older people is early morning wakening. This normal physiological change causes many older people to want to stay up late so that they do not wake up at 4:00 or 5:00 in the morning.
PTS: 1
CON: Sleep, Rest, and Activity
17. ANS: 1 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 4. Identify older adults who are most at risk for developing rest and sleep disturbances. Chapter page reference: 185 Heading: Pain Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Application [Applying] Concept: Comfort Difficulty: Moderate Feedback 1 Failure to identify pain as a factor may adversely affect the patient’s ability to function. The patient’s level of pain must be assessed first. 2 Pain medication would be provided after determining the patient’s pain level. 3 Reviewing the causes of the pain can occur after the pain level has been assessed. 4 Pain management strategies can occur after the pain level has been assessed.
PTS: 1
CON: Comfort
18. ANS: 3 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 4. Identify older adults who are most at risk for developing rest and sleep disturbances. Chapter page reference: 190 Heading: Sleep Disorders Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity; Cognition Difficulty: Moderate Feedback 1 The patient’s diet is not contributing to the confusion. 2 The time the patient was admitted is not contributing to the confusion. 3 Older adults who do not get enough sleep can experience confusion. 4 The patient’s activities are not contributing to the confusion.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Sleep, Rest, and Activity | Cognition
19. ANS: 3 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 4. Identify older adults who are most at risk for developing rest and sleep disturbances. Chapter page reference: 190 Heading: Sleep Disorders Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity; Oxygenation Difficulty: Moderate
1 2 3
4
Feedback The patient’s routine oral intake will not cause the new onset of ankle edema. The patient’s ability to perform ADLs living would not cause the edema. The patient might be experiencing sleep apnea. Sleep apnea causes a person to feel fatigued all of the time. Sleep apnea can lead to right heart failure, which would explain the new onset of ankle edema. The amount of physical activity performed during the day would not cause the ankle edema.
PTS: 1
CON: Sleep, Rest, and Activity | Oxygenation
20. ANS: 2 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 5. Apply nursing interventions to older adults who are experiencing problems with activity, rest, or sleep. Chapter page reference: 184 Heading: How to Keep Older Adults Active Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate
1 2 3 4
Feedback Walking in a mall might be too strenuous for this patient. Walking short distances several times a day will help increase this patient’s tolerance. Walking in the park might be too strenuous for this patient. Walking in the grocery story might be too strenuous for this patient.
PTS: 1
CON: Sleep, Rest, and Activity | Promoting Health
21. ANS: 4 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 5. Apply nursing interventions to older adults who are experiencing problems with activity, rest, or sleep. Chapter page reference: 187 Heading: Point of Interest Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate
1 2 3 4
Feedback The patient should be encouraged to have 2 hours and 30 minutes of aerobic activity a week and 2 or more days of muscle strengthening activity each week. The patient does not need to increase the time to 30 minutes a day. That would be 3 hours and 30 minutes a week of aerobic activity. The patient needs to increase the amount slightly, not decrease the amount. Two hours and 30 minutes a week calculates to approximately 22 minutes a day of aerobic activity.
PTS: 1
CON: Sleep, Rest, and Activity | Promoting Health
22. ANS: 3 Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 5. Apply nursing interventions to older adults who are experiencing problems with activity, rest, or sleep. Chapter page reference: 187 Heading: Point of Interest Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate
1 2 3 4
Feedback Exercising with weights may keep the arms limber, but that’s not the complete reason. Exercising with weights may keep the elbows limber, but that’s not the complete reason. Exercising with weights like canned soup is being done to maintain muscle tone and function. The patient is not shaking the soup. It is being used as a weight for musclestrengthening exercise.
PTS: 1 MULTIPLE RESPONSE 23. ANS: 1, 3, 4 Feedback
CON: Sleep, Rest, and Activity | Promoting Health
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1.
2. 3. 4. 5.
Suggesting that she think about an assisted living facility where she may have help as needed but maintain independence is also appropriate. Many assisted living facilities also have scheduled and age-appropriate exercise programs. Finding family members to move in to help the patient would not be appropriate because the patient already has a method to obtain food and living necessities. Encouraging the patient to use a walker for shopping will increase physical activity. Encouraging getting out of the house to interact with others is a suggestion to reduce feelings of isolation. Suggesting the patient accept limitations is the patient’s current status. The intention is to improve the patient’s activity status.
Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 2. Discuss the significance of activity for people with and without chronic diseases. Chapter page reference: 184 Heading: How to Keep Older Adults Active Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate PTS: 1
CON: Sleep, Rest, and Activity | Promoting Health
24. ANS: 1, 2, 3, 5 Feedback 1. Exercise helps to manage arthritis. 2. Exercise helps to prevent diabetes. 3. Exercise helps to prevent osteoporosis. Exercise is not identified as helpful in the prevention or management of diverticulitis, 4. although exercise can improve bowel function and prevent constipation. 5. Exercise helps to prevent heart disease. Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 2. Discuss the significance of activity for people with and without chronic diseases. Chapter page reference: 186 Heading: Focused Learning Chart: Advantages of Exercise Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Easy PTS: 1
CON: Sleep, Rest, and Activity | Promoting Health
25. ANS: 2, 4, 5 Feedback 1. Needing help to stand indicates that the patient is not participating in routine physical activity.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2. 3. 4. 5.
Routine physical activity helps to control weight. Resting after walking a few feet indicates that the patient is not participating in routine physical activity. Being able to bend down to pick up a newspaper indicates that flexibility is improved, evidence of participating in routine physical activity. Improvement in mental functioning is an indication of participation in routine physical activity.
Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 1. Express an understanding of the importance of activity for all older adults, including the most disabled. Chapter page reference: 183 Heading: Introduction Integrated Processes: Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate PTS: 1
CON: Sleep, Rest, and Activity | Promoting Health
26. ANS: 1, 2, 3 Feedback 1. Arthritis is identified as being the most common chronic health problem in older people. 2. Diabetes is identified as being one of the top ten most common chronic health problems in older people. 3. Hypertension is identified as being the second most common chronic health problem in older people. 4. Prostate cancer is not identified as being a common chronic health problem in older people. Urinary incontinence is not identified as being a common chronic health problem in older 5. people. Chapter number and title: Chapter 10: Activity, Rest, and Sleep as Criteria for Health Chapter/learning objective: 1. Express an understanding of the importance of activity for all older adults, including the most disabled. Chapter page reference: 184 Heading: Box 10.2 Ten Most Common Chronic Diseases in People Older Than Age 65 in the United States Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity; Promoting Health Difficulty: Moderate PTS: 1
CON: Sleep, Rest, and Activity | Promoting Health
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 11: End-of-Life Issues in Older Adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which would NOT be included in palliative care? 1) Chemotherapy 2) Flotation mattress 3) Intravenous (IV) lines for hydration 4) Pain medication for relief of distress
2. Which statement about hospice care is NOT true? 1) Hospice care has a small patient-to-worker ratio. 2) Hospice care serves the dying patient exclusively. 3) Hospice care is responsive 24 hours a day 7 days a week. 4) Hospice care encourages the involvement of the patient’s personal physician.
3. An older patient who recently lost his spouse sits in the bedroom, venturing out only for brief minutes. His eyes are reddened and swollen, his appetite is decreased, and even the simplest task is too exhausting for him. In which stage of grief is this patient? 1) Denial 2) Bargaining 3) Depression 4) Acceptance
4. What best defines tolerance? 1) Compassion and endurance 2) Impatience and impartiality 3) Impatience and open-mindedness 4) Closed-mindedness and impartiality
5. Which behavior exemplifies empathy? 1) Crying with patients 2) Understanding patients 3) Identifying with patients 4) Making choices for patients
6. Which is NOT a benchmark of a good listener? 1) Taking time 2) Not interrupting 3) Asking appropriate questions 4) Assuming what the person is going to say
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
7. An older patient has a living will that clearly states no intubation, no IV hydration, and no feeding tube. As the end of life nears, the patient’s daughter requests a feeding tube for the patient. What should the facility do? 1) Go to court to figure out what action to take. 2) Ask the patient’s physician to make the decision. 3) Go along with the daughter and insert a feeding tube. 4) Refuse because the patient has clearly stated wishes in a legal document.
8. What is the primary objective of an advance directive? 1) Prevent abuse of incompetent patients. 2) Follow the wishes of the person who wrote it. 3) Give families the right to make health-care decisions for the patient. 4) Give the state permission to make life-or-death decisions for the patient.
9. What are the components of a quality hospice program? 1) Is sensitive to different cultures, has a small patient-to-worker ratio, responds Monday through Friday, 9:00 a.m. to 5:00 p.m. 2) Has community support, allows for high patient-to-caregiver ratios, responds to family and patient needs 3) Has an interdisciplinary team, is sensitive to cultural differences, responds to patient and family wants and needs 4) Has a specific religious belief structure, has small patient-to-caregiver ratios, is rigid in their ability to respond to specific needs
10. Which behavior is NOT necessary when working with dying patients? 1) Flexibility 2) Immaturity 3) Sense of humor 4) Good listening skills
11. An older patient who just lost her husband of 60 years is seen yelling at his picture, at the pictures of their children and grandchildren, and at the Bible in her hand. What should the nurse do? 1) Call her family members. 2) Call the physician for a restraint order. 3) Stay with her and allow her to be angry at the situation. 4) Check the medication log to see if she can have something for agitation.
12. The family of a dying patient has been sitting at his bedside for hours, watching over the decreasing respirations. No one is speaking. What should the nurse say to the patient’s son? 1) Encourage him to try to feed his father. 2) Encourage him to count the respirations to pass the time. 3) Encourage him to go home because this might be a long process. 4) Encourage him to talk to the patient because hearing is the last sense to go.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
13. An older patient with a terminal illness is beginning hospice care. What should the nurse realize about this patient? 1) The patient should prepare a living will. 2) The patient should be admitted to a hospital. 3) The patient has approximately 6 months to live. 4) The patient will receive medications to cure the illness.
14. The nurse desires to become a member of a hospice team. What should the nurse expect to do when providing hospice care? 1) Stay with the patient around-the-clock. 2) Encourage the patient to maintain independence. 3) Instruct the patient to stop eating food and fluids. 4) Provide support and education to family members.
15. A terminally ill patient died 2 days after starting hospice. What should this indicate to the nurse? 1) Hospice was used too little. 2) Hospice was used too much. 3) Hospice was used appropriately. 4) Hospice was not indicated for this patient.
16. The spouse of a recently deceased older patient says that he does not really remember the funeral. Which stage of the grieving process is the spouse describing? 1) Shock 2) Denial 3) Despair 4) Depression 17. An older person grieving the loss of her spouse says that she doesn’t want to live anymore. What should this statement indicate to the nurse? 1) The patient is bargaining. 2) The patient may attempt suicide. 3) The patient is accepting the spouse’s death. 4) The patient is denying that the spouse has died.
18. An older patient who lost her spouse a year ago is seen crying quietly in church during the singing of one hymn. What should this patient’s behavior indicate? 1) The patient is unable to complete grieving. 2) The patient is denying that the death occurred. 3) The patient is in the depression phase of grieving. 4) The patient is in the acceptance phase of grieving.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
19. A terminally ill older patient is finding fault with the care being provided and complaining that no one cares about him. What action should the nurse take to demonstrate tolerance? 1) Stay with the patient. 2) Leave the patient alone. 3) Say that it’s not your fault that the patient is dying. 4) Argue that the patient has received appropriate care.
20. While providing morning care to a terminally ill patient the nurse observes the nursing assistant laughing with the patient. What should the nurse do? 1) Explain to the assistant that death is not a laughing matter. 2) Suggest that laughter be limited because others are trying to rest. 3) Realize that the laughter is helping the patient soothe the eventual outcome. 4) Assign the assistant to other non-patient related tasks because of inappropriate behavior.
21. During a home visit, a terminally ill patient tells the nurse about his years in the Army and how he should have gone to “cooking and baking school” instead of becoming a military policeman. What should the nurse do during this story that indicates listening? 1) Say nothing. 2) Interrupt the patient to measure vital signs. 3) Remind the patient that time is limited for the visit. 4) Ask if the patient regrets not learning how to cook and bake.
22. While providing morning care to a terminally ill patient the nurse notes that the patient has been incontinent of bowel and bladder for the first time since admission. What should this indicate to the nurse? 1) The patient is near death. 2) The patient’s diet needs to be adjusted. 3) The patient is receiving too much pain medication. 4) The patient should be reminded to call for help with toileting.
23. The nurse notes that a terminally ill patient has cold extremities despite being saturated with sweat. What should the nurse do? 1) Place the patient on a cooling blanket. 2) Place a fan in the room, angled to cool the patient’s torso. 3) Change the gown and cover the arms and legs with a blanket. 4) Increase the room temperature and remove blankets from the patient.
24. While sitting at the bedside of a dying patient, the patient’s two sons are discussing the patient’s rifle collection and state that they hope their father identified which of them was to receive the guns in the will. What should the nurse do? 1) Close the patient’s room door. 2) Remind the sons that their father needs rest and that they should leave. 3) Suggest that the sons get a copy of the will so that their questions will be answered.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Take the sons into the hallway to remind them that their father hears what they are saying.
25. The spouse of a terminally ill patient asks why antibiotics are being prescribed for an infection when the patient is going to die anyway. How should the nurse respond? 1) “The infection could cause discomfort.” 2) “The antibiotics will add days to the patient’s life.” 3) “Permitting the patient to die is a form of assisted suicide.” 4) “I’ll ask the physician why the medication was prescribed.”
26. The nurse desires to work for a hospice agency. Which type of care should the nurse expect to provide to assigned patients? 1) Curative 2) Palliative 3) Restorative 4) Rehabilitative
27. A dying patient tells the nurse that he does not want any more renal dialysis treatments and just wants to be permitted to die. What should the nurse do with medications prescribed to control the patient’s edema? 1) Mark them as refused. 2) Provide them to the patient. 3) Throw the medications in the trash. 4) Place the medications in another patient’s medication drawer.
28. An older patient tells the nurse that he does not want to create a living will because he does not want to die. What should the nurse say in response to this patient? 1) “A living will is not a death sentence.” 2) “That’s probably a good idea. Don’t tempt fate.” 3) “I know what you mean. I don’t have one either.” 4) “Having a living will makes sure that you receive the care that you want when death approaches.”
29. The graduate nurse has relocated to another state and is beginning a position in a skilled nursing facility. Where should the nurse obtain information regarding advance directives for the new state of residence? 1) Ask the nurse manager. 2) Discuss it with the administrator. 3) Contact the new state board of nursing. 4) Ask the school of nursing about the information.
Multiple Response Identify one or more choices that best complete the statement or answer the question. 30. Which is true about end-of-life care? Select all that apply.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1) 2) 3) 4) 5)
It is the same for all people Includes managing symptoms Considers referrals to support the patient Includes communication and education about choices Requires the nurse to be in touch with individual beliefs
31. What describes terminal restlessness? Select all that apply. 1) Could include yelling or moaning 2) Involuntary thrashing or agitation 3) Rarely occurs during the dying process 4) A common occurrence at the end of life 5) Occurs as a result of progressive shutdown of body systems
32. When are the stages of grief present? Select all that apply. 1) When a pet dies 2) During a divorce 3) Starting a new job 4) After a mastectomy 5) When someone dies
33. Which are advance directives? Select all that apply. 1) A will 2) A living will 3) A health-care proxy 4) A durable power of attorney 5) Assignment of an estate executor
34. Which are signs of impending death? Select all that apply. 1) Cold extremities 2) Frequent coughing 3) Weak, rapid pulse 4) Profuse perspiration 5) Slow pupil response to light
35. The nurse is helping a patient think about things to include in a living will. What should the nurse suggest to the patient? Select all that apply. 1) Feeding tube 2) Breathing tube 3) Food and fluids 4) Pacemaker insertion 5) Mechanical ventilation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 11: End-of-Life Issues in Older Adults Answer Section MULTIPLE CHOICE 1. ANS: 1 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 5. Use your knowledge of palliative care to provide the information to a patient and family. Chapter page reference: 204 Heading: End-of-Life Decision Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Grief and Loss Difficulty: Easy Feedback 1 Chemotherapy is aimed at a cure and is not palliative care. 2 Palliative care is not aimed at a cure but at symptom management and comfort. Special bedding is a comfort measure. 3 Palliative care is not aimed at a cure but at symptom management and comfort. An IV line for hydration is a comfort measure. 4 Palliative care is not aimed at a cure but at symptom management and comfort. Pain medication is a comfort measure.
PTS: 1
CON: Grief and Loss
2. ANS: 2 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 5. Use your knowledge of palliative care to provide the information to a patient and family. Chapter page reference: 204 Heading: End-of-Life Decision Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Grief and Loss Difficulty: Easy Feedback 1 Hospice care has a small patient-to-worker ratio. 2 Hospice care serves not only the dying patient but also the patient’s family, finding out their needs and responding to them in a culturally sensitive way. 3 Hospice care is responsive 24 hours a day 7 days a week. 4 Hospice care encourages the involvement of the patient’s personal physician.
PTS: 1
CON: Grief and Loss
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3. ANS: 3 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 2. Identify the five stages of grief as outlined by Kübler-Ross. Chapter page reference: 201 Heading: Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Grief and Loss Difficulty: Moderate Feedback 1 Denial is the psyche’s way of protecting itself from the harsh, bitter truth. This psychological protection is there until the person’s psyche can deal with the loss. 2 Bargaining is making a deal; planning to do something so that the pain of loss will not occur or will go away. 3 Depression is frequently manifested by crying, withdrawal, poor appetite, and low energy. 4 When the grieving person reaches acceptance, there is a sense of relief. The grief process is over and living has started again.
PTS: 1
CON: Grief and Loss
4. ANS: 1 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care. Chapter page reference: 202 Heading: Tolerance and Empathy Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Grief and Loss Difficulty: Easy Feedback 1 Tolerance is compassion and endurance. 2 Tolerance is patience and impartiality. 3 Tolerance is patience and open-mindedness. 4 Tolerance is open-mindedness and patience.
PTS: 1
CON: Grief and Loss
5. ANS: 2 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care. Chapter page reference: 202 Heading: Tolerance and Empathy Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Grief and Loss Difficulty: Easy Feedback 1 Empathy is not assuming the patient’s emotions. 2 The definition of empathy is the ability to identify with the patient by being sympathetic and understanding. 3 Empathy is not identifying with patients. 4 Empathy is not a decision-making process.
PTS: 1
CON: Grief and Loss
6. ANS: 4 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care. Chapter page reference: 202 Heading: Box 11.1 Qualities to Develop Before Working with Dying People Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Grief and Loss Difficulty: Easy Feedback 1 A good listener takes time. 2 A good listener does not interrupt. 3 A good listener asks appropriate questions. 4 A good listener does not assume what the speaker will say.
PTS: 1
CON: Grief and Loss
7. ANS: 4 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 6. Differentiate between a living will and a durable power of attorney. Chapter page reference: 205 Heading: Advance Directives Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Legal Difficulty: Moderate Feedback 1 A court does not need to be consulted to make this decision. 2 The physician is not responsible for making this decision. 3 Inserting a feeding tube would be in violation of the patient’s living will. 4 Family members and facilities must abide by the patient’s wishes when those wishes are stated in a living will. Not even family members can make decisions for an incompetent patient with clear and convincing evidence of the patient’s wishes. In this case, the clear and convincing evidence exists as a living will.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Legal
8. ANS: 2 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 6. Differentiate between a living will and a durable power of attorney. Chapter page reference: 205 Heading: Advance Directives Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Legal Difficulty: Easy Feedback 1 A secondary benefit is to prevent others from being able to abuse the individual if he or she should become incompetent. 2 The primary purpose of the advance directive is to follow the wishes of the person who wrote it. 3 Advance directives are not written by family to make decisions for other family members. 4 The state has the right to assign independent individuals to make health-care decisions for incompetent individuals, however, an advance directive would prevent state intervention.
PTS: 1
CON: Legal
9. ANS: 3 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 1. Define the essential characteristics of a hospice organization. Chapter page reference: 204 Heading: Box 11.2 Essential Components of Hospice Programs Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Grief and Loss Difficulty: Easy Feedback 1 A quality hospice program is available 24/7 and not just 9:00 a.m. to 5:00 p.m. 2 A quality hospice program has a small patient-to-caregiver ratio. 3 A quality hospice program is sensitive to all cultures, values, and beliefs and has an interdisciplinary team of experts in state-of-the-art care of dying persons with small patient-to-caregiver ratios. 4 A quality hospice program does not have a specific belief structure and is not rigid in responding to specific needs.
PTS: 1
CON: Grief and Loss
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
10. ANS: 2 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care. Chapter page reference: 202 Heading: Box 11.1 Qualities to Develop Before Working with Dying People Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Grief and Loss Difficulty: Easy Feedback 1 All personnel working with dying individuals need a high level of flexibility. 2 All personnel working with dying individuals need a high level of maturity. 3 All personnel working with dying individuals need a sense of humor. 4 All personnel working with dying individuals need good listening skills.
PTS: 1
CON: Grief and Loss
11. ANS: 3 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 2. Identify the five stages of grief as outlined by Kübler-Ross. Chapter page reference: 200 Heading: Anger Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 Family members do not need to be notified. 2 A restraint order is not required. 3 Anger is a stage in the grieving process. It is normal and healthy to be angry. Staying with the patient ensures that the patient is safe. 4 Medicating for agitation is not appropriate.
PTS: 1
CON: Grief and Loss
12. ANS: 4 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 4. List the eight stages of imminent death. Chapter page reference: 206 Heading: Imminent Signs of Death Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
It is inappropriate to try to feed a dying patient. It is inappropriate to have the son count the respirations. Encouraging the son to go home might be a risk if the patient is that near to death. Research shows that the last sense to leave is hearing. Families should be encouraged to talk to the dying individual. Tell stories, reminisce—whatever they are comfortable with.
PTS: 1
CON: Grief and Loss
13. ANS: 3 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 1. Define the essential characteristics of a hospice organization. Chapter page reference: 204 Heading: End-of-Life Decisions Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Grief and Loss Difficulty: Easy Feedback 1 A living will has nothing to do with the hospice program. 2 Hospice care can be provided in the home and other types of facilities. 3 A patient requiring hospice usually has about 6 months to live. 4 Hospice care is not curative.
PTS: 1
CON: Grief and Loss
14. ANS: 4 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 1. Define the essential characteristics of a hospice organization. Chapter page reference: 204 Heading: End-of-Life Decisions Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 Hospice team members do not stay with the patient around-the-clock. 2 The patient is terminally ill and most likely will not be able to maintain independence. 3 The patient should have an intake that makes the patient comfortable. 4 The hospice team cares for the patient and provides education and support to family members.
PTS: 1
CON: Grief and Loss
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
15. ANS: 1 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 1. Define the essential characteristics of a hospice organization. Chapter page reference: 204 Heading: End-of-Life Decisions Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Grief and Loss Difficulty: Easy Feedback 1 Often, referrals to a hospice come “too little, too late” to be most effective. Only 30% of dying patients are referred to hospice and some of these individuals are referred in the last hour or day of their lives. 2 Hospice is underutilized. 3 For this patient, hospice was not effective or long enough. 4 This patient was terminally ill. Hospice was indicated.
PTS: 1
CON: Grief and Loss
16. ANS: 2 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 2. Identify the five stages of grief as outlined by Kübler-Ross. Chapter page reference: 200 Heading: Denial Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Grief and Loss Difficulty: Easy Feedback 1 Shock is not a stage in the grieving process. 2 Denial is often described as “being in a daze,” which would explain why the spouse does not remember the funeral. 3 Despair is not a stage in the grieving process. 4 Depression is characterized by crying, sleeping, and having low energy.
PTS: 1
CON: Grief and Loss
17. ANS: 2 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 2. Identify the five stages of grief as outlined by Kübler-Ross. Chapter page reference: 201 Heading: Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Grief and Loss
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Moderate Feedback 1 Stating the desire to not live anymore is not bargaining. 2 The patient is at risk for suicide because of the stated desire to not live anymore. The nurse should seek additional help for this patient. 3 Stating the desire to not live anymore is not accepting the spouse’s death. 4 Stating the desire to not live anymore is not denial.
PTS: 1
CON: Grief and Loss
18. ANS: 4 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 2. Identify the five stages of grief as outlined by Kübler-Ross. Chapter page reference: 201 Heading: Acceptance Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Grief and Loss Difficulty: Moderate Feedback 1 Crying does not indicate that the patient has not completed grieving. 2 Crying does not indicate that the patient is in denial. 3 Crying in church does not indicate that the patient is in the depression phase of grieving. 4 During acceptance, the grieving person may still cry when thinking about the deceased person or when experiencing something that makes the person recall the deceased person. This is normal.
PTS: 1
CON: Grief and Loss
19. ANS: 1 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care. Chapter page reference: 202 Heading: Tolerance and Empathy Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 Staying with the patient indicates tolerance of the behavior. 2 Leaving the patient alone does not indicate tolerance. 3 The nurse should not say that it isn’t her fault that the patient is dying. This is immature and inappropriate behavior. 4 The nurse should not defend the care that has been provided. This does not demonstrate
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
tolerance.
PTS: 1
CON: Grief and Loss
20. ANS: 3 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care. Chapter page reference: 202 Heading: Sense of Humor Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 A sense of humor is important when caring for patients who are dying. There is no need to explain that death is not a laughing matter. 2 Restricting joy and laughter during this time would be hurtful and inappropriate. 3 Having a sense of humor with the dying person is a simple way to assist in relieving, reducing, and soothing the symptoms of a disease. 4 The nursing assistant did nothing wrong and did not demonstrate inappropriate behavior.
PTS: 1
CON: Grief and Loss
21. ANS: 4 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care. Chapter page reference: 202 Heading: Good Listening Skills Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 Saying nothing indicates that the nurse is not listening to the patient. 2 Interrupting indicates that the nurse is not listening to the patient. 3 Being in a hurry indicates that the nurse is not listening to the patient. 4 Asking specific questions about the story indicates that the nurse is listening to the patient.
PTS: 1
CON: Grief and Loss
22. ANS: 1 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 4. List the eight stages of imminent death.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 206 Heading: Imminent Signs of Death Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 Incontinence of bowel and bladder are signs of imminent death. 2 Because the patient is terminally ill changing the diet will not affect continence. 3 The patient is not incontinent because of too much pain medication. 4 The patient is terminally ill and may be unable to call for help.
PTS: 1
CON: Grief and Loss
23. ANS: 3 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 4. List the eight stages of imminent death. Chapter page reference: 206 Heading: Imminent Signs of Death Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 A cooling blanket would be inappropriate because the patient is nearing death. 2 A fan would cause the patient to be chilled despite having profuse sweating. The extremities are already cool to touch. 3 The patient should be kept as comfortable as possible. A dry gown should be applied. The arms and legs should be kept as warm as possible for comfort. 4 Increasing the room temperature and removing blankets would not increase this patient’s comfort.
PTS: 1
CON: Grief and Loss
24. ANS: 4 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 4. List the eight stages of imminent death. Chapter page reference: 206 Heading: Imminent Signs of Death Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 The sons are carrying on a conversation that is inappropriate. The nurse should not
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
permit the conversation to continue. Saying that the patient needs rest does not support the family’s need to be with the dying patient. Suggesting that the sons look at the will is too personal a statement for the nurse to make and would be inappropriate. The nurse needs to remind the sons that hearing is a sense that is often present until death and unless they want their father to know what they are talking about they should limit the discussion.
PTS: 1
CON: Grief and Loss
25. ANS: 1 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 5. Use your knowledge of palliative care to provide the information to a patient and family. Chapter page reference: 204 Heading: End-of-Life Decision Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 The goals of palliative care are to provide older adults with comfort and to manage their symptoms. This might include treating an infection that is causing a dying person discomfort while not treating the terminal illness. 2 The antibiotics may or may not affect the terminal illness. 3 The nurse does not need to be rude. The spouse is not talking about assisted suicide. 4 The nurse does not need to talk with the physician about the antibiotic. The nurse can explain the purpose of the medication to the spouse.
PTS: 1
CON: Grief and Loss
26. ANS: 2 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 5. Use your knowledge of palliative care to provide the information to a patient and family. Chapter page reference: 204 Heading: Box 11.2 Essential Components of Hospice Programs Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 Palliative care does not cure an illness. 2 Hospice workers provide palliative care to terminally ill dying patients.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
Palliative care does not restore function. Palliative care does not rehabilitate a patient or help the patient achieve maximum physical functioning.
PTS: 1
CON: Grief and Loss
27. ANS: 2 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 5. Use your knowledge of palliative care to provide the information to a patient and family. Chapter page reference: 204 Heading: End-of-Life Decision Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate
1 2
3 4
Feedback The nurse needs to at least offer the medication to the patient before marking them as refused. Palliative care is the term used to describe care that is no longer aimed at a cure or active treatment of a certain medical condition. Instead, the goals of palliative care are to provide older adults with comfort and to manage their symptoms. The nurse should provide the patient with the medications for symptom management. The nurse should not throw the medications in the trash. This is unacceptable behavior. The nurse should not place the medications in another patient’s medication drawer. This is unacceptable behavior.
PTS: 1
CON: Grief and Loss
28. ANS: 4 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 6. Differentiate between a living will and a durable power of attorney. Chapter page reference: 205 Heading: Advance Directives Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Legal Difficulty: Moderate Feedback 1 Having a living will does not mean that the person should expect to die. 2 The nurse should encourage the patient to have an advance directive. 3 The nurse should not reinforce the patient’s fear of having an advance directive. 4 A living will is a type of advance directive that provides information about the patient’s wishes for care.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Legal
29. ANS: 3 Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 6. Differentiate between a living will and a durable power of attorney. Chapter page reference: 206 Heading: Advance Directives Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Legal Difficulty: Moderate Feedback 1 The nurse is responsible for finding out information about advance directives. The nurse should not ask the nurse manager for this information. 2 The nurse is responsible for finding out information about advance directives. The nurse should not ask the administrator for this information. 3 The nurse is responsible for finding out information about advance directives. The nurse should contact the new state board of nursing. 4 The nurse is responsible for finding out information about advance directives. The nurse should not ask the school of nursing for this information.
PTS: 1
CON: Legal
MULTIPLE RESPONSE 30. ANS: 2, 3, 4, 5 Feedback 1. End-of-life care and related issues are unique to each person. 2. End-of-life care includes symptom management. 3. End-of-life care includes referrals. 4. End-of-life care includes communication and education. End-of-life care requires the nurse to be comfortable, or at least knowledgeable, about 5. personal beliefs and attitudes about death. Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care. Chapter page reference: 198 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Grief and Loss Difficulty: Easy PTS: 1 31. ANS: 1, 2, 4, 5
CON: Grief and Loss
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1. 2. 3. 4. 5.
Feedback Terminal restlessness could include yelling or moaning. Terminal restlessness is involuntary thrashing or agitation. Terminal restlessness is a part of the dying process. Terminal restlessness is a common occurrence at the end of life. Terminal restlessness occurs as a result of progressive shutdown of body systems.
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 4. List the eight stages of imminent death. Chapter page reference: 206 Heading: Imminent Signs of Death Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Grief and Loss Difficulty: Easy PTS: 1
CON: Grief and Loss
32. ANS: 1, 2, 4, 5 Feedback 1. The stages of grief are present at times throughout people’s lives, including the death of a pet. 2. The stages of grief are present at times throughout people’s lives, including during a divorce. The stages of grief are present at times throughout people’s lives, but not usually during a 3. happy event like starting a new job. 4. The stages of grief are present at times throughout people’s lives, including after surgery. 5. The stages of grief are present at times throughout people’s lives, including after the death of a loved one. Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 2. Identify the five stages of grief as outlined by Kübler-Ross. Chapter page reference: 200 Heading: Stages of Grief Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Grief and Loss Difficulty: Easy PTS: 1
CON: Grief and Loss
33. ANS: 2, 3, 4 Feedback 1. A will is not an advance directive. It explains how a person wants their personal effects handled upon death. 2. A living will is an advance directive. A health-care proxy is another name for a durable power of attorney, which is an advance 3. directive. 4. A durable power of attorney is an advance directive.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
5.
Assignment of an estate executor occurs with a will.
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 6. Differentiate between a living will and a durable power of attorney. Chapter page reference: 205 Heading: Advance Directives Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Legal Difficulty: Easy PTS: 1
CON: Legal
34. ANS: 1, 3, 4, 5 Feedback 1. Signs of impending death include cold extremities. 2. Frequent coughing is not a sign of impending death. 3. Signs of impending death include a weak, rapid pulse. 4. Signs of impending death include profuse perspiration. 5. Signs of impending death include slow or no pupil response to light. Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 4. List the eight stages of imminent death. Chapter page reference: 206 Heading: Imminent Signs of Death Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Grief and Loss Difficulty: Easy PTS: 1
CON: Legal
35. ANS: 1, 2, 4, 5 Feedback A feeding tube would indicate that the patient could no longer eat. This is something that 1. should be considered when preparing a living will. A breathing tube would indicate that the patient cannot maintain an airway. This is something 2. that should be considered when preparing a living will. 3. Food and fluids would not be included in a living will. 4. A pacemaker indicates that the patient needs assistance with cardiovascular function. This is something that should be considered when preparing a living will. 5. Mechanical ventilation means that the patient needs help breathing. This is something that should be considered when preparing a living will. Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults Chapter/learning objective: 6. Differentiate between a living will and a durable power of attorney. Chapter page reference: 205
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Advance Directives Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Legal Difficulty: Moderate PTS: 1
CON: Legal
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 12: Environments of Care Multiple Choice Identify the choice that best completes the statement or answers the question. 1. What is the goal of an environmental assessment? 1) Promote independent function. 2) Establish an older adult’s housekeeping abilities. 3) Detect reasons to admit an older adult to a long-term care facility. 4) Assist the family with documenting reasons they should seek durable power of attorney.
2. After admitting an 86-year-old resident to a retirement community, the nurse assisted with transitioning to the new home, arranged Meals on Wheels, provided a list of local physicians, and made arrangements for the community Welcome Wagon to make a visit. What type of care did the nurse perform? 1) Hospice 2) Transpersonal caring 3) Micromanaging the client 4) Environmental management
3. When entering an older patient’s home the nurse notices that the room is very warm. What patient behavior should the nurse attribute to the environment? 1) Hunger 2) Lethargy 3) Talkativeness 4) Being motivated
4. The nurse is visiting an assisted living facility to help an older person decide if she wants to relocate to this environment. Which observation should the nurse question as being desirable for this person? 1) Lack of community lounge 2) Garden with benches and chairs 3) Recreation room with a television and magazines 4) Residents visiting in the common areas on each floor
5. The nurse determines that one apartment in an assisted living facility would not be appropriate for a person who relies on a wheelchair. What did the nurse observe to make this determination? 1) Bath tub with shower 2) Absence of throw rugs 3) Oversized door openings 4) Handicapped-accessible commode
6. Which would NOT be included in an environmental safety risk assessment? 1) Noting clutter and throw rugs 2) Medication storage and date of medications
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Noting electrical wiring, frayed cords, and hot extension cords 4) Sorting through older adults’ mail to see if they are paying their bills on time
7. Which intervention increases the functionality of the environment? 1) Installing grab bars in the bathroom 2) Padding the bed for an incontinent older adult 3) Changing light bulbs to energy-saving, low-wattage bulbs 4) Inserting an indwelling catheter so that the older adult does not have to get out of the chair to void
8. If the nurse is evaluating the home of an elderly person who has had a total hip replacement, what areas should be considered as being the most important? 1) Friendliness of the neighbors 2) The safety of the neighborhood and the internal safety of the home 3) If emergency medical services are available in the event that the patient falls 4) The accessibility of a grocery store and drug store and the availability of a working telephone
9. While conducting a home assessment the nurse identifies safety issues in the patient’s bathroom. What did the nurse assess to make this determination? 1) Grab bars in the shower 2) Grab bars around the commode 3) Throw rug absent from the floor 4) Cord for electric shaver crossing over the sink
10. The nurse notes that an older patient smokes. What would be imperative for this patient to have in the home? 1) Functioning smoke alarms 2) Electric cooking appliances 3) Water in every room of the house 4) Telephone number for the fire department
11. An older patient is hospitalized with a broken hip after falling in the home. What should the nurse discuss as a priority when making a home visit? 1) The time the patient goes to sleep at night 2) The location of the pharmacy that the patient uses 3) Asking someone to take the patient’s toy poodle 4) When the patient expects the mail to be delivered each day
12. What does the respect for personal space and privacy help develop? 1) A climate of caring 2) Nursing assessments 3) A comprehensive care plan
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Customer satisfaction with nursing care
13. Which is NOT a component of a caring climate? 1) Privacy 2) Dependence 3) Personal space 4) Activity and involvement
14. An older person who used to work until midnight doesn’t go to sleep until 3:00 a.m. and likes to stay in bed until 11:00 a.m. The facility that the patient lives in provides breakfast at 8:00 a.m. What should the nurse do to ensure that this patient’s nutritional needs are being met? 1) Wake the patient up for breakfast at 8:00 a.m. 2) Stop the delivery of a breakfast tray for this patient. 3) Have the breakfast tray delivered with the lunch tray. 4) Place the breakfast tray aside to be warmed up when the patient wakes up.
15. An older patient is being admitted to an extended care facility for several weeks for extensive wound care and hemodialysis. What should be done to personalize this patient’s living area during this time? 1) Dress the patient in personal clothing. 2) Place the patient’s toilet articles in the bathroom. 3) Keep the patient’s slippers on the floor next to the bed. 4) Ask family to bring in a favorite picture to place on the bedside table.
16. An older patient with terminal cancer is being discharged back to his home. What service should be recommended to this patient’s family for care? 1) Hospice 2) Nursing home 3) Adult day services 4) Skilled nursing facility
17. A spouse is the primary caregiver for an 80-year-old ill patient. The spouse does not want to place the patient in a nursing facility but is experiencing extreme exhaustion. What should the nurse recommend to the spouse? 1) Respite care 2) Senior center 3) Hospitalization 4) Home health nursing
18. An older patient who lives alone is recovering from total hip replacement surgery with the plan to return home. The patient’s sister will be staying for 1 week after discharge. Which referral is appropriate for this patient? 1) Hospice 2) Senior center
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Home health services 4) Skilled nursing facility
19. Which is a criterion for hospice services? 1) A cancer diagnosis 2) Lack of family support 3) Terminal disease process 4) Chronic disease with acute exacerbation
20. Which is NOT a part of hospice care? 1) Personal care services 2) Funeral arrangement services 3) Family counseling and support 4) Ongoing support for families after the person’s death
21. An older person is increasingly confused from Alzheimer’s disease and the spouse is unable to continue to care for the patient at home. What referral should be made for the patient? 1) Hospitalization 2) Retirement center 3) Skilled nursing facility 4) Intermediate nursing facility
22. A 78-year-old patient is distressed over the high maintenance costs of a large home. What should be recommended as a living alternative for the patient? 1) Senior center 2) Retirement center 3) Skilled nursing facility 4) Intermediate nursing facility
23. Who directs the care and instruction for an LPN providing home care services? 1) The physician 2) The family and patient 3) The registered nurse (RN) case manager 4) The secretary at the agency who makes the assignments 24. What would be the LPN’s primary responsibilities in an adult day services center? 1) Medications and meals 2) Activities and teaching 3) Assessments and medications 4) Meal preparation and activity planning
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
25. In which environment does the nurse require some level of creativity because of a limitation of equipment and supplies? 1) Hospice 2) Home care 3) Adult day services 4) Retirement communities
26. A patient is interested in adult day services. What should the nurse remind the patient about the financing of these services? 1) Medicare pays for these services. 2) Medicare does not pay for these services. 3) Medicaid does not pay for these services. 4) Personal insurance pays for these services.
27. The nurse is preparing to make a visit to the home of an older patient newly diagnosed with heart failure. How much time should the nurse plan to spend with the patient? 1) Less than an hour 2) A complete 8-hour day 3) Between 4 and 6 hours 4) As much time as needed to provide treatments
28. The nurse is hired to staff a community care clinic. Which type of care should the nurse expect to provide to older community members? 1) Vaccinations 2) Routine physicals 3) Wellness activities 4) Available resources
29. For which person would an assisted living community be an appropriate choice? 1) A non-ambulatory terminally ill patient 2) A completely independent and ambulatory older adult 3) A non-ambulatory, very frail person with a serious chronic illness 4) An ambulatory patient who has a chronic condition that requires medication
30. What type of care would the nurse provide in an assisted living community? 1) Preparing meals 2) Helping with laundry 3) Assisting with daily grooming 4) Assessing medication responses
31. A participant in an adult day services program tells the nurse that she needs to start on insulin every day to help manage her diabetes. What should the nurse make a priority for this patient?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1) 2) 3) 4)
Ability to self-inject the medication Importance of having the eyes checked every year Need to see the primary care physician every 3 months Frequency of checking capillary blood glucose levels at home
32. Which observation should the nurse question in a person who is a participant in an adult services program? 1) Laughing while watching a comedy movie 2) Walking slowly to the bathroom with a walker 3) Helping clean up materials used to make posters 4) Changing from actively participating in an activity to sleeping in a chair
33. The nurse notices that an older participant in adult day services asks for leftover food to take home every day. What should the nurse suggest as assistance for this participant? 1) Meals on Wheels 2) Menus of restaurants that deliver 3) Telephone numbers of grocery stores that deliver 4) Names of caregivers willing to come into the home and cook for the person
34. An 86-year-old patient is diagnosed with relocation-related stress. Which is a symptom of this disorder? 1) Attending all available activities in the facility 2) Watching television and visiting with other residents in the day room 3) Exhibiting increased confusion and wandering behavior at night 4) Refusing to take a tub bath and washing himself at the sink in his room
35. What intervention would help decrease stress related to relocation? 1) Having residents eat their meals in the dining room 2) Taking residents on a tour of the facility and introducing them to all of the caregivers 3) Spending an afternoon reviewing all of the facility policies and procedures that relate to resident care 4) Encouraging residents to discuss bringing some of their furniture and personal belongings with their families
36. What should be a part of the environment for a confused resident of a nursing facility? 1) A standardized appearance 2) A stark and unstimulating atmosphere 3) Sensory stimulation through colors, furniture, and wall coverings 4) A home-like, familiar atmosphere with the resident’s own belongings
37. What should be done on the first day that a new resident is in a nursing facility? 1) Introduce the new resident to all of the staff in the unit. 2) Encourage the resident to go to the afternoon bingo game. 3) Help the resident make the environment cozy and home-like.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Accompany the resident to the dining room at lunch to meet all the residents of the floor.
38. An older person is argumentative and refuses to sit with family members during dinner because the discussion will be about the patient’s upcoming relocation to an assisted living facility. What is this older person demonstrating? 1) Conflict 2) Rigidity 3) Noncompliance 4) Transitional stress
39. An older patient needing hemodialysis three times a week and extensive wound care is unable to be cared for at home by family members. The patient agrees to be admitted to a skilled nursing facility but refuses to talk with any of the staff or family members who come to visit. What should be done to assist this patient? 1) Transport the patient to the recreation room. 2) Nothing. The patient will adjust in time. 3) Have the staff introduce themselves one at a time. 4) Encourage placement of personal items to be easily viewed.
Multiple Response Identify one or more choices that best complete the statement or answer the question. 40. While visiting the home of an older patient who recently became widowed the nurse determines that the patient has a strong support system. What occurred that caused the nurse to make this determination? Select all that apply. 1) Delivery person rang the doorbell 2) Paid caregiver was doing the laundry 3) Daughter was visiting with her mother 4) Neighbor came over to bring a pot of soup 5) Friend telephoned to ask for the best time to visit
41. Which behaviors indicate that a new resident of a nursing facility is experiencing relocation trauma? Select all that apply. 1) Agitation 2) Acting out 3) Poor appetite 4) Hallucinations 5) Disorientation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 12: Environments of Care Answer Section MULTIPLE CHOICE 1. ANS: 1 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 1. Discuss the role of the licensed practical nurse (LPN) as an environmental manager. Chapter page reference: 212 Heading: Environmental Management Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Promoting Health Difficulty: Easy Feedback 1 Environmental assessments are performed to identify problems and potential problems. A plan for alternatives or correcting the problem is developed to support the functional ability of the older person. 2 The goal of an environmental assessment is not to assess housekeeping abilities. 3 The goal of an environmental assessment is not to detect reasons to admit an older adult to a long-term care facility. 4 The goal of an environmental assessment is not to assist the family with documenting reasons they should seek durable power of attorney.
PTS: 1
CON: Promoting Health
2. ANS: 2 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 1. Discuss the role of the licensed practical nurse (LPN) as an environmental manager. Chapter page reference: 213 Heading: Think Like a Nurse Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Promoting Health Difficulty: Moderate Feedback 1 Hospice care is provided to patients who are terminally ill. 2 Dr. Jean Watson, author of The Science of Human Caring theory, refers to transpersonal caring as a holistic approach on caring about all aspects of the person’s life, including the environment. 3 Micromanaging is not a type of care. 4 Environmental management begins with an assessment of the environment. The nurse provided much more than environmental care.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Promoting Health
3. ANS: 2 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 1. Discuss the role of the licensed practical nurse (LPN) as an environmental manager. Chapter page reference: 213 Heading: Environmental Management Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Promoting Health Difficulty: Moderate Feedback 1 A warm room is not identified as affecting appetite. 2 If a room is too warm the patient may demonstrate lethargy. 3 A warm room is not identified as affecting communication level. 4 A warm room is not likely to be motivating.
PTS: 1
CON: Promoting Health
4. ANS: 1 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 1. Discuss the role of the licensed practical nurse (LPN) as an environmental manager. Chapter page reference: 212 Heading: Environmental Management Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Promoting Health Difficulty: Moderate Feedback 1 When assessing an assisted living facility the nurse should question if there is an area for residents to socialize with family and friends. 2 A garden with benches and chairs would be a pleasant location to socialize. 3 A recreation room with a television and magazines would be a pleasant place to spend time with friends or family. 4 Visiting in a common area on each floor would be a pleasant place to talk with family and friends.
PTS: 1
CON: Promoting Health
5. ANS: 1 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 1. Discuss the role of the licensed practical nurse (LPN) as an environmental manager.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 213 Heading: Environmental Management Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Promoting Health Difficulty: Moderate Feedback 1 A bath tub with shower would be difficult for the person who uses a wheelchair to use. 2 Absence of throw rugs would be desirable. 3 Oversized door openings would be desirable. 4 A handicapped-accessible commode would be desirable.
PTS: 1
CON: Promoting Health
6. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 2. Describe at least two components of the physical environment that nurses need to consider. Chapter page reference: 213 Heading: Safety Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 Noting clutter and throw rugs is an appropriate component of the environmental assessment. 2 Medication storage and date of medications is an appropriate component of the environmental assessment. 3 Noting electrical wiring, frayed cords, and hot extension cords is an appropriate component of the environmental assessment. 4 It is inappropriate to review anyone’s mail without permission. Regarding bill payments, ask a family member to review the older adult’s mail.
PTS: 1
CON: Safety
7. ANS: 1 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 2. Describe at least two components of the physical environment that nurses need to consider. Chapter page reference: 213 Heading: Environmental Management Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Safety
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Moderate Feedback 1 Grab bars in the bathroom can be installed to enable an older adult to get into and out of the shower or tub. Grab bars can also assist with balance during transfers. 2 Padding the bed might be viewed as increasing functionality of the environment by preventing the whole bed from becoming soiled, but a toileting program, urinal or bedpan, or bedside commode would be more appropriate for increasing function. 3 Light bulbs need to have increased wattage to promote vision for older adults. 4 An indwelling catheter is inappropriate simply to decrease toileting and ambulation.
PTS: 1
CON: Safety
8. ANS: 2 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 2. Describe at least two components of the physical environment that nurses need to consider. Chapter page reference: 213 Heading: Safety Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 Neighbor friendliness is important but not the most important area to assess. 2 The safety of the neighborhood and the internal safety of the home would be the most important for the nurse to assess. 3 Emergency medical services access is important but the goal is for the patient to not need this service. 4 Shopping areas are not the most important areas to assess for safety. A working telephone is important.
PTS: 1
CON: Safety
9. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 2. Describe at least two components of the physical environment that nurses need to consider. Chapter page reference: 213 Heading: Safety Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Safety Difficulty: Moderate Feedback 1 Grab bars in the shower would be desirable.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
Grab bars around the commode would be desirable. Absence of throw rugs would be desirable. Electrical cords crossing over a water source could be a safety hazard.
PTS: 1
CON: Safety
10. ANS: 1 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 2. Describe at least two components of the physical environment that nurses need to consider. Chapter page reference: 213 Heading: Safety Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 Because the patient smokes in the home it would be imperative for the patient to have functioning smoke alarms. 2 Electric cooking appliances are not necessary. 3 It is unrealistic for there to be a water source in every room in the house. 4 Having the telephone number for the fire department would be important, however, the patient should be able to call emergency services through 911.
PTS: 1
CON: Safety
11. ANS: 3 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 2. Describe at least two components of the physical environment that nurses need to consider. Chapter page reference: 213 Heading: Safety Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 The time the patient goes to sleep is not an issue. 2 The location of the pharmacy that the patient uses is not an issue. 3 The patient’s toy poodle may be a safety hazard. The pet could get under foot, causing the patient to fall. 4 The time the patient’s mail is delivered is not a safety issue.
