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Which intervention addresses a right guaranteed a long-term care facility resident?

a. Ethnic foods are made available to culturally diverse residents who would like

them.

b. Each resident has access to a telephone in his or her room.

c. Family members are welcome at any time.

d. A professional hairdresser is available 3 days a week.

ANS: C

The Bill of Rights for long-term care residents includes the right to immediate visitation and

access at any time for family, health care providers, and legal advisors and the right to

reasonable visitation and access for others. While generally provided, the remaining

interventions are not directly related to the guaranteed rights.

Which statement made by the resident of a long-term care facility is evidence that the facility

is providing care in accordance with the Bill of Rights for long-term care residents?

a. "It's so nice to have my hometown newspaper available here."

b. "Going out to the theater with the other residents is a nice social activity."

c. "I was told that if I didn't want to change rooms, I didn't have to."

d. "The whole place was decorated so beautifully for the holidays."

ANS: C

The Bill of Rights for long-term care residents assures the individual the right to be

transferred only for appropriate reasons as indicated by the correct option. While positive in

nature, the remaining statements are not directly related to any of the guaranteed rights.

Which statement made by a nurse regarding a resident of a long-term care facility requires

follow-up by the nurse manager?

a. "If he doesn't take his medication, he'll get no dessert tonight."

b. "She can't take a walk outdoors today; it's much too cold and snowy."

c. "The grandchildren have colds so they should not visit this week."

d. "I don't understand why, but she wants a different doctor to see her."

ANS: A

The Bill of Rights for long-term care residents assures the individual the right to be free of

any form of abuse. Using a threat to gain the resident's cooperation is a form of

verbal/emotional abuse and must be addressed by the nurse manager. The client may indeed

request a change in medicine providers, even if the staff is unaware of the reasoning behind

the request. The remaining statements related to resident safety, not the denial of their

guaranteed rights.

An older married couple is considering selling their home and moving into a continuing care

retirement community (CCRC). What is the major benefit of a CCRC?

a. They provide affordable living for older adults.

b. They have all levels of care in one location, allowing for easy transition between

levels.

c. They are paid for by Medicare.

d. They allow the older adult's family to retain ownership of the property after the

owner dies.

ANS: B

A major benefit of a CCRC is that it has all levels of care in one location, which allows

community members to make the transition between levels without life-disrupting moves.

Costs of a CCRC can range greatly from an affordable rate to a very large amount of money.

The cost of a CCRC is not covered by Medicare. In the majority of the CCRCs, the property

reverts back to the community after the death of the owner.

An older adult is considering residential care/assisted living (RC/AL). The nurse knows that

the older adult needs additional teaching when the older adult states which of the following?

a. "I read a recent article that stated that more older adults would prefer to move to an

assisted living community than a nursing home if they could no longer care for

themselves."

b. "I am happy that Medicare pays for the cost of living in an RC/AL."

c. "I will have to check with my long-term care insurance company. I heard that it

might pay for RC/AL."

d. "RC/AL costs significantly less than nursing home care."

ANS: B

Medicare does not cover the cost of RC/AL. All of the other statements are true.

Which nursing evaluation supports the fact that the goals of long-term client care have been

achieved? (Select all that apply.)

a. Resident has participated in bath with minimal assistance from the staff.

b. Resident has experienced no falls since admission 3 months ago.

c. Resident continues to show loss of strength in upper extremities.

d. Resident is not required to dress or feed self since assistance is always available.

e. Resident demonstrates improved weight bearing on affected leg; discharge to be

considered.

ANS: A, B, E

Goals of long-term care include providing a safe and supportive environment for chronically

ill and functionally dependent people; restoring and maintaining the highest practicable level

of functional independence; and providing coordinated interdisciplinary care to residents who

plan to return to home. The remaining options show loss of function that is likely preventable

and an environment that does not support autonomy and independence.

A nurse is discharging an older patient after a hospitalization for a hip fracture. The patient is

a participant in a Program for All Inclusive Care for the Elderly (PACE). The nurse

understands what is true about a PACE program? (Select all that apply.)

a. It provides services to older people who would otherwise need a nursing home

level of care.

b. It does not provide services to participants who reside in a nursing home.

c. It is only available to individuals who have both Medicare and Medicaid.

d. It provides medications, eyeglasses, and transportation to care.

e. It provides urgent and preventive care.

ANS: A, D, E

This program is a Medicaid and Medicare program that provides community services to

people age 55 or older who would otherwise need a nursing home level of care. Participants

must meet the criteria for nursing home admission, prefer to remain in the community, and be

eligible for Medicare and Medicaid.

An older patient diagnosed with dementia is referred for adult day services (ADS). The

patient's adult child asks the nurse about the benefits of ADS. The nurse considers which of

the following in formulating a response? (Select all that apply.)

a. ADS are designed to provide social and some health services for older adults.

b. ADS are covered under Medicare Part B.

c. ADS offer respite services for caregivers from the responsibilities of caregiving.

d. ADS often provide educational programs and support groups for caregivers.

e. ADS are all staffed with registered nurses.

ANS: A, C, D

Adult day services are community-based group programs designed to provide social and some

health services to adults who need supervised care in a safe setting during the day. They also

offer caregivers respite from the responsibilities of caregiving, and most provide educational

programs, support groups, and individual counseling for caregivers. Some ADS are private

pay, and others are funded through Medicaid home and community-based waiver programs,

state and local funding, and the Veterans Administration. While most ADS do have

professional nursing staff, there is no mandate that they do.

Which factor influences the decrease in nursing home beds in the United States include?

