Chapter 13: Promoting Healthy Adaptation to Aging My Nursing Test Banks

Chapter 13: Promoting Healthy Adaptation to Aging

Test Bank

MULTIPLE CHOICE

1. An 82-year-old man is alert and oriented and in good physical health except for some arthritic pain that slows me down, but I just keep moving. He lives alone in an apartment in a senior citizen complex but enjoys the company of other residents and takes part in the social activities there. His lifestyle is an example of:

a.

an exception to the expected norm.

b.

the disengagement theory.

c.

the activity theory.

d.

the biologic theory.

ANS: C

The activity theory states that persons who remain active and interested in outside activities live longer.

DIF: Cognitive Level: Analysis REF: p. 165 OBJ: Theory #3

TOP: Theories of Aging KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

2. The nurse understands that the best explanation of why a particular person lives into his 90s in relatively good health is that the person:

a.

had healthy parents who passed on to him good genes and no hereditary diseases.

b.

has lived a healthful lifestyle, which has included preventative care, good nutrition, exercise, and a positive outlook.

c.

has treated illness with old-fashioned home remedies while avoiding the use of many prescription drugs.

d.

reads a lot about the newest advances in health care and tries these approaches as soon as they are publicized.

ANS: B

Lifestyle and personality together probably contribute to longevity more than genetics, new medical approaches, or old-fashioned home remedies, although those may contribute in important ways. A healthy lifestyle decreases the risk of disease and its sequelae.

DIF: Cognitive Level: Comprehension REF: p. 165 OBJ: Theory #3

TOP: Longevity KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: physiological adaptation

3. An 85-year-old widow who lives alone has fallen several times in the last month and has been noted by her children to be confused about her medications and to frequently forget what is cooking on the stove until it is burned. These observations indicate that:

a.

she needs to be hospitalized to determine the cause of her confusion and falls.

b.

home delivery of a hot meal each day would solve her cooking risk.

c.

nursing home placement would be the best solution to her problems of aging.

d.

further assessment is needed to evaluate an increased level of assistance.

ANS: D

The widow is showing signs of needing additional assistance. It might include home- delivered meals or nursing home-placement, but further assessment needs to be performed. Acute care hospitalization is not indicated in this situation.

DIF: Cognitive Level: Analysis REF: p. 172 OBJ: Clinical Practice #5

TOP: Aging Parents KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

4. The nurse clarifies that the immune system failure theory states that:

a.

the elderly lose their ability to effectively respond to infections and are more likely to die from them.

b.

the body no longer recognizes itself and begins to attack itself, causing illness.

c.

toxins and harmful chemicals (free radicals) in the environment cause damage to body cells.

d.

the diminished activity of the elderly make them susceptible to illness.

ANS: A

With advancing age, the immune system of the elderly has less ability to fight infections.

DIF: Cognitive Level: Knowledge REF: p. 165 OBJ: Theory #1

TOP: Theories of Aging KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: physiological adaptation

5. The nurse seeks out residents with whom they reminisce in an interview regarding the residents life story. The value of this activity is that:

a.

it gives the staff more time to care for other residents and perform routine care.

b.

it can affirm the positives of the residents life and lead to ego integrity for the resident.

c.

nursing home residents have long days to pass, and any activity helps the time pass more quickly.

d.

students learn about the good old days and better appreciate the modern conveniences available today.

ANS: B

Eriksons psychosocial task for older adults is ego integrity, which can be assisted by life review and reminiscence.

DIF: Cognitive Level: Comprehension REF: p. 170 OBJ: Theory #6

TOP: Psychological Aspects of Aging KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

6. The home health aide who visits an older adult reports to the nurse that the patient has many new bruises on her arms and face. The patient states that her daughter has a temper and got mad when she visited the day before. The nurse should:

a.

call the daughter for clarification.

b.

notify her nursing supervisor to report the incident to the authorities.

c.

tell the aide to report it to the nursing supervisor.

d.

plan to visit the patient when the daughter will be present.

ANS: B

It is a legal requirement for licensed health care personnel to report suspected elder abuse to protect the public (patient). An LPN should report to the RN supervisor first. The aide is supervised by the nurse and thus the nurse is responsible. It is not the nurses responsibility to determine whether the daughter is abusing the patient but only to report it so that it can be investigated by the proper agency.

