N10 Final Combined

Health literacy is defined as:
A. the capacity to read basic health information in order to make appropriate health decisions.
B. the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.
C. the capacity to read and write in order to access health care.
D. the capacity to read and execute health care documents.

B. the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.

The daughter of an older hospitalized patient tells a nurse: "I am worried about my father. His memory is sharper when he is at home. He is forgetful, but is functional. Since he has been hospitalized his memory problems are much worse." The best response by the nurse is:
A. "It is common for long-term memory to be more impacted by age-related changes than short-term memory."
B. "Memory changes are often worse when an individual is in an unfamiliar or stressful situation."
C. "Perhaps you are just noticing your father's memory loss now that he is hospitalized."
D. "There is a lot of new information for your father to process here in the hospital; he is overloaded."

B. "Memory changes are often worse when an individual is in an unfamiliar or stressful situation."

An older resident in a senior community tells a nurse: "I am really worried. I joined an exercise class, and I just learned everyone's name yesterday, and I cannot remember them all today. Am I developing Alzheimer's disease?" The best response by the nurse is:
A. "You should be concerned. It is very unusual to forget something that you just learned."
B. "Let's monitor your recall abilities to see if the problem persists."
C. "Don't worry, a decline in both short- and long-term memory is a normal part of getting older."
D. "Although it is normal to have some changes in memory, forgetting names is very unusual."

B. "Let's monitor your recall abilities to see if the problem persists."

A nurse is developing an educational session for a group of older adults at a senior center. Which of the following would the nurse include in the education? (Select all that apply.)
A. Attention span, language, and communication skills typically remain stable with increasing age.
B. Older brains slow down and take longer to process constantly increasing amounts of information.
C. In order to preserve brain function, it is important to engage in challenging cognitive activities.
D. Older adults are not able to develop new cognitive abilities.
E. Individuals over age 100 have a higher prevalence of dementia than younger individuals.

A. Attention span, language, and communication skills typically remain stable with increasing age.
B. Older brains slow down and take longer to process constantly increasing amounts of information.
C. In order to preserve brain function, it is important to engage in challenging cognitive activities.

An older female resident of an assisted living facility says the following to a nurse: "I am very frightened about getting dementia. I have read a lot about brain exercises, but I am not sure what I should be doing." The nurse formulates a response based on knowledge of which of the following? (Select all that apply.)
A. Individuals should engage in some type of brain exercising activity a couple of times a week for at least 25 minutes.
B. Brain exercising activities are only effective if an individual has not experienced any memory problems at all.
C. Brain exercising activities may include computer-based games, memory training, board games, reading, and engaging in conversation.
D. Physical activity is important for wellness but is unrelated to brain health.
E. Individuals should choose brain exercise activities that are unfamiliar, challenging, and fun.

A. Individuals should engage in some type of brain exercising activity a couple of times a week for at least 25 minutes.
C. Brain exercising activities may include computer-based games, memory training, board games, reading, and engaging in conversation.
E. Individuals should choose brain exercise activities that are unfamiliar, challenging, and fun.

A nurse is planning a fall prevention education refresher session for the residents of a long-term care facility. The individuals are all cognitively intact and range in age from 80 to 100. The previous education on fall prevention was presented 2 months ago. What special considerations should the nurse take in relation to teaching this group of older adults? (Select all that apply.)
A. Make sure that all pamphlets are in large readable font (14-16 points) and include upper and lower case lettering.
B. Start education on falls from the beginning. It is unlikely that anyone remembers previous material.
C. Present all the information at once in one long session.
D. Ensure that there is adequate lighting in the room and that the temperature is comfortable.
E. Provide ongoing positive feedback during the session.

A. Make sure that all pamphlets are in large readable font (14-16 points) and include upper and lower case lettering.
D. Ensure that there is adequate lighting in the room and that the temperature is comfortable.
E. Provide ongoing positive feedback during the session.

A nurse hears a colleague state the following: "Can you believe that Mr. Jones' daughter just bought him a tablet computer? He is 90 years old. It is ridiculous to think that he can learn to use it." The nurse formulates a response based on research that shows: (Select all that apply.)
A. older adults comprise the fastest growing population using computers and the Internet.
B. Internet use is less prevalent in individuals over age 75 than those ages 65-74.
C. older American men are the fastest growing group of social networking site users.
D. older adults use the Internet only for social networking and recreational uses.
E. technology has the potential to improve quality of life for older adults.

A. older adults comprise the fastest growing population using computers and the Internet.
B. Internet use is less prevalent in individuals over age 75 than those ages 65-74.
E. technology has the potential to improve quality of life for older adults.

The greatest risk for injury for a client with progressed Parkinson's disease is:
A. falls.
B. suicide.
C. bleeding ulcers.
D. respiratory arrest.

A. falls.

An older adult with suspected Parkinson's disease has a "challenge test" performed in order to confirm the diagnosis. The nurse understands that a "challenge test" will demonstrate which of the following?
A. Immediate reversal of all symptoms of Parkinson's disease after administration of levodopa
B. Dramatic improvement of symptoms of Parkinson's disease after administration of levodopa
C. Dramatic improvement in gait only after administration of levodopa
D. Dramatic improvement in tremor only after administration of levodopa

B. Dramatic improvement of symptoms of Parkinson's disease after administration of levodopa

A nurse is caring for an older adult with Parkinson's disease. The patient is receiving the medication levodopa-carbidopa. The nurse understands that in order to maximize effectiveness, the administration schedule for this medication should adhere to which of the following?
A. Administer with meals only
B. Administer first thing in the morning only
C. Administer on an empty stomach, 30-60 minutes before or 45-60 minutes after a meal
D. Administer with a full 8 oz of water and have the patient sit upright for 30 minutes after

C. Administer on an empty stomach, 30-60 minutes before or 45-60 minutes after a meal

While the older African American is at the highest risk for developing dementia, the nurse demonstrates an understanding of this disease process's risk factors when assessing this population's:
A. weight and elimination patterns.
B. heart rate and capillary refill status.
C. genetic makeup.
D. muscle strength and reflex times.