PTS: 1
CON: Safety
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
12. ANS: 1 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 3. Discuss the aspects included in a climate of caring. Chapter page reference: 213 Heading: Climate of Caring Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing Roles; Promoting Health Difficulty: Easy Feedback 1 The climate of caring is supported with respect for the older adult’s privacy and need for personal space. 2 Respect for personal space and privacy is used to promote a total caring climate that is not just specific to nursing assessments. 3 Respect for personal space and privacy is used to promote a total caring climate that is not just specific to care plans. 4 Respect for personal space and privacy is used to promote a total caring climate that is not just specific to satisfaction with nursing care.
PTS: 1
CON: Nursing Roles | Promoting Health
13. ANS: 2 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 3. Discuss the aspects included in a climate of caring. Chapter page reference: 213 Heading: Climate of Caring Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Nursing Roles; Promoting Health Difficulty: Easy Feedback 1 Privacy is a part of a caring environment. 2 A caring climate promotes an older person’s function at the highest possible level of independence. Fostering dependence is not part of a caring climate. 3 Personal space is a part of a caring environment. 4 Activity and involvement are parts of a caring environment.
PTS: 1
CON: Nursing Roles | Promoting Health
14. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 3. Discuss the aspects included in a climate of caring. Chapter page reference: 214 Heading: Stimulation and Personalization Integrated Processes: Nursing Process: Implementation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Nutrition; Nursing Roles; Promoting Health Difficulty: Moderate Feedback 1 Waking the patient up for a meal at 8:00 a.m. would interrupt the patient’s sleep. 2 The patient’s meal should not be stopped or held. 3 Receiving two trays for one meal is inappropriate. 4 Setting the tray aside to be warmed up when the patient wakes up is the best action and personalizes the care the patient needs.
PTS: 1
CON: Nutrition | Nursing Roles | Promoting Health
15. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 3. Discuss the aspects included in a climate of caring. Chapter page reference: 214 Heading: Stimulation and Personalization Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Nursing Roles; Promoting Health Difficulty: Moderate Feedback 1 Wearing personal clothing will not personalize the patient’s space. 2 Placing toilet articles in the bathroom will not personalize the patient’s space. 3 Keeping the slippers on the floor will not personalize the patient’s space. 4 Having a favorite picture on the bedside table helps to personalize the patient’s space.
PTS: 1
CON: Nursing Roles | Promoting Health
16. ANS: 1 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 219 Heading: Hospice Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate
1 2 3
Feedback Hospice care generally involves services provided in the home to an older adult and the family members. The patient would have to leave the home for nursing home care. Adult day services are programs that provide more social and interpersonal care than
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
personal care. The patient would have to leave the home for skilled nursing care.
PTS: 1
CON: Health Care System
17. ANS: 1 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 217 Heading: Settings of Care Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 Respite care is a service for caregivers who need time away from their family member. The respite worker usually comes into the home to provide care for the older adult. 2 The senior center might be a place for the spouse to go while the respite worker cares for the patient. 3 Hospitalization would be inappropriate for the spouse. 4 Home health care requires that the patient, not the spouse, have a skilled need for services.
PTS: 1
CON: Health Care System
18. ANS: 3 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 218 Heading: Home Care Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 The patient does not have a terminal illness. 2 A senior center would not be able to provide the level of care the patient needs at this time. 3 Home health services include skilled nursing, physical therapy, and home health assistants. 4 Skilled nursing might be needed after the sister leaves but not before.
PTS: 1 19. ANS: 3
CON: Health Care System
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 219 Heading: Hospice Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Health Care System Difficulty: Easy Feedback 1 Not everyone who has a cancer diagnosis is dying. 2 Lack of family support does not qualify for hospice. 3 Hospice services are designed to provide support to dying people and their families. 4 Acute exacerbation of a chronic disease process does not meet the criteria for hospice care.
PTS: 1
CON: Health Care System
20. ANS: 2 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 219 Heading: Hospice Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Health Care System Difficulty: Easy Feedback 1 Hospice provides personal care services. 2 Hospice volunteers or workers often assist a person in expressing his or her desires for funeral plans, but they do not arrange funerals. 3 Hospice provides family counseling and support. 4 Hospice provides ongoing support for families after the person’s death.
PTS: 1
CON: Health Care System
21. ANS: 3 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 220 Heading: Nursing Homes Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Hospitalization is inappropriate because the patient is not experiencing a lifethreatening process that needs intensive medical evaluation and treatment. A retirement center would not provide enough supervision for the patient. Because of increasing confusion, a skilled nursing facility would be the most appropriate placement. An intermediate care facility would not provide enough supervision for the patient.
PTS: 1
CON: Health Care System
22. ANS: 2 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 219 Heading: Assisted Living Environment Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 Senior centers are activity centers, not living alternatives. 2 A retirement center is a supportive living environment. Residents maintain their independence but are free of maintenance worries, can receive housekeeping services, and can even choose to have meals prepared in a central dining room. 3 A skilled nursing facility requires the patient to have a functional need, not simply the inability to maintain the home financially. 4 An intermediate care facility requires the patient to have a functional need, not simply the inability to maintain the home financially.
PTS: 1
CON: Health Care System
23. ANS: 3 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 218 Heading: Home Care Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Health Care System Difficulty: Easy Feedback 1 The physician does not direct the care or provides instruction to the LPN. 2 The family and patient do not direct the care or provide instruction to the LPN. 3 The LPN works directly under the supervision of the RN case manager. 4 The secretary making the assignments does not direct the care or provide instruction to the LPN.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Health Care System
24. ANS: 3 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 217 Heading: Adult Day Services Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 Meal preparation is not a primary activity of the LPN. 2 Activities would not be a primary activity of the LPN. 3 In an adult day services center, the LPN’s major responsibility is the dispensing and supervision of client medication and assessing the subtle changes that may occur. 4 Meal preparation and activity planning would not be primary activities of the LPN.
PTS: 1
CON: Health Care System
25. ANS: 2 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 218 Heading: Home Care Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 Supplies and equipment are not frequently limited with hospice care. 2 Working in patients’ homes requires the nurse to be creative and to learn some improvisation. Supplies and equipment are frequently limited. 3 Supplies and equipment are not frequently limited in adult day services. 4 Supplies and equipment are not frequently limited in retirement communities.
PTS: 1
CON: Health Care System
26. ANS: 2 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 217 Heading: Adult Day Services Integrated Processes: Nursing Process: Implementation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 Medicare does not cover adult day services. 2 Medicare is not an option to pay for adult day services. 3 Medicaid may cover adult day services through the waiver program. 4 Personal insurance is not identified as a payer for adult day services.
PTS: 1
CON: Health Care System
27. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 218 Heading: Home Care Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 A home-care visit is rarely less than 1 hour in length. 2 The home-care nurse does not provide 8 hours of care. 3 Four to six hours of care is extremely long for a home-care visit. 4 A home-care visit will take as much time as needed to ensure prescribed treatments are provided.
PTS: 1
CON: Health Care System
28. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 219 Heading: Community-Based Care Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 Vaccinations would be more appropriate for children. 2 Routine physicals would be applicable for all patients, not specifically for older patients. 3 Wellness activities would be applicable for all patients, not specifically for older patients.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
In a community clinic the nurse uses assessment skills and provides information on resources available in the community to meet the older person’s needs.
PTS: 1
CON: Health Care System
29. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 4. Identify at least four settings in which nursing care for older adults is provided. Chapter page reference: 220 Heading: Assisted Living Environment Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 Non-ambulatory terminally ill patients should be treated by hospice care. 2 A completely independent and ambulatory adult does not need the services of an assisted living community and probably should forego the cost of such a placement until it is needed. 3 Non-ambulatory patients with serious chronic conditions should be treated in a hospital or skilled nursing facility. 4 Assisted living communities generally require residents to be ambulatory and fairly independent. Taking medication for a chronic condition does not bar a person from an assisted living facility.
PTS: 1
CON: Health Care System
30. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 5. Describe how nurses in various care settings meet the needs of older adults. Chapter page reference: 220 Heading: Assisted Living Environment Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 The nurse would not help with meal preparation. 2 The nurse would not help with patient laundry. 3 The nurse would not help with daily grooming. 4 The nurse would assess medication responses.
PTS: 1 31. ANS: 1
CON: Health Care System
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 5. Describe how nurses in various care settings meet the needs of older adults. Chapter page reference: 217 Heading: Adult Day Services Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Health Care System Difficulty: Moderate Feedback 1 The older patient may not be able to self-inject the medication. This would be the priority for the patient. 2 Annual eye examinations are important for all older patients and not just specifically for someone who is starting on insulin. 3 Routine physical examinations are important for all older patients and not just someone who is starting on insulin. 4 Additional teaching about diabetes management can occur after the nurse knows that the patient can safely self-administer the insulin at home.
PTS: 1
CON: Health Care System
32. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 5. Describe how nurses in various care settings meet the needs of older adults. Chapter page reference: 217 Heading: Adult Day Services Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Health Care System Difficulty: Moderate Feedback 1 Laughing while watching a comedy movie would be expected behavior. 2 Walking slowly with a walker would be desirable behavior. 3 Assisting with cleaning up after an activity would be positive behavior. 4 Sleeping instead of actively participating in an activity should be investigated if the behavior is a change from the routine level of participation.
PTS: 1
CON: Health Care System
33. ANS: 1 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 5. Describe how nurses in various care settings meet the needs of older adults. Chapter page reference: 217 Heading: Adult Day Services Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Health Care System Difficulty: Moderate Feedback 1 Because the participant asks for leftover food to take home this might mean that the person has limited resources for food. Meals on Wheels would be appropriate. 2 Asking for food indicates limited resources. Menus of restaurants that deliver would cost money. 3 If the person is asking for food, then there are limited resources to purchase food from a grocery store. 4 Attendance at adult day services necessitates a certain level of independence. The person most likely is able to cook but does not have the financial resources to purchase food.
PTS: 1
CON: Health Care System
34. ANS: 3 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 6. Discuss relocation stress and ways in which a nurse can help an older person adjust to a new environment. Chapter page reference: 215 Heading: Relocation Trauma Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Stress Difficulty: Moderate Feedback 1 Residents who are having trouble adjusting to a new environment more often withdraw and do not become active in facility activities. 2 Residents who are having trouble adjusting to a new environment more often withdraw and do not become active in facility activities. 3 Increased confusion and wandering are classic symptoms of relocation trauma. 4 The refusal to take a tub bath could be interpreted as a personal choice issue.
PTS: 1
CON: Stress
35. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 6. Discuss relocation stress and ways in which a nurse can help an older person adjust to a new environment. Chapter page reference: 215 Heading: Relocation Trauma Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Eating meals in the dining room may or may not impact relocation stress. Introducing residents to caregivers may not influence the level of relocation stress. Reviewing policies and procedures may increase the level of relocation stress. Having familiar belongings in the resident’s room, along with providing the resident access to personal items, often lessens the trauma of relocation.
PTS: 1
CON: Stress
36. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 6. Discuss relocation stress and ways in which a nurse can help an older person adjust to a new environment. Chapter page reference: 214 Heading: Stimulation and Personalization Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback 1 If every room appears the same, it may add to the resident’s confusion. 2 Barren and stark surroundings might relate to sensory deprivation. 3 The use of colors and stimulating wall coverings has been shown to increase agitation. 4 Personalization of the environment for the resident’s comfort and to reflect the resident’s identity is the most important environmental consideration.
PTS: 1
CON: Stress
37. ANS: 3 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 6. Discuss relocation stress and ways in which a nurse can help an older person adjust to a new environment. Chapter page reference: 215 Heading: Relocation Trauma Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1 This can be done after the resident becomes comfortable in the new environment. 2 This can occur after the resident’s environment is made comfortable. 3 To help minimize relocation trauma, staff members should help the resident make the new environment as comfortable and familiar as possible. 4 This can be done at any time after the resident moves in.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Stress
38. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 6. Discuss relocation stress and ways in which a nurse can help an older person adjust to a new environment. Chapter page reference: 215 Heading: Relocation Trauma Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Stress Difficulty: Moderate Feedback 1 Argumentative behavior may be the result of conflict. 2 Refusing to participate in a discussion or share a meal does not demonstrate rigidity. 3 The person may be viewed as being noncompliant to the other family members, however, this is not what the person is demonstrating. 4 The person is acting out, which is a characteristic of transitional stress, particularly because the person is relocating to a new living environment.
PTS: 1
CON: Stress
39. ANS: 4 Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 6. Discuss relocation stress and ways in which a nurse can help an older person adjust to a new environment. Chapter page reference: 215 Heading: Relocation Trauma Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Coordinated Care Cognitive level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1 Relocation stress might be heightened when overloading the person with new people and experiences too quickly. 2 Relocation trauma is temporary and the behavioral signs of decompensation should diminish as the older person becomes familiar with the new environment, however, the nurse should help the patient acclimate. 3 Introducing the person experiencing relocation stress to too many people may be overwhelming. 4 The more familiar the new environment is to the older person, the easier the transition is for the person. Bringing favorite objects to the new setting increases its familiarity to the older person.
PTS: 1
CON: Stress
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
MULTIPLE RESPONSE 40. ANS: 2, 3, 4, 5 Feedback 1. Delivery people are not identified as being in an environment of caring. 2. The climate of caring involves the people in the environment. The people in an older person’s living environment may include paid caregivers. 3. The climate of caring involves the people in the environment. The people in an older person’s living environment may include family members. 4. The climate of caring involves the people in the environment. The people in an older person’s living environment may include neighbors. 5. The climate of caring involves the people in the environment. The people in an older person’s living environment may include friends. Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 3. Discuss the aspects included in a climate of caring. Chapter page reference: 213 Heading: Climate of Caring Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Nursing Roles; Promoting Health Difficulty: Moderate PTS: 1
CON: Nursing Roles | Promoting Health
41. ANS: 1, 2, 4, 5 Feedback 1. Agitation is a manifestation of relocation trauma. 2. Acting out is a manifestation of relocation trauma. 3. Poor appetite is not a manifestation of relocation trauma. 4. Hallucinations are a manifestation of relocation trauma. 5. Disorientation is a manifestation of relocation trauma. Chapter number and title: Chapter 12: Environments of Care Chapter/learning objective: 6. Discuss relocation stress and ways in which a nurse can help an older person adjust to a new environment. Chapter page reference: 215 Heading: Relocation Trauma Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Stress Difficulty: Easy PTS: 1
CON: Stress
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Multiple Choice Identify the choice that best completes the statement or answers the question. 1. What defines the scope of practice of the licensed practical nurse (LPN)? 1) State Nurse Practice Act 2) Shift-related responsibilities 3) Needs of the facility or hospital 4) Registered nurse (RN) charge nurse, supervisor, or director of nursing 2. Which is an example of an authoritarian style of leadership? 1) Nursing assistants are not assigned to breaks and lunches. 2) The practical nurse designs a rotating schedule for assigning breaks and lunch. 3) The practical nurse assigns the nursing assistants to specific times for their breaks and lunch. 4) Nursing assistants sign up for the break and lunch that they prefer and negotiate if there are any conflicts. 3. What best describes the work environment with a democratic leader? 1) Teamwork 2) Following orders 3) Structured time and task responsibilities 4) Individual accountability and responsibility 4. While dealing with an acute patient care situation the charge nurse starts giving orders to staff and directs others to pick up supplies. What type of management style is this nurse using? 1) Permissive 2) Democratic 3) Laissez-faire 4) Authoritarian 5. The charge nurse gathers the nursing staff in the conference room to discuss a patient care situation. A subcommittee of team members is formed to implement specific recommendations. What type of management style is being used by the charge nurse? 1) Permissive 2) Democratic 3) Laissez-faire 4) Authoritarian 6. A nurse manager wants to feel good, wants the staff to always feel good, and has this as her primary goal. What type of management style is this manager practicing? 1) Permissive 2) Democratic 3) Participative 4) Authoritarian 7. Staff nurses are overheard saying that they don’t care about the unit or the work that needs to be done because nothing is ever good enough. Which type of style is most likely being used to manage these employees? 1) Multicratic
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Democratic 3) Laissez-faire 4) Authoritarian 8. The nurse manager follows the multicratic leadership style. For which situation would this style be LEAST effective? 1) Manager directs staff during an emergency situation 2) Manager encourages staff to self-schedule for shifts 3) Manager insists that a resident get dressed for breakfast 4) Manager asks staff for opinions on implementing a new policy 9. Which does NOT describe nonverbal communication? 1) Body posture 2) Sharing messages using words 3) The kind of clothes a person wears 4) The most honest communication method 10. Which is NOT an appropriate strategy for communicating with older adults? 1) Shout loudly. 2) Sit at eye level with the older adult. 3) Close the door to shut out background noises. 4) Listen carefully and verify the older adult’s statements. 11. Which strategy would facilitate communication with families? 1) Referring the family to a social worker 2) Being available to talk at the nurses’ station 3) Asking the family to telephone to ask questions 4) Meeting in a quiet room away from the care area 12. How does presbycusis affect communication? 1) Difficulty speaking 2) Difficulty seeing near objects 3) Difficulty discriminating sounds 4) An abnormal change for older adults 13. How does presbyopia affect communication? 1) Difficulty speaking 2) Difficulty seeing near objects. 3) Difficulty discriminating sounds 4) An abnormal finding in older adults 14. Which facilitates communication in interdisciplinary team (IDT) conferences? 1) Setting time limits on the discussion of each resident 2) Requiring that all members attend on time and are prepared 3) Writing the needed changes in the plan of care before the meeting 4) Inviting the family to meet with individual members of the team rather than coming to IDT meetings 15. What type of communication includes the words “I feel”? 1) Active listening 2) Passive communication 3) Assertive communication
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Aggressive communication 16. Which is an assertive response to being embarrassed by another nurse in front of a family? 1) “Could you just shut up?” 2) “I feel you are out of line.” 3) “You are so insensitive to my feelings.” 4) “When you yell at me in front of family members, I feel very humiliated.” 17. What type of communication does this statement demonstrate? “When you take responsibility for my tasks, I feel threatened and unprofessional. We should try to talk about events that occur so that we can resolve them together.” 1) Passive 2) Assertive 3) Nonverbal 4) Aggressive 18. What is the major block to active listening with an angry resident? 1) Lack of time to listen 2) Tendency to prepare a defense 3) Amount of anger being expressed 4) Unwillingness of the angry person to negotiate solutions 19. The family of a nursing home resident is yelling at the nurse’s station about the substandard care being provided to the resident. What action should the nurse take first? 1) Listen to the family member. 2) Move the conversation to a private area. 3) Offer the family member a chair to sit down. 4) Tell the family member to wait in the resident’s room. 20. What is a characteristic of a good nurse manager? 1) Always doing 2) Always planning 3) Relying on crisis management to attain results 4) Evaluating subordinates only when required to by organization rules 21. What is essential for the nurse manager to understand about planning? 1) It is the act of sitting in an office with the door shut to think things through clearly. 2) It is the ability to make a plan and have the strength to never change it despite what happens. 3) It is the process of making decisions based on facts and information rather than emotions and wishes. 4) It is developing the flexibility to keep making changes in the plan in each of the four critical aspects of the planning loop. 22. What causes the need for crisis management? 1) Budget cuts 2) Poor planning 3) Lack of supplies 4) Inappropriate workloads 23. What is crisis management? 1) Something that cannot be avoided
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) An effective method of resolving problems 3) Instilling a feeling of trust in staff members 4) Something that can be prevented by anticipating problems and planning 24. The nurse is testing a plan of care. Which step of the planning loop is the nurse performing? 1) Assessment 2) Planning 3) Implementation 4) Evaluation 25. The staff development trainer is preparing materials to instruct new charge nurses about the planning loop. What should the trainer use to help explain this loop? 1) Nursing process 2) Care planning process 3) Discharge planning process 4) Policies and procedures 26. The charge nurse intends to use the planning loop for a staff scheduling issue. What information should the nurse collect first? 1) Number of staff available to work 2) Dates for the next charge nurse meetings 3) Number of care plans completed on residents 4) Expected time the pharmacy will deliver medications 27. The nurse manager must know how to determine priorities to be effective. When identifying priorities what needs should the manager think of? 1) Upper management 2) The entire organization 3) The staff, because happy staff give good care 4) The person most likely to sue the organization 28. Nursing assistants who work the day shift have requested that they be assigned the same group of residents every day that they work. What is a negative aspect of this proposal? 1) Potential for residents to become accustomed to a certain routine 2) Potential for residents to have increased interpersonal bonding with a nursing assistant 3) Potential for residents to develop a sense of being part of the team that plans their individual care 4) Potential for a demanding resident to “burn out” a nursing assistant who is routinely assigned to care for him or her 29. Which is NOT a category of nursing staff according to Benner? 1) Expert 2) Novice 3) Proficient 4) Incompetent 30. The nurse manager has one expert certified nursing assistant (CNA), two advanced beginner CNAs, two proficient CNAs, one competent CNA, and one novice CNA assigned for the day shift. Who should be paired with the novice CNA? 1) Expert CNA 2) Proficient CNA
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Competent CNA 4) Advanced beginner CNA 31. A resident is being moved to a room at the other end of the hall. What should the nurse manager do about the assignment for this resident? 1) Keep the same CNA. 2) Reassign to another CNA. 3) Assign to the charge nurse. 4) Nothing, because all care should be completed. 32. A resident who has a body mass index of 33 must be transferred to a chair. The charge nurse assigns a novice CNA who is 5 foot 1 inch tall and of slight build. What should be done about this situation? 1) Tell the staff nurse to transfer the resident to the chair. 2) Nothing, because the CNA must learn to manage all types of residents. 3) Remind the charge nurse of the resident’s size so the assignment can be changed. 4) Consider terminating the CNA for inability to provide care to all types of residents. 33. Which is NOT a part of the Five Rights of Delegation? 1) Right patient 2) Right direction 3) Right supervision 4) Right circumstances 34. Which task should NOT be assigned to a CNA? 1) Assist a frail older adult to the bathroom. 2) Decide how often the pulse reading should be taken. 3) Help an older adult with personal grooming. 4) Take an apical pulse and report the reading to the nurse. 35. Before delegating, what should the licensed nurse do? 1) Select the nursing assistant to delegate tasks to. 2) Ask the nursing assistants if they are willing to perform extra tasks. 3) Ask the charge nurse if there is anything in particular that is a priority. 4) Learn permissible delegation behaviors from the State Nurse Practice Act. 36. What is the priority when delegating tasks to certified or unlicensed assistive personnel? 1) Resident safety 2) Task completion 3) Cost effectiveness 4) Time management 37. What opportunity does the employment interview serve? 1) Exchange information with qualified applicants. 2) Determine if the applicant has the necessary physical attributes for the job. 3) Determine if the applicant has the necessary education or training for the position. 4) Ensure that the applicant’s race and ethnic heritage are congruent with the resident population. 38. Which statement is inappropriate during a job interview? 1) “Have you ever worked night shifts?” 2) “Where did you receive your CNA training?” 3) “Tell me about your last nursing assistant position.”
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) “You have a lovely name. Were you born in the United States?” 39. The nurse hears about an afternoon shift nursing assistant using the telephone in one of the resident’s rooms to talk to friends and not completing assigned resident care duties. What is the most important action of the nurse before confronting the assistant? 1) Review the facility’s guidelines for probation. 2) Visit each of the residents in the assistant’s care assignment. 3) Call the nursing supervisor to initiate the termination process. 4) Write a detailed narrative of the nursing assistant’s complaints. 40. A nursing assistant is having trouble staying awake on the night shift and is found sleeping in the day room. What should the nurse do? 1) Encourage the nursing assistant to work day shifts. 2) Ask the other assistants to cover for the employee who is sleeping. 3) Review options and provide the employee with a written warning. 4) Suggest changing daytime activities so sleep can occur when not working. 41. A reliable CNA who is liked by most staff and some patients is very loud and gregarious while at work, which frequently causes a problem. During the annual evaluation, this issue is not addressed. What does this say about the employee’s behavior? 1) This is appropriate because the employee is reliable. 2) This is appropriate because the employee cannot change his personality. 3) This should be ignored because for the last 2 weeks it has not been a problem. 4) This is inappropriate because the manager is not helping the employee improve and is being too lenient. 42. A nursing assistant with an evaluation due in 2 weeks came in early to help with a staffing crisis and saved a choking family member by performing the Heimlich maneuver. The evaluation is certain to be full of high praise for skills and teamwork. Is this an appropriate evaluation? 1) This is a fair evaluation because of care provided over the last 2 weeks. 2) This is a situation in which a halo effect is influencing the entire evaluation. 3) This is a situation in which a leniency error is influencing the entire evaluation. 4) This is a fair evaluation because of no problems with the employee over the entire year. Multiple Response Identify one or more choices that best complete the statement or answer the question. 43. The nurse manager is planning to hire additional CNAs to begin September 1. When should the manager expect the new staff to have completed orientation? 1) October 1 2) November 1 3) December 1 4) January 1 44. Why should the manager assign an expert nursing assistant to serve as a mentor for newly hired assistants? 1) To reduce the amount of overtime pay 2) To have the expert assistant serve as a role model 3) To give the expert assistant a break with resident care 4) To determine if the new hire is appropriate for the role
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
45. Which is NOT a component of total quality management (TQM)? 1) Employee focus 2) Total organizational involvement 3) Identifying processes for improvement 4) Using quality tools for outcome measurement 46. What comment made by nursing staff indicates additional education about TQM would be beneficial? 1) “I’ll be right there.” 2) “That’s not my job.” 3) “We work together.” 4) “What can I do to help?” 47. For which characteristic of TQM would the Plan-Do-Check-Act (PDCA) Cycle be appropriate? 1) Customer/patient focus 2) Total organizational involvement 3) Identify key processes to improve 4) Use of quality tools and statistics for measurement 48. The licensed nurse is considering delegating tasks to assistive personnel. What needs to be done before performing this delegation? Select all that apply. 1) Review position descriptions. 2) Check for appropriate supplies. 3) Study the policy and procedure manual. 4) Ask the medical director for permission. 5) Analyze the times scheduled for staff lunches. 49. The administrator of a skilled nursing facility is implementing a clinical ladder for licensed and certified staff. What should the administrator expect as benefits of this model? Select all that apply. 1) Improved morale 2) Less overtime pay 3) Improved staff health 4) Improved patient care 5) Less employee turnover 50. The manager is preparing materials to explain TQM to the care staff. What should the manager emphasize as the overall purpose of TQM? Select all that apply. 1) Improve quality of service. 2) Ensure customer satisfaction. 3) Increase access to health care. 4) Reduce the cost of health care. 5) Eliminate overlapping positions.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Answer Section MULTIPLE CHOICE 1. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 1. Identify the four management styles and determine when each would be effectively used in the gerontological setting. Chapter page reference: 225 Heading: Management and Leadership Roles Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Regulations Difficulty: Easy Feedback 1 The State Nurse Practice Act is what defines the scope of practice for the LPN. 2 Shift-related responsibilities define the job responsibilities of the LPN but these job responsibilities must be within the practical nursing scope of practice. 3 Needs of the facility or hospital define the job responsibilities of the LPN but these job responsibilities must be within the practical nursing scope of practice. 4 The RN charge nurse, supervisor, or director of nursing define the job responsibilities of the LPN but these job responsibilities must be within the practical nursing scope of practice. PTS: 1 CON: Regulations 2. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 1. Identify the four management styles and determine when each would be effectively used in the gerontological setting. Chapter page reference: 225 Heading: Authoritarian Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate Feedback 1 Not assigning lunch and breaks is an example of laissez-faire leadership. 2 This is an example of a democratic leadership style. 3 An authoritarian leader makes the decisions in the work environment. 4 This is an example of a democratic leadership style.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Management 3. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 1. Identify the four management styles and determine when each would be effectively used in the gerontological setting. Chapter page reference: 226 Heading: Democratic or Participative Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Management Difficulty: Easy Feedback 1 Teamwork and the value of all the team members are the central themes of a democratic leadership style. 2 This is an authoritarian work style. 3 This is an authoritarian work style. 4 This describes the laissez-faire work style. PTS: 1 CON: Management 4. ANS: 4 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 1. Identify the four management styles and determine when each would be effectively used in the gerontological setting. Chapter page reference: 225 Heading: Authoritarian Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate Feedback 1 This is not the permissive management style. 2 This is not the democratic management style. 3 This is not the laissez-faire management style. 4 Authoritarian leaders thrive in emergency situations. They are more interested in seeing the work get done or the problem resolved than the creative and caring approach. PTS: 1 CON: Management 5. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 1. Identify the four management styles and determine when each would be effectively used in the gerontological setting. Chapter page reference: 226
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Democratic or Participative Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate Feedback 1 This is not the permissive leadership style. 2 Democratic managers have a strong sense of team. The team gathers, assesses, and implements change. Although this process may take a great deal of time and energy it works well in geriatric environments because it is people-focused. 3 This is not the permissive or laissez-faire leadership style. 4 This is not the authoritarian leadership style. PTS: 1 CON: Management 6. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 1. Identify the four management styles and determine when each would be effectively used in the gerontological setting. Chapter page reference: 226 Heading: Permissive or Laissez-faire Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate Feedback 1 The permissive or laissez-faire management style allows employees to make decisions, formulate plans, set goals, and manage the organization. This manager does not require accountability from the staff. Although seemingly ideal, because of the amount of accountability placed on health-care providers by legislation this style is not effective in a medical environment. 2 This is not the democratic style of leadership. 3 This is not a participative or democratic style of leadership. 4 This is not an authoritarian style of leadership. PTS: 1 CON: Management 7. ANS: 4 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 1. Identify the four management styles and determine when each would be effectively used in the gerontological setting. Chapter page reference: 225 Heading: Authoritarian Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate Feedback 1 The multicratic style uses a variety of styles based on the situation. This is the ideal management style. 2 The democratic style encourages input and participation by others. 3 The laissez-faire style is one in which there is no clear direction. It will either be a success or a complete failure. 4 The authoritarian style can be oppressive and decrease motivation among workers. PTS: 1 CON: Management 8. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 1. Identify the four management styles and determine when each would be effectively used in the gerontological setting. Chapter page reference: 227 Heading: Multicratic Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate Feedback 1 During an emergency situation the authoritarian style would be beneficial. 2 Encouraging self-scheduling would be either democratic or laissez-faire. 3 Insisting that a resident do anything is an inappropriate use of the authoritarian style. 4 Asking for staff input would be the democratic style. PTS: 1 CON: Management 9. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 228 Heading: Nonverbal Communication Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy Feedback 1 Nonverbal communication refers to body posture. 2 Nonverbal communication takes into account everything but words. 3 Nonverbal communication refers to clothing.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
Nonverbal communication refers to the actual thought and feeling behind the words.
PTS: 1 CON: Communication 10. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 228 Heading: Communicating with Patients and Residents Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy Feedback 1 Shouting is a poor communication technique because it raises the pitch and the volume of the speaker’s voice. Older adults have difficulty hearing higher pitched tones. 2 Sitting at eye level with the older adult is an appropriate strategy for communicating with older adults. 3 Closing the door to shut out background noises is an appropriate strategy for communicating with older adults. 4 Listening carefully and verifying the older adult’s statements is an appropriate strategy for communicating with older adults. PTS: 1 CON: Communication 11. ANS: 4 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 229 Heading: Communicating With the Families of Older Adults Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Communication Difficulty: Moderate Feedback 1 Referrals to a social worker are appropriate, but often the family just wants an opportunity to ask questions about the family member and the care the person is receiving. 2 The nurses’ station is a poor choice because of the lack of privacy and likelihood of interruption. 3 The telephone is a poor choice because of the lack of privacy and likelihood of interruption. 4 Inviting the family to a quiet room and setting a time limit for the conversation will help
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
the family and the nurse focus on the communication within an appropriate time frame. PTS: 1 CON: Communication 12. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 228 Heading: Communicating with Patients and Residents Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy Feedback 1 Aphasia is difficulty speaking. 2 Presbyopia is difficulty seeing near objects. 3 Presbycusis is a barrier to communication in individuals having difficulty discriminating sounds. 4 Presbycusis is a normal part of the aging process. PTS: 1 CON: Communication 13. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 228 Heading: Communicating with Patients and Residents Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy Feedback 1 Aphasia is difficulty speaking. 2 Presbyopia is difficulty seeing near objects. 3 Presbycusis is a barrier to communication in individuals having difficulty discriminating sounds. 4 Presbyopia is a normal part of the aging process. PTS: 1 CON: Communication 14. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 230 Heading: Interdisciplinary Team Communication Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Collaboration Difficulty: Easy Feedback 1 Setting time limits on discussions is a poor choice because it is inflexible. If a resident’s condition is changing more time may be required to update the resident’s plan of care. 2 Preparation and timeliness facilitate the communication process in IDT meetings. 3 Changing the plan of care before the meeting is a poor choice because it is not taking advantage of the diverse resources of the IDT in planning care. 4 The resident and family are part of the IDT. Discussing resident and family concerns with the whole IDT group avoids miscommunication and deals with problems in a timely manner. PTS: 1 CON: Collaboration 15. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 231 Heading: Assertive Communication Skills Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy Feedback 1 Active listening is a communication skill that complements assertive behavior. 2 Passive communication “runs away” from the conversation. 3 “I feel” messages are assertive responses to aggressive communication. 4 Aggressive communication “fights back” during the conversation. PTS: 1 CON: Communication 16. ANS: 4 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 232 Heading: Assertive Communication Skills Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Communication Difficulty: Moderate Feedback 1 Telling someone to shut up is an aggressive response. 2 Saying someone is out of line is an aggressive statement. 3 Accusing someone of being insensitive is an aggressive response. 4 An assertive response describes the situation and the person’s feelings. PTS: 1 CON: Communication 17. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 232 Heading: Assertive Communication Skills Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Communication Difficulty: Moderate Feedback 1 Passive communication runs from the conversation. 2 Assertive communication requires that the person resist the normal urge to attack when feeling uncomfortable. Statements should follow an “I feel,” “When you,” and “We should” format. This is a mature and constructive method to deal with uncomfortable situations. 3 Nonverbal communication contains no words. 4 Aggressive communication is attacking with words. PTS: 1 CON: Communication 18. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 232 Heading: Active Listening Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy Feedback 1 Nurses often think that they do not have enough time to listen but they spend time
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
defending themselves and arguing with angry residents. One of the biggest blocks to communication is not listening and responding defensively to emotion rather than the verbal communication. Anger is the emotion being expressed. Unwillingness to negotiate a solution is a blocking mechanism.
PTS: 1 CON: Communication 19. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 2. Identify communication skills and techniques that can be effectively incorporated into your role as a charge nurse. Chapter page reference: 232 Heading: Active Listening Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy Feedback 1 The nurses’ station is not an appropriate location for emotional outbursts. 2 The person who is out of control must be removed to a private setting. This prevents that individual from self-embarrassment in front of others and it places the nurse in an environment with fewer distractions. 3 Offering a chair supports the nurses’ station as an appropriate environment for the conversation. 4 Telling the family to wait in the resident’s room could cause the anger to escalate. PTS: 1 CON: Communication 20. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 5. Recognize the use of the planning loop in setting priorities. Chapter page reference: 234 Heading: Care Planning Loop Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Management Difficulty: Easy Feedback 1 Planning is a form of doing. 2 A good manager is always reviewing the big picture to manage the unit and evaluate the work of subordinates to determine if the individual needs of the older adults are being met most effectively. 3 Crisis management is not an effective approach to attain results. 4 Subordinate performance is important and should be done routinely and not just when
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
required by organizational rules. PTS: 1 CON: Management 21. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 5. Recognize the use of the planning loop in setting priorities. Chapter page reference: 234 Heading: Care Planning Loop Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Management Difficulty: Easy Feedback 1 This might need to be done while planning but it is not essential for planning. 2 This indicates inflexibility with planning. 3 An effective nurse manager must determine that planning is critical to getting the total workload done effectively. It is the process of making decisions based on facts and information rather than emotions and wishes. 4 This might be too flexible, which can cause confusion and poor planning. PTS: 1 CON: Management 22. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 5. Recognize the use of the planning loop in setting priorities. Chapter page reference: 235 Heading: Crisis Management Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Management Difficulty: Easy Feedback 1 Crisis management involves poor planning and can often be avoided by looking into the future and anticipating budget cuts. 2 Crisis management involves poor planning and can often be avoided by looking into the future. 3 Crisis management involves poor planning and can often be avoided by looking into the future and anticipating lack of supplies. 4 Crisis management involves poor planning and can often be avoided by looking into the future and anticipating inappropriate workloads. PTS: 1 23. ANS: 4
CON: Management
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 5. Recognize the use of the planning loop in setting priorities. Chapter page reference: 235 Heading: Crisis Management Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Management Difficulty: Easy Feedback 1 Crisis management can be avoided by planning. 2 Crisis management is not an effective problem-solving approach. 3 Crisis management fosters anxiety in staff. 4 Crisis management can be prevented by anticipating problems and planning. PTS: 1 CON: Management 24. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 5. Recognize the use of the planning loop in setting priorities. Chapter page reference: 235 Heading: Implementation Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate Feedback 1 Assessment is collecting data before planning. 2 Planning is determining a course of action. 3 Implementation is the test of good planning. 4 Evaluation is determining if goals set during planning were achieved. PTS: 1 CON: Management 25. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 5. Recognize the use of the planning loop in setting priorities. Chapter page reference: 234 Heading: Care Planning Loop Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1
2 3 4
The planning loop is similar to the nursing process. The loop begins with assessment, advances to goal setting, then implementation, and ends with evaluation with ongoing assessment occurring throughout. The planning loop is not similar to the care planning process. The planning loop is not similar to policies and procedures. The planning loop is not similar to the discharge planning process.
PTS: 1 CON: Management 26. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 5. Recognize the use of the planning loop in setting priorities. Chapter page reference: 234 Heading: Assessment Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate Feedback 1 To address a staffing issue the nurse needs to first assess the number of staff available to work. 2 Times for charge nurse meetings will not affect the staff scheduling issue. 3 The number of care plans completed will not affect the staff scheduling issue. 4 The time when the pharmacy will deliver medications will not affect the staff scheduling issue. PTS: 1 CON: Management 27. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 4. Integrate decision making skills into safe patient care scenarios. Chapter page reference: 236 Heading: Priority Setting Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate Feedback 1 Upper management’s needs are not more important than those of the staff or residents. 2 The effective manager is successful in meeting priorities of staff and patients or residents and the needs of the business side of the organization. When both of these critical areas are considered when setting priorities the needs of the entire organization are met. 3 The staff’s needs are not more important than the resident’s or the rest of the organization. 4 This would be a crisis management approach that is not appropriate.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Management 28. ANS: 4 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 4. Integrate decision making skills into safe patient care scenarios. Chapter page reference: 236 Heading: Making Care Assignments for Older Adults Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate Feedback 1 This would be a positive outcome. 2 This would be a positive outcome. 3 This would be a positive outcome. 4 A resident who is demanding or who has difficult and complex care needs has the potential to require more patience and energy than a nursing assistant can give on a daily basis. This can lead to burnout. PTS: 1 CON: Management 29. ANS: 4 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 4. Integrate decision making skills into safe patient care scenarios. Chapter page reference: 236 Heading: Making Care Assignments for Older Adults Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Management Difficulty: Easy Feedback 1 This is the last stage of developing proficiency. 2 This is the first stage of developing proficiency. 3 This is the stage before expert. 4 This is not a stage of developing proficiency according to Benner. PTS: 1 CON: Management 30. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 4. Integrate decision making skills into safe patient care scenarios. Chapter page reference: 236 Heading: Making Care Assignments for Older Adults Integrated Processes: Nursing Process: Planning
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate Feedback 1 The novice should be paired with the expert to ensure adequate role modeling of position expectations. 2 The proficient CNA would be the second choice. 3 The competent CNA would be the third choice. 4 The advanced beginner should not be used because this CNA is still learning the role. PTS: 1 CON: Management 31. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 4. Integrate decision making skills into safe patient care scenarios. Chapter page reference: 238 Heading: Making Care Assignments for Older Adults Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate Feedback 1 Keeping the same CNA means that that employee would have to travel long distances to provide care. 2 Changing the CNA makes the most sense for the resident and the staff. 3 The charge nurse should not have a patient care assignment. 4 This is inappropriate. The resident will continue to need care throughout the shift. PTS: 1 CON: Management 32. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 4. Integrate decision making skills into safe patient care scenarios. Chapter page reference: 238 Heading: Making Care Assignments for Older Adults Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate Feedback 1 The CNA is responsible for care. 2 This does not take the CNA’s physical limitations into consideration. 3 When the assignments are made, the physical, muscular work of the care should be considered so as not to overwork a particular employee
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
There is not a reason to terminate the CNA.
PTS: 1 CON: Management 33. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 3. Identify delegation skills required for the LPN charge nurse in the gerontological setting. Chapter page reference: 238 Heading: Delegation Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Management Difficulty: Easy Feedback 1 Patients may or may not influence delegation. Delegation can be organizational needs or tasks and patient care activities. 2 The Five Rights of Delegation include the right direction. 3 The Five Rights of Delegation include the right supervision. 4 The Five Rights of Delegation include the right circumstances. PTS: 1 CON: Management 34. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 3. Identify delegation skills required for the LPN charge nurse in the gerontological setting. Chapter page reference: 239 Heading: Delegation Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Management Difficulty: Easy Feedback 1 CNAs can assist with toileting. 2 CNAs can assist with grooming. 3 CNAs cannot assess, plan, or evaluate any aspect of patient care; they cannot determine how often a pulse reading should be taken on a specific patient. 4 CNAs can measure an apical pulse and report the finding to the nurse. PTS: 1 CON: Management 35. ANS: 4 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 3. Identify delegation skills required for the LPN charge nurse in the gerontological setting. Chapter page reference: 238 Heading: Delegation Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Management Difficulty: Easy Feedback 1 Selecting a nursing assistant to delegate to is done at the time of delegation. 2 Asking if an assistant is willing to perform extra tasks is not a step in the delegation process. 3 Asking the charge nurse to prioritize is not a part of delegating. 4 The first step is to become familiar with the State Nurse Practice Act for the employing state. This document defines the roles and responsibilities of a licensed nurse to determine if the State Nurse Practice Act allows for delegation and, if so, whether there are any limitations as to what can be delegated to a CNA or unlicensed assistive person. PTS: 1 CON: Management 36. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 3. Identify delegation skills required for the LPN charge nurse in the gerontological setting. Chapter page reference: 238 Heading: Delegation Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Management Difficulty: Easy Feedback 1 The resident’s safety must be taken into consideration when planning to delegate tasks. 2 Task completion is essential but not the main priority when delegating tasks. 3 Cost effectiveness is not the main priority when delegating tasks. 4 Time management is not the main priority when delegating tasks. PTS: 1 CON: Management 37. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 6. Identify three common errors made in doing employee evaluations. Chapter page reference: 240 Heading: Interview Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Comprehension [Understanding] Concept: Management Difficulty: Easy Feedback 1 The purpose of the interview is to exchange information. 2 Hiring based on physical appearance is discriminatory. 3 All applications should be screened and only qualified applicants should be interviewed. 4 Hiring based on ethnicity is discriminatory. PTS: 1 CON: Management 38. ANS: 4 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 6. Identify three common errors made in doing employee evaluations. Chapter page reference: 241 Heading: Interview Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate
1 2 3 4
Feedback Asking about work history is an appropriate question. Asking about education is an appropriate question. Asking about work history is an appropriate question. Asking an individual’s national heritage or where he or she was born could be interpreted as a discriminatory question.
PTS: 1 CON: Management 39. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 6. Identify three common errors made in doing employee evaluations. Chapter page reference: 242 Heading: Employee Evaluation Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate Feedback 1 After collecting data the guidelines for probation may need to be reviewed. 2 Gathering resident care data and documenting findings before confronting the employee about an unacceptable behavior would strengthen the rationale for placing the nursing assistant on probation. 3 It is premature to consider terminating the employee on hearsay only.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
Writing a detailed narrative of the complaint would be a good idea, but it is not as important as having first-hand information regarding the problem.
PTS: 1 CON: Management 40. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 6. Identify three common errors made in doing employee evaluations. Chapter page reference: 242 Heading: Employee Evaluation Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate Feedback 1 Switching to day shifts might not fit into the facility’s care needs. 2 The nursing assistants should not have to cover the assignment of another nursing assistant. 3 It is inappropriate for a nursing assistant to sleep during her shift. The facility policy for probation or warnings should be instituted. 4 The nurse should not have to counsel an employee to do less activities in order to get adequate rest. PTS: 1 CON: Management 41. ANS: 4 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 6. Identify three common errors made in doing employee evaluations. Chapter page reference: 242 Heading: Employee Evaluation Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate Feedback 1 The evaluation should help the employee improve. 2 An evaluation should not be done to have an employee change basic personality characteristics. 3 The evaluation should not be based on behavior that occurred over the last 2 weeks. 4 The leniency error contributes to a less-than-accurate evaluation. The manager must be honest, fair, and objective. PTS: 1 42. ANS: 2
CON: Management
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 6. Identify three common errors made in doing employee evaluations. Chapter page reference: 242 Heading: Employee Evaluation Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate Feedback 1 The evaluation should not be based on 2 weeks of performance. 2 The halo effect allows one event or trait to influence the entire evaluation; in this case, recent behaviors. The objectivity of the evaluation is being clouded by the halo behavior. 3 This is not an example of the leniency error. 4 A fair evaluation should be based on skills and not merely the absence of problems. PTS: 1
CON: Management
MULTIPLE RESPONSE 43. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 6. Identify three common errors made in doing employee evaluations. Chapter page reference: 243 Heading: Providing Education for Employees Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate
1. 2. 3. 4.
Feedback The new staff will not be adequately oriented in 1 month. The new staff will not be adequately oriented in 2 months. Orientation for new CNAs should be at least 3 months. Although orientation should last at least 3 months, extending it to 4 months might be a bit lengthy.
PTS: 1 CON: Management 44. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 6. Identify three common errors made in doing employee evaluations. Chapter page reference: 243 Heading: Providing Education for Employees
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate
1. 2. 3. 4.
Feedback Assigning an expert assistant to a newly hired assistant is not done to reduce the amount of overtime pay. The expert CNA who is willing to be a role model and mentor for the new employee should be a valued employee who consistently demonstrates expert clinical skills and care behaviors. Assigning an expert assistant to a newly hired assistant is not done to give the expert assistant a break with resident care. Assigning an expert assistant to a newly hired assistant is not done to determine if the new hire is appropriate for the role.
PTS: 1 CON: Management 45. ANS: 1 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 7. Explain the importance of “total quality management” as it relates to the gerontological setting. Chapter page reference: 244 Heading: Total Quality Management Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Quality Improvement Difficulty: Easy
1. 2. 3. 4.
Feedback Employee focus is not a component of TQM. Total organization involvement is a component of TQM. Identifying processes for improvement is a component of TQM. Using quality tools for outcome measurement is a component of TQM.
PTS: 1 CON: Quality Improvement 46. ANS: 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 7. Explain the importance of “total quality management” as it relates to the gerontological setting. Chapter page reference: 244 Heading: Total Quality Management Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Quality Improvement Difficulty: Moderate
1. 2. 3. 4.
Feedback TQM encourages responsiveness to resident needs. This philosophy of TQM eliminates the idea of “That’s not my job.” TQM encourages working together. In TQM everyone works toward the overall goal of satisfied customers.
PTS: 1 CON: Quality Improvement 47. ANS: 3 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 7. Explain the importance of “total quality management” as it relates to the gerontological setting. Chapter page reference: 245 Heading: Total Quality Management Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Quality Improvement Difficulty: Moderate
1. 2. 3. 4.
Feedback The PDCA cycle is not used specifically for customer/patient focus. The PDCA cycle is not used to measure total organizational involvement. The phrase “identification of key processes” refers to the efficiency or effectiveness of the work people or teams do together. An example is the PDCA cycle. The PDCA cycle is not used as a quality tool or statistic for measurement.
