This study guide examines Gerontologic course in nursing.
In this guide, you will find the following study materials:
- Test Bank For Gerontologic Nursing 6th Edition by Sue Meiner, and Jennifer Yeager
- Test Bank for Gerontological Nursing Competencies for Care 4th Edition Mauk
- Test bank for ebersole and hess gerontological nursing and healthy aging 6th edition
- Test Bank for Gerontological Nursing 10th Edition Eliopoulos
- Test Bank for Aging and the Life Course an Introduction to Social Gerontology, 7th Edition, Jill Quadagno
- N212 GERO ATI 2.0 Gerontology Quiz
Test Bank 1. Gerontologic Nursing Test Bank by Meiner, 6th Edition
MULTIPLE CHOICE
1. In 2010, the revised Standards and Scope of Gerontological Nursing Practice was published. The nurse would use these standards to:
a. promote the practice of gerontologic nursing within the acute care setting.
b. define the concepts and dimensions of gerontologic nursing practice.
c. elevate the practice of gerontologic nursing.
d. incorporate suggested interventions from others who practice gerontologic nursing. ANS: D
The current publishing of the Standards and Scope of Gerontological Nursing Practice in 2010 incorporates the input of gerontologic nurses from across the United States. It was not intended to promote gerontologic nursing practice within acute care settings, define concepts or dimensions of gerontologic nursing practice, or elevate the practice of gerontologic nursing. DIF: Remembering (Knowledge) REF: Page 2 OBJ: 1-1
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2. When attempting to minimize the effect of ageism on the practice of nursing older adults, a nurse needs to first:
a. recognize that nurses must act as advocates for aging patients.
b. accept that this population represents a substantial portion of those requiring nursing care. c. self-reflect and formulate one’s personal view of aging and the older patient.
d. recognize ageism as a form of bigotry shared by many Americans.
ANS: C
Ageism is an ever-increasing prejudicial view of the effects of the aging process and of the older population as a whole. With nurses being members of a society holding such views, it is critical that the individual nurse self-reflect on personal feelings and determine whether such feelings will affect the nursing care that he or she provides to the aging patient. Acting as an advocate is an important nursing role in all settings. Simply accepting a fact does not help end ageism, nor does recognizing ageism as a form of bigotry.
DIF: Applying (Application) REF: N/A OBJ: 1-9
TOP: Teaching-Learning MSC: Safe and Effective Care Environment
3. When discussing factors that have helped to increase the number of healthy, independent older Americans, the nurse includes the importance of:
a. increased availability of in-home care services. b. government support of retired citizens.
c. effective antibiotic therapies.
d. the development of life-extending therapies. ANS: C
The health and ultimate autonomy of older Americans has been positively impacted by the development of antibiotics, better sanitation, and vaccines. These public health measures have been more instrumental in increasing the numbers of healthy, independent older Americans than have in-home care services, government programs, or life-extending therapies.
DIF: Remembering (Knowledge) REF: Page 2 OBJ: 3-3
TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance
4. Based on current data, when presenting an older adult’s discharge teaching plan, the nurse includes the patient’s:
a. nonrelated caretaker.
b. paid caregiver.
c. family member.
d. intuitional representative.
ANS: C
Less than 4% of older adults live in a formal health care environment. The majority of the geriatric population lives at home or with family members.
DIF: Applying (Application) REF: N/A OBJ: 3-3
TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment
5. The nurse planning care for an older adult who has recently been diagnosed with rheumatoid arthritis views the priority criterion for continued independence to be the patient’s:
a. age.
b. financial status.
c. gender.
d. functional status.
ANS: D
Maintaining the functional status of older adults may avert the onset of physical frailty and cognitive impairment, two conditions that increase the likelihood of institutionalization.
DIF: Remembering (Knowledge) REF: Page 8 OBJ: 1-6
TOP: Nursing Process: Planning MSC: Physiologic Integrity
6. A nurse working with the older adult population is most likely to assess a need for a financial social service’s referral for a(n):
a. white male.
b. black female.
c. Hispanic male.
d. Asian American female. ANS: B
The poverty rate among older black women is substantially higher than that seen among males or females of other ethnic groups. White males had the least poverty.
DIF: Applying (Application) REF: N/A OBJ: 1-4
TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment
7. Which of the following statements made by a nurse preparing to complete a health assessment and history on an older patient reflects an understanding of the general health status of this population?
a. “I’ll need to document well regarding the medications the patient is currently prescribed.”
b. “I would like to understand how supportive the patient’s family members are.”
c. “Most older patients are being treated for a variety of chronic health care issues.”
d. “It will be interesting to see whether this patient sees herself as being healthy.” ANS: D
It is a misconception that old age is synonymous with disease and illness. The nurse should always determine the patient’s sense of wellness and independence when conducting a health and history assessment. An assessment of medication use and family support is important for any patient. Many older adults do have chronic health conditions, but their perception is more important than a single number.
DIF: Applying (Application) REF: N/A OBJ: 1-4
TOP: Nursing Process: Assessment MSC: Health Promotion
8. The nurse is caring for an older adult who has been admitted to an acute care hospital for treatment of a fractured femur. The family expresses concern about the patient’s pending transfer to a subacute care facility. What response by the nurse is best?
a. “Acute care facilities lack the long-term physical therapy support your dad requires.”
b. “Your dad will be much happier in a more serene, private environment.”
c. “The subacute facility will focus on helping your dad maintain his independence.”
d. “Insurance, including Medicare, will cover only a limited amount of time here.”
ANS: C
The transfer of the patient to a subacute facility is based on the need to maintain the patient’s level of function and independence, a task the acute care facility is not prepared to address once the patient is physiologically stable. The patient may or may not be happier in the new setting; the nurse should not make this judgment. It is true that insurance only pays for a limited amount of time in an acute care facility, but this is not the best reason for the patient to transfer.
DIF: Applying (Application) REF: N/A OBJ: 1-6
TOP: Communication and Documentation
MSC: Health Promotion and Maintenance
9. To best assure both the quality of care and the safety of the older adult patient who requires in-home unlicensed assistive personal (UAP) assistance, the geriatric nurse:
a. evaluates the competency of the UAP staff.
b. assumes the roles of case manager and patient advocate. c. arranges for the needed UAP provided services.
d. assesses the patient for functional limitations.
ANS: A
As more care traditionally provided by professional nurses is being transferred to UAP, the nurse must assume more responsibility for educating, training, and evaluating the competency of UAP staff to provide safe, effective care for the older adult patient.
DIF: Applying (Application) REF: N/A OBJ: 1-2
TOP: Communication and Documentation
MSC: Safe and Effective Care Environment
10. The nurse working with older adults understands what information about certification in gerontologic nursing?
a. It is mandatory for those in long-term care settings.
b. It is voluntary and shows clinical expertise in an area. c. It allows nurses to be paid by third-party payers.
d. It allows nurses to advance their careers in a job.
ANS: B
Certification is voluntary and shows that a nurse has additional knowledge and expertise in a certain area of practice. It is not mandatory in specific care settings. It does not allow for third-party reimbursement. It may be part of a career ladder
program, but that is not true of all work settings.
DIF: Remembering (Knowledge) REF: Page 2 OBJ: 1-2
TOP: Teaching-Learning MSC: Safe Effective Care Environment
11. A nurse works in a gerontologic clinic. What action by the nurse takes highest priority?
a. Serving as a patient advocate
b. Educating patients about diseases
c. Helping patients remain independent d. Referring patients to home health care
ANS: C
One of the challenges and priorities of the gerontologic nurse is helping patients maintain their independence. DIF: Remembering (Knowledge) REF: Page 10 OBJ: 1-2
TOP: Nursing Process: Implementation MSC: Health Promotion
12. A nurse is caring for an older patient in the emergency department. What information about the patient will be most helpful in creating a plan of care?
a. Baseline physical and cognitive functioning
b. Living conditions and family support
c. Medications and current medical problems
d. Results of the Mini Mental State examination
ANS: A
The nurse is encouraged to view older patients as individuals and consider their baseline physical and cognitive functional status as a standard by which to compare the patient’s current status. The other information is also important, but the basis of individualized care begins with the patient’s strengths and weaknesses.
DIF: Applying (Application) REF: N/A OBJ: 1-6
TOP: Nursing Process: Assessment MSC: Health Promotion
13. The faculty member explains to students that many older Americans continue to work past the “retirement age.” What best explains this trend?
a. Feeling healthier longer
b. Changing financial outlook
c. Becoming bored in retirement
d. A desire to give back
ANS: B
As financial situations may have declined as a result of many economic factors, more older adults work past their “retirement age.” The other options may be reasons for some to continue working, but financial necessity is the reason the majority continue to do so.
DIF: Remembering (Knowledge) REF: Page 7 OBJ: 1-3
TOP: Teaching-Learning MSC: Health Promotion
14. What information does the faculty member teach students about Medicare?
a. Covers anyone with end stage renal disease
b. Part A covers some prescription costs
c. Part B covers inpatient hospital costs
d. Part D eliminates the drug “donut hole” ANS: A
Although Medicare is primarily for those over the age of 65, it does cover people of any age with end-stage kidney disease. Part A covers hospital costs. Part B is medical insurance. The “donut hole“ was fixed by the Affordable Care Act.