C. genetic makeup.

An older adult is diagnosed with Alzheimer's disease. The nurse knows that this diagnosis is made on the presence of which of the following? (Select all that apply.)
A. A decline from a previous level of functioning
B. Fluctuation of symptoms over the course of a 24-hour period
C. An insidious onset
D. A gradual decline in cognitive abilities
E. The cognitive changes worsen in the evening hours

A. A decline from a previous level of functioning C. An insidious onset

A diagnosis of Parkinson's disease is made based on the presence of which of the following
symptoms? (Select all that apply.)
A. Rigidity
B. Resting tremor
C. Bradykinesia
D. Orthostatic hypotension
E. Progressive decline in cognitive function

A. Rigidity
B. Resting tremor
C. Bradykinesia

An older patient is concerned that her neighbor was recently diagnosed with Alzheimer's disease and asks a nurse what can be done to decrease the risk of Alzheimer's disease. The nurse includes which of the following in the response to the patient? (Select all that apply.)
A. Maintain blood pressure within normal limits.
B. Smoking cessation.
C. Maintain control of blood sugar (hemoglobin A1C ≤7).
D. Eliminate fats from the diet.
E. Maintain healthy body weight.

A. Maintain blood pressure within normal limits.
B. Smoking cessation.
C. Maintain control of blood sugar (hemoglobin A1C ≤7).
E. Maintain healthy body weight.

Differences in the presentation of patients with Alzheimer's disease (AD) and Dementia with Lewy bodies (DLB) are: (Select all that apply.)
A. individuals with LB develop motor symptoms, and individuals with AD do not.
B. individuals with AD display impairments in judgment whereas individuals with LB do not.
C. the use of traditional atypical medication is contraindicated for individuals with LB.
D. LB usually occurs in individuals under age 60, and AD occurs in individuals only over age 60.
E. individuals with LB develop language symptoms, and individuals with AD do not.

A. individuals with LB develop motor symptoms, and individuals with AD do not.
C. the use of traditional atypical medication is contraindicated for individuals with LB.

An older adult is referred to a geriatric nurse practitioner because of changes in memory and reports by family members that "there is something different about her." The nurse practitioner evaluates the older adult for potentially reversible causes for the changes, which include: (Select all that apply.)
A. depression.
B. delirium.
C. osteoporosis.
D. rheumatoid arthritis.
E. medication side effects.

A. depression.
B. delirium.
E. medication side effects.

A nurse understands that the pathophysiology of Parkinson's disease includes which of the following? (Select all that apply.)
A. A deficiency of the neurotransmitter dopamine
B. An inability of the neurons to absorb dopamine
C. A reduction of dopamine receptors
D. An accumulation of Lewy Bodies, especially in the basal ganglia
E. The presence of neurofibrillary tangles and amyloid plaques in the brain

A. A deficiency of the neurotransmitter dopamine
C. A reduction of dopamine receptors
D. An accumulation of Lewy Bodies, especially in the basal ganglia

A client is newly diagnosed with type 2 diabetes mellitus. Which diagnostic test will best evaluate the management plan prescribed for this client?
A. A yearly funduscopic examination by an ophthalmologist
B. Regular foot examinations by a podiatrist
C. Quarterly hemoglobin A1C
D. Biannual cholesterol testing

C. Quarterly hemoglobin A1C

Which is the most likely reason that type 2 diabetes mellitus is often difficult to diagnose in older adults?
A. Presenting symptoms occur very quickly.
B. The disease rarely occurs in older adults.
C. The classic symptoms may not be present in older adults.
D. There are no recognizable symptoms; it is a "silent killer."

C. The classic symptoms may not be present in older adults.

Hyperglycemia is harder to detect in older adults due to which of the following?
A. There is a higher tolerance for elevated levels of circulating glucose in older adults.
B. Older adults tend to metabolize glucose at a faster rate than younger adults.
C. Fingerstick glucose monitoring is inaccurate in older adults.
D. The classic signs of elevated glucose levels, polyuria, polyphagia, and polydipsia are rarely present in older adults.

A. There is a higher tolerance for elevated levels of circulating glucose in older adults.

A nurse is caring for an older adult who is diagnosed with type 2 Diabetes. The patient is prescribed oral medication for diabetes. The nurse can expect that which of the following medications is prescribed as a first-line therapy?
A. Insulin
B. Sulfonylureas
C. Metformin
D. Chlorpropramide

C. Metformin

An older adult with type 2 DM who is being treated with insulin wants to increase his activity level and begin a walking program. What recommendations should the nurse provide to this patient?
A. A walking program is not recommended for an older adult with diabetes.
B. The walking regimen needs to be done on a regularly scheduled basis.
C. Regular exercise should not exceed 30 minutes three times a week.
D. Insulin can most probably be discontinued if the individual adheres to the walking program.

B. The walking regimen needs to be done on a regularly scheduled basis.

A nurse is educating an otherwise healthy older adult with diabetes mellitus about diabetes treatment goals. Which of the following does the nurse recommend? (Select all that apply.)
A. Hemoglobin A1C (Hb A1C) value of

A. Hemoglobin A1C (Hb A1C) value of

An older patient asks a nurse: "I went to my diabetes doctor and everything was stable. The nurse practitioner spent the entire time teaching me about decreasing my risks of heart disease. It seemed odd that she did not focus on teaching me how to better control my diabetes. Do you know why?" The nurse formulates a response based on the understanding that: (Select all that apply.)
A. promoting cardiovascular health has the potential to minimize the complications of DM.
B. there is little evidence that demonstrates that the course of DM can be altered in an older adult.
C. the benefits of better control of blood pressure and lipid levels are seen much quicker than the benefits of better glycemic control.
D. older adults are less receptive to teaching about diabetes than they are to teaching about cardiovascular disease.
E. diabetes is not a common chronic condition in older adults.