PTS: 1 CON: Quality Improvement 48. ANS: 1, 3 Feedback 1. The nurse should become familiar with the written job descriptions. Any job assigned must be within the employee’s job description. 2. Checking for supplies is not a part of delegation. 3. The nurse should become familiar with the policy and procedures for the facility. 4. The medical director does not need to be contacted prior to delegating care. 5. The staff’s scheduled lunches are not a priority when delegating. Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 3. Identify delegation skills required for the LPN charge nurse in the gerontological setting. Chapter page reference: 238 Heading: Delegation Integrated Processes: Nursing Process: Implementation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate PTS: 1 CON: Management 49. ANS: 1, 4, 5 Feedback 1. Facilities have found that clinical ladders can improve employee morale. 2. Clinical ladders are not known to reduce overtime pay. 3. Clinical ladders are not known to improve the health of the employees. 4. The benefit to the facility is better patient care. 5. Facilities have found that clinical ladders can assist with employee retention. Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 6. Identify three common errors made in doing employee evaluations. Chapter page reference: 243 Heading: Providing Education for Employees Integrated Processes: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Moderate PTS: 1 CON: Management 50. ANS: 1, 2 Chapter number and title: Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse Chapter/learning objective: 7. Explain the importance of “total quality management” as it relates to the gerontological setting. Chapter page reference: 244 Heading: Total Quality Management Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Quality Improvement Difficulty: Moderate
1. 2. 3. 4. 5. PTS: 1
Feedback The overall purpose of TQM is to improve quality of service. The overall purpose of TQM is to ensure customer satisfaction. TQM does not focus on access to health care. TQM does not focus on the cost of health care. TQM does not focus on staffing issues. CON: Quality Improvement
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 14 Infection Control Test Bank for Anderson’s Caring for Older Adults Holistically, 6th Edition, Tamara R. Dahlkemper
Acquired Immune Deficiency Syndrome (AIDS) A disorder in which the immune system is gradually weakened and eventually disabled by the human immuno-defiency virus (HIV)
aerobic Containing oxygen; referring to an organism, environment, or cellular process that requires oxygen.
airborne precautions procedures used to prevent the spread of airborne pathogens
anaerobic living or active in the absence of free oxygen
antisepsis disinfectants applied directly to exposed body surfaces
asepsis Free from infection or pathogens; the actions practiced to make and maintain an object free from infection or pathogens.
autoclave a pressurized container designed to sterilize materials with moist heat. this resembles a larger version of an ordinary home pressure cooker.
bacteria (microbiology) single-celled or noncellular spherical or spiral or rod-shaped organisms lacking chlorophyll that reproduce by fission
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
bioterrorism the use of biological, such as pathogens, in terrorist attacks
causative agent cause of a specific disease process
cavitation Formation, growth and pulsation of gas or vapor filled bubbles
chain of infection process of events involved in the transmission and development of an infectious disease
chemical disinfection A process that destroys or kills pathogenic organisms.
clean not spreading pollution or contamination
communicable disease a disease that can be communicated from one person to another
contact precautions practices used to prevent spread of disease by direct or indirect contact
contaminated contaminated with infecting organisms
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
disinfection treatment to destroy harmful microorganisms
droplet precautions used when the disease-causing microorganism does not stay suspended in the air and travels only short distances after being expelled.
endogenous the infection or disease originates within the body
epidemic a widespread outbreak of an infectious disease; affects a large number of people within a population, community, or region at the same time
exogenous derived or originating externally
fomites inanimate objects that serve as reservoirs for microbes e.g. contaminated medical equipment
fungi Kingdom composed of heterotrophs; many obtain energy and nutrients from dead organic matter
helminths parasitic worms
hepatitis B an acute (sometimes fatal) form of viral hepatitis caused by a DNA virus that tends to persist in the blood serum and is transmitted by sexual contact or by transfusion or by ingestion of contaminated blood or other bodily fluids
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
hepatitis C a viral hepatitis clinically indistinguishable from hepatitis B but caused by a single-stranded RNA virus
microorganism any organism of microscopic size
mode of transmission a way for the causative agent to be transported
nonpathogens part of the normal flora of the body and are beneficial in maintaining certain body processes
nosocomial Infections that originate in hospitals
opportunistic Microorganisms that are normal residents of a host but can cause illness when the host's defenses are weakened by such factors as poor nutrition or a recent bout with the flu.
pathogens an organism that produces disease in a host organism disease being alteration of one or more metabolic functions in response to the presence of the organism
personal protective equipment (PPE) equipment used to protect from exposure to pathogens, items such as gloves, gowns, masks, protective eyewear, and hair coverings are used to protect the nurse from infectious organisms
portal of entry
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
a pathway by which the caustive agent enters the host
portal of exit a way for the causative agent to be released from the reservoir
protective isolation air filtered, patients vulnerable or highly susceptible to infections; also known as reverse isolation
protozoa single celled organisms with the ability to move independently
reservoir anything (a person or animal or plant or substance) in which an infectious agent normally lives and multiplies
rickettsiae parasitic microorganisms which meanst they cannot live outside the cells of another living organism
standard precautions practices used in health care facilities to prevent the spread of infection
sterile free from germs
sterile field A work area free of all pathogens and non-pathogens (including spores)
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
sterilization the procedure of making some object free of live bacteria or other microorganisms (usually by heat or chemical means)
susceptible host host not possessing resistance against an infectious agent
transmission-based isolation precautions Method of treating patients who have communicable diseases.
ultrasonic related to a frequency of sound vibrations beyond the normal hearing range; high in frequency
viruses tiny particles, smaller than bacteria and other pathogens, which must invade living cells in order to reproduce; when they invade, the cells are damaged or destroyed in the process releasing new particles to infect other cells
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 15: Common Medical Diagnoses Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which statement is true about chronic conditions in an older patient? 1) Chronic conditions are stable and unchangeable over time. 2) Chronic conditions are often cured when they are detected. 3) Chronic conditions develop rapidly and respond to prompt medical intervention. 4) Chronic conditions often are not evident until they negatively affect an older person’s functional ability. 2. What are the three most common chronic health conditions of older adults? 1) Diabetes mellitus, arthritis, influenza 2) Arthritis, heart disease, diabetes mellitus 3) Arthritis, heart disease, sensory changes 4) Diabetes mellitus, heart disease, pneumonia 3. Which nursing focus is appropriate when dealing with chronic conditions? 1) Base care on the ability to cure. 2) Allow patients to deny a disability because it will pass. 3) Use more sophisticated, high-technology interventions to assist the patient. 4) Assist the patient to attain the highest possible level physically, socially, psychologically, and spiritually. 4. An older person with chronic obstructive pulmonary disease (COPD) asks why the pneumococcal vaccination is necessary. How should the nurse respond to this person? 1) “It will prevent the development of pneumonia.” 2) “It will improve your lung functioning as you age.” 3) “It will reduce shortness of breath and fatigue when exercising.” 4) “It will prevent the COPD from getting worse.” 5. While attending a community health fair, an older person says that she doesn’t know when arthritis developed. One day she was able to bend over to tie her shoes and the next day she couldn’t. How should the nurse respond to this person? 1) “Maybe you don’t have arthritis.” 2) “Have you been to see your doctor?” 3) “Chronic conditions develop over time.” 4) “The stiffness will resolve in a few months.” 6. When calling on an older community member, the nurse is greeted at the door by a non-family member who identifies herself as the caregiver. What should the nurse focus on when assessing this community member? 1) Financial status 2) Environmental safety 3) Potential for elder abuse 4) Chronic health problems 7. The nurse reviews ways to help an older person maintain independence with osteoarthritis. Which patient statement indicates that additional teaching about the chronic condition is required? 1) “I’ll take my medications and in a few months the arthritis will be healed.”
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) “If I get up from bed slowly and move deliberately the joint pain will ease.” 3) “I understand the importance of walking every day to keep my muscles strong.” 4) “I will use pillows to support my joints so that I can get adequate rest each night.” 8. Which statement describes a goal for the review of systems? 1) Analyze older adults’ awareness of their bodies. 2) Increase the speed and efficiency of the physical examination. 3) Identify symptoms that affect the current health status of the older adult. 4) Relax older adults so that they are less nervous for the actual examination. 9. The nurse is preparing to conduct a review of systems with an older patient. Which observation should indicate to the nurse that questions about the respiratory system are a priority? 1) Burping 2) Dry skin 3) Coughing 4) Walking slowly 10. An older patient is experiencing shortness of breath during the night. How should the nurse document this finding? 1) Orthopnea 2) Dyspnea on exertion 3) Paroxysmal nocturnal dyspnea 4) Shortness of breath during sleep 11. During the review of systems, an older patient explains experiencing increased hunger, frequent urination, and a 5-lb weight loss in the last month. Which body system should the nurse focus on when assessing for additional information? 1) Endocrine 2) Pulmonary 3) Genitourinary 4) Gastrointestinal 12. What is the underlying problem in a myocardial infarction (MI)? 1) The heart stops pumping blood. 2) The heart valves have become stiff and do not close properly. 3) The heart muscle is not receiving enough blood to operate properly. 4) The major blood vessels bringing blood to the heart become occluded, causing peripheral edema and lung congestion. 13. What manifestations of an MI might be assessed in an older patient? 1) Pain in the joints 2) Severe constipation 3) Nausea and dyspnea 4) Headache and intense hunger 14. Which are possible complications of an MI in an older adult? 1) Deconditioning, nausea, and congestive heart failure (CHF) 2) Tuberculosis, nausea, and vomiting 3) Emboli, extension of the infarct, and CHF 4) Diabetes, CHF, and thrombi 15. Which statement best describes CHF?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1) It is commonly associated with birth defects that do not manifest until old age. 2) It is a congested and overloaded cardiovascular system that requires the heart to work harder. 3) It is heart failure associated with the heart’s loss of muscle mass and efficiency in conduction of electrical impulses. 4) The major blood vessels bringing blood to the heart become occluded, causing peripheral edema and lung congestion. 16. Which would NOT be a nursing responsibility in caring for an older adult with CHF? 1) Provide a low-salt diet. 2) Weigh at the same time every day. 3) Assess for signs of pedal or other dependent edema. 4) Increase fluid intake to compensate for potential fluid depletion with the use of diuretics. 17. Which is NOT a common cause of CHF in an older adult? 1) Anemia 2) Diabetes 3) Thyroid disease 4) Heart valve calcification 18. What technique should the nurse use to check for postural hypertension? 1) Blood pressure (BP) and pulse while lying, sitting, and standing with no rest period 2) BP and respirations lying, sitting, and standing at 5-minute intervals 3) BP and respirations after 20 minutes of rest in a flat position, then with 5 minutes of sitting and again 5 minutes after standing 4) BP and pulse after 5 to 10 minutes of rest in a flat position, then within 1 minute of sitting and again after 1 minute of standing 19. An older patient is prescribed digoxin. What is NOT essential for the nurse to keep in mind for this medication? 1) High doses may cause confusion as a side effect. 2) Falling from orthopnea is a common and frequent side effect. 3) It requires periodic monitoring of drug blood levels to prevent toxicity. 4) It is used in the treatment of CHF to strengthen the force of the heart contraction. 20. An older patient who is being treated with high-volume intravenous fluids for dehydration is prescribed propranolol (Inderal) for migraines and cimetidine for gastric ulcers. The patient currently has bilateral edema of the lower extremities, edema of the periorbital area, and a respiratory rate of 26. What should the nurse suspect is occurring with this patient? 1) CHF 2) Gout 3) Medication reaction 4) Impending MI 21. Which would NOT be wise to instruct as a health promotion nursing intervention for older adults with hypertension? 1) Encouraging a physician-ordered exercise plan 2) Monitoring blood pressure changes associated with positional hypotension 3) Making diet changes to encourage weight loss, reduced salt intake, and lowered cholesterol intake 4) Tapering older adults off of antihypertensive medications as soon as their blood pressure
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
returns to normal range 22. Which patient is at a higher risk for hypertension? 1) White man, age 55, height 6 feet, weight 210 lb 2) White woman, age 70, height 5 feet 1 inch, weight 130 lb 3) African-American man, age 70, height 6 feet, weight 250 lb 4) African-American man, age 72, height 6 feet 2 inches, weight 190 lb 23. What causes leg ulcers in older adults with peripheral vascular disease (PVD)? 1) Poor hygiene practices 2) Pressure from bed-bound status 3) Dryness of the skin 4) Impaired circulation to lower extremities 24. What should the nurse include when teaching a patient with PVD? 1) Uncrossing legs, avoiding temperature extremes, using cotton socks 2) Avoiding constricting clothing, avoiding infection, having one glass of red wine per day 3) Keeping legs dependent, avoiding temperature extremes, and avoiding constricting clothing 4) Applying salve with gauze and tape to open areas, having one glass of red wine per day, avoiding temperature extremes 25. Which are characteristics of a right hemisphere stroke not typically associated with a left hemisphere stroke? 1) Weakness and paralysis 2) Hemiparesis and hemiparalysis 3) Poor judgment and overestimation of abilities 4) Need for support for ambulation and activities of daily living (ADLs) 26. What causes unilateral neglect? 1) Brainstem involvement 2) Left hemisphere stroke 3) Total loss of movement or sensation 4) Loss of visual fields related to the stroke 27. An older patient who has had a stroke insists on doing things for herself. This is creating safety concerns. Which type of stroke did this patient most likely experience? 1) Brainstem 2) Cerebellar 3) Left hemisphere 4) Right hemisphere 28. What should the nurse do to prevent the risk of deconditioning with an older adult who has had a stroke? 1) Increase fluid intake. 2) Monitor medications. 3) Initiate a mobility program. 4) Promote a regular toileting schedule. 29. What would least likely reduce the risk of complications after a stroke? 1) Monitoring medications 2) Ensuring adequate hydration 3) Providing immunizations for pneumonia, flu, and tetanus 4) Encouraging dependence on family members and caregivers
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
30. What is the primary nursing goal for an older person with Parkinson’s disease (PD)? 1) Maintain continence. 2) Maintain function and self-care. 3) Facilitate taking medications as ordered. 4) Avoid development of the characteristic shuffling gait. 31. Which is NOT true of Parkinson’s disease (PD)? 1) It most commonly affects women. 2) The primary treatment is medication. 3) It usually appears between 60 and 80 years of age. 4) It is characterized as a progressive disease with slow movement, rigidity, unstable posture, and tremors at rest. 32. Which is considered a major cause of blindness? 1) Glaucoma 2) Presbyopia 3) Cataract development 4) Macular degeneration 33. Which statement is true about hearing loss in older people? 1) It is uncommon. 2) It cannot be treated or compensated for. 3) It may affect high-frequency tones in particular. 4) It occurs more frequently in women than in men. 34. Which are primary symptoms of chronic obstructive pulmonary disease (COPD)? 1) Cough, joint pain, and peripheral edema 2) Heart palpitations and difficulty breathing 3) Cough, shortness of breath, and dyspnea on exertion 4) Peripheral edema, cyanotic nail beds, and heart palpitations 35. Which would NOT be a helpful self-care measure for an older adult with COPD? 1) Keep track of a medication schedule. 2) Obtain influenza and pneumococcal immunizations to prevent infections. 3) Recognize signs and symptoms of infection, such as cough or changes in sputum. 4) Engage in an aggressive aerobic exercise program to promote effective oxygen use. 36. An older patient with end-stage COPD is anxious and claims that the oxygen tubing is clogged and not providing enough oxygen. Which self-care strategy would assist this patient to be more comfortable? 1) Quitting smoking 2) Increasing the liter flow on the oxygen 3) Increasing the dosage of narcotic pain relievers 4) Teaching strategies to deal with anxiety and obstruction of air flow 37. An older patient is experiencing morning stiffness in the back, hips, and knees, along with enlarged joints. What should the nurse explain about these manifestations? 1) Joint replacement surgery is contraindicated. 2) These problems are associated with degenerative joint disease. 3) These problems are an expected consequence of aging. 4) Less exercise and weight-bearing activities is recommended.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
38. What is the major goal of nursing care for an older person with osteoporosis? 1) Limitation of activities 2) Changing of dietary practices 3) Prevention of further bone demineralization 4) Prevention of injuries, especially related to falls 39. Which would NOT be helpful to teach patients with osteoporosis and their family members? 1) Limiting caffeine, tobacco, and alcohol 2) Decreasing the intake of yogurt and milk 3) Removal of scatter rugs and other trip items 4) Installing grab bars in the shower and toilet areas 40. Which would NOT be a part of the teaching plan for an older adult who has type 2 diabetes mellitus? 1) Care of feet 2) Limitation of activity 3) Need for regular eye examinations 4) Recognition of signs and symptoms of infection 41. What are the nursing considerations for an older adult who has been started on thyroid replacement therapy? 1) Schedule for weekly blood glucose levels. 2) Schedule for a drug blood level done in 4 weeks and teach how to monitor heart rate. 3) Schedule for a complete blood count (CBC) and electrolyte level within 1 month and teach the signs and symptoms of infection. 4) Schedule for weekly blood glucose levels and encourage doing daily self-blood glucose monitoring. 42. What is hypothyroidism often confused with? 1) Emphysema 2) Characteristics of aging 3) Congestive heart failure 4) Degenerative joint disease 43. An older person with hypertension is being started on an aerobic exercise program. What should the nurse emphasize when teaching the patient about this program? 1) Be sure to stretch after walking. 2) Take a cool shower after walking. 3) Perform 15 minutes of aerobic walking five times a week. 4) Perform 10 minutes of aerobic walking two to three times a week. 44. An older person prescribed an angiotensin-converting enzyme inhibitor has stopped taking the medication. For which adverse effect of the medication should the nurse assess in this patient? 1) Anxiety 2) Insomnia 3) Palpitations 4) Nonproductive cough 45. The nurse is preparing an education session for older community members on actions to prevent a stroke. What should the nurse emphasize as being the most important modifiable risk factor for stroke? 1) Arthritis 2) Pneumonia 3) High blood pressure
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Gastroesophageal reflux disease 46. An older patient recovering from a stroke coughs when drinking fluids. What should the nurse consider to prevent this patient from aspirating? 1) Thickening the fluids 2) Increasing intravenous fluid infusion 3) Making the patient nothing by mouth status 4) Providing all nourishment through tube feedings 47. An older patient with CHF talks with adult children about the future and what they should focus on to take care of their family home once she passes away. What should the nurse realize that this conversation indicates? 1) The patient has financial difficulty. 2) The adult children are unemployed. 3) The adult children still live at home. 4) The patient has achieved gerotranscendence. 48. The nurse is assessing a newly admitted older resident to a skilled nursing facility. Which statement indicates that the patient has achieved gerotranscendence? 1) “I worked too much during my life.” 2) “I’m so angry with my family for putting me here.” 3) “I can’t wait to get better so I can go to bingo with my friends.” 4) “I have enjoyed a wonderful life and know I won’t live forever.” Multiple Response Identify one or more choices that best complete the statement or answer the question. 49. An older person says that she does not want to become sick like many of her friends and just sit around talking about illnesses. What should the nurse suggest to help this person prevent the development of chronic health problems? Select all that apply. 1) Don’t smoke. 2) Eat a healthy diet. 3) Engage with family and friends. 4) Enjoy alcohol with every dinner. 5) Have routine physical examinations. 50. Why is a review of systems when assessing and taking the history particularly useful with an older adult? Select all that apply. 1) Older adults often have nonspecific atypical symptoms. 2) The review cuts into the amount of time the patient needs to be examined. 3) Changes associated with aging may affect more than one body system. 4) The review determines if prescribed medications are appropriate for the health problems. 5) Older adults often have a complex history and a review can help relate past experiences with the present. 51. When conducting a nursing assessment of the gastrointestinal tract, which questions would be helpful? Select all that apply. 1) Sexual activity 2) Use of laxatives 3) Food intolerances
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Burning or pain with urination 5) Abdominal distress before or after meals 52. Which immunizations should the nurse assess for when conducting a review of systems with an older patient? Select all that apply. 1) Polio 2) Shingles 3) Influenza 4) Hepatitis B 5) Pneumococcal 53. The nurse is beginning a review of systems with an older patient. What areas should be included when assessing this patient’s neurological system? Select all that apply. 1) Gait 2) Vision 3) Hearing 4) Bruising 5) Nocturia 54. What are symptoms of diabetes in an older person? Select all that apply. 1) Thirst 2) Fatigue 3) Weakness 4) Confusion 5) Weight loss 55. Which blood tests are used to help diagnose an acute MI? Select all that apply. 1) Troponin 2) Phosphokinase 3) Serum albumin 4) Creatine kinase 5) Hemoglobin A1c 56. An older patient is newly diagnosed with CHF. Which medication should the nurse expect to be prescribed for this patient? Select all that apply. 1) Digoxin 2) Diuretics 3) Antibiotics 4) Anticoagulants 5) Angiotensin-converting enzyme inhibitors
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 15: Common Medical Diagnoses Answer Section MULTIPLE CHOICE 1. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 1. Explain differences between acute and chronic stages of common medical problems in older adults. Chapter page reference: 269 Heading: Acute versus Chronic Conditions Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Nursing Difficulty: Easy Feedback 1 Chronic conditions typically have an up-and-down course marked by exacerbations complicated by other stressors. 2 This describes an acute health problem. 3 This describes an acute health problem. 4 Chronic conditions develop over time and often are not noticed by the person with the problem until major deficits manifest. PTS: 1 CON: Nursing 2. ANS: 2 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 1. Explain differences between acute and chronic stages of common medical problems in older adults. Chapter page reference: 269 Heading: Acute versus Chronic Conditions Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Nursing Difficulty: Easy Feedback 1 Influenza is an acute illness that is serious for older adults because it can be lifethreatening when superimposed over a chronic disease process. 2 Chronic conditions commonly found in elderly individuals include cardiovascular disease, arthritis, and diabetes. 3 Sensory changes are not identified as being the most common chronic conditions in an older person. 4 Pneumonia is an acute illness that is serious for older adults because it can be lifethreatening when superimposed over a chronic disease process.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Nursing 3. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 1. Explain differences between acute and chronic stages of common medical problems in older adults. Chapter page reference: 270 Heading: Acute versus Chronic Conditions Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Nursing; Nursing Roles Difficulty: Easy Feedback 1 Curing the condition is appropriate for an acute illness. 2 Denying a disability is inappropriate. The patient needs assistance with learning to manage the disability. 3 High-technology interventions are appropriate for an acute illness. 4 The goal is to provide care that is helpful in managing chronic diseases. This care should be focused on assisting the older adult to function at the highest possible level in the physical, social, psychological, and spiritual arenas of life. PTS: 1 CON: Nursing | Nursing Roles 4. ANS: 1 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 1. Explain differences between acute and chronic stages of common medical problems in older adults. Chapter page reference: 270 Heading: Acute versus Chronic Conditions Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Nursing; Nursing Roles Difficulty: Moderate Feedback 1 Chronic diseases cannot be prevented by vaccination but can be controlled with appropriate medication. 2 The pneumococcal vaccination will not improve the patient’s lung function. 3 The pneumococcal vaccination will not improve shortness of breath and fatigue when exercising. 4 The pneumococcal vaccination will not prevent the patient’s COPD from getting worse. PTS: 1 CON: Nursing | Nursing Roles 5. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 1. Explain differences between acute and chronic stages of common medical problems in older adults. Chapter page reference: 270
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Acute versus Chronic Conditions Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Nursing; Nursing Roles Difficulty: Moderate Feedback 1 Diagnosing the person’s health problem is beyond the nurse’s scope of practice. 2 Suggesting that she sees a physician does not help the person understand the development of a chronic health problem. 3 Chronic conditions develop over time and often are not noticed by the person with the problem until major deficits manifest. 4 The person has a chronic health problem that will not resolve in a few months. PTS: 1 CON: Nursing | Nursing Roles 6. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 1. Explain differences between acute and chronic stages of common medical problems in older adults. Chapter page reference: 270 Heading: Acute versus Chronic Conditions Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Nursing; Nursing Roles Difficulty: Moderate Feedback 1 The person’s financial status does not need to be assessed. 2 Although important, the person’s environment is not an issue. 3 There is no evidence that the community member is experiencing elder abuse. 4 Chronic conditions tend to require more help from the informal system of caregiving. Often an older adult develops a partnership with members of the informal system to gain more control over the chronic disease. PTS: 1 CON: Nursing | Nursing Roles 7. ANS: 1 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 1. Explain differences between acute and chronic stages of common medical problems in older adults. Chapter page reference: 270 Heading: Acute versus Chronic Conditions Integrated Processes: Nursing Process: Evaluation Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Analysis [Analyzing] Concept: Nursing; Nursing Roles Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Osteoarthritis is a chronic health problem that will not be cured or healed in a few months. Moving slowly would help the patient prevent falls. Exercise is beneficial to the person with osteoarthritis. Joint support will help reduce pain when resting.
PTS: 1 CON: Nursing | Nursing Roles 8. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 2. Describe at least two common physiological changes in each body system that are normal aging changes. Chapter page reference: 271 Heading: Review of Systems Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Body awareness is not a goal of the review of systems, although the review of systems might assist in pinpointing specific areas of concern and developing rapport with older adults before the physical examination. 2 Speed is not a goal of the review of systems, although the review of systems might assist in pinpointing specific areas of concern and developing rapport with older adults before the physical examination. 3 The review of systems is instrumental in assisting older adults and the nurse to identify problems that older adults may have forgotten to report or thought were unimportant. 4 Relaxation is not a goal of the review of systems, although the review of systems might assist in pinpointing specific areas of concern and developing rapport with older adults before the physical examination. PTS: 1 CON: Assessment 9. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 2. Describe at least two common physiological changes in each body system that are normal aging changes. Chapter page reference: 272 Heading: Pulmonary System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1 Burping would indicate that the gastrointestinal system would be a priority. 2 Dry skin would indicate that the endocrine system would be a priority. 3 Coughing would indicate that the respiratory system is a priority.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
Walking slowly would indicate that the musculoskeletal system is a priority.
PTS: 1 CON: Assessment 10. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 2. Describe at least two common physiological changes in each body system that are normal aging changes. Chapter page reference: 272 Heading: Pulmonary System Integrated Processes: Communication and Documentation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1 Orthopnea is shortness of breath when lying flat. 2 Dyspnea on exertion describes shortness of breath with activity. 3 Paroxysmal nocturnal dyspnea is shortness of breath during the night when sleeping. 4 Shortness of breath during sleep describes paroxysmal nocturnal dyspnea. PTS: 1 CON: Assessment 11. ANS: 1 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 2. Describe at least two common physiological changes in each body system that are normal aging changes. Chapter page reference: 273 Heading: Endocrine System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1 The patient is describing manifestations of diabetes, which is an endocrine system disorder. 2 The patient’s symptoms are not associated with a pulmonary system disorder. 3 The patient’s symptoms are not associated with a genitourinary system disorder. 4 The patient’s symptoms are not associated with a gastrointestinal system disorder. PTS: 1 CON: Assessment 12. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 273 Heading: Coronary Artery Disease Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Perfusion Difficulty: Easy Feedback 1 The heart stopping pumping would indicate sudden death, which might occur with an acute MI. 2 Stiff heart valves could occur from some disease processes. 3 The term coronary artery disease (CAD) indicates that the heart muscle is not receiving a blood supply adequate to meet its needs. CAD includes myocardial ischemia and infarction. 4 It is unusual for major blood vessels to occlude. PTS: 1 CON: Perfusion 13. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 273 Heading: Coronary Artery Disease Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Perfusion Difficulty: Easy Feedback 1 Joint pain is a musculoskeletal system problem. 2 Constipation is a gastrointestinal problem. 3 Nausea and dyspnea are symptoms that can signal decreased myocardial blood flow and MI. 4 Headache and intense hunger could be neurological and endocrine system problems. PTS: 1 CON: Perfusion 14. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 274 Heading: Coronary Artery Disease Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Perfusion Difficulty: Easy Feedback 1 Nausea might be a symptom of a pending MI. 2 Tuberculosis is an infectious disease. Nausea and vomiting might be symptoms of a
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
pending MI. Common complications of an MI in the older adult include thrombi and emboli, CHF, arrhythmias, and extension of the infarct. Diabetes is an endocrine disorder, unrelated to an MI.
PTS: 1 CON: Perfusion 15. ANS: 2 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 274 Heading: Congestive Heart Failure Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Perfusion Difficulty: Easy Feedback 1 CHF is not associated with birth defects in old age. 2 When the heart is a less effective pump, it is unable to keep up with a high volume demand. Consequently, there is more blood pooling and movement of fluid into the interstitial spaces. 3 CHF is not associated with loss of heart muscle mass and changes in electrical conduction. 4 CHF is not associated with major blood vessels becoming occluded. PTS: 1 CON: Perfusion 16. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 274 Heading: Congestive Heart Failure Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Perfusion Difficulty: Moderate Feedback 1 A low-salt diet would be beneficial for this patient. 2 Daily weight assessment would be necessary. 3 Assessment for edema would be necessary. 4 Diuretics are administered to remove excess fluid, so increasing fluid intake would be an inappropriate response. PTS: 1 17. ANS: 2
CON: Perfusion
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 274 Heading: Congestive Heart Failure Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Perfusion Difficulty: Easy Feedback 1 Anemia can cause CHF. 2 Diabetes does not cause CHF. 3 Thyroid disease can cause CHF. 4 Heart valve calcification can cause CHF. PTS: 1 CON: Perfusion 18. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 274 Heading: Congestive Heart Failure Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Perfusion Difficulty: Moderate
1 2 3 4
Feedback This is not the correct technique to assess for postural hypotension. This is not the correct technique to assess for postural hypotension. This is not the correct technique to assess for postural hypotension. To assess for postural hypotension, the blood pressure and pulse should be checked after 5 to 10 minutes of resting in a flat position, again within 1 minute of sitting, and again 1 minute after standing.
PTS: 1 CON: Perfusion 19. ANS: 2 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 274 Heading: Congestive Heart Failure Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Parenteral Therapies Cognitive level: Application [Applying]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Perfusion Difficulty: Moderate Feedback 1 This is an appropriate nursing consideration when caring for an older patient taking digoxin. 2 Falling from orthopnea is a side effect of diuretics, not digoxin. 3 This is an appropriate nursing consideration when caring for an older patient taking digoxin. 4 This is an appropriate nursing consideration when caring for an older patient taking digoxin. PTS: 1 CON: Perfusion 20. ANS: 1 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 274 Heading: Congestive Heart Failure Integrated Processes: Nursing Process: Evaluation Client Need: Physiological Integrity: Parenteral Therapies Cognitive level: Analysis [Analyzing] Concept: Perfusion Difficulty: Moderate Feedback 1 An acute episode of CHF may be caused by increased fluids and beta-blockers (Inderal). 2 Gout would not cause rapid respirations and periorbital edema. 3 A medication reaction might cause periorbital edema and rapid respirations, but it would not normally cause lower extremity edema. 4 An impending MI would not create periorbital edema. PTS: 1 CON: Perfusion 21. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 276 Heading: Hypertension Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Perfusion Difficulty: Moderate Feedback 1 Exercise plans are excellent health promotion activities for older adults with hypertension. 2 Monitoring for postural blood pressure changes is an excellent health promotion activity for older adults with hypertension.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
Diet changes are excellent health promotion activities for older adults with hypertension. Hypertension is a “silent” disease that is often first noticed on a random blood pressure reading. Generally, an older adult who is diagnosed with hypertension must take medications for the rest of his or her life to keep blood pressure in the normal range.
PTS: 1 CON: Perfusion 22. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 275 Heading: Hypertension Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Knowledge [Remembering] Concept: Perfusion Difficulty: Easy Feedback 1 Caucasian males of normal weight are not at the greatest risk for hypertension. 2 Caucasian females of normal weight are not at the greatest risk for hypertension. 3 African-American men older than 65 years who are obese are at the greatest risk for hypertension. 4 African-American men of normal weight are not at the greatest risk for hypertension. PTS: 1 CON: Perfusion 23. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 277 Heading: Peripheral Vascular Disease Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Perfusion Difficulty: Easy Feedback 1 Poor hygiene practices increase an older adult’s risk of developing skin breakdown but are not specifically related to PVD. 2 Pressure from bed-bound status increases an older adult’s risk of developing skin breakdown but is not specifically related to PVD. 3 Dry skin increases an older adult’s risk of developing skin breakdown but is not specifically related to PVD. 4 The impaired circulation of PVD increases the older adult’s risk for having decreased circulation and impaired wound healing. PTS: 1
CON: Perfusion
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
24. ANS: 1 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 277 Heading: Peripheral Vascular Disease Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Perfusion Difficulty: Moderate Feedback 1 Patients should be taught to uncross legs, avoid temperature extremes, and use cotton socks. 2 Red wine has no bearing on PVD. 3 The legs should be elevated. 4 Patients should be taught to avoid tape and salve on the area. Red wine has no bearing on PVD. PTS: 1 CON: Perfusion 25. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 278 Heading: Stroke Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Neurological Regulation Difficulty: Easy Feedback 1 Weakness and paralysis occur in both types of strokes. 2 Hemiparesis and hemiparalysis are seen in both types of strokes. 3 Judgment errors and overestimation of abilities are characteristic of a right-hemisphere stroke. 4 Need for support for ambulation and ADLs are necessary for both types of strokes. PTS: 1 CON: Neurological Regulation 26. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 278 Heading: Stroke Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Knowledge [Remembering] Concept: Neurological Regulation Difficulty: Easy Feedback 1 Hemianopsia is not specific to any type or location of a stroke. 2 Hemianopsia is not specific to any type or location of a stroke. 3 Hemianopsia is not caused by a total loss of movement or sensation. 4 The visual field losses of homonymous and bitemporal hemianopsia can result in an older person being unaware of personal and environmental things that are out of the visual field. PTS: 1 CON: Neurological Regulation 27. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 278 Heading: Stroke Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Neurological Regulation Difficulty: Easy Feedback 1 This behavior is not typical of a brainstem stroke. 2 This behavior is not typical of a cerebellar stroke. 3 This behavior is not typical of a left hemisphere stroke. 4 Often, older people who have a stroke affecting the right half of the brain have a decreased awareness of their functional limitations. PTS: 1 CON: Neurological Regulation 28. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 278 Heading: Stroke Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Neurological Regulation Difficulty: Moderate Feedback 1 Fluid intake would not affect deconditioning. 2 Medications would not affect deconditioning. 3 A mobility program would decrease the risk of deconditioning. 4 A toileting schedule would not affect deconditioning.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Neurological Regulation 29. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 279 Heading: Stroke Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Neurological Regulation Difficulty: Moderate Feedback 1 Monitoring medications would help reduce the risk of complications after a stroke. 2 Ensuring adequate hydration would help reduce the risk of complications after a stroke. 3 Providing immunizations would help reduce the risk of complications after a stroke. 4 It is essential to maintain mobility and foster independence as appropriate. Patients must be encouraged to do whatever they can for themselves. PTS: 1 CON: Neurological Regulation 30. ANS: 2 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 279 Heading: Parkinson’s Disease Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Neurological Regulation Difficulty: Easy Feedback 1 Maintaining continence would not be a primary goal. 2 Promoting activity and self-care assists an older adult with PD to maintain functional ability. 3 Facilitating medication taking would not be a primary goal. 4 Safety promotion versus avoiding the shuffling gait is probably a more realistic goal. PTS: 1 CON: Neurological Regulation 31. ANS: 1 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 279 Heading: Parkinson’s Disease Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Neurological Regulation Difficulty: Easy Feedback 1 PD is mostly found in men. 2 The primary treatment for PD is medication. 3 PD usually appears between 60 and 80 years of age. 4 PD is characterized as a progressive disease with slow movement, rigidity, unstable posture, and tremors at rest. PTS: 1 CON: Neurological Regulation 32. ANS: 1 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 280 Heading: Sensory Losses Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Sensory Perception Difficulty: Easy Feedback 1 Glaucoma is the asymptomatic increase in intraocular pressure that is a major cause of blindness. 2 Presbyopia can be treated with corrective lenses or bifocals. 3 Cataracts can be surgically removed. 4 Macular degeneration causes decreased central vision but not blindness. PTS: 1 CON: Sensory Perception 33. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 281 Heading: Sensory Losses Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Sensory Perception Difficulty: Easy Feedback 1 Hearing loss is common in elderly individuals. 2 Hearing aids that amplify sound are readily available. 3 The ability to hear high-frequency tones decreases with age. 4 Hearing loss occurs more frequently in older men than in older women.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Sensory Perception 34. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 281 Heading: Chronic Obstructive Pulmonary Disease Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Oxygenation Difficulty: Easy Feedback 1 Joint pain is not usually noted as a symptom of COPD. 2 Heart palpitations and difficulty breathing may be symptoms but are not the common primary symptoms of COPD. 3 Chronic cough, shortness of breath, and dyspnea on exertion are the classic symptoms of COPD. 4 Heart palpitations, peripheral edema, and cyanotic nail beds may be symptoms but are not the common primary symptoms of COPD. PTS: 1 CON: Oxygenation 35. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 281 Heading: Chronic Obstructive Pulmonary Disease Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Oxygenation Difficulty: Moderate Feedback 1 Keeping track of a medication schedule is an appropriate self-care activity to teach an older adult with COPD. 2 Obtaining influenza and pneumococcal immunizations to prevent infections is an appropriate self-care activity to teach an older adult with COPD. 3 Recognizing signs and symptoms of infection, such as cough or changes in sputum, is an appropriate self-care activity to teach an older adult with COPD. 4 Older adults with COPD have a lowered tolerance of aerobic exercise. They are less able to adjust to increased body oxygen needs. An aggressive aerobic program would be inappropriate. PTS: 1 36. ANS: 4
CON: Oxygenation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 282 Heading: Chronic Obstructive Pulmonary Disease Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Oxygenation Difficulty: Moderate Feedback 1 Quitting smoking is probably not going to increase the oxygen that is needed now. 2 Increasing the oxygen flow can act as respiratory depressants and might contribute to respiratory arrest. 3 Narcotic analgesics can act as respiratory depressants and might contribute to respiratory arrest. 4 Teaching an older adult with COPD relaxation strategies, posturing, and deep breathing exercises can decrease anxiety and increase the efficiency of coughing. PTS: 1 CON: Oxygenation 37. ANS: 2 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 282 Heading: Osteoarthritis and Degenerative Joint Disease Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Mobility Difficulty: Moderate Feedback 1 Joint replacement would be an option for this patient. 2 The symptoms of morning stiffness and increased joint size of fingers and knees are classic signs of degenerative joint disease. 3 Osteoarthritis and osteoporosis are very common chronic diseases of aging people but they are not considered part of the normal aging process. 4 Exercises that assist with mobility and function are appropriate for an older adult with degenerative joint disease. PTS: 1 CON: Mobility 38. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 283 Heading: Osteoporosis
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Fluid and Electrolyte Balance Difficulty: Easy Feedback 1 This is not appropriate for a patient with osteoporosis. 2 This might need to be done but is not the major goal of nursing care for the patient with osteoporosis. 3 Prevention of further bone demineralization is attempted, but an older person who has osteoporosis has already sustained a significant loss of bone mass to place him or her at risk for fractures related to falls. 4 Promoting safety to reduce the risk of falls is a major nursing intervention to prevent injuries. PTS: 1 CON: Fluid and Electrolyte Balance 39. ANS: 2 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 283 Heading: Osteoporosis Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 Patients with osteoporosis should limit caffeine, tobacco, and alcohol. 2 Patients with osteoporosis should increase their calcium intake with fortified foods such as low-fat milk, yogurt, cereal, and orange juice. 3 Patients with osteoporosis should remove scatter rugs and other trip items. 4 Patients with osteoporosis should install grab bars in the shower and toilet areas. PTS: 1 CON: Fluid and Electrolyte Balance 40. ANS: 2 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 284 Heading: Type 2 Diabetes Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Metabolism Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Foot care is an appropriate teaching topic. An older adult who has type 2 diabetes should have a regular exercise and diet plan. Activity is not limited because of a diagnosis of type 2 diabetes. Regular eye examinations are an appropriate teaching topic. Recognizing manifestations of infection is an appropriate teaching topic.
PTS: 1 CON: Metabolism 41. ANS: 2 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 284 Heading: Hypothyroidism Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Metabolism Difficulty: Moderate Feedback 1 This would be appropriate for a person with diabetes. 2 Thyroid replacement therapy is monitored by drug levels to ensure that the older person is receiving the appropriate dose of thyroxine. 3 This would be appropriate for a person with many health problems but not hypothyroidism. 4 This would be appropriate for a person with diabetes. PTS: 1 CON: Metabolism 42. ANS: 2 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 284 Heading: Hypothyroidism Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Metabolism Difficulty: Easy Feedback 1 Hypothyroidism is not often confused with emphysema. 2 The presence of a low thyroid level is often overlooked because of the similarity between the symptoms of hypothyroidism and characteristics of aging. 3 Hypothyroidism is not often confused with congestive heart failure. 4 Hypothyroidism is not often confused with degenerative joint disease. PTS: 1 43. ANS: 4
CON: Metabolism
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 276 Heading: Hypertension Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Perfusion Difficulty: Moderate Feedback 1 Stretching should occur before walking. 2 Cooling the muscles after walking does not mean to take a cool shower. 3 Walking 15 minutes five times a week may be too strenuous at first. 4 The older adult can start with 10 minutes of aerobic walking two to three times a week. The time and frequency of aerobic activity can gradually be increased by 5 to 10 minutes each week. PTS: 1 CON: Perfusion 44. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 276 Heading: Hypertension Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Parenteral Therapies Cognitive level: Application [Applying] Concept: Perfusion Difficulty: Moderate Feedback 1 Anxiety is not an adverse effect of angiotensin-converting enzyme inhibitors. 2 Insomnia is not an adverse effect of angiotensin-converting enzyme inhibitors. 3 Palpitations are not adverse effects of angiotensin-converting enzyme inhibitors. 4 A common side effect when an angiotensin-converting enzyme inhibitor is used to treat hypertension is a nonproductive cough. PTS: 1 CON: Perfusion 45. ANS: 3 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 277 Heading: Stroke Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Neurological Regulation Difficulty: Moderate Feedback 1 Arthritis is not linked to stroke. 2 Pneumonia is not linked to stroke. 3 High blood pressure is the most important modifiable risk factor of stroke. 4 Gastroesophageal reflux disease is not linked to stroke. PTS: 1 CON: Neurological Regulation 46. ANS: 1 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 279 Heading: Stroke Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Neurological Regulation Difficulty: Moderate Feedback 1 People with swallowing difficulties after a stroke frequently have more difficulty with fluids than they do with swallowing solids. Thicker liquids may be tolerated better than thin liquids. 2 The nurse cannot independently increase an intravenous infusion rate. 3 The nurse cannot independently make a patient nothing by mouth status. 4 The nurse cannot independently insert a feeding tube and begin tube feedings. PTS: 1 CON: Neurological Regulation 47. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 285 Heading: Gerotranscendence Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Development Difficulty: Moderate Feedback 1 There is no information to suggest that the patient has financial difficulty. 2 There is no information to support that the adult children are unemployed. 3 There is no information to support that the adult children still live at home. 4 Gerotranscendence means that an older person is ready for the losses of old age and the inevitability of death.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Development 48. ANS: 4 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 285 Heading: Gerotranscendence Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Development Difficulty: Moderate Feedback 1 Regret is an indication that gerotranscendence has not been achieved. 2 Anger is an indication that gerotranscendence has not been achieved. 3 Unrealistic expectations are indications that gerotranscendence has not been achieved. 4 An older adult who has succeeded in Erikson’s developmental plan can accept death because of a life well-lived. The individual generally can continue living with singular or multiple acute and chronic diseases because there are few regrets in his or her life. PTS: 1
CON: Development
MULTIPLE RESPONSE 49. ANS: 1, 2, 3, 5 Feedback 1. Older adults who practice healthy behaviors like not smoking are more likely to remain healthy, live independently, and incur fewer health-related costs. 2. Older adults who practice healthy behaviors like eating a healthy diet are more likely to remain healthy, live independently, and incur fewer health-related costs. 3. Older adults who engage with family and friends are more likely to remain healthy, live independently, and incur fewer health-related costs. 4. Alcohol every day might not be considered practicing a healthy behavior. 5. Older adults who take advantage of clinical preventative services are more likely to remain healthy, live independently, and incur fewer health-related costs. Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 1. Explain differences between acute and chronic stages of common medical problems in older adults. Chapter page reference: 269 Heading: Acute versus Chronic Conditions Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Nursing; Nursing Roles Difficulty: Moderate
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Nursing | Nursing Roles 50. ANS: 1, 3, 4, 5 Feedback 1. A review of systems is especially useful for older adults because they often have atypical symptoms. 2. A review of systems is not done to cut down on the amount of time the patient needs to be examined. 3. A review of systems is especially useful for older adults because they often have symptoms that may affect more than one body system. 4. A review of systems is done to determine if prescribed medications are appropriate for the health problem. For example, some medications may be inappropriate if the person has problems with falling. 5. A review of systems is especially useful for older adults because they often a complex history that can be related to present problems. Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 2. Describe at least two common physiological changes in each body system that are normal aging changes. Chapter page reference: 271 Heading: Review of Systems Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy PTS: 1 CON: Assessment 51. ANS: 2, 3, 5 Feedback 1. Although sexual activity should be assessed in the interview it would not be in the gastrointestinal area. 2. Use of laxatives would be assessed for the gastrointestinal area. 3. Food intolerances would be assessed for the gastrointestinal area. 4. Although urination should be assessed in the interview it would not be in the gastrointestinal area. 5. Abdominal distress before or after meals would be assessed for the gastrointestinal area. Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 2. Describe at least two common physiological changes in each body system that are normal aging changes. Chapter page reference: 272 Heading: Gastrointestinal System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Assessment 52. ANS: 2, 3, 5 Feedback 1. The polio vaccination is typically provided in infancy or childhood. 2. The older person should be assessed for having the shingles vaccination. 3. The older person should be assessed for having the influenza vaccination. 4. Hepatitis B is not routinely assessed in the older person. 5. The older person should be assessed for having the pneumococcal vaccination. Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 2. Describe at least two common physiological changes in each body system that are normal aging changes. Chapter page reference: 272 Heading: Pulmonary System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate PTS: 1 CON: Assessment 53. ANS: 1, 2, 3 Feedback 1. Gait is a part of the neurological system assessment. 2. Vision is a part of the neurological system assessment. 3. Hearing is a part of the neurological system assessment. 4. Bruising is a part of the cardiovascular system assessment. 5. Nocturia is a part of the genitourinary system assessment. Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 2. Describe at least two common physiological changes in each body system that are normal aging changes. Chapter page reference: 272 Heading: Neurological System Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate PTS: 1 CON: Assessment 54. ANS: 2, 3, 4 Feedback 1. Thirst, a common symptom in younger people, is not so common among older adults. 2. Changes such as fatigue are more often the presenting symptoms. 3. Changes such as weakness are more often the presenting symptoms.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4. 5.
Changes such as mental confusion are more often the presenting symptoms. Weight loss, a common symptom in younger people, is not so common among older adults.
Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 284 Heading: Think Like a Nurse Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Metabolism Difficulty: Easy PTS: 1 CON: Metabolism 55. ANS: 1, 2, 4 Feedback 1. Troponin level is used to diagnose an acute MI. 2. Phosphokinase level is used to diagnose an acute MI. 3. Serum albumin is used to diagnose nutritional disorders. 4. Creatine kinase level is used to diagnose an acute MI. 5. Hemoglobin A1c is used to evaluate effectiveness of treatment for diabetes.
Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 274 Heading: Coronary Artery Disease Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Perfusion Difficulty: Easy PTS: 1 CON: Perfusion 56. ANS: 1, 2, 5 Chapter number and title: Chapter 15: Common Medical Diagnoses Chapter/learning objective: 3. Demonstrate nursing care appropriate for long-term care of an older adult who has one or more of the common pathologies discussed in this chapter. Chapter page reference: 274 Heading: Congestive Heart Failure Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Parenteral Therapies Cognitive level: Application [Applying] Concept: Perfusion Difficulty: Moderate
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1. 2. 3. 4. 5. PTS: 1
Feedback Digoxin is routinely prescribed for a patient with CHF. Diuretics are routinely prescribed for a patient with CHF. Antibiotics would be prescribed for an infection. Anticoagulants would be prescribed for a patient with a clotting disorder. Angiotensin-converting enzyme inhibitors are prescribed for a patient with CHF. CON: Perfusion
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 16: Physiological Assessment Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which finding on physical examination would indicate a stroke? 1)
Facial droop
2)
Facial edema
3)
Ptosis of both eyelids
4)
Forward flexion of the neck
2. What should be included when assessing the head, neck, and face? 1)
Head position and proportions, dental care
2)
Lice, level of stress, and frequency of nosebleeds
3)
Facial tic and facial edema, range of motion (ROM) of the neck
4)
Hair distribution, head injury, ROM of the arms
3. Which is NOT typically included when the nurse is assessing the health history of an older person’s nose and sinuses? 1)
Discussion of appetite
2)
History of nose trauma
3)
History of allergies or hay fever
4)
History of colds and upper respiratory infections
4. How should the nurse examine the patency of each nostril? 1)
Check the older person’s sense of smell.
2)
Check for the presence of any nasal discharge.
3)
Examine the nasal mucosa to ensure that it is pink and moist.
4)
Ask the older person to inhale and exhale through each nostril while occluding the other nostril.
5. When assessing a patient’s sense of smell, the nurse gives a whiff of freshly ground coffee beans to an older patient. The patient identifies coffee with the left nostril but cinnamon with the right nostril. How should the nurse interpret this finding?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1)
Abnormal; odors should be perceived the same in both nostrils.
2)
Normal; all people differentiate odors differently with each nostril.
3)
Abnormal; the patient needs surgery immediately to cure a blockage.
4)
Normal; it is necessary to use both nostrils together to determine odors accurately.
6. What would be an abnormal finding in the examination of an older person’s mouth? 1)
Decreased saliva production
2)
Pink, moist, and smooth gums
3)
Varicose veins on the underside of the tongue
4)
White patches along the gum line or under dentures
7. What is NOT essential when evaluating the mouth of an older patient?
8.
1)
A visit to the dentist
2)
A visual inspection of teeth, tongue, and palate
3)
Wearing gloves for proper universal precautions
4)
Removing dentures or other nonpermanent appliances
Which area is NOT included when assessing an older patient’s neurological system? 1)
The patient’s grooming
2)
The patient’s financial issues
3)
Appropriateness of attire to season
4)
Appropriate vs. inappropriate behaviors during the interview
9. What findings during examination of the older person’s legs would indicate chronic arterial insufficiency? 1)
Varicose veins
2)
Bilateral pedal edema
3)
Transparent, shiny, hairless skin
4)
Localized areas of inflammation and
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
redness 10. What is an important strategy for the nurse to use when inspecting an older adult’s peripheral vascular status? 1)
Compare one side of the body with the other.
