Exam 4 - Middle Age and Elderly

A 35-year-old person asks the nurse working in a dermatology clinic what causes skin to wrinkle. Which of the following statements would be the most appropriate way for the nurse to reply?

A. There really is nothing you can do to prevent a lot of wrinkles. It is part of aging.

B. As we age, we lose fat beneath the skin so wrinkles appear. There is nothing we can do to prevent it.

C. Wrinkles appear for a number of reasons, including loss of fat beneath your skin and too much sun exposure.

D. Wrinkles are caused by genetic factors.

C. Wrinkles appear for a number of reasons, including loss of fat beneath your skin and too much sun exposure.

A 45-year-old client who has experienced a 10-pound weight gain during the past year asks the nurse if she thinks iron supplements would help increase her energy. Which of the following would be the most appropriate action for the nurse to take?

A. Ask the client to describe her daily activity and diet.

B. Leave a note requesting an iron supplement on the client's chart for the doctor.

C. Provide the client with information related to aerobic exercise classes.

D. Ask the client if she is still menstruating.

A. Ask the client to describe her daily activity and diet.

Which of the following is a normal physiological change that occurs during middle age?

A. Increase in gastric emptying resulting in acid reflux

B. Reduction in height caused by kyphosis

C. Reduction of glomerular filtration by 50%

D. Increase in the amount of estrogen produced in both genders

C. Reduction of glomerular filtration by 50%

A nurse is conducting a community education program. Which of the following should be stressed as the leading cause of death in middle-aged adults?

A. Automobile accidents

B. Malignant disease

C. Homicide

D. Suicide

B. Malignant disease

A nurse formed a political action committee to advocate for health insurance for the uninsured. On which of the following populations would the nurse focus the group efforts?

A. Asian Americans

B. Blacks

C. Hispanic Americans

D. Working poor white Americans

C. Hispanic Americans

A nurse has been asked to develop a visit plan for a mobile mammogram van. Which of the following considerations would be made by the nurse when deciding which neighborhoods to visit?

A. Hispanic women have the highest rate of breast cancer of all minority groups in the United States.

B. The death rate from breast cancer is higher in Hispanic women than for women in other ethnic groups.

C. The death rate from breast cancer in Hispanic women has risen in the past 10 years.

D. Breast cancer in Hispanic women is usually diagnosed at an early stage.

B. The death rate from breast cancer is higher in Hispanic women than for women in other ethnic groups.

A nurse has received a grant to provide a community-based education series for middle-aged adults. Which of the following topics would allow the nurse to have the greatest impact on the health of members of this age group?

A. Diet and Exercise

B. Seatbelt Use

C. Depression Screening

D. Cancer Prevention

A. Diet and Exercise

The nurse collects the following assessment data from a woman, Hispanic ethnicity, BMI 29 kg/M2, age 41. Which of the following actions should be taken by the nurse?

A. Encourage the client to continue her dietary and exercise patterns.

B. Discuss her current dietary and exercise lifestyle habits.

C. Counsel the client that she will face chronic health problems because of her weight.

D. Encourage the client to adopt a low-calorie diet to help control her weight.

B. Discuss her current dietary and exercise lifestyle habits.

A nurse working in a rural location is interested in starting a weight management group for clients in the area. Which of the following interventions is most likely to ensure success?

A. Using a pre-set list of topics for discussion.

B. Relying on printed material to relay information to the group.

C. Asking for a list of topics that interest the group.

D. Beginning each session with a two-mile walk.

C. Asking for a list of topics that interest the group.

A 52-year-old postmenopausal woman tells the nurse that she is afraid she will develop osteoporosis like her mother did. Which of the following statements is the most appropriate response by the nurse?

A. The American diet is much better now than when your mother was your age, so you have enough calcium in your diet to keep your bones strong.

B. You have a strong genetic risk factor. There is not much we can do to stop the process.

C. You need about 1,000 mg of calcium a day to keep your bones strong. Let's talk about your diet.

D. Tell me about your diet. How much walking do you do each day? And what medications do you take?

D. Tell me about your diet. How much walking do you do each day? And what medications do you take?

Which of the following statements about alcohol intake is correct?