DIF: Understanding (Comprehension) REF: Page 9 OBJ: 1-3
TOP: Teaching-Learning MSC: Health Promotion
15. A nursing manager notes that many older patients are admitted to the nursing unit for acute problems. What action can the manager take to most benefit this population?
a. Provide mandatory education on the needs of the older patient.
b. Provide restorative therapy programs designed for this group.
c. Ensure staffing numbers are adequate for dependent patients.
d. Encourage all nurses to obtain gerontologic certification.
ANS: B
Many older adults need acute care for sudden illness and injury but live in a state of functional decline, which could possibly be prevented by establishing a restorative therapy program. The other actions will help the older patients cared for in the unit, but only to limited degrees.
DIF: Applying (Application) REF: N/A OBJ: 1-4
TOP: Nursing Process: Implementation MSC: Physiologic Integrity: Reduction of Risk Potential
16. The dean of a new nursing program wishes to ensure graduates are prepared to care for older patients. What document should guide the dean in designing the curriculum?
a. The Nurse Practice Act for that state
b. The American Nurses Association (ANA) code of ethics for nurses c. Healthy People 2020
d. The Recommended Baccalaureate Competencies and Curricular Guidelines
ANS: D
The Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults is an updated version of The Essentials of Baccalaureate Education for Professional Nursing Practice. This document was first published by the American Association of Colleges of Nursing (AACN) in 2008 and was updated in 2010. The other three documents do not have information about curricular requirements to prepare students to care for the older population.
DIF: Applying (Application) REF: N/A OBJ: 1-2
TOP: Teaching-Learning MSC: Health Promotion
17. A nurse wants to plan a community event at a retirement center. What topic would most likely be best received?
a. Heart healthy living b. Financial planning
c. Avoiding scams
d. Ethnic cooking classes
ANS: A
Older adults are demanding more programs and services aimed at health maintenance and promotion and disease and disability prevention. Based on this information, the heart healthy living presentation would be best received.
DIF: Applying (Application) REF: N/A OBJ: 1-3
TOP: Teaching-Learning MSC: Health Promotion
18. What does the bedside nurse understand about his or her role in nursing research?
a. Research is only done by doctorally prepared nurses.
b. All nurses have a role in delivering research-based care. c. A bedside nurse can be part of a hospital research team.
d. The bedside nurse can collect data if the nurse has been properly trained.
ANS: B
All nurses are charged to deliver patient-centered care based on evidence-based practice, research, quality improvement, and informatics. The bedside nurse is part of an interdisciplinary team that is responsible for redesigning the health care structure of the future.
DIF: Understanding (Comprehension) REF: Page 13 TOP: Teaching-Learning
MSC: Safe Effective Care Environment: Management of Care
MULTIPLE RESPONSE
1. The clinic nurse caring for an older diabetic patient with a sixth grade education anticipates that the patient may experience difficulty (Select all that apply.)
a. recognizing the importance of keeping clinic appointments. b. following a low-carbohydrate diet.
c. paying for insulin and syringes.
d. deciding on a primary health care provider. e. naming a health care surrogate.
ANS: A, B, C
Even though the educational level of the older population has steadily increased, as a population they are less educated than the general population. This deficiency can account for a lack of understanding regarding the need for medical care and the importance of following a treatment plan. These patients may also have fewer financial resources to devote to health care issues.
DIF: Analyzing (Analysis) REF: N/A OBJ: 1-4
TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment
2. The nurse studying the history of gerontologic nursing learns which information about the specialty? (Select all that apply.)
a. The number of older Americans is diminishing.
b. The geriatric nursing conference group was established in 1962.
c. The gerontologic clinical nurse specialist certification was offered in 1989. d. There were no writings about the care of older persons until World War II. e. The first Standards of Practice for Geriatric Nursing was written in 1969.
ANS: B, C, E
The geriatric nursing conference group was established in 1962, the gerontologic clinical nurse specialist certification was first offered in 1989, and the first Standards of Practice for Geriatric Nursing was written in 1969. The population of older Americans is the fastest-growing subset of the population. Writings about care of the aged can be found from as early as
1900.
DIF: Remembering (Knowledge) REF: Page 2-3 OBJ: 1-2
TOP: Teaching-Learning MSC: Nursing Process: Assessment
3. The student asks the gerontologic clinic nurse why so many older people are women. What information does the nurse provide? (Select all that apply.)
a. Reduced maternal mortality
b. Decreased deaths from infectious diseases c. More deaths from chronic disease in men d. More deaths in war occur in men
e. Women tend to smoke and drink less than men
ANS: A, C, D
A decrease in maternal mortality, decreased deaths from infectious diseases, and more chronic illness in men account for the disparity in genders as people age.
DIF: Understanding (Comprehension) REF: Page 6 OBJ: 1-5
TOP: Teaching-Learning MSC: Health Promotion
4. The gerontologic nurse plans community programming for older women, noting what facts about this population subgroup? (Select all that apply.)
a. More likely to live alone
b. Increased chance of living in poverty c. Taking care of a spouse
d. Suffering many chronic diseases
e. Living with extended families
ANS: A, B, D
Older women have a greater chance than men of living alone and in poverty. They also have a greater degree of functional impairment and chronic disease.
DIF: Remembering (Knowledge) REF: Page 6 OBJ: 1-5
TOP: Nursing Process: Analysis MSC: Health Promotion
5. The nurse knows that the most common causes of death in the older population result from which diseases? (Select all that apply.)
a. Cerebrovascular disease b. End-stage kidney disease c. Heart disease
d. Cancer
e. Diabetes
ANS: A, C, D
The most common causes of death in the older population are cerebrovascular disease, heart conditions, and cancer. End- stage renal disease and diabetes are not among the top three causes of death.
Chapter 02: Theories of Aging
Meiner: Gerontologic Nursing, 5th Edition
MULTIPLE CHOICE
1. The practitioner who believes in the free radical theory of aging is likely to recommend that the older adult:
a. avoid excessive intake of zinc or magnesium.
b. supplement his or her diet with vitamins C and E. c. increase intake of complex carbohydrates.
d. avoid the use of alcohol or tobacco.
ANS: B
Vitamins C and E are two naturally occurring antioxidants that appear to inhibit the functioning of the free radicals or possibly decrease their production in the body. The free radical theory of aging is not related to zinc, magnesium, carbohydrates, or alcohol and tobacco.
DIF: Applying (Application) REF: N/A OBJ: 2-2
TOP: Nursing Process: Planning MSC: Health Promotion
2. To provide effective care to the older adult, the nurse must understand that:
a. older adults are not a homogeneous sociologic group. b. little variation exists in cohort groups of older adults.
c. health problems are much the same for similar age groups of older adults.
d. withdrawal by an older adult is a normal physiologic response to aging. ANS: A
The key societal issue addressed by the age stratification theory is the concept of interdependence between the aging person and society at large. This theory views the aging person as an individual element of society and also as a member, with peers, interacting in a social process. The theory attempts to explain the interdependence between older adults and society and how they constantly influence each other in a variety of ways. Variation exists among the members of a cohort. Health problems are not the same for every individual of the same age. Withdrawal by an older adult is not a normal response to aging but
may be a sign of depression.
DIF: Understanding (Comprehension) REF: Page 16 OBJ: 2-2
TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance
3. The nurse is using the eight stages of life theory to help an older adult patient assess the developmental stage of personal ego differentiation. The nurse does this by assisting the patient to:
a. determine feelings regarding the effects of aging on the physical being. b. describe feelings regarding what he or she expects the future to hold.
c. identify aspects of work, recreation, and family life that provide a sense of self-worth and pleasure.
d. elaborate on feelings about the prospect of his or her personal death. ANS: C
During the stage of ego differentiation versus work role preoccupation, the task for older adults is to achieve identity and feelings of worth from sources other than the work role. The onset of retirement and termination of the work role may reduce feelings of self-worth. In contrast, a person with a well-differentiated ego, who is defined by many dimensions, can replace the work role as the major defining source for self-esteem. Determining feelings related to the effects of aging, future death, or what the future may hold is not part of this theory.
DIF: Applying (Application) REF: N/A OBJ: 2-4
TOP: Nursing Process: Implementation MSC: Psychosocial Integrity
4. A patient is recovering from a mild cerebral vascular accident (stroke). The home care nurse notes that the patient is talking about updating a will and planning funeral arrangements. Which of the following responses is most appropriate for the nurse to make?
a. “You seem to be preoccupied with dying.”
b. “Is there anything I can do to help you?”
c. “Are you worried about dying before you get your affairs in order?”
d. “Let’s focus on how you are recovering rather than on your dying.” ANS: B
According to Peck’s expansion of Erikson’s theory, the older adult who has successfully achieved ego integrity and ego transcendence accepts death with a sense of satisfaction regarding the life led and without dwelling on its inevitability. The patient’s action reflects a healthy transition and should be supported.
