Chapter 23 My Nursing Test Banks

Kozier & Erbs Fundamentals of Nursing, 10/E
Chapter 23

Question 1

Type: MCSA

A nurse is working with a group of clients in a community center, all over the age of 85. How should the nurse classify this group of clients?

1. Young-old

2. Middle-old

3. Old-old

4. Elite-old

Correct Answer: 3

Rationale 1: Those of age 65 to 74 years are referred to as the young-old.

Rationale 2: Those of age 75 to 84 are the middle-old.

Rationale 3: Those of age 85 to 100 are the old-old.

Rationale 4: Individuals over 100 are considered the elite-old.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Identify the different categories of older adults as they range from 65 to 100 years of age.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 365

Question 2

Type: MCMA

The nurse is planning care for an older adult client. On what should the nurse focus if following the Functional Consequences Theory on aging?

Standard Text: Select all that apply.

1. Promote safety.

2. Promote mental health.

3. Improve quality of life.

4. Promote spiritual health.

5. Promote growth and development.

Correct Answer: 1, 3

Rationale 1: Miller developed the Functional Consequences Theory in 1990. Functional consequences are age-related changes, actions that have placed the client at risk for illness or injury, and risk factors for disease. The nurse should design interventions that promote safety.

Rationale 2: In the Nursing Theory of Successful Aging developed by Flood, the client experiences spiritual connections and a sense of meaning and worth. Nurses must target interventions for the older adult in the promotion of mental health throughout the aging process.

Rationale 3: Miller developed the Functional Consequences Theory in 1990. Functional consequences are age-related changes, actions that have placed the client at risk for illness or injury, and risk factors for disease. The nurse should design interventions that improve the clients quality of life.

Rationale 4: In the Nursing Theory of Successful Aging developed by Flood, the client experiences spiritual connections and a sense of meaning and worth. Nurses must target interventions for the older adult in the promotion of spiritual health throughout the aging process.

Rationale 5: The Theory of Thriving asserts that nurses must intervene to promote the older adults growth and development.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. List the common biological theories of aging.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 369

Question 3

Type: MCSA

A nurse is presenting a health education program to a group of older adults at a senior citizens center. Considering the physiological changes of this age group, how should the nurse set the temperature of the room?

1. It should be set at a temperature that is comfortable for the nurse.

2. It should be set cooler than what is comfortable for the nurse.

3. It should be set warmer than the nurses preference.

4. The temperature of the room is not one of the nurses concerns.

Correct Answer: 3

Rationale 1: Because elderly persons have a loss of subcutaneous fat, their tolerance of cold is decreased and they would not be comfortable in a temperature suited to a younger individual.

Rationale 2: Because elderly persons have a loss of subcutaneous fat, their tolerance of cold is decreased and they typically do not enjoy cooler temperatures.

Rationale 3: Because elderly persons have a loss of subcutaneous fat, their tolerance of cold is decreased and they typically enjoy warmer temperatures.

Rationale 4: If the environment is not comfortable to the audience, they will be distracted and not be able to focus or concentrate on the presentation and any information the nurse shares.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. Describe the demographic, socioeconomic, ethnicity, and health characteristics of older adults in the United States.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 370

Question 4

Type: MCSA

In the review of an elderly clients chart, the nurse reads that the client has sarcopenia. What should the nurse expect the client to report?

1. Weight loss and nausea

2. Hair loss and thin skin

3. Bleeding and bruising tendencies

4. Lack of strength and tiring easily

Correct Answer: 4

Rationale 1: Sarcopenia is not generally related to weight loss or nausea.

Rationale 2: Alopecia is loss of hair.

Rationale 3: Thrombocytopenia may cause bleeding and bruising.

Rationale 4: Sarcopenia is defined as a steady decrease in muscle fibers, a normal physiological change of aging. The age-related mechanism appears to be related to denervation of the muscle and causes elders to often complain about their lack of strength and how quickly they tire.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8. Describe the usual physical changes that occur during older adulthood.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 370

Question 5

Type: MCSA

An elderly client comes to the clinic for follow-up after a long hospitalization. When the client asks about increasing strength and endurance, what should the nurse respond?