2)
Massage the older adult’s legs to see if circulation improves.
3)
Avoid touching the skin because of characteristic skin tenderness.
4)
Flex and extend the knees to determine tolerance of joint movement.
11. Which is true about measuring blood pressure readings while an older person is lying, sitting, and standing? 1)
Is usually done only with a physician’s order
2)
Can assist in identifying orthostatic hypotension
3)
Is unnecessary, unless the older person complains of chest pain
4)
Can identify the cause of increased heart rate when the older person changes positions
12. Which is true about a heart murmur in an older adult? 1)
It is a common normal finding.
2)
It is of no concern in an older adult.
3)
It can be the cause of chronic atrial fibrillation.
4)
It is caused by thickening and rigid heart valves, decreasing strength of contractions.
13. What should the nurse recall when crackles are assessed in the lungs of an older patient? 1)
They are always pathological.
2)
They are a whistling noise caused by air passing through a narrowed airway.
3)
They are caused by air passing through moisture and sound like hair rubbing between fingers.
4)
They are often heard in adults with
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
chronic obstructive pulmonary disease (COPD) and asthma. 14. Which question could the nurse ask regarding possible tuberculosis? 1)
“Do you smoke?”
2)
“Do you have a productive cough?”
3)
“Have you had a recent chest xray?”
4)
“Do you have a cough with bloodstreaked sputum?”
15. During palpation of an older person’s abdomen, when should the area of discomfort or pain be palpated? 1)
Last
2)
First
3)
In the order that the nurse is most comfortable
4)
In the middle of the examination when the patient is distracted
16. What is true about decreased gastric motility in an older person? 1)
It occurs normally with aging.
2)
It is a life-threatening emergency.
3)
It necessitates medication and possibly surgery to correct.
4)
It can be determined within a few seconds of auscultating bowel sounds.
17. Which is an abnormal skin change in an older person? 1)
Thinning scalp hair
2)
Skin folds under the breasts
3)
Pressure ulceration over a bony prominence
4)
Senile keratosis or senile lentigines skin lesion
18. An older patient has a bright purple lesion on the left arm with clear borders. What should the nurse do? 1)
Ask about recent falls.
2)
Question about new medications or foods.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3)
Set up an appointment with the dermatologist.
4)
Explain the normal skin changes that include senile purpura.
19. Compression fractures of the spine are common in older adults with osteoporosis. What is the usual patient manifestation? 1)
Pain in legs
2)
Acute lower back pain
3)
Abdominal discomfort
4)
Loss of control of urine
20. An older male patient complains of urinary frequency and an interrupted stream. What would be an appropriate response? 1)
Tell him to accept it and do nothing.
2)
Suggest that he see a physician for a prostate-specific antigen (PSA) test.
3)
Tell him it is a completely normal part of aging.
4)
Discuss with him that he may have prostate cancer.
21. Which would NOT be a priority when assessing an older patient with incontinence? 1)
Ability to sit with legs dependent
2)
Assessment of current medications
3)
Previous bowel and bladder regimen
4)
Psychosocial issues regarding incontinence
22. What should the nurse keep in mind when assessing the head and neck of an older patient? 1)
It is not really necessary to complete.
2)
It will take twice as long to complete.
3)
It will be uncomfortable for the older patient.
4)
It is the same as if assessing a younger person.
23. The nurse documents that an older person’s neurological status is within normal limits. What did the nurse use to make this clinical determination?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1)
Hand grasps equal
2)
Rigid lower extremities
3)
Pedal pulses present both feet
4)
Full range of motion of both shoulders
24. The nurse suspects that an older patient has a stasis ulcer on the left inner ankle. For which health problem should the nurse assess this patient? 1)
Varicose veins
2)
Venous insufficiency
3)
Arterial insufficiency
4)
Deep vein thrombosis
25. The nurse spent a great deal of time locating an older patient’s right pedal pulse. What should the nurse do to ensure that future assessments of this pulse can be completed in a timely manner? 1)
Mark the location with a felt-tipped pen.
2)
Apply a gauze dressing over the location.
3)
Tell the patient where the pulse is located.
4)
Document the location in the medical record.
26. Which assessment finding should the nurse identify as being common in an older adult? 1)
Neck crepitus
2)
Left facial droop
3)
Periorbital edema
4)
Occasional epistaxis
27. While assessing an older male patient’s nose and throat, what should the nurse document as being an expected finding? 1)
Increased nasal hair
2)
Occluded left nostril
3)
Deviated nasal septum
4)
Crusting within the nares
28. The nurse notes that an older patient’s pupils sluggishly respond to light. What should the nurse do with this information? 1)
Document it as a normal finding.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2)
Report the finding to the charge nurse.
3)
Discuss how long the patient had cataracts.
4)
Explain that an ophthalmologist appointment is needed.
29. The nurse notes that an older patient’s radial pulse area is difficult to compress. What should this indicate to the nurse? 1)
Dehydration
2)
Poor nutrition
3)
Fluid overload
4)
Normal finding
30. What would provide the best information to determine if an older patient is able to provide self-care at home? 1)
Review of systems
2)
Functional assessment
3)
Complete medical history
4)
Comprehensive health assessment
31. What does the Katz scale assess? 1)
Safety in the home
2)
Activities of daily living (ADLs)
3)
Cardiac output in persons with CHF
4)
Nutritional elements of Meals on Wheels, the federally funded food program for elderly people
32. What finding should the nurse use to determine that an older patient is having difficulty with instrumental activities of daily living (IADLs)? 1)
Takes medication daily
2)
Hired a cleaning person
3)
Does laundry once a week
4)
Grocery shops on Thursdays
33. Which observation indicates that an older person is having difficulty with IADLs? 1)
Prepares breakfast
2)
Showers every other day
3)
Asks for help balancing checkbook
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4)
Dresses in street clothes before lunch
34. What is the most valid indicator when assessing a patient’s ADLs? 1)
Asking questions
2)
Observing behaviors
3)
Discussing with the family
4)
Validating with the physician
35. An older person’s self-care ability is being questioned. What should cause the nurse the most concern about this patient? 1)
Wears nightgown and robe all day
2)
Ambulates with a cane during the day and a walker at night
3)
Eats one meal a day during the week that is delivered by the local community center
4)
Walks to the bathroom to void but frequently has incontinent episodes; the bedroom and bathroom smell of urine
36. Which is one way to determine if an older patient has an adequate dietary intake? 1)
Study laboratory values.
2)
Measure current weight.
3)
Determine body mass index (BMI).
4)
Analyze food eaten over the last 24 hours.
37. An older patient is concerned about ongoing constipation. What should the nurse focus on when assessing this patient? 1)
Fluid intake
2)
Protein intake
3)
Sleeping pattern
4)
Leisure activities
38. The nurse is determining an older person’s ability to bathe. Which home observation should facilitate this person’s independence? 1)
Bathtub
2)
Walk-in shower
3)
Garden hose outside
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4)
Stationary tub in the basement
39. What home observation might negatively impact an older person’s ability to perform ADLs? 1)
Bathroom in the cellar
2)
Nightlight in the hallway
3)
Bedside commode in bedroom
4)
Grab bars next to the commode
Multiple Response Identify one or more choices that best complete the statement or answer the question. 40. Which are signs of chronic venous insufficiency? Select all that apply. 1)
Hair loss
2)
Thick, rigid toenails
3)
Hyperpigmentation
4)
Pedal edema that improves at night
5)
Distended tortuous veins, cyanosis if dependent
41. What should be included when assessing an older patient’s peripheral vascular system? Select all that apply. 1)
Palpating peripheral pulses
2)
Assessing for edema using a tape measure
3)
Measuring the blood pressure on each arm
4)
Observing the color and temperature of the skin
5)
Noticing the hairiness or lack of hair on the extremities
42. What information should be collected during every health history to have an understanding of an older patient’s overall health status? Select all that apply. 1)
Diet
2)
Exercise
3)
Water intake
4)
Years retired
5)
Sleep pattern
43. What should the nurse identify as expected findings when assessing an older patient’s
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
mouth and throat? Select all that apply. 1)
Smooth tongue
2)
Pink soft palate
3)
Pale hard palate
4)
Red and midline uvula
5)
Gums pink, moist, and smooth
44. What is included in the ADLs scale? Select all that apply. 1)
Feeding
2)
Transferring
3)
Cooking
4)
Continence
5)
Telephoning
Chapter 16: Physiological Assessment Answer Section MULTIPLE CHOICE 1. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 292 Heading: Head, Neck, and Face Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Neurological Regulation Difficulty: Easy Feedback 1
Facial drooping or asymmetry is a classic abnormal finding on a physical examination that may be associated with a stroke.
2
Facial edema is an abnormal finding that could be related to cortisone use, allergic reactions, renal failure, hormonal imbalance, or heart failure.
3
Ptosis of the eyelids is a normal aging change and is not considered abnormal unless it interferes with vision.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
Forward flexion of the neck is a normal result of spinal kyphosis.
PTS: 1 CON: Neurological Regulation 2. ANS: 3 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 293 Heading: Head, Neck, and Face Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1
Dental care is included in the assessment of the mouth.
2
Stress and nosebleeds would not be included in the assessment of the head, neck, and face.
3
The face and neck ROM are included in the assessment.
4
ROM of the arms would not be included in the assessment of the head, neck, and face.
PTS: 1 CON: Assessment 3. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 293 Heading: Nose and Sinuses Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Appetite would not give specific information regarding nasal function, even though there is a relationship between smell and the taste of food.
2
History of nose trauma would give
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
the nurse information regarding the function of the older person’s nose and sinuses. 3
History of allergies or hay fever would give the nurse information regarding the function of the older person’s nose and sinuses.
4
History of colds and upper respiratory infections would give the nurse information regarding the function of the older person’s nose and sinuses.
PTS: 1 CON: Assessment 4. ANS: 4 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 293 Heading: Nose and Sinuses Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Checking the older person’s sense of smell is part of the examination of the nose but does not address nasal patency or the older person’s ability to move air through the nose.
2
Checking for the presence of any nasal discharge is part of the examination of the nose but does not address nasal patency or the older person’s ability to move air through the nose.
3
Examining the nasal mucosa to ensure that it is pink and moist is part of the examination of the nose but does not address nasal patency or the older person’s ability to move air through the nose.
4
The possibility of a deviated septum or large obstructive nasal polyp is suspected if an older person is un-
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
able to move air through one or both nostrils. PTS: 1 CON: Assessment 5. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 293 Heading: Nose and Sinuses Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
The physician should be notified of the abnormal finding so that appropriate testing, if indicated, can be done.
2
It is abnormal for the smell to be perceived differently in each nostril.
3
A blockage may or may not exist.
4
It is abnormal for the smell to be perceived differently in each nostril.
PTS: 1 CON: Assessment 6. ANS: 4 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 2. Describe at least three normal aging changes for each body system. Chapter page reference: 294 Heading: Mouth and Throat Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Decreased saliva production is a normal aging change of the mouth.
2
Pink, moist, and smooth gums are normal aging changes of the mouth.
3
Varicose veins on the underside of the tongue are normal aging
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
changes of the mouth. 4
White patches on the oral mucosa could be leukoplakia (a precancerous lesion).
PTS: 1 CON: Assessment 7. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 294 Heading: Mouth and Throat Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Follow-up with a dentist may be recommended based on the nurse’s findings.
2
A visual inspection of teeth, tongue, and palate should be included.
3
Wearing gloves for proper universal precautions is essential.
4
If the older adult wears dentures, remove them before starting the examination.
PTS: 1 CON: Assessment 8. ANS: 2 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 294 Heading: Neurological System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Grooming is observed during the neurological assessment.
2
Financial issues play no part in the
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
neurological evaluation. 3
Evaluate the older adult’s appearance throughout the examination.
4
Behaviors are assessed during the neurological assessment.
PTS: 1 CON: Assessment 9. ANS: 3 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 295 Heading: Peripheral Vascular System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Varicose veins are distended veins.
2
Pedal edema is a classic symptom of heart failure.
3
Hairless, transparent, shiny skin is a symptom of decreased peripheral circulation.
4
Inflammation and redness are symptoms of infection or deep vein thrombosis.
PTS: 1 CON: Assessment 10. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 295 Heading: Peripheral Vascular System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
The physical examination of the peripheral vascular system includes inspection, palpation, and ausculta-
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
tion. The nurse should always compare one side of the body with the other when using these assessment methods. 2
Massaging the older adult’s legs to see if circulation improves is not a strategy when assessing the peripheral vascular system.
3
Avoiding touching the skin because of characteristic skin tenderness is not a strategy when assessing the peripheral vascular system.
4
Flexing and extending the knees to determine tolerance of joint movement is not a strategy when assessing the peripheral vascular system.
PTS: 1 CON: Assessment 11. ANS: 2 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 296 Heading: Cardiac System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1
These blood pressure readings can be done without a physician’s order.
2
A greater than 20 mm Hg decrease in systolic blood pressure when an older person changes positions is referred to as orthostatic hypotension. This decrease in blood pressure can be related to dizziness, lightheadedness, fainting, unsteadiness, and falls.
3
These blood pressure readings are unrelated to complaints of chest pain.
4
It is normal for the heart rate to increase when changing positions. It is the body’s natural response to
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
maintain blood pressure with positional changes. PTS: 1 CON: Assessment 12. ANS: 4 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 296 Heading: Cardiac System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1
It is an abnormal finding.
2
It is of concern and should be reported to the physician.
3
Heart murmurs do not cause atrial fibrillation.
4
A heart murmur is a common but abnormal finding and should be reported to the physician. It is caused by thickened and rigid heart valves and decreased strength of myocardial contractions.
PTS: 1 CON: Assessment 13. ANS: 3 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 298 Heading: Respiratory System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy Feedback 1
Crackles that disappear after coughing are not pathological.
2
Wheezing is a whistling noise caused by air passing through a narrowed airway.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3
Crackles are from air passing through moisture and sound like hair rubbing between fingers.
4
A wheeze, indicating a narrowed airway, is heard in adults with COPD and asthma.
PTS: 1 CON: Assessment 14. ANS: 4 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 297 Heading: Respiratory System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy Feedback 1
Smoking is not related to tuberculosis.
2
A productive cough is associated with COPD.
3
A chest x-ray might be done if the patient were experiencing signs of pneumonia or a heart problem.
4
Blood-streaked sputum—frequently with a dry, hacking cough—is a sign of tuberculosis.
PTS: 1 CON: Assessment 15. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 299 Heading: Gastrointestinal System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
To avoid splinting (tightening of the abdominal muscles), the area of
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
pain or discomfort is always palpated last. 2
Auscultation should occur first.
3
The nurse needs to follow a process to gather the most accurate data.
4
Palpation should occur at the end of the assessment, not in the middle.
PTS: 1 CON: Assessment 16. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 2. Describe at least three normal aging changes for each body system. Chapter page reference: 298 Heading: Gastrointestinal System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1
Decreased gastric motility accompanies the normal aging process.
2
It is not a life-threatening emergency.
3
It does not need to be treated with medications or surgery.
4
The nurse may need to listen carefully for up to 5 minutes per quadrant to assess bowel sounds adequately.
PTS: 1 CON: Assessment 17. ANS: 3 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 2. Describe at least three normal aging changes for each body system.. Chapter page reference: 299 Heading: Integumentary System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1
Thinning scalp hair is a normal skin change.
2
Skin folds under the breasts are normal skin changes.
3
Ulcerations of the skin are abnormal skin changes. Development of a pressure ulcer might be a sign of lack of activity or repositioning.
4
Senile keratosis or senile lentigines skin lesion are normal skin changes.
PTS: 1 CON: Assessment 18. ANS: 4 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 2. Describe at least three normal aging changes for each body system. Chapter page reference: 302 Heading: Table 16.1 Normal and Abnormal Skin Lesions Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
This skin lesion is not related to a fall.
2
This skin lesion is not related to medications or food.
3
A dermatologist can be consulted if the patient is anxious about the lesion.
4
Senile purpura is a vivid purple patch with good borders. It is a normal skin change for elderly adults. It will fade.
PTS: 1 CON: Assessment 19. ANS: 2 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 302 Heading: Musculoskeletal System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Assessment Difficulty: Moderate Feedback 1
Pain that radiates into the legs is more commonly related to spinal nerve compression.
2
Acute lower back pain is the most common sign of a compression fracture of the spine.
3
Abdominal discomfort is not a usual symptom of problems with the spine.
4
Loss of bladder control is more commonly related to spinal nerve compression.
PTS: 1 CON: Assessment 20. ANS: 2 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 304 Heading: Reproductive System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
The symptoms can be embarrassing and annoying so they should not be ignored.
2
Symptoms of frequent urination, interruption in urinary stream, and dribbling of urine are common signs of benign prostatic hypertrophy (BPH), which is common in older men. The symptoms should be reported to a physician, who may suggest a PSA test to help in diagnosing and assessing the possibility of cancer.
3
Although some urinary tract changes may occur with aging, the specific symptoms mentioned are characteristics of BPH.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
It is inappropriate to discuss cancer without adequate information.
PTS: 1 CON: Assessment 21. ANS: 4 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 304 Heading: Urinary System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
To empty the bladder fully it is necessary to sit with legs dependent.
2
Diuretics and anti-Parkinsonian drugs affect the urinary system.
3
It is important to know what is “normal” for each individual client.
4
Although psychosocial issues are important to consider, the physiological issues must be addressed first.
PTS: 1 CON: Assessment 22. ANS: 4 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 292 Heading: Head, Neck, and Face Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
The head and neck assessment must be completed.
2
It will not take twice as long to complete this assessment.
3
It will not be uncomfortable for the
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
older patient. 4
The assessment of the head and neck is the same for older adults as for younger people.
PTS: 1 CON: Assessment 23. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 295 Heading: Neurological System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1
Hand grasps is part of the neurological assessment.
2
Rigid lower extremities would be observed during a musculoskeletal status assessment.
3
Pedal pulses would be assessed with the peripheral vascular system assessment.
4
Shoulder range of motion would be assessed with the musculoskeletal status assessment.
PTS: 1 CON: Assessment 24. ANS: 2 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 295 Heading: Peripheral Vascular System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Stasis ulcers are rare with varicose veins.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2
Stasis ulcers commonly occur with deep vein insufficiency. Venous stasis ulcers are located on the sides of the ankles.
3
Arterial ulcers may involve toes or places where the skin has been bumped or bruised.
4
Stasis ulcers are not associated with deep vein thrombosis.
PTS: 1 CON: Assessment 25. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 295 Heading: Peripheral Vascular System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
If there is difficulty finding a pulse it can be marked with a felt-tipped pen after it is found.
2
A dressing would be inappropriate.
3
The patient is not responsible for assessing the pulses.
4
Documentation should occur, however, this will not help locate the pulse in the future.
PTS: 1 CON: Assessment 26. ANS: 4 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 2. Describe at least three normal aging changes for each body system. Chapter page reference: 293 Heading: Nose and Sinuses Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1
Neck crepitus is an abnormal finding.
2
Left facial droop is an abnormal finding.
3
Periorbital edema is an abnormal finding.
4
Occasional epistaxis commonly occurs more often in older than younger patients.
PTS: 1 CON: Assessment 27. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 2. Describe at least three normal aging changes for each body system. Chapter page reference: 293 Heading: Nose and Sinuses Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Frequently, older men have an increased amount of nasal hair.
2
Nasal occlusion is not a normal finding.
3
A deviated nasal septum is not a normal finding.
4
Crusting within the nares is not a normal finding.
PTS: 1 CON: Assessment 28. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 2. Describe at least three normal aging changes for each body system. Chapter page reference: 293 Heading: Eyes Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1
Pupils should be equal in size unless they have been unequal throughout life or have become unequal as a result of surgery or trauma. They may react more slowly to light than they did in the person’s youth.
2
This finding does not need to be reported to the charge nurse.
3
Sluggish pupil reaction is not associated with cataracts.
4
An appointment with an ophthalmologist is not required.
PTS: 1 CON: Assessment 29. ANS: 4 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 2. Describe at least three normal aging changes for each body system. Chapter page reference: 296 Heading: Peripheral Vascular System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1
Increased resistance to compression does not indicate dehydration.
2
Increased resistance to compression does not indicate poor nutrition.
3
Increased resistance to compression does not indicate fluid overload.
4
Normal vessels feel smooth and resilient. In older adults, increased resistance to compression may be palpated because of rigid and tortuous artery walls.
PTS: 1 CON: Assessment 30. ANS: 2 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 3. List two tools that are commonly used to evaluate functional status. Chapter page reference: 305 Heading: Functional Assessment Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy Feedback 1
A review of systems does not provide self-care information.
2
A functional assessment would provide information about the patient’s ability to provide self-care.
3
A complete medical history does not provide self-care information.
4
A comprehensive health assessment does not provide self-care information.
PTS: 1 CON: Assessment 31. ANS: 2 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 3. List two tools that are commonly used to evaluate functional status. Chapter page reference: 305 Heading: Activities of Daily Living Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy Feedback 1
The Katz scale is not used to determine home safety.
2
The Katz scale is used to determine if an older person has the ability to provide self-care.
3
The Katz scale does not determine cardiac output.
4
The Katz scale is not used to measure nutrition.
PTS: 1 CON: Assessment 32. ANS: 2 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 3. List two tools that are commonly used to evaluate functional status. Chapter page reference: 306
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Activities of Daily Living Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1
Taking medication without assistance does not indicate difficulty with IADLs.
2
Hiring a cleaning person indicates difficulty with IADLs.
3
Doing laundry does not indicate difficulty with IADLs.
4
Grocery shopping does not indicate difficulty with IADLs.
PTS: 1 CON: Assessment 33. ANS: 3 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 3. List two tools that are commonly used to evaluate functional status. Chapter page reference: 306 Heading: Activities of Daily Living Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1
Preparing breakfast indicates ability to perform IADLs.
2
Showering indicates ability to perform ADLs.
3
Asking for help with a checkbook indicates difficulty with IADLs.
4
Dressing indicates ability to perform ADLs.
PTS: 1 CON: Assessment 34. ANS: 2 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 3. List two tools that are commonly used to evaluate functional status. Chapter page reference: 305
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Activities of Daily Living Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Asking questions is not the most valid indicator when assessing a patient’s ADLs.
2
Observing behaviors is the most valid indicator when assessing a patient’s ADLs.
3
Discussing with the family is not the most valid indicator when assessing a patient’s ADLs.
4
Validating with the physician is not the most valid indicator when assessing a patient’s ADLs.
PTS: 1 CON: Assessment 35. ANS: 3 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 4. Discuss the importance of nutrition to the physiological wellbeing of the older adult. Chapter page reference: 305 Heading: Activities of Daily Living Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Choosing to wear pajamas all day is a normal choice for older adults living in their own homes.
2
Using assistive devices for ambulation should not cause the nurse concern.
3
Eating one meal a day is not sufficient nutrition. Malnutrition is lifethreatening.
4
The urine smell and the incontinence are concerns, however, they are not life-threatening.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Assessment 36. ANS: 4 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 4. Discuss the importance of nutrition to the physiological wellbeing of the older adult. Chapter page reference: 298 Heading: Gastrointestinal System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
All laboratory values do not focus on nutritional status.
2
A patient can be of normal weight but be malnourished.
3
BMI does not indicate nourishment.
4
Analyzing foods eaten over the last 24 hours is the best way to determine if an older person has an adequate dietary intake.
PTS: 1 CON: Assessment 37. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 4. Discuss the importance of nutrition to the physiological wellbeing of the older adult. Chapter page reference: 298 Heading: Gastrointestinal System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1
Adequate fluids are necessary to have normal bowel evacuation.
2
Protein does not aid with constipation.
3
Sleeping pattern has nothing to do with constipation.
4
Leisure activities have nothing to do with constipation.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Assessment 38. ANS: 2 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 5. Describe at least two important components to include in a home assessment. Chapter page reference: 305 Heading: Activities of Daily Living Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1
The patient might not be able to safely get into and out of a bathtub.
2
A walk-in shower facilitates independence with bathing.
3
A garden hose would not be used for bathing.
4
A stationary tub in the basement would not be appropriate for bathing.
PTS: 1 CON: Assessment 39. ANS: 1 Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 5. Describe at least two important components to include in a home assessment. Chapter page reference: 305 Heading: Instrumental Activities of Daily Living Integrated Processes: Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1
Having a bathroom in the cellar means the patient has to walk down the stairs to use it. This could adversely affect the ability to complete ADLs.
2
Nightlights are a safety feature.
3
A bedside commode in the bedroom would help facilitate ADLs.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Grab bars next to the commode would be a safety feature.
4
PTS: 1
CON: Assessment
MULTIPLE RESPONSE 40. ANS: 1, 3, 4, 5 Feedback 1.
Signs and symptoms of chronic venous insufficiency include hair loss.
2.
Thick, rigid toenails are seen in chronic arterial insufficiency.
3.
Signs and symptoms of chronic venous insufficiency include hyperpigmentation.
4.
Signs and symptoms of chronic venous insufficiency include pedal edema that resolves at night with rest and with elevation.
5.
Signs and symptoms of chronic venous insufficiency include distended tortuous veins and cyanosis when legs are dependent.
Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 295 Heading: Peripheral Vascular System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy PTS: 1 41. ANS: 1, 4, 5
CON: Assessment Feedback
1.
Peripheral pulses should be palpated.
2.
A tape measure should be used to assess for edema.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3.
Blood pressure is not a part of the peripheral vascular system assessment.
4.
Color and temperature of the skin should be assessed.
5.
Amount of hair on the extremities should be assessed.
Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 296 Heading: Peripheral Vascular System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate PTS: 1 42. ANS: 1, 2, 3, 4
CON: Assessment Feedback
1.
Information needed to have an accurate record of the person’s overall health includes diet.
2.
Information needed to have an accurate record of the person’s overall health includes exercise.
3.
Information needed to have an accurate record of the person’s overall health includes water intake.
4.
Years retired is not information needed to have an accurate record of the person’s overall health.
5.
Information needed to have an accurate record of the person’s overall health includes sleep pattern.
Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 1. Describe two unique aspects of physiological assessment for older adults. Chapter page reference: 291 Heading: History Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate PTS: 1 43. ANS: 2, 3, 4, 5
CON: Assessment Feedback
1.
A smooth tongue could indicate a vitamin B 12 deficiency.
2.
The soft palate should be pink.
3.
The hard palate should be pale.
4.
The uvula should be red and midline.
5.
The gums should be pink, moist, and smooth.
Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 2. Describe at least three normal aging changes for each body system.. Chapter page reference: 294 Heading: Mouth and Throat Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate PTS: 1 44. ANS: 1, 2, 4
CON: Assessment Feedback
1.
Feeding is included in the ADLs scale.
2.
Transferring is included in the ADLs scale.
3.
Cooking is included in the IADLs scale.
4.
Continence is included in the ADLs scale.
5.
Telephoning is included in the IADLs scale.
Chapter number and title: Chapter 16: Physiological Assessment Chapter/learning objective: 3. List two tools that are commonly used to evaluate functional
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
status. Chapter page reference: 305 Heading: Activities of Daily Living Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy PTS: 1
CON: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 17: Common Clinical Problems: Physiological Multiple Choice Identify the choice that best completes the statement or answers the question. 1. An older patient recovering from a stroke has been very depressed and noncompliant with the physical therapy regimen. Which nursing intervention is important to initiate to prevent immobility in this patient? 1)
Force the patient to participate in the activity program.
2)
Refer the patient to the facility social worker for counseling.
3)
Walk the patient to the bathroom before and after meals and before bedtime.
4)
Change the patient’s activity program to activities that can be done in a wheelchair.
2. What is LEAST likely to occur to the body physiologically with immobility? 1)
Bone dissolution
2)
Parkinson’s disease
3)
Joint stiffness and decreased range of motion
4)
A decrease in muscle strength equal to 20% to 30% over 7 to 9 days
3. How does physical exercise affect the cardiovascular system? 1)
Increasing cardiac output
2)
Decreasing cardiac efficiency
3)
Decreasing cardiac response to activity
4)
Maintaining pulse rate in response to activity
4. What is the most significant and overlooked nursing intervention to promote functional ability for an older adult? 1)
Ensure safety.
2)
Promote fluids.
3)
Decrease stressors.
4)
Maintain and improve mobility.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
5. During the night, an older patient fell, was incontinent of urine, and complained of not being able to get to the bathroom because the side rails on the bed were raised. What is the most appropriate nursing intervention to prevent this patient from falling again? 1)
Initiate a toileting program.
2)
Place a commode next to the bed.
3)
Apply a soft waist restraint at night.
4)
Put the side rails down during the night.
6. Which normal aging change increases an older adult’s risk of falling? 1)
Vision changes
2)
Cognitive changes
3)
Decreased cardiac output
4)
Decreased aerobic reserve
7. What contributes to an older person developing immobility? 1)
Fear of falling
2)
Release of safety restraints
3)
Restorative ambulation program
4)
Decreasing psychoactive medications
8. Patients with Parkinson’s disease frequently have a shuffling gait and use assistive devices for ambulation. What is the reason for these people to have a high risk of falling? 1)
Gait and balance
2)
Posture and mental status
3)
Posture and ability to use a walker
4)
Ability to use a walker and mental status
9. Which situation would NOT increase an older adult’s risk of falling? 1)
Mood lighting
2)
Small bathroom with toilet, sink, and tub
3)
Large sunroom with clear path to bedroom and bathroom
4)
Having children’s toys and books scattered around the room
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
10. Which is NOT a psychological or social effect of incontinence on an older person? 1)
Dementia
2)
Depression
3)
Diminished self-concept
4)
Withdrawal from social activities
11. What is one of the most common causes of urinary incontinence in an immobile older person? 1)
Fecal impaction
2)
Dietary indiscretions
3)
Congestive heart failure (CHF)
4)
Lack of awareness of the urge to void
12. Why can diuretics increase the incidence of urinary incontinence? 1)
They increase urine volume.
2)
They induce signs and symptoms of diabetes mellitus.
3)
The potential for older people to be dehydrated increases while taking these medications.
4)
The chemical action they have on the kidneys decreases the older person’s awareness of the urge to void.
13. Which is true about stress incontinence? 1)
It is more common in men.
2)
It is caused by bladder obstruction.
3)
It is most common in long-term care facilities.
4)
It is a sudden loss of small amounts of urine when coughing, laughing, or lifting.
14. A 79-year-old man is complaining of leaking urine and constipation. Which health problem is this patient most likely experiencing? 1)
Diabetes
2)
Heart failure
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3)
Alzheimer’s disease
4)
A fecal impaction, causing overflow incontinence
15. The mnemonic DRIP is used to help remember the possible causes of acute incontinence. Which does not represent a letter within this mnemonic? 1)
Delirium
2)
Infection
3)
Renal stones
4)
Pharmaceutical and psychological
16. An older patient who is incontinent has bacteria in the urine. What should the nurse expect to be prescribed for this patient? 1)
Bedrest
2)
Antibiotics
3)
Fluid restriction
4)
Oxygen therapy
17. A newly admitted resident of a skilled facility has to void, however, a wheelchair and stretcher are blocking the entrance to the bathroom. Which type of incontinence is this patient most likely going to experience? 1)
Urge
2)
Stress
3)
Overflow
4)
Functional
18. When an older adult reports problems with urinary incontinence what should be the primary goal? 1)
Prevent urinary tract infections.
2)
Ensure that the older person is free from any skin breakdown.
3)
Identify any reversible or treatable cause of the incontinence.
4)
Select the type of incontinence pad that would allow the older person the most freedom and protection.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
19. What is the goal of a bladder retraining program? 1)
Have the older person void every 2 hours.
2)
Increase the period of time between voiding.
3)
Increase the older person’s awareness of the urge to void.
4)
Increase the older person’s awareness of incontinence episodes.
20. Which is NOT considered as being a cause of constipation in an older adult? 1)
Diuretics
2)
Sedatives
3)
Antibiotics
4)
Aluminum-containing antacids
21. Which is a characteristic of a bladder retraining program? 1)
Empty the bladder every 2 hours.
2)
Ingest 240 mL of fluid every 2 hours.
3)
Ambulate to the bathroom every 6 hours.
4)
Use the toilet every 4 hours around the clock.
22. What is the purpose of passive range of motion (ROM) for an immobilized older adult? 1)
Replaces the need for ambulation
2)
Increases the risk of deep vein thrombosis
3)
Decreases the risk of falls and skin breakdown
4)
Maintains joint flexibility and delays muscle wasting
23. What is a characteristic of a stage III pressure ulcer? 1)
A non-blanchable erythema
2)
Partial-thickness skin loss involving the epidermis or dermis
3)
Full-thickness skin loss with extensive destruction; tissue necrosis; or damage to muscle, bone, or supporting tissue
4)
Full-thickness skin loss involving damage to
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
or necrosis of subcutaneous tissue down to, but not involving, the fascia
24. What is NOT included in the care of pressure ulcers? 1)
Daily bath
2)
Adequate nutrition
3)
Use of gel-filled mattresses
4)
Frequent change of position
25. An older patient is sitting in a wheelchair for 3 hours. When changing position the nurse notes an area of redness over the coccyx. Which risk factor caused this patient’s area of erythema? 1)
Friction
2)
Pressure
3)
Shearing
4)
Moisture
26. Which statement is false? 1)
Meat is the most expensive source of protein and iron.
2)
Pastas, grains, and breads are examples of carbohydrates.
3)
Vitamin-rich foods are necessary but not necessarily expensive.
4)
Carbohydrates and fats are filling, less expensive, and as equally nutritious as proteins.
27. An older patient who is losing weight refuses to come to meals and when he does he cannot sit down long enough to eat. What should the nurse do to improve this patient’s nutritional status? 1)
Increase food choices.
2)
Use body restraints for meals.
3)
Call the physician for medication to alter his behavior.
4)
Provide him with sandwiches, small pieces of fruit and cheese, and spill-proof drink containers.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
28. An older person who uses the bathroom three times a night is experiencing eye problems, extreme fatigue, weakness, unsteadiness, and depression. What should the nurse say in response to this patient’s symptoms? 1)
“As people get older, they need less sleep.”
2)
“You may be having symptoms of sleep deprivation.”
3)
“Depression usually changes a person’s sleep patterns.”
4)
“Changes in sleep patterns are a normal aging change.”
29. The nurse notes that an older patient has a behavior change during the evening hours. What should the nurse suspect is occurring with this patient? 1)
Dehydration
2)
Relocation trauma
3)
Sundown syndrome
4)
Reaction to medications
30. Which action should the nurse suggest to an older person to promote sleep? 1)
Take a sleeping aid.
2)
Avoid bedtime snacks.
3)
Go to bed early in the evening.
4)
Get more physical activity during the day.
31. Which is an example of an iatrogenic disorder? 1)
Stroke
2)
Sensory loss
3)
Pressure ulcers
4)
Diabetes mellitus
Multiple Response Identify one or more choices that best complete the statement or answer the question. 32. Alterations in mobility result primarily from problems with which body systems? Select all that apply. 1)
Sensory system
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2)
Respiratory system
3)
Genitourinary system
4)
Cardiovascular system
5)
Musculoskeletal system
33. Which potential respiratory problems is the nurse helping to prevent by encouraging an older person to increase activity? Select all that apply. 1)
Influenza
2)
Atelectasis
3)
Pneumonia
4)
Tuberculosis
5)
Chronic bronchitis
34. How can the nurse instruct the older patient who is prescribed bedrest to improve mobility? Select all that apply. 1)
Guided imagery
2)
Aerobic exercises
3)
Isometric exercises
4)
Anaerobic exercises
5)
Active ROM exercises
35. What contributes to the development of postural sway with ambulation? Select all that apply. 1)
Medications
2)
Environment
3)
Aging changes
4)
Chronic diseases
5)
Prolonged bedrest
36. After an assessment, the nurse determines that an older patient is at risk for falling. What assessment findings did the nurse use to make this clinical decision? Select all that apply. 1)
Has sleep apnea
2)
Is hard of hearing
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3)
Drinks caffeinated coffee
4)
Has osteoarthritis in both hips
5)
Takes acetaminophen for pain
37. For which type of incontinence would a prompted bladder retraining program be the most beneficial? Select all that apply. 1)
Urge
2)
Stress
3)
Surgical
4)
Overflow
5)
Functional
38. What physiological factors increase an older person’s risk of developing pressure ulcers? Select all that apply. 1)
Age
2)
Friction
3)
Moisture
4)
Immobility
5)
Nutritional status
39. Which nutrients are often lacking in an older person’s diet? Select all that apply. 1)
Fats
2)
Iron
3)
Calcium
4)
Vitamin C
5)
Riboflavin
40. What should the nurse recognize as causes for an older person to experience anorexia? Select all that apply. 1)
Depression
2)
Poor dentition
3)
Social isolation
4)
Vitamin deficiency
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
5)
Quality of institutional food
41. The nurse is concerned that an older patient is at risk for aspirating. What information did the nurse use to make this clinical determination? Select all that apply. 1)
Prefers to eat alone
2)
Poor appetite for breakfast
3)
Difficulty swallowing liquids
4)
Serum albumin level 2.8 g/dL
5)
Frequent episodes of heartburn
42. Which observations indicate that an older person may be experiencing sleep apnea? Select all that apply. 1)
Talking during sleep
2)
Moaning while turning in bed
3)
Changing positions throughout the night
4)
Cessation of breathing for 10 seconds or more
5)
Loud choking or snoring when breathing resumes
43. What health conditions are associated with untreated sleep apnea? Select all that apply. 1)
Stroke
2)
Osteoarthritis
3)
Cardiac disease
4)
Cognitive decline
5)
Decreased quality of life
44. What contributes to iatrogenesis in hospitals? Select all that apply. 1)
Dehydration
2)
Malnutrition
3)
Constipation
4)
Overuse of drugs
5)
Prolonged immobilization
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
45. What are common iatrogenic disorders seen in a nursing facility? Select all that apply. 1)
Stroke
2)
Pressure ulcers
3)
Immobilization
4)
Nosocomial infections
5)
Adverse drug reactions
Chapter 17: Common Clinical Problems: Physiological Answer Section MULTIPLE CHOICE 1. ANS: 3 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 1. Describe how the nurse can assist in maintaining mobility for the older adult at risk for impaired mobility. Chapter page reference: 315 Heading: Nursing Implications Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Mobility Difficulty: Moderate Feedback 1
Forcing the patient to participate in the physical therapy program is inappropriate if the patient chooses not to participate.
2
Referring the patient to the social worker is an appropriate nursing intervention but would not prevent immobility.
3
Ambulating daily would facilitate mobility for the patient, even if the physical therapy program is not being followed.
4
Providing the patient with activities that can be done in a wheelchair is an appropriate nursing intervention but would not prevent immobility.
PTS: 1
CON: Mobility
2. ANS: 2 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 1. Describe how the nurse can assist in maintaining mobility for the older adult at risk for impaired mobility. Chapter page reference: 313 Heading: Alteration in Mobility Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Mobility Difficulty: Easy Feedback 1
When the body is immobilized there is bone dissolution. This process is called disuse osteoporosis and it makes the bones of the older person still more brittle.
2
Parkinson’s disease is affected by immobility but it is not caused by immobility.
3
When there is immobility the muscles that bridge the joint shorten. With decreased muscle length and thickening of the joint cartilage the joints become stiff, which seriously impacts the ability of the person to move.
4
At complete rest muscle strength can decline at a rate of 20% to 30% in a 7 to 9 day period.
PTS: 1
CON: Mobility
3. ANS: 1 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 1. Describe how the nurse can assist in maintaining mobility for the older adult at risk for impaired mobility. Chapter page reference: 314 Heading: Cardiovascular System Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Mobility; Perfusion Difficulty: Easy Feedback 1
Physical exercise increases cardiac output. Immobility prevents physical activity from creating increased cardiac output.
2
Exercise improves cardiac efficiency.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3
Exercise increases cardiac response to activity.
4
Exercise is not done to maintain the pulse rate in response to activity.
PTS: 1
CON: Mobility | Perfusion
4. ANS: 4 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 1. Describe how the nurse can assist in maintaining mobility for the older adult at risk for impaired mobility. Chapter page reference: 315 Heading: Nursing Implications Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Mobility Difficulty: Easy Feedback 1
Safety is important but it does not increase functional ability.
2
Fluids are important but they do not increase functional ability.
3
Stressors are important but they do not increase functional ability.
4
An upright position promotes increased bone mass, muscle strength, and psychological well-being. Maintaining and improving mobility is essential.
PTS: 1
CON: Mobility
5. ANS: 1 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 2. Define two categories of risk factors for falls in older people. Chapter page reference: 317 Heading: Extrinsic Factors Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Urinary Elimination; Safety Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1
Toileting programs can reduce the incidence of an older adult’s attempting to go into the bathroom without assistance.
2
Placing a commode at the bedside would improve the older adult’s access to toileting facilities but would not decrease the older adult’s risk of falling.
3
Older adults who are restrained have an increased incidence of incontinence.
4
Lowering the side rails would improve the older adult’s access to toileting facilities but would not decrease the older adult’s risk of falling.
PTS: 1
CON: Urinary Elimination | Safety
6. ANS: 1 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 2. Define two categories of risk factors for falls in older people. Chapter page reference: 317 Heading: Intrinsic Factors Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Sensory Perception; Safety Difficulty: Easy Feedback 1
Decreased night vision and accommodation, decreased visual acuity, and decreased peripheral vision place an older adult at risk for falling.
2
Cognitive changes are normal with aging but do not have a direct effect on the risk of falling.
3
Decreased cardiac output occurs with aging but does not have a direct effect on the risk of falling.
4
Decreased aerobic reserve occurs with aging but does not have a direct effect on the risk of falling.
PTS: 1
CON: Sensory Perception | Safety
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
7. ANS: 1 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 2. Define two categories of risk factors for falls in older people. Chapter page reference: 316 Heading: Intrinsic Factors Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Safety Difficulty: Easy Feedback 1
The individual may begin to fear falling and may eventually become more sedentary. Such behavior leads to an eventual loss of function and an increased need to depend on others for activities of daily living (ADLs).
2
Releasing safety restraints decreases the risk of falls and immobility.
3
Restorative ambulation programs decrease the risk of falls and immobility.
4
Decreasing psychoactive medications decreases the risk of falls and immobility.
PTS: 1
CON: Safety
8. ANS: 1 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 2. Define two categories of risk factors for falls in older people. Chapter page reference: 317 Heading: Intrinsic Factors Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Comprehension [Understanding] Concept: Mobility; Safety Difficulty: Easy Feedback 1
Shuffling gait, caused by the inability to lift the foot totally off the floor for each step, and lack of balance, place these patients at a high risk for falls.
2
Although posture may be stooped and mental status may be cloudy these would not affect the fall risk.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3
Ability to use a walker may affect fall risk but it would decrease it.
4
Ability to use a walker may affect fall risk but it would decrease it.
PTS: 1
CON: Mobility | Safety
9. ANS: 3 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 2. Define two categories of risk factors for falls in older people. Chapter page reference: 317 Heading: Extrinsic Factors Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Comprehension [Understanding] Concept: Mobility; Safety Difficulty: Easy Feedback 1
Poor lighting increases an older adult’s risk of falling.
2
Narrow spaces increase an older adult’s risk of falling.
3
Large, bright, open spaces allow for greater ease of mobility.
4
Clutter increases an older adult’s risk of falling.
PTS: 1
CON: Mobility | Safety
10. ANS: 1 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 3. Identify two categories of incontinence. Chapter page reference: 318 Heading: Urinary Incontinence Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Urinary Elimination; Self Difficulty: Easy Feedback 1
Urinary incontinence does not cause dementia but many demented older adults have
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
problems with incontinence. 2
A person with incontinence may experience depression.
3
A person with incontinence may have a diminished self-concept.
4
A person with incontinence may withdraw from social activities.
PTS: 1
CON: Urinary Elimination | Self
11. ANS: 1 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 3. Identify two categories of incontinence. Chapter page reference: 319 Heading: Acute Incontinence Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Bowel Elimination; Urinary Elimination Difficulty: Easy Feedback 1
Fecal impaction may obstruct the bladder outlet and may cause overflow urinary incontinence.
2
Dietary indiscretions do not cause urinary incontinence.
3
CHF does not cause urinary incontinence.
4
Lack of awareness of the urge to void is not caused by immobility.
PTS: 1
CON: Bowel Elimination | Urinary Elimination
12. ANS: 1 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 3. Identify two categories of incontinence. Chapter page reference: 319 Heading: Acute Incontinence Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Urinary Elimination Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Feedback 1
Diuretics cause an increase in urine output.
2
Diuretics do not induce diabetes mellitus.
3
Although diuretics can contribute to dehydration they do not cause urinary incontinence.
4
Diuretics do not change the awareness of the urge to void.
PTS: 1
CON: Urinary Elimination
13. ANS: 4 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 3. Identify two categories of incontinence. Chapter page reference: 320 Heading: Chronic Incontinence Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Urinary Elimination Difficulty: Easy Feedback 1
It is more common in women than in men, often as a result of damage to the pelvic floor muscles during childbirth.
2
Overflow incontinence is caused by bladder outlet obstruction creating impaired emptying.
3
Urge incontinence, not stress incontinence, is most common in long-term care facilities where individuals may not get the immediate help they need.
4
Stress incontinence is a sudden loss of small amounts of urine when coughing, laughing, or lifting.
PTS: 1
CON: Urinary Elimination
14. ANS: 4 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 3. Identify two categories of incontinence. Chapter page reference: 319 Heading: Acute Incontinence
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Bowel Elimination; Urinary Elimination Difficulty: Moderate Feedback 1
Leaking urine and constipation are not manifestations of diabetes.
2
Leaking urine and constipation are not manifestations of heart failure.
3
Leaking urine and constipation are not manifestations of Alzheimer’s disease.
4
Fecal impaction may obstruct the bladder outlet and may cause overflow urinary incontinence.
PTS: 1
CON: Bowel Elimination | Urinary Elimination
15. ANS: 3 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 3. Identify two categories of incontinence. Chapter page reference: 319 Heading: Acute Incontinence Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Urinary Elimination Difficulty: Moderate Feedback 1
Delirium contributes to incontinence.
2
Infection contributes to incontinence.
3
Renal stones do not contribute to incontinence.
4
Pharmaceutical or psychological concerns contribute to incontinence.
PTS: 1
CON: Urinary Elimination
16. ANS: 2 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 3. Identify two categories of incontinence. Chapter page reference: 319
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Acute Incontinence Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Urinary Elimination Difficulty: Moderate Feedback 1
Bedrest is not a treatment for a urinary tract infection.
2
When bacteria is accompanied by urinary incontinence the person should be treated and the effect of the treatment on the incontinence should be noted.
3
A fluid restriction would make the urinary tract infection worse.
4
Oxygen therapy is not a treatment for a urinary tract infection.
PTS: 1
CON: Urinary Elimination
17. ANS: 4 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 3. Identify two categories of incontinence. Chapter page reference: 320 Heading: Chronic Incontinence Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Urinary Elimination Difficulty: Moderate Feedback 1
Urge incontinence is the urge to go but not having enough time to get to the toilet before the urine is released.
2
Stress incontinence occurs when a small amount of urine is released after there is a sudden increase in intra-abdominal pressure caused by coughing, sneezing, laughing, or lifting.
3
Overflow incontinence is caused by impaired bladder emptying and overdistention of the bladder.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
PTS: 1
Inaccessible toilets can cause functional incontinence.
CON: Urinary Elimination
18. ANS: 3 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 4. Explain how prompted voiding and habit training schedules can be used by the nurse for prevention or reversal of incontinence. Chapter page reference: 319 Heading: Types of Incontinence Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Urinary Elimination Difficulty: Moderate Feedback 1
Preventing urinary tract infections is a nursing intervention for an older adult experiencing incontinence.
2
Ensuring that the older person is free from any skin breakdown is a nursing intervention for an older adult experiencing incontinence.
3
Causes of incontinence—such as urinary tract infections, enlargement of the prostate, and inability to get to the bathroom in time to void —can all be reversed with nursing or medical intervention.
4
Selecting incontinence pads that allow freedom and protection is a nursing intervention for an older adult experiencing incontinence.
PTS: 1
CON: Urinary Elimination
19. ANS: 2 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 4. Explain how prompted voiding and habit training schedules can be used by the nurse for prevention or reversal of incontinence. Chapter page reference: 320 Heading: Chronic Incontinence Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Urinary Elimination Difficulty: Moderate Feedback 1
Having the person void every 2 hours is a component of a bladder program.
2
Bladder retraining attempts to increase the capacity of the bladder and increase the time between voiding.
3
Increasing the awareness to void is a component of a bladder program.
4
Increasing awareness of incontinence episodes is a component of a bladder program.
PTS: 1
CON: Urinary Elimination
20. ANS: 3 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 4. Explain how prompted voiding and habit training schedules can be used by the nurse for prevention or reversal of incontinence. Chapter page reference: 321 Heading: Constipation Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Bowel Elimination Difficulty: Easy Feedback 1
Diuretics can lead to constipation.
2
Sedatives can lead to constipation.