A. promoting cardiovascular health has the potential to minimize the complications of DM.
C. the benefits of better control of blood pressure and lipid levels are seen much quicker than the benefits of better glycemic control.

A nurse is caring for an older adult who has hyperthyroidism. The nurse knows that the following manifestations are more likely in the older adult: (Select all that apply.)
A. depression.
B. weight loss.
C. heat intolerance.
D. dyspnea.
E. tremor.

A. depression.
B. weight loss.
D. dyspnea.

A nurse works in an outpatient diabetes clinic. The nurse knows that the minimum standard of care for a patient with diabetes includes assessment of the following at each visit: (Select all that apply.)
A. neurological examination.
B. inspecting the feet.
C. glaucoma testing.
D. mood and coping.
E. obtaining TSH levels.

A. neurological examination.
B. inspecting the feet.
D. mood and coping.

A nurse is educating an older adult with diabetes on glucose self-monitoring. When developing the teaching plan, the nurse includes which of the following goals in the teaching plan? The patient will: (Select all that apply.)
A. demonstrate the technique for obtaining a blood sample.
B. verbalize actions to take when results indicate an error on the machine.
C. state the correct timing of blood glucose monitoring.
D. state the signs and symptoms of both hyperglycemia and hypoglycemia.
E. demonstrate technique for storing and transporting insulin correctly.

A. demonstrate the technique for obtaining a blood sample.
B. verbalize actions to take when results indicate an error on the machine.
C. state the correct timing of blood glucose monitoring.

The nurse is caring for an older client who experienced a hip replacement surgery 10 hours ago. Which intervention will help minimize this client's risk of developing delirium?
A. Requesting that staff offer fluids each time they interact with the client
B. Medicating the client to best facilitate restorative sleep
C. Encouraging the client to remain still and thus minimize pain
D. Suggesting that visitors are limited to family members only

A. Requesting that staff offer fluids each time they interact with the client

Which intervention best addresses the principle that is the basis for communicating with a client experiencing postsurgical delirium?
A. Reminding the client that delirium is generally acute and reversible
B. Assuming that the client's statements are an attempt to express needs
C. Allowing the client sufficient time to formulate an answer to questions
D. Using nonverbal communication techniques to communicate with the client

B. Assuming that the client's statements are an attempt to express needs

An older client admitted to the hospital after having sustained a fall at home is diagnosed with a right hip fracture and experienced a surgical reduction of the fracture. At 2:30 AM, she awakens from sleep insisting that her daughter is in the other room and wants to see her. Attempts to reorient her to the surroundings are unsuccessful. In reviewing the client's record, what data would be considered a primary risk factor for the delirium?
A. History of dementia
B. Death of the client's husband last month
C. The client's age
D. History of cardiac disease

A. History of dementia

An older client diagnosed with dementia resides with his daughter. When the homecare nurse visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, "I don't know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him." How will the nurse respond to the client's daughter?
A. "Let's think about what you may have done to anger your father?"
B. "Let's try to figure out what your father was trying to say with his behavior."
C. "Scratching is usually a sign of untreated pain. Do you think your father is in pain?"
D. "Maybe you should consider having a home health care provider take over responsibility for your father's physical care."

B. "Let's try to figure out what your father was trying to say with his behavior."

A nurse is caring for a patient with a diagnosis of delirium. Which of the following is an expected assessment finding for this patient?
A. Normal attention span
B. Fluctuation in symptoms
C. Normal sleep cycle
D. Increased appetite

B. Fluctuation in symptoms

Which intervention to manage a wandering client in a long-term care facility should be implemented? (Select all that apply.)
A. Walk with the person, allowing them control within the bounds of safety.
B. Redirect the person back toward the facility.
C. Call the person by his or her formal name.
D. Using physical restraints to prevent wandering to maintain safety.
E. Make direct eye contact with the person.

A. Walk with the person, allowing them control within the bounds of safety.
B. Redirect the person back toward the facility.
C. Call the person by his or her formal name.
E. Make direct eye contact with the person.

Which information will the nurse manager include when discussing the major differentiation between delirium and dementia with novice nurses? (Select all that apply.)
A. The delirious client learns to make up answers to hide his or her confusion.
B. Delirium requires increased monitoring at night.
C. The client diagnosed with dementia generally looks frightened.
D. Dementia results in a steady decline in cognitive abilities.
E. Delirium is characterized by fluctuations in alertness.

B. Delirium requires increased monitoring at night.
D. Dementia results in a steady decline in cognitive abilities.
E. Delirium is characterized by fluctuations in alertness.

A nurse is caring for a 92-year-old female patient who was admitted to the hospital 1 day after she had outpatient cataract surgery. The patient who lives in an assisted living facility became very confused and agitated and was found wandering in the lobby of the building in her nightgown. She refused to return to her room and stated that there were "bad men" in her room. The patient has a history of dementia, diabetes, heart failure, and is on seven different medications. She was widowed 1 year ago. The nurse suspects that she has delirium. What are the patient's risk factors for delirium? (Select all that apply.)
A. Age of 92
B. Residing in an assisted living facility
C. History of dementia
D. Female gender
E. Recent cataract surgery

A. Age of 92
C. History of dementia
E. Recent cataract surgery

A nurse in a long-term care facility is concerned that a 94-year-old resident with dementia is losing weight. Upon assessment, the nurse notes that the resident, who is able to feed herself independently, consumes less than 50% of each of her meal trays. Which of the following strategies can the nurse utilize to improve this resident's intake? (Select all that apply.)
A. Assign a nursing assistant to feed the resident.
B. Assign a nursing assistant to sit with the resident as the resident eats.
C. Serve the resident finger foods.
D. Serve the resident one dish at a time.
E. Alter the dining ambience to reduce distractions.

B. Assign a nursing assistant to sit with the resident as the resident eats.
C. Serve the resident finger foods.
D. Serve the resident one dish at a time.
E. Alter the dining ambience to reduce distractions.