1. Your muscles can be strengthened, which might help you function better.

2. It wont matter if you exercise. At your age, theres little room for improvement.

3. Once muscle mass is decreased, theres nothing that can be done for strength improvement.

4. Maybe you should think about going to a nursing home. At least the people there will be able to help with your needs.

Correct Answer: 1

Rationale 1: There is evidence that an older adults muscles can be strengthened through exercise and training, with concomitant improvements in functional status.

Rationale 2: It would be inappropriate for the nurse to assume that there is no room for improvement.

Rationale 3: Physical changes associated with the aging process are normal, but not something that cant be improved upon.

Rationale 4: There is evidence that an older adults muscles can be strengthened through exercise and training, with concomitant improvements in functional status. It would be inappropriate for the nurse to suggest that the client is a suitable candidate for long-term care.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8. Describe the usual physical changes that occur during older adulthood.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 371

Question 6

Type: MCSA

A group of elderly women come to the community center for exercise classes taught by the community health nurse. This activity will help lead to which outcome for these clients?

1. Reverse the effects of aging and cure pain.

2. Slow bone density loss and decrease muscle atrophy.

3. Eliminate the risk for osteoporosis.

4. Prevent pathologic fractures.

Correct Answer: 2

Rationale 1: Exercise and proper nutrition will not reverse the effects of aging, nor will they eliminate the risk for osteoporosis.

Rationale 2: Programs of physical activity and proper nutrition will slow bone density loss and decrease muscle atrophy and stiffness that occurs with aging.

Rationale 3: Exercise and proper nutrition will not reverse the effects of aging, nor will they eliminate the risk for osteoporosis.

Rationale 4: Pathologic fractures occur spontaneously, without a fall or trauma to the bone. Many are a result of low bone density or tumor.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 8. Describe the usual physical changes that occur during older adulthood.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 372

Question 7

Type: MCSA

A nurse is teaching a wellness class for older adults. In order to address the sensory loss that accompanies the aging process, the nurse should recommend that these clients take which action?

1. Use hearing aids and glasses.

2. Wear shaded glasses indoors to reduce glare.

3. Switch to brighter lighting in their home.

4. Exercise more and increase calcium intake.

Correct Answer: 3

Rationale 1: Not all elderly people need glasses or hearing aids.

Rationale 2: Changes in vision associated with aging include loss of visual acuity, less power of adaptation to darkness and dim light, decrease in accommodation to near and far objects, loss of peripheral vision, and difficulty in discriminating similar colors. Wearing darker glasses will not increase the brightness of the home.

Rationale 3: Changes in vision associated with aging include loss of visual acuity, less power of adaptation to darkness and dim light, decrease in accommodation to near and far objects, loss of peripheral vision, and difficulty in discriminating similar colors. Having brighter lighting in their home may help with some of these vision changes.

Rationale 4: Exercise and nutrition do not address sensory problems.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and

chronic care of patients and promoting health across the lifespan

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15. Describe selected health problems associated with older adults.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 372

Question 8

Type: MCSA

A school nurse is bringing a group of students to a nursing home for a social exchange project. Before the students arrive, the nurse reminds them to do what when speaking to the residents?

1. Speak as loud as they can.

2. Speak into the residents ears.

3. Write out what they want to say on a piece of paper.

4. Speak distinctly, while facing the residents.

Correct Answer: 4

Rationale 1: This option assumes that all residents have significant hearing loss, which is ageism.

Rationale 2: This option assumes that all residents have significant hearing loss, which is ageism.

Rationale 3: This option assumes that all residents have significant hearing loss, which is ageism.

Rationale 4: Hearing loss in the elderly is greater in the higher frequencies than the lower ones. Older adults with hearing loss usually hear speakers with low, distinct voices best, and it is always appropriate to speak while facing a target.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8. Describe the usual physical changes that occur during older adulthood.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 373

Question 9

Type: MCSA

A nurse is preparing an education program on safety concerns for elderly adults living in their own homes. To address the sensory changes in this age group, what should the nurse recommend to this group?