3
Antibiotics do not generally contribute to constipation; they contribute to diarrhea.
4
Certain antacids can lead to constipation.
PTS: 1
CON: Bowel Elimination
21. ANS: 1 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 4. Explain how prompted voiding and habit training schedules can be used by the nurse for prevention or reversal of incontinence. Chapter page reference: 320 Heading: Chronic Incontinence Integrated Processes: Nursing Process: Implementation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Urinary Elimination Difficulty: Moderate Feedback 1
Most bladder retraining schedules begin with a schedule of toileting every 2 hours.
2
Bladder retraining programs do not include the volume of fluid to ingest.
3
Waiting every 6 hours to void is too long a period of time.
4
Bladder schedules gradually increase voiding to every 3 to 4 hours while awake.
PTS: 1
CON: Urinary Elimination
22. ANS: 4 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 5. Identify the mechanical and physiological risk factors for pressure ulcers. Chapter page reference: 324 Heading: Alteration in Skin Integrity: Pressure Ulcers Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Mobility Difficulty: Easy Feedback 1
Passive ROM does not replace the need for ambulation.
2
Passive ROM does not increase the risk of deep vein thrombosis.
3
Passive ROM does not decrease the risk of falls or skin breakdown.
4
Passive ROM helps to maintain joint flexibility and delay muscle wasting associated with immobility.
PTS: 1
CON: Mobility
23. ANS: 4 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 5. Identify the mechanical and physiological risk factors for pressure ulcers.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 323 Heading: Staging Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Skin Integrity Difficulty: Easy Feedback 1
This describes a stage I pressure ulcer.
2
This describes a stage II pressure ulcer.
3
This describes a stage IV pressure ulcer.
4
A stage III pressure ulcer manifests as a deep crater. It involves full-thickness skin loss involving damage to or necrosis of subcutaneous tissue down to, but not involving, the fascia.
PTS: 1
CON: Skin Integrity
24. ANS: 1 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 5. Identify the mechanical and physiological risk factors for pressure ulcers. Chapter page reference: 324 Heading: Alteration in Skin Integrity: Pressure Ulcers Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Skin Integrity Difficulty: Easy Feedback 1
Older adults do not need daily baths. Excessive bathing and rubbing while drying can damage the skin.
2
Adequate nutrition is included in the care of pressure ulcers.
3
Gel-filled mattresses are used in the care of pressure ulcers.
4
Frequent position changes are used in the care of pressure ulcers.
PTS: 1
CON: Skin Integrity
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
25. ANS: 2 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 5. Identify the mechanical and physiological risk factors for pressure ulcers. Chapter page reference: 322 Heading: Alteration in Skin Integrity: Pressure Ulcers Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Skin Integrity Difficulty: Easy Feedback 1
Friction occurs when the skin is moved across the sheets, such as when the person is being pulled up rather than lifted up in the bed.
2
Pressure is when normal tissue is squeezed between the internal pressure of the bone and an external source of pressure or friction, such as the chair.
3
Shearing occurs when the person slides and the skin does not move, stretching the subcutaneous tissue and vessels. Rupture of the blood vessels results.
4
Moisture can increase the friction between the surface and the skin. Moisture can also cause maceration (softening of the skin), which weakens the skin and increases the risk of infection.
PTS: 1
CON: Skin Integrity
26. ANS: 4 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 6. Discuss the problems pertaining to adequate food intake in older people. Chapter page reference: 325 Heading: Altered Nutritional Status Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Nutrition Difficulty: Easy Feedback 1
Meat is the most expensive form of protein and iron.
2
Carbohydrates include pasta, grains, and
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
bread. 3
Vitamin-rich foods do not need to be expensive.
4
Carbohydrates and fats are not as nutritious as proteins.
PTS: 1
CON: Nutrition
27. ANS: 4 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 6. Discuss the problems pertaining to adequate food intake in older people. Chapter page reference: 326 Heading: Altered Nutritional Status Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1
Offering more choices may or may not be beneficial.
2
Restraining would not increase his nutritional intake.
3
Medicating would not increase his nutritional intake.
4
Carrying his food and drink with him adjusts his meals to accommodate for his behaviors and probably would be effective.
PTS: 1
CON: Nutrition
28. ANS: 2 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 7. Describe two sleep disorders common to older adults. Chapter page reference: 326 Heading: Sleep Pattern Disturbance Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1
This may be true but does not explain the patient’s symptoms.
2
The sleep patterns of older people can be disturbed by factors such as needing to void frequently during the night (nocturia). These changes can lead to ineffective sleep or sleep deprivation. Sleep deprivation is marked by fatigue, tiredness, eye problems, muscle tremor, muscle weakness, diminished coordination and attention span, apathy, and depression.
3
This may be true but it does not explain the patient’s symptoms.
4
This may be true but it does not explain the patient’s symptoms.
PTS: 1
CON: Sleep, Rest, and Activity
29. ANS: 3 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 7. Describe two sleep disorders common to older adults. Chapter page reference: 327 Heading: Sleep Pattern Disturbance Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Analysis [Analyzing] Concept: Sleep, Rest, and Activity Difficulty: Moderate Feedback 1
Dehydration is a risk factor for sundown syndrome.
2
Relocation trauma is a risk factor for sundown syndrome.
3
Sundown syndrome is an unexplained exacerbation of confusion in the evening and nighttime hours.
4
A medication reaction would have symptoms occurring throughout the day.
PTS: 1 30. ANS: 4
CON: Sleep, Rest, and Activity
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 7. Describe two sleep disorders common to older adults. Chapter page reference: 327 Heading: Sleep Pattern Disturbance Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Application [Applying] Concept: Sleep, Rest, and Activity Difficulty: Moderate Feedback 1
Most of the medications used to promote sleep are not efficiently metabolized by the aging body and the person may experience a hangover effect the next day. In addition, these drugs tend to cause blurred vision, dry mouth, and urinary retention.
2
A bedtime snack helps with comfort.
3
Because it is known that an elderly person cannot sleep as long as a younger person can it is unreasonable to put an individual to bed at 8:00 pm and expect that person to stay in bed until 7:00 am the next day.
4
During the daytime, increased physical activity may promote sleep.
PTS: 1
CON: Sleep, Rest, and Activity
31. ANS: 3 Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 8. Define iatrogenesis, and list common iatrogenic problems experienced by older persons. Chapter page reference: 328 Heading: Iatrogenesis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy Feedback 1
Stroke is not an iatrogenic disorder.
2
Sensory loss is not an iatrogenic disorder.
3
Iatrogenic disorders can be defined as
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
disorders that a person acquires as a result of receiving treatment by a physician, nurse, or other member of the interdisciplinary team (IDT). Iatrogenic disorders include pressure ulcers. 4
PTS: 1
Diabetes mellitus is not an iatrogenic disorder.
CON: Critical Thinking
MULTIPLE RESPONSE 32. ANS: 1, 2, 4, 5 Feedback 1.
Changes in vision can contribute to immobility.
2.
Normal aging changes and any disorders affecting the respiratory system are major causes of immobility.
3.
Disorders of the genitourinary system are not identified as being major causes of immobility.
4.
Normal aging changes and any disorders affecting the cardiovascular system are major causes of immobility.
5.
Normal aging changes and any disorders affecting the musculoskeletal system are major causes of immobility.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 1. Describe how the nurse can assist in maintaining mobility for the older adult at risk for impaired mobility. Chapter page reference: 312 Heading: Alteration in Mobility Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Mobility Difficulty: Easy PTS: 1
CON: Mobility
33. ANS: 2, 3 Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1.
Influenza is a viral infection. Activity will not prevent this from occurring.
2.
Aging changes to the respiratory system put the older person at risk for complications when immobility is present. Such changes place the older person at increased risk for developing atelectasis when immobilized.
3.
Aging changes to the respiratory system put the older person at risk for complications when immobility is present. Such changes place the older person at increased risk for developing pneumonia when immobilized.
4.
Tuberculosis is a bacterial infection. Activity will not prevent this from occurring.
5.
Chronic bronchitis is caused by smoking and exposure to environmental pollutants. Activity will not prevent this from occurring.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 1. Describe how the nurse can assist in maintaining mobility for the older adult at risk for impaired mobility. Chapter page reference: 314 Heading: Respiratory System Integrated Processes: Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Mobility; Oxygenation Difficulty: Moderate PTS: 1
CON: Mobility | Oxygenation
34. ANS: 3, 5 Feedback 1.
Guided imagery will not help improve mobility.
2.
Aerobic exercises are too strenuous for the patient on bedrest.
3.
While on bedrest, older adults can be taught isometric exercises.
4.
Anaerobic exercises are too strenuous for the patient on bedrest.
5.
While on bedrest, older adults can be taught active ROM exercises.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 1. Describe how the nurse can assist in maintaining mobility for the older adult at risk for impaired mobility. Chapter page reference: 315 Heading: Nursing Implications Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Mobility Difficulty: Moderate PTS: 1
CON: Mobility
35. ANS: 1, 3, 4 Feedback 1.
Medications contribute to the development of postural sway.
2.
Environment does not contribute to the development of postural sway.
3.
Aging changes contribute to the development of postural sway.
4.
Chronic diseases contribute to the development of postural sway.
5.
Prolonged bedrest contributes to the development of postural sway.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 2. Define two categories of risk factors for falls in older people. Chapter page reference: 316 Heading: Intrinsic Factors Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Comprehension [Understanding] Concept: Mobility; Safety Difficulty: Easy PTS: 1
CON: Mobility | Safety
36. ANS: 1, 2, 4 Feedback 1.
Sleep disorders are associated with falls.
2.
Hearing impairment is associated with falls.
3.
Caffeinated beverages are not associated with
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
falls. 4.
Osteoarthritis is associated with falls.
5.
Acetaminophen is not associated with falls.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 2. Define two categories of risk factors for falls in older people. Chapter page reference: 317 Heading: Box 17.1 Medical Conditions Associated With Fall Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Mobility; Safety Difficulty: Moderate PTS: 1
CON: Mobility | Safety
37. ANS: 1, 2 Feedback 1.
Bladder retraining techniques are most helpful with urge incontinence.
2.
Bladder retraining techniques are most helpful with stress incontinence.
3.
Surgical is not a type of incontinence.
4.
Bladder retraining techniques are not helpful with overflow incontinence.
5.
Bladder retraining techniques are not helpful with functional incontinence.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 4. Explain how prompted voiding and habit training schedules can be used by the nurse for prevention or reversal of incontinence. Chapter page reference: 320 Heading: Chronic Incontinence Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Comprehension [Understanding] Concept: Urinary Elimination Difficulty: Easy PTS: 1
CON: Urinary Elimination
38. ANS: 1, 4, 5 Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1.
Aging skin increases the likelihood of developing pressure ulcers because it is less resistant to the mechanical forces that can damage the skin.
2.
Friction is a mechanical risk factor for pressure ulcer development.
3.
Moisture is a mechanical risk factor for pressure ulcer development.
4.
Immobility removes the protective mechanism of pressure.
5.
Malnutrition and the subsequent weight loss lead to loss of muscle mass and subcutaneous tissue. This diminishes the body’s protective padding and increases the pressure over the bony prominences.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 5. Identify the mechanical and physiological risk factors for pressure ulcers. Chapter page reference: 322 Heading: Alteration in Skin Integrity: Pressure Ulcers Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Skin Integrity Difficulty: Easy PTS: 1
CON: Skin Integrity
39. ANS: 2, 3, 4, 5 Feedback 1.
The older person’s diet is not often lacking in fats.
2.
The older person’s diet is often lacking in iron.
3.
The older person’s diet is often lacking in calcium.
4.
The older person’s diet is often lacking in vitamin C.
5.
The older person’s diet is often lacking in riboflavin.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 6. Discuss the problems pertaining to adequate food intake in older people.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 325 Heading: Altered Nutritional Status Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Nutrition Difficulty: Easy PTS: 1
CON: Nutrition
40. ANS: 1, 2, 3, 5 Feedback 1.
Causes of anorexia in older adults include depression.
2.
Poor dentition may make it difficult for the individual to chew.
3.
Causes of anorexia in older adults include social isolation.
4.
Vitamin deficiency occurs because of anorexia.
5.
Causes of anorexia in older adults include unappetizing institutional foods.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 6. Discuss the problems pertaining to adequate food intake in older people. Chapter page reference: 325 Heading: Altered Nutritional Status Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Nutrition Difficulty: Easy PTS: 1
CON: Nutrition
41. ANS: 3, 5 Feedback 1.
Preferring to eat alone can contribute to anorexia.
2.
Poor appetite for breakfast could lead to anorexia.
3.
The possibility of aspiration is increased with dysphagia.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4.
Serum albumin level is used to measure nutritional status, not determine the risk for aspiration.
5.
The possibility of aspiration is increased with gastroesophageal reflux problems.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 6. Discuss the problems pertaining to adequate food intake in older people. Chapter page reference: 325 Heading: Altered Nutritional Status Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Nutrition Difficulty: Moderate PTS: 1
CON: Nutrition
42. ANS: 4, 5 Feedback 1.
Talking during sleep has no physiological explanation.
2.
Moaning when turning in bed could indicate pain.
3.
Changing positions during the night is a normal expectation of sleep.
4.
Cessation of breathing for 10 seconds or more is a primary objective symptom of sleep apnea.
5.
Loud snoring or choking after an apnea period is a primary objective symptom of sleep apnea.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 7. Describe two sleep disorders common to older adults. Chapter page reference: 327 Heading: Sleep Pattern Disturbance Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Comprehension [Understanding] Concept: Sleep, Rest, and Activity Difficulty: Easy PTS: 1
CON: Sleep, Rest, and Activity
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
43. ANS: 1, 3, 4, 5 Feedback 1.
Untreated sleep apnea is associated with stroke.
2.
Osteoarthritis is not associated with sleep apnea.
3.
Untreated sleep apnea is associated with cardiac disease.
4.
Untreated sleep apnea is associated with cognitive decline.
5.
Untreated sleep apnea is associated with decreased quality of life.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 7. Describe two sleep disorders common to older adults. Chapter page reference: 327 Heading: Sleep Pattern Disturbance Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Basic Care and Comfort Cognitive level: Comprehension [Understanding] Concept: Sleep, Rest, and Activity Difficulty: Easy PTS: 1
CON: Sleep, Rest, and Activity
44. ANS: 1, 2, 4, 5 Feedback 1.
Common causes of iatrogenesis in the hospital include dehydration secondary to preparation for diagnostic tests.
2.
Common causes of iatrogenesis in the hospital include malnutrition secondary to preparation for diagnostic tests.
3.
Constipation does not contribute to iatrogenesis.
4.
Common causes of iatrogenesis in the hospital include overuse of drugs.
5.
Common causes of iatrogenesis in the hospital include prolonged immobilization.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 8. Define iatrogenesis, and list common iatrogenic problems experienced by older persons.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 328 Heading: Iatrogenesis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy PTS: 1
CON: Critical Thinking
45. ANS: 2, 3, 4, 5 Feedback 1.
Stroke is not an iatrogenic health problem.
2.
In the nursing home, common iatrogenic disorders include pressure ulcers.
3.
In the nursing home, common iatrogenic disorders include immobilization.
4.
In the nursing home, common iatrogenic disorders include nosocomial infections.
5.
In the nursing home, common iatrogenic disorders include adverse drug reactions.
Chapter number and title: Chapter 17: Common Clinical Problems: Physiological Chapter/learning objective: 8. Define iatrogenesis, and list common iatrogenic problems experienced by older persons. Chapter page reference: 328 Heading: Iatrogenesis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy PTS: 1
CON: Critical Thinking
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 18: Psychological Assessment Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which is NOT a characteristic of mental wellness? 1) Having a clear purpose in life 2) Maintaining open relationships 3) Coping creatively with life’s situations 4) Maintaining physical health despite being overwhelmed by stress 2. Which characteristic indicates a lack of mental health wellness? 1) A strong reality orientation 2) A feeling of impending doom 3) A clear meaning and purpose in life 4) A capability for open and creative relationships 3. What is the best way to measure cognition? 1) Evaluating choices 2) Assessing mental function 3) Reviewing educational level 4) Monitoring interpersonal communication 4. Which would be a symptom of short-term memory loss? 1) Always looking for glasses 2) Inability to recall year of birth 3) Forgetting the names of one’s children 4) Inability to count backward from 100 by sevens 5. “Where do I belong?” is an example of what type of statement? 1) Altered judgment 2) Altered perception 3) Short-term memory loss 4) Long-term memory loss 6. “High school years weren’t important to me” is an example of what type of statement? 1) Altered perception 2) Long-term memory loss 3) Short-term memory loss 4) Altered problem solving 7. “When you are old like me, what you had for breakfast isn’t important” is an example of what type of statement? 1) Altered perception 2) Long-term memory loss 3) Short-term memory loss 4) Altered problem solving 8. What is the first symptom of Alzheimer’s disease? 1) Depression
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Behavior changes 3) Long-term memory loss 4) Short-term memory loss 9. “The lady in the mirror took my dress” is an example of what type of statement? 1) Altered perception 2) Long-term memory loss 3) Short-term memory loss 4) Altered problem solving 10. Which is NOT considered to be a higher level of thought? 1) Managing finances 2) Knowing how to do laundry 3) Remembering to order heating oil in the winter 4) Knowing how to turn off the stove after cooking 11. What is being tested when a person is asked to count backward from 100 by sevens? 1) Perception 2) Calculating ability 3) Short-term memory 4) Problem-solving ability 12. Which statement is true about mental health? 1) Gerotranscendence is psychological well-being. 2) Healthy mental health depends on enmeshment. 3) Having good mental health depends on positive nurturing. 4) Healthy mental health is the result of positive life experiences. 13. Family members sit with an older patient and listen while he tells about a period of time when he was in the Army and lived with extended family in another state. What should the nurse identify as a characteristic of this patient’s memories? 1) They are fiction. 2) They are based on facts. 3) They are evidence of cognitive decline. 4) They are based on the patient’s belief system. 14. Which describes the first phase of developing a perception? 1) Form an opinion. 2) Collect data through the five senses. 3) Question the validity of observations. 4) Compare data with previous experiences. 15. Which statement indicates that an older patient with dementia has an alteration in perception? 1) “The bingo game starts at 3:00 pm and I can’t be late.” 2) “My family is expected to arrive later this afternoon.” 3) “The best breakfast here is scrambled eggs and toast.” 4) “The people here are all prisoners and you are the guards.” 16. The nurse is concerned that an older patient is becoming disoriented. What information caused the nurse to have this concern? 1) Patient cannot find reading glasses 2) Patient identifies the year as being 1945
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Patient is expecting family to visit later in the day 4) Patient thinks the dining hall is where the recreation room is located 17. The nurse is preparing to conduct a short test of mental functioning with an older person. Which aspect of this test may be omitted? 1) Memory 2) Thinking 3) Perception 4) Orientation 18. What is the nurse testing when asking a resident to repeat three items after the nurse? 1) Memory recall 2) Memory retention 3) Memory encoding 4) Short-term memory 19. What is the nurse testing when asking a resident the day, month, and year? 1) Orientation 2) Memory recall 3) Long-term memory 4) Short-term memory 20. Which is NOT a correct assumption about mental status tools? 1) Most tools are short. 2) They assess level of impairment. 3) They take into consideration education and race. 4) They can be used with medical and psychiatric patients. 21. Which would NOT be a reason for an older adult becoming uncooperative during a mental competency assessment? 1) Feeling defensive 2) Feeling forced to cooperate 3) Having a poor attention span 4) Having the nurse focus entirely on the adult 22. When administering the Mini-Cog mental status examination, the older patient refuses to draw the face of a clock. How should the nurse score this finding? 1) Delirium 2) Confusion 3) Correct response 4) Abnormal response 23. What technique should the nurse use to ensure that a mental status examination tool is valid and reliable? 1) Seek evidence-based information about the tool. 2) Ask the charge nurse which tool meets the criteria. 3) Read an article about testing performed on the tool. 4) Have two nurses use it and score the patient at the same time. 24. What should the nurse do to gain an older patient’s cooperation when conducting a mental status examination? 1) Ask the patient to select the time. 2) Schedule the examination after morning care.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Plan to complete the examination before bedtime. 4) Fit the examination in while providing medications. 25. Which are aids for memory and mental function that an older adult might use? 1) List making and environmental cues 2) Changing routine to avoid getting into repetitive patterns 3) A wide variation of daily experiences to trigger memory 4) Attempting to meet new people to keep social skills intact 26. Which is true about confused older adults who retain social skills? 1) They are often ignored in social situations. 2) They are often more confused in social situations. 3) They are often encouraged not to interact with others. 4) They are often assessed as being able to function at a higher level. 27. During an annual assessment, an older patient has decreases in memory recall and orientation. What might cause this type of change in mental status? 1) Dementia 2) Normal aging 3) Severe depression 4) Elevated blood pressure 28. What should be done with information learned during a mental health assessment? 1) The information must be used on the patient’s behalf. 2) The information could be used as case studies in textbooks. 3) The information should be used to further nursing research. 4) The information should be shared with family and friends of the patient in an open forum. 29. What should the nurse do with a completed mental status examination? 1) Give it to the family. 2) Send it to the physician. 3) Place it on the medical record. 4) Fax it to the insurance company. 30. An older patient’s mental functioning is lower than the score of a mental status examination indicates. What should this information suggest to the nurse? 1) The patient has dementia. 2) The patient has a mental illness. 3) The examination needs to be repeated. 4) The examination was performed incorrectly. 31. An older person is demonstrating a significant change in personality. What should the nurse suspect is occurring with this patient? 1) Pick’s disease 2) Parkinson’s disease 3) Alzheimer’s disease 4) Cardiovascular disease 32. An older patient is demonstrating signs of dementia. What should the nurse plan for this patient? 1) Reassess mental status frequently. 2) Transfer to a facility that specializes in dementia. 3) Reassess using a different mental status examination tool.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Schedule a conference to share the findings with the family. 33. An older patient who is recovering from a spinal cord injury refuses to participate in any facility activities and refuses to leave his room when his family visits. The occupational therapist is having difficulty getting him to participate in feeding and other upper extremity activities. What might be the cause of this type of behavior? 1) Delirium 2) Depression 3) Relocation trauma 4) Undiagnosed head injury 34. What is severe depression in an older person LEAST likely to effect? 1) Nursing home placement 2) Memory and cognitive function 3) Treatment of chronic disease processes 4) Personal hygiene and activities of daily living 35. An older patient who lives alone has dried feces on his legs and under the fingernails. Additional observations include oily hair, unkempt beard, and a weight loss of 15 lb over the last 2 months. For what is this patient at risk? 1) Diabetes 2) Tuberculosis 3) Adult day care 4) Nursing home placement 36. The nurse notes that an older community member who has been sad since the death of her spouse has experienced pneumonia and exacerbation of heart failure over the last 3 months. What should the nurse suspect is occurring with this patient? 1) Depression is causing the illnesses. 2) The patient’s home needs a thorough cleaning. 3) The patient is not taking medications as prescribed. 4) Family members are ignoring the patient’s feelings. 37. The nurse overhears nursing assistants talk about how an older newly admitted patient is mean and argues with everyone who comes into the room. What should the nurse suspect is occurring with this patient? 1) Depression 2) Poor oxygenation 3) Body fluid imbalance 4) Inadequate nutritional intake 38. The nurse suspects that an older patient is depressed. What should the nurse expect to be most affected when completing a mental status examination with this patient? 1) Memory 2) Thinking 3) Judgment 4) Calculation 39. An older patient being treated for depression claims that she recalls certain aspects of her life differently than what her family state occurred. What should the nurse identify as being the reason for the discrepancy between the patient’s memory and the family’s statements? 1) The patient is confused. 2) The patient’s memories are biased.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) The family is misunderstanding the events. 4) The family wants the patient to stay institutionalized. Multiple Response Identify one or more choices that best complete the statement or answer the question. 40. When should mental status assessments be completed? Select all that apply. 1) Every day 2) At least once a week 3) At the time of admission 4) After the patient has been settled for a few months 5) Any time there is a decline in activities of daily living or change in behavior 41. Which criteria are tested with the Mini Cog mental status examination? Select all that apply. 1) Calculating 2) Remembering 3) Communicating 4) Problem-solving 5) Corrects for education and culture 42. What is the purpose of a psychological assessment? Select all that apply. 1) Care planning 2) Determining placement in a facility 3) Identifying strengths and weaknesses 4) Determining the cost of nursing care 5) Pointing out the need for psychiatric evaluation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 18: Psychological Assessment Answer Section MULTIPLE CHOICE 1. ANS: 4 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 333 Heading: Mental Health Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition Difficulty: Easy Feedback 1 Having a clear purpose in life describes mental wellness. 2 Maintaining open relationships describes mental wellness. 3 Coping creatively with life’s situations describes mental wellness. 4 Overwhelming stress is not a characteristic of mental wellness. Even if there are no evident physical changes, overwhelming stress would have physical manifestations. PTS: 1 CON: Cognition 2. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 333 Heading: Mental Health Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition Difficulty: Easy Feedback 1 A strong reality orientation indicates mental health wellness. 2 A feeling of impending doom does not indicate mental health wellness. 3 A clear meaning and purpose in life indicates mental health wellness. 4 A capability for open and creative relationships indicates mental health wellness. PTS: 1 CON: Cognition 3. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 334 Heading: Cognition Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition Difficulty: Easy Feedback 1 Alterations are not always evident in everyday choices. 2 Cognition, the ability to process information, is best measured with mental status examinations. 3 Educational level affects the individual’s life experiences and baseline knowledge but it is not a means for measuring cognitive ability. 4 Individuals with alterations in their cognitive patterns can often successfully engage in social communication. PTS: 1 CON: Cognition 4. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 334 Heading: Memory Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 Short-term memory loss would encompass looking for glasses that were just placed in the drawer or on the nightstand. Loss of short-term memory or forgetfulness can be a symptom of confusion or high stress levels. 2 Inability to recall year of birth is an example of long-term memory loss. 3 Forgetting the names of one’s children is an example of long-term memory loss. 4 Counting backward from 100 by sevens is a measurement of calculation ability. PTS: 1 CON: Cognition 5. ANS: 3 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 334 Heading: Memory Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 Alterations in judgment affect the safety of older adults. 2 Altered perceptions often cause an older adult to exhibit paranoid behavior. 3 Confused residents often ask, “Where do I belong?” when they lose their memory and
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
problem-solving abilities. This is a reflection of their inability to use recent experiences to solve problems or answer questions. Long-term memory loss would affect memories of distant events.
PTS: 1 CON: Cognition 6. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 334 Heading: Memory Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 This is not an example of altered perception. 2 Often older adults minimize things that they can no longer remember rather than acknowledge that the memories no longer exist. 3 This is not an example of short-term memory loss. 4 This is not an example of altered problem solving. PTS: 1 CON: Cognition 7. ANS: 3 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 334 Heading: Memory Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 This is not an example of altered perception. 2 This is not an example of long-term memory loss. 3 Often older adults minimize things that they cannot remember rather than acknowledge that the memories do not exist. Short-term memory loss often can go undetected for a long time because of the minimizing skills that older adults develop. 4 This is not an example of altered problem solving. PTS: 1 CON: Cognition 8. ANS: 4 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 334 Heading: Memory
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 Depression is not the first symptom of Alzheimer’s disease. 2 Behavior change is not the first symptom of Alzheimer’s disease. 3 Long-term memory loss is not the first symptom of Alzheimer’s disease. 4 The first symptom of Alzheimer’s disease is usually short-term memory loss. PTS: 1 CON: Cognition 9. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 335 Heading: Perception Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 Because of alterations in perceptions or ability to interpret the environment accurately, an older adult may lose familiarity with things such as mirrors and not recognize the reflection as being self. 2 This is not an example of long-term memory loss. 3 This is not an example of short-term memory loss. 4 This is not an example of altered problem solving. PTS: 1 CON: Cognition 10. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 336 Heading: Thinking Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 The higher thought processes include ability to think abstractly. 2 Knowing how to do laundry is a lower level of thinking and is less fragile. 3 The higher thought processes include capacity to reason. 4 The higher thought processes include good judgment.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Cognition 11. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 336 Heading: Calculating Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 This is not a test of perception. 2 Counting backward requires concentration and attentiveness to the task, along with calculation ability. 3 This is not a test of memory. 4 This is not a test of problem-solving ability. PTS: 1 CON: Cognition 12. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 333 Heading: Mental Health Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 If an individual has achieved gerotranscendence, that person has increased personal life satisfaction, made a redefinition of self and relationships with others, and become open to new and creative possibilities. Gerotranscendence is psychological well-being. 2 Enmeshment is a term used by some family therapists to describe interactions among family members that keep them dependent on each other. This does not guarantee positive mental health. 3 Mental health is not a product of good nurturing. 4 Mental health is not a product of positive life experiences. PTS: 1 CON: Cognition 13. ANS: 4 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 334 Heading: Memory Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Analysis [Analyzing] Concept: Cognition Difficulty: Moderate Feedback 1 The stories are not fiction or made up. 2 The stories are not likely to be based on facts. 3 Recalling long-term memories is not evidence of cognitive decline. 4 The stories older persons tell of their childhood or young adulthood are stories based on their belief systems rather than on what actually happened. PTS: 1 CON: Cognition 14. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 334 Heading: Perception Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition Difficulty: Easy Feedback 1 Forming an opinion occurs when perceptions are compared. 2 The first phase of forming a perception is the ability to use the five senses to collect information about the environment. 3 Questioning the validity of observations is not a part of perception. 4 This occurs after the data about observations is collected. PTS: 1 CON: Cognition 15. ANS: 4 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 335 Heading: Perception Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Cognition Difficulty: Moderate Feedback 1 This is just a statement about an upcoming event. 2 This is an observation that family is scheduled to arrive. 3 This is an opinion about the meal choice. 4 This is a statement that demonstrates impaired memory and a natural distrust of a strange environment that is exaggerated in an institutionalized older person. PTS: 1
CON: Cognition
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
16. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 335 Heading: Orientation Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Cognition Difficulty: Moderate Feedback 1 Misplacing reading glasses could be an indication of short-term memory changes. 2 Orientation depends on a person’s ability to link each minute with the previous minute. Disorientation with respect to time is the first major confusion to occur as a result of dementia. 3 Expecting family to visit later in the day indicates being oriented to time. 4 Not recalling the location of a room in a facility does not indicate disorientation. PTS: 1 CON: Cognition 17. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 1. Identify three cognitive functions. Chapter page reference: 336 Heading: Orientation Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 Tests to determine memory are not usually omitted. 2 Tests for abstract thinking are not included as part of the short tests of mental function. 3 Tests to determine perception are not usually omitted. 4 Tests to determine orientation are not usually omitted. PTS: 1 CON: Cognition | Assessment 18. ANS: 3 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 2. Use a standardized examination to screen for cognitive functioning. Chapter page reference: 338 Heading: Memory Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition; Assessment Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Recall requires that a longer time pass and that the information be internalized. Memory retention requires that a longer time pass and that the information be internalized. Memory encoding involves the ability to mimic or repeat stated information immediately after receiving the information. Short-term memory requires that a longer time pass and that the information be internalized.
PTS: 1 CON: Cognition | Assessment 19. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 2. Use a standardized examination to screen for cognitive functioning. Chapter page reference: 338 Heading: Orientation Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 Orientation to time is tested by asking the date. 2 Asking the date does not test for memory recall. 3 Asking the date does not test for long-term memory. 4 Asking the date does not test for short-term memory. PTS: 1 CON: Cognition | Assessment 20. ANS: 3 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 2. Use a standardized examination to screen for cognitive functioning. Chapter page reference: 338 Heading: Table 18.1 Mental Status Examinations Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition; Assessment Difficulty: Easy Feedback 1 Most assessment tools are short. 2 The tools assess level of impairment. 3 Only the Short Portable Mental Status Questionnaire (SPMSQ) Mini Cog corrects for education level and race. 4 The tools can be used for all types of patients and problems. PTS: 1 CON: Cognition | Assessment 21. ANS: 4 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 2. Use a standardized examination to screen for cognitive functioning.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 341 Heading: Assessment Techniques Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition; Assessment Difficulty: Easy Feedback 1 Individuals may be uncooperative if they have not been approached properly and asked to participate. 2 There may be a reaction if the adult is pushed beyond his or her competency. 3 If testing takes a long amount of time, the attention span may be affected. 4 Older adults would not become uncooperative because they have the full attention of the nurse. PTS: 1 CON: Cognition | Assessment 22. ANS: 4 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 2. Use a standardized examination to screen for cognitive functioning. Chapter page reference: 339 Heading: Box 18.1 Brief Description of Common Screening Tools Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 There is not enough information to determine if the patient is experiencing delirium. 2 There is not enough information to determine if the patient is experiencing confusion. 3 A correct response is all numbers drawn in the appropriate spot on the clock and the hands at the appropriate time. 4 Refusal to draw the clock is scored as abnormal. PTS: 1 CON: Cognition | Assessment 23. ANS: 4 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 2. Use a standardized examination to screen for cognitive functioning. Chapter page reference: 340 Heading: When to Assess Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 Seeking evidence-based information will not necessarily support that the tool is valid and reliable.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
Asking the charge nurse which tool meets the criteria will not necessarily support that the tool is valid and reliable. Reading an article about the testing performed on the tool will not necessarily support that the tool is valid and reliable. Because rating scales are designed to collect standard information about older persons in a methodical way, nurses should review the methods of using the rating scales together. This practice ensures that information is gathered in the same way. One nurse can interview an older adult while another nurse observes, then they can reverse roles and compare the answers they received.
PTS: 1 CON: Cognition | Assessment 24. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 2. Use a standardized examination to screen for cognitive functioning. Chapter page reference: 341 Heading: Timing Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 Allowing an older person to select a time may be the most effective way to gain cooperation. 2 Scheduling the examination after morning care will not necessarily gain the patient’s cooperation. 3 Completing the exam before bedtime will not necessarily gain the patient’s cooperation. 4 Fitting the examination in while providing medications will not necessarily gain the patient’s cooperation. PTS: 1 CON: Cognition | Assessment 25. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 3. Identify four uses of psychological assessments. Chapter page reference: 342 Heading: Applications in Clinical Practice Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition; Assessment Difficulty: Easy Feedback 1 Older adults often make lists of things to do and hang calendars and reminder notes to aid their memory. 2 Change often increases confusion rather than stimulating memory. 3 Variety and new situations often increase confusion rather than stimulating memory. 4 Meeting new people often increases confusion rather than stimulating memory.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Cognition | Assessment 26. ANS: 4 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 3. Identify four uses of psychological assessments. Chapter page reference: 342 Heading: Applications in Clinical Practice Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition; Assessment Difficulty: Easy Feedback 1 Older confused adults who retain social skills are not ignored in social situations. 2 Older confused adults who retain social skills are not more confused in social situations. 3 Older confused adults who retain social skills are not encouraged not to interact with others. 4 Older adults who retain social skills can often mask serious cognitive and functional problems from others. Acquaintances of socially intact confused older adults usually are surprised when they discover that the older adult has dementia. PTS: 1 CON: Cognition | Assessment 27. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 3. Identify four uses of psychological assessments. Chapter page reference: 342 Heading: Applications in Clinical Practice Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition; Assessment Difficulty: Easy Feedback 1 Dementia has a gradual onset that may be detected only by an annual cognitive examination. 2 Decreased cognition is not a normal aging change. 3 Depression would not cause a change in mental status. 4 Elevated blood pressure would not cause a change in mental status. PTS: 1 CON: Cognition | Assessment 28. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 3. Identify four uses of psychological assessments. Chapter page reference: 342 Heading: What to do with Assessment Information Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition; Assessment Difficulty: Easy Feedback 1 All information obtained from the older person must be used on the individual’s behalf. 2 The information was not gathered to be used as case studies in textbooks. 3 The information was not gathered to further nursing research. 4 The information is not to be shared with anyone; it is private and confidential. PTS: 1 CON: Cognition | Assessment 29. ANS: 3 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 3. Identify four uses of psychological assessments. Chapter page reference: 342 Heading: What to do with Assessment Information Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 This information is not to be shared with the family. 2 This information is not sent to the physician. 3 This information should be dated and appear in an accessible place on the chart with a notation that this document must remain on the chart. 4 This information is not faxed to the insurance company. PTS: 1 CON: Cognition | Assessment 30. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 3. Identify four uses of psychological assessments. Chapter page reference: 342 Heading: What to do with Assessment Information Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 It does not mean that a patient has dementia when a person’s mental functioning seems much lower than the score of a psychological assessment might indicate. 2 When a person’s mental functioning seems much lower than the score of a psychological assessment might indicate, a mental illness is suspected. 3 The examination does not need to be repeated when a person’s mental functioning seems much lower than the score of a psychological assessment might indicate. 4 The examination was not performed incorrectly when a person’s mental functioning
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
seems much lower than the score of a psychological assessment might indicate. PTS: 1 CON: Cognition | Assessment 31. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 3. Identify four uses of psychological assessments. Chapter page reference: 342 Heading: What to do with Assessment Information Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 The most significant early symptom of Pick’s disease is a change in personality. 2 Personality changes are not associated with Parkinson’s disease. 3 Personality changes are not associated with Alzheimer’s disease. 4 Personality changes are not associated with cardiovascular disease. PTS: 1 CON: Cognition | Assessment 32. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 3. Identify four uses of psychological assessments. Chapter page reference: 342 Heading: What to do with Assessment Information Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 Symptoms of dementia are moving targets that must be tracked. The tracking is done by frequent, well-recorded assessments. 2 It is premature to consider transferring the patient to a facility that specializes in dementia. 3 The same mental status examination tool should be used for reassessments. 4 The family does not need to be contacted regarding the patient’s mental status at this time. PTS: 1 CON: Cognition | Assessment 33. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 4. Describe the impact of depression on the mental status score. Chapter page reference: 339 Heading: Assessing Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Analysis [Analyzing] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 The patient is not demonstrating symptoms of delirium. 2 The patient seems to be exhibiting classic withdrawal symptoms of depression that can be expected with his sudden loss of independence and self-care ability. 3 The patient is not demonstrating symptoms of relocation trauma. 4 The patient is not demonstrating symptoms of a head injury. PTS: 1 CON: Cognition | Assessment 34. ANS: 3 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 4. Describe the impact of depression on the mental status score. Chapter page reference: 339 Heading: Assessing Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition; Assessment Difficulty: Easy Feedback 1 Older adults who are depressed often may be placed in a nursing home. 2 Older adults with depression will demonstrate alterations in memory and cognitive functioning. 3 Depression usually does not affect how chronic diseases, such as congestive heart failure and hypertension, are treated. It is hoped that part of the treatment for all older adults with chronic disease processes would include support of positive coping mechanisms to prevent depression. 4 Older persons with depression will have changes in ability to care for personal needs. PTS: 1 CON: Cognition | Assessment 35. ANS: 4 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 4. Describe the impact of depression on the mental status score. Chapter page reference: 339 Heading: Assessing Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition; Assessment Difficulty: Easy Feedback 1 There is no evidence to support that the patient is at risk for developing a disease such as diabetes. 2 There is no evidence to support that the patient is at risk for developing a disease such as tuberculosis.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
Adult day care is not an appropriate solution because the patient has physical hygiene needs that cannot be met. Older individuals who are depressed frequently exhibit poor personal hygiene and nutrition. These individuals are at high risk for nursing home placement because they lack motivation.
PTS: 1 CON: Cognition | Assessment 36. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 4. Describe the impact of depression on the mental status score. Chapter page reference: 339 Heading: Assessing Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 There is a heavy emotional cost to depression that ultimately affects the immune system, which can lead to physical illnesses and infections. 2 There is no evidence that the patient’s illnesses are being caused by an unclean environment. 3 There is no evidence that the patient is not taking medications as prescribed. 4 There is no evidence that the patient’s family is ignoring the patient’s feelings. PTS: 1 CON: Cognition | Assessment 37. ANS: 1 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 4. Describe the impact of depression on the mental status score. Chapter page reference: 339 Heading: Assessing Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 The most impressive feature of depression is an unpleasant mood. 2 There is not enough information to determine if the patient is having issues with oxygenation. 3 There is not enough information to determine if the patient is having issues with body fluid balance. 4 There is not enough information to determine if the patient is having issues with nutritional intake. PTS: 1 38. ANS: 1
CON: Cognition | Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 4. Describe the impact of depression on the mental status score. Chapter page reference: 340 Heading: Assessing Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 Memory seems to be the function most influenced by a depressed mood. 2 Thinking is not identified as being the function most influenced by a depressed mood. 3 Judgement is not identified as being the function most influenced by a depressed mood. 4 Calculation is not identified as being the function most influenced by a depressed mood. PTS: 1 CON: Cognition | Assessment 39. ANS: 2 Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 4. Describe the impact of depression on the mental status score. Chapter page reference: 340 Heading: Assessing Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Cognition; Assessment Difficulty: Moderate Feedback 1 There is no evidence that the patient is confused. 2 Information committed to memory when a person is depressed is likely to be biased. 3 There is not enough information to determine if the family is misunderstanding the events. 4 There is no information to support that the family wants the patient to remain institutionalized. PTS: 1
CON: Cognition | Assessment
MULTIPLE RESPONSE 40. ANS: 3, 5 1. 2. 3. 4. 5.
Feedback Mental status assessments do not need to be done every day. Mental status assessments do not need to be done once a week. Mental status assessments should be done on admission to determine a baseline. Mental status assessments do not need to be done after waiting a few months. Mental status assessments should be done any time that staff members notice behavioral changes or functional status changes.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 2. Use a standardized examination to screen for cognitive functioning. Chapter page reference: 340 Heading: When to Assess Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition; Assessment Difficulty: Moderate PTS: 1 CON: Cognition | Assessment 41. ANS: 2, 3, 4, 5 Feedback 1. The Mini Cog assessment does not include calculating. 2. The Mini Cog assessment includes remembering. 3. The Mini Cog assessment includes communicating. 4. The Mini Cog assessment includes problem-solving. 5. The Mini Cog assessment corrects for education and culture. Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 2. Use a standardized examination to screen for cognitive functioning. Chapter page reference: 338 Heading: Table 18.1 Mental Status Examinations Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition; Assessment Difficulty: Easy PTS: 1 CON: Cognition | Assessment 42. ANS: 1, 2, 3 Feedback 1. The purpose of a psychological assessment is to aid with care planning. 2. The purpose of a psychological assessment is to help determine placement in a facility. 3. The purpose of a psychological assessment is to identify strengths and weaknesses. 4. The purpose of a psychological assessment is not to determine the cost of nursing care. 5. The purpose of a psychological assessment is to point out the need for psychiatric evaluation. Chapter number and title: Chapter 18: Psychological Assessment Chapter/learning objective: 3. Identify four uses of psychological assessments. Chapter page reference: 342 Heading: Applications in Clinical Practice Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition; Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Easy PTS: 1
CON: Cognition | Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 19: Common Clinical Problems: Psychological Multiple Choice Identify the choice that best completes the statement or answers the question. 1. What best describes bipolar affective disorder? 1) An exaggerated fear of a particular object 2) A state of not knowing the day, time, or where one is 3) A psychological disease involving severe thought and perception disorder 4) A psychological disorder involving mood swings from mania to depression 2. An older patient is fearful, crying out that birds are flying around her room. What psychological condition is this patient most likely demonstrating? 1) Illusion 2) Paranoia 3) Somatization 4) Hallucination 3. An older patient calls for the nurse because there are alligators in the bathroom. What should the nurse do first? 1) Stay calm. 2) Tell the patient that the alligators are real. 3) Get help from another staff member. 4) Explain that the alligators are not there but realize it is a problem for the patient. 4. While making a routine visit to an older patient’s home, the nurse notices a pile of digoxin and potassium wrapped in a napkin. For what should the nurse assess this patient? 1) Diabetes 2) Dementia 3) Failure to thrive 4) Suicidal thoughts 5. An older patient grabs the nurse by the arm with one hand and begins to strike the nurse with the other hand. What should the nurse do? 1) Cover the face. 2) Push the patient away. 3) Pinch the patient’s hand. 4) Release the patient’s hand by rotating away from the thumb. 6. An older patient in a nursing facility tells the nurse that she knows that she didn’t commit any crimes and wants to see her attorney. What should the nurse suspect this patient is experiencing? 1) Illusion 2) Delusion 3) Paranoia 4) Hallucination 7. Which action should the nurse take to reduce emotional distress in an older patient newly admitted to a nursing facility? 1) Suggest family stay with the patient during the night. 2) Assign the same staff member to the patient for care.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Move the patient to a room closer to the nurses’ station. 4) Place the patient in a room farther away from the nurses’ station. 8. What is the most important thing for the nurse to do when developing a relationship with a patient with psychological problems? 1) Develop trust with the patient. 2) Limit visits to prevent codependency. 3) Learn the full name of the patient and the names of close family members. 4) Memorize the patient’s medications and side effects to monitor the patient closely. 9. The nurse is visiting the home of an older patient who has just been forced to retire from his position at the local factory. Which statement would help draw the patient into a discussion about the job loss? 1) “Why be upset? You will feel fine in time.” 2) “It is normal to feel lost when you are forced to retire.” 3) “How did you feel when the factory forced you to retire?” 4) “Retirement is a great opportunity to try new things that you did not have time to do when you were working.” 10. Which statement shows the use of empathy in communicating with an older person? 1) “It must be difficult for you to care for your wife and father.” 2) “I know how you feel. My grandmother lived with us while I was growing up.” 3) “Growing old is not easy for anyone, especially with the added burden of caring for your wife and father.” 4) “I have visited with families who have spouses, parents, and grandparents with many more health problems than your wife and father.” 11. Why is the technique of open questioning with older adults experiencing loss useful? 1) Helps the older adult move out of the anger stage of grieving a loss 2) Encourages suppression of nonproductive thoughts related to the loss 3) Encourages older adults to express feelings and thoughts related to loss 4) Stimulates the productive resolution of the grieving process related to a loss 12. Which is an example of a good open question? 1) “Is this your room?” 2) “Are you in a nursing home?” 3) “Why are you in a nursing home?” 4) “Where did you live before you came to the nursing home?” 13. What is an important consideration before using touch with a resident with psychological problems? 1) Ask the resident’s permission before touching. 2) Review the resident’s chart for any history of abuse. 3) Ask the family members if touch can be used to communicate with the resident. 4) Review the facility’s policies regarding physical contact with residents and ensure that another staff member is present when the resident is touched. 14. What type of techniques are matching and mirroring? 1) Guiding choices 2) Validation therapy 3) Using universal symbols 4) Nonverbal communication
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
15. What would be the preferred sense response to a resident who states, “I feel a mean streak in that nursing assistant”? 1) “What do you feel when Mary is caring for you?” 2) “Mary is a very caring person and isn’t mean at all.” 3) “Tell me what you see that makes you feel that way.” 4) “I know what you’re talking about; she frightens me, too.” 16. What is the most effective treatment plan for older adults having problems with depression? 1) Antidepressant medications 2) Validation groups and antipsychotic medications 3) Reality orientation groups and antipsychotic medications 4) Antidepressant medications and development of personal coping skills 17. Which is NOT an external factor that may help prevent depression? 1) Sunlight 2) Exercise 3) Medications 4) Proper nutrition 18. An older patient with a psychological problem is reluctant to speak to the nurse. Which technique should the nurse use to diffuse the older person’s tension? 1) Use humor. 2) Ask closed questions. 3) Sit with the patient in silence. 4) Tell the patient that refusing to talk is not an option. 19. The nurse says to an older patient, “Would you like to attend bingo or sit outside with the garden club?” What is the nurse doing? 1) Providing guided choices 2) Assessing the patient’s interests 3) Determining if the patient likes to sit outside 4) Determining if the patient wants to be around people 20. The nursing assistants refuse to care for a patient with Alzheimer’s disease because he becomes very agitated at times during bathing. What is the best response by the licensed practical nurse? 1) Tell the patient that the behavior is unacceptable and restraints will need to be used. 2) Tell the staff to take turns caring for the patient and set up a revolving assignment schedule. 3) Review the plan of care with the interdisciplinary team to develop strategies to decrease the patient’s agitation during bathing. 4) Transfer the patient to another section of the facility to take the stress off of the nursing assistants who have been caring for him since his admission. 21. What is the best strategy to manage an individual who is agitated? 1) Do nothing. 2) Raise the voice. 3) Keep the person talking. 4) Move closer to speak to the patient. 22. Which intervention would help minimize disorientation for a hospitalized older person? 1) Keeping the television on all day and night to provide diversion
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Waking the older person every 2 hours to orient to the surroundings 3) Allowing the older person to bring small, familiar objects to the hospital 4) Having multiple caregivers to give the older person a feeling of security by having many individuals caring for him 23. A female older patient with early-onset Alzheimer’s disease goes into male patients’ rooms, crawls into bed with them, and fondles their genital areas. What does the nurse need to consider in developing nursing interventions to deal with this behavior? 1) The patient has the right to express sexual feelings. 2) The problem is the staff’s attitude toward sexual expression. 3) The patient’s behavior may demonstrate a need for affection and touch. 4) Patients have the right to express sexual needs and demonstrate sexual behaviors. 24. An older patient who is disoriented believes that a fire has destroyed the city. What question should the nurse ask this patient? 1) “Can you see the city?” 2) “Why do you think that?” 3) “Why is this an issue with you?” 4) “What is the worst that will happen?” 25. What would be the appropriate response to an older person who states, “I just don’t want to live anymore?” 1) Ask the older adult if he or she has a suicide plan. 2) Assign a nursing assistant to sit with the older adult. 3) Notify the family that the older person is not feeling well. 4) Encourage the older person to get involved in activities outside of the home. 26. An older patient who refuses food and medication is diagnosed with failure to thrive. What is this disorder associated with? 1) Depression 2) Chronic mental illness 3) Gastrointestinal dysfunction 4) Knowledge deficit related to health promotion practices 27. An older patient has become increasingly confused over the past year. A family member reports that the confusion seems to be increasing steadily. What is the most likely source of the patient’s confusion? 1) Delirium 2) Dementia 3) Depression 4) Normal aging 28. An older patient being treated for dehydration is reported by the nursing assistant as acting “really weird.” How should the nurse respond to the assistant? 1) “Confusion is normal for people who are sick.” 2) “The patient should probably go to the hospital if she is that sick.” 3) “Having an IV is very frightening, so the patient will probably be confused as long as IV therapy continues.” 4) “Dehydration and infection are reversible causes of confusion, and the patient’s confusion will probably improve with the IV fluids and antibiotic treatment.” 29. Which disease process does NOT have dementia as a major symptom? 1) Head injuries
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Alzheimer’s disease 3) Congestive heart disease 4) Impaired blood flow to the brain 30. An older patient with Alzheimer’s disease (AD), paces the halls in his home, talks to people who are not there, and becomes angry when asked why he is talking to the wall. What is this behavior a characteristic of? 1) Late stages of AD 2) The early stage of AD 3) All older people with AD 4) The middle, or second, stage of AD 31. What is somatization? 1) A symptom of hypochondria 2) A physical reaction to an emotional problem 3) A group of disease symptoms that have no apparent cause 4) A physical problem that causes emotional pain or depression 32. The Health Care Financing Administration (HCFA) has stated that a resident in a long-term care facility has the right to have the least restrictive treatment to promote health. Which treatment would be questionable under these guidelines? 1) Administering a sedative to a resident who has been complaining of insomnia 2) Fastening a Velcro belt on a wheelchair-bound resident who is able to unfasten himself or herself 3) Taping an arm board to a resident’s wrist to promote the flow of an IV that stops when the resident bends his or her wrist 4) Applying a soft waist restraint on a resident who repeatedly falls after climbing over the side rails of the bed to go to the bathroom 33. When are physical and chemical restraints appropriately used? 1) When the resident refuses to participate in his or her care 2) When the physician orders the physical or chemical restraint 3) When all other treatments or interventions have been unsuccessful in promoting resident safety and health 4) When the resident has a chronic mental illness that has significantly compromised his or her ability to follow directions during care 34. Which is true about the use of physical restraints? 1) Once applied, the patient should be left alone. 2) They should be removed every 2 hours for a brief time. 3) They should be removed for a short period once during each shift. 4) They should be left in place until the patient shows a change in behavior. 35. The nurse is caring for an older patient experiencing disorientation. What direction should the nurse provide when preparing the patient for bed? 1) “Unbutton your shirt.” 2) “Put on your pajamas.” 3) “Take off your clothes.” 4) “Hang up your clothes.” 36. An older patient with a psychological problem is experiencing slowed thought processes. What should the nurse do when communicating with this patient?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1) 2) 3) 4)
Speak slowly. Use vague pronouns. Leave the patient alone. Stand a few feet away from the patient.