A nurse is assessing an older patient with new onset confusion. The nurse understands that in order to have a diagnosis of delirium, the patient must exhibit which of the following? (Select all that apply.)
A. Acute onset of symptoms or fluctuating course
B. Inattention
C. Disorganized thinking
D. Altered level of consciousness
E. Flat affect

A. Acute onset of symptoms or fluctuating course
B. Inattention
C. Disorganized thinking
D. Altered level of consciousness

A client who reported "a problem sleeping" shows an understanding of good sleep hygiene by:
A. doing 10 pushups before bed to encourage a "pleasant tiredness."
B. seldom eating a bedtime snack.
C. engaging in computer games as a pre-bed activity.
D. avoiding daytime napping.

D. avoiding daytime napping.

When an older adult client is diagnosed with restless leg syndrome/Willis-Ekbom Disease (RLS/WED), the nurse is confident that client education on the condition's contributing factors has been effective when the client states:
A. "A warm bath at night instead of in the morning is my new routine."
B. "Eating a banana at breakfast assures me the potassium I need."
C. "I've cut way back on my caffeinated coffee, teas, and sodas."
D. "I elevate my legs on a pillow so as to improve circulation."

C. "I've cut way back on my caffeinated coffee, teas, and sodas."

A nurse in a long-term care facility notes that an older resident with dementia awakens frequently at night and is restless and agitated. Which of the following interventions will be most effective to help manage this resident's sleep problems?
A. Passive music therapy at bedtime
B. Limiting fluid intake for the resident
C. Educating the resident on the association between dementia and insomnia
D. Administering a mild sedative hypnotic at bedtime

A. Passive music therapy at bedtime

An older patient asks a nurse, "I really have trouble sleeping and my doctor does not want to prescribe a sleeping pill for me. He says they are not good for older people. I really don't understand his response. Can you help me?" The best response by the nurse is:
A. "Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep."
B. "Prescription sleeping medications have many adverse effects in older people. Why don't you try using an over-the-counter medication?"
C. "Sleeping medications do not provide any improvement in sleep for older people."
D. "Sleep problems are common in older people. There really is nothing that you can do to help with that."

A. "Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep."

An older adult's diagnosis of sleep apnea is supported by nursing assessment and history data that include: (Select all that apply.)
A. followed a vegetarian diet for last 28 years.
B. male gender.
C. a smoking history of 1 pack a day for 45 years.
D. 30 pounds over ideal weight.
E. history of Crohn's disease.

B. male gender.
C. a smoking history of 1 pack a day for 45 years.
D. 30 pounds over ideal weight.

An older patient asks a nurse, "It seems like all of my friends and I have difficulty sleeping. Is it common among older people?" The nurse formulates a response based on the knowledge that normal age-related changes in sleep include: (Select all that apply.)
A. total sleep time and sleep efficiency are reduced.
B. rapid eye movement (REM) sleep is shorter, less intense, and more evenly distributed.
C. sleep requirements for older adults are less than that of younger adults.
D. daytime napping is common.
E. sleep tends to be deeper in older adults than in younger adults.

A. total sleep time and sleep efficiency are reduced.
B. rapid eye movement (REM) sleep is shorter, less intense, and more evenly distributed.
D. daytime napping is common.

An older adult tells a nurse that he is experiencing difficulty falling asleep, he routinely gets into bed at 8:30 PM and watches his favorite television shows until 11:00 PM, and often lies awake for hours after. Which of the following suggestions are appropriate for the nurse to give to this patient? (Select all that apply.)
A. Go to bed only when sleepy.
B. If unable to sleep within a reasonable time (15-20 minutes), get out of bed and pursue relaxing activities.
C. Engage in moderate exercise to induce fatigue.
D. Do not watch television or work in bed.
E. If unable to sleep, engage in enjoyable activities on the computer.

A. Go to bed only when sleepy.
B. If unable to sleep within a reasonable time (15-20 minutes), get out of bed and pursue relaxing activities.
D. Do not watch television or work in bed.

An older patient is diagnosed with RLS/WEB. Which of the following nonpharmacologic interventions should the nurse include in the plan of care? (Select all that apply.)
A. Engage in regular mild to moderate physical activity including stretching activities for the lower extremities.
B. Avoid caffeine, alcohol, and tobacco.
C. Avoid
hot baths.
D. Relaxation techniques may be helpful.
E. A mild sleeping medication such as diphenhydramine (Benadryl) might be helpful.

A. Engage in regular mild to moderate physical activity including stretching activities for the lower extremities.
B. Avoid caffeine, alcohol, and tobacco.
D. Relaxation techniques may be helpful.

A long-term care facility has selected sleep promotion as its quality improvement project. Which of the following interventions would be appropriate to implement on this unit? (Select all that apply.)
A. Ensuring that all residents receive evening care and are in bed by 8:00 PM
B. Taking as many residents as possible outside for 30 minutes daily
C. Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9:00 PM and 6:00 AM
D. Avoiding waking residents for routine care during the night
E. Limiting caffeine and fluids before bedtime

B. Taking as many residents as possible outside for 30 minutes daily
C. Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9:00 PM and 6:00 AM
D. Avoiding waking residents for routine care during the night
E. Limiting caffeine and fluids before bedtime

A nurse is caring for an older adult who is in the pre-trajectory phase of the Chronic Illness Trajectory. The nurse knows that this phase is characterized by which of the following:
A. the absence of signs or symptoms of the illness.
B. diagnostic testing being conducted.
C. a progressive decline in physical and or mental status.
D. a period of temporary remission from the crisis.

A. the absence of signs or symptoms of the illness.

A major difference in the diagnosis of chronic disease between younger adults and older adults is that:
A. chronic disease is often diagnosed earlier in younger adults and measures can be implemented to prevent later problems.
B. chronic disease is often diagnosed earlier in older adults since they are more likely to seek medical care.
C. chronic disease is usually not identified in older adults because of the many age-related changes.
D. chronic illness is uncommon in younger adults.