A. Women have a higher death rate related to alcoholism than men.

B. A woman who drinks two glasses of wine per day with her evening meal is considered a moderate drinker.

C. More women than men are considered problem drinkers.

D. Women who experience fewer cognitive effects from drinking are less likely to drink heavily than do women who get a "buzz" from drinking.

A. Women have a higher death rate related to alcoholism than men.

The Occupational Health Nurse is planning a health fair for employees. Which of the following information about dental health should be included?

A. Drinking bottled water helps prevent tooth decay.

B. Gingivitis results in bone destruction and can be eliminated by flossing daily.

C. Preventative dental care requires a visit to the dentist every four months.

D. In addition to screening for tooth decay, dentists screen for mouth cancer.

D. In addition to screening for tooth decay, dentists screen for mouth cancer.

Which of the following people has exceeded the recommended guidelines for activity?

A. A 36-year-old man who engages in bike riding and has a pulse rate of 137 during activity.

B. A 45-year-old woman who swims and has a pulse rate of 145 during activity.

C. A 50-year-old man who jogs and has a pulse rate of 120 during activity.

D. A 60-year-old woman who walks briskly and has a pulse rate of 125 during activity.

D. A 60-year-old woman who walks briskly and has a pulse rate of 125 during activity.

A 63-year-old woman complains to the nurse that she has insomnia and sleeps only 6 hours a night. Which of the following responses should be made by the nurse?

A. Do you want a sleeping pill?

B. Make sure that you do not nap during the day even if you are tired.

C. Do you feel excessively tired during the day?

D. The nurse practitioner may want to run some simple tests to find out why you are having trouble sleeping.

C. Do you feel excessively tired during the day?

A nurse conducted a five-week education series about health maintenance. Which of the following statements by a participant indicates the analysis stage of cognition as defined by Bloom's Taxonomy?

A. If I eat too much food and do not exercise, I will gain weight.

B. Fat is more calorie-dense than is protein. If I eat calorie-dense foods and do not moderate exercise at least five days a week, I will gain weight.

C. I will walk briskly at least a mile a day, six days a week, to maintain a healthy weight.

D. I can eat more if I exercise more.

B. Fat is more calorie-dense than is protein. If I eat calorie-dense foods and do not moderate exercise at least five days a week, I will gain weight.

 62-year-old person states to the nurse, I have trouble with my peripheral vision. Sometimes I do not notice objects unless they are in front of me. Which of the following disorders is the client likely experiencing?

A. Presbyopia

B. Glaucoma

C. Cataracts

D. Diabetic Retinothopy 

B. Glaucoma

Which of the following middle-aged adults has successfully transitioned to Erickson's generatively versus stagnation stage of development?

A. A 60-year-old woman who retired last year and volunteers at a homeless shelter two days a week.

B. A 63-year-old man who regrets his career choice and feels he cannot change careers.

C. A 45-year-old woman who resents having to care for her aging mother-in-law.

D. A 50-year-old man who is not saved for retirement but spends his discretionary income on vacations he takes by himself.

A. A 60-year-old woman who retired last year and volunteers at a homeless shelter two days a week.

A 52-year-old woman is going through menopause and tells the nurse working in the Women's Health Center that she is interested in slowing down the aging process and asks if she could take estrogen. Which of the following statements would be the best response by the nurse?

A. The latest research has shown that estrogen is safe to take and will help keep you healthy. I'll tell the nurse practitioner that you are interested in estrogen therapy.

B. Estrogen is safe to take for about 10 years. I'll get you some information on estrogen therapy that you can take home and read. C. The safety of long-term estrogen therapy is inconclusive. It is primarily used short-term to relieve hot flashes.

D. You can get the same effects from natural products in a health food store, and each product is backed up by research showing that it is effective.

C. The safety of long-term estrogen therapy is inconclusive. It is primarily used short-term to relieve hot flashes.

The occupational health nurse is asked to develop a plan to reduce work-related injuries. Which of the following recommendations would the nurse stress as the most effective way to reduce work-related injuries?