DIF: Applying (Application) REF: N/A OBJ: 2-4
TOP: Nursing Process: Implementation MSC: Psychosocial Integrity
5. Your patient’s spouse died recently from a sudden illness after 45 years of marriage. The patient was the primary caregiver for the spouse during this time. The patient is now depressed and withdrawn and has verbalized feelings of uselessness. Which action by the nurse is best?
a. Encourage the patient take up a hobby that will occupy some time. b. Explain that volunteering would be an excellent way to stay useful. c. Assure the patient that these feelings of sadness will pass with time.
d. Ask the patient to share some cherished memories of the spouse.
ANS: B
Volunteering will help the patient to interact with people and feel productive and valued for the ability to help others as stated in the activity theory. A hobby does not offer the chance to help others. Assuring the patient that feelings will pass is false reassurance and does nothing to help the patient to be proactive. Reminiscing is a valued activity, but it is not the best choice for regaining a sense of usefulness.
DIF: Applying (Application) REF: N/A OBJ: 2-4
TOP: Nursing Process: Implementation MSC: Psychosocial Integrity
6. A patient has recently been diagnosed with end-stage renal disease. The patient has cried often throughout the day and finally confides in the nurse that “I am going home to be with my Lord.” The nurse’s best response is:
a. “There is no reason to believe the end is near.”
b. “Do you want me to call your family?”
c. “We have a wonderful chaplain if you’d like me to call him.”
d. “I think this is the time for us to pray together.” ANS: C
It is important for the nurse to acknowledge the spiritual dimension of a person and support spiritual expression and growth while addressing spirituality as a component in holistic care without imposing upon the patient. Because the patient has made reference to the Lord, the nurse can safely offer religion-oriented spiritual care. Telling the patient there is no reason to believe that death is near does not help the patient work through emotions. Asking about calling the family is a yes/no question and is not therapeutic. The nurse is assuming too much by saying it is time to pray.
DIF: Applying (Application) REF: N/A OBJ: 2-4
TOP: Nursing Process: Implementation MSC: Psychosocial Integrity
7. A nurse is responsible for the care of 20 older adults in a unit of an assisted living facility. In order to best address the needs and wants of the entire unit’s population, the nurse:
a. strictly adheres to facility policies so that all patients will be treated equally.
b. encourages specific age cohorts to gather in the dayroom because they share similar interests. c. has the unit vote on which television programs will be watched each evening.
d. schedules the patients’ bathing times according to their individual preferences.
ANS: D
Older adults continue to feel valued and viewed as active members of society when allowed to maintain a sense of control over their living environment by attention to personal choices and rituals. Adhering strictly to policies does not allow for individualized care. Not all in the same age cohort will have similar interests. Voting on television programs does not ensure each individual feels a sense of worth.
DIF: Applying (Application) REF: N/A OBJ: 2-5
TOP: Nursing Process: Planning MSC: Psychosocial Integrity
8. An older patient who reports being “healthy enough to cut my own fire wood” is being assessed prior to outpatient surgery. The nurse recognizes which assessment observation as a possible result of the wear-and-tear theory?
a. Swollen finger joints b. Red, watery eyes
c. Grimacing when raising left arm
d. Bilaterally bruising on the forearms
ANS: C
This theory proposes that cells wear out over time because of continued use. The pain caused by movement of the shoulder is the observation most likely a result of the patient’s practice of cutting his own firewood. The other choices do not
demonstrate continued use that is part of the wear-and-tear theory of aging. DIF: Applying (Application) REF: N/A OBJ: 2-2
TOP: Nursing Process: Assessment MSC: Physiologic Integrity
9. A nurse cares for many older patients. Which finding should the nurse identify as pathologic in a 72-year-old?
a. Two hospitalizations in 6 months for respiratory infections b. Patient reports of sleeping only of 5 to 6 hours each night
c. Thinning hair and brittle nails
d. Dry, tissue paper–like skin
ANS: A
Although there is an age-related decrease in immune function, reoccurring infections serious enough to require hospitalization are not considered a normal age-related finding. Decreased sleeping, thinning hair, brittle nails, and dry skin are all normal signs of aging.
DIF: Application (Apply) REF: N/A OBJ: 2-1
TOP: Nursing Process: Assessment MSC: Physiologic Integrity
10. In planning the care for an older adult patient, the nurse will best promote health and wellness by:
a. encouraging independent living and self-care.
b. scheduling regular cardiac and respiratory health screenings. c. effectively delivering health-related educational information.
d. promoting a nutritious diet and an age-appropriate exercise routine.
ANS: C
Providing well-prepared and effectively delivered health-related educational information will provide the best means of promoting a patient’s ability to impact his or her wellness and general health. Each of the other options is too narrow to be the most effective way to promote health and wellness.
DIF: Applying (Application) REF: N/A OBJ: 2-5
TOP: Nursing Process: Planning MSC: Health Promotion
11. The student learning about aging theories understands that the main difference between stochastic theories and nonstochastic theories is which of the following?
a. Stochastic theories view aging as a random, cumulative process. b. Stochastic theories view aging as similar among all people.
c. Nonstochastic theories view aging as a result of psychosocial factors.
d. Nonstochastic theories are backed by research, whereas stochastic theories are not. ANS: A
Stochastic theories view aging as a result of random events and their cumulative effects. Nonstochastic theories view aging as a result of predetermined, timed phenomena. Both are types of biologic theories.
DIF: Remembering (Knowledge) REF: Page 17 OBJ: 2-1
TOP: Teaching-Learning MSC: Physiologic Integrity: Physiologic Adaptation
12. Which theory of aging does the student learn is related to problems with DNA transcription?
a. Radical theory b. Error theory
c. Cross linkage theory
d. Wear-and-tear theory
ANS: B
The error theory poses that errors in DNA transcription lead to aging. The radical theory views the effects of free radicals as critical to aging. The cross linkage theory states that normally separated molecular structures are bound together through chemical reactions and that this interferes with metabolic processes. The wear-and-tear theory postulates that normal activity causes wear and tear on the body, leading to aging.
DIF: Remembering (Knowledge) REF: Page 19 OBJ: 2-1
TOP: Teaching-Learning MSC: Physiologic Integrity: Physiologic Adaptation
13. According to which theory does cancer occur as a possible result of aging?
a. Radical theory b. Error theory
c. Immunity theory
d. Pacemaker theory
ANS: C
Immunosenescence is the term used in immunity theory to describe an age-related decrease in immune functioning. According to this theory, as people age, they are more prone to getting cancer or autoimmune diseases because of this phenomenon. This is a nonstochastic theory. Radical and error theories are both stochastic. The pacemaker theory looks at the interrelated role of the neurologic and endocrine systems and aging.
DIF: Remembering (Knowledge) REF: Page 19 OBJ: 2-1
TOP: Teaching-Learning MSC: Physiologic Integrity: Physiologic Adaptation
14. A nurse assesses an older patient who has lost a great deal of weight in a short time. When asked, the patient states this behavior started after the patient read a magazine article on the benefits of extreme caloric restrictions. What response by the nurse is best?
a. “That research was done on rodents and not on humans.”
b. “You shouldn’t restrict your calories so severely.”
c. “You have lost so much weight you need dietary supplements.”
d. “You can’t believe everything you read in those magazines.” ANS: A
The metabolic theory of aging postulates that organisms have a specific metabolic lifetime and that by lowering metabolic rate, life span can be increased. However, this has been demonstrated in rodents and the nurse should educate the patient on this information. The other options do not give information that will help the patient make an informed decision as to whether or not to follow this activity.
DIF: Applying (Application) REF: N/A OBJ: 2-1
TOP: Communication and Documentation
MSC: Physiologic Integrity: Reduction of Risk Potential
15. A nurse is caring for an older patient who is sedentary and does not want to participate in any activities. What action by the nurse is best?
a. Inform the patient about the consequences of immobility.
b. Promote activity by explaining the “use it or lose it” concept. c. Tell the patient he or she will feel better by being more active. d. Explain the relationship of being active and being independent.
ANS: D
Activity increases circulation, provides range of motion, and leads to clearer mental functioning. Activity helps a person remain independent and able to perform activities of daily living (ADLs) and instrumental ADLs. Presenting information in a positive light that encourages the patient to take control of one’s own health is more likely to be successful than stressing the negative such as consequences of immobility or the concept of “use it or lose it.” Telling the patient that he or she will feel better does not give concrete information the patient can use to make decisions.
DIF: Applying (Application) REF: N/A OBJ: 2-4
TOP: Teaching-Learning MSC: Health Promotion
16. The nurse working with older patients teaches the student that disengagement theory potentially causes which problem?
a. Fear
b. Isolation c. Anxiety
d. Malnutrition
ANS: B
The no-longer supported disengagement theory posed that older people withdrew from society as they aged and that this was a mutually agreed upon behavior. The result would be isolation as the person became focused solely on him- or herself. Fear, anxiety, or malnutrition could be a further consequence, but isolation and withdrawal from society was “expected” according to this theory.
