Chapter 24: Relationships, Roles, and Transitions My Nursing Test Banks

Chapter 24: Relationships, Roles, and Transitions

Test Bank

MULTIPLE CHOICE

1. Which of the following statements is not true of older adult relationships?

a.

After 50 years of marriage, a couple can face new and severe challenges to their relationship.

b.

Older adults often hold their families together by arranging get-togethers and documenting the familys history and rituals.

c.

Losing a brother or sister brings an older adult face-to-face with his or her own death.

d.

For older adults, friends can never take the place of family.

ANS: D

Friendships can provide the commitment and support that is sometimes lacking in family relationships.

Physical and psychosocial changes related to aging, such as declining health, reduced income, and mismatched needs, may cause a severe strain even for a couple who has been together for 50 years or more. A person who holds his or her family together by arranging get-togethers and documenting the familys history and rituals is known as a kin-keeper. The impact of the loss of a brother or sister, not only at the time of the death but also when a younger survivor reaches the age at which the lost sibling died, can be quite disruptive.

PTS:1DIF:UnderstandREF:8

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

2. Which of the following statements is true about the role of grandparents?

a.

The usefulness of grandparents declined with the advent of the industrial age.

b.

Today, many grandparents are the primary caregivers of their grandchildren.

c.

The value of grandparents is to provide gifts to younger family members.

d.

Traditionally, parents are subordinate to the grandparents in caregiving.

ANS: B

Grandparents have always had an important role to play and have become more important than ever in recent decades. An increasing number of parents have been unable to provide necessary care for their children as a result of personal problems; often, grandparents fill the gaps. Grandparents provide continuity, family tradition, and accumulated wisdom. Parents are still expected to be the primary caregivers.

PTS:1DIF:UnderstandREF:17-18

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

3. An older man is being abused by his daughter, a single working mother of four children, with whom he lives. The nurse investigates and learns that the abuse is due to situational stress. Which of the following interventions should the nurse implement to address the short-term crisis?

a.

Immediately remove him from his daughters home.

b.

Encourage the daughter to work with social services.

c.

Arrange respite care or day care for the patient.

d.

Place the patient in a long-term care facility.

ANS: C

By relieving the daughter of some responsibilities, respite care is likely to be beneficial for the older adult and his daughter; it can help reduce tension.

Unlike children, abused older adults cannot be removed from their situations without their permission. Helping the daughter manage the situational stress would be more effective. Encouraging the daughter to work with social services can help teach her more effective and harmless ways of solving problems, but it does not address the short-term crisis. Placing the patient in a long-term care facility may eventually be necessary, but improving the living situation within the patients family would be better.

PTS:1DIF:ApplyREF:21-22

TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment

4. Which of the following statements is true about caregiving?

a.

Dementia in an older adult can cause grief in the caregiver, comparable with the grief from the older adults death.

b.

Middle-aged adults and older parents reverse life-long caregiving roles with increasing age.

c.

Older adults should relocate to the caregivers home when long distances separate the two.

d.

Increasing numbers of adult children who are developmentally disabled become caregivers for their older parents.

ANS: A

As the dementia progresses, the patient may cease to recognize a spouse or child. The parent still remains the parent, and the idea that the parent somehow becomes a child again is demeaning. The older person may have significant support in the community where he or she lives. Older parents often remain the caregivers for disabled children, which is a serious burden.

PTS:1DIF:UnderstandREF:13-24| 51-55

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

5. Which disease has become known as the great imitator?

a.

Human immunodeficiency virus (HIV)

b.

Acquired immunodeficiency syndrome (AIDS)

c.

Alzheimer disease

d.

Schizophrenia

ANS: A

The compromised immune system of an older individual makes him or her more susceptible to HIV or AIDS than a younger person. AIDS in older adults has been called the great imitator; many of the symptoms, such as fatigue, weakness, weight loss, and anorexia, are common to other disease conditions and may be attributed to normal aging. Alzheimer disease and schizophrenia are not known as the great imitator.

PTS:1DIF:UnderstandREF:31-32

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

6. Which is the most important element for older adults to have for enhancing the transition into retirement?

a.

Good health

c.

401k retirement plan

b.

Private pension

d.

Preretirement planning

ANS: D

Good health is always a desirable state; however, if an older adult in poor health plans for retirement, then the transition to the changes of retirement can be smoother if the planning accounts for health challenges. With preretirement planning, private pensions are not obligatory. With preretirement planning, 401k retirement plans are not obligatory; however, these plans are effective saving plans for retirement; they allow employees to save pretax dollars. Preretirement planning is the most important aspect of a smooth transition into retirement because it affords the individual a chance to prepare for losses associated with retirement such as income, interpersonal communication, health insurance, status, influence, and other issues. Health, social, and financial planning help the older adult adapt to expected or sudden retirement.