37. What are reminiscence groups designed to do? 1) Reorient the older adult. 2) Provide opportunities for life review. 3) Decrease confusion for the older adult. 4) Test the older adult’s long-term memory. 38. Resocialization groups focus on social roles and self-esteem. They are not designed to deal with feelings or to solve problems. For which residents is this type of group most appropriate? 1) Mildly confused residents 2) Residents with depression 3) Residents with chronic mental illness 4) Residents who are new to the facility 39. Validation groups and reality orientation groups are designed for residents experiencing confusion or malorientation. Which statement is true regarding validation and reality orientation? 1) Validation deals with feelings and reality orientation addresses problem solving. 2) Validation is a “feel good” approach for the caregiver, whereas reality orientation helps the resident feel better. 3) Resolving loss is a goal of validation therapy, and keeping older adults oriented to their environment is the goal of reality orientation. 4) Validation confronts the older adult to express feelings of anger and resentment, and reality orientation places those feelings in the reality of today. 40. The nurse is helping an older resident work through structured reminiscence. What is the purpose of this activity? 1) Test long-term memory. 2) Evaluate life experiences. 3) Encourage communication. 4) Validate short-term memory. 41. What is used during remotivation therapy? 1) Facts 2) Feelings 3) Thoughts 4) Impressions 42. What are psychotropic medications used for with older adults? 1) Avoiding the use of restraints 2) Managing problematic behaviors 3) Decreasing the symptoms of dementia 4) Treating psychotic features of dementia 43. Which is NOT a disadvantage of psychotropic medications in the treatment of mental health problems for older patients? 1) Drowsiness as a side effect 2) Potential toxicity at usual dosages
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Changing levels of chemicals in the brain 4) Length of time to achieve therapeutic levels 44. What must be assessed when an older patient has been started on a tricyclic antidepressant? 1) Respiratory status 2) Pulse rate and rhythm 3) Orthostatic hypotension 4) Therapeutic blood levels 45. An older patient has been falling since starting on a new psychotropic medication. What could be the best explanation for this? 1) Orthostatic hypotension 2) Overdosing of the medication 3) Interaction with other medications 4) Relaxation of the patient’s paranoid tendencies 46. An older person who has been taking psychotropic medication for a month is planning to stop taking the medication because it does not appear to be working. How should the nurse respond to this patient? 1) “Increasing the dosage might help.” 2) “It really does not matter if you take the medication or not.” 3) “It can take several weeks for the medication effects to occur.” 4) “You will probably have to be hospitalized if you stop the medication.” 47. An older patient is diagnosed with toxicity from taking a psychotropic medication. What should the nurse explain as the reason for this adverse reaction? 1) “Clearing of the drug is slower as we age.” 2) “You were prescribed the wrong medication.” 3) “You were taking too much of the medication.” 4) “This is expected and means the drug is working.” Multiple Response Identify one or more choices that best complete the statement or answer the question. 48. After the completion of an assessment, the nurse becomes concerned that an older patient is at risk for developing depression. What findings did the nurse use to make this clinical decision? Select all that apply? 1) Oldest daughter visits every day 2) Spouse passed away a month ago 3) Has two alcoholic drinks per night 4) Recently moved to an assisted living facility 5) Driver’s license suspended for multiple accidents 49. What does calling an older patient “dearie” indicate? Select all that apply. 1) Empathy 2) Sympathy 3) Patronizing 4) Comfort level of the nurse 5) Hindrance to effective communication 50. Which techniques should the nurse use to ensure that an older patient hears correctly? Select all that apply. 1) Speak in a normal tone.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) 3) 4) 5)
Move closer to the patient. Shout into the patient’s ear. Stand in front of the patient. Avoid standing in a bright light.
51. Which observations indicate that an older patient is becoming agitated? Select all that apply. 1) Pacing 2) Talking loudly 3) Threatening the staff 4) Crying in a dark room 5) Stating bugs are on the walls 52. The family is upset because of the behaviors exhibited by an older patient experiencing delirium. What should the nurse instruct the family to do during this time? Select all that apply. 1) Reduce stress. 2) Turn on the television. 3) Engage in conversation. 4) Limit the number of visitors. 5) Maintain a quiet environment. 53. What is a purpose for stimulating memories of childhood or adulthood in an older person? Select all that apply. 1) Test long-term memory. 2) Solidify cognitive skills. 3) Improve feelings of self-worth. 4) Validate ability to think rationally. 5) Provide an opportunity to do a life review. 54. What is the purpose of recalling school days with a group of older patients? Select all that apply. 1) Promotes socialization 2) Validates educational level 3) Assesses calculation ability 4) Encourages communication 5) Provides mental stimulation 55. An older patient is prescribed a psychotropic medication. What should the nurse include when instructing the patient and family about this medication? Select all that apply. 1) Fluid intake 2) Side effects 3) Toxic effects 4) Actions if a dose is missed 5) The reason for the medication
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 19: Common Clinical Problems: Psychological Answer Section MULTIPLE CHOICE 1. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 1. Recognize three behaviors that may signal the presence of a psychological problem in an older adult. Chapter page reference: 349 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Mood Difficulty: Easy Feedback 1 A phobia is an exaggerated fear of a particular object. 2 Disorientation is a state of not knowing what day or time it is, or not knowing where one is. 3 Schizophrenia is a psychological disease involving severe thought and perception disturbances. 4 Bipolar affective disorder is a psychological disease involving mood swings from mania to depression. PTS: 1 CON: Mood 2. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 1. Recognize three behaviors that may signal the presence of a psychological problem in an older adult. Chapter page reference: 349 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Mood Difficulty: Easy Feedback 1 Illusions are misconceptions of real events. 2 Paranoia is a way of thinking that interprets others as being intentionally harmful. 3 Somatization is extreme preoccupation with physical problems. 4 Hallucinations are false sensory impressions, often seeing or hearing something that is not there. PTS: 1 3. ANS: 1
CON: Mood
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 1. Recognize three behaviors that may signal the presence of a psychological problem in an older adult. Chapter page reference: 353 Heading: Problem Behaviors Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1 When dealing with such problems, the first rule is to stay calm. 2 Do not play into the symptom. 3 If feeling uncomfortable or in danger, help should be obtained. 4 The next most important thing is to tell the truth. Do not play into the symptom. Be caring, honest, and genuine with the person. PTS: 1 CON: Mood 4. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 1. Recognize three behaviors that may signal the presence of a psychological problem in an older adult. Chapter page reference: 358 Heading: Depression and Suicide Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1 There is no reason to associate this patient’s actions with diabetes. 2 There is a need for more information before linking this patient’s behavior with dementia. 3 Failure to thrive occurs when an older adult no longer makes an attempt to keep up with life. 4 Noncompliance with medication or hoarding may be part of a suicide plan. This topic should be gently explored with the older adult. PTS: 1 CON: Mood 5. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 1. Recognize three behaviors that may signal the presence of a psychological problem in an older adult. Chapter page reference: 354 Heading: Agitation Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Safety and Infection Control
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 Covering the face will not help the nurse to be removed from the situation. 2 The nurse should not push anyone. 3 Pinching the patient is not acceptable behavior. 4 If a person becomes physically aggressive it is important to remember that the thumb is the weakest point of the hand. If a person has a hold on you, the way to remove yourself is by rotating away from the thumb of the person’s hand. PTS: 1 CON: Safety 6. ANS: 2 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 1. Recognize three behaviors that may signal the presence of a psychological problem in an older adult. Chapter page reference: 349 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive level: Analysis [Analyzing] Concept: Safety Difficulty: Moderate Feedback 1 An illusion is a misperception of a real event or object. 2 A delusion is a false, fixed idea or belief. 3 Paranoia is a way of thinking that systematically interprets others as being intentionally harmful. 4 Hallucination is a false sensory impression, often seeing or hearing something that is not there. PTS: 1 CON: Safety 7. ANS: 2 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 1. Recognize three behaviors that may signal the presence of a psychological problem in an older adult. Chapter page reference: 354 Heading: Dealing with Psychological Problems Caused by Stress Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Applying [Application] Concept: Stress Difficulty: Moderate Feedback 1 Suggesting that the family stay with the patient during the night will not help reduce the patient’s emotional distress. 2 Making an extra effort to assign the same staff members to an older person in the
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
hospital and in the nursing home may help to prevent emotional distress. Moving the patient to a room closer to the nurses’ station will not help reduce the patient’s emotional distress. Placing the patient in a room farther away from the nurses’ station will not help reduce the patient’s emotional distress.
PTS: 1 CON: Stress 8. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 348 Heading: General Guidelines for Communication Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Applying [Application] Concept: Cognition, Stress Difficulty: Moderate Feedback 1 During the beginning of a relationship, people are often uncomfortable. When working with a patient with psychological disorders there can be serious problems that interfere with the development of a relationship, such as paranoia or limited short-term memory. Earning the trust of the patient is crucial to any meaningful relationship. 2 Visits should not be limited. 3 Learning the name of the patient and family members is not essential during the beginning phase of a relationship. 4 The patient’s medications will not help with relationship building. PTS: 1 CON: Cognition | Stress 9. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 350 Heading: Open Questions Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Applying [Application] Concept: Cognition, Stress Difficulty: Moderate Feedback 1 This is a closed statement that identifies the nurse’s beliefs about how the patient should be feeling. 2 This is a closed statement that identifies the nurse’s beliefs about how the patient should be feeling. 3 An open question encourages the patient to talk about feelings. 4 This is a closed statement that identifies the nurse’s beliefs about how the patient should
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
be feeling. PTS: 1 CON: Cognition | Stress 10. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 351 Heading: Empathy and Genuineness Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Applying [Application] Concept: Cognition, Stress Difficulty: Moderate Feedback 1 This statement focuses on the older person and the problem. 2 This statement minimizes the older person’s experience. 3 This statement does not address the unique difficulties of the older person but instead states that others have the same experience. 4 This statement minimizes the older person’s experience. PTS: 1 CON: Cognition | Stress 11. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 350 Heading: Open Questions Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Grief and Loss Difficulty: Easy Feedback 1 Open questioning does not help with the grieving process. 2 Open questioning should give older adults an opportunity to express thoughts without judgment of their productivity in resolving the loss. 3 Open questioning helps older adults express feelings and thoughts related to the loss. 4 Open questioning does not help with the grieving process. PTS: 1 CON: Grief and Loss 12. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 350 Heading: Open Questions
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy Feedback 1 This is a question that is answered by yes or no. 2 This is a question that is answered by yes or no. 3 “Why” questions require the person to think logically. A disoriented person cannot think rationally or logically. 4 Good open questions cannot be answered yes or no. PTS: 1 CON: Communication 13. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 352 Heading: Touch Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy Feedback 1 Asking for permission is the best and most appropriate response. 2 This assumes that residents who have experienced abuse would not accept touch during communication. 3 Consulting residents’ families is an important aspect of nursing practice, however, asking a resident’s permission before touching his or her hand or hugging during conversation is the most appropriate response. 4 Consulting facility policies is an important aspect of nursing practice, however, asking a resident’s permission before touching his or her hand or hugging during conversation is the most appropriate response. PTS: 1 CON: Communication 14. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 352 Heading: Matching and Mirroring Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Feedback Guiding choices is a verbal communication technique. Validation therapy uses many techniques but is primarily concerned with group support and problem solving. Using universal symbols is a nonverbal communication technique but it does not involve mirroring or matching. Mirroring and matching are techniques of nonverbal communication. Mirroring is doing exactly what the person is doing (as if the person were looking in a mirror) and matching is using the same pattern or intensity of tone the person is using. Both techniques must be practiced carefully so as not to make fun of the person.
PTS: 1 CON: Communication 15. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 356 Heading: Preferred Sense Words Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Communication Difficulty: Moderate Feedback 1 This addresses what the resident feels, which from the patient’s statement would be the preferred sense. 2 This does not address the patient’s preferred sense. 3 This asks the patient resident what is seen, not felt. 4 This does not address the patient’s preferred sense. PTS: 1 CON: Communication 16. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 357 Heading: Depression Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Mood Difficulty: Easy Feedback 1 Antidepressant medications alone are not as effective in treating depression and preventing future exacerbations. 2 Antipsychotic medications are inappropriate for the treatment of depression. Validation therapy is designed for confused older adults.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
Reality orientation is designed for confused older adults. Antipsychotic medications are inappropriate for the treatment of depression. Medications and counseling to support individual coping skills are the standards for treatment of depression.
PTS: 1 CON: Mood 17. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 358 Heading: Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Mood Difficulty: Easy Feedback 1 Sunlight may help to prevent depression. 2 Exercise may help to prevent depression. 3 Antidepressants are not given to prevent depression. 4 Proper nutrition may help to prevent depression. PTS: 1 CON: Mood 18. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 348 Heading: Beginning a Relationship Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Communication Difficulty: Moderate Feedback 1 If the person with a psychological problem does not talk, the nurse can be creative by using humor to diffuse tension. 2 Asking closed questions isn’t going to make the patient talk. 3 Sitting with the patient in silence is not productive. 4 The nurse should not threaten the patient into talking. PTS: 1 CON: Communication 19. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 350 Heading: Guided Choices Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Communication Difficulty: Moderate Feedback 1 Giving a patient the choice between two activities is guided choices. 2 Giving the patient the choice between two activities is not assessing the patient’s interests. 3 Giving the patient the choice between two activities is not determining if the patient likes to sit outside. 4 Giving the patient the choice between two activities is not determining if the patient wants to be around people. PTS: 1 CON: Communication 20. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 354 Heading: Agitation Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The patient should not be threatened with restraints. 2 This does not take the patient’s need for consistent caregivers into consideration. 3 This is appropriate because all members of the health-care team, the family, and the resident are involved in solving the care problem. 4 This does not address the patient’s need to have consistent caregivers. PTS: 1 CON: Cognition 21. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 354 Heading: Agitation Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The nurse should maintain eye contact and match the person’s breathing pattern.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
The nurse should keep calm. In agitation, it is best to keep the person talking. The nurse should step back a few feet to give the person space.
PTS: 1 CON: Cognition 22. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 354 Heading: Dealing With Psychological Problems Caused by Stress Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The noise of television can be a distressing negative sensory stimulus, especially when it is on all the time. 2 Waking older individuals at frequent intervals can interrupt sleep patterns and negatively affect rest and sleep patterns. 3 Relocation is a common cause of disorientation for hospitalized older patients. 4 Having multiple caregivers is more confusing. PTS: 1 CON: Cognition 23. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 355 Heading: Sexual Acting Out Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Sexuality Difficulty: Moderate Feedback 1 This addresses an area that the nurse needs to consider when designing care. 2 This is not an area that needs to be highlighted in this situation. 3 This explores the possible cause of the behavior and would lead to development of nursing interventions with the patient that could meet a need for affection and touch. This would decrease the need for the patient to try to meet these needs with other residents. 4 This addresses an area that the nurse needs to consider when designing care. PTS: 1 CON: Sexuality 24. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 356 Heading: Asking the Extreme Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 Asking about the city would not be appropriate. 2 Asking a why question is distressing for a confused person. 3 Asking a why question is distressing for a confused person. 4 Asking questions about the extreme of the situation sometimes helps a confused person focus on the reality of here and now. PTS: 1 CON: Cognition 25. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 358 Heading: Depression and Suicide Integrated Processes: Nursing Process: Application Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 This recognizes that the patient is at risk for suicide. 2 This ignores the patient’s risk for suicide. 3 This ignores the patient’s risk for suicide. 4 This ignores the patient’s risk for suicide. PTS: 1 CON: Cognition 26. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 359 Heading: Failure to Thrive Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Mood Difficulty: Easy Feedback 1 Failure to thrive is recognized as a symptom of depression. 2 Individuals with chronic mental illness may refuse food and medications. 3 Individuals with gastrointestinal dysfunction may refuse food and medications. 4 Individuals with knowledge deficits may refuse food and medications.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Mood 27. ANS: 2 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 360 Heading: Dementia Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Cognition Difficulty: Easy Feedback 1 Confusion related to delirium is characterized by a rapid onset and the presence of a reversible cause. 2 Confusion that increases over a period of time is characteristic of dementia. 3 Confusion is not the primary symptom of depression. 4 Confusion is not a symptom of normal aging. PTS: 1 CON: Cognition 28. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 359 Heading: Delirium Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 Confusion is not normal for all people who are ill. 2 The facility is able to treat the dehydration. 3 Although IV therapy can be frightening, that is not the cause of the confusion. 4 Infection and dehydration are reversible causes of confusion, and the patient’s mental status is likely to improve if these problems are reversed. PTS: 1 CON: Cognition 29. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 360 Heading: Dementia Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Easy Feedback 1 Head trauma has the potential for associated dementia because of damage to brain tissue. 2 Alzheimer’s disease has the potential for associated dementia because of damage to brain tissue. 3 Congestive heart disease relates to the condition of the heart muscle, and unless there is an accompanying decrease in the ability of the heart to get blood to the brain, confusion is not a major symptom. 4 Impaired cerebral circulation has the potential for associated dementia because of damage to brain tissue. PTS: 1 CON: Cognition 30. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 361 Heading: Stages of Disorientation Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition Difficulty: Easy Feedback 1 The last stage of AD is characterized by impaired speech and mobility, along with decreased awareness of environment and personal needs. 2 During the first stage of AD, the major symptom is forgetfulness, especially short-term memory loss. 3 The patient’s manifestations are not characteristic of all older people with AD. 4 The second, or middle, stage of AD is characterized by changes in mood, thinking, and behavior. Hallucinations, agitation, and pacing are common symptoms of this stage of the disease. PTS: 1 CON: Cognition 31. ANS: 2 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 365 Heading: Physical and Mental Health Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Stress Difficulty: Easy Feedback 1 Often an individual’s physical complaints have been minimized (labeled hypochondria) because there has been no apparent cause for the symptoms.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
Somatization describes physical symptoms that are related to emotional stressors or problems Often an individual’s physical complaints have been minimized (labeled hypochondria) because there has been no apparent cause for the symptoms. Many physical problems can cause an individual to exhibit emotional side effects. Depression and grief are just two emotional responses to two physical problems. This is not somatization.
PTS: 1 CON: Stress 32. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 365 Heading: Patient Rights and Legal Responsibilities Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Safety Difficulty: Easy Feedback 1 Administering a sedative to treat insomnia provides the resident with a choice. 2 Because the patient is able to unfasten the safety belt this does not restrict movement. 3 An arm board used to promote IV flow is less restrictive than restraining the arm to the bed and is probably more desirable than restarting the IV. 4 Restraining a resident who repeatedly falls is a restrictive treatment of convenience. Toileting, lowering the side rails, and ambulating the resident are less restrictive, but labor-intensive, alternatives to restraining the resident. PTS: 1 CON: Safety 33. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 365 Heading: Patient Rights and Legal Responsibilities Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Safety Difficulty: Easy Feedback 1 The criterion of providing the least restrictive environment was designed so residents maintained their right to choose treatment options. 2 Even if a physician orders a restraint, the nurse is responsible for documenting the use of less restrictive means to manage the behavior before a restraint is used. 3 The Health Care Financing Administration (HCFA) requires that nonrestrictive measures be attempted and documented as unsuccessful before the use of chemical or physical restraints.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
The criterion of providing the least restrictive environment was designed to advocate for residents with altered thought processes.
PTS: 1 CON: Safety 34. ANS: 2 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 365 Heading: Patient Rights and Legal Responsibilities Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Safety Difficulty: Easy Feedback 1 Restraints should be checked every 2 hours. 2 When restraints are used they should be the least restrictive, the patient should be monitored closely, and the restraints should be removed for a brief period every 2 hours. 3 Restraints should be checked more than once a shift. 4 Restraints should not be kept in place until a change in behavior occurs. PTS: 1 CON: Safety 35. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 350 Heading: Giving Instructions Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 When giving directions it is best to do so slowly, one step at a time. Individuals who are disoriented may be unable to perform any self-care activities unless they are prompted by very simple cues. 2 Telling someone who is disoriented to put on pajamas might not be possible for that individual. 3 Telling someone who is disoriented to take off clothes might be too much information for the person to process. 4 Telling someone who is disoriented to hang up clothes might not be understood. PTS: 1 CON: Cognition 36. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 356 Heading: Speaking Slowly Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 Many people who have emotional problems have slowed thought processes. When this problem is combined with normal aging changes, it is very important for the nurse to use slightly slower speech and wait a little longer for the person to respond. 2 Vague pronouns are used if a person is unable to fill in the details with enough facts to be understood. 3 The patient with a slowed thought process does not need to be left alone. 4 The patient with a slowed thought process is not angry. The nurse does not need to stand a few feet away from the patient. PTS: 1 CON: Cognition 37. ANS: 2 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 4. Compare reality orientation, reminiscence, remotivation, resocialization, and validation techniques. Chapter page reference: 363 Heading: Reminiscence Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition Difficulty: Easy
1 2 3 4
Feedback Reorienting focuses on promoting the cognitive function of an older adult. Reminiscence groups use the life review process to validate the self-concept and experiences of older adults. Decreasing confusion promotes the cognitive function of the older adult. Testing long-term memory promotes the cognitive function of the older adult.
PTS: 1 CON: Cognition 38. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 4. Compare reality orientation, reminiscence, remotivation, resocialization, and validation techniques. Chapter page reference: 364 Heading: Resocialization Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Cognition Difficulty: Easy
1
2 3 4
Feedback Mildly confused residents do very well in socially oriented groups. Often, social skills have not declined at the same rate as cognitive skills, and the older adult can experience success in interpersonal interactions in social situations that build self-esteem. A group focused on rewarding social skills is inappropriate for depressed residents. A group focused on rewarding social skills is inappropriate for residents with chronic mental illness. A resocialization group may be appropriate for residents who are new to the facility but often groups are more appropriate for residents who are familiar with the routine, staff, and other residents.
PTS: 1 CON: Cognition 39. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 4. Compare reality orientation, reminiscence, remotivation, resocialization, and validation techniques. Chapter page reference: 364 Heading: Validation Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition Difficulty: Easy
1 2 3
4
Feedback Validation does not deal with feelings and reality orientation does not address problem solving. Validation is not a “feel good” approach for the caregiver. Reality orientation is not used to help the resident feel better. Validation groups and reality orientation groups are often seen as opposing ways to address confusion in older adults. Reality orientation attempts to reorient residents to the environment. Validation groups work to help residents express feelings and work through resolution of feelings without reality as a criterion. Validation does not cause the older adult to express feelings of anger and resentment. Reality orientation is not used to place feelings into the reality of today.
PTS: 1 CON: Cognition 40. ANS: 2 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 4. Compare reality orientation, reminiscence, remotivation, resocialization, and validation techniques. Chapter page reference: 363 Heading: Reminiscence Integrated Processes: Nursing Process: Implementation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The life review process is not done to test long-term memory. 2 A very structured form of reminiscence is the life review process. This process provides an opportunity for evaluation and integration of life experiences. 3 The life review process is not done to encourage communication. 4 The life review process is not done to validate short-term memory. PTS: 1 CON: Cognition 41. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 4. Compare reality orientation, reminiscence, remotivation, resocialization, and validation techniques. Chapter page reference: 363 Heading: Remotivation Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 In remotivation the focus is on factual information. 2 Feelings are not explored during remotivation. 3 Thoughts are not the focus during remotivation. 4 Impressions are not the focus during remotivation. PTS: 1 CON: Cognition 42. ANS: 4 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 5. Select important information about psychological medications to include in teaching. Chapter page reference: 365 Heading: Psychotropic Medications Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Cognition Difficulty: Easy Feedback 1 Psychotropic medications are not used for chemical restraint. 2 Psychotropic medications are not to be used to manage problematic behaviors. 3 Psychotropic medications are used for psychological problems. 4 Psychotropic medications are very effective in treating hallucinations, paranoia, and self-injuring behaviors associated with dementia. A pronounced side effect of
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
psychotropic medications is sedation. PTS: 1 CON: Cognition 43. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 5. Select important information about psychological medications to include in teaching. Chapter page reference: 365 Heading: Psychotropic Medications Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Cognition Difficulty: Easy Feedback 1 Drowsiness is a disadvantage of using psychotropic medications. 2 Potential toxicity is a disadvantage of using psychotropic medications. 3 Changing the levels of chemicals in the brain is the major function of psychotropic medications. 4 Length of time to achieve therapeutic levels is a disadvantage of using psychotropic medications. PTS: 1 CON: Cognition 44. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 5. Select important information about psychological medications to include in teaching. Chapter page reference: 365 Heading: Psychotropic Medications Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 Respiratory status is important to monitor on all residents but is usually not affected by psychotropic medications. 2 Pulse rate and rhythm is important to monitor on all residents but is usually not affected by psychotropic medications. 3 A resident’s blood pressure often decreases when he or she changes positions after being started on a psychotropic medication. 4 Therapeutic blood levels are not drawn until approximately 1 month after starting the medication. PTS: 1 CON: Cognition 45. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 5. Select important information about psychological medications to include in teaching. Chapter page reference: 365 Heading: Psychotropic Medications Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Cognition Difficulty: Moderate Feedback 1 Orthostatic hypotension is a serious side effect of psychotropic medications and increases an older adult’s fall risk. 2 Overdosing could potentially increase an older adult’s fall risk but when the medication has just been started it is most likely that the fall is related to orthostatic hypotension. 3 Interacting with other medications could potentially increase an older adult’s fall risk but when the medication has just been started it is most likely that the fall is related to orthostatic hypotension. 4 Relaxation of paranoid tendencies would not cause falls or increase fall risk. PTS: 1 CON: Cognition 46. ANS: 3 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 5. Select important information about psychological medications to include in teaching. Chapter page reference: 365 Heading: Psychotropic Medications Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The nurse cannot suggest an increase in dosage. This is beyond the nurse’s scope of practice. 2 The medication has been prescribed for a reason. The nurse needs to encourage the patient to continue taking it. 3 Many psychotropic drugs require time—sometimes several weeks—before a therapeutic effect is achieved. This waiting period may be longer for some older people. 4 There is no evidence to support hospitalization if psychotropic medication is discontinued. PTS: 1 CON: Cognition 47. ANS: 1 Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 5. Select important information about psychological medications to include in teaching. Chapter page reference: 365
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Psychotropic Medications Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 Older people may show more signs of toxicity at lower-than-usual doses because their ability to excrete the drug is impaired, resulting in a buildup of the drug in the bloodstream. 2 Drug toxicity does not occur because of an incorrectly prescribed medication. 3 Older people may show signs of toxicity at lower than usual doses, not too high of a dose. 4 Drug toxicity is not expected and does not mean that the drug is working. PTS: 1
CON: Cognition
MULTIPLE RESPONSE 48. ANS: 2, 3, 4, 5 Feedback 1. Family visiting would not be a finding that suggests that the patient is at risk for depression. 2. Grieving is a risk factor for depression. 3. Alcohol use is a risk factor for depression. 4. A change in environment is a risk factor for depression. 5. Loss of independence is a risk factor for depression. Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 1. Recognize three behaviors that may signal the presence of a psychological problem in an older adult. Chapter page reference: 357 Heading: Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Mood Difficulty: Moderate PTS: 1 49. ANS: 3, 5 1. 2. 3. 4. 5.
CON: Mood Feedback Empathy is showing genuine interest and concern, maintaining eye contact, listening closely, and showing respect. Calling someone “dearie” does not indicate sympathy. “Dearie” is a demeaning, patronizing way to address an older adult. Regardless of the nurse’s comfort level the patient should not be called “dearie.” Patronizing an older adult hinders effective communication.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 350 Heading: Empathy and Genuineness Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy PTS: 1 CON: Communication 50. ANS: 1, 2, 4, 5 Feedback 1. To improve hearing the nurse should speak in a normal tone. 2. To improve hearing the nurse should move closer to the patient. 3. To improve hearing the nurse should not shout into the patient’s ear. 4. To improve hearing the nurse should stand in front of the patient. 5. To improve hearing the nurse should avoid standing in a bright light in case the patient is lip reading. Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 2. Explain how to use nursing interventions for older adults with common psychological problems. Chapter page reference: 351 Heading: Listening Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Communication Difficulty: Moderate PTS: 1 CON: Communication 51. ANS: 1, 2, 3 Feedback 1. Some people show signs of increasing irritability before a severe problem occurs. Others may have sudden, explosive outbursts. Notice if someone is pacing more or faster. 2. Some people show signs of increasing irritability before a severe problem occurs. Others may have sudden, explosive outbursts. Notice if someone is talking very loudly. 3. Some people show signs of increasing irritability before a severe problem occurs. Others may have sudden, explosive outbursts. Notice if someone is making threatening comments to staff or others. 4. Crying in a dark room can indicate depression. 5. Stating bugs are on the wall are hallucinations. Chapter number and title: Chapter 19: Common Clinical Problems: Psychological
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 354 Heading: Agitation Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Stress Difficulty: Easy PTS: 1 CON: Stress 52. ANS: 1, 4, 5 Feedback 1. Family members should be encouraged to provide a stress-free environment for the older adult. 2. Turning on the television could be too much stimulation for the patient. 3. Engaging in conversation could be too much stimulation for the patient. 4. Family members should be encouraged to limit the number of visitors during an episode of delirium. 5. Family members should be encouraged to maintain a quiet environment. Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 3. Manage difficult behaviors of older adults. Chapter page reference: 359 Heading: Delirium Integrated Processes: Teaching/Learning Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Cognition Difficulty: Easy PTS: 1 53. ANS: 3, 5 1. 2. 3. 4. 5.
CON: Cognition Feedback Stimulating memories of childhood or adulthood in an older person is not done to test longterm memory. Stimulating memories of childhood or adulthood in an older person is not done to solidify cognitive skills. Stimulating memories of childhood or early adulthood can serve to improve feelings of selfworth. Stimulating memories of childhood or early adulthood is not done to validate thinking rationally. Stimulating memories of childhood or early adulthood provides an opportunity to review their lives.
Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 4. Compare reality orientation, reminiscence, remotivation, resocialization, and validation techniques.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 363 Heading: Reminiscence Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition; Stress Difficulty: Easy PTS: 1 CON: Cognition | Stress 54. ANS: 1, 4, 5 Feedback 1. Recalling early school days promotes socialization. 2. Recalling early school days does not validate educational level. 3. Recalling early school days does not assess calculation ability. 4. Recalling early school days encourages communication. 5. Recalling early school days provides mental stimulation. Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 4. Compare reality orientation, reminiscence, remotivation, resocialization, and validation techniques. Chapter page reference: 363 Heading: Reminiscence Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Cognition; Stress Difficulty: Easy PTS: 1 CON: Cognition | Stress 55. ANS: 2, 3, 4, 5 Feedback 1. Medication teaching does not include fluid intake. 2. Teaching the older person and his or her family about side effects is very important when psychotropic drugs are used. 3. Teaching the older person and his or her family about toxic effects is very important when psychotropic drugs are used. 4. Teaching the older person and his or her family what to do if a dose is missed is very important when psychotropic drugs are used. 5. Teaching the older person and his or her family about the reason for the medication is very important when psychotropic drugs are used. Chapter number and title: Chapter 19: Common Clinical Problems: Psychological Chapter/learning objective: 5. Select important information about psychological medications to include in teaching. Chapter page reference: 365 Heading: Psychotropic Medications Integrated Processes: Teaching/Learning
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Cognition Difficulty: Moderate PTS: 1
CON: Cognition
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 20: Rehabilitation and Restorative Care Multiple Choice Identify the choice that best completes the statement or answers the question. 1. What is the goal of restorative care? 1) Maintaining baseline function 2) Basing care on the age of a long-term care resident 3) Maximizing the abilities and functions of older adults 4) Providing the same care for all residents with a specific medical diagnosis
2. Which statement is true? 1) Restorative care is fast-paced. 2) Restorative care provides intensive short-term strengthening and retraining. 3) Rehabilitation continues the process of strengthening and retraining over time. 4) Restorative care begins after the rehabilitation goals are reached and the patient is at a plateau.
3. Which statement best describes the practice role of the nurse in restorative care? 1) Provide care to avoid serious injury or disability. 2) Provide care until the resident is discharged to home. 3) Provide care to support adjustment to the disease process. 4) Provide care to support the development of self-care abilities.
4. Which statement best describes the educator role of the nurse in restorative care? 1) Teach the resident and family the importance of rehabilitation. 2) Teach the resident and family about the importance of activity after being disabled. 3) Teach the resident and family about the disease process, treatment options, and management strategies. 4) Teach the resident and family what they need to know to make choices and be involved in the restorative process.
5. Which statement best describes the counselor role of the nurse in restorative care? 1) Counseling residents and their families is an important role for the interdisciplinary team. 2) Counseling residents and their families is not within the usual scope of practical nursing practice. 3) Counseling residents and their families is aimed at assisting them with valuing the care they receive. 4) Counseling residents and their families is aimed at assisting them with expressing their feelings and developing positive strategies to express their feelings.
6. Which statement best describes the advocate role of the nurse in restorative care? 1) As an advocate, the practical nurse develops an adversarial role with the interdisciplinary
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
team. 2) As an advocate, the practical nurse intervenes when family members do not support the plan of care. 3) As an advocate, the practical nurse confronts the interdisciplinary team when their goals do not address their advocacy role. 4) As an advocate, the practical nurse uses his or her power and influence to promote an environment that supports the goals of restorative care.
7. What would NOT be included as part of the licensed practical nurse’s (LPN’s) role in research? 1) Designing the research methodology for the project 2) Answering questions asked by the patient and family members 3) Gathering data under the direction of the registered nurse (RN) researcher 4) Interviewing older persons to determine if they qualify for the research project
8. An older retired teacher is being admitted for rehabilitation after sustaining a pelvic fracture while riding a motorcycle. Which existing health problems would not be essential to consider when creating this patient’s rehabilitation plan? 1) Diabetes, arthritis, asthma 2) Diabetes, benign prostatic hypertrophy 3) Poor peripheral vision, arthritis, asthma 4) Hypertension, osteoporosis, hearing loss
9. Which statement describes a strength of a resident for restorative care? 1) The resident coughs when eating. 2) The resident verbalizes complaints of pain. 3) The resident cannot communicate verbally. 4) The resident has fallen when attempting to ambulate to the toilet.
10. An older patient recovering from a myocardial infarction is taking the loss of independence and self-care ability well. Which statement addresses this assessment? 1) The patient is probably just thankful to be alive. 2) The patient has probably withdrawn and is depressed. 3) The patient must be in the denial phase of grieving a loss. 4) The patient is demonstrating the concept that loss and its meaning vary with individuals.
11. Which rehabilitation principle should guide the rehabilitation of an older patient recovering from a stroke? 1) Loss and its meaning vary with every person. 2) Convalescence is a gradual process that can take a long time. 3) Values are examined and limitations are put in perspective over time. 4) The duration of rehabilitation depends on the psychological acceptance of the older adult’s condition.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
12. An older patient with end-stage emphysema refuses physical therapy, continues to smoke, and realizes that death will probably result from emphysema. Which rehabilitation principle should guide this patient’s rehabilitation? 1) Loss and its meaning vary with every person. 2) Convalescence is a gradual process that can take a long time. 3) Values are examined and limitations are put into perspective over time. 4) The duration of rehabilitation depends on the psychological acceptance of the older adult of his or her condition.
13. An older patient has been diagnosed with situational depression after having a leg amputated from severe peripheral vascular disease related to diabetes mellitus. Which rehabilitation principle should guide this patient’s rehabilitation? 1) Loss and its meaning vary with every person. 2) Convalescence is a gradual process that can take a long time. 3) More severe emotional reactions are produced when the disability is traumatic. 4) The duration of rehabilitation depends on the psychological acceptance of the older adult of his or her condition.
14. An older patient has a reputation of being a “difficult resident.” Which rehabilitation principle should guide this patient’s rehabilitation? 1) Loss and its meaning vary with every person. 2) More severe emotional reactions are produced when the disability is traumatic. 3) The duration of rehabilitation depends on the psychological acceptance of the older adult of his or her condition. 4) Personality problems are generally related to personality characteristics of the older person before he or she was disabled.
15. Which is a rehabilitation goal for an older adult? 1) The resident will reach full rehabilitation potential in the next 30 days. 2) The resident will not have any setbacks during the rehabilitation period. 3) The resident will have no signs of skin breakdown through the long-term care stay. 4) The resident will allow therapy staff to design his or her rehabilitation program.
16. Which area is NOT a part of the database when developing goals for an older patient’s rehabilitative and restorative care? 1) Family status 2) Physical status 3) Functional status 4) Psychological status
17. Which statement LEAST describes passive range of motion? 1) A method of preventing deformities 2) A form of exercise that the patient must do unassisted
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) A method of preventing increased limitation of activity 4) A method of assisting an individual to resume independence of function
18. A stroke has affected an older patient’s ability to move and ambulate. Which intervention should be part of this patient’s plan of care? 1) Perform passive range of motion to all joints. 2) Encourage weight-lifting exercises to increase strength. 3) Encourage ambulation without assistance to determine walking ability. 4) Encourage transferring without assistance to determine ability to transfer.
19. An older patient is admitted to a long-term care facility with pressure ulcers on the coccyx and both hips. Which intervention would be LEAST likely to be supportive for this patient? 1) Hourly turning and repositioning program 2) Bedrest with dressing changes twice a day 3) Toileting program to reduce incontinent episodes 4) Assisted active range of motion and assisted ambulation
20. An older patient is prescribed bedrest for 2 weeks to aid in the healing of a fractured ankle. What is an appropriate rehabilitation intervention for this patient? 1) Use a walker to teach standing on one foot. 2) Transfer from wheelchair to toilet for activity. 3) Use a Hoyer lift to transfer to the tub for bathing. 4) Perform active range-of-motion and weight-lifting exercises in bed.
21. An older patient recovering from a fractured hip and wrist is motivated to stay active and is eager to attend rehabilitation sessions. The patient informs family and friends when to visit so as not to interfere with rehabilitation. What has influenced this patient’s motivation and desire for rehabilitation? 1) Positive self-esteem and self-image 2) Pain medication altering perception of the environment 3) Advanced age, which motivates her to make each day special 4) Family expectation for the patient to recover and return home
22. An older patient, widowed for 5 years, is morbidly obese and was admitted to a facility for complications related to weight. What would NOT be a component of this patient’s rehabilitation plan? 1) Exercise program 2) Reduced calorie intake 3) Diet and exercise education 4) Review of health complications of obesity
23. Which behavior supports the goals of rehabilitative and restorative care when caring for an older patient? 1) Lifting a patient with a weak left leg from the bed to a chair 2) Bathing an older patient in bed instead of showering as prescribed
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Encouraging a patient recovering from a stroke to put on own shirt 4) Transporting a patient with end stage renal failure to the dining room in a wheelchair
24. The nurse is creating an education plan for an older patient’s rehabilitation. What should the nurse include as the focus of this plan? 1) Health measures to obtain and retain function 2) Strategies to solve and cope effectively with problems 3) Influence and power to bring about necessary changes 4) Resolution of actual problems and prevention of potential problems
25. For which role should the nurse expect to provide an older patient with a contract regarding rehabilitative and restorative care? 1) Educator 2) Researcher 3) Case manager 4) Bedside caregiver
26. What can the nurse use to help understand the changes that an older patient recovering from a stroke is experiencing related to loss of function and independence? 1) Stages of grief 2) Gerotranscendence 3) Levels of disorientation 4) Erikson’s developmental stages
27. The nurse notes than an older person has difficulty walking stairs. What type of change is this patient experiencing? 1) Functional 2) Instrumental 3) Psychological 4) Socioeconomic
28. An older patient has an indwelling urinary catheter for several days after hip replacement surgery. Which would NOT be a part of this patient’s bladder training program? 1) Teach how to use a urinal. 2) Increase fluid intake up to 2,000 mL/day. 3) Reinsert the catheter if unable to void in 8 hours. 4) Straight catheterize the bladder after voiding to assess for residual urine.
29. An older patient is diagnosed with a fecal impaction. Which would NOT be part of this patient’s restorative care program? 1) Increase dietary fiber. 2) Increase fluid intake to 1,500 mL/day.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Ambulate to the bathroom after meals. 4) Administer Fleet’s enema every other day to ensure bowel evacuation.
30. An older patient with Parkinson’s disease was receiving enteral tube feedings which have been discontinued. What should NOT be included in this patient’s feeding program? 1) Supplementing meals with snacks 2) Instructing the spouse on how to feed the patient 3) Setting up the meal tray and encouraging self-feeding 4) Staff feeding and encouraging the patient to self-feed finger foods
31. Which health-care professional should be consulted for devices to help an older person perform self-care activities? 1) Social worker 2) Case manager 3) Physical therapist 4) Occupational therapist
32. During a home visit, the nurse notes that an older person with weakness is having difficulty bathing. What should the nurse suggest to improve this patient’s independence with self-care? 1) Grab bars 2) Throw rugs 3) Shower chair 4) Elevated commode seat
33. An older person with a spinal cord injury is being discharged to home. What should the nurse suggest to improve this person’s ability to perform self-care? 1) Apply a lift sheet to the bed. 2) Use leg braces as prescribed. 3) Lower the sinks, counters, and mirrors. 4) Place a donut on the seat of the wheelchair.
34. A patient with spinal rods is having difficulty putting on shoes. What should the nurse suggest to improve this patient’s self-care abilities? 1) Wear bedroom slippers. 2) Use a long-handled shoehorn. 3) Wear shoes without backs. 4) Have family help with the shoes.
35. An older patient receiving daily stool softeners has not had a bowel movement for a week. What should be considered to help this patient? 1) An enema 2) A laxative
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Increased oral fluids 4) Additional stool softeners
Multiple Response Identify one or more choices that best complete the statement or answer the question. 36. Which caregivers are members of the rehabilitative care team? Select all that apply. 1) Pharmacists, hospice nurses 2) Nurses, social workers, dietitians 3) Dietary aides, environmental service workers 4) Psychologists, respiratory therapists, physicians 5) Physical therapists, occupational therapists, speech therapists
37. Which factors might limit rehabilitative care? Select all that apply. 1) Environmental safety 2) Personal value system 3) Insurance reimbursement 4) Insufficient family support 5) Access to the rehabilitation team
38. What must be included when designing goals for an older patient receiving rehabilitative and restorative care? Select all that apply. 1) Mobility 2) Living with a disability 3) Involvement in activities 4) Financial needs being met 5) Independence and self-care
39. An older patient is experiencing musculoskeletal changes that are affecting the rehabilitation and restorative program of care. What changes should the nurse keep in mind when caring for this patient? Select all that apply. 1) Muscle atrophy 2) Decreased bone mass 3) Subcutaneous fat loss 4) Thickened heart valves 5) Decreased joint flexibility
40. What sociological data should the nurse collect when conducting a holistic assessment of an older patient beginning a rehabilitative and restorative program? Select all that apply. 1) Judgment 2) Family support 3) Thinking ability 4) Interaction with others
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
5) Community involvement 41. Which actions support an older patient’s psychosocial and spiritual well-being? Select all that apply. 1) Providing uninterrupted time to pray 2) Supporting visits from the family pastor 3) Asking if God would permit bad things to happen 4) Reminding the patient that personal reflection is a waste of time 5) Encouraging placement of religious items in the room
42. An older patient is being instructed on a walking program. What should the nurse emphasize as important to maintaining this program? Select all that apply. 1) Daily foot care 2) Dietary roughage 3) Properly fitted shoes 4) Toileting every 2 hours 5) Adequate caloric intake
43. An older patient is fitted with leg braces to be worn at all times. What should the nurse explain is the purpose of these braces? Select all that apply. 1) Correct deformities. 2) Prevent deformities. 3) Provide locomotion. 4) Support body weight. 5) Limit involuntary movements.
44. An older patient will be using crutches for safe ambulation. Which muscle groups need to be strengthened before using these devices? Select all that apply. 1) Back 2) Arms 3) Neck 4) Chest 5) Shoulders
45. Why should the use of an indwelling urinary catheter be avoided when conducting bladder retraining for an older patient? Select all that apply. 1) Lowers self-esteem 2) Lowers self-concept 3) Reduces ambulation 4) Promotes bowel constipation 5) Encourages the development of urinary tract infections
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 20: Rehabilitation and Restorative Care Answer Section MULTIPLE CHOICE 1. ANS: 3 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 371 Heading: Understanding Rehabilitation and Restorative Concepts Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 This does not address the holistic approach of restorative care. 2 Restorative care is not based on the age of the resident. 3 Restorative care is the essence of rehabilitation of functional abilities. 4 Restorative care is not based on medical diagnosis.
PTS: 1
CON: Promoting Health
2. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 371 Heading: Understanding Rehabilitation and Restorative Concepts Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 Speed is not the goal in rehabilitation or restorative care. 2 This is the definition of rehabilitation. 3 This is part of the definition of restorative care. 4 Restorative care begins after the rehabilitation goals are reached and the patient is at a plateau.
PTS: 1
CON: Promoting Health
3. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 372 Heading: Nursing Roles Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Nursing Roles Difficulty: Easy Feedback 1 This describes nursing care but does not address the focus of rehabilitation. 2 This describes nursing care but does not address the focus of rehabilitation. 3 This describes nursing care but does not address the focus of rehabilitation. 4 Restorative care is focused on supporting the resident’s ability to perform self-care.
PTS: 1
CON: Nursing Roles
4. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 372 Heading: Educator Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Nursing Roles Difficulty: Easy Feedback 1 This is an accurate description of the content of teaching plans but does not address the specific goals for teaching the resident and family as part of the restorative care process. 2 This is an accurate description of the content of teaching plans but does not address the specific goals for teaching the resident and family as part of the restorative care process. 3 This is an accurate description of the content of teaching plans but does not address the specific goals for teaching the resident and family as part of the restorative care process. 4 Teaching in the restorative process is directed at facilitating the ability of the resident and family to make informed decisions and assist with the planning of care.