DIF: Understanding (Comprehension) REF: Page 22 OBJ: 2-5
TOP: Teaching-Learning MSC: Psychosocial Integrity
17. The nurse working in a long-term care facility used the developmental theory of aging in practice. In caring for a frail, nearly bed bound patient, how can the nurse use this theory?
a. Engage the patient in intellectually stimulating activities. b. Encourage the patient to participate in chair exercises.
c. Ensure that the patient participates in all the group activities.
d. Give the patient small “chores” to do for the facility. ANS: A
In this theory, being active can mean physical or intellectual activity. The nurse can engage the patient in intellectually stimulating activities that allows the person a sense of satisfaction. The other options all call for physical activity, which the patient may or may not be able to perform.
DIF: Applying (Application) REF: N/A OBJ: 2-4
TOP: Nursing Process: Implementation MSC: Psychosocial Integrity
18. The nurse working at a long-term care facility notes that one patient who is usually outgoing refuses to participate in games that require keeping score. What action by the nurse is best?
a. Ask the patient why he or she won’t participate.
b. Assess the patient’s level of frustration with these activities. c. Find other activities for the patient to participate in.
d. Do nothing; the patient can choose activities to engage in. ANS: B
Although it is true that patients should be able to choose activities in which to participate, the best option is to assess the patient for frustration or anxiety associated with these types of activities. Once that is determined, the nurse can find other activities the patient can engage in successfully and is willing to participate in if the games are not an option. Asking “why” questions often puts people on the defensive and is not a therapeutic communication technique.
DIF: Applying (Application) REF: N/A OBJ: 2-4
TOP: Nursing Process: Assessment MSC: Psychosocial Integrity
19. The nurse planning community events for older people uses sociologic theories to guide practice. Which activity planned by the nurse best fits these theories?
a. Group exercise programs b. Volunteering at a day care c. Healthy cooking classes
d. Reminiscing therapy
ANS: B
Using the sociologic theories to guide care, the nurse would plan events that allowed the older adult to remain active in the community and a valued member of society. Volunteering would offer the adult a way to stay engaged and provide a service to successive generations. Exercise and cooking classes would more fit in the biologic theories. Reminiscing therapy is a technique using psychological theories. All are good ideas for activities, but the one that specifically uses sociologic theory is the volunteer work.
DIF: Applying (Application) REF: N/A OBJ: 2-2
TOP: Nursing Process: Analysis MSC: Psychosocial Integrity
20. What statement by a patient most indicates healthy aging according to Jung?
a. “I wish I had traveled more when I was younger because now I can’t.”
b. “I am proud of my past accomplishments at work and home raising my kids.”
c. “My leg amputation makes things harder, but I still find a way to work.”
d. “I still like to read the paper and novels and enjoy a little gardening.” ANS: C
This patient shows acceptance of past accomplishments and finds value in him- or herself despite current limitations, which is healthy aging according to Jung. The person who wants to travel more displays remorse. The focus on past accomplishments does not show current acceptance. Reading and gardening do not show acceptance of past accomplishments.
DIF: Analyzing (Analysis) REF: N/A OBJ: 2-2
TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity
21. A nurse is trying to teach a hospitalized older patient how to self-inject insulin. The patient is restless and does not seem to be paying attention. What action by the nurse is best?
a. Ask if the patient needs to use the bathroom.
b. Tell the patient you’ll try again later in the day.
c. Ask if the patient prefers that you teach the family. d. Refer the patient for home health care services.
ANS: A
According to Maslow, physical needs take priority over other activities. This patient may be hungry, cold, tired, or need to
use the bathroom. Telling the patient you’ll try again later, asking if you should teach the family, and referring to home health care does not provide for any unmet physical needs.
DIF: Applying (Application) REF: N/A OBJ: 2-4
TOP: Nursing Process: Implementation MSC: Physiologic Integrity: Basic Care and Comfort
22. The new nurse at a long-term care center asks the director of nursing why he needs to learn so many theories of aging. What response by the director is best?
a. “No theories have been proven yet.”
b. “A wide range of theories allows for holistic care.”
c. “It’s required knowledge for certification exams.”
d. “All the theories are important, so we use them all.” ANS: B
Using a combination of different theories, each with its own focus, allows the nurse to plan individualized, holistic nursing care.
DIF: Applying (Application) REF: N/A OBJ: 2-5
TOP: Communication and Documentation MSC: Psychosocial Integrity
MULTIPLE RESPONSE
1. According to Maslow, a fully actualized person displays which traits? (Select all that apply.)
a. Spontaneity
b. Self-direction c. Creativity
d. Ethical conduct
e. Acceptance of self
ANS: A, B, C, E
A fully actualized person displays the following characteristics: perception of reality; acceptance of self, others, and nature; spontaneity; problem-solving ability; self-direction; detachment and the desire for privacy; freshness of peak experiences; identification with other human beings; satisfying and changing relationships with other people; a democratic character structure; creativity; and a sense of values. Maslow does not specify ethical conduct.
Chapter 03: Legal and Ethical Issues(FREE) Chapter 03: Legal and Ethical Issues Meiner: Gerontologic Nursing, 5th Edition MULTIPLE CHOICE
1. A nurse caring for older adult patients shows an understanding of the implementation of standards of care when:
a. dialing the telephone when the patient wants to call his daughter. b. requesting the patient’s favorite dessert on his birthday.
c. closing the patient’s door when he is praying.
d. reminding the patient to call for assistance before getting out of bed. ANS: D
A standard of care is a guideline for nursing practice and establishes an expectation for the nurse to provide safe and appropriate care, such as reminding the patient to call for assistance before getting out of bed. Standards of care may be established on national or regional levels. Dialing the phone for the patient, closing the patient’s door, and requesting a special dessert are not actions that conform to standards of care.
DIF: Applying (Application) REF: N/A OBJ: 3-1
TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment
2. A nurse new to geriatric nursing asks the nurse manager to clarify how to handle a patient’s claim that she has been physically abused. The nurse manager responds most appropriately when stating:
a. “I’ll show you where you can find this state’s reporting requirements.” b. “As a nurse you are considered a ‘mandated reporter’ of elder abuse.” c. “As long as you are reasonably sure abuse has occurred, report it.”
d. “You need to report any such claims directly to me.” ANS: A
To be responsive to the legal obligation to report reasonably suspicious acts of abuse and because there is great variation among the states, nurses should determine the specific reporting requirements of their jurisdictions, including where reports and complaints are received and in what form they must be made. The statements that the nurse is a mandatory reporter and that abuse should be reported if suspected are true, but they do not help the nurse learn to handle the complaint. The manager may want to know about claims of abuse and it may be facility policy to report up the chain of command, but the nurse is responsible for filing the formal complaint.
DIF: Applying (Application) REF: N/A OBJ: 3-8
TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment
3. The nurse recognizes that a nursing aide likely to abuse an older patient is one who has:
a. ineffective verbal communication skills.
b. little experience working with the older population. c. poor stress management skills.
d. been a victim of abuse.
ANS: C
It has been shown that the primary abusers of nursing facility residents are nurse aides and orderlies who have never received training in stress management.
DIF: Remembering (Knowledge) REF: Page 32 OBJ: 3-8
TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment
4. An older adult resident of a long-term care nursing facility frequently attempts to get out of bed and is at risk of sustaining an injury. The nurse’s planned intervention to minimize the patient’s risk for injury is guided by:
a. the patient’s right to self-determination and to be free to get out of bed.
b. an understanding that nondrug interventions must be tried before medications. c. the knowledge that application of a vest restraint requires a physician’s order. d. the patient’s cognitive ability to understand and follow directions.
ANS: B
The drug use guidelines are based on the principles that certain problems can be handled with nondrug interventions and that such forms of treatment must be ruled out before drug therapy is initiated. The patient does have the right to self- determination, but the staff must ensure the patient’s safety. Vest restraints do require an order, but environmental measures must be tried before chemical or physical restraints. The patient’s cognitive abilities do not allow for unjustified physical or chemical restraints.
DIF: Remembering (Knowledge) REF: Page 35-6 OBJ: 3-7
TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment
5. During the state inspection of a skilled nursing facility, a surveyor notes suspicion that a particular nurse may not be providing the proper standard of care. The nurse manager informs the nurse to expect:
a. a review of the situation by the state board of nursing. b. termination of employment from the facility.
c. mandatory remediation related to the suspect care issues.
d. unannounced reevaluation of performance within the next 3 months. ANS: A
In such cases, the surveyor may forward the record showing the relevant findings to the appropriate state agency or board for review of the nurse’s practice, requesting a determination of whether the nurse may have violated the state’s nurse practice act. Regulations do not specify that the nurse be terminated, have remediation, or have an unannounced reevaluation.
DIF: Understanding (Comprehension) REF: Page 37 OBJ: 3-1
TOP: Communication and Documentation
MSC: Safe and Effective Care Environment
6. An 87-year-old patient is unsure of the purpose of a living will. The nurse describes its purpose best when stating:
a. “It’s a legal document that Social Services can help you create.”
b. “It designates a family member to make decisions if you become incompetent.”
c. “It provides a written description of your wishes in the event you become terminally ill.”
d. “It assures you won’t be subjected to treatments you don’t want.” ANS: C
Living wills are intended to provide written expressions of a patient’s wishes regarding the use of medical treatments in the event of a terminal illness or condition.