DIF: Cognitive Level: Analysis REF: p. 170 OBJ: Theory #4

TOP: Family Relationships KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

7. A 76-year-old neighbor confides to the nurse that she is having to get up in the middle of the night to void and often wets herself before she can get to the bathroom during the day. The nurses best explanation would be:

a.

As you get older, your bladder muscle loses tone and you can hold less urine.

b.

You are probably drinking too much during the day and especially before bedtime.

c.

You probably have a bladder infection that should be treated with antibiotics.

d.

With age, the urine becomes very concentrated and causes the bladder to empty spontaneously.

ANS: A

Physiologic changes of aging include decreased bladder and sphincter tone, resulting in stress incontinence and more frequent voiding.

DIF: Cognitive Level: Application REF: p. 166, Table 13-1

OBJ: Clinical Practice #1 TOP: Physical Changes

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: physiological adaptation

8. A nurse making a home visit to a 75-year-old woman discovers that the patient stays in bed or on the couch most of the time because she is afraid of falling. The nurse should arrange for a:

a.

sitter to stay with the woman during the day.

b.

wheelchair to increase mobility.

c.

physical therapist to teach resistance training.

d.

special cushion for the chair and bed to reduce the risk of decubiti.

ANS: C

A physical therapist can teach resistance and balance training to help prevent falls.

DIF: Cognitive Level: Analysis REF: p. 167 OBJ: Theory #4

TOP: Physical Health Concerns KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: physiological adaptation

9. The home health nurse assesses an 80-year-old who has fallen twice in the last 10 days. The nurse discovers that the patient uses a cane for ambulation stability, drinks up to 6 cups of coffee a day, has altered depth perception because of cataracts, and has recently carpeted her home with a smooth tight weave carpet. The nurse suspects the cause of her recent falls to be the:

a.

use of the cane.

b.

new carpet.

c.

large intake of caffeine.

d.

altered depth perception.

ANS: D

Altered depth perception, changes in gait, and slow reaction times may cause falls in the elderly. The cane helps with stability, and the smooth tight weave carpet should not cause falls.

DIF: Cognitive Level: Analysis REF: p. 167 OBJ: Theory #4

TOP: Fall Prevention KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: physiological adaptation

10. A 70-year-old widower continues to work part time in a demanding business, while traveling in his free time with a 68-year-old widow to visit longtime friends and relatives. He remains an active member of several community organizations. His life is an example of a person who:

a.

is acting like a younger person to prove to himself that he is not old.

b.

is adjusting well to the changes of benign senescence.

c.

should slow down and enjoy retirement while he is still healthy.

d.

is avoiding the psychosocial tasks of aging such as retirement and slowing down.

ANS: B

Benign senescence is the normal changes of aging, and many healthy people at 70 years of age do not fit the stereotype of old but are more like older adults of 45 to 70 years.

DIF: Cognitive Level: Analysis REF: p. 166, Table 13-1

OBJ: Theory #3 TOP: Cognitive Aspects of Aging

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

11. A 78-year-old man is admitted to the hospital after a fall from his bed at home that resulted in a fractured hip and several fractured ribs. He states, I dont know how I broke so many bones. I only fell out of bed. The nurse can explain that:

a.

loss of calcium from bone occurs in older adults and can result in fractures from minor trauma.

b.

it is likely that an underlying disease made him more susceptible to fractures.

c.

the bedside table near the bed added to his injuries.

d.

the height of the bed will need to be lowered when he goes home to prevent further injuries.

ANS: A

A physiologic change of aging is loss of calcium from bone, resulting in osteoporosis and greater likelihood of fractures.

DIF: Cognitive Level: Application REF: p. 166, Table 13-1

OBJ: Theory #4 TOP: Physical Changes of Aging

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: physiological adaptation

12. An 84-year-old patient who is hospitalized for pneumonia says to the nurse, I dont know why Ive lived so long. All my friends are gone, my children and grandchildren are all independent and successfulnobody needs me anymore. An appropriate response by the nurse is:

a.

You have a lot to live for. Your children and grandchildren really love you.

b.