A. chronic disease is often diagnosed earlier in younger adults and measures can be implemented to prevent later problems.

A man who is a smoker is hospitalized for orthopedic surgery. A nurse takes the opportunity to provide smoking cessation education. The patient asks the nurse: "I have been smoking for most of my life. Why are you wasting your time telling me to stop smoking? Isn't it too late?" The nurse bases the response on the knowledge that:
A. if major lifestyle risk factors are eliminated, a significant amount of disease could be prevented.
B. If major lifestyle risk factors are eliminated, the risk for premature death is eliminated.
C. smoking cessation at a late age will not impact the smoker but can reduce exposure of family members to second-hand smoke.
D. smoking cessation education is only effective in individuals under age 75.

A. if major lifestyle risk factors are eliminated, a significant amount of disease could be prevented.

A nurse cares for an older adult who is described as being "frail." The nurse understands that in order to be characterized as frail an individual must possess which of the following characteristics? (Select all that apply.)
A. Slow walking speed
B. Low activity level
C. Self-reported exhaustion
D. Taking at least five prescribed medications
E. A diagnosis of at least two chronic conditions

A. Slow walking speed
B. Low activity level
C. Self-reported exhaustion

A nurse is planning health education on chronic illnesses for a group of seniors in the community. When deciding upon which illnesses to focus upon, the nurse knows that which of the following are the most common diseases in the United States? (Select all that apply.)
A. Heart disease
B. Cancer
C. Asthma
D. Osteoarthritis
E. Diabetes

A. Heart disease
B. Cancer
D. Osteoarthritis
E. Diabetes

The role of a nurse caring for an older patient who is in the stable phase of a chronic illness may include which of the following? (Select all that apply.)
A. Coordinating care with members of the interdisciplinary team
B. Administering medications to the patient
C. Providing assistance with bathing and dressing
D. Ensuring that the patient's immunizations are up to date
E. Providing emergency care

A. Coordinating care with members of the interdisciplinary team
B. Administering medications to the patient
C. Providing assistance with bathing and dressing

A nurse is teaching a group of older adults about healthy aging. The nurse discusses global lifestyle risk factors for chronic disease. The nurse includes which of the following in the education? (Select all that apply.)
A. Smoking cessation and avoidance of tobacco
B. Maintenance of high levels of physical activity
C. Importance of eating a balanced diet
D. Development of advance directives
E. Maintenance of blood pressure readings at a level of 120/80 or lower

A. Smoking cessation and avoidance of tobacco
B. Maintenance of high levels of physical activity
C. Importance of eating a balanced diet

When assessing an older client for indications of depression, the nurse bases the intervention on the knowledge that:
A. the older client's symptoms may be atypical for the disorder.
B. depression is a common mental disorder among the older population.
C. the older client is generally willing to discuss his or her mental health symptoms.
D. depression is not as commonly seen in this population as are anxiety disorders.

A. the older client's symptoms may be atypical for the disorder.

The nurse preparing educational information on the most common mental health disorder among the older adult population should include:
A. methods for reducing anxiety.
B. a written depression screening tool.
C. local schizophrenia support groups.
D. signs and symptoms of alcoholism.

B. a written depression screening tool.

An older adult client has been voluntarily admitted for treatment of alcohol dependency. In implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging?
A. Assessing the client for both depression and anxiety
B. Discussing the poor prognosis of this disorder with the client
C. Explaining the need for proper nutrition to minimize the effects of alcoholism
D. Identifying the effects of chronic alcoholism on the human body

A. Assessing the client for both depression and anxiety

In order to focus on the older population with the greatest risk for suicide, the nurse would conduct a depression screening that targets:
A. African American men.
B. white men.
C. white women.
D. African American women.

B. white men.

An older adult says to the nurse, "I don't know why I can't handle booze like I used to when I was younger." The nurse's response is based on the knowledge that:
A. older adults develop higher blood alcohol levels due to age-related changes in the neurological system.
B. older adults develop higher blood alcohol levels due to age-related changes that alter absorption and distribution of alcohol.
C. older adults develop higher blood alcohol levels due to slowed reaction times.
D. older adults develop higher blood alcohol levels due to cognitive changes.

B. older adults develop higher blood alcohol levels due to age-related changes that alter absorption and distribution of alcohol.

How should the nurse reply when an older adult asks, "How much alcohol is good for you?"
A. "Alcohol isn't good for you so avoid it as a general rule."
B. "Experts in the field recommend only one regular sized drink a day."
C. "It's been said that red wine has health benefits, but that doesn't mean drink a whole bottle."
D. "If you are only drinking on special occasions, limit yourself to two drinks."

B. "Experts in the field recommend only one regular sized drink a day."

An older adult has recently experienced a number of stressful life events. The client comes to the ambulatory clinic and tells the nurse that, "On top of all I've had to endure, now I've got this flu!" In rendering care for this client, the nurse recognizes that:
A. the client is exhibiting attention-seeking behaviors to substitute for poor coping skills.
B. crisis and stressful situations may produce emotions that erode the health of the older people.
C. the client is exhibiting learned helplessness as a result of the recent stressors.
D. a period of crisis will ultimately lead to a lower level of physical and mental functioning.

B. crisis and stressful situations may produce emotions that erode the health of the older people.

An older client in an adult day care program tells the nurse, "I'm very stressed because another neighbor passed away." The most therapeutic response by the nurse is:
A. "You are experiencing grief, not stress."
B. "Tell me what you did when your other neighbor passed away."
C. "Are you worrying about your own death?"
D. "Let's get involved in some activities and not think about sad things."

B. "Tell me what you did when your other neighbor passed away."

A nurse who is caring for an older patient with bipolar disorder knows that the patient needs additional education when the patient states:
A. "Bipolar disorder often results in 'a leveling out' of symptoms as one ages."
B. "Relapses in bipolar disorder tend to be precipitated by medical problems."
C. "The length of the phases of depression and mania varies."
D. "Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults."