DIF: Understanding (Comprehension) REF: Page 39 OBJ: 3-10
TOP: Teaching-Learning MSC: Safe and Effective Care Environment
7. The nurse is caring for an unresponsive patient who has terminal cancer with a Do Not Resuscitate order in effect. A
family member tells the nurse, “I’ll sue you and every other nurse here if you don’t do everything possible to keep her alive.” The nurse understands that protection from legal prosecution in this situation is provided by:
a. legal immunity granted when acting according to the patient’s expressed wishes.
b. the legal view that the duty to put into effect the patient’s wishes falls to the physician.
c. knowledge of and compliance with facility policies and procedures regarding end-of-life care. d. implementing interventions that preserve the patient’s right to self-determination.
ANS: C
In this case, immunity applies only to the physician and not to the nurse because the physician is given the legal duty to put into effect the patient’s wishes. Consequently, the nurse must rely on effective communication with the physician, patient, and family, and on the quality of the facility’s policies and procedures, to be sure that his or her actions are consistent with the legally required steps.
DIF: Understanding (Comprehension) REF: Page 42 OBJ: 3-10
TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment
8. The nurse is caring for a terminally ill older patient who has a living will that excludes pulmonary and cardiac resuscitation. The family expresses a concern that the patient may “change her mind.” The nurse best reassures the family by stating:
a. “The nursing staff will watch her very closely for any indication she has changed her mind.”
b. “We will discuss her wishes with her regularly.”
c. “She can change her mind about any provision in the document at any time.”
d. “Your mother was very clear about her wishes when she signed the document.” ANS: A
AMD provisions appropriately provide that people can change their minds at any time and by any means. Nurses need to be alert to any indications from a patient. Based on the person’s medical condition, subtle signs such as a gesture or a nod of the head may be easily overlooked. The patient may or may not be able to discuss her condition. Stating that the mother was very clear in her wishes does not take into account the fact that patients can change their minds any time.
DIF: Applying (Application) REF: N/A OBJ: 3-7
TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment
9. A patient residing in a long-term care facility has been experiencing restlessness and has often been found by nursing staff wandering in and out of other patients’ rooms during the night. The nurse views the patient’s PRN antipsychotic medication order as:
a. an appropriate intervention to help assure his safety.
b. an option to be used only when all other nondrug interventions prove ineffective. c. inappropriate unless the physician is notified and approves its use.
d. not an option because it should not be used to manage behaviors of this type.
ANS: D
Reasons for the use of antipsychotic drugs do not include behaviors such as restlessness, insomnia, yelling or screaming, inability to manage the resident, or wandering. The staff must provide nondrug alternatives to help calm the patient.
DIF: Analysis (Analyze) REF: N/A OBJ: 3-7
TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment
10. An alert but disoriented older patient lives with family members. The home health nurse, being aware of the role of patient advocate, recognizes the obligation to report possible patient abuse based on:
a. a family member stating, “It’s hard being a caregiver.”
b. assessment showing bruises in the genital area. c. observation of mild changes in orientation.
d. patient’s report of always being hungry.
ANS: B
Even when a patient exhibits disorientation, any report of mistreatment or neglect is to be considered reasonably suspicious and so should be reported. Bruises in the genital area raise suspicions of abuse. The family stating caregiving is hard does not mean they don’t have enough support to cope. Mild changes in orientation may be expected in a disoriented patient. The patient who is always hungry should be followed up with a nutrition assessment, and this may or may not be a sign of abuse. DIF: Application (Apply) REF: N/A OBJ: 3-8
TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment
11. An older adult patient has been approached to participate in a research study. The nurse best advocates for the patient’s right of self-determination by:
a. evaluating the patient’s cognitive ability to understand the consequence of the study. b. determining what risks to the patient are involved.
c. discussing the importance of the study with the patient and his family.
d. encouraging the patient to discuss the decision with trusted family or friends. ANS: A
The right to self-determination has its basis in the doctrine of informed consent. Informed consent is the process by which competent individuals are provided with information that enables them to make a reasonable decision about any treatment or intervention that is to be performed on them. The other options do not address autonomy and self-determination.
DIF Applying (Application)
REF: N/A OBJ: 3-7 TOP: Communication and Documentation
MSC: Safe and Effective Care Environment
12. A nurse responsible for the care of older adult patients shows the best understanding of the nursing standards of practice when basing nursing care on the:
a. physician’s medical orders.
b. stated requests of the individual patient.
c. care that a responsible geriatric nurse would provide. d. implementation of the nursing process.
ANS: C
Nursing standards of practice are measured according to the expected level of professional practice of those in similar roles and clinical fields. Nursing care is not judged against the physician’s orders, stated requests of the patient, or implementation of the nursing process.
DIF: Remembering (Knowledge) REF: Page 30 OBJ: 3-1
TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment
13. The nurse caring for an older patient who resides in an assisted living facility is asked to obtain and witness the patient’s signature on a living will document. The nurse responds most appropriately when stating:
a. “I will, because such a document is so valuable to the patient’s plan of care.”
b. “I’ll ask the patient’s family if they agree that the patient should sign the document.”
c. “First I need to discuss the purpose of this document with the patient.”
d. “I’m sorry but I cannot ethically do that.”
ANS: D
It is not permissible for the nurse to secure the patient’s signature or to witness the patient’s signature on a living will document. Generally speaking, an employee or owner of a facility in which the patient resides cannot witness this document. DIF: Application (Apply) REF: N/A OBJ: 3-9
TOP: Nursing Process: Implementation MSC: Safe and Effective Care Environment
14. A graduate nurse learns about the provisions of the Health Insurance Portability and Accountability Act (HIPAA), which include which of the following?
a. Requires employers to offer health care insurance
b. Regulates the amount employers can charge for insurance c. Mandates that employers provide specific benefits
d. Helps maintain coverage when a person changes jobs
ANS: D
HIPAA has several provisions, one of which is that it helps people maintain health care insurance when they are changing jobs. The other statements are common misconceptions about HIPAA.
DIF: Remembering (Knowledge) REF: Page 31 OBJ: 3-5
TOP: Teaching-Learning MSC: Safe Effective Care Environment
15. The nurse manager in a long-term care facility reviews resident care plans at what interval?
a. Quarterly
b. Every 60 days c. Annually
d. When changes occur
ANS: A
The resident care plan is routinely reviewed quarterly. DIF: Remembering (Knowledge) REF: Page 33 OBJ: 3-1
TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment
16. The manager of a long-term care facility is evaluating patients’ use of drugs. The resident on which of the following medications would be allowed to continue taking medications to control behavior?
a. On anxiolytics; now able to participate in group activities
b. Given a benzodiazepine at night; roommate now sleeps well c. Given sedatives; eats 100% of meals if resident is fed
d. Taking an antipsychotic; no longer wanders at night
ANS: A
Drugs should not be used to control behavior. If used to manage health conditions, the patient should show improvement. The patient who is now able to participate in activities shows an increase in functional ability, so this medication is therapeutic for this patient. The other patients are given drugs to control behavior.
DIF: Applying (Application) REF: N/A OBJ: 3-7
TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment
17. To meet current guidelines regarding incontinence in a long-term care facility, what action by the director of nursing is best?
a. Assess residents for the ability to participate in a bladder training program. b. Take all residents to the toilet every 2 hours and after meals.
c. Ensure all residents wear incontinence briefs, which are changed routinely.
d. Ask physicians and other providers to prescribe medications for bladder control.
ANS: A
Urinary incontinence is a common problem that can lead to several complications. The extent to which residents participate in bladder training programs is an area of focus for facility inspectors. Some residents may need routine toileting, wearing briefs, and medications, but they should all be assessed for the ability to participate in bladder training.
DIF: Applying (Application) REF: N/A OBJ: 3-4
TOP: Nursing Process: Assessment MSC: Physiologic Integrity: Reduction of Risk Potential
18. The director of nursing at a long-term care facility is getting ready for the annual inspection. What information guides the director?
a. Visits cannot be unannounced.
b. The director must be off site during the inspection. c. Nurses must answer questions from the inspectors. d. Results will be shared only through the mail.
ANS: C
Nurses present during inspections must answer questions posed by the inspectors. Visits can be unannounced. The director should be present during the survey. Results are shared during a conference, then a report is mailed later.
DIF: Remembering (Knowledge) REF: Page 36 OBJ: 3-4
TOP: Communication and Documentation
MSC: Safe Effective Care Environment
19. The nursing student learns about the Patient Self-Determination Act. What is a key provision of this act?
a. It establishes new rights for patients in medical facilities. b. It requires facilities to educate patients on their rights.
c. It allows families to be approached for organ donation.
d. It spells out the procedures for creating an advance directive. ANS: B
The intent of this law is to ensure that patients are given information about the extent to which their rights are protected under state law. It does not establish new rights, is not related to organ donation, and does not specify procedures for advance directives.