1. Have carbon monoxide detectors that are checked on a scheduled basis.

2. Place a list of emergency numbers near the phone.

3. Install telephones that use a blinking light instead of a ringer.

4. Ask someone to do their cooking for them.

Correct Answer: 1

Rationale 1: A decreased or absent sense of smell adds to the safety issues of this age group. Because of this, and if the elderly persons home has natural gas appliances or furnace, a carbon monoxide detector would alert the person of any gas leaks or problems present.

Rationale 2: Emergency numbers by the phone is a good idea, but does not address sensory changes.

Rationale 3: Telephones that utilize a blinking light are used for people who are significantly hearing impaired.

Rationale 4: It is not necessary for someone to do cooking for this age group, although they may be inclined to use more salt due to decreased sense of smell and taste.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16. List examples of health promotion topics for older adulthood.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 382

Question 10

Type: MCSA

An elderly client comes to the clinic after checking his blood pressure several times in the local discount store. The nurse checks the blood pressure and finds that it is 146/80. What should the nurse say to this client?

1. Having blood pressure a little high is normal at your age. Yours is fine.

2. Ill recheck this in a while, but your systolic pressure is too high.

3. Well wait and see what the doctor says, but I doubt he will be concerned.

4. You should be on medicine for high blood pressure.

Correct Answer: 2

Rationale 1: Current evidence indicates that a systolic pressure of greater than 140 mm Hg is as problematic in older adults as in younger ones and should be treated.

Rationale 2: Isolated systolic hypertension was considered to be normal in older adults and was frequently not treated. Now, evidence indicates that a systolic pressure of greater than 140 mm Hg is as problematic in older adults as in younger ones and should be treated.

Rationale 3: Current evidence indicates that a systolic pressure of greater than 140 mm Hg is as problematic in older adults as in younger ones and should be treated.

Rationale 4: It would be up to the physician or primary care provider whether or not to treat. The nurse does not make this decision.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15. Describe selected health problems associated with older adults.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 370

Question 11

Type: MCSA

The elderly client comes to the clinic reporting gastrointestinal problems, including frequent constipation and indigestion, but denies any recent weight loss. The nurse initially recognizes that these symptoms

1. indicate a concern and could be caused by cancer.

2. indicate the need for an upper and lower GI x-ray series.

3. could be related to normal changes in muscle tone and activity.

4. are probably indicative of a gastric ulcer or colitis.

Correct Answer: 3

Rationale 1: It would be premature, as well as outside the scope of nursing practice, for the nurse to consider any other pathology.

Rationale 2: With the normal aging process, there is a decrease in muscle tone, digestive juices, and intestinal activity. These together may lead to indigestion and constipation in the older adult. It would be premature, as well as outside the scope of nursing practice, for the nurse to tell the client that there is a need for invasive testing.

Rationale 3: With the normal aging process, there is a decrease in muscle tone, digestive juices, and intestinal activity. These together may lead to indigestion and constipation in the older adult.

Rationale 4: It would be premature, as well as outside the scope of nursing practice, for the nurse to consider any other pathology.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8. Describe the usual physical changes that occur during older adulthood.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 371

Question 12

Type: MCSA

An older adult client comes to the clinic with reports of not being able to hold her urine, stating: I feel so terrible. This shouldnt happen at my age. How should the nurse respond?

1. You shouldnt feel badly. Lots of people have this trouble.

2. Youll probably have to start wearing incontinence briefs. Then you wont be worried about accidents.

3. Getting old isnt much fun, is it?

4. There could be a number of causes for this. I need to ask you some more questions about it.

Correct Answer: 4

Rationale 1: This option inappropriately attempts to minimize the clients concerns.

Rationale 2: Incontinence briefs are useful products for people who have urinary incontinence (UI), but the cause for all cases must be investigated.