PTS: 1
CON: Nursing Roles
5. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 373
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Counselor Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Nursing Roles Difficulty: Easy Feedback 1 This does not address the counseling role of the practical nurse. 2 The practical nurse counsels residents and families to express feelings and develop positive coping skills after developing trust and rapport with the resident and family. 3 The goal of counseling is not to assist residents to value the care they receive but rather to provide an opportunity to assist them in dealing with their feelings. 4 Counseling residents and their families has the goal of assisting them with developing positive ways to express their feelings and of coping with their disability.
PTS: 1
CON: Nursing Roles
6. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 373 Heading: Advocacy Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Nursing Roles Difficulty: Easy Feedback 1 If the nurse becomes an adversary of the interdisciplinary team, the nurse is not acting in the resident’s best interest. 2 This is an example of advocacy but is too narrow to describe the advocacy of practical nurses. 3 This is an example of advocacy but is too narrow to describe the advocacy of practical nurses. 4 The practical nurse supports the attainment of the restorative care goals through encouraging the change in attitudes, care skills, and environment that would promote restorative care.
PTS: 1
CON: Nursing Roles
7. ANS: 1 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 373 Heading: Researcher Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Nursing Roles Difficulty: Easy Feedback 1 The RN serves as the principal investigator, which means designing the research, writing a proposal for funding, and ensuring the integrity of the research being done. 2 The LPN answers questions. 3 The LPN gathers data. 4 The LPN assists with the interviewing of participants.
PTS: 1
CON: Nursing Roles
8. ANS: 2 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 374 Heading: Physical Changes Affecting Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Collaboration Difficulty: Moderate Feedback 1 Musculoskeletal concerns and respiratory problems would be of the most concern. 2 Diabetes and benign prostatic hypertrophy would have the least effect on the patient’s rehabilitation plan. 3 Musculoskeletal concerns, respiratory problems, and perception changes would be of the most concern. 4 Musculoskeletal concerns, cardiovascular problems, and perception changes would be of the most concern.
PTS: 1
CON: Collaboration
9. ANS: 2 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 374 Heading: Goals of Rehabilitation and Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 Residents who cough while eating are often exhibiting signs of aspiration.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
If the resident can verbalize complaints of pain, this can work as an asset to involving the resident in his or her care. Lack of verbal communication limits the resident’s involvement in the care process. Residents who have fallen often require restorative care with goals aimed at decreasing fall risks.
PTS: 1
CON: Promoting Health
10. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 376 Heading: Developing Goals for Rehabilitation and Restorative Care Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 Believing that the patient is simply thankful to be alive is a trivial way to express acceptance. 2 The patient is not demonstrating signs of depression. 3 The patient is not demonstrating denial caused by a loss. 4 Older adults are a diverse group of individuals. The adjustment to disability or loss of independence is affected by the older adult’s life experiences, previous coping mechanisms, values and beliefs, and social support system.
PTS: 1
CON: Promoting Health
11. ANS: 2 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 377 Heading: Developing Goals for Rehabilitation and Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 This is a principle of rehabilitation but does not address rehabilitation as a slow process. 2 Convalescence is often a slow process, with older adults demonstrating small improvements over time. Older adults, families, and health-care workers can often become frustrated with the slowness of the process. 3 This is a principle of rehabilitation but does not address rehabilitation as a slow process.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
This is a principle of rehabilitation but does not address rehabilitation as a slow process.
PTS: 1
CON: Promoting Health
12. ANS: 3 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 377 Heading: Developing Goals for Rehabilitation and Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 This does not address the patient’s conscious choice to continue to smoke as an expression of values and beliefs. 2 This does not address the patient’s conscious choice to continue to smoke as an expression of values and beliefs. 3 The patient’s desire to continue smoking and acceptance of the consequences is an expression of values and beliefs about health and quality-of-life choices. 4 This does not address the patient’s conscious choice to continue to smoke as an expression of values and beliefs.
PTS: 1
CON: Promoting Health
13. ANS: 3 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 377 Heading: Developing Goals for Rehabilitation and Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 This is a principle of rehabilitation but the patient’s depression is most likely explained by the traumatic nature of the disability. 2 This is a principle of rehabilitation but the patient’s depression is most likely explained by the traumatic nature of the disability. 3 The loss of a limb is a very disfiguring and traumatic event. There is a connection between traumatic disability and an increased emotional reaction during rehabilitation. 4 This is a principle of rehabilitation but the patient’s depression is most likely explained by the traumatic nature of the disability.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Promoting Health
14. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 377 Heading: Developing Goals for Rehabilitation and Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 The patient does not seem to be having difficulty accepting loss. 2 The patient does not seem to be having a severe emotional reaction to the functional limitations. 3 The patient does not seem to be denying the disability. 4 An older adult’s personality characteristics and traits do not change with aging but sometimes seem to intensify.
PTS: 1
CON: Promoting Health
15. ANS: 3 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 376 Heading: Developing Goals for Rehabilitation and Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 Rehabilitation is not a short-term process and is often continued throughout the life of an older adult with a chronic disease or disability. 2 It is inappropriate to expect that an older adult will not experience setbacks through the rehabilitation process. 3 Maintaining skin integrity is a goal for rehabilitation. 4 Rehabilitation and restorative care require active participation of the older adult and his or her family. Exclusion of the older adult in planning the rehabilitation program is inappropriate.
PTS: 1 16. ANS: 1
CON: Promoting Health
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 376 Heading: Developing Goals for Rehabilitation and Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 Family status plays a part in psychological status. 2 Physical status is an area in which changes must be noted. 3 Functional status is an area in which changes must be noted. 4 Psychological status is an area in which changes must be noted.
PTS: 1
CON: Promoting Health
17. ANS: 2 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 377 Heading: Implementation of Goals in Rehabilitation and Restorative Care Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Mobility Difficulty: Easy Feedback 1 Passive range of motion helps prevent deformities. 2 Passive range of motion generally requires that another person, usually the nurse or therapist, takes responsibility for the exercise program. 3 Passive range of motion is a method of preventing increased limitation of activity. 4 Passive range of motion is a method of assisting an individual to resume independence of function.
PTS: 1
CON: Mobility
18. ANS: 2 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 380 Heading: Improvement of Function Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Mobility Difficulty: Moderate Feedback 1 Passive range of motion does not encourage active participation in the rehabilitation plan of care. 2 Performing weight-lifting exercises is the most appropriate intervention. 3 Ambulating without assistance could increase this patient’s risk of falling. 4 Transferring without assistance could increase this patient’s risk of falling.
PTS: 1
CON: Mobility
19. ANS: 2 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 380 Heading: Improvement of Function Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Skin Integrity Difficulty: Moderate Feedback 1 Hourly turning and repositioning should be a part of this patient’s rehabilitation plan. 2 Bedrest would enhance the negative outcomes of immobility. 3 A toileting program should be a part of this patient’s rehabilitation plan. 4 Assisted active range of motion and assisted ambulation should be a part of this patient’s rehabilitation plan.
PTS: 1
CON: Skin Integrity
20. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 381 Heading: Delay of Deterioration Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Mobility Difficulty: Moderate Feedback 1 The patient is prescribed bedrest; using a walker would not be appropriate. 2 The patient is prescribed bedrest; transferring from wheelchair to toilet would not be appropriate. 3 The patient is prescribed bedrest; using a Hoyer lift to transfer to the tub would not be
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
appropriate. An older adult who is ordered to be on bedrest has treatment-induced immobility. All nursing interventions should be aimed at preventing the negative effects of immobility. Range of motion and weight lifting in bed can help to maintain joint flexibility and muscle strength.
PTS: 1
CON: Mobility
21. ANS: 1 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 375 Heading: Psychological Changes Affecting Rehabilitative and Restorative Care Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Self Difficulty: Moderate Feedback 1 A high degree of personal motivation most likely comes from feeling needed and wanted by all those around her, boosting self-esteem and self-image. 2 There is no way of knowing if the patient’s pain medication is altering her motivation. 3 There is no way of knowing how the patient feels about advancing age. 4 There is no way of knowing the family’s influence on her motivation to recover.
PTS: 1
CON: Self
22. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 376 Heading: Psychological Changes Affecting Rehabilitative and Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Self Difficulty: Moderate Feedback 1 An exercise program would be a component of this patient’s rehabilitation plan. 2 Reduced calorie intake would be a component of this patient’s rehabilitation plan. 3 Diet and exercise education would be a component of this patient’s rehabilitation plan. 4 The patient is aware of the complications of obesity. The staff must be very encouraging and supportive so that the patient can gain trust in sharing fears and concerns with the staff. Self-image and self-esteem will increase by positive reinforcement for weight loss, increased activity tolerance, and strength.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Self
23. ANS: 3 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 370 Heading: Understanding Rehabilitation and Restorative Concepts Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Analysis [Analyzing] Concept: Promoting Health Difficulty: Moderate Feedback 1 With rehabilitative and restorative nursing care, “faster” is not the goal. 2 With rehabilitative and restorative nursing care, “faster” is not the goal. 3 The older person deserves the right to feel the satisfaction of accomplishing a task or meeting a personal goal. 4 With rehabilitative and restorative nursing care, “faster” is not the goal.
PTS: 1
CON: Promoting Health
24. ANS: 1 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 372 Heading: Educator Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Included in the education plan should be health measures to obtain and retain function. 2 Strategies to solve and cope effectively with problems are a part of counseling. 3 When assuming the role of advocate, LPNs use their influence and power as health-care professionals to bring about necessary changes for the older person and the family’s well-being. 4 The major focus for a case manager is to resolve actual problems and prevent potential problems for the aging person.
PTS: 1
CON: Promoting Health
25. ANS: 3 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 373 Heading: Case Manager Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 The educator does not use a contract. 2 The researcher does not use a contract. 3 Once the treatment plan is agreed on, a contract is entered into by the individual, family members, and nurse. This contract allows the plan to be implemented with clear communication with each person involved. 4 The bedside caregiver does not use a contract.
PTS: 1
CON: Promoting Health | Nursing Roles
26. ANS: 1 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 373 Heading: Point of Interest Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate Feedback 1 Kübler-Ross’s five stages of grief can be used to understand the feelings associated with loss of function and independence. 2 Gerotranscendence would not be helpful in understanding the patient’s sense of loss of function and independence. 3 The patient is not demonstrating disorientation. 4 Erikson’s developmental stages would not be helpful in understanding the patient’s feelings of loss of function and independence.
PTS: 1
CON: Grief and Loss
27. ANS: 1 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 375 Heading: Functional Changes Affecting Rehabilitative and Restorative Care Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Mobility Difficulty: Easy Feedback 1 Inability to negotiate stairs in the home is a functional change that affects rehabilitative and restorative care. 2 Inability to negotiate stairs in the home is not an instrumental change. 3 Inability to negotiate stairs in the home is not a psychological change. 4 Inability to negotiate stairs in the home is not a socioeconomic change.
PTS: 1
CON: Mobility
28. ANS: 3 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs. Chapter page reference: 384 Heading: Continence Training Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Urinary Elimination Difficulty: Moderate Feedback 1 Teaching the older adult how to use a urinal is part of a bladder training program. 2 The importance of a good fluid intake to promote urinary function is part of a bladder training program. 3 Reinserting the indwelling catheter is not part of a bladder training program. 4 Straight catheterization for residual volume of urine after voiding is part of the evaluation of bladder function.
PTS: 1
CON: Urinary Elimination
29. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs. Chapter page reference: 384 Heading: Continence Training Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Bowel Elimination Difficulty: Moderate Feedback 1 Enemas are used to promote bowel function only if the older adult does not have full control of the voluntary muscles used to evacuate the bowel. Stool softeners and
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2 3 4
suppositories are the laxative methods of choice because they promote normal bowel evacuation. Increasing dietary fiber promotes bowel function. Increasing fluid intake promote bowel function. Walking to the bathroom is a way to increase activity to promote bowel function.
PTS: 1
CON: Bowel Elimination
30. ANS: 3 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs. Chapter page reference: 384 Heading: Feeding and Self-Feeding Programs Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 This promotes the patient’s nutritional status. 2 This promotes active participation in the patient’s care. 3 The patient has Parkinson’s disease and has probably lost the strength and movement necessary to self-feed. Although it is desirable to involve the patient in the feeding program, it would be inappropriate to set a meal tray in front of the patient and expect self-feeding to occur. 4 This promotes the patient’s return to self-feeding activities.
PTS: 1
CON: Nutrition
31. ANS: 4 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs. Chapter page reference: 384 Heading: Self-Promoting Behaviors and Activities of Daily Living Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy Feedback 1 The social worker helps with resources and psychosocial issues. 2 The case manager coordinates the patient’s care. 3 The physical therapist helps with mobility and strengthening to improve function. 4 Occupational therapists can provide assistive equipment that makes self-care easier.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Promoting Health
32. ANS: 3 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs. Chapter page reference: 384 Heading: Self-Promoting Behaviors and Activities of Daily Living Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Grab bars would help with safety. 2 Throw rugs should be removed to promote safety in the bathroom. 3 A chair in the tub or shower may allow a weak individual to be able to bathe independently. 4 An elevated commode seat would accommodate the person with difficulty sitting or rising from a sitting position.
PTS: 1
CON: Promoting Health
33. ANS: 3 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs. Chapter page reference: 384 Heading: Self-Promoting Behaviors and Activities of Daily Living Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 A lift sheet would help with moving in bed. 2 Leg braces would help prevent limb deformity. 3 Lowered sinks, counters, and mirrors might allow a wheelchair-bound person to sit up to the sink to wash and perform other personal care. 4 A donut on the wheelchair seat would help prevent skin breakdown.
PTS: 1
CON: Promoting Health
34. ANS: 2 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 384 Heading: Self-Promoting Behaviors and Activities of Daily Living Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Bedroom slippers cannot be worn outside of the home. 2 Long-handled shoehorns allow older people who are unable to bend over to put on their own socks and shoes. 3 Wearing shoes without backs is not safe. 4 Having family help will not promote the patient’s self-care.
PTS: 1
CON: Promoting Health
35. ANS: 1 Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs. Chapter page reference: 384 Heading: Continence Training Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Bowel Elimination Difficulty: Moderate Feedback 1 Enemas should be used only in an emergency. Absence of a bowel movement for a week is an emergency. 2 Laxatives promote normal bowel evacuation, however, this patient has not had a bowel movement for a week. 3 Increasing fluid intake promotes bowel function but will not help with the issue of no bowel movement for a week. 4 Additional stool softeners will not help with the urgency of the situation.
PTS: 1
CON: Bowel Elimination
MULTIPLE RESPONSE 36. ANS: 2, 4, 5 Feedback Hospice nurses and pharmacists are not identified as being members of the rehabilitative care 1. team. 2. Nurses, social workers, and dietitians are members of the rehabilitative care team. 3. Dietary aides and environmental service workers are not identified as being members of the rehabilitative care team.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4. 5.
Psychologists, respiratory therapists, and physicians are members of the rehabilitative care team. Physical therapists, occupational therapists, and speech therapists are members of the rehabilitative care team.
Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 370 Heading: Understanding Rehabilitation and Restorative Concepts Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Collaboration Difficulty: Easy PTS: 1
CON: Collaboration
37. ANS: 1, 3, 4, 5 Feedback 1. Limiting factors often include insufficient environmental safety. 2. Personal values should not prevent access to rehabilitation. 3. Limiting factors often include insufficient insurance reimbursement. 4. Limiting factors often include insufficient family support. 5. Limiting factors often include insufficient access to the rehabilitation team. Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 371 Heading: Understanding Rehabilitation and Restorative Concepts Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Knowledge [Remembering] Concept: Collaboration Difficulty: Easy PTS: 1
CON: Collaboration
38. ANS: 1, 2, 3, 5 Feedback 1. The components of a successful rehabilitation and restorative program must include goals regarding mobility. 2. The components of a successful rehabilitation and restorative program must include goals regarding living with a disability. 3. The components of a successful rehabilitation and restorative program must include goals regarding involvement in activities. 4. The components of a successful rehabilitation and restorative program do not include goals regarding finances.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
5.
The components of a successful rehabilitation and restorative program must include goals regarding independence and self-care.
Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 374 Heading: Goals of Rehabilitation and Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Comprehension [Understanding] Concept: Collaboration Difficulty: Easy PTS: 1
CON: Collaboration
39. ANS: 1, 2, 3, 5 Feedback 1. Musculoskeletal changes can create mobility difficulties. Such situations can occur because of muscle atrophy. 2. Musculoskeletal changes can create mobility difficulties. Such situations can occur because of decreased bone mass. 3. Musculoskeletal changes can create mobility difficulties. Such situations can occur because of loss of subcutaneous fat. 4. Thickened heart valves would affect the patient’s cardiovascular status. Musculoskeletal changes can create mobility difficulties. Such situations can occur because of 5. decreased flexibility of the joints and limbs. Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 374 Heading: Physical Changes Affecting Restorative Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate PTS: 1
CON: Promoting Health
40. ANS: 2, 4, 5 Feedback 1. Judgment is part of the psychological assessment. 2. Family support is part of the sociological assessment. 3. Thinking ability is part of the psychological assessment. 4. Interaction with others is part of the sociological assessment. 5. Community involvement is part of the sociological assessment.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 375 Heading: Focused Learning Chart Integrated Processes: Nursing Process: Assessment Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive level: Application [Applying] Concept: Promoting Health Difficulty: Moderate PTS: 1
CON: Promoting Health
41. ANS: 1, 2, 5 Feedback Interventions that address the psychosocial and spiritual needs of older adults include 1. uninterrupted time to pray. Interventions that address the psychosocial and spiritual needs of older adults include 2. arrangements for visits from the local clergy. Asking questions about God permitting bad things to happen will not support the patient’s 3. spiritual needs. Reminding the patient that personal reflection is a waste of time is a personal opinion that 4. does not support the patient’s psychological or spiritual well-being. Interventions that address the psychosocial and spiritual needs of older adults include allowing 5. religious artifacts in the room. Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 1. Define the concepts of rehabilitation and restorative nursing in a holistic framework. Chapter page reference: 379 Heading: Goal 6: Psychosocial and Spiritual Well-Being Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Promoting Health; Spirituality Difficulty: Moderate PTS: 1
CON: Promoting Health | Spirituality
42. ANS: 1, 3 1. 2. 3. 4. 5.
Feedback Excellent foot care is critical to maintaining a walking program. Roughage helps with bowel function. Properly fitting shoes are important to establish proper posture while walking. Toileting every 2 hours helps with urinary continence. Adequate caloric intake is essential for a re-feeding program.
Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 382 Heading: Walking Programs Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Mobility Difficulty: Moderate PTS: 1
CON: Mobility
43. ANS: 1, 2, 4, 5 Feedback 1. Leg braces are devices that are used to correct deformities. 2. Leg braces are devices that are used to prevent deformities. 3. Leg braces do not have a mechanism for locomotion. 4. Leg braces are devices that are used to support body weight. 5. Leg braces are devices that are used to limit involuntary movements. Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs. Chapter page reference: 383 Heading: Walking Programs Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Mobility Difficulty: Moderate PTS: 1
CON: Mobility
44. ANS: 1, 2, 4, 5 Feedback 1. Strengthening exercises should be provided while the person is still confined to bed. These exercises include the muscles of the back. 2. Strengthening exercises should be provided while the person is still confined to bed. These exercises include the muscles of the arms. 3. Neck muscles are not used to ambulate with crutches. Strengthening exercises should be provided while the person is still confined to bed. These 4. exercises include the muscles of the chest. Strengthening exercises should be provided while the person is still confined to bed. These 5. exercises include the muscles of the shoulders. Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs. Chapter page reference: 383 Heading: Walking Programs Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Application [Applying] Concept: Mobility Difficulty: Moderate PTS: 1
CON: Mobility
45. ANS: 1, 2, 5 Feedback 1. Catheter insertion lowers the self-esteem of the person trying to regain control of bladder function. 2. Catheter insertion lowers the self-concept of the person trying to regain control of bladder function. 3. Catheter insertion does not affect ambulation. 4. Catheter insertion does not impact bowel function. 5. Urinary infection can result within 24 hours of catheter insertion. Chapter number and title: Chapter 20: Rehabilitation and Restorative Care Chapter/learning objective: 2. Identify the clinical implications of restorative care in walking programs, continence training, and feeding and self-help programs. Chapter page reference: 384 Heading: Continence Training Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Urinary Elimination Difficulty: Moderate PTS: 1
CON: Urinary Elimination
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
fChapter 21: Pharmacology and Its Significance for Older Adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1. What best explains protein binding? 1)
It is how medications move into and through the body.
2)
It refers to the effect of specific medications at the site of action.
3)
It refers to the time required for half the medication to be excreted or inactivated.
4)
It refers to the capacity of proteins in the bloodstream to be binding sites for drugs.
2. Which problem with medication administration is NOT related to normal aging? 1)
Cognitive changes
2)
Decreased taste acuity
3)
Changes in touch and dexterity
4)
Inability to get medications from the pharmacy
3. An older patient stopped taking prescribed antihypertensive medications because it caused constipation. How should the nurse respond to this patient? 1)
“You know that you have to take the blood pressure medicine no matter how you feel.”
2)
“Constipation is a problem with that medication. What did you try to help relieve the constipation while you were taking is?”
3)
“I told you that you could get a little constipated. You can’t quit taking a blood pressure medication without first telling the doctor.”
4)
“There are many different kinds of blood pressure medicines. You could have just called the office and we would have called in a prescription for something else.”
4. What does slowed gastrointestinal motility and delayed gastric emptying time, coupled with a decrease in
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
gastrointestinal blood flow, affect in older adults? 1)
Absorption of medications
2)
Excretion of most drugs through the bowel
3)
Distribution of ingested drugs through the body
4)
General intolerance of oral medications experienced by older adults
5. Why do protein-bound medications frequently cause side effects in older adults? 1)
Older adults are more susceptible to adverse drug reactions.
2)
Older adults do not have adequate kidney function to excrete protein-bound drugs.
3)
Older adults often have a decreased serum albumin level that increases the amount of free drug.
4)
Older adults take many drugs and adverse drug reactions are primarily caused by polypharmacy.
6. What is true about decreased renal excretion of drugs? 1)
It does not affect drug effect.
2)
It decreases the effect of drugs.
3)
It is not a concern for older adults.
4)
It potentially increases the effect of the drug.
7. An older patient recovering from emergency surgery under general anesthesia is still sedated after 12 hours. The family is concerned and thinks there is something wrong. What should the nurse do? 1)
Call the physician.
2)
Increase the intravenous (IV) rate.
3)
Refuse requests for pain medication because of sedation.
4)
Explain that it takes longer for the effects of anesthesia to wear off because of the patient’s age.
8. Which classification of medications is MOST likely to cause gastric ulcers?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1)
Diuretics
2)
Analgesics
3)
Antihypertensives
4)
Anti-inflammatory medications
9. What is a serious potential side effect of acetaminophen? 1)
Liver damage
2)
Fecal impaction
3)
Chronic diarrhea
4)
Decreased nutrient absorption in the bowel
10. Which of these medications does NOT have diarrhea as a possible side effect? 1)
Iron supplements
2)
Diuretics
3)
Antibiotics
4)
Narcotic analgesics
11. Which medication may cause a dry mouth? 1)
Diuretics
2)
Antibiotics
3)
Antipsychotic medications
4)
Anti-inflammatory medications
12. Which medications can cause diffuse stomach pains, vomiting, and diarrhea? 1)
Mylanta, colchicine
2)
Compazine, Tagamet
3)
Erythromycin, Ventolin
4)
Aspirin, iron supplement, potassium supplement
13. What physiological problem is NOT potentially caused by taking antacids? 1)
Early angina
2)
Vomiting and headache
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3)
Diarrhea or constipation
4)
Fluid retention and subsequent hypertension
14. The nurse notes that the health-care provider increased the dosage of aspirin prescribed for an older patient. What is the reason for this dosage to be increased? 1)
Leaner overall body mass
2)
Increased amount of fat tissue
3)
Decreased secretion of stomach acid
4)
Less ionization of aspirin in older people
15. An older patient is prescribed a medication dose that is half the usually prescribed strength. What should the nurse realize as being the reason for this decrease in dosage? 1)
Alteration in gastric pH
2)
Decline in overall metabolism
3)
Increase in gastric acid production
4)
Renal clearance changes with aging
16. An older patient has poor skin turgor and dry mucous membranes. What should the nurse consider when providing this patient with routinely prescribed medications? 1)
The patient will develop diarrhea.
2)
Additional medication will be required.
3)
The concentration of the medication may increase.
4)
The medication should be provided with minimal water.
17. The nurse learns that an older patient has been taking a double dose of diuretics and sleeping pills. What could be the reason for this patient to make such a serious mistake in the medication regimen? 1)
Generic labeling
2)
Poor physical health
3)
Decreased cognitive ability
4)
Number of different medications and the complexity of the medication regimen
18. Which is an example of drug misuse?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1)
Taking another person’s prescribed medications
2)
Taking more than two prescription medications at one time
3)
Taking nonprescription medications without a physician’s order
4)
Taking medications out of their bottles and placing them into a medication box
19. What might an older adult who skips doses of medication so the medication lasts longer be experiencing? 1)
Financial difficulties
2)
Increasing confusion
3)
Inability to read the label for the correct dosing
4)
Knowledge deficit related to proper dosing of medication
20. Which is a home remedy that can cause serious fluid and electrolyte imbalance? 1)
Garlic
2)
Warm milk
3)
Tea and honey
4)
Sodium bicarbonate
21. An older patient with heart failure has 4+ pitting edema of both feet and ankles, moist crackles in the bases of both lungs, and marked shortness of breath. What could contribute to worsening of the patient’s heart failure? 1)
Alcohol
2)
Antacids
3)
Laxatives
4)
Cold remedies containing aspirin (acetylsalicylic acid [ASA])
22. Which is NOT a serious side effect related to excessive laxative use? 1)
Daily bowel movements
2)
Fluid and electrolyte imbalance
3)
Inhibited absorption of nutrients
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4)
Atonic bowel with chronic constipation
23. An older patient has a history of chronic alcohol abuse. Which statement best describes this patient’s physical status? 1)
Inappropriate weight gain
2)
Intact cognition and problem-solving ability
3)
Compromised dietary intake and nutritional status
4)
Inability to participate in any physical exercise program
24. Why must the nurse include questions regarding alcohol consumption when assessing an older patient? 1)
It serves as an indicator for self-abuse.
2)
It is a social problem that must be addressed.
3)
It can potentiate or decrease the effects of many other drugs.
4)
It may be necessary to plan on assisting the patient through alcohol withdrawal.
25. An older patient is waiting for a delivery of medication that was purchased through the Internet from Canada. What should the nurse say after learning this information? 1)
Nothing. This is an acceptable practice.
2)
“Take half the prescribed dose because the dosages are different.”
3)
“You should order medications from Mexico the next time.”
4)
“Find out if the dosages are equivalent before taking the medication.”
26. During an assessment, the nurse learns that an older patient is taking furosemide and Lasix every morning. What should the nurse suspect as the potential reason for this overuse of the diuretic? 1)
Patient is confused
2)
Patient has financial issues
3)
Patient has severe heart failure
4)
Patient had the prescriptions filled at different pharmacies
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
27. An older patient is prescribed several medications to be taken throughout the day. What could improve this patient’s compliance with taking the medications? 1)
Place all medications in the bedroom.
2)
Keep all medications on the kitchen counter.
3)
Have all medications to be taken once a day.
4)
Set alarms for when medication is supposed to be taken.
28. Why should the interdisciplinary care team analyze an older patient’s medications according to Beers criteria? 1)
Reduce and simplify medication use.
2)
Analyze that the correct route is being used.
3)
Ensure the most cost-effective medications are prescribed.
4)
Direct health-care providers to prescribe the most current medications.
29. The nurse is making a visit to the home of an older patient. Which action indicates that the nurse is implementing Beers criteria? 1)
Removing unnecessary medications
2)
Reviewing anticipated effects of medications
3)
Instructing on the use of prescribed medications
4)
Counseling when to report adverse effects of medications
30. An older patient has several outdated prescriptions that need to be discarded. What should the nurse do to help safely remove these medications from the patient’s home? 1)
Flush them down the commode.
2)
Place the medications in the trash.
3)
Take them to a drug disposal station.
4)
Dilute them with water before rinsing down the drain.
31. What best describes chronopharmacology?
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1)
The study of sleep deprivation on the body’s use of medications
2)
A situation in which medication doses are repeatedly missed
3)
The circadian rhythms affecting the pharmacokinetics of medications
4)
The practice of prescribing medications within specific medication classes
32. An older patient with heart failure has more symptoms in the evening than after sleeping throughout the night. What does this finding support? 1)
Circadian rhythms affect disease symptoms.
2)
The patient does not really have heart failure.
3)
Sleep is an effective treatment for heart failure.
4)
Medications taken for heart failure work better during the night.
33. An older patient experiences nasal stuffiness and congestion first thing in the morning. What could help explain this phenomenon? 1)
Room ventilation
2)
Pharmacokinetics
3)
Chronopharmacology
4)
Number of hours of sleep
34. Why should the nurse keep in mind chronopharmacology when providing medications to an older patient? 1)
Reduces the cost of medication
2)
Improves the patient’s psychosocial status
3)
Cuts down on the amount of nursing care required
4)
Results in more effective use of medication by the body
35. Which tool should the home care nurse create to help an older patient remember to take medications? 1)
Yellow construction paper with bold black letters
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2)
Small pink card with black letters laminated for the wallet
3)
Blue poster with purple letters, laminated for permanence
4)
A list of medications by color so the patient does not have to remember their names
36. What is the best indication that patients understand their medications? 1)
Asking questions
2)
Having patients restate and demonstrate
3)
Nodding their heads during conversation
4)
Stating that, yes, they do understand
37. Which statement would be best when writing out a list of medications for a patient? 1)
Lasix, 20 mg qd
2)
Lasix, 20 mg in the morning
3)
Lasix, 20 mg po once a day in the morning
4)
Lasix, 1 tablet by mouth every morning after breakfast
38. An older patient is complaining of an upset stomach caused by new medications. The prescription reads, “Must be taken on an empty stomach.” What should the nurse recommend to this patient? 1)
Stop taking the medication.
2)
Drink 8 oz of milk with each dose.
3)
Drink a minimum of 8 oz of water with each dose.
4)
Take it with a sip of water and the stomach upset will go away.
39. What assessment information is essential to have before administering a new medication to an older adult? 1)
Time of last meal
2)
Known drug allergies
3)
History of past drug use
4)
Name of the patient’s pharmacy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
40. An older patient has a nursing diagnosis of “Noncompliance with medication regimen related to inability to open childproof bottles.” Which intervention is appropriate for this patient? 1)
Instruct the patient to dump each container of pills into a cup.
2)
Instruct the patient to take the tops off of the medication bottles.
3)
Instruct the patient to put daily doses of medication in plastic cups.
4)
Instruct the patient to request special container lids from the pharmacy.
41. An older patient does not have a good reminder system for when medications have already been taken. Which would be the most desirable method for this patient to use? 1)
A medication box
2)
A checklist or calendar
3)
Color coding the medication bottles
4)
Turning the medication bottle upside down after taking the medication
42. An older patient is admitted to an acute care facility with newly diagnosed diabetes. Both the patient and spouse have questions regarding diet, insulin, and exercise. What should the nurse do? 1)
Tell them that they should ask the physician.
2)
Tell them that all of this will be covered on discharge.
3)
Begin to talk to them in generalities about diabetes and some life changes.
4)
Tell them that there is no rush; you will set up appointments for them in the coming days with all of the disciplines.
43. How should the nurse administer a tetanus booster to an older adult? 1)
In the abdomen
2)
In the deltoid muscle
3)
In the dorsogluteal muscle
4)
Instruct to self-administer the medication
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
44. What should the nurse recall regarding enteric-coated medications? 1)
They are liquid.
2)
They are injected.
3)
They are dissolved in the stomach.
4)
They must be crushed to be effective.
45. Which strategy for a medication teaching plan for older adults facilitates compliance with the medication regimen? 1)
Give older adults printed medication orders.
2)
Provide opportunities for older adults to ask questions.
3)
Test the ability of older adults to read the medication labels.
4)
Teach the family about the dosing, desired effects, and side effects of all medications.
46. Which technique best evaluates if an older patient understands medication teaching? 1)
Monitor for adverse drug effects.
2)
Provide and score a written examination about the medication.
3)
Have the older person prepare and take the prescribed medications.
4)
Observe the older person explain the medication to a family member.
47. An older patient is having difficulty swallowing a time-release capsule. What should the nurse do? 1)
Open the capsule and pour it into a glass of water.
2)
Crush the capsule and place into the patient’s food.
3)
Ask the pharmacy for a liquid form of the medication.
4)
Open the capsule and place the medication on the patient’s tongue.
Multiple Response
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Identify one or more choices that best complete the statement or answer the question. 48. Which statement is true for the older adult? Select all that apply. 1)
Constipation and diarrhea change the body’s absorption ability.
2)
Drugs are absorbed poorly if the intestine is impacted with stool, as in constipation.
3)
Manufacturers have changed certain drug formulas to be more suitable to the slower geriatric bowel.
4)
Because of decreased absorption, some standard drug dosages may be inappropriate for an older adult.
5)
Gastric pH becomes more acidic and there is an increase in the number of absorbing cells in the intestinal mucosa.
49. What affects the distribution of a drug in the body? Select all that apply. 1)
Mobility
2)
Dehydration
3)
Rest and sleep
4)
Decreased blood flow
5)
Decreased plasma protein levels
50. The nurse suspects that an older patient is experiencing an adverse drug reaction (ADR). What assessment findings did the nurse use to make this clinical determination? Select all that apply. 1)
Anxiety
2)
Insomnia
3)
Confusion
4)
Restlessness
5)
Sluggish bowel sounds
51. The nurse suspects that an older patient is demonstrating medication misuse phenomena. What did the nurse assess to come to this conclusion? Select all that apply. 1)
Taking half a dose of a prescribed diuretic
2)
Giving a neighbor several pain medications
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3)
Sharing antihypertensive medications with a friend
4)
Filling a prescription at the neighborhood pharmacy
5)
Taking a medication for an infection and nasal congestion
52. The nurse is reviewing an older patient’s medications for adherence with Beers criteria. What should the nurse analyze each medication for? Select all that apply. 1)
Medications that should be taken with food
2)
Medications to be used with caution in older adults
3)
Medications that should be stored away from heat and humidity
4)
Potentially inappropriate medications and classes to avoid in older adults
5)
Potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate
53. What is important to encourage older adults to do when discussing medications? Select all that apply. 1)
Ask questions.
2)
Stop taking medication if side effects occur.
3)
Take half doses when stomach upset occurs.
4)
Fill all prescriptions at the same pharmacy.
5)
Bring a list of current medications to all doctor’s appointments.
54. What should the nurse keep in mind when preparing to instruct an older patient on medications? Select all that apply. 1)
Use a low-pitched voice.
2)
Speak clearly and slowly.
3)
Face the patient when speaking.
4)
Plan sessions in 1-hour increments.
5)
Select an environment with good lighting.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 21: Pharmacology and Its Significance for Older Adults Answer Section MULTIPLE CHOICE 1. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 389 Heading: Introduction Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback 1
This is the definition of pharmacokinetics.
2
This is the definition of pharmacodynamics.
3
This is the definition of half-life.
4
Proteins in the bloodstream are binding sites for many drugs. The portion of a drug that is bound to a protein is inactive. Only a free drug is active to have the desired effect. Not all drugs are protein bound but if a patient is taking two drugs that are, they are competing for the same number of sites and there is an increased percentage of free drug in the bloodstream. In this scenario, there is an increased impact on the effects and possible adverse effects of both drugs.
PTS: 1
CON: Medication
2. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 389 Heading: Factors Affecting Pharmacotherapeutics for Older Adults Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Easy Feedback 1
Self-administration of medications calls for very safety-conscious and creative nursing management.
2
Poisonous substances may need to be labeled in large letters and placed in a location removed from the medications because the older adult may be unable to determine the danger from the taste of the poison.
3
Containers for the drugs may need to be changed to something the older adult can open and read.
4
The ability to get medications from the pharmacy is not related to aging.
PTS: 1
CON: Medication
3. ANS: 2 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 391 Heading: Challenges with Taking Medications Correctly Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
This does not provide an opportunity to address the patient’s learning needs.
2
By discussing the constipation, the nurse can explore the patient’s learning needs and teach about managing constipation, which was a serious problem for the patient.
3
This does not provide an opportunity to address the patient’s learning needs.
4
This does not provide an opportunity to address the patient’s learning needs.
PTS: 1
CON: Medication
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4. ANS: 1 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 393 Heading: Decreased Absorption Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication Difficulty: Easy Feedback 1
The aging changes in the gastrointestinal system greatly affect the absorption of drugs that are taken orally. Aging changes seem to decrease cumulatively the absorption of most medications.
2
Most medications are excreted by the kidneys, not the bowel.
3
Even though distribution is decreased in the older adult, it is because of vascular, hydration, or decreased muscle mass and increased fat stores, not because of changes in the gastrointestinal tract.
4
It is an overgeneralization to say that older people have a “general intolerance of oral medications.”
PTS: 1
CON: Medication
5. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 394 Heading: Distribution Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication Difficulty: Easy Feedback 1
This is an incorrect statement; older adults are
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
not more susceptible to adverse drug reactions. 2
Older adults have decreased kidney function that affects their ability to excrete all drugs that are excreted by the kidney. This is not, however, the major cause of side effects from protein-bound drugs.
3
Decreased levels of serum albumin provide fewer binding sites for protein-bound drugs. This causes an increased amount of free drug in the plasma to bind to drug receptor sites and increases the drug’s effect.
4
This is an incorrect statement; adverse drug reactions are not primarily caused by polypharmacy.
PTS: 1
CON: Medication
6. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 394 Heading: Excretion Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication Difficulty: Easy Feedback 1
Renal excretion of drugs affects drug effect.
2
Renal excretion of drugs does affect the drug effects.
3
Altered kidney function with aging is one of the main reasons that older adults require less medication to achieve the desired drug effect.
4
If the ability of the kidney to excrete drugs is decreased, drugs remain in the bloodstream for a longer time in a higher concentration. This situation has the potential to increase the length of the drug’s effect and lead to adverse side effects.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Medication
7. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 394 Heading: Excretion Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
The physician does not need to be notified because this is an expected response.
2
The nurse would need a physician order to change the IV rate.
3
The nurse should be checking vital signs to determine that there is no other problem.
4
Anesthesia, a drug normally excreted by respiration, may have an increased effect on an older patient because of decreased respiratory and vital capacity.
PTS: 1
CON: Medication
8. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 396 Heading: Table 21.1 Specific Drug Problems of Elderly Patients Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback 1
Gastric ulceration is not a serious side effect of diuretics.
2
Gastric ulceration is not a serious side effect of analgesics.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3
Gastric ulceration is not a serious side effect of antihypertensives.
4
Anti-inflammatory medications—such as aspirin, steroids, and indomethacin—are very irritating to the gastric mucosa.
PTS: 1
CON: Medication
9. ANS: 1 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 396 Heading: Table 21.1 Specific Drug Problems of Elderly Patients Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback 1
Acetaminophen toxicity can cause serious liver damage.
2
Acetaminophen is not associated with fecal impaction.
3
Use of acetaminophen can be related to diarrhea but it is not life-threatening.
4
Acetaminophen is not associated with decreased nutrient absorption.
PTS: 1
CON: Medication
10. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 396 Heading: Table 21.1 Specific Drug Problems of Elderly Patients Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1
Iron can cause either diarrhea or constipation.
2
Diuretics can cause diarrhea.
3
Antibiotics can cause diarrhea.
4
Narcotics cause constipation, not diarrhea.
PTS: 1
CON: Medication
11. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 396 Heading: Table 21.1 Specific Drug Problems of Elderly Patients Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback 1
Diuretics do not have a dry mouth as a side effect.
2
Antibiotics do not have a dry mouth as a side effect.
3
A common side effect of antipsychotic medications is a dry mouth.
4
Anti-inflammatory medications do not have a dry mouth as a side effect.
PTS: 1
CON: Medication
12. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 396 Heading: Table 21.1 Specific Drug Problems of Elderly Patients Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1
Mylanta, an antacid, and colchicine, an antigout medication, would alter absorption of nutrients.
2
Compazine, an antiemetic, and Tagamet, an antiulcer medication, would cause dry mouth.
3
Erythromycin, an antibiotic, and Ventolin, an anti-asthma medication, may promote diarrhea.
4
Acetylsalicylic acid (aspirin), iron, and potassium may cause ulcers and result in the symptoms described.
PTS: 1
CON: Medication
13. ANS: 2 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 396 Heading: Antacid Abuse Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback 1
The use of antacids can mask early angina because the patient thinks it is heartburn instead.
2
Antacids do not cause vomiting or headaches.
3
Antacids can cause either constipation or diarrhea.
4
Antacids contain large amounts of sodium and can increase the severity of cardiovascular disease, renal disease, and hypertension.
PTS: 1
CON: Medication
14. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 393 Heading: Decreased Absorption Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication Difficulty: Easy Feedback 1
Body mass affects distribution of medications.
2
Fat tissue affects distribution of medications.
3
Acetylsalicylic acid (aspirin) is more ionized in older people because their secretion of stomach acid is decreased. Absorption of aspirin may be decreased in older adults.
4
Acetylsalicylic acid (aspirin) is more ionized in older people.
PTS: 1
CON: Medication
15. ANS: 2 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 394 Heading: Metabolism Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
An alteration in gastric pH affects medication absorption.
2
Older adults experience a decrease in the rates of overall metabolism and a decline in the body’s ability to transform active drugs into inactive drugs. The overall effect of these changes is that the medication remains for a longer time in an active form in older people. Some drugs may remain in the body twice as long as in younger adults.
3
Gastric acid production decreases with aging.
4
Renal clearance changes affect excretion, not
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
drug metabolism.
PTS: 1
CON: Medication
16. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 394 Heading: Distribution Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
There is no evidence to support that the patient will develop diarrhea from the medications.
2
Dehydration will increase the concentration of the medication in the patient’s blood. Additional medication will not be required.
3
Dehydration can result in decreased serum volume, which would increase the concentration of a medication in the blood.
4
The medication route is not an issue.
PTS: 1
CON: Medication
17. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 391 Heading: Polypharmacy and Chronic Health Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication; Safety Difficulty: Moderate Feedback 1
There is not enough information to determine that the patient’s medication error is caused by generic labeling.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2
There is not enough information to determine that the patient’s medication error is caused by poor physical health.
3
There is not enough information to determine that the patient’s medication error is caused by decreased cognitive ability.
4
The number of medications and the complexity of the medication regimen have a direct correlation with increased adverse drug reactions and emergency department visits by older adults.
PTS: 1
CON: Medication | Safety
18. ANS: 1 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 393 Heading: Financial Concerns Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication; Safety Difficulty: Easy Feedback 1
Taking another person’s prescription medications is an example of drug misuse.
2
This is not an example of drug misuse.
3
Over-the-counter medication use is appropriate as long as the older adult follows the instructions for use.
4
This helps with remembering to take medications and would not be drug misuse.
PTS: 1
CON: Medication | Safety
19. ANS: 1 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 393 Heading: Financial Concerns Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Comprehension [Understanding] Concept: Medication Difficulty: Easy Feedback 1
Sometimes financial concerns lead older adults to misuse prescription medications. Taking a medication every other day rather than every day is a common but dangerous practice.
2
This could be a reason for the older patient to skip doses, however, the patient is trying to make the prescription last longer because of cost.
3
This is highly unlikely because the patient is trying to make the prescription last longer.
4
This does not explain the patient’s intention to make the prescription last longer.
PTS: 1
CON: Medication
20. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 395 Heading: Specific Drug Problems for Older Adults Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication; Fluid and Electrolyte Balance Difficulty: Easy Feedback 1
Garlic has no serious documented side effects as long as the patient is not allergic to the food.
2
Warm milk has no serious documented side effects as long as the patient is not allergic to the food.
3
Tea and honey have no serious documented side effects as long as the patient is not allergic to the foods.
4
Sodium bicarbonate is often used as an antacid by older adults. The high sodium content can cause severe fluid retention and
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
cardiac overload.
PTS: 1
CON: Medication | Fluid and Electrolyte Balance
21. ANS: 2 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 397 Heading: Antacid Abuse Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication; Fluid and Electrolyte Balance Difficulty: Easy Feedback 1
Alcohol use and abuse can contribute to fluid and electrolyte imbalances but usually not to fluid overload problems.
2
Older adults often use large amounts of antacids that have high sodium content. The high sodium content can cause fluid retention and exacerbation of the symptoms of heart failure.
3
Laxatives are associated with fluid and electrolyte depletion.
4
Aspirin-containing cold remedies do not have fluid retention as a side effect.
PTS: 1
CON: Medication | Fluid and Electrolyte Balance
22. ANS: 1 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 397 Heading: Laxative Abuse Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication; Fluid and Electrolyte Balance; Bowel Elimination Difficulty: Easy Feedback 1
The desire for a daily bowel movement is often the reason that an older adult uses
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
laxatives. The expectation to have a daily bowel movement often is unrealistic because of the older person’s decreased food intake and decreased physical exercise. A daily bowel movement is not a serious complication of laxative use. 2
Because a laxative accelerates the movement of stool through the digestive system, it can decrease the time available to absorb nutrients and water in the small and large intestines and cause “dumping” of essential nutrients, vitamins, and minerals.
3
Because a laxative accelerates the movement of stool through the digestive system, it can decrease the time available to absorb nutrients and water in the small and large intestines and cause “dumping” of essential nutrients, vitamins, and minerals.
4
An atonic bowel that is unable to move feces adequately through the large intestine can be caused by overuse of laxatives.
PTS: 1
CON: Medication | Fluid and Electrolyte Balance | Bowel Elimination
23. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 397 Heading: Alcohol Abuse Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Addiction; Nutrition Difficulty: Easy Feedback 1
Alcohol abuse would contribute to weight loss rather than gain.
2
Alcohol abuse is often cited as a causative factor of cognitive impairment.
3
The physiological and socioeconomic effects of chronic alcohol use negatively affect the older adult’s dietary practices and nutritional status.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
PTS: 1
All older adults need to participate in a physical exercise program that promotes their highest level of function.
CON: Addiction | Nutrition
24. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 397 Heading: Alcohol Abuse Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Addiction; Medication Difficulty: Easy Feedback 1
Alcohol does not serve as an indicator for self-abuse.
2
Even though alcoholism might be a social problem this is not the reason for the nurse to assess for alcohol use.
3
Of primary importance when prioritizing care would be to determine what, if any, potential interactions exist between alcohol and prescribed or over-the-counter medications.
4
The nurse would need physician orders and support from the physician and other team members to assist the patient through alcohol withdrawal.
PTS: 1
CON: Addiction | Medication
25. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 392 Heading: Point of Interest Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication; Safety Difficulty: Moderate
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Feedback 1
This is not an acceptable practice and can lead to adverse medication effects.
2
The nurse cannot prescribe a change in dosage for a medication.
3
This is incorrect because Mexico does not have the same strict manufacturing controls as the United States.
4
Medications may not have the same strict manufacturing controls that are in place in the United States and the dosages of the medications may not be equivalent to those in the United States.
PTS: 1
CON: Medication | Safety
26. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 395 Heading: Pharmacology Problems Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication; Safety Difficulty: Moderate Feedback 1
There is not enough information to determine if the patient is confused.
2
Taking a double dose would not support the patient with financial issues.
3
There is not enough information to determine if the patient has heart failure.
4
If one prescription is labeled furosemide and the other is labeled Lasix there is a good chance that these medications were filled at different pharmacies, which would explain why the patient is taking both medications.
PTS: 1 27. ANS: 3
CON: Medication | Safety
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 391 Heading: Challenges with Taking Medications Correctly Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication; Safety Difficulty: Moderate Feedback 1
The bedroom might not be a convenient location for the patient to take medication.
2
The kitchen counter might be too cluttered for the patient to remember to take medication.
3
The use of medications that are dosed only once a day can help the person be compliant in taking medications.
4
Setting alarms adds another element of planning for the patient to take medication.
PTS: 1
CON: Medication | Safety
28. ANS: 1 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 3. List four ways a licensed nurse can support the physician in implementing Beers criteria. Chapter page reference: 397 Heading: Beers Criteria Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication; Safety Difficulty: Easy Feedback 1
Beers criterion presents a standardized and collaborative approach for medication reduction and simplification.
2
Beers criterion is not used to analyze that the correct route is being used.
3
Beers criterion is not used to ensure that the most cost-effective medications are prescribed.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
PTS: 1
Beers criterion is not used to direct health-care providers to prescribe the most current medications.
CON: Medication | Safety
29. ANS: 1 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 3. List four ways a licensed nurse can support the physician in implementing Beers criteria. Chapter page reference: 398 Heading: Promoting Safe Medication Use Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication; Safety Difficulty: Moderate Feedback 1
Removing unnecessary medications prevents confusion.
2
Reviewing effects of medications is part of medication teaching.
3
Instructing on the use of medications is part of medication teaching.
4
Counseling when to report adverse effects is part of medication teaching.
PTS: 1
CON: Medication | Safety
30. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 3. List four ways a licensed nurse can support the physician in implementing Beers criteria. Chapter page reference: 398 Heading: Point of Interest Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication; Safety Difficulty: Moderate Feedback 1
Do not flush medications.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2
Do not place medications in the garbage.
3
Dispose of the medications at a drug disposal station.
4
Do not rinse medications down the drain.