A. Make the work environment smoke-free.

B. Reduce environmental noise levels.

C. Conduct regular walk-through assessments at the work site.

D. Increase paid personal days from 1 to 3.

A. Make the work environment smoke-free.

Which of the following effects of divorce on middle-aged adults and children has been documented by research?

A. Children adapt to divorce more rapidly than do adults.

B. Emotional healing after a divorce takes approximately 24 months in adults.

C. Children of divorced parents may have lifelong difficulty forming relationships.

D. Children of divorced parents undergo similar emotional turmoil as their parents.

C. Children of divorced parents may have lifelong difficulty forming relationships.

A nurse is discussing sexuality with middle-aged men and women. Which of the following information should be stressed by the nurse? A. Contraception usage should be decreased as a woman nears menopause.

B. Difficulty with sexual performance among men happen near age 60.

C. HIV infection after age 50 is rare.

D. The majority of new HIV AIDS cases occur among middle-aged adults.

D. The majority of new HIV AIDS cases occur among middle-aged adults.

An occupational health nurse is planning injury prevention educational sessions. Which of the following considerations should be made by the nurse?

A. Education should be focused on workers with the least experience.

B. All workers need continued education related to safety issues.

C. OSHA rules apply to all companies with more than 25 employees.

D. Middle-aged workers have the lowest rate of injury of any age group.

B. All workers need continued education related to safety issues.

Taking into account all of the agents that affect middle-aged adults, the nurse plans a health education workshop focused on developing an individualized lifestyle change program for each participant. Which of the following actions should the nurse stress that individuals take first?

A. Limiting unprotected exposure to sun

B. Starting a smoking cessation program

C. Exercising at least three times a week

D. Scheduling a complete physical and dental exam

D. Scheduling a complete physical and dental exam

Which of the following medications is generally recommended to help preserve cardiovascular health in middle-aged women?

A. Aspirin

B. Folic acid

C. Estrogen D.

Estrogen receptor modulator

A. Aspirin

Which of the following individuals is at risk for developing osteoporosis? Select all that apply.

A. A 55-year-old man who is on a low dose of oral prednisone every day because of rheumatoid arthritis.

B. A 40-year-old woman who works as a secretary.

C. A 60-year-old woman who walks three miles a day.

D. A 50-year-old man who works as a mason.

A. A 55-year-old man who is on a low dose of oral prednisone every day because of rheumatoid arthritis.

B. A 40-year-old woman who works as a secretary.

Blacks are more likely than non-Hispanic white Americans to be diagnosed with cancer at a later stage and have a less optimal outcome after the diagnosis is made. Which of the following reasons help explain this difference? Select all that apply.

A. Lack of access to or utilization of cancer screening.

B. Lack of health insurance.

C. Genetic variations.

D. Lack of resiliency against disease.

A. Lack of access to or utilization of cancer screening.

B. Lack of health insurance.

C. Genetic variations.

A community health nurse is caring for a variety of different people in the community. Which of the following individuals would the nurse recognize as being at risk to experience increased stress related to family dynamics? Select all that apply.

A. A 54-year-old whose young adult daughter and grandson move back into their home.

B. A 44-year-old single mother raising three adolescent children without child support.

C. A 60-year-old couple whose children have established successful careers in another state.

D. A 36-year-old couple whose child plays competitive tennis.

A. A 54-year-old whose young adult daughter and grandson move back into their home.

B. A 44-year-old single mother raising three adolescent children without child support.

D. A 36-year-old couple whose child plays competitive tennis.

The occupational health nurse working for a large corporation is a member of a task force to improve the work environment. Which of the following suggestions by the nurse would help to improve work conditions? Select all that apply.

A. On-site walking paths

B. On-site food vendors

C. On-site counseling services

D. On-site meetings of support groups such as Alcoholics Anonymous

A. On-site walking paths

C. On-site counseling services

D. On-site meetings of support groups such as Alcoholics Anonymous

A nurse is planning to write a grant for a health promotion project in the community. Which of considerations should the nurse make when determining the appropriate population for this project?

A. The fastest growing population is children under the age of 12.

B. The fastest growing population is young black American adults.

C. The fastest growing population is white middle-aged adults.

D. The fastest growing population is non-white older adults age 65 and older.

D. The fastest growing population is non-white older adults age 65 and older.

Which of the following statements made by a client best identifies someone who would benefit from health promotion interventions?