(Select all that apply.)

a. An increase in the use of residential care facilities.

b. A shortage of certified nursing assistants (CNAs).

c. An increase in Medicaid reimbursement for community-based care alternatives.

d. A shortage of registered nurses who are certified in gerontology.

e. The high cost of care in a nursing home.

ANS: A, C

The number of nursing home beds is decreasing in the United States as a result of the

increased use of residential care facilities and more reimbursement by Medicaid programs for

community-based care alternatives. However, in most areas of the country, the supply and use

of nursing homes is still greater than those of other long-term care services options. While

there is a shortage of certified nursing assistants as well as RNs who are certified in

gerontology, this does not account for the decrease in nursing home beds in the United States.

The cost of care in a nursing home is high; however, that is not the driving factor in the

decrease in the number of nursing home beds in the United States.

Differences between subacute care and long-term care include which of the following? (Select all that apply.)

a. Subacute care is more costly than long-term care.

b. Higher levels of professional staffing are generally found in subacute settings.

c. Medicare covers the costs of both subacute and long-term care.

d. Subacute patients tend to be younger and more cognitively intact.

e. Subacute care is usually delivered in a hospital setting and long-term care in a

nursing home setting.

ANS: A, B, D

Subacute care is more intensive than traditional nursing home care and several times more

costly. For subacute patients, the expectation is that the patient will be discharged home or to

a less intensive setting. Subacute care is largely reimbursed by Medicare. Patients in subacute

units are usually younger and less likely to be cognitively impaired than those in traditional

nursing home care. Generally, higher levels of professional staffing are found in the subacute

setting than those in the traditional nursing home setting because of the acuity of the patient's

condition. Both subacute and long-term care are delivered in a nursing home setting.

You have four rooms to choose from for your older client to be admitted this afternoon.

Which room would you choose to best suit safety needs?

a. A brightly lit, blue room with cozy throw rugs

b. An orange-carpeted room with soft lighting and yellow walls

c. A brightly lit, blue room with an EZ-Glide wax floor

d. A fluorescent-lighted room with green walls and a glossy, tiled floor

ANS: B

Light colors such as red, orange, and yellow are more easily seen by aging eyes. Softer

lighting will help reduce some of the glare and is also easier seen by aging eyes. Fidelity of

color is less accurate with the blues, greens, and violets of the spectrum, and the slowed

ability of the pupils to adjust to light makes glare a problem. Glare can come from sunlight,

but a brightly waxed floor and glossy tile can also cause glare.

An older adult client shares with the nurse that, "I don't know what it is but it seems that I

need more light for reading or even watching television as I get older." The nurse explains

that this change is due to what aging effect?

a. Yellowing of the lens.

b. Impact arcus senilis has on visual acuity

c. Flattening and thinning of the cornea.

d. Retinal changes that begin to occur with aging.

ANS: A

Color clarity diminishes by 25% in the sixth decade and by 59% in the eighth decade. Some

of this difficulty is linked to the yellowing of the lens and the impaired transmission of light to

the retina. The average 80 year old needs more than twice as much light as a 20 year old to see

equally well. Arcus senilis does not affect vision. It is true that the cornea becomes flatter and

thinner with aging, which results in astigmatism. Astigmatism does not account for the need

for increased light that this patient is reporting. The changes in the retina do not account for

the need for increased light that this patient is reporting.

A 77-year-old client being treated for angle-closure glaucoma asks the nurse what caused the

glaucoma. The nurse's response should be based on what fact regarding glaucoma?

a. The angle of the iris causes obstruction of fluid in the eye.

b. Spasms of the orbicular muscle.

c. Changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves.

d. Bits of broken coalesced vitreous from the peripheral or central part of the retina.

ANS: A

Angle-closure glaucoma occurs when the angle of the iris causes obstruction of the aqueous

humor through the trabecular network. Spasms of the orbicular muscle can cause the lower lid

to turn inward. If it stays this way, it is called entropion. The changes described contribute to

decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral

or central part of the retina is the definition of floaters.

An older patient tells a nurse, "The doctor says I have something wrong with my eyes,

something called presbyopia. Can you explain why I have this? I was always fortunate to have

good eyesight." The nurse formulates a response based on what knowledge?

a. The lens of the eye loses elasticity causing a loss of focus for near objects.

b. The cornea of the eye becomes thicker and less curved causing an increase in

astigmatism.

c. The lens of the eye increases in opacity causing a decrease in light refraction.

d. The cornea of the eye forms a gray ring at the edges.

ANS: A

Presbyopia is the loss of focus for near objects, caused by a loss of elasticity and hence a loss

of accommodation of the lens of the eye. All of the other options are normal age-related

changes; however, they are not related to presbyopia.

An older resident in a long-term care facility reports to the nurse that they has been noticing

changes in their vision, including the appearance of halos around objects and a yellow tint to

most objects. The nurse knows that these complaints are most often associated with what

vision disorder?

a. Cataracts.

b. Glaucoma.

c. Diabetic retinopathy.

d. Age-related macular degeneration.

ANS: A

Signs of cataracts include the appearance of halos around objects as light is diffused, blurring,

decreased perception of light and color giving a yellow tint to most objects, and a sensitivity

to glare.

An older patient reports the following symptoms to a nurse during a routine visit to the

geriatric clinic: blurry vision, the need for more light when reading, and blind spots in the

middle of his visual field. The client also states, "Strangely enough my peripheral vision

continues to be pretty good." The nurse suspects that the patient has which of the following

vision disorders?

a. Glaucoma

b. Age-related macular degeneration

c. Diabetic retinopathy

d. Cataracts

ANS: B

Blurry vision, needing more light, and blind spots in the middle of the visual field (scotomas)

are all characteristics of age-related macular degeneration. The other three eye diseases do not

present with these symptoms.