You must have inherited good genes. You should be thankful youre still alive.

c.

Tell me about your children and what it was like when you were raising them.

d.

The pneumonia has made you feel morbid. Things will look up!

ANS: C

Encouraging reminiscing helps the older adult put her life in perspective and acquire a sense of ego.

DIF: Cognitive Level: Application REF: p. 170 OBJ: Clinical Practice #4

TOP: Psychosocial Aspects of Aging KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

13. An 80-year-old man has no chronic diseases and is alert, oriented, and physically active. Which of the following nursing diagnoses is likely to be present as a result of the normal aging process?

a.

Poisoning, risk for, related to the many medications an older person must take.

b.

Suffocation, risk for, related to declining respiratory function.

c.

Hopelessness, related to recognition of the end of life drawing near.

d.

Constipation, related to slowed peristalsis.

ANS: D

Constipation is a common nursing diagnosis for older adults in otherwise good health. In addition to peristalsis slowing, most older adults experience decreased taste and smell resulting in decreased appetite and food intake, as well as decreased physical mobility.

DIF: Cognitive Level: Analysis REF: p. 166, Table 13-1

OBJ: Theory #4 TOP: Physical Changes

KEY: Nursing Process Step: Diagnosis MSC: NCLEX: Health Promotion and Maintenance

14. The nurse warns that infection after exposure to respiratory illness in the older adult:

a.

is more likely to result in serious lower respiratory infection related to weakened respiratory muscles and fewer cilia.

b.

is likely to be fatal due to the older persons low resistance.

c.

results in rates of infection similar to those in the younger adult.

d.

can be easily prevented with the use of antibiotics when the adult is exposed.

ANS: A

Changes in the older adult respiratory system make older adults more susceptible to infections that can be very serious. Although some infections are life threatening, most are not.

DIF: Cognitive Level: Comprehension REF: p. 166, Table 13-1

OBJ: Theory #4 TOP: Physical Changes

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

15. When the nurse is conducting a class for senior citizens at a local assisted living facility, to enhance physical health, he encourages the older residents to engage in some form of exercise for at least:

a.

1 hour every other day.

b.

10 minutes at a time several times a day.

c.

30 minutes a day, five times a week.

d.

1 hour every morning.

ANS: C

Exercise for as little as 30 minutes a day 5 days a week is beneficial.

DIF: Cognitive Level: Application REF: p. 169 OBJ: Clinical Practice #2

TOP: Physical Health Promotion Behaviors

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: physiological adaptation

16. The nurse points out that there are many myths about the elderly that are not true. The statement that reflects the most accuracy about the elderly is:

a.

most old people live in nursing homes.

b.

genetics is the main factor in longevity.

c.

the optimistic, happy person generally lives longer.

d.

most old people are isolated from their families.

ANS: C

Myths about old people include: most old people live in nursing homes, genetics is the main factor in longevity, and most old people are isolated from their families. It is true that a major contributor to longer life is that the optimistic, happy person generally lives longer.

DIF: Cognitive Level: Comprehension REF: p. 171 OBJ: Theory #3

TOP: Theories of Aging KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

17. When the 75-year-old patient tells the nurse that he has had a good and rewarding life and has enjoyed every minute of it, the nurse is aware that the patient has attained the Eriksonian stage of:

a.

generativity.

b.

autonomy.

c.

integrity.

d.

intimacy.

ANS: C

Erik Eriksons psychosocial development theory includes the stage of ego integrity vs. despair, which is characterized by reflection on ones life and ones achievements. A sense of pride or despair is developed regarding the accomplishments in life that have been made or were lost.

DIF: Cognitive Level: Comprehension REF: p. 170 OBJ: Theory #3

TOP: Theorists KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. When a 68-year-old recent retiree confides in the health clinic nurse that he has felt depressed and withdrawn since retirement, the nurse suggests that he:

a.

talk with the physician about anti-depression medication.

b.

arrange his day so that he is able to take a nap in the afternoon.

c.

set a small goal for himself to be met every day.

d.

eat three regular meals as he did when he was employed.

ANS: C

Setting a small goal to be met allows for direction in the day. Many recent retirees miss the regulation of employment.