DIF: Remembering (Knowledge) REF: Page 42 OBJ: 3-7
TOP: Teaching-Learning MSC: Safe Effective Care Environment
MULTIPLE RESPONSE
1. To best address the patient’s right to self-determination, which of the follow questions does the nurse ask at the time the patient is admitted to a nursing facility? (Select all that apply.)
a. “Do you understand what a living will and durable power of attorney are?”
b. “If you have already prepared an advance care directive, can you provide it now?”
c. “Are you prepared to discuss your end-of-life choices with the nursing staff?”
d. “Have you discussed your end-of-life choices with your family or designated surrogate?”
e. “Would you like help with preparing a living will or a durable power of attorney?” ANS: A, B, D, E
All the correct options address the patient’s right to make an informed decision regarding health care issues by using various advance directives. The patient does not need to discuss end-of-life choices with the staff in order to exercise the right to self- determination.
DIF: Application (Apply) REF: N/A OBJ: 3-7
TOP: Integrated Process: Teaching-Learning
MSC: Safe and Effective Care Environment
2. What provisions for nursing service are part of the Omnibus Budget Reconciliation Act (OBRA) as it pertains to long-term care facilities? (Select all that apply.)
a. Resident assessments
b. Annual screenings
c. Minimum staffing
d. Ensuring resident rights
e. Registered nurse educational requirements
ANS: A, B, C, D
OBRA’s service requirements include resident assessments and screenings, minimum staffing requirements, and ensuring resident rights. Educational requirements for nurses are not part of this mandate.
DIF: Remembering (Knowledge) REF: Page 33 OBJ: 3-4
TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment
3. The director of nursing at a certified long-term care facility overhauls the nursing assistant training program to include which features? (Select all that apply.)
a. 12 hours of classroom content
b. Training in infection control measures c. Instruction on resident rights
d. 6 hours of quarterly in-service education
e. Education on safety measures
ANS: B, C, D, E
Requirements for a nursing assistant’s education includes training in infection control and interpersonal skills, instruction on resident rights and safety procedures, and 6 hours of education through in-services quarterly. Nursing assistants must have classroom training before working with residents, but the amount of time is not specified.
DIF: Applying (Application) REF: N/A OBJ: 3-3
TOP: Teaching-Learning MSC: Safe Effective Care Environment
4. The adult child of a long-term care facility resident receives a phone call from the director of nursing stating that her parent has 30 days to move out of the home. Under what conditions can a facility require a resident to move?(Select all that apply.)
a. Nonpayment for services received
b. Needs exceeding what the facility can provide
c. Stay is no longer required based on the resident’s medical condition
d. Facility is going out of business
e. Frequent disruptive behavior during the night
ANS: A, B, C, D
A facility can require a resident to leave in four situations: nonpayment for services, needs that exceed what the facility can provide, the patient’s medical condition no longer warrants long-term care, or the facility is going out of business. Being disruptive is not a cause for expelling a resident.
Chapter 04: Gerontologic Assessment
Meiner: Gerontologic Nursing, 5th Edition
MULTIPLE CHOICE
1. The geriatric nurse recognizes that the body’s homeostatic mechanisms may be compromised in the:
79-year-old with moderate Alzheimer disease who requires assistance with all activities of daily living
a. (ADLs).
b. 73-year-old with a history of chronic bronchitis who lives with family.
c. 86-year-old who lost a spouse and is moving into an assisted living facility.
d. 69-year-old with peripheral vascular disease who is visited by home health care weekly. ANS: C
Test Bank 2: Kristen Mauk Gerontological Nursing Competencies For Care Exam Questions
1. A negative attitude towards aging and the aged is called:
a) geriatrics
b) racism
c) ageism
d) ethnocentrism
2. Which of the following is not considered a core competency for nurses caring for older adults?
a) Analyze the impact of an aging society on the health care system
b) Obtain certification in gerontological nursing
c) Prevent or reduce common risk factors that contribute to functional decline
d) Recognize one’s own attitudes about aging
3. The nurse wishes to obtain basic certification in the specialty of gerontological nursing. Which of the following is true about this credential?
a) there is an experience requirement
b) one must pass an exam
c) one must have a BSN
d) a and b only
4. When the nurse reads an article and uses the findings of a study to improve the quality of the patients for whom she cares, she is implementing the role of:
a) teacher
b) manager
c) research consumer
d) advocate
5. A lawyer wishes to hire a nurse consultant who has advanced education and certification in gerontology. Based on their listed credentials, which of the following nurses best fits his wishes?
a) Sally Smith, RN, BSN, BC
b) Mary Malloy, RN, MS, GNP
c) Andy Jones, LPN, CRRC
d) Greg Reed, RN, MSN
6. The AACN/John A. Hartford Foundation Competencies are helpful to nurses because they:
a) offer suggestions about how to gain employment in geriatrics
b) provide a guideline for the knowledge that is expected to provide quality care to older adults
c) were designed to prepare nurses to pass the State Board Exam
d) were written for nurses working on a graduate degree in gerontology
7. The nurse has a question about the appropriateness of an older patient’s medication dose. Which of the following professionals would be best qualified to answer such a question?
a) the geropsychologist
b) the geropharmacist
c) the financial gerontologist
d) the gerontological rehabilitation nurse
8. The health care professional who wants to gain experience in working with older adults who are post-acutely recovering from serious illness or injury, have challenging medical issues needing 24 hour per day nursing, but who cannot yet tolerate a full rehabilitation program may be best suited for employment in what setting:
a) acute care hospital
b) assisted living
c) rehabilitation
d) subacute care
9. Which of the following levels of care would be most appropriate for a healthy 84 year old man who can take care of himself, but wants to live in a place where he can socialize and have help available if needed?
a) a group foster home
b) a transitional care unit
c) an independent unit in a senior living complex
d) assisted living in a nursing home
10. When the nurse reads an article and uses the findings of a study to improve the quality of the patients for whom she cares, she is implementing the role of:
a) teacher
b) manager
c) research consumer
d) advocate
11. Which of the following is not true about assisted living facilities?
a) if their care needs become too great, they may have to seek other living arrangements
b) persons pay for assistance out of pocket
c) the average resident is in his 60’s
d) they have assumed about 15% of the previous nursing home population
12. A person aged 84 would be classified, according to current systems, as:
a) young old
b) middle old
c) old old
d) very old
13. The clinical nurse specialist (CNS) in gerontology differs from the GNP in that:
a) the GNP usually works in a collaborative practice with a physician
b) the CNS has less education than the GNP
c) the GNP has a doctorate
d) the CNS does less consulting than the GNP
14. What is the most compelling reason for health professionals to be educated in the area of gerontology?
a) to address the comprehensive nursing shortage
b) to make an increase in salary
c) to prepare to be challenged by the educated baby boomers
d) to prepare to care for the growing number of older persons in the population
15. An intergenerational approach to care for the aging is advisable because of what fact?
a) baby boomers want their children to take of them in old age
b) Gen X and Gen Y persons do not know anything about aging
c) most older persons are cared for by their children
d) nearly a half million grandparents are raising their grandchildren
16. What best explains the lack of prepared, qualified health professionals to care for the aged?
a) a shortage of nursing faculty
b) medical programs not including gerontology content
c) not enough health professionals choosing gero as a specialty
d) the current nursing shortage
Test Bank 3: Gerontological Nursing and Healthy Aging (Touhy & Jett) Test Bank Questions
1. Which factor(s) associated with aging contribute(s) to the high incidence of type 2 diabetes mellitus in older adults? (Select all that apply.)
a. Fewer T lymphocytes
c. Decreased thyroid function
d. Decreased physical activity
e. Left ventricular hypertrophy
f. Decreased insulin sensitivity
ANS: B, C, D, F
Less lean muscle mass means that the body has fewer insulin receptor sites; thus, glucose circulates in the blood stream longer, leading to hyperglycemia and type 2 diabetes mellitus. Decreased thyroid function decreases the metabolic rate. If the metabolic rate decreases without a corresponding decrease in caloric intake, then the body consumes more food than it needs for its metabolic rate, and hyperglycemia occurs. Decreased physical activity contributes to type 2 diabetes in two ways. First, a less active person has less lean muscle mass than an active person. Second, physical activity helps metabolize glucose; if activity decreases and food consumption does not decrease, then hyperglycemia occurs. Insulin sensitivity decreases with age and increases the need for insulin in older adults. To prevent hyperglycemia, older adults must increase physical activity and decrease food consumption. Fewer T lymphocytes are associated with age-related changes caused by autoimmune reactions wherein the body recognizes itself as a foreign substance and works to destroy it.
Type 1 diabetes mellitus is considered an autoimmune disorder. Left ventricular hypertrophy is not directly related to the increased incidence of type 2 diabetes in older adults; however, if hypertrophy leads to exercise intolerance, then it can be related to an increased incidence of type 2 diabetes.
2. When caring for an older man patient, the nurse is aware that which changes are associated with the male reproductive sysUtemSandNagiTng? (SeOlect all that apply.)
a. Testes soften.
b. Seminiferous tubules thicken.
c. Sperm count decreases.
d. Ejaculation is slower.
e. Incontinence is common.
ANS: A, B, D
Although men have the ability to produce sperm throughout their lives, they also experience changes in the functioning of the reproductive and the urogenital organs in later life. The changes are usually more subtle and noticed only as they accumulate, beginning when men are in their 50s. The testes atrophy and soften. The seminiferous tubules thicken, and obstruction caused by sclerosis and fibrosis can occur. Although sperm count does not decrease, fertility may be reduced because of a higher number of sperm lack motility or have structural abnormalities. Erectile changes are also seen; more stimulation is needed to achieve a full erection, ejaculation is slower and less forceful, and refractory periods are longer. Incontinence is not a normal age-related change.