A nurse is providing glaucoma education for a group of older adults in a senior center. The

nurse knows that the following groups are most likely to develop glaucoma and so be the

focus of the education? (Select all that apply.)

a. African Americans

b. Mexican Americans

c. Individuals with a family history of glaucoma

d. Individuals with diabetes

e. Asian Americans

ANS: A, B, C, D

African Americans are at risk of developing glaucoma at an earlier age than other racial and

ethnic groups. Mexican Americans, individuals with a family history of glaucoma, and

individuals with diabetes are among the other high-risk groups. Asian Americans are more

likely to lose eyesight from age-related macular degeneration than other groups.

A nurse is performing preoperative teaching for an older adult who is scheduled to have a

cataract extraction and lens implant. The nurse includes which of the following in the teaching

plan? (Select all that apply.)

a. Avoid lifting heavy objects after the surgery.

b. Avoid bending from the waist after the surgery.

c. Take stool softeners as needed.

d. Maintain strict control of your blood sugar and blood pressure.

e. Maintain a dry sterile dressing over the eye for 10 days.

ANS: A, B, C

Postcataract surgery the individual needs to avoid heavy lifting, straining, and bending from

the waist. Fall prevention is also very important as is complying with eye drop administration.

Maintaining strict blood sugar and blood pressure control is most important for diabetic

retinopathy, not for cataract extraction. There usually is not a dressing over the operative site

and not for 10 days.

An older patient is diagnosed with diabetic retinopathy. The patient asks a nurse: "Is there

anything that I can do to prevent progression of this disease and blindness?" The nurse

includes which of the following into the response? (Select all that apply.)

a. Strict control of blood glucose levels is important in slowing disease progression.

b. Laser photocoagulation treatments can stop progression of the disease.

c. Control of blood pressure and cholesterol levels are important steps slowing

disease progression.

d. Wearing sunglasses to protect the eyes from ultraviolet light can stop disease

progression.

e. Eating a diet high in beta-carotene can stop disease progression.

ANS: A, B, C

Constant strict control of blood pressure, blood glucose, and cholesterol and laser

photocoagulation treatments can halt progression of the disease. Neither protecting the eyes

from ultraviolet light nor eating a diet high in beta-carotene has been proven to be effective in

stopping disease progression.

A nurse is conducting an assessment of an older patient's eyes. The nurse expects to see

which of the following normal age-related changes of the external eye? (Select all that apply.)

a. The eyelids are less elastic and droopy.

b. The eyes are very dry.

c. The eyelids may not close completely.

d. There is a loss of eyelashes.

e. The lower lid may be turned outward.

ANS: A, B, C, E

Normal age-related changes in the external eye include a loss of elasticity causing drooping.

Eyes become drier, and the eyelids may not close completely. Decreases in orbital muscle

strength may result in entropion, the outward turning of the lower lid. Loss of eyelashes is not

a normal age-related change.

An older client reports to a nurse, "My daughter says there is something wrong with my

hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What

does she expect? I noticed that at Christmas dinner, with all the racket around, I had some

trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it

has been getting steadily worse; it seems to be both ears as well." Based on the client's

description, the nurse suspects which sensorineural hearing related disorder?

a. Presbycusis

b. Otosclerosis

c. Tinnitus

d. A perforated eardrum

ANS: A

Presbycusis is a type of sensorineural hearing loss. It is slow and progressive and often

ignored by older adults and considered normal aging. One of the first signs of presbycusis is

difficulty hearing and understanding speech in noisy environments. A hallmark of presbycusis

is difficulty separating the incoming speech signal from background noise. Presbycusis begins

in the high frequencies and later affects the lower frequencies. Individuals often accuse people

of mumbling. Often, it is recognized by others first, before the affected person notices it.

Otosclerosis is a cause of conductive hearing loss, as is a perforated eardrum. Tinnitus is a

perception of sound in one or both ears where no external sound is present.

An older nursing home resident reports that, "My hearing loss is getting worse." What is the

first action of the nurse?

a. Refer the resident for an evaluation for a hearing aid.

b. Raise her voice when speaking to the resident.

c. Examine the resident's ears for cerumen impaction.

d. Teach the resident to read lips.

ANS: C

When hearing loss is suspected or a person with existing hearing loss experiences increasing

difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first

intervention since the cause of the hearing loss has not been determined. Hearing aids do not

help all type of hearing losses. Raising one's voice is not effective; it often makes hearing

more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is

critical to first ascertain what the cause of the hearing loss is.

An older patient asks a nurse, "My doctor referred me to a hearing specialist who thinks that

surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those

things works?" The nurse formulates a response based on what knowledge?

a. A cochlear implant is a permanent, surgically implanted hearing aid.

b. A cochlear implant speeds up the conduction of sound to the auditory nerve.

c. A cochlear implant functions as an artificial auditory nerve.

d. A cochlear implant directly stimulates the auditory nerve.

ANS: D

A cochlear implant bypasses damaged portions of the ear and directly stimulates the auditory

nerve. None of the other options accurately describe information related to a cochlear implant.

A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years

obtains a new hearing aid. Which information will be included in the nurse's teaching plan?

a. "Many people find that hearing aids only help with certain types of hearing loss

that are caused by previous noise exposure."

b. "With the right hearing aid, you can expect your hearing to be back to normal."

c. "Hearing aids are covered by Medicare Part B."

d. "Even though hearing aids will help you, they also bring challenges like distorted

speech and amplified background noise."

ANS: D

Hearing aids do bring challenges, such as distorted speech and amplified background noise.