PTS:1DIF:UnderstandREF:9-13| 47-48

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

7. Which one of the following older adults is most likely to need preretirement counseling to avoid significant concerns in retirement?

a.

African-American woman who is a certified public accountant

b.

Mexican-American woman who receives cash for cleaning services

c.

Middle-aged man who has a history of type 1 diabetes mellitus

d.

Older male clerk who works for the Department of Homeland Security

ANS: B

Older adults with the most need for retirement planning are usually the same people who are least likely to receive it. The Mexican-American woman will most likely need preretirement counseling to avoid significant problems in retirement. She has three characteristics indicating a need for retirement planning: (1) her sex is female, (2) her job implies a lack of education or training, and (3) she does not pay into Social Security or federal taxes. Thus she can potentially fail to pay into the federal system for a sufficient length of time to be eligible for Social Security and Medicare benefits in retirement. In addition, her job is unlikely to offer a 401k plan.

Although the African-American woman is a member of a minority group, she is a professional and likely to earn a significant income in a finance-related business. Her occupation and education places her well to receive significant retirement planning. The middle-aged man has one factor potentially associated with the need for retirement planningpoor health. The older clerk has one factor potentially associated with the need for retirement planninghe is likely to be a low-level employee.

PTS:1DIF:UnderstandREF:9-13| 47-48

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

8. The community health nurse delivers a program to middle-aged adults about retirement planning and wants to them to choose the year of their retirement. Which is the most important area on which the participants should focus to ease the transition to retirement?

a.

Kind of legacy they want to leave behind

b.

Type of setting for their personal residence

c.

Location of convenient health care services

d.

Ability to maintain a stable standard of living

ANS: D

The most significant factors contributing to a smooth transition into retirement are health, income, and social involvement; therefore the nurse helps the participants focus on financial issues to begin retirement planning, thereby establishing the future retirees ability to maintain health, income, and social involvement. By choosing a year for retirement, individuals can estimate their retirement income and consult specialists in retirement planning, such as the employees human resources department, to determine retirement benefits.

Defining the kind of legacy is a secondary factor and less likely to contribute to a smooth transition into retirement. The location of retirement and the location of health care services are also less likely to contribute to a smooth transition into retirement.

PTS:1DIF:AnalyzeREF:9-13| 47-48

TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment

9. Which one of the following older adults has the highest economic risk in retirement at the beginning of retirement?

a.

Divorced woman who has lived in this country for 3 years

b.

Male veteran who is an above-the-knee amputee and was a teacher

c.

Female widow who is a primary care nurse practitioner

d.

Man who immigrated from China and designs computer software

ANS: A

The older divorced woman who has lived in this country for 3 years has three factors associated with economic risk in retirement: (1) female sex, (2) divorced, and (3) immigrant with inadequate time to be eligible for government-sponsored retirement benefits.

The older male veteran, an above-the-knee amputee, was a teacher and has one risk factordisability. The older female widow and primary care nurse practitioner has two risk factors: (1) female gender and (2) widowhood. The older man who emigrated from China and designs computer software has one risk factorimmigrant.

PTS:1DIF:UnderstandREF:9-13| 47-48

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

10. As the wife of a university president, an older woman met exciting people and traveled extensively until her husband died. Besides losing an intimate partner, the nurse identifies that this woman is most likely to grieve for the loss of which area of her life?

a.

Self-confidence

c.

Status in community

b.

Economic security

d.

Intellectual stimulation

ANS: C

After the loss of her husband, this older adult will most likely mourn the loss of her status in the community; no longer is she a wife or the wife of a community leader. After her husbands death, the opportunities for university-related travel and social occasions will most likely disappear from her life.

After extensive travel and sophisticated social stimulation, this older adult is likely to be self-confident and to have acquired life skills from her experiences. The president of a university is likely to have planned for retirement and is likely to have left his survivors with an adequate estate. This woman will most likely to be able to provide intellectual stimulation in her own life, although the stimulation from the university-related activities will likely decrease.

PTS:1DIF:ApplyREF:9-13| 47-48

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

11. The children of an older woman ask the nurse for advice about helping their mother heal after her husbands (their fathers) death. Which strategy should the nurse share with the family?

a.

Appoint one family member to take her on outings.

b.

Coordinate family expressions of care and concern.

c.

Have each child plan a long trip with her assistance.

d.

Take her to community events to meet other people.