PTS: 1
CON: Medication | Safety
31. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 4. Define the purpose of understanding chronopharmacology Chapter page reference: 399 Heading: Chronopharmacology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback 1
Chronopharmacology has nothing to do with sleep deprivation.
2
Chronopharmacology has nothing to do with missing medication doses.
3
Chronopharmacology is the study of the absorption, distribution, metabolism, elimination, and effect of medication based on circadian rhythms.
4
Chronopharmacology has nothing to do with prescribing medications according to medication classes.
PTS: 1
CON: Medication
32. ANS: 1 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 4. Define the purpose of understanding chronopharmacology Chapter page reference: 399 Heading: Chronopharmacology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Feedback 1
Through the study of circadian rhythms research scientists recognize that diseases do not display characteristics that are consistent over a 24-hour period.
2
This finding does not suggest that the patient was misdiagnosed.
3
This finding does not suggest that sleep is an effective treatment for heart failure.
4
There is not enough information to support that medications for heart failure work better during the night.
PTS: 1
CON: Medication
33. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 4. Define the purpose of understanding chronopharmacology Chapter page reference: 399 Heading: Chronopharmacology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback 1
The patient’s nasal stuffiness may or may not be related to room ventilation.
2
The patient’s nasal stuffiness is not related to pharmacokinetics.
3
Through the study of chronopharmacology it has been determined that allergic rhinitis symptoms are generally worse in the morning.
4
The patient’s nasal stuffiness is not related to the number of hours of sleep the patient received.
PTS: 1
CON: Medication
34. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 4. Define the purpose of understanding chronopharmacology
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 399 Heading: Chronopharmacology Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
Chronopharmacology is not identified as specifically reducing the cost of medication.
2
Chronopharmacology does not impact the patient’s psychosocial status.
3
Chronopharmacology does not impact the amount of nursing care required.
4
Honoring circadian rhythms results in more effective use of medication by the body.
PTS: 1
CON: Medication
35. ANS: 1 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 389 Heading: Sensory Changes Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
A large yellow sign with bold black letters would be the easiest to see.
2
Older adults frequently have difficulty distinguishing colors with glare on laminated documents.
3
Older adults frequently have difficulty distinguishing colors with glare on laminated documents.
4
Older adults frequently have difficulty distinguishing colors and with small print.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Medication
36. ANS: 2 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 390 Heading: Decreased Hearing Acuity Integrated Processes: Nursing Process: Evaluation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication Difficulty: Moderate Feedback 1
Asking questions is very good but does not indicate their comprehension of the task.
2
The best method to ensure comprehension is having patients restate in their own words and demonstrate.
3
Individuals may, out of habit, nod their heads during a discussion but this does not indicate comprehension.
4
Individuals may, out of habit, verbally state they understand but this does not indicate comprehension.
PTS: 1
CON: Medication
37. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 390 Heading: Cognitive Changes Integrated Processes: Nursing Process: Evaluation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication Difficulty: Moderate Feedback 1
The patient may not want to appear uninformed and may not know what “qd” means.
2
The patient may not want to appear
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
uninformed and may not know how many pills equal 20 mg. 3
The patient may not want to appear uninformed and may not know what “po” means.
4
This is the best way to convey the drug, the amount, the route, and when to take it by associating the medication with a task.
PTS: 1
CON: Medication
38. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 391 Heading: Challenges with Taking Medications Correctly Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
The nurse should not direct the patient to stop taking the medication.
2
Milk is not an empty stomach.
3
Drinking 8 oz of water with the medication may decrease stomach irritation by washing it through the stomach faster. Water is not considered a full stomach.
4
A sip of water would not be sufficient and would encourage the upset stomach to continue.
PTS: 1
CON: Medication
39. ANS: 2 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 399 Heading: Assessment Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
Time of last meal is a component of the drug assessment but is not as essential as knowing allergies before administering a medication.
2
To prevent a potential anaphylactic reaction it is essential to know if the older adult has medication allergies before administering a new medication.
3
Drug use history is a component of the drug assessment but is not as essential as knowing allergies before administering a medication.
4
Name of pharmacy is a component of the drug assessment but is not as essential as knowing allergies before administering a medication.
PTS: 1
CON: Medication
40. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 400 Heading: Planning Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
This is an inappropriate and potentially dangerous suggestion.
2
This is an inappropriate and potentially dangerous suggestion.
3
This is an inappropriate and potentially dangerous suggestion.
4
Pharmacies stock non–child-protective, flipoff caps and provide them to older adults.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Medication
41. ANS: 1 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 400 Heading: Planning Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
Medication boxes have slots for different days and times. When the medication is gone from the slot the patient knows the medication has been taken.
2
Checklists and calendar marking are a good idea—if the older adult remembers to mark the checklist and calendar.
3
Color coding might assist with vision problems but would not assist with remembering to take medications.
4
Turning the bottle upside down would work if the patient remembers to turn it right side up again before bedtime or the first thing in the morning. If this is not done the patient may start missing doses, thinking that the medication has already been taken.
PTS: 1
CON: Medication
42. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 400 Heading: Planning Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication; Nursing Roles Difficulty: Moderate Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1
The nurse provides the teaching.
2
Hospital stays are very short and the amount of information to be covered can be overwhelming for one session.
3
It is never too early to begin the education process.
4
Although appointments with the disciplines might be needed, the nurse should begin the teaching process now because the patient has expressed a desire to learn more.
PTS: 1
CON: Medication | Nursing Roles
43. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 401 Heading: Implementation Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
The abdomen is typically a location for subcutaneous medications.
2
Because of decreased muscle mass, the deltoid muscle is not a good site.
3
The tetanus booster should be given in the dorsogluteal muscle.
4
The patient should not be self-administering vaccinations.
PTS: 1
CON: Medication
44. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 401 Heading: Implementation
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication Difficulty: Moderate Feedback 1
Enteric-coated drugs are oral tablets.
2
Enteric-coated drugs are oral tablets.
3
Enteric-coated drugs are tablets with a specialized coating so that they do not dissolve with gastric acid. They have increased effectiveness and decreased stomach upset.
4
They should never be crushed or dissolved because this disrupts the coating.
PTS: 1
CON: Medication
45. ANS: 2 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 402 Heading: Evaluation Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
This is a component of a medication teaching plan for older adults but does not engage the older adult in active problem solving.
2
Providing older adults with the opportunity to ask questions gives them the chance to examine their medication regimen and enlist assistance in solving problems with it.
3
This is a component of a medication teaching plan for older adults but does not engage the older adult in active problem solving.
4
This is a component of a medication teaching plan for older adults but does not engage the older adult in active problem solving.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1
CON: Medication
46. ANS: 4 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 400 Heading: Planning Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication; Nursing Roles Difficulty: Moderate Feedback 1
Monitoring for adverse drug effects may or may not be related to medication teaching.
2
It is not appropriate to provide a written medication test to a patient.
3
Having the patient prepare and take prescribed medication may not be appropriate in many health-care settings.
4
Having the older person teach someone else provides an opportunity to observe the patient’s integration of the medication teaching.
PTS: 1
CON: Medication | Nursing Roles
47. ANS: 3 Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 401 Heading: Implementation Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1
Time-release capsules should not be opened.
2
Time-release capsules should not be crushed
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
and mixed with food. 3
If the person is unable to swallow the capsule, contact the physician or pharmacist for a liquid form of the medication.
4
Time-release capsules should not be opened or crushed.
PTS: 1
CON: Medication
MULTIPLE RESPONSE 48. ANS: 1, 2, 3, 4 Feedback 1.
Changes in gastrointestinal motility, such as constipation and diarrhea, alter the time that medication travels through the intestine, which alters absorption amounts.
2.
Because of the changes in gastrointestinal (GI) motility, drugs that are manufactured for normal adult GI motility are not suited to the slower geriatric bowel. Some drugs may be absorbed in lesser amounts.
3.
Drugs are absorbed poorly if the intestine is impacted with stool, as in constipation.
4.
Gastric pH becomes less acidic and there is an overall decrease in the number of absorbing cells in the intestinal mucosa.
5.
Manufacturers have not reconfigured drugs to be suitable to a slower bowel.
Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 393 Heading: Decreased Absorption Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication Difficulty: Easy PTS: 1
CON: Medication
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
49. ANS: 2, 4, 5 Feedback 1.
Mobility does not affect the distribution of a drug in the body.
2.
A lower blood volume resulting from dehydration decreases drug distribution.
3.
Rest and sleep do not affect the distribution of a drug in the body.
4.
As people age, changes in the cardiovascular system may lead to decreased blood flow to specific target tissue and decreased drug distribution
5.
Decreased plasma protein levels found in many older adults may lead to less of the drug being bound to protein and more of the drug free to exert its actions.
Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 1. Discuss how aging changes affect the pharmacodynamics and pharmacokinetics of medications. Chapter page reference: 394 Heading: Distribution Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication Difficulty: Easy PTS: 1
CON: Medication
50. ANS: 1, 2, 3, 4 Feedback 1.
Anxiety can be misidentified as confusion or dementia and the ADR may go unrecognized and untreated.
2.
Insomnia can be misidentified as confusion or dementia and the ADR may go unrecognized and untreated.
3.
Confusion can be misidentified as confusion or dementia and the ADR may go unrecognized and untreated.
4.
Restlessness can be misidentified as confusion or dementia and the ADR may go
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
unrecognized and untreated. Sluggish bowel sounds are not used to identify ADRs.
5.
Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 392 Heading: Polypharmacy and Chronic Health Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication; Safety Difficulty: Moderate PTS: 1
CON: Medication | Safety
51. ANS: 1, 2, 3, 5 Feedback 1.
Misuse phenomena include incorrect dosing.
2.
Misuse phenomena include sharing medications between neighbors.
3.
Misuse phenomena include sharing medications with friends.
4.
Filling a prescription at the neighborhood pharmacy is not medication misuse.
5.
Misuse phenomena include using a medication for a variety of purposes.
Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 2. Explain the impact of polypharmacy on safety for older adults. Chapter page reference: 395 Heading: Pharmacology Problems Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication; Safety Difficulty: Moderate PTS: 1
CON: Medication | Safety
52. ANS: 2, 4, 5 Feedback 1.
This is not a part of the Beers criteria.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2.
Beers criteria divide medications into three separate groups. This is part three of the Beers criteria.
3.
This is not a part of the Beers criteria.
4.
Beers criteria divide medications into three separate groups. This is the first part of the Beers criteria.
5.
Beers criteria divide medications into three separate groups. This is the second part of the Beers criteria.
Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 3. List four ways a licensed nurse can support the physician in implementing Beers criteria. Chapter page reference: 397 Heading: Beers Criteria Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication; Safety Difficulty: Moderate PTS: 1
CON: Medication | Safety
53. ANS: 1, 4, 5 Feedback 1.
The patient needs to ask questions to learn about the medications and the effects.
2.
The patient should never be counseled to stop taking medications.
3.
The patient should not be encouraged to take half-doses of medications.
4.
To prevent complex, multidrug medication regimens and complications it is helpful if one pharmacist handles all of the prescriptions for an individual.
5.
To prevent complex, multidrug medication regimens and complications it is helpful for all physicians to know and understand the other medications and over-the-counter drugs being taken.
Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
in maintaining proper pharmacotherapeutics. Chapter page reference: 392 Heading: Polypharmacy and Chronic Health Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication Difficulty: Moderate PTS: 1
CON: Medication
54. ANS: 1, 2, 3, 5 Feedback 1.
When teaching an older adult the nurse should use a low-pitched voice.
2.
When teaching an older adult the nurse should speak clearly and slowly.
3.
When teaching an older adult the nurse should face the patient when speaking.
4.
When teaching an older adult the nurse should plan sessions in 15- to 20-minute increments.
5.
When teaching an older adult the nurse should select an environment with good lighting.
Chapter number and title: Chapter 21: Pharmacology and Its Significance for Older Adults Chapter/learning objective: 5. Develop a nursing care plan to synthesize interventions to assist older persons in maintaining proper pharmacotherapeutics. Chapter page reference: 400 Heading: Planning Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication; Nursing Roles Difficulty: Moderate PTS: 1
CON: Medication | Nursing Roles
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter 22: Laboratory Values and Older Adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which is NOT considered a routine laboratory examination for an older adult? 1) Urinalysis 2) Stool guaiac 3) Drug screen 4) Cell blood count 2. Which is NOT a typical symptom of a urinary tract infection? 1) Polyuria 2) Frequency 3) Incontinence 4) Burning with voiding 3. Which is an abnormal urinalysis finding for older adults? 1) Glucose in the urine 2) Trace of protein in the urine 3) 0 to 3 red blood cells in the urine 4) 0 to 4 white blood cells in the urine 4. What is a stool guaiac a test for? 1) Blood in the stool 2) Parasites in the stool 3) Abnormal epithelial cells 4) Large amounts of white blood cells 5. What can a low red blood cell count be associated with? 1) Dehydration 2) Bacterial infection 3) Recent hemorrhage 4) Recent viral infection 6. Which disease process is most commonly associated with a low hemoglobin value? 1) Anemia 2) Renal failure 3) Osteoporosis 4) Heart failure 7. What does blood hematocrit measure? 1) The ratio of red blood cells to white blood cells 2) The oxygen-carrying ability of the red blood cells 3) The total number of red blood cells in whole blood 4) The percentage of blood volume of packed red blood cells 8. What are red blood cell indices useful in diagnosing? 1) Anemia 2) Heart failure 3) Respiratory diseases
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Coronary heart disease 9. What is the importance of platelets? 1) Blood clotting process 2) Response of the body to infection 3) Smooth flow of blood through the capillaries 4) Production of red blood cells and white blood cells 10. What is the prothrombin time (PT) primarily used to monitor? 1) Thickness of the blood 2) Older adults who are taking oral anticoagulant therapy 3) The risk of an older adult developing a bleeding disorder 4) Dissolving blood clots for older adults with deep vein thrombosis 11. What is true about activated partial thromboplastin time (APTT)? 1) It is the same as prothrombin time (PT). 2) It is the same as partial thromboplastin time (PTT). 3) It is more sensitive than PT in determining clotting. 4) It is lower than the therapeutic range in which a patient may have bleeding problems. 12. What is a symptom of a high blood glucose level? 1) Hunger 2) Sweating 3) Restlessness 4) Urinary frequency 13. Which disease is associated with an elevated blood glucose level? 1) Anemia 2) Renal failure 3) Diabetes mellitus 4) Degenerative joint disease 14. What is hyponatremia? 1) Low sodium blood levels 2) High sodium blood levels 3) Low potassium blood levels 4) High potassium blood levels 15. What does hyperkalemia refer to? 1) Low sodium blood levels 2) High sodium blood levels 3) Low potassium blood levels 4) High potassium blood levels 16. What is a manifestation of hyperkalemia? 1) Irregular heart beat 2) Increased pedal edema 3) Elevated blood pressure 4) Decreased urinary output 17. What role does chloride play in the regulation of body functions? 1) Promotes wound healing
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Maintains acid-base balance 3) Regulates hormone secretion 4) Absorbs calcium into the bone 18. What does potassium regulate? 1) Blood flow to the heart 2) Water retention by the kidneys 3) Insulin secretion of the pancreas 4) Electrical conduction through the heart 19. What is being assessed when blood urea nitrogen (BUN) and serum creatinine levels are monitored? 1) Renal function 2) Cardiac function 3) Acid-base balance 4) Tissue repair ability 20. Which blood component is elevated in gout? 1) Bilirubin 2) Uric acid 3) Creatinine 4) Blood urea nitrogen (BUN) 21. An older patient’s erythrocyte sedimentation rate (ESR) is 60 mm/hr. What health problem should the nurse suspect is occurring in this patient? 1) Diabetes 2) Heart failure 3) Diverticulitis 4) Temporal arteritis 22. Which is an appropriate instruction for an older adult having a stool guaiac laboratory evaluation? 1) Take a laxative the evening before the test. 2) Have enemas until clear the morning of the test. 3) Avoid eating red meat 2 to 3 days before the test. 4) Increase vitamin C intake 2 days before the examination. 23. What is the decrease in white blood cell counts for an older adult being treated for lung cancer probably related to? 1) Tissue inflammation from radiation therapy 2) Excessive stress in dealing with the diagnosis and treatment of lung cancer 3) An infectious process related to the older adult’s immunocompromised status 4) Suppression of bone marrow production of white blood cells by chemotherapy drugs 24. What is a common complaint of older adults with low serum calcium levels? 1) Constipation 2) Excessive thirst 3) Muscle cramping 4) Bone and joint aching 25. What is true about liver function test results and older people? 1) Increase for older adults 2) Decrease for older adults 3) Lose reliability with aging
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4) Remain unchanged with aging 26. Which lipoprotein levels place an older adult at risk for coronary artery disease? 1) Low total cholesterol 2) Elevated low-density lipids 3) Elevated high-density lipids 4) Low level of plasma triglycerides 27. An older patient is being evaluated for osteoporosis. Which laboratory finding should the nurse anticipate being found in this patient? 1) Increased calcium 2) Increased alkaline phosphatase 3) Decreased white blood cell count 4) Increased alanine aminotransferase (ALT) 28. A patient is being evaluated for a myocardial infarction (MI). What laboratory values would NOT be associated with this health problem? 1) Increased serum protein 2) Increased creatinine kinase (CK) II 3) Increased alanine aminotransferase (ALT) 4) Increased aspartate aminotransferase (AST) 29. Which statement about iron is false? 1) Iron may cause constipation. 2) Iron deficiency anemia is caused by poor diet. 3) Iron is essential to the function of hemoglobin. 4) Serum iron may be depleted even though iron stores increase. 30. What is associated with a decreased incidence of coronary heart disease? 1) Normal total cholesterol levels but high LDL levels 2) Normal total cholesterol levels and high triglyceride levels 3) High HDL cholesterol, low LDL cholesterol, and low triglycerides 4) Low HDL cholesterol, high LDL cholesterol, and low triglycerides 31. The nurse notes that a nursing home resident has a 4-mm area of induration after receiving the intradermal tuberculin solution. What should the nurse anticipate being planned for this patient? 1) Nothing 2) Scheduled for a chest x-ray 3) Repeated test in 1 to 2 weeks 4) Started on antituberculosis medication 32. An older patient with renal failure has a change in serum phosphate level. What should the nurse explain as being the reason for the altered phosphorus level? 1) “A lack of phosphate can lead to renal failure.” 2) “Too much phosphate in the body can cause renal failure.” 3) “The kidneys use phosphate to ensure adequate functioning.” 4) “The kidneys regulate phosphate excretion to maintain a balance with serum calcium.” 33. The nurse notes that an older patient’s glomerular filtration rate (GFR) is declining. Which serum laboratory value should the nurse review for alterations? 1) Serum sodium 2) Serum calcium
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3) Serum creatinine 4) Serum potassium 34. How does the white blood cell count respond during an acute infection in an older adult? 1) No change in the white blood cell count 2) Slight decrease in the white blood cell count 3) Dramatic white blood cell count elevation 4) Similar to the white blood cell response of a younger person 35. An older patient has a low hemoglobin level. What should the nurse expect to assess in this patient? 1) Fatigue 2) Peripheral edema 3) Low urine output 4) Elevated blood pressure 36. Which medication does NOT cause blood glucose levels to increase? 1) Insulin 2) Corticosteroids 3) Furosemide (Lasix) 4) Phenytoin (Dilantin) 37. What is digoxin used to treat? 1) Diabetes 2) Seizure disorder 3) Renal insufficiency 4) Congestive heart failure 38. The pharmacy has converted all oral pills to liquid form for an older patient who is no longer able to swallow pills. What change would have been made to this patient’s digoxin? 1) The same 2) Increased 3) Decreased 4) Subject to fluctuations 39. An older patient is currently taking Lasix, 40 mg bid; digoxin, 125 mg qd; and Inderal, 20 mg qd. Which laboratory value should be of concern to the nurse? 1) Digoxin level 1.0 mg/mL 2) Sodium level 140 mEq/L 3) Potassium level 2.5 mEq/L 4) Potassium level 4.0 mEq/L 40. What is the medication classification for theophylline? 1) Diuretic 2) Antibiotic 3) Vasodilator 4) Bronchodilator 41. Which does NOT indicate possible theophylline toxicity? 1) Nausea 2) Restlessness 3) Heart arrhythmias 4) Visual disturbances
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
42. An older patient takes phenytoin for seizure activity, isoniazid for tuberculosis, aspirin for arthritis, and Tagamet for ulcers. What should the nurse expect to assess in 1 month? 1) Increased folic acid 2) No change in levels 3) Decreased phenytoin serum levels 4) Abnormal increase in serum phenytoin levels 43. An older patient is diagnosed with low vitamin B12 and folic acid levels. Which medication could be causing this alteration in the patient’s values? 1) Digoxin 2) Penicillin 3) Metformin 4) Theophylline 44. An older patient has a blood glucose level of 64 mg/dL. Which medication could be causing this low blood glucose level? 1) Digoxin 2) Phenytoin 3) Furosemide 4) Beta blocker 45. The nurse needs to collect a random urine specimen from an older patient. How many mL of urine should the nurse collect? 1) 10 mL 2) 30 mL 3) 240 mL 4) 24-hour urine specimen 46. An older patient who has been taking iron supplements continues to have low red blood cell count values. What should the nurse expect to be prescribed for this patient? 1) Increased iron dosage 2) Reduction in oral fluids 3) Limited intake of red meat 4) Transfusion of packed red blood cells 47. An older patient who takes digoxin at 10:00 am every day is to have blood drawn for a digoxin level. When should the nurse inform the laboratory to draw the blood for this test? 1) 1030 hours 2) 1200 hours 3) 1600 hours 4) 2400 hours 48. An older patient taking an oral anticoagulant develops a nosebleed. Which laboratory value should the nurse assess in this patient? 1) Hemoglobin 2) Red blood cell count 3) Partial thromboplastin time 4) International normalized ratio 49. Which are NOT considered baseline laboratory values to assess nutritional status? 1) Serum albumin
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
2) Serum creatinine 3) Creatinine kinase 4) Complete blood count (CBC) 50. An older patient is experiencing body itching, loss of hair, general weakness, and a wound that won’t heal. Laboratory work completed includes a complete blood count (CBC), urinalysis, blood glucose, and protein. Which laboratory result should be expected for this patient? 1) Concentrated urine 2) All within normal limits 3) Increased white blood cells 4) Decreased serum protein level 51. An older patient is having a serum transferrin level drawn. What will this laboratory value assess? 1) Fat stores 2) Protein stores 3) Carbohydrates 4) Vitamin levels 52. An older patient has an elevated serum albumin level. What should the nurse suspect is occurring with this patient? 1) Liver disease 2) Hyperthyroidism 3) Multiple myeloma 4) Rheumatoid arthritis Multiple Response Identify one or more choices that best complete the statement or answer the question. 53. Why is daily dietary ingestion of calcium necessary? Select all that apply. 1) Calcium is a part of the clotting cascade. 2) Calcium is excreted in the urine and feces. 3) Calcium is needed to ensure cardiac health. 4) Calcium is necessary for fluid and electrolyte balance. 5) Most of the body’s calcium is stored in the teeth and bones. 54. What health problems are associated with a low folic acid level? Select all that apply. 1) Anemia 2) Heart failure 3) Liver disease 4) Renal disease 5) Protein malnutrition 55. An older patient who has had consistent pulse rates of 78 beats per minute now has a pulse of 66 and irregular. What should the nurse do? Select all that apply. 1) Measure an apical pulse for 1 minute. 2) Administer half a dose of the medication. 3) Provide half of the medication now and half in1 hour. 4) Administer the medication and plan on rechecking in 1 hour. 5) Withhold the medication and call the physician or charge nurse.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
56. Which medications could cause a false-positive stool guaiac? Select all that apply. 1) Iron 2) Aspirin 3) Tagamet 4) Digoxin 5) Acetaminophen 57. The nurse notes that an older patient has a low platelet count. Which medications should the nurse suspect are causing this laboratory value? Select all that apply. 1) Vicodin 2) Penicillin 3) Furosemide 4) Indomethacin 5) Quinidine sulfate 58. What physical conditions increase an older patient’s risk of developing malnutrition? Select all that apply. 1) Loss of appetite 2) Sensory deficits 3) Chronic illnesses 4) Issues shopping for groceries 5) Chewing and swallowing issues Completion Complete each statement.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
59. An older patient weighs 165 lb. How many grams of protein should this patient ingest to maintain a healthy immune system? Record your answer as a whole number.
Chapter 22: Laboratory Values and Older Adults Answer Section MULTIPLE CHOICE 1. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 410 Heading: Common Screening Tests Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Urinalysis is a routine baseline test. 2 Stool guaiac is a routine baseline test. 3 A drug screen is a diagnostic tool to evaluate the drugs that may be used or to evaluate symptoms and is not done routinely. 4 Cell blood count is a routine baseline test. PTS: 1 CON: Assessment 2. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 410 Heading: Urinalysis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Infection; Assessment Difficulty: Easy Feedback 1 Polyuria is not a typical symptom of a urinary tract infection. 2 Urinary frequency is a usual symptom of a urinary tract infection. 3 Incontinence is a usual symptom of a urinary tract infection. 4 Burning with voiding or dysuria is a usual symptom of a urinary tract infection. PTS: 1 CON: Infection | Assessment 3. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 410 Heading: Urinalysis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 The kidneys are very effective at returning glucose to the general circulation and excrete glucose only if the serum level is abnormally high. 2 It is normal to have a trace of protein in the urine. 3 It is normal to have a few red blood cells in the urine. 4 It is normal to have a few white blood cells in the urine. PTS: 1 CON: Assessment 4. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 414 Heading: Stool for Occult Blood (Stool Guaiac) Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Stool guaiac is a test to identify blood in the stool. 2 Stool guaiac does not identify parasites in the stool. 3 Stool guaiac does not identify abnormal epithelial cells in the stool. 4 Stool guaiac does not evaluate for white blood cell amounts in the stool. PTS: 1 CON: Assessment 5. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 414 Heading: Red Blood Cell Count Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
1 2 3 4
Dehydration may cause a false elevation in the number of red blood cells counted. Bacterial infections do not affect the red blood cell count. Recent hemorrhage or bleeding causes a decrease in the number of red blood cells. Viral infections do not affect the red blood cell count.
PTS: 1 CON: Assessment 6. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 415 Heading: Red Blood Cell Count Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Low hemoglobin is one of the laboratory results that is related to anemia. 2 Renal failure is not the most common disease process associated with a low hemoglobin value. 3 Osteoporosis is not the most common disease process associated with a low hemoglobin value. 4 Heart failure is not the most common disease process associated with a low hemoglobin value. PTS: 1 CON: Assessment 7. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 415 Heading: Hematocrit Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Hematocrit is not a comparison of red blood cells and white blood cells. 2 Hematocrit does not measure the oxygen-carrying capacity of the red blood cells. 3 Hematocrit is measured as a percentage; it is not a count of the total number of red blood cells. 4 Hematocrit is the percentage of blood volume that packed red blood cells represent. PTS: 1 8. ANS: 1
CON: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 415 Heading: Red Blood Cell Indices Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 There are many different types of anemia and red blood cell indices assist in classifying the anemia by providing information regarding the size of the red blood cells, the amount of hemoglobin concentration, and the hemoglobin weight of the average red blood cell. 2 Red blood cell indices are not used to diagnose heart failure. 3 Red blood cell indices are not used to diagnose respiratory diseases. 4 Red blood cell indices are not used to diagnose coronary heart disease. PTS: 1 CON: Assessment 9. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 417 Heading: Platelet Count Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Platelets provide the foundation for the formation of the fibrin clot. 2 The platelet level does not increase or decrease in response to an infection. 3 Platelets do not affect the thickness or smooth flow of blood in the capillaries. 4 Platelets do not have a role in the development of red blood cells and white blood cells. PTS: 1 CON: Assessment 10. ANS: 2 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 418 Heading: Coagulation Tests: Prothrombin Time (PT) Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Assessment Difficulty: Easy Feedback 1 Clotting times are not related to thinness of blood. 2 PT measures the portion of the clotting cascade that is changed with oral anticoagulant treatment. PT could identify defects in the clotting cascade that could be useful in calculating bleeding risk. 3 PT is not used to identify older adults who are at risk for the development of bleeding disorders. 4 Clotting times are not related to dissolving of clots. PTS: 1 CON: Assessment 11. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 419 Heading: Partial Thromboplastin Time or Activated Partial Thromboplastin Time Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 APTT evaluates all clotting factors by measuring the time needed to form a clot. 2 It is more sensitive than PTT. 3 APTT evaluates all clotting factors by measuring the time needed to form a clot. It is more sensitive than PTT. APTT is used for monitoring anticoagulation by heparin. 4 If laboratory values are below the therapeutic range, clotting occurs too quickly, meaning that anticoagulation therapy has been unsuccessful. PTS: 1 CON: Assessment 12. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 419 Heading: Blood Glucose, Plasma Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Hunger is a symptom of a low blood glucose level. 2 Sweating is a symptom of a low blood glucose level. 3 Restlessness is a symptom of a low blood glucose level.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
When serum glucose levels are elevated the body attempts to get rid of the glucose by increasing urinary output.
PTS: 1 CON: Assessment 13. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 420 Heading: Blood Glucose, Plasma Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Anemia is not related to elevated blood glucose levels. 2 Renal failure is not related to elevated blood glucose levels. 3 Elevated blood glucose levels are the primary sign of diabetes mellitus. 4 Degenerative joint disease is not related to elevated blood glucose levels. PTS: 1 CON: Assessment 14. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 421 Heading: Sodium, Serum Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Hyponatremia is a low sodium blood level. 2 Hypernatremia is a high sodium blood level. 3 Hypokalemia is a low serum potassium level. 4 Hyperkalemia is a high serum potassium level. PTS: 1 CON: Assessment 15. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 422 Heading: Potassium, Serum Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Hyponatremia is a low sodium blood level. 2 Hypernatremia is a high sodium blood level. 3 Hypokalemia is a low serum potassium level. 4 Hyperkalemia is a high serum potassium level. PTS: 1 CON: Assessment 16. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 422 Heading: Potassium, Serum Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Potassium is the ion that regulates muscle activity by maintaining electrical conduction within cardiac muscle. The heart is the most important muscle of the body. If potassium levels are elevated, this could cause muscle irritability, creating an irregular heartbeat. 2 Elevated sodium level could cause pedal edema. 3 Elevated sodium levels could cause hypertension. 4 Elevated sodium levels could cause a reduction in urine output. PTS: 1 CON: Assessment 17. ANS: 2 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 423 Heading: Chloride, Serum Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Chloride does not have a role in wound healing. 2 Chloride helps the body to maintain acid-base balance. 3 Chloride does not have a role in hormone secretion. 4 Chloride does not have a role in calcium absorption.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Assessment 18. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 422 Heading: Potassium, Serum Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Potassium does not regulate blood flow. 2 Potassium does not regulate water retention. 3 Potassium does not regulate insulin secretion. 4 Potassium is the ion that primarily moves across the cell membrane into the intracellular space, causing an electrical impulse. PTS: 1 CON: Assessment 19. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 424 Heading: End Products of Metabolism Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 BUN and creatinine are waste products of metabolism that are excreted by the kidneys. Increased levels of serum BUN and creatinine may indicate decreased kidney function. 2 BUN and creatinine are not used to monitor cardiac function. 3 BUN and creatinine are not used to monitor acid-base balance. 4 BUN and creatinine are not used to monitor tissue repair ability. PTS: 1 CON: Assessment 20. ANS: 2 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 424 Heading: Uric Acid, Serum Integrated Processes: Nursing Process: Assessment
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Bilirubin is the product of red blood cell destruction and is not related to gout. 2 Uric acid is the byproduct of purine metabolism. Elevations of uric acid in an older adult with acute inflammation of a joint are often diagnostic of gouty arthritis. 3 Creatinine is a waste product of metabolism and is used to measure renal function. Creatinine levels are not elevated in gout. 4 BUN is a waste product of metabolism and is used to measure renal function. BUN is not elevated in gout. PTS: 1 CON: Assessment 21. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 417 Heading: Erythrocyte Sedimentation Rate Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 ESR is not used to diagnose diabetes. 2 ESR is not used to diagnose heart failure. 3 ESR is not used to diagnose diverticulitis. 4 Normal ESR levels are 1 to 30 mm/hr in people over 60 years of age. In older people an elevated ESR is associated with temporal arteritis, which is common in the elderly. PTS: 1 CON: Assessment 22. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 414 Heading: Stool for Occult Blood (Stool Guaiac) Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Nursing Roles Difficulty: Moderate Feedback 1 Bowel preparations are unnecessary before a stool guaiac examination. 2 Bowel preparations are unnecessary before a stool guaiac examination. 3 Red meat that is ingested before a stool guaiac examination can invalidate the results.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
Vitamin C intake can cause false-positive results.
PTS: 1 CON: Nursing Roles 23. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 416 Heading: White Blood Cell Count Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Cellular Regulation Difficulty: Moderate Feedback 1 The number of white blood cells increases in response to inflammation. 2 Stress generally increases the white blood cell count. 3 Infection generally causes an elevation in the number of white blood cells, however, in an immunocompromised older adult there may be no elevation. 4 Radiation and chemotherapy treatment for cancer can cause depression of the ability of bone marrow to manufacture white blood cells. PTS: 1 CON: Cellular Regulation 24. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 422 Heading: Calcium, Plasma Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 Low serum calcium does not cause constipation. 2 Low serum calcium does not cause excessive thirst. 3 Low serum calcium levels can cause muscle cramping. 4 Low serum calcium does not cause bone and joint aching. PTS: 1 CON: Assessment 25. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 425 Heading: Liver Function Tests Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering]
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Concept: Assessment Difficulty: Easy Feedback 1 Liver function tests do not increase with aging. 2 Liver function tests do not decrease with aging. 3 Liver function tests do not lose reliability with aging. 4 Most liver function test results remain unchanged with aging. PTS: 1 CON: Assessment 26. ANS: 2 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 429 Heading: Lipoproteins Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy Feedback 1 Low total cholesterol decreases the risk of coronary artery disease. 2 Elevation of low-density lipids is a risk factor for the development of coronary artery disease. 3 Elevated high-density lipids decrease the risk of coronary artery disease. 4 Low level of plasma triglycerides decreases the risk of coronary artery disease. PTS: 1 CON: Assessment 27. ANS: 2 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 425 Heading: Alkaline Phosphatase Level Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy Feedback 1 Calcium levels might be low or unchanged in osteoporosis. 2 Alkaline phosphatase levels may increase secondary to osteoporosis. 3 Osteoporosis does not affect white blood cell count. 4 ALT is used to determine liver cell damage. PTS: 1 CON: Assessment 28. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 426 Heading: Liver Function Tests Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy Feedback 1 Serum protein would be unchanged by the cellular damage of MI. 2 CK II would be elevated in an acute MI. 3 ALT would be elevated in an acute MI. 4 AST would be elevated in an acute MI. PTS: 1 CON: Assessment 29. ANS: 2 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 428 Heading: Iron Indicators Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy Feedback 1 Iron can cause constipation. 2 Iron deficiency anemia is caused by gastrointestinal blood loss or malabsorption. 3 Iron is essential to the function of hemoglobin. 4 Serum iron may be depleted even though iron stores increase. PTS: 1 CON: Assessment 30. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 429 Heading: Lipoproteins Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy Feedback 1 Older people may have a total cholesterol level within normal range but have low HDL and elevated LDL levels and be at increased risk for coronary heart disease. 2 Triglyceride levels should be low to guard against coronary heart disease. 3 A decreased incidence of coronary heart disease is associated with high HDL cholesterol, low LDL cholesterol, and low triglyceride levels.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
4
Although total cholesterol levels are valuable tools, they should be combined with a measure of HDL and LDL cholesterol.
PTS: 1 CON: Assessment 31. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 410 Heading: Tuberculin Skin Test Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Infection; Health Promotion Difficulty: Moderate
1 2 3
4
Feedback The test should be repeated in 1 to 2 weeks. A chest x-ray is not indicated at this time. Anergy is common in older people. Because of this decreased ability to elicit an inflammatory response to the intradermal tuberculin solution, a second intradermal purified protein derivative (PPD) injection is recommended 1 to 2 weeks after the first one. The patient’s area of induration does not indicate active disease. Medication is not needed at this time.
PTS: 1 CON: Infection | Health Promotion 32. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 423 Heading: Phosphate, Serum Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 A phosphate deficiency does not cause renal failure. 2 An excess of phosphate does not cause renal failure. 3 Phosphate is not used by the kidneys for adequate functioning. 4 The kidneys regulate phosphate excretion to maintain a balance with serum calcium. PTS: 1 CON: Fluid and Electrolyte Balance 33. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 424
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Heading: Creatinine, Serum Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Urinary Elimination Difficulty: Moderate Feedback 1 Serum sodium levels are not directly related to the GFR. 2 Serum calcium levels are not directly related to the GFR. 3 Serum creatinine levels are directly related to the GFR. 4 Serum potassium levels are not directly related to the GFR. PTS: 1 CON: Urinary Elimination 34. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 416 Heading: White Blood Cell Differential Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Comprehension [Understanding] Concept: Infection Difficulty: Easy Feedback 1 Often, infectious processes are missed in older adults because they do not have the typical white blood cell elevation of a younger person during infections. 2 There is usually not a decrease in white blood cell counts. 3 There is not a dramatic elevation in white blood cell counts. 4 The white blood cell response is not the same as a younger person. PTS: 1 CON: Infection 35. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 2. Apply an understanding of laboratory tests to the health of elderly persons. Chapter page reference: 415 Heading: Hemoglobin Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Comprehension [Understanding] Concept: Hematologic Regulation Difficulty: Moderate Feedback 1 A low hemoglobin level adversely affects the amount of oxygen in body tissues. This causes fatigue. 2 Peripheral edema is not associated with a low hemoglobin level. 3 Low urine output is not associated with a low hemoglobin level. 4 Elevated blood pressure is not associated with a low hemoglobin level.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Hematologic Regulation 36. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 420 Heading: Blood Glucose, Plasma Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Metabolism; Medication Difficulty: Easy Feedback 1 Insulin is the intravenous (IV) or subcutaneous medication that decreases blood glucose by facilitating cellular access. 2 Corticosteroids can increase blood glucose level. 3 Furosemide (Lasix) can increase blood glucose level. 4 Phenytoin (Dilantin) can increase blood glucose level. PTS: 1 CON: Metabolism | Medication 37. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 430 Heading: Digoxin (Lanoxin) Level, Serum Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Comprehension [Understanding] Concept: Medication Difficulty: Easy Feedback 1 Digoxin is not used to treat diabetes. 2 Digoxin is not used to treat seizure disorder. 3 Digoxin is not used to treat renal insufficiency. 4 Digoxin is used to treat congestive heart failure and cardiac arrhythmias. PTS: 1 CON: Medication 38. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 430 Heading: Digoxin (Lanoxin) Level, Serum Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Pharmacological Therapies
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Comprehension [Understanding] Concept: Medication Difficulty: Easy Feedback 1 The same dose could lead to digoxin toxicity. 2 Increasing the dose could cause life-threatening problems. 3 Absorption levels increase with the change from pill to elixir, therefore a decreased dosage is used to prevent digoxin toxicity. 4 The dose will not fluctuate. PTS: 1 CON: Medication 39. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 430 Heading: Digoxin (Lanoxin) Level, Serum Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication Difficulty: Moderate Feedback 1 This is a normal value. 2 This is a normal value. 3 Patients receiving digoxin are at high risk from arrhythmias secondary to low potassium levels. This is a low level which should cause the nurse concern. 4 This is a normal value. PTS: 1 CON: Medication 40. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 431 Heading: Theophylline, Serum Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback 1 Theophylline is not a diuretic. 2 Theophylline is not an antibiotic. 3 Theophylline is not a vasodilator. 4 Theophylline is a bronchodilator.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
PTS: 1 CON: Medication 41. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 431 Heading: Theophylline, Serum Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy Feedback 1 Nausea is associated with theophylline toxicity. 2 Restlessness is associated with theophylline toxicity. 3 Arrhythmias are associated with theophylline toxicity. 4 Visual disturbances are not a common symptom of theophylline toxicity, they are a common symptom of digoxin toxicity. PTS: 1 CON: Medication 42. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 432 Heading: Phenytoin (Dilantin), Serum Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication Difficulty: Moderate Feedback 1 Folic acid would not be affected. 2 Phenytoin level will be affected. 3 Phenytoin level would not decrease. 4 Isoniazid, aspirin (acetylsalicylic acid), and cimetidine (Tagamet) all would cause an increase in serum phenytoin levels. PTS: 1 CON: Medication 43. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 418 Heading: Folic Acid and Vitamin B-12 Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Cognitive level: Analysis [Analyzing] Concept: Medication Difficulty: Moderate Feedback 1 Digoxin does not affect vitamin B12 or folic acid levels. 2 Penicillin does not affect vitamin B12 or folic acid levels. 3 Metformin, a common oral drug for diabetes, may decrease folic acid and vitamin B12. 4 Theophylline does not affect vitamin B12 or folic acid levels. PTS: 1 CON: Medication 44. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 420 Heading: Blood Glucose: Plasma Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication Difficulty: Moderate Feedback 1 Digoxin has no effect on blood glucose. 2 Phenytoin can increase blood glucose. 3 Furosemide may increase blood glucose. 4 Beta blockers may cause hypoglycemia. PTS: 1 CON: Medication 45. ANS: 1 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 5. Describe nursing actions appropriate for abnormal laboratory values Chapter page reference: 413 Heading: Urinalysis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Assessment Difficulty: Easy Feedback 1 All random urine specimens need at least 10 ml of urine for analysis. 2 A random urine specimen does not need 30 mL of urine. 3 A random urine specimen does not need 240 mL of urine. 4 A random urine specimen does not need a 24-hour urine specimen. PTS: 1 CON: Assessment 46. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter/learning objective: 5. Describe nursing actions appropriate for abnormal laboratory values Chapter page reference: 415 Heading: Red Blood Cell Count Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Hematologic Regulation Difficulty: Moderate Feedback 1 Increasing the iron dosage is not typically done. 2 There is no need to reduce oral fluid intake. 3 Red meat would help with iron stores. 4 If levels are extremely low, a blood or packed red blood cell (PBRC) transfusion might be ordered by the physician. PTS: 1 CON: Hematologic Regulation 47. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 5. Describe nursing actions appropriate for abnormal laboratory values Chapter page reference: 430 Heading: Digoxin (Lanoxin) Level, Serum Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1 This is immediately after the patient receives a dose of the medication. 2 This is too soon after the patient takes a dose of the medication. 3 Draw blood samples for determining serum digoxin levels at least 5 to 6 hours after the daily dose. The best time to have this sample drawn would be at 1600 hours. 4 This is inappropriate in that it would disturb the patient’s sleep. PTS: 1 CON: Assessment 48. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 5. Describe nursing actions appropriate for abnormal laboratory values Chapter page reference: 419 Heading: International Normalized Ratio Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Hematologic Regulation Difficulty: Moderate Feedback 1 Hemoglobin is not used to evaluate the effectiveness of oral anticoagulants. 2 Red blood cell count is not used to evaluate the effectiveness of oral anticoagulants.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3 4
Partial thromboplastin time is used to evaluate the effectiveness of heparin. The international normalized ratio is used to evaluate the effectiveness of oral anticoagulants.
PTS: 1 CON: Hematologic Regulation 49. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 6. List and describe rationale for laboratory tests related to social and lifestyle choices. Chapter page reference: 426 Heading: Nutritional Indicators Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Nutrition Difficulty: Easy Feedback 1 Serum albumin is used to determine nutritional status. 2 Serum creatinine is used to determine nutritional status. 3 Creatinine kinase is used for evaluating cardiac function and status of muscle tissue. 4 CBC is used to determine nutritional status. PTS: 1 CON: Nutrition 50. ANS: 4 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 6. List and describe rationale for laboratory tests related to social and lifestyle choices. Chapter page reference: 427 Heading: Total Serum Protein Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Nutrition Difficulty: Moderate Feedback 1 There is no reason to believe that the patient’s urine will be concentrated. 2 The laboratory values will not be within normal limits. 3 There is no reason to believe that the patient’s white blood cell count will be elevated. 4 Although it is possible that there is an underlying infection or that the patient is dehydrated, the signs and symptoms of dermatitis, hair loss, and weakness, added to a non-healing wound, would lead to a decreased serum protein level. PTS: 1 CON: Nutrition 51. ANS: 2 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 6. List and describe rationale for laboratory tests related to social and lifestyle choices.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 429 Heading: Nutritional Indicators Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Nutrition Difficulty: Easy Feedback 1 Lipids evaluate fat stores. 2 Serum transferrin is an indicator of protein stores. 3 Blood glucose helps determine carbohydrate stores. 4 Specific laboratory tests are used to determine vitamin stores. PTS: 1 CON: Nutrition 52. ANS: 3 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 6. List and describe rationale for laboratory tests related to social and lifestyle choices. Chapter page reference: 427 Heading: Protein Indicators Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Cellular Regulation; Nutrition Difficulty: Easy Feedback 1 Albumin is decreased in liver disease. 2 Albumin is decreased in hyperthyroidism. 3 Albumin is increased in multiple myeloma. 4 Albumin is decreased in rheumatoid arthritis. PTS: 1
CON: Cellular Regulation | Nutrition
MULTIPLE RESPONSE 53. ANS: 2, 3, 5 Feedback 1. Calcium is not part of the clotting cascade. 2. Calcium is excreted in the urine and feces. 3. A lack of calcium causes dysrhythmias. 4. Calcium is not an essential electrolyte for fluid and electrolyte balance. 5. Daily calcium (1 g/day) is needed because calcium is stored in bone and teeth and not readily available. Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Chapter page reference: 422 Heading: Calcium, Plasma Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy PTS: 1 CON: Assessment 54. ANS: 1, 3, 4, 5 Feedback 1. Folic acid decrease indicates anemia. 2. Folic acid decreases are not associated with heart failure. 3. Folic acid decrease indicates liver disease. 4. Folic acid decrease indicates renal disease. 5. Folic acid decrease indicates protein malnutrition. Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 418 Heading: Folic Acid and Vitamin B-12 Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Assessment Difficulty: Easy PTS: 1 55. ANS: 1, 5 1. 2. 3. 4. 5.
CON: Assessment Feedback Because the heart rate is irregular it should be measured apically for 1 full minute. The nurse cannot change the prescribed dose of medication. The nurse cannot change the prescribed dose of the medication. The patient’s health status could deteriorate if the medication is provided. A sudden change in rate or rhythm should be reported to the physician. The nurse should suspect digoxin toxicity and withhold the medication until speaking with the physician.
Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 430 Heading: Digoxin (Lanoxin) Level, Serum Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Application [Applying] Concept: Medication
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
Difficulty: Moderate PTS: 1 56. ANS: 1, 2 1. 2. 3. 4. 5.
CON: Medication Feedback Iron supplements can invalidate a stool guaiac results. Aspirin can invalidate a stool guaiac results. Tagamet has no impact on a stool guaiac. Digoxin has no impact on a stool guaiac. Acetaminophen has no impact on a stool guaiac.
Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 413 Heading: Stool for Occult Blood (Stool Guaiac) Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Knowledge [Remembering] Concept: Medication Difficulty: Easy PTS: 1 CON: Medication 57. ANS: 2, 3, 4, 5 Feedback 1. Vicodin is not identified as a drug that causes a low platelet count. 2. Drugs that can cause a low platelet count include penicillin. 3. Drugs that can cause a low platelet count include furosemide. 4. Drugs that can cause a low platelet count include Indomethacin. 5. Drugs that can cause a low platelet count include quinidine sulfate. Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 4. Identify medications that have an influence on laboratory tests for elderly patients. Chapter page reference: 417 Heading: Platelet Count Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological Therapies Cognitive level: Analysis [Analyzing] Concept: Medication Difficulty: Moderate PTS: 1 CON: Medication 58. ANS: 1, 2, 3, 5 Feedback 1. Physical reasons for malnutrition include loss of appetite. 2. Physical reasons for malnutrition include sensory deficits.
Test Bank: Anderson’s Caring For Older Adults Holistically 6th Edition Tamara R. Dahlkemper
3. 4. 5.
Physical reasons for malnutrition include chronic illnesses. An issue with grocery shopping is an environmental issue for malnutrition. Physical reasons for malnutrition include chewing and swallowing issues.
Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 6. List and describe rationale for laboratory tests related to social and lifestyle choices. Chapter page reference: 427 Heading: Focused Learning Chart Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Knowledge [Remembering] Concept: Nutrition Difficulty: Easy PTS: 1
CON: Nutrition
COMPLETION 59. ANS: 60 Chapter number and title: Chapter 22: Laboratory Values and Older Adults Chapter/learning objective: 1. Identify laboratory tests that are important indicators of health and disease in elderly patients. Chapter page reference: 428 Heading: Globulins, Serum Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Immunity; Nutrition Difficulty: Moderate Feedback: The older patient needs to ingest 0.8 grams of protein per kg of body weight. To determine this patient’s protein needs first determine the weight in kg by dividing the weight in lb by 2.2 or 165/2.2 = 75 kg. Then multiply the weight in kg by 0.8 g or 75 kg x 0.8 g = 60 grams. The patient should ingest 60 grams of protein each day. PTS: 1
CON: Immunity | Nutrition
