A
A man is terminally ill with end-stage prostate cancer. Which is the best statement about this man's wellness?
a. Wellness can only be achieved with aggressive medical interventions.
b. Wellness is not a real option for this client because he is terminally ill.
c. Wellness is defined as the absence of disease.
d. Nursing interventions can help empower a client to achieve a higher level of wellness
ANS: D
Nursing interventions can help empower a client to achieve a higher level of wellness; a nurse can foster wellness in his or her clients. Wellness is defined by the individual and is multidimensional. It is not just the absence of disease. A wellness perspective is based on the belief that every person has an optimal level of health independent of his or her situation or functional level. Even in the presence of chronic illness or while dying, a movement toward wellness is possible if emphasis of care is placed on the promotion of well-being in a supportive environment.
Which nursing intervention is a holistic approach to an older adult?
a. Performs glucose testing during the weekly worship service
b. Wheels ambulatory adults to exercise when running late
c. Assigns female nurses to older women who are Islamic
d. Allows older adults in a nursing home to eat meals alone
ANS: C
The nurse uses a holistic approach to the care of an older female adult who is Islamic because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture. Interrupting an older adult's worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older adult's life by testing for glucose before the service begins. In transporting ambulatory adults to the exercise program in wheelchairs to save time, the nurse disregards the need for self-esteem and exercise, both important aspects of physical well-being. Ambulatory adults can walk with assistance, if needed, to exercise programs and can benefit from the additional activity and independence. The nurse can be tempted to allow an older adult to eat meals alone in his or her room if this will motivate the person to eat or if the older adult has dysphasia and is embarrassed. However, although focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being.
24. A 75-year-old patient, whose marriage ended in divorce after two years, has lived alone for the past 50 years. Feeling as if life has had little meaning, the patient is terrified of living out the remaining years and of dying. The age-related issue to be resolved is:
A. disengagement vs. activity.
B. ego integrity vs. despair.
C. self-determination vs. resignation.
D. self-esteem vs. self-actualization.
ANS:B
A nurse is caring for an older adult who asks the following: "I have heard that it is important to eat a diet that is high in fruits and vegetables to age successfully. Is that correct?" The nurse considers which of the following theories of aging when responding to the older adult's question?
a. Oxidative stress theory
b. Immunological theory
c. Free radical theory
d. Telomere theory
ANS: C
Although the intake of supplemental antioxidants is deleterious to one's health, there is evidence that diets inclusive of natural antioxidants, such as those high in fruits and vegetables or a Mediterranean diet rich in red wine and olive oil, are healthful.
A nurse is caring for an older patient in the hospital who reports: "I am worried because simple tasks such as balancing my checkbook seem to take me longer. Is there something wrong with me?" The best response by the nurse is:
a. "As you age, normal changes in the brain occur that make central processing take longer, so don't worry."
b. "You have every reason to be concerned. This is an abnormal finding; we need to contact your physician."
c. "As you age, changes in the brain lead to decreased intellectual