Although hearing aids are not indicated for all individuals with hearing loss, they are not

restricted to those with hearing loss due to excessive noise exposure. Hearing aids do not

restore hearing to normal. Medicare does not usually cover the cost of hearing aids.

A nurse in an assisted living community notes that one of the residents who is diagnosed with

a hearing impairment has new bilateral hearing aids. The resident is observed frequently not

wearing the hearing aids. The nurse knows that which of the following factors contribute to

low hearing aid use after purchase? (Select all that apply.)

a. Difficulty placing hearing aid properly in the ear

b. Stigma associated with wearing a hearing aid

c. Difficulty changing the batteries in the hearing aid

d. Ineffectiveness of hearing aids for individuals with age-related hearing loss

e. Hearing annoying loud noises

ANS: A, B, C, E

Options A, B, C, and E are all factors associated with low use after purchase. Option D is

incorrect; most individuals with age-related hearing loss do experience some hearing

enhancement with hearing aid use.

An older adult client reports hearing whistling in both ears when no external sounds are

present and is diagnosed with tinnitus. Which of the following are causes of tinnitus that the

nurse discusses with the client? (Select all that apply.)

a. Exposure to loud noises

b. Use of a hearing aid

c. Cerumen buildup

d. Side effects of medications

e. Age-related changes in the middle and inner ear

ANS: A, C, D

Exposure to loud noise and cerumen buildup are known to exacerbate or cause tinnitus. Over

200 prescription and nonprescription medications have tinnitus as a side effect. There are also

many ototoxic medications. Hearing aids are not known to be a cause or a trigger to worsen

tinnitus and are at times used to amplify environmental noise to mask tinnitus. Tinnitus is not

an age-related change, although it occurs in about 11% of individuals who have presbycusis.

An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of

sensorineural hearing loss include which auditory disorders? (Select all that apply.)

a. Tumors of the middle ear.

b. Cerumen impaction.

c. Infections of the external and middle ear.

d. Age-related hearing impairment like presbycusis

e. Prolonged exposure to excessive and loud noise.

ANS: D, E

Age-related hearing impairment, or presbycusis, is a form of sensorineural hearing loss.

Excessive and loud noise can cause noise-induced hearing loss, which is also a common type

of sensorineural hearing loss. Auditory tumors, cerumen impaction, and external and middle

ear infection are all associated with conductive hearing loss.

A client who reported "a problem sleeping" shows an understanding of good sleep hygiene

when engaging in what activity?

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.

ANS: D

Limiting or avoiding daytime napping is a good sleep hygiene practice, retiring relaxing

bedtime routine should be established and a bedtime snack is acceptable if the food is light

and easily digested. Electronic devices should be turned off at least 30 minutes before

bedtime.

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 makes which statement?

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."

ANS: C

Increased caffeine use can be a contributing factor to RLS/WED. There is no research to

confirm that a warm bath prior to sleep or elevating the legs will minimize/prevent RLS. A

potassium deficiency has not been identified as a contributing factor to RLS.

A nurse in a long-term care facility notes that an older resident diagnosed 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

ANS: A

Passive music therapy given at bedtime has been found to increase sleep quality among older

adults residing in nursing homes. Limiting fluid intake may or may not be effective depending

on whether or not the resident has nocturia. Educating the resident about the association

between dementia and insomnia may be feasible depending on the resident's mental status but

will not necessarily ameliorate the problem. Sedative hypnotics are not the first-line treatment

for older adults with dementia and sleep disturbances.

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?" What is the best response by the nurse?

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."

ANS: A

Adverse effects of sleep medications, including over-the-counter medications, include

problems with daily function, changes in mental status, motor vehicle accidents, daytime

drowsiness, and increased risk of falls with only minimum improvement in sleep. Sleep

problems are common in older adults; however, there are many non-pharmacologic

interventions that can be utilized to improve sleep.

An older adult's diagnosis of sleep apnea is supported by nursing assessment and history data

that include which of the following? (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.

ANS: B, C, D

Rest factors for sleep apnea include being male, a smoking habit, and excess weight. There is

no current research to support a connection between a vegetarian diet (possible low protein) or

Crohn's disease to the development of sleep apnea.

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 which of the following? (Select all that

apply.)

a. Generally 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.

ANS: A, B, D

Normal age-related changes in older adults include a reduced total sleep time and sleep

efficiency and shorter, less intense, and more evenly distributed REM sleep. Older adults tend

to nap during the daytime. Sleep requirements do not decrease as one ages. Sleep tends to be

objectively and subjectively lighter in older adults.

An older adult reports experiencing difficulty falling asleep. The patient reports routinely

getting into bed at 8:30 PM and watches favorite television shows until 11:00 PM. Then the

patient often lies awake for hours after. Which 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.

ANS: A, B, D

Some interventions to improve sleep include going to bed only when sleepy, matching the

number of hours in bed to the actual hours of sleep, and reserving the bed for sleep and sex

only. Engaging in exercise immediately before sleep will not assist the person in falling

asleep, and use of the computer is also discouraged as it can disturb sleep.

An older patient is diagnosed with restless leg syndrome (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 might be helpful.

ANS: A, B, D

Nonpharmacologic therapy includes stretching the lower extremities, mild to moderate

physical activity, hot baths, massage, acupressure, relaxation techniques, and avoidance of

caffeine, alcohol, and tobacco. The use of diphenhydramine (Benadryl) as a sleeping

medication for older adults is not appropriate. There is also no evidence that it will decrease

RLS/WEB.