A. I have a new grandchild and want to be part of her life.

B. My mother lived until she was 90, so  a long life is in my genes.

C. Some chronic illness is just part of aging.

D. I hope I'll live a lot longer, but one never knows.

A. I have a new grandchild and want to be part of her life.

Which of the following statements concerning nutrition in older adults is true?

A. Older adults who live in their own homes are more likely to be malnourished than older adults living in a nursing home.

B. Older adults lose their desire for high-fat, salty foods.

C. Meals served in long-term care institutions are usually more well-balanced than foods eaten by older adults living at home.

D. Many older adults are not aware of food assistance programs.

D. Many older adults are not aware of food assistance programs.

Which of the following statements concerning urinary incontinence is correct?

A. Urge incontinence occurs when one has the urge to void but is unable.

B. Stress incontinence is associated with emotional turmoil.

C. Functional incontinence is associated with environmental barriers.

D. Incontinence with high post-void residual occurs when someone laughs or sneezes.

C. Functional incontinence is associated with environmental barriers.

Which of the following nursing diagnosis is a priority related to the problem of urinary incontinence?

A. Risk for social isolation

B. Risk for impaired skin integrity

C. Risk for inadequate fluid intake

D. Risk for impaired coping

B. Risk for impaired skin integrity

A 75-year-old man tells the nurse that he has difficulty staying asleep during the night. Which of the following responses should be made by the nurse?

A. Older adults need as much sleep as middle-aged and younger adults. Let's talk about your sleep patterns.

B. I'll ask the nurse practitioner to prescribe a sleeping pill for you.

C. Taking naps during the day can help relieve excessive fatigue and will help you sleep better.

D. Let's talk about your sleep schedule and things that might prevent you from getting a restful night's sleep.

D. Let's talk about your sleep schedule and things that might prevent you from getting a restful night's sleep.

A nurse is conducting a community education program about cognition in older adults. Which of the following information should be included?

A. Some form of mild dementia is a normal part of aging.

B. All forms of dementia have the same symptoms, but progress at different rates.

C. Assessment for dementia should be part of routine physical exams.

D. Elders who score below 27 points on the mini mental state exam are not likely to have a cognition problem.

C. Assessment for dementia should be part of routine physical exams.

A nurse has recently accepted the position of Unit Nurse Manager on a long-term care unit. Which of the following directives should the nurse give to the staff nurses?

A. Encourage residents to participate in unit activities such as Scrabble and Bingo.

B. Demonstrate the caring aspect of nursing by dressing residents before breakfast.

C. Fill in missing words during conversation with the residents to avoid embarrassment.

D. Instruct the aides to get residents ready for breakfast as quickly as possible to make sure they are ready to eat.

A. Encourage residents to participate in unit activities such as Scrabble and Bingo.

A nurse is assisting with development of menu items at a long-term care facility. Which of the following menus would the nurse most likely recommend?

A. One egg over easy, one slice of whole wheat toast with sugar-free jam, four ounces of orange juice.

B. Five-ounce cheeseburger cooked medium well with lettuce and tomato, ten baked potato chips, and one cup of decaf coffee with low-fat and artificial sweetener.

C. Chef salad with two ounces each ham and turkey, lettuce, tomato, bean sprouts, onion, green pepper with low-fat dressing, and one small roll with low-fat spread.

D. Turkey, bacon, lettuce, and tomato sandwich on whole wheat bread with two teaspoons of low-fat mayonnaise, ten vegetable chips, and iced tea with artificial sweetener.

D. Turkey, bacon, lettuce, and tomato sandwich on whole wheat bread with two teaspoons of low-fat mayonnaise, ten vegetable chips, and iced tea with artificial sweetener.

Which of the following individuals would be at greatest risk of injury?

A. 80-year-old who does not have air conditioning or a fan.

B. 70-year-old who has new dentures.

C. 68-year-old who has difficulty tasting salt in food.

D. 84-year-old who needs hearing aids. 

A. 80-year-old who does not have air conditioning or a fan.

According to Erickson's Theory of Development, which of the following older adults has successfully navigated the stage of ego-integrity versus despair?