3. A nurse performs an assessment of an older adult’s oral cavity. Which of the following findings are normal age related changes? (Select all that apply.)
b. Recession of gums
c. A white film on the tongue
d. Decreased saliva production
e. Gums that bleed easily
ANS: A, B, D
There are many age-related changes in the oral cavity. With wear and tear, teeth lose enamel and dentin and become more vulnerable to decay. Without care, teeth may be lost. Gums recede, and there is a decrease in saliva production. Bleeding gums is indicative of infection, and a white film on the tongue is also indicative of an infection.
4. A nurse is caring for an older adult in the hospital who reports decreased hearing. Which of the following interventions should the nurse use when communicating with this patient? (Select all that apply.)
a. Raise the pitch of the voice when speaking with the patient.
b. Speak very slowly using simple words when speaking to the patient.
c. Face the patient when speaking.
d. Decrease background noise when speaking with the patient.
e. Obtain a sign language interpreter to speak with the patient.
ANS: C, D
With normal age-related hearing loss, the patient can still hear, so a sign language interpreter would not be appropriate. In addition, it is not known whether or not this patient is able to communicate in sign language. Presbycusis, age-related hearing loss, is primarily the loss of
the ability to hear high-frequNenUcyRsSoIunNdGs. TTBhe.reCfoOreM, raising the pitch of the voice would not help the situation. Speaking very slowly and using simple words may be seen as demeaning to the patient. It is important to face the patient and to decrease background noise. Facing the patient is helpful if the patient reads lips.
11. An older man asks a nurse: “How do you define aging? Do I meet the criteria of a senior citizen?” The nurse understands that one can define aging in many different manners. If the nurse chooses to define aging as “social aging,” the nurse would consider which of the following aspects?
a. The man retired from his job as a police officer.
b. The man takes six different medications multiple times over the course of the day.
c. The man walks with a rolling walker.
d. The man celebrated his 65th birthday.
ANS: A
Social aging is determined by changes in roles. Taking multiple medications multiple times over the course of the day and walking with a rolling walker are functional determinants of aging. Age refers to chronological aging.
12. The holistic health movement has impacted health care in which of the following ways?
a. It has focused health care on disease prevention.
b. It has reshaped how health and health care are perceived.
c. It has improved access to health care.
d. It has introduced numerous alternative modalities into health care.
ANS: B
The holistic paradigm has reshaped how health and health care are perceived. Wellness is seen as a state of being which can be defined anywhere along the continuum of health.
13. According to Healthy People 2020, older adults have been identified as a priority, with a goal to improve their health, function, and quality of life. Identify the targeted chronic focus areas for improvement. (Select all that apply.)
a. Diabetes
b. Arthritis
c. Congestive heart failure
d. Dementia
e. Cancer
f. Pressure ulcers
ANS: A, B, C, D
In a push toward wellness, older adults were identified as a priority area for the first time. The targeted chronic areas of focus were identified as diabetes, arthritis, congestive heart failure, and dementia.
14. Identify the Healthy People 2020 emerging issues in the health of older adults. (Select all that apply.)
a. Coordinating care for the older adult population
b. Assisting older adults in the management of their own care
c. Identifying levels of training for those caring for older adults
d. Making community resources available for older adults
e. Increase in health disparities for rural older adults
ANS: A, B, C
According to United States Department of Health and Human Services’ Healthy People 2020, emerging issues in the health of older adults include coordinating care, helping older adults manage their own care, establishing quality measures, identifying minimum levels of training for people who care for older adults, and researching and evaluating appropriate training to equip providers with the tools they need to meet the needs of older adults.
15. Researchers hypothesize that most super-centenarians survive and are in good health due to which of the following factors? (Select all that apply.)
a. They have a different genetic makeup than other older adults have.
b. They tend to live in wealthier areas of the world.
c. The exact cause of this phenomenon is not known.
d. Contributing factors to their good health include quality medical care and improved social conditions.
e. They have large extended families to assist in their care.
ANS: C, D
The exact cause of super-centenarians’ longevity is not known; researchers describe it as attributable to “rare and unpredictable reasons.” Contributing factors include medical care and improved sociopolitical conditions. There is no known difference in biological or sociological factors between super-centenarians and other older adults. Super-centenarians exist all over the world.
16. The nurse in an assisted living facility (ALF) is preparing a lecture on aging for the residents. The philosophy of the ALF is to approach aging from the viewpoint of health. Based on this philosophy, the nurse includes which of the following topics? (Select all that apply.)
a. “The Many Chronic Illnesses of Aging”
b. “Channeling Your Inner Strength Toward Wellness”
c. “Maximizing Function As You Age”
d. “Conserving Your Strength As You Age”
e. “Keep Moving, Maintain Your Mobility”
ANS: B, C, D
A wellness perspective is based on the belief that every person has an optimal level of wellness independent of functional ability. This viewpoint approaches aging with an emphasis on resilience, strength, resources, and capabilities rather than focusing on existing pathological conditions.
Test Bank 4: Introduction to Social Gerontology Exam Questions
1. (p. 04) Which of the following is not part of the definition of senescence?
A. It is the application of evolutionary principles to understand decline in old age.
B. Death is a part of the process of natural selection.
C. Death is a way to weed out worn-out members of a population.
D. Old age can be a period of renewal and increased wisdom.
2. (p. 04) A subfield of gerontology is:
A. scientology.
B. social gerontology.
C. sociology.
D. social work.
3. (p. 04) Social gerontologists are concerned mainly with the of aging.
A. physical component
B. biological component
C. social component
D. financial component
4. (p. 04) Which of the following is not a factor associated with successful aging?
A. setting goals and working to achieve them
B. participating in meaningful activities
C. adopting a lifestyle to reach maximum level of functioning
D. accepting compulsory retirement
5. (p. 06) Which of the following statements is true about the frail elderly?
A. They are predominantly engaged in the life of the community.
B. They are usually mentally and physically fit.
C. They can never improve from their health conditions.
D. They depend on others for carrying out their daily activities.
Accessibility: Keyboard Navigation
6. (p. 06-07) A good example of functional age is:
A. a person between the ages of 65-74.
B. retiring from one's employment at 48.
C. at the age of 58, no longer being able to run 20 miles.
D. classifying oneself as "old" or "elderly."
7. (p. 06) Which of the following is not an example of chronological age?
A. young-old at 65-74
B. well old at any age
C. middle-old 75-84
D. oldest-old 85 and older
8. (p. 06) Chronological age poses a problem in social gerontology because it:
A. is a subjective factor.
B. lumps people of different generations together.
C. can be a good predictor of old age.
D. is a specific point in a person's life.
9. (p. 07) Which of the following statements is true about subjective age identity?
A. It has no relationship with the gender of an individual.
B. It appears to be influenced by the social class of an individual.
C. It is the accurate description of an individual's functional age.
D. It typically categorizes people into the well elderly, the impaired elderly, and the frail elderly.
10. (p. 06) Mrs. Martin recently became a grandmother. The best term to define the change in her life is:
A. social role.
B. functional age.
C. chronological age.
D. subjective age.
11. (p. 07) Which of the following is not one of the functional categories devised by gerontologists?
A. well elderly
B. somewhat impaired elderly
C. employed elderly
D. frail elderly
12. (p. 07) Functional age may be measured by:
A. reduced skin elasticity.
B. diminished long-term memory.
C. speech defect.
D. level of activity.
13. (p. 07) Why do women tend to associate more negative connotations with aging than do men?
A. Women, on average, die earlier than men.
B. Women are evaluated on physical attractiveness and reproductive potential, and aging affects both.
C. Women lose mental capacity as they age more quickly than men.
D. Men think they get better looking with age so they don't mind it as much.
14. (p. 08) Gerontologists define a "cohort" as the:
A. study of family processes.
B. actual number of years lived by a group of people.
C. average number of years lived by a group of people.
D. aggregate of individuals who experience the same event within the same time interval.
15. (p. 09) Which of the following generations is the best educated and most diverse of any generation?
A. the swing generation
B. the echo boomers
C. the millennials
D. the silent generation
16. (p. 09) Identify an accurate statement about the millennials.