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

ANS: B, C, D, E

Strategies to promote sleep for individuals in long-term care and hospitals include allowing

the resident to stay out of the bed and the room for as long as possible before bed, and not

placing him or her in bed too early. Exposing individuals to sunlight for 30 minutes daily in a

comfortable outdoor location is also helpful in promoting sleep. Limiting fluids and caffeine

before bedtime is also helpful. Changing institutional routines to avoid waking residents for

routine care and providing care when residents wake up are also successful strategies to

promote sleep.

The nurse is preparing educational material concerning fire safety in the home. What research

data will be included in the material?

a. Most fires occur during the daytime hours.

b. Fire mortality is highest in adults older than 80 years of age.

c. Most people who die in fires are killed by the flames.

d. Most fires occur outside the home.

ANS: B

Fire-related mortality is three times higher in individuals over age 80. Most deaths in fires are

caused by smoke injuries. Most fires occur within the home, and most fires occur at night.

The nurse is recommending that a client diagnosed with moderate stage Alzheimer's disease

attend a support group after becoming defensive about not driving the family automobile. The

patient is particular angry about "being stuck at home all the time." What is the priority

outcome expected for this client when attending the group sessions?

a. Facilitating socialization thus minimizing the effects of social isolation.

b. Assisting with minimizing the loss as a factor in causing depression.

c. Providing caregivers with respite while assuring the client is well attended to.

d. Allowing for the opportunity for a mental health professional to assess the client.

ANS: B

Support groups designed specifically to deal with loss of driving privileges among individuals

with dementia may be important in alleviating depressive symptoms and other negative

outcomes associated with cessation of driving. The remaining options represent possible

outcomes but they do not have the priority that minimizing depression has for this client.

A 79-year-old client resides independently in the community. The visiting home health nurse

finds that despite it being 90° F outside, the windows are closed and the client is wearing a

sweater. The nurse initially recognizes that this behavior may be related to which of the

following?

a. Cognitive changes that diminish the individual's awareness of temperature

changes.

b. Age-related neurosensory changes that diminish awareness of temperature

changes.

c. A delirium-related acute illness that is affecting body heat production.

d. Age-related motor deficiencies that result in self-neglect.

ANS: B

Neurosensory changes related to aging tend to delay or diminish the individual's awareness of

temperature changes and may impair behavior or thermoregulatory responses to dangerously

high or low temperatures. There is no evidence in this scenario that the client has cognitive

changes, an acute illness, or is incapable of self-care, and such assumptions should not be

routinely made based on age alone.

A homecare nurse in an area of the country that is prone to tornadoes routinely discusses

disaster preparedness with older adult clients. What is the primary rationale for this

intervention?

a. Older adults are less likely to seek formal and informal help when affected by

natural disasters.

b. The older adult is more likely to live in a communal environment that provides

assistance in times of natural disasters.

c. Most older adults have insurance to help them recover from material losses due to

a natural disaster.

d. Federal and private assistance agencies generally provide older adults with priority

attention in time of natural disasters.

ANS: A

Older adults are less likely to seek assistance than younger adults in times of disaster. The

remaining options are not generally proven to be true for the majority of older adults.

A homecare nurse visits an older patient who lives in a Naturally Occurring Retirement

Community (NORC). The nurse understands that NORCs are identified as what?

a. Purpose-built senior housing communities.

b. Neighborhoods or buildings where a large segment of the residents are older

adults.

c. Communities where volunteers coordinate access to services for older adults.

d. Intentional collaborative housing where residents participate in the design and

operation of the neighborhood.

ANS: B

NORCs are neighborhoods or buildings where a large number of the residents are older adults.

They were not purposely built as senior housing. The residents in a NORC aged in place. The

village model is where volunteers coordinate access to affordable care for seniors. Cohousing

is an intentional collaborative model where residents participate in the design and operation of

the neighborhood.

What information should be included in an informational program to be presented on burn

prevention to a senior citizens group? (Select all that apply.)

a. Do not smoke in bed or when sleepy.

b. Wear well-fitted clothing when cooking or when grilling outdoors.

c. Establish a meeting place for all family members outside of the home in case of a

fire.

d. Establish a plan for exiting each room of your home in the case of a fire.

e. Have a fire extinguisher readily available in the kitchen.

ANS: A, B, E

Measures to prevent burns include not smoking in bed or when sleepy, not wearing

loose-fitting clothing (e.g., bathrobes, nightgowns, pajamas) when cooking or around an open

heat source, and installing a portable hand fire extinguisher in the kitchen. The remaining

options are related to safely evacuating a home in case of a fire.

Which precaution would be beneficial in minimizing an older adult's risk of being a victim of

fraud? (Select all that apply.)

a. Do not allow uninvited salespersons into your home.

b. Never provide personal information to telephone sales solicitors.

c. Rely on the advice of people who only friends have recommended.

d. Contact the local Medicare or Medicaid service office for information when

needed.

e. Keep your bank account and credit card numbers with you at all times.

ANS: A, B, D

The correct options provide sound advice, but relying on friends alone for advice may not be

prudent while personal information should be kept in a safe place, not necessarily on your

person.

The benefits of telehealth include which of the following? (Select all that apply.)

a. Promotes self-management of illness in rural and underserved areas.

b. Facilitates remote physical assessment and monitoring of chronic conditions.

c. Decreases costs by replacing the role of the nurse with technology.

d. Decreases costs by reducing hospital readmissions.

e. Is reimbursed by all health care insurances.

ANS: A, B, D

Telehealth promotes self-management of illness and facilitates remote assessment and

monitoring in rural and underserved areas. Evidence has demonstrated that it reduces costs by

decreasing hospital readmission. Telehealth does not replace the role of the nurse; the

technology augments the ability of the nurse to reach clients in remote areas. Unfortunately,

not all health care insurers reimburse for telehealth services.