Rationale 3: The client already feels badlythe nurse only makes this feeling worse by adding to it.

Rationale 4: Elders may be susceptible to urinary incontinence (UI) because of changes in the kidneys and bladder. UI is never normal and the nurse must promptly investigate the cause, onset, and any other symptoms.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15. Describe selected health problems associated with older adults.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 371

Question 13

Type: MCSA

An older male client comes to the clinic and states to the nurse that he hasnt been interested in sexual intercourse lately. He states: I guess this is part of getting old, too. What should the nurse explain about decreased sexual interest in older clients?

1. It does decrease and gradually disappears.

2. It should not be taken as seriously as it would be if the client were a younger person.

3. It is caused by decreased hormone activity and there is little that can be done about it.

4. It decreases but does not disappear.

Correct Answer: 4

Rationale 1: Libido may decrease but not disappear.

Rationale 2: If an older man reports a loss in sexual interest, the nurse should be as concerned as when a younger man reports a loss of interest in sexual activity.

Rationale 3: Decrease in hormone secretion and activity is a normal aging process, but there may be treatment measures that can help if this is the case.

Rationale 4: The major age-related change in sexual response is timing. It takes longer to become sexually aroused, longer to complete intercourse, and longer before sexual arousal can occur again.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8. Describe the usual physical changes that occur during older adulthood.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 374

Question 14

Type: MCSA

In planning any health program for elderly adults, the nurse will implement Eriksons theory of task development. The nurse realizes that in this stage of life, the successful completion of the task allows the person to

1. have a feeling of satisfaction from past accomplishments.

2. make connections with the younger generation.

3. wish he or she could live life over again.

4. live out his or her last years in physical health.

Correct Answer: 1

Rationale 1: Eriksons task of this developmental stage is integrity versus despair. People who develop integrity accept their lives with a sense of wholeness and satisfaction with their past accomplishments.

Rationale 2: Making connections with the younger generation is part of the task of the middleadult age group.

Rationale 3: People who despair often believe they made poor choices during life and wish they could live life over.

Rationale 4: Physical health is not part of psychosocial development.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10. Describe developmental tasks of the older adult.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 375

Question 15

Type: MCSA

When consulting Eriksons developmental theory, the nurse determines that which older adult will have the least difficulty being successful with the task of this stage?

1. A client who felt success through her childrens accomplishments

2. A client who held his job and work status as the defining feature of his life

3. A client who maintained a balance between work and home

4. A client who planned to really enjoy life once she retired

Correct Answer: 3

Rationale 1: Those who have been concerned only with the accomplishments of their children can be left with a feeling of emptiness when the children leave.

Rationale 2: People who have been concerned only with the paycheck and their job status can be left with a feeling of emptiness when the job no longer exists.

Rationale 3: People who learned early in life to live well-balanced and fulfilling lives are generally more successful in retirement.

Rationale 4: People who attempt suddenly to refocus and enrich their lives at retirement usually have difficulty.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10. Describe developmental tasks of the older adult.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 375

Question 16

Type: MCSA

A gerontological nurse is helping a potential home health client acquire the supplies that will be needed once the client is discharged from acute care. When considering these supplies, what should the nurse recall?

1. Medicare will cover supplies, but only with a physicians written order.

2. Between insurance supplements and Medicare, the older client shouldnt have any difficulty with coverage.

3. Most clients in this age group live on a fixed income, and supplies used should be as economical as possible.

4. Clients have to be responsible for their own supplies.

Correct Answer: 3

Rationale 1: Assuming that all supplies are covered by Medicare when ordered by a physician is erroneous.

Rationale 2: Assuming that all supplies are covered by Medicare and/or supplemental insurance is erroneous.

Rationale 3: The financial needs of this age group vary considerably, and problems with income are related to low retirement benefits, lack of pension plans, and increasing length of retirement years. Nurses should be aware of the costs of health care and use supplies that are as economical as possible.