D. "Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults."

A nurse administers the Short Michigan Alcohol Screening Test Geriatric Version (S-MAST-G) to an older adult. The older adult receives a score of "2." The nurse knows that this score is indicative of:
A. no problem with alcohol.
B. a problem with alcohol.
C. a mild problem with alcohol.
D. a severe problem with alcohol.

B. a problem with alcohol.

When discussing electroconvulsive therapy (ECT) with an older, chronically depressed adult and his family, which statement will the nurse use to support this intervention? (Select all that apply.)
A. "This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications."
B. "ECT is contraindicated in frail adults with multiple comorbidities."
C. "ECT is a safe intervention for those with psychotic ideation."
D. "ECT is the most effective treatment for older adults with major depression."
E. "ECT results in a more immediate reduction in depressive symptoms."

A. "This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications."
D. "ECT is the most effective treatment for older adults with major depression."
E. "ECT results in a more immediate reduction in depressive symptoms."

A nurse is assisting an older adult to cope with depression after the loss of a spouse. Which of the following actions should the nurse take? (Select all that apply.)
A. Encourage the person to develop a daily activity schedule that includes pleasant activities.
B. Validate depressed feelings as aiding recovery.
C. Discourage angry outbursts.
D. Suggest that the person not make any decisions until the depression has passed.
E. Involve the family in teaching about depression.

A. Encourage the person to develop a daily activity schedule that includes pleasant activities.
B. Validate depressed feelings as aiding recovery.
E. Involve the family in teaching about depression.

A nurse is conducting an assessment of an older adult in a geriatric clinic. The patient states that he drinks two to three alcoholic beverages daily. The patient has multiple chronic comorbid conditions and is on five different medications. Which of the following medications is the nurse concerned will interact with the alcohol? (Select all that apply.)
A. Naproxen for pain
B. Daily multivitamin
C. Prozac for depression
D. Celebrex for arthritis
E. Toprol XL for hypertension

A. Naproxen for pain
C. Prozac for depression
E. Toprol XL for hypertension

A nurse in a long-term care facility is approached by an older resident who is crying and states: "You need to help me. The mean little men are in my room again. They are watching me from the corner and they are laughing at me. Make them go away." The nurse accompanies the resident to the room and there is no one in the corner of the room. What is the best response by the nurse? (Select all that apply.)
A. "Yup, I see them. Let me call security to haul the men away."
B. "Can you tell me what you are so frightened of?"
C. "I will do my best to keep you safe."
D. "I understand that you are very frightened and upset."
E. "You know that there is no one there. Stop carrying on like this."

B. "Can you tell me what you are so frightened of?"
C. "I will do my best to keep you safe."
D. "I understand that you are very frightened and upset."

When an older adult reports experiencing several different stressors over the last 6 months, the nurse demonstrates an understanding of the physiological effects of stress on the body by: (Select all that apply.)
A. assessing the client using the Geriatric Depression Scale (GDS).
B. testing the client's urine for red blood cells.
C. screening the client for abnormally high serum glucose levels.
D. inquiring as to whether the client has experienced weight changes.

C. screening the client for abnormally high serum glucose levels.
D. inquiring as to whether the client has experienced weight changes.

The partner of a client comments, "Our sex life will certainly suffer now that he's had a heart attack." Which statement is the basis for the nurse's response?
A. The client should no longer have sexual relations because of the demand on his heart.
B. The energy expenditure during sex is equivalent to briskly climbing six flights of stairs.
C. People with heart disease may reduce their sexual activity out of fear of their condition.
D. The couple will benefit from attending a cardiac support group.

C. People with heart disease may reduce their sexual activity out of fear of their condition.

Which statement regarding touch and touch zones is most accurate?
A. People between the ages 66 and 100 are the most often touched.
B. Newly graduated nurses tend to touch clients less often than do nursing students.
C. When performing pericare, the nurse is working within the zone of intimacy.
D. Illness, confinement, and dependency are stresses on the intimate zone of touch.

D. Illness, confinement, and dependency are stresses on the intimate zone of touch.

Which outcome regarding the effects of therapeutic touch on the skin is inaccurate?
A. Brings about sensory stimulation.
B. Helps relieve physical and psychosocial pain.
C. Is known to reduce anxiety and tension.
D. Improves skin integrity.

D. Improves skin integrity.

Which question has priority when assessing a client for risk factors related to the use of sildenafil (Viagra)?
A. "How old are you?"
B. "Are you currently being treated for hypertension?"
C. "Do you have a history of respiratory infections?"
D. "Have you ever been told you have prostate problems?"

B. "Are you currently being treated for hypertension?"

Symptoms of HIV are often under-recognized in older adults because:
A. there is a very low incidence of HIV in older adults.
B. many of the classic symptoms are also common to other conditions common in older adults.
C. presenting symptoms are markedly different from those in younger adults.
D. AIDS progresses much slower in older adults so symptoms are not recognized easily.

B. many of the classic symptoms are also common to other conditions common in older adults.

What intervention should a nurse implement when an older male diagnosed with dementia is observed masturbating in the unit's dayroom?
A. Remove the resident from the dayroom and complete an assessment of his behavior.
B. Cover the resident's lap with a blanket and leave him in the dayroom.
C. Counsel the resident by telling him that his behavior is inappropriate.
D. Distract the resident so that he will stop the behavior.

A. Remove the resident from the dayroom and complete an assessment of his behavior.

An older widow who is a newly admitted resident of a long-term care facility develops a romantic relationship with a male resident. When the resident's daughter demands that the staff "put a stop to this sexual behavior right now," the nurse's response is based on the understanding that:
A. such activity in a long-term care facility is inappropriate.
B. older adults need to express love and intimacy.
C. sexual desire is usually absent in older adults.
D. sexual activity can be dangerous for older adults with chronic illnesses.