A nurse is caring for a frail older adult in a long-term care facility and is concerned about

preventing hypothermia. Which of the following interventions should the nurse implement?

(Select all that apply.)

a. Make sure that the temperature in the resident's room is at least 68° F.

b. Cover residents well when in bed and while bathing.

c. Provide a head covering for the resident.

d. Maintain resident in bed covered with heavy blankets at all times.

e. Provide hot, high-protein meals and bedtime snacks.

ANS: A, B, C, E

Interventions to prevent hypothermia in frail elders include maintaining an ambient

temperature of no lower than 68° F, providing a head covering whenever possible—in bed,

out of bed, and particularly out-of-doors, covering patients well when in bed and when

bathing, and providing hot, high-protein meals and bedtime snacks to add heat and sustain

heat production throughout the day and as far into the night as possible. In addition, it is

important to get the patient out of bed and provide as much exercise as possible to generate

heat from muscle activity.

The daughter of an older patient says to a nurse, "I am so concerned that my dad is still

driving. He is dangerous! He has had a couple of accidents and I am worried that he is going

to kill himself or, worse, somebody else. What can I do?" The nurse recommends which of the

following involved type action strategies for driving cessation? (Select all that apply.)

a. Report the person to the division of motor vehicles for license suspension.

b. Hold a family meeting with the person to discuss the situation and come to a

mutual agreement of the problem.

c. Arrange for alternate transportation for the person.

d. Confiscate the keys to the car.

e. Ask the patient's physician to write a prescription for the person to stop driving.

ANS: B, C

Options B and C are examples of the involved type of action strategies for driving cessation.

Options A, D, and E are all examples of the imposed type of action strategies for driving

cessation.

A nurse suspects that the next-door neighbor, an older adult, is a victim of elder abuse by an

adult child. What is the appropriate action for the nurse to do in this situation?

a. Because the neighbor is not a patient, the nurse should not get involved.

b. Visit the neighbor frequently to confirm the suspicions.

c. Complete a confidential report with the adult protective services in the area.

d. Ask the neighbor if they are being abused.

ANS: C

The best action is to make a confidential report with the local authorities. Suspected cases

should be reported at once to the agency, which will send a trained investigator to determine

whether an abusive or imminently dangerous situation exists and will be able to offer safety to

the victim and resources to the relatives and family members. In some states with mandatory

reporting, failure to report suspicions may result in civil and/or criminal penalties.

The nurse is providing care to a client diagnosed with dementia. What option is an example of

the appropriate use of implied consent by the nurse?

a. Preparing to draw blood from a client's arm after asking, "Can I see your arm?"

b. Changing the client's dressing when the client asks, "Will you change this bandage now?"

c. Using the client's monthly allowance to buy a watch when he continuously asks for the time

d. Arranging for a benign mole to be removed after the client states, "I don't like this here."

ANS: B

The correct option demonstrates the client's willing to have a low-risk procedure completed.

The remaining options, especially the one dealing with a surgical procedure, lack the element

of client cooperation and/or understanding in the decision-making process.

Which option is an example of elder exploitation?

a. A homebound client is left alone for days at a time by the caregiver.

b. An older client is smacked if he doesn't eat all of his food.

c. A client diagnosed with Alzheimer's disease is bathed only twice a month.

d. A homebound client can only get groceries by agreeing to pay for her neighbor's groceries, too.

ANS: D

In elder mistreatment by exploitation, the abuser takes advantage of the older person for

monetary or personal benefit. In this case, the client is being coerced to buy her neighbor's

groceries. Abandonment is defined as the desertion or willful forsaking of an older person.

Abuse is any action or inaction harming or endangering the welfare of an older adult. The

definition of neglect involves failure to provide adequate care or services for an older adult.

A frail, elderly widow is admitted to the hospital after sustaining a fall. The client lives alone

and has no living relatives. After cognitive testing reveals mild cognitive impairment, the

interdisciplinary team on the Acute Care for the Elderly Unit recommends long-term care

placement and that a durable power of attorney for health care (DPOA-HC) be established.

When the client seems confused over what a DPOA-HC's responsibilities are, the nurse

responds best with which statement?

a. "A DPOA-HC is a person you name to make health care decisions for you when

you can't make them for yourself."

b. "A DPOA-HC is a person you trust to make financial decisions for you and to

manage your money."

c. "A DPOA-HC is a person appointed by the court to make sure you get good care

and to manage your affairs."

d. "A DPOA-HC is a person who is appointed by the court to make nursing home

placement decisions for your care."

ANS: A

A person designated by the individual to make health care decisions when the individual is not

able is the definition of durable power of attorney for health care. A power of attorney is a

person designated by the individual to make financial decisions when the individual is not

able to or at his or her request. The definition of a guardian is a person appointed by the court

to have care, custody, and control of a disabled person and to manage personal and/or

financial affairs. A guardian is able to make many more decisions than just nursing home

placement decisions.

Which of the following statements made by a family caregiver would a nurse consider most

indicative of elder abuse?

a. "I get so frustrated because my father used to be so competent and now cannot

even feed himself."

b. "Mom cannot pay her own bills anymore. We went to the bank and arranged for

me to have access to her checking account and help her pay the bills."

c. "My dad wanders at night and I can't be bothered with him. I mix sleeping pills in

his dinner so that he will fall asleep."

d. "Mom asks me to do everything for her, but I think it is better if she keeps on

doing as much as she is capable of."

ANS: C

Option C is an example of elder mistreatment. While wandering is a serious concern,

surreptitiously administering sleeping pills is not the best response to this situation and is

indicative of elder mistreatment. All of the other situations described are difficult; however,

there is no indication of abuse.