Rationale 4: The nurse should assist the client to apply for whatever assistance programs are available.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Describe the development of gerontological nursing and the roles of the gerontological nurse.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 376

Question 17

Type: MCMA

A group of older clients is interested in living options available in the community when they may need some assistance with their daily needs. What should the nurse suggest as possibilities to meet these needs?

1. Adult foster care

2. Group homes

3. Retirement villages

4. Long-term care facilities

5. Adult day-care centers

Correct Answer: 1, 2, 5

Rationale 1: Adult foster care offers services to individuals who can care for themselves but require some form of supervision for safety purposes.

Rationale 2: Group homes offer services to individuals who can care for themselves but require some form of supervision for safety purposes.

Rationale 3: Retirement villages provide social support, but do not provide assistance with medication and activities of daily living (ADLs).

Rationale 4: Long-term care facilities provide all care when elderly persons are no longer able to care for themselves; they are not considered assistance living.

Rationale 5: The older adult who lives at home can attend a daycare center that provides health and social services to the older person. While the older adult is at daycare, the caregiver has a respite from the daily care. Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Describe the different care settings for older adults.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 377

Question 18

Type: MCSA

An elderly client who has had a stroke is ready for hospital discharge. How should the gerontological nurse case manager support this clients independence?

1. Allow the client to be actively involved in all decisions made.

2. Make arrangements based on what the nurse feels is in the best interest of the client.

3. Work closely with the social worker and physician to make the decisions necessary for the client.

4. Set up a meeting with the family members so decisions can be made.

Correct Answer: 1

Rationale 1: Nurses need to acknowledge the older clients ability to think, reason, and make decisions. Most elders are willing to listen to suggestions and advice, but they do not want to be ordered around. It would be quite appropriate to include the physician or primary care provider, social worker, as well as the family in the decision-making process, but always and foremost, to include the client.

Rationale 2: Nurses need to acknowledge the older clients ability to think, reason, and make decisions. This option does not reflect an understanding of the clients right to autonomy.

Rationale 3: This option does not reflect an understanding of the clients right to autonomy. It would be quite appropriate to include the physician or primary care provider, social worker, as well as the family in the decision-making process, but always and foremost, to include the client.

Rationale 4: This option does not reflect an understanding of the clients right to autonomy. Nurses need to acknowledge the older clients ability to think, reason, and make decisions. It would be quite appropriate to include the physician or primary care provider, social worker, as well as the family in the decision-making process, but always and foremost, to include the client.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Describe the development of gerontological nursing and the roles of the gerontological nurse.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 377

Question 19

Type: MCSA

Some nursing students are doing their first clinical rotation in a long-term care facility. What should the nurse educator remind the students to do to meet the needs of this particular client group?

1. Do all care for the clients, as theyre unable to do it independently.

2. Always remember that the clients self-respect must be maintained in all interactions of the students.

3. Make sure the clients care is done in a timely manner, and sometimes that means doing things for the client.

4. Treat this group of clients with a greater level of respect than younger clients.

Correct Answer: 2

Rationale 1: There is much diversity among older clients, and nurses should be wary of stereotyping this group.

Rationale 2: Older people appreciate the same thoughtfulness, consideration, and acceptance of their abilities as younger people do.

Rationale 3: The aging client may be slower and less meticulous in many activities, and many young people err in thinking they are helpful to older people when they take over for them and do the job much faster and more efficiently. This is an unprofessional belief and disregards the clients right to autonomy and independence.

Rationale 4: This is not a practice that a nurse educator would encourage because all clients, regardless of age, are treated respectfully.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8. Describe the usual physical changes that occur during older adulthood.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 377

Question 20

Type: MCSA

A nurse is working with clients in an assisted living facility. In the past month, there have been several deaths among the residents and their spouses. In helping the remaining residents deal with these deaths, the nurse understands that adjustment may be easier for which resident?

1. A resident who spent most of her days attending to her partner who is now deceased

2. A resident who had a wide circle of friends, besides her spouse

3. A resident who was not inclined to participate in any activities offered at the facility

4. A resident who started to become more dependent on the nursing staff at the facility

Correct Answer: 2

Rationale 1: Independence established prior to the loss of a mate makes adjustment easier.