A. They are commonly known as the swing generation.
B. They were born before Generation X.
C. They are less likely than other generations to practice organized religion.
D. They are the least connected generation in the entire human history.
17. (p. 08) Cohort aging refers to:
A. people in different historical eras.
B. people 85 and over.
C. distinctive experiences which cohort members share.
D. the continuous advancement of a cohort to one age category to another over the life span.
18. (p. 10) A feature of the baby boomer cohort is that:
A. it was much larger than the cohort born during the Great Depression.
B. it was confronted with an environment that was less competitive than the environment their parents encountered.
C. it was the cohort that was more educated than the millennials.
D. it was the cohort that had the best connectivity among other cohort groups.
19. (p. 10) The term "ageism" refers to:
A. a composite of ideas and beliefs attached to people as a group or category.
B. avert or hostile attitudes directed toward a group of people.
C. overt action directed toward a group of older people.
D. systematic stereotyping of and discrimination against people because they are old.
20. (p. 12) People with ageist attitudes:
A. often view women more harshly than they view men.
B. predominantly believe that older people usually live free of disability.
C. typically refrain from stereotyping older people who receive healthcare.
D. assume that older people are politically weak.
21. (p. 13) All of the following are examples of the double standard of aging by gender except:
A. men are more likely to be evaluated for their sexual appeal and women for emotional support.
B. men are more likely to be independent and self-reliant than women.
C. aging in women is less attractive than for men.
D. women are more likely to use cosmetic techniques to conceal their age than men.
22. (p. 12) Research has found that television:
A. consistently portrays the aged in a positive and non-stereotypical fashion.
B. ads have improved significantly in the way they depict older people.
C. mostly does not focus on young people.
D. rarely treats older people with disrespect.
23. (p. 14) A fact about aging is that:
A. most retirees are busy, active, and satisfied with their working lives.
B. more than 80 percent of people 65 and older live in nursing homes.
C. older men and women spend only 10 percent of their lives free of disability.
D. people become extremely mellow as they grow old.
24. (p. 14) Which of the following is not a stereotype of older adults?
A. The aged are isolated from family members.
B. Most older people are disabled.
C. The majority of men and women are out of the labor force by age 62.
D. The aged are politically powerful.
25. (p. 18) Which group has the highest income in old age?
A. unmarried people
B. married couples
C. women living alone
D. men living alone
26. (p. 18) Which of the following statements is true about education?
A. High school completion rates are the same across different ethnic groups.
B. Younger minorities are much more likely than their elders to have a college degree.
C. The educational gap by race and ethnicity is ever widening.
D. Each succeeding generation has less education opportunities than the generation that preceded it.
True / False Questions
27. (p. 04) Social gerontology is a subfield of gerontology, concerned primarily with the social aspects of aging.
TRUE
28. (p. 05) Successful aging involves both the individual and society.
TRUE
29. (p. 06) There is one major definition of aging.
FALSE
30. (p. 08) An example of age cohort would include all interns at a particular company.
TRUE
31. (p. 09) The millennials are less likely than other generations to hold liberal attitudes toward controversial issues such as gay marriage.
FALSE
32. (p. 09) People who were born during the Depression are members of the "Swing Cohort."
FALSE
33. (p. 09) There is little variation in cohorts by gender or ethnic composition.
FALSE
34. (p. 10) According to research, by the year 2017 more than 66% of very old women will have at least two surviving children.
TRUE
35. (p. 10) Research has found that by middle school age, most children held uniform views about the elderly.
FALSE
36. (p. 11) In the context of ageism, prejudice refers to negative stereotypes about older people.
TRUE
37. (p. 13) The portrayal of elderly people in television ads has improved significantly in the last 40 years.
TRUE
38. (p. 16) Men are more likely to be widowed than women.
FALSE
39. (p. 15) The majority of older people are in poor health.
FALSE
Essay Questions
40. How would you define successful aging?
Answers will vary.
41. How are older people depicted in the television shows that you watch?
Answers will vary.
N212 GERO ATI 2.0 Gerontology Solved Quiz
1. A nurse is completing medication reconciliation for an older adult client who is receiving multiple medications. which of the following actions should the nurse take first?
a. Clarify the client's list of medications with the pharmacist.
b. Compare the current list against the new medication prescriptions. c. Investigate any discrepancies on the list.
d. Ask the client about over-the-counter medications she is taking.: d. Ask the client about over-the-counter medications she is taking.
Rationale: When performing medication reconciliation, it is important that the nurse collect a list of all the medications the client takes in order to compare the full list
of medications against any new medications the client will take. The list should include prescriptions, over-the-counter medications, and herbal and nutritional sup- plements.
2. A nurse at a long-term facility is planning care for a client who has Alzheimer's disease and wanders at night. which of the following interventions should the nurse include in the plan?
a. Place the client in wrist restraints at night.
b. Request a prescription for a psychotropic medication.
c. Assign the client to a room closer to the nurse's station.
d. Keep the television on at night.: c. Assign the client to a room closer to the nurse's station.
Rationale: The nurse should place the client who wanders in a room that allows for close observation. The nurse should provide clients who wander a safe place to walk and supervision when the client is ambulating.
3. A nurse at a long-term care facility is teaching an older adult client about ambulating with a quad-cane. Which of the following statements should the nurse include in the teaching?
a. "Adjust the height of the cane so that you can flex your elbow at 45 degrees."
b. "Hold the cane in the hand on the stronger side of your body." c. "Place the flat side of the cane away from your foot."
d. "Move the cane and your stronger leg at the same time.": b. "Hold the cane in the hand on the stronger side of your body."
Rationale: The client should hold the cane with the hand on the stronger side of her body so that she can move the cane to support the weaker leg. This action allows for a more normal gait, with the ipsilateral arm and weaker leg moving at the same time.
4. A nurse is performing skin assessments for a group of older adult clients. Which of the following findings should the nurse identify as a benign, age-re- lated skin change commonly seen in older adult clients?
a. Liver spots b. Nevi
c. Atopic dermatitis
d. Psoriasis: a. Liver spots
Rationale: Also known as age spots or lentigines, are flat, brownish-black macules that usually occur in sun-exposed areas of the body. Aging and exposure to sunlight, or other forms of ultraviolet light, can result in increased pigmentation. Liver spots are extremely common after 40 years of age; they occur most often on the forearms, shoulders, face, forehead, and backs of the hands, which are also the areas of highest sun exposure. They are harmless and painless, but they can affect the client's cosmetic appearance.
5. A nurse in an assisted living facility is assessing an older adult client who moved in 3 months ago following the death of his partner. The client reports awakening early in the morning and admits to feeling very sad. The nurse should identify that the. client is experiencing which of the following types
of grief?
a. Anticipatory grief b. Delayed grief
c. Acute grief
d. Disenfranchised grief:
c. Acute grieF
Rationale: The client experiencing acute grief will have both somatic and psycho- logical manifestations of distress, such as the inability to sleep well or profound sadness. The nurse should identify that this client is experiencing acute grief and further assess his support system, concurrent stressors in his life, and his ability to manage stress.
6. A nurse is providing teaching to a client who is to start taking alendronate sodium. Which of the following recommendations should the nurse include in the teaching?
a. "The medication may be crushed if you have difficulty swallowing it." b. "Drink a full glass of milk when you take the medication."
c. "Take the medication at bedtime."
d. "Discontinue the medication if you develop heartburn.": d. "Discontinue the medication if you develop heartburn."
Rationale: The nurse should instruct the client to stop taking the medication if she develops heartburn or if it worsens and to contact her provider. This is an indication that esophageal irritation has occurred. Ways to avoid this are to take alendronate with 240 mL (8 oz) of water and to avoid lying down for 30 to 60 min after taking the medication.
7. A nurse is caring for an older adult client who reports that he has just retired and expresses feelings of loneliness due to the loss of daily interactions with coworkers. Which of the following responses should the nurse make?
a. "Do you know about the local senior citizen group?" b. "You need to take a vacation."
c. "But now you can finally relax and enjoy your life."
d. "Why don't you go into work and visit with your old friends?": a. "Do you know about the local senior citizen group?"
Rationale: The nurse should assist the client in the resocialization process by using the therapeutic communication technique of giving information. Becoming involved in an organization might assist the client in resocialization, which is beneficial to clients who have depended upon their employment for social interaction.
8. A nurse at a long-term care facility is planning care for an adult client who has dementia. Which of the following interventions should the nurse include in the plan?
a. Vary the staff members caring for the client. b. Use photographs as memory triggers.
c. Provide a minimum of three activity choices to the client.
d. Break client tasks down to three or four steps at a time.:
b. Use photographs as memory triggers.
Rationale: The nurse should place photographs on the unit that trigger the client's memories, such as a picture of a toilet at the entrance to the bathroom, or a picture of the client as a young adult at the entrance to her room.
9. A nurse is providing teaching to a client who is to start taking finasteride. Which of the following statements by the client indicates an understanding of the teaching?
a. "I will see improvement in my symptoms within one week." b. "I can expect an increased libido with this medication."
c. "I should see a decrease in my PSA levels."
d. "I must take this medication within 60 min of sexual activity.": c. "I should see a decrease in my PSA levels."
Rationale: The nurse should emphasize that the decrease in PSA (prostate-specific antigen) levels with this medication will be measured 6 months after starting treat- ment. The expected decline is 30% to 50% in the PSA level.
10. A nurse is caring for an older adult client who has a terminal illness. the client tells the nurse, "I just want to live one more month so I can see my grandchild get married." Which of the following Kübler-Ross stages of grief should the nurse identify the client is experiencing?
a. Depression b. Acceptance c. Denial
d. Bargaining: d. Bargaining
Rationale: This is the third stage of grief, according to Kübler-Ross. Bargaining represents a last effort at overcoming death by earning longer life. Trying to put off death for one last major celebration in the client's life, like the marriage of a grandchild, is a form of bargaining.
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