An older woman tearfully tells a nurse, "I must buy my neighbor all their groceries or they

won't drive me to the store or the doctor." This is an example of which type of elder

mistreatment?

a. Financial exploitation

b. Psychological abuse

c. Caregiver neglect

d. Abandonment

ANS: A

Financial exploitation involves taking advantage of an older person for monetary gain.

When a cognitively impaired, wealthy, white client is noted to have burns on her upper back,

her son states that the patient burned herself when attempting to shower. Which statement by

a member of the team reflects a need for further education on elder abuse? (Select all that

apply.)

a. "She is wealthy; abuse does not happen in people of financial means."

b. "Even if we are not sure, we are legally bound to report our suspicions."

c. "We need to consider that most abusers are either adult children or spouses."

d. "Her cognitive deficiencies put her at risk for elder abuse."

e. "The client is white, and race plays an important role in who is likely to be

abused."

ANS: A, E

Elder abuse occurs among all races and socioeconomic groups in the United States. All

suspected incidences of elder abuse should be reported, even if it is just a suspicion. Most

abuse occurs in the home setting, the majority of abusers are spouses or children, and the risk

of abuse increases with increased dependency of the elder.

A nurse is preparing education on elder abuse for a group of older adults and caregivers at a

senior center. The nurse preparing to discuss seniors who are more likely to be abused or

neglected includes which of the following? (Select all that apply.)

a. Individuals with cognitive impairment

b. Individuals who abused the caregiver earlier in life

c. Individuals who live in an institutional setting

d. Individuals who are married and living with a spouse

e. Men living alone or in a household with family members

ANS: A, B, C

Individuals who are living alone are more likely to be abused. Women who are living alone or

in a household with family members are more likely to be abused than are men.

A nurse working in an emergency department is caring for an 89-year-old adult brought to the hospital by an adult child for a fracture of the right arm. The patient is wheelchair dependent and lives with their adult child who is the primary caregiver......The patient

cannot recall the circumstances of the fall. The patient is weeping and cradling their right arm.

The patient's history reveals two previous wrist fractures over the course of the past year. Upon assessment,

the patient is non-weight-bearing (NWB). The nurse suspects physical abuse based on which

of the following findings? (Select all that apply.)

a. Bruises are in various stages of healing.

b. The fracture is inconsistent with the patient's functional ability.

c. Caregiver suffering stress from caring for a functionally dependent individual.

d. Patient is crying.

e. Patient has a history of previous wrist fractures.

ANS: A, B

Specific signs of physical abuse include unexplained bruising or lacerations or those in

unusual areas in various stages of healing, and fractures inconsistent with functional ability.

This patient has many bruises in different areas all in various stages of healing, which leads

one to believe that they were sustained at different times. The patient is NWB, so the

daughter's statement that she fell while getting out of the wheelchair to go the bathroom does

not match the patient's functional abilities. While there could be caregiver stress in this

situation, the scenario does not mention it. While the patient's crying is concerning, it could

be due to many other factors, including pain. A previous history of wrist fractures is

concerning as well, but there are many other possible reasons for repeated fractures.

A nurse suspects elder mistreatment in which of the following patients seen in the emergency

department? (Select all that apply.)

a. An 85-year-old with cardiac disease who is taking blood thinners and has multiple

bruises on their arms and hands.

b. An 86-year-old nursing home resident admitted to the hospital with perineal

bleeding and three large bruises on the inner thigh.

c. A 77-year-old who fell at home and broke the left arm after tripping over a pet cat.

d. A 73-year-old with a history of gastric ulcers who is vomiting blood and found to

be anemic and has a low BMI.

e. A 69-year-old with a history of diabetes who is admitted for diabetic foot ulcers

wearing dirty clothing and smelling of urine.

ANS: B, E

An 86-year-old nursing home resident admitted to the hospital with perineal bleeding and

three large bruises on the inner thigh has the signs of sexual abuse. The 69-year-old with a

history of diabetes who is admitted for diabetic foot ulcers and is wearing dirty clothing and

smells like urine has the signs of neglect (either self or caregiver). The remaining patients do

not exhibit the signs of elder mistreatment.

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

ANS: D

The individual is exhibiting disenfranchised grief since situations have distanced him or her

from the family, making grieving openly impossible. Pathological grief begins with a normal

grieving process, but obstacles interfere with a normal evolution toward adjustment, causing

reactions to be exaggerated. Anticipatory grief is a response to a real or perceived loss before

the loss occurs. Acute grief is a crisis; it is a syndrome of physical and psychological

symptoms of distress, often accompanied by functional disruption.

When working with a bereaved individual, what is the goal of nursing interventions?

a. Assisting the individual to go through the stages of grief work in the optimal order.

b. Fostering the griever's movement from disequilibrium and instability to a new

steady state.

c. Encouraging the individual to talk about his or her feelings about the deceased

individual.

d. Offering support and advice about how to successfully achieve grief work.

ANS: B

Good nursing must be flexible, practical, resourceful, gently realistic, and abundantly

optimistic. The nurse fosters the griever's movement from disequilibrium and instability to a

new, albeit modified, steady state. There is no optimal order in which to experience grief. Not

all individuals are able to talk about their feelings, nor is it helpful for everyone. The role of

nursing is to offer support, but not advice.

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

ANS: C

Persons who cope less effectively tend to be more rigid, pessimistic, and demanding. They are

more likely to be dogmatic and expect perfection in themselves and others. Ineffective copers

are more likely to live alone, socialize little, and have few close friends or have an ineffective

support network. They may have a history of mental illness or have guilt, anger, or

ambivalence toward the person who has died or that which has been lost. On the contrary,

"good copers" maintain composure when necessary, can generally use good judgment, and

can remain optimistic and appropriately hopeful without denying the loss.