Rationale 2: Independence established prior to the loss of a mate makes adjustment easier. A person who had meaningful relationships and friendships or economic security, ongoing interests in the community or private hobbies, and a peaceful philosophy of life copes more easily with bereavement.

Rationale 3: Not participating in functions offered may indicate feelings of inadequacy or insecurity after a death has occurred.

Rationale 4: Becoming more dependent on the staff may indicate feelings of inadequacy or insecurity after a death has occurred.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11. Describe psychosocial changes to which the older adult adjusts during the aging process.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 377

Question 21

Type: MCSA

A nurse who works in a long-term care facility has noticed that one of the residents has been showing signs of impaired cognitive and selfcare abilities over the last 2 weeks. The nurse should

1. remember that memory loss is a normal, age-related change.

2. investigate for possible physiologic problems.

3. instruct the staff to be extra attentive, as this person needs more assistance.

4. inform the residents family that the resident probably has some form of dementia.

Correct Answer: 2

Rationale 1: Cognitive impairment that interferes with normal life is not considered part of normal aging. A decline in intellectual abilities that interferes with social or occupational functions should always be regarded as abnormal and be investigated.

Rationale 2: Cognitive impairment that interferes with normal life is not considered part of normal aging. A decline in intellectual abilities that interferes with social or occupational functions should always be regarded as abnormal and be investigated.

Rationale 3: This option does not address the loss of function the client is experiencing.

Rationale 4: This option is premature and not within the scope of nursing practice.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12. Explain changes in cognitive abilities that occur during the aging process.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 378

Question 22

Type: MCSA

A client has been diagnosed with dementia. The family wants to know how to plan for the future. What is the best response by the nurse?

1. Your family members symptoms will get worse, but there are medications to stop the progress.

2. You should plan right now on which long-term care facility you will want to utilize when the time comes.

3. Dementia is a progressive deterioration. Its important for you to clearly understand what to look for in symptoms.

4. Dementia can be treated once the cause is known.

Correct Answer: 3

Rationale 1: There are no cures, but some medications may help to slow the progression.

Rationale 2: Family members must be educated on the course of dementia and be encouraged to learn as much about coping skills as possible.

Rationale 3: Dementia is a progressive loss of cognitive function. The most common type is Alzheimers disease. The cause is unknown. The most prominent symptoms are cognitive dysfunctions, including decline in memory, learning, attention, judgment, orientation, and language skills. Family members must be educated on the course of dementia and be encouraged to learn as much about coping skills as possible.

Rationale 4: There are no cures, but some medications may help to slow the progression.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 12. Explain changes in cognitive abilities that occur during the aging process.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 378

Question 23

Type: MCSA

A client has had Alzheimers dementia for a period of time and continues to live at home with his spouse. What would be one of the gerontological nurses responsibilities?

1. Make sure the client is being prescribed appropriate medication.

2. Provide support for the spouse.

3. Assess the client early to ensure proper care.

4. Find a suitable long-term care facility for the client.

Correct Answer: 2

Rationale 1: Medication prescription is not a nursing responsibility.

Rationale 2: The nurses responsibility is to provide supportive nursing care, accurate information, and referral assistance, if necessary, to the caregiver. Caregivers may experience physical and emotional exhaustion while they render continuous care.

Rationale 3: It is important for the nurse to do an ongoing assessment of both the client and the caregiver as the clients condition deteriorates.

Rationale 4: The nurses responsibility is to provide supportive nursing care, accurate information, and referral assistance, if necessary, but finding a suitable longterm facility is not a nursing responsibility.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Describe the development of gerontological nursing and the roles of the gerontological nurse.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 380

Question 24

Type: MCSA

The nurse is explaining the difference between dementia and delirium to the spouse of a client with Alzheimers disease. What should the nurse say to make this distinction?