DIF: Cognitive Level: Application REF: p. 169 OBJ: Theory #3

TOP: Theorists KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

COMPLETION

19. An 85-year-old has been increasingly confused and disoriented to place and time over the last several months. He also has difficulty remembering what he ate, who visited, and where the recreation room is. This behavior is indicative of ___________.

ANS:

dementia

Confusion, memory loss, and disordered thinking are early signs of dementia. Causes of dementia include malnutrition, medications, mini-strokes, and Alzheimers disease.

DIF: Cognitive Level: Analysis REF: p. 169, Table 13-2

OBJ: Clinical Practice #4 TOP: Physical Health Concerns

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: physiological adaptation

20. A 67-year-old submitted a job application at a local gas station. The station manager said, Arent you retired? I cant hire you. Youre too old to be working! This is an example of _____________.

ANS:

ageism

Ageism is defined as any discrimination related to age, including job discrimination.

DIF: Cognitive Level: Analysis REF: p. 169 OBJ: Theory #2

TOP: Employment and Retirement KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

21. The home health nurse assesses the older patients in her case load for signs of abuse. The nurse is aware that the primary incidence of abuse is _________.

ANS:

neglect

In patients over the age of 80 who suffer abuse, the primary type of abuse is neglect.

DIF: Cognitive Level: Knowledge REF: p. 170 OBJ: Theory #4

TOP: Elder Abuse KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: basic care and comfort

MULTIPLE RESPONSE

22. To promote cognitive health for a 79-year-old, the nursing student should encourage the patient to do which of the following? (Select all that apply.)

a.

Read the newspaper.

b.

Put together puzzles.

c.

Take naps when tired.

d.

Write letters.

e.

Toilet independently.

ANS: A, B, D

Mental stimulation such as these activities maintains active and healthy neural connections, which promotes cognitive health.

DIF: Cognitive Level: Application REF: p. 169 OBJ: Clinical Practice #3

TOP: Cognitive Health Promotion Behaviors

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

23. A 76-year-old recently lost her spouse. They lived in a large house with a yard that they managed well until her spouses sudden death. She is in good health and stays active but is becoming concerned about her ability to maintain the large house by herself. The nurses most helpful suggestion would be to: (Select all that apply.)

a.

recommend living with her daughter who lives 2 hours away.

b.

encourage her to investigate apartment rentals.

c.

encourage her to check herself into a skilled nursing facility.

d.

hire a gardener and a housekeeper to maintain the property.

e.

encourage her to involve family in any decisions related to her living arrangements.

ANS: B, E

Many older adults choose to rent an apartment when they cannot maintain a house and yard. Including family members in important decisions keeps communication lines open. Family members can offer support and recommendations to their parent(s), easing the decision-making process.

DIF: Cognitive Level: Analysis REF: pp. 170-171 OBJ: Clinical Practice #5

TOP: Psychosocial Health Promotion Behaviors

KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity

24. An 82-year-old patient expresses concern of always being cold. Based on knowledge of the physical changes associated with aging, the nurse could appropriately respond: (Select all that apply.)

a.

Wrap up warmly, because the cold feeling is a result of decreased bone calcium that occurs with aging.

b.

Chronic constipation can lead to a sense of cold because of the reduced peristalsis.

c.

Subcutaneous fat is reduced as part of aging. This fat that helps to keep you warm decreases.

d.

A low level of thyroid hormone causes you to feel cold.

e.

Eat more protein foods to help your body generate heat.

ANS: C, D

Decreased subcutaneous fat and slowed thyroid production contribute to older people feeling cold.

DIF: Cognitive Level: Application REF: p. 166, Table 13-1

OBJ: Theory #4 TOP: Physical Changes KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity

25. The nurse points out elements in our culture that support longevity in older people, which include: (Select all that apply.)

a.

reducing stress from regular exercise on the body in younger years.

b.

being actively involved in their own health care.

c.

taking of antibiotics through their lifetime.

d.

increasing education about health matters.

e.

avoiding the eating of red meat.

ANS: B, D

Active participation in ones own health care, being better educated about illness, and illness prevention are elements in attaining a longer life span.

DIF: Cognitive Level: Application REF: p. 166 OBJ: Theory #3

TOP: Longevity KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

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