A patient is terminally ill. Although it has never been discussed in the family or stated outright

by the physician, the patient is growing to believe that death will come as a result of this

illness. Upon which concept will the nurse base the therapeutic intervention?

a. Closed awareness

b. Suspected awareness

c. Mutual pretense

d. Open awareness

ANS: B

In suspected awareness, the patient suspects that he or she is going to die. Hints are bandied

back and forth, and a contest ensues for control of the information. Mutual pretense is a

situation of "let's pretend." Everyone knows the death is approaching, but the patient, family,

friends, nurses, and physicians do not talk about it—real feelings are kept hidden, and too

often, so are questions. Open awareness acknowledges the reality of approaching death.

When would the nurse suspect that the spouse of a terminally ill client is experiencing

anticipatory grief?

a. The spouse dramatically reduces the time spent attending to the client.

b. The spouse refuses to leave the client's bedside regardless of the reason.

c. The spouse sobs inconsolably whenever visiting the client.

d. The spouse spends hours recalling details of their life together.

ANS: A

Anticipatory grief is the response to a real or perceived loss before it occurs, such as in

anticipation of the death of a loved one. Behaviors that may signal anticipatory grief include a

sudden change in attitude toward the thing or person to be lost. The other options are

characteristics of normal grieving.

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.

ANS: D

An individual is living until he or she has died; the nurse works with the older adult and

significant others to maintain as high a quality of life as possible before, during, and after the

loss or death. While the other options are true they are not directly involved in grief work.

A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to

eat or drink. The patient is alert and oriented, and states that they have no desire to eat, which

is causing the family great distress. In order to best address the client and family, what

intervention should the nurse implement?

a. Explaining the family's concern to the client

b. Educating the family that this is normal behavior in this situation

c. Contacting the health care provider for an order for enteral feeding

d. Contacting the dietitian for feeding supplements

ANS: B

The nurse should educate the family that this is a normal part of the dying process and should

not pressure the client, contact the physician for enteral feeding, or contact the dietitian for

feeding supplements. Because the patient is expressing a desire not to eat, his wishes should

be honored. Essential to the facilitation of self-esteem is the premise that the values of the

patient must figure significantly in the decisions that will affect the course of dying.

Whenever possible, the nurse can have the person decide when to groom, eat, wake, sleep, and

so on.

Following the death of a spouse, the client states, "How will I go on? I just don't know how I

can live without them." 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."

ANS: C

The person who is actively grieving cannot yet look ahead or know that the despair and other

feelings will resolve. The nurse can soften the despair by fostering reasonable and appropriate

hope, such as, "You will make it through one moment at a time, and I will be here to help."

The other answers do not foster reasonable and appropriate hope and do not validate the

person's concerns.

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 their 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

ANS: A, C, D, E

Some of the ways nurses help grieving clients move through disequilibrium and instability to

a new, albeit modified, steady state are by ensuring questions are answered, by facilitating

opportunities for culturally based and desired bereavement rituals, giving the client

permission to express emotions, and by just listening It is not an acceptable practice to initiate

such an intervention as asking the client to pray.

A nurse is caring for a patient in Portland, Oregon, who has a terminal illness. The patient

tells the nurse that, "I have 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 relive suffering with treatment.

e. If palliative sedation hastens death, it is considered assisted suicide.

ANS: A, C, D

In 1997, the U.S. Supreme Court declared that while universal physician-assisted suicide was

illegal, pharmacological sedation for the relief of refractory symptoms (e.g., pain, nausea and

vomiting, dyspnea), by whatever means necessary, was acceptable. This has been referred to

as terminal sedation but is more accurately called palliative sedation. The intent of the

sedation is to provide comfort but to go no further. This is based on the concept of double

effect—that is, if the sedation provides comforts even if it is possible that death is hastened, it

is considered neither assisted suicide nor euthanasia and is acceptable. While replete with

ethical questions, the intention must be to relieve the suffering with treatment and to that

extent only.

The daughter of a patient diagnosed with a chronic illness that has reached the terminal phase

talks about the palliative care referral that the primary care provider made for her parent.

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."

ANS: A, E

While many individuals are not referred to palliative care until they are at the end of life,

ideally, the earlier they are referred, the better. There is no time frame for referral regarding

the point that they are in their illness. Palliative care is offered simultaneously with

life-prolonging or stabilizing care for those living with chronic conditions. Palliative care uses

an interprofessional model of care. Palliative care can be offered in any setting across the

continuum of care and on any unit; it is a philosophy of care.

A patient tells a nurse that they have prepared a living will (LW). The nurse understands that a

living will involves what? (Select all that apply.)

a. Advanced directives used in the situation of persons unable to speak for

themselves.

b. A legal document is binding in all states and territories of the United States.

c. Appointing a proxy to uphold the patient's wishes.

d. Including the provision that the patient's next of kin have more authority than the

appointed proxy.

e. An LW be revoked by the patient at any time in either writing or verbally.

ANS: A, C, E

The Patient Self-Determination Act (PSDA) recognized a Living Will (LW) as an advanced

directive that is specifically related to a situation in which a person is facing a terminal illness

and unable to speak for herself or himself. It is a morally and, in some jurisdictions, legally

binding document in which adults could express their wishes regarding end-of-life decisions

for some future time when they were unable to do so for themselves. The exact requirements

for a living will and the associated laws around it vary from state to state. The patient appoints

a proxy to uphold his or her wishes when he or she is no longer able to do so. As the proxy is

selected by the individual, the legal assumption is that a designated person has more authority

than the next-of-kin. The patient can revoke an LW verbally or in writing at any time for any

reason.