1. Delirium is easily distinguished from dementia.

2. Dementia is reversible and treatable.

3. Delirium is an acute and reversible syndrome.

4. Dementia is the only condition that is characterized by changes in memory, judgment, language, mathematic calculation, abstract reasoning, and problem-solving ability.

Correct Answer: 3

Rationale 1: Both dementia and delirium have many of the same characteristics.

Rationale 2: Delirium is an acute, reversible syndrome; dementia is not.

Rationale 3: Once the underlying pathology is treated, the delirium disappears.

Rationale 4: Both dementia and delirium have many of the same characteristics.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15. Describe selected health problems associated with older adults.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 380

Question 25

Type: MCSA

A hospitalized older client is recovering from an acute illness. As the client nears the end of his hospitalization, he questions the nurse about medications and care after discharge. The gerontological nurse should

1. inform the physician that the client needs to go to a nursing home.

2. assess the clients independence and ability to function in his own home before discharge.

3. tell the client not to worry about going home.

4. invite the clients family to come to the hospital so the nurse can explain the clients care to them.

Correct Answer: 2

Rationale 1: Informing the physician that the client needs long-term care is inappropriate at this point.

Rationale 2: Older adults often perceive that being in the hospital could change their ability to be autonomous and independent. As a result, the nurse needs to assess the older adults stage or perception of need for control and autonomy during his hospitalization and his fears and hopes about being discharged from the hospital setting.

Rationale 3: Telling the client not to worry is not therapeutic and does not address his concerns.

Rationale 4: The client is a capable adult and should be included in all decision-making situations, not have them deferred to the family.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Describe the development of gerontological nursing and the roles of the gerontological nurse.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 381

New Questions

Question 26

Type: MCSA

The nurse is completing an assessment to determine an older patients development of moral reasoning. Which observation indicates that the client has developed moral reasoning as anticipated?

1. Considers relationships as well as justice in moral decisions

2. Approaches moral decisions based upon the consequences to self

3. Follows societys rules of conduct in response to the expectations of others

4. Bases moral judgments on connectedness to others and the value of relationships

Correct Answer: 1

Rationale 1: Older adults begin to make moral decisions that are consistent with the theories of both Kohlberg and Gilligan. Older men consider relationships, as well as justice, in moral decisions, and older women add justice to the factors they consider in moral situations.

Rationale 2: Approaching moral decisions based upon the consequences to self does not exemplify development of moral reasoning for the older adult client.

Rationale 3: Following societys rules of conduct in response to the expectations of others is a belief of Kohlberg; however, this does not demonstrate the development of moral reasoning for an older adult.

Rationale 4: Basing moral judgments on connectedness to others and the value of relationships is a belief of Gilligan, who identified this approach to moral behavior in women.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13. Compare and contrast Kohlbergs and Gilligans theories of moral reasoning in older adults.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

Page Number: 378

Question 27

Type: MCMA

The nurse is identifying health promotion needs for an older adult client. What should the nurse consider for this client?

Standard Text: Select all that apply.

1. Offering to arrange a pneumococcal vaccine for a client turning 60 years old

2. Assessing the 62-year-old client for situational depression.

3. Discussing smoking cessation classes with a 64-year-old

4. Asking a 78-year-old client whether he had his cholesterol tested within the last 3 years

5. Measuring the 79-year-old clients height and weight

Correct Answer: 2, 3, 5

Rationale 1: Appropriate health promotion practices would encourage such a vaccine for the client 65 years of age or older.

Rationale 2: Appropriate health promotion practices would encourage depression screenings for older adult clients.

Rationale 3: Appropriate health promotion practices would encourage smoking cessation classes for older adult clients.

Rationale 4: Appropriate health promotion practices would encourage such screening for older adult clients only until the age of 75.

Rationale 5: Appropriate health promotion practices would include regular measuring of both height and weight for older adult clients.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care

AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16. List examples of health promotion topics for older adulthood.

MNL Learning Outcome: 2.1.4. Analyze the older adults physiologic and psychosocial development.

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