A. 72-year-old man who is reluctant to retire because work is everything to me.

B. 78-year-old woman who has scheduled her third facelift.

C. 80-year-old man who has informed his children that he has made his final funeral arrangements.

D. 67-year-old woman who is depressed because she has not been promoted at work for the past 10 years.

C. 80-year-old man who has informed his children that he has made his final funeral arrangements.

A couple in their 60s has assumed responsibility for raising their two grandchildren ages 9 and 12 because the children's parents died in a car accident. Which of the following are priority nursing interventions that the nurse can implement to help the grandparents cope with the responsibility of raising their grandchildren?

A. Connecting them with the Grandparents Raising Grandchildren Support Group

B. Encouraging them by reinforcing how they successfully raise their own children

C. Volunteering to provide respite time for them as needed

D. Assuring them that their stress level will lessen as they gain confidence

A. Connecting them with the Grandparents Raising Grandchildren Support Group

A nurse is conducting a staff development program about human sexuality for nurses who work in a long-term care facility. Which of the following statements would most likely be made by the nurse?

A. The desire for sexual intimacy declines rapidly with age.

B. Older adults are very well informed about sexuality.

C. Older adults need to practice safe sex.

D. The danger of contracting STDs during sexual intimacy is extremely low in older adults.

C. Older adults need to practice safe sex.

The clinic nurse has seen the following four people today. Which of the following people is demonstrating a healthy coping pattern?

A. Discussed very little except the loss of her husband three years ago.

B. Talks about the good times she had and her husband had before his illness and death one year ago.

C. States that life is not worth living without her husband who died two years ago.

D. Blames herself for her husband's death because she did not make him go to the doctor.

B. Talks about the good times she had and her husband had before his illness and death one year ago.

A nurse is assigned to provide care for a 96-year-old bedridden man who experiences severe pain from a chronic neurological disease. The man asks the nurse to please help him leave the world so that his suffering ends. Which of the following actions would be most appropriate for the nurse to take?

A. Assist the doctor with the man's request

B. Refuse to care for the man

C. Contact the pain care specialist

D. Provide the man with names of doctors who participate in assisted suicide

C. Contact the pain care specialist

A nurse is conducting a home visit for an older adult in the summer. Which of the following items should the nurse locate in the home?

A. Fan

B. Porch chair

C. Synthetic blend clothing

D. Thermometer

A. Fan

The community health nurse has obtained a grant to offer a safe driving series for older adults. Which of the following information should the nurse stress during the series?

A. Traffic fatalities involving older adults occur mainly at dusk.

B. The cause of two vehicle accidents is frequently an older driver striking another car.

C. The average blood alcohol level in older adults involved in accidents is higher than the blood alcohol level of younger drivers involved in accidents.

D. Re-learning the art of defensive driving can help reduce the likelihood that an older driver will be involved in a motor vehicle accident.

D. Re-learning the art of defensive driving can help reduce the likelihood that an older driver will be involved in a motor vehicle accident.

As part of a community-wide flu vaccination program for older adults, the nurse is assisting at a vaccination clinic. Which of the following questions should the nurse ask before administering the vaccine?

A. Do you have any food allergies?

B. Have you had the pneumococcal vaccine?

C. Have you had the flu in the past five years?

D. Do you have Medicare?

A. Do you have any food allergies?

A man tells a nurse that he is concerned about his risk of developing cancer. Which of the following behaviors would place the man at a higher risk of developing cancer?

A. Smoking a half of a pack of cigarettes a day.

B. Exercising three times a week.

C. Consuming green, leafy vegetables several times a week.

D. Visiting a chiropractor every week.

A. Smoking a half of a pack of cigarettes a day.

Which of the following statements is the best definition of polypharmacy?

A. The use of more than five medications prescribed by different physicians.

B. The use of multiple medications for the same or different health problems.

C. The use of multiple pharmacies and self-management of medications.

D. The use of multiple medications and supplements simultaneously.

B. The use of multiple medications for the same or different health problems.