ANS: B

The nurse suggests that the family work together to provide extended expressions of caring and concern for their mother; many small expressions of concern and caring from several sources help the bereaved gain the strength and confidence needed to survive a huge loss. Multiple small gestures are more likely to help build strength and confidence than a few large gestures.

One person is unlikely to provide enough support for the bereaved, and this strategy can potentially imply that only one person is concerned. Helping a widow meet new people can be unsuitable; she may be uninterested or unwilling to attend events for meeting new people. In addition, she may feel that the family is trying to find a replacement for the deceased to ease the familys burden. However, the family can offer to accompany her to such events.

PTS: 1 DIF: Apply REF: 12-16 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

12. What makes nursing support of caregivers so important for health care in the United States?

a.

Family members providing care in the home are the best caregivers.

b.

Eighty percent of caregiving takes place in the home of the older adult.

c.

The health care system reimburses families for caregiving from Medicare.

d.

Informal caregiving saves the health care system enormous sums of money.

ANS: D

The value of caregiving is estimated at $257 billion; therefore informal caregiving is a huge savings for the health care system that it might potentially be unable to provide in the event that it was called to do so.

Although family members can be the most convenient and are the least expensive, they do not necessarily make the best caregivers. Family members provide 80% of the caregiving for older adults. Caregiving is not an expense for which Medicare reimburses the family.

PTS:1DIF:UnderstandREF:13-24| 51-55

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

13. Which of the following statements is true about relationships of older adults?

a.

Loneliness is evidence of self-centeredness and an unwillingness to love.

b.

A person may be lonely even when surrounded by other people.

c.

Hostile behavior indicates that a person prefers to be left alone.

d.

A pet cannot substitute for human attention.

ANS: B

The mere presence of other people, without significant personal exchange, does not prevent or alleviate loneliness.

Loneliness is evidence of the capacity to love. Hostile behavior can be a sign of loneliness. Pets can provide comfort, touch, affection, and an opportunity to care for another being.

PTS:1DIF:UnderstandREF:12-57

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

MULTIPLE RESPONSE

1. In a retirement planning program, the community health nurse wants to help participants avoid disappointment in retirement. The nurses program emphasizes which of the following elements that must be adequate to meet postretirement expectations? (Select all that apply.)

a.

Financial planning

b.

Company-sponsored benefits

c.

Company-sponsored health care

d.

Government-sponsored benefits

e.

Ability to maintain a personal residence

f.

Safety and security of a personal residence

ANS: A, B, C, D

Overall financial planning is important to provide a stable source of income for retirement if individuals want to fulfill their retirement expectations. Company-sponsored benefits must be sufficient in retirement to avoid large, unplanned expenses. Health care expenses in retirement are more likely to be significant; therefore retirement health care must be adequate to avoid huge, unexpected expenses. If government-sponsored benefits are inadequate for retirement, then the individual must plan to fill the gaps with preretirement planning.

The ability to maintain a residence is not essential to fulfill retirement expectations. Safety and security of the personal residence is also not essential to fulfill retirement expectations.

PTS: 1 DIF: Remember REF: 9-13| 47-48 TOP: Nursing Process: Planning

MSC: Safe, Effective Care Environment

2. The nurse should suggest which of the following to a spouse of a patient with dementia who has displayed inappropriate sexual behavior to decrease the occurrence? (Select all that apply.)

a.

Intimate relations

c.

Kiss

b.

Hug

d.

Touch

ANS: B, C, D

Inappropriate sexual behavior may be triggered by unmet intimacy needs or may be symptoms of an underlying physical problem, such as a urinary tract or vaginal infection. Encouraging family and friends to touch, hug, kiss, and hold hands when visiting may help meet the patients touch and intimacy needs and decrease inappropriate sexual behavior.

PTS: 1 DIF: Understand REF: 31 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

3. Which population(s) is(are) most at risk for developing HIV? (Select all that apply.)

a.

Those over the age of 50 years

b.

Women

c.

Those who are cognitively impaired

d.

Those who are sexually active

ANS: A, B, D

Older adults who are sexually active are at risk for HIV, AIDS, and other sexually transmitted diseases. People older than 50 years of age are approximately one sixth as likely to use condoms during sex. Older women who are sexually active are at high risk for HIV, AIDS, and other sexually transmitted infections from an infected partner, resulting, in part, from normal age changes of the vaginal tissuea thinner, drier, friable vaginal lining that makes viral entry more efficient. Being cognitively impaired does not put one at high risk.

PTS:1DIF:UnderstandREF:31-33

TOP: Nursing Process: Assessment MSC: Physiological Integrity

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