B. older adults need to express love and intimacy.

Which intervention has priority before touching a client's consent zone?
A. Draping the area to minimize exposure
B. Having another nurse present
C. Explaining why the area will be touched while asking permission
D. Assuring the client that the touch is absolutely necessary

C. Explaining why the area will be touched while asking permission

A nurse practitioner is using the PLISSIT model to guide a discussion of sexuality with an older patient in the geriatric clinic. Which of the following are congruent with the PLISSIT model? (Select all that apply.)
A. "What concerns or questions do you have about fulfilling your sexual needs?"
B. "Let me tell you about the impact of your cardiac disease on sexual activity."
C. "I have a few suggestions on lubricants that might make intercourse more comfortable for you."
D. "Most older adults are not comfortable talking about sexuality, but it is important to do so."
E. "It is not unusual to have difficulty performing sexually as you age."

A. "What concerns or questions do you have about fulfilling your sexual needs?"
B. "Let me tell you about the impact of your cardiac disease on sexual activity."
C. "I have a few suggestions on lubricants that might make intercourse more comfortable for you."

An older man who recently had a myocardial infarction is being discharged home from the hospital. He tells a nurse, "I am really worried about having sex with my wife. I am afraid that I am going to have another heart attack." The best response by the nurse includes which of the following? (Select all that apply.)
A. "If you are able to engage in mild to moderate physical activity without symptoms, you can resume sexual activity."
B. "You really should not engage in sexual activity until 3 months have passed post heart attack."
C. "It is best if you avoid eating a large meal for several hours before you have sexual relations."
D. "If you have chest pain while having sex, stop and rest, and take your nitroglycerin."
E. "You might want to consider some alternate positions that avoid strain."

A. "If you are able to engage in mild to moderate physical activity without symptoms, you can resume sexual activity."
C. "It is best if you avoid eating a large meal for several hours before you have sexual relations."
D. "If you have chest pain while having sex, stop and rest, and take your nitroglycerin."
E. "You might want to consider some alternate positions that avoid strain."

Two older residents of a long-term care facility are engaged in a romantic relationship. The residents are both cognitively intact. A nurse finds the two residents engaging in sexual activity. The response of the nurse includes which of the following? (Select all that apply.)
A. Inform the residents that they cannot engage in a sexual relationship while they are residents of the facility.
B. Provide a safe private area where the residents can engage in sexual activity.
C. Ignore the residents' activity.
D. Provide education for the residents using the PLISSIT model.
E. Contact the family members of the residents in order to get consent from them.

B. Provide a safe private area where the residents can engage in sexual activity.
D. Provide education for the residents using the PLISSIT model.

Which of the following reactions to the loss of a spouse or long-term partner is a unique example of older adult male bereavement?
A. Withdrawing from friends and family
B. Remarrying within months of the loss
C. Focusing on "doing" rather than "feeling"
D. Experiencing moderate to severe depression

B. Remarrying within months of the loss

Which question will best assess the ability of the LGBT older couple to successfully adjust to the challenges of aging?
A. "How long have you been in this relationship?"
B. "Can you tell me about your support system?"
C. "As a couple are you financially secure?"
D. "Do you as a couple share similar religious beliefs?"

B. "Can you tell me about your support system?"

When acting as a fictive kin, in which activity will a paid caregiver engage?
A. Being responsible for paying the client's bills
B. Organizing the client's birthday celebration
C. Accompanying the client to doctor's appointments
D. Assuring the client has clean, appropriate clothing available

B. Organizing the client's birthday celebration

A widowed grandmother is about to assume the role of custodial parent for her 6-year-old grandchild. Which intervention has priority when preparing the grandmother for long-term success in this new role?
A. Reviewing the developmental milestones of childhood
B. Identifying local sources of child counseling services
C. Discussing the common challenges of parenting a 6 year old
D. Teaching stress management and relaxation techniques

D. Teaching stress management and relaxation techniques

Which behavior suggests that an older adult who has lost his life partner is successfully managing the exploration stage of the adjustment process?
A. He enrolls in a cooking class.
B. He explains that he can't make a decision about moving "just yet."
C. He agrees to eat some of his "favorite soup" that his daughter has made.
D. He is heard saying, "I'll never get over the loss, but my life has a purpose."

A. He enrolls in a cooking class.

Which statement by the person preparing for retirement indicates they may need specialized counseling and targeted education?
A. "I'm so glad I'll have a pension to draw from."
B. "I don't know what I'm going to do since practicing law has always filled my days."
C. "I'm waiting until I'm eligible for Medicare so I can be sure to continue treatment for my heart failure."
D. "I'm really looking forward to quitting this government job."

C. "I'm waiting until I'm eligible for Medicare so I can be sure to continue treatment for my heart failure."

Which nursing intervention best addresses the need for social support demonstrated by an older adult couple who will be assuming responsibility for the raising of two grandchildren?
A. Facilitating a support group for children being raised by grandparents
B. Helping the grandparents express their feeling regarding this unexpected role change
C. Offering a monthly parenting class for this cohort of grandparents
D. Suggesting couple's therapy to assist in managing any new stress on their marriage

C. Offering a monthly parenting class for this cohort of grandparents

Which statements made by a couple who have recently retired support the nurse's evaluation that the transition to retirement has been a successful one? (Select all that apply.)
A. "I'm afraid we can't make it that weekend; we'll be visiting the grandchildren."
B. "I'm not accustomed to sharing my kitchen with anyone else."
C. "One week I was working 50 hours and the next I didn't have to get up until noon."
D. "I often wonder if my buddies from the plant miss me."
E. "We have found a few painless ways to reduce our monthly expenses."

A. "I'm afraid we can't make it that weekend; we'll be visiting the grandchildren."
E. "We have found a few painless ways to reduce our monthly expenses."

Which intervention demonstrates effective care for an individual who has expressed a wish to "retire sometime soon"? (Select all that apply.)
A. Asking about when she plans to retire
B. Assessing her ability to handle the stresses of retirement
C. Engaging her in a conversation about her interests
D. Inquiring about the existence of any chronic illnesses
E. Scheduling a full physical examination

A. Asking about when she plans to retire
B. Assessing her ability to handle the stresses of retirement
C. Engaging her in a conversation about her interests
D. Inquiring about the existence of any chronic illnesses
E. Scheduling a full physical examination

An older woman is preparing to move in with her daughter following the death of her spouse of 55 years. The daughter asks a nurse, "I know we are doing the right thing for mom, but I am a bit nervous about this. Do you have any suggestions about things that we should do in preparation?" The nurse responds: (Select all that apply.)
A. "Have you chosen an area of the house for your mom to live in?"
B. "Have you considered scheduling regular visits for your mom with your sister who lives out of state?"
C. "You have every right to be nervous; multigenerational households are usually not successful."
D. "Have you investigated what activities are available at the senior center near your home?"
E. "Since your mom is so computer literate she can stay in touch with her friends when she moves."

A. "Have you chosen an area of the house for your mom to live in?"
B. "Have you considered scheduling regular visits for your mom with your sister who lives out of state?"
D. "Have you investigated what activities are available at the senior center near your home?"
E. "Since your mom is so computer literate she can stay in touch with her friends when she moves."

Which behavior is characteristic of grief by a disenfranchised adult child in response to a parent's death following a lengthy, painful illness?
A. Crying out loudly while invoking "God's help" to go on with life
B. Announcing to family members, "I've already grieved the loss"
C. Having difficulty even deciding what to wear to the funeral
D. Going on a drinking binge instead of attending the funeral

D. Going on a drinking binge instead of attending the funeral

When working with a bereaved individual, the goal of nursing interventions is to:
A. assist the individual to go through the stages of grief work in the optimal order.
B. foster the griever's movement from disequilibrium and instability to a new steady state.
C. encourage the individual to talk about his or her feelings about the deceased individual.
D. offer support and advice about how to successfully achieve grief work.

B. foster the griever's movement from disequilibrium and instability to a new steady state.

A "good coper" is more likely to have which characteristic?
A. History of mental illness.
B. Expectations of perfection
C. Optimistic outlook
D. Demanding of others

C. Optimistic outlook

A woman is terminally ill. Although it has never been discussed in the family or stated outright by her physician, she is growing to believe that she will die because of her illness. Upon which concept will the nurse base therapeutic intervention on?
A. Closed awareness
B. Suspected awareness
C. Mutual pretense
D. Open awareness

B. Suspected awareness

The nurse suspects that the spouse of a terminally ill client is experiencing anticipatory grief when he:
A. dramatically reduces the time he spends attending to the client.
B. refuses to leave the client's bedside regardless of the reason.
C. sobs inconsolably whenever he visits.
D. spends hours recalling details of their life together.

A. dramatically reduces the time he spends attending to the client.

The nurse sits at the bedside of a comatose, terminally ill older client reading the wishes expressed in the numerous cards the client has received. Which concept of grief work is the nurse addressing with this intervention?
A. Everyone needs social interaction.
B. The nurse needs to "attend to the patient."
C. Hearing is believed to be the last sense to be lost.
D. The individual is living until he or she is dead.

D. The individual is living until he or she is dead.

A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to eat or drink. He is alert and oriented, and states that he has no desire to eat, which is causing the family great distress. In order to best address the client and family, the nurse should:
A. explain the family's concern to the client.
B. educate the family that this is normal behavior in this situation.
C. contact the physician for an order for enteral feeding.
D. contact the dietitian for feeding supplements.

B. educate the family that this is normal behavior in this situation.

Following the death of her husband, the client states, "How will I go on? I just don't know how I can live without him." What is the best response by the nurse?
A. "Many people have lost their spouse and have done well. You will too."
B. "Don't worry. Your family will help you get through this."
C. "You're going to get through this one day at a time and I will be there to help you."
D. "Look on the bright side. Your husband is no longer suffering."

C. "You're going to get through this one day at a time and I will be there to help you."

Which intervention fosters the grieving client's movement from disequilibrium and instability to a new steady state? (Select all that apply.)
A. Answering the client's questions regarding the trajectory of his or her illness
B. Offering to pray with the client and family
C. Scheduling a meeting with the client and family to identify alternative end-of-life plans
D. Encouraging the client to cry when they feel like it
E. Being available to just listen to the client talk about dying

A. Answering the client's questions regarding the trajectory of his or her illness
C. Scheduling a meeting with the client and family to identify alternative end-of-life plans
D. Encouraging the client to cry when they feel like it
E. Being available to just listen to the client talk about dying

A nurse is caring for a patient in Portland, Oregon, who has a terminal illness. The patient tells the nurse that she has made a decision to try palliative sedation. The nurse knows that palliative sedation includes which of the following? (Select all that apply.)
A. Pharmacological relief of refractory symptoms will be achieved by whatever means necessary.
B. The intent of palliative sedation is to relieve refractory symptoms as long as death isn't hastened.
C. Palliative sedation is legal in all 50 states.
D. The goal of palliative sedation is to relieve suffering with treatment.
E. If palliative sedation hastens death, it is considered assisted suicide.

A. Pharmacological relief of refractory symptoms will be achieved by whatever means necessary.
C. Palliative sedation is legal in all 50 states.
D. The goal of palliative sedation is to relieve suffering with treatment.

The daughter of a patient who has a chronic illness that has reached the terminal phase talks about the palliative care referral that the primary care provider made for her mother. Which of the following statements indicate that the daughter needs additional education about palliative care? (Select all that apply.)
A. "I know that palliative care is only available to people who have 6 months or less to live. That is really hard to cope with."
B. "My mom still can be actively treated while receiving palliative care."
C. "I understand that the palliative care team is made up of health care professionals of all different disciplines, not just doctors and nurses."
D. "The goal of palliative care is to prevent or to minimize suffering"
E. "My mom will have to be transferred to a special unit in the hospital in order to receive palliative care."

A. "I know that palliative care is only available to people who have 6 months or less to live. That is really hard to cope with."
E. "My mom will have to be transferred to a special unit in the hospital in order to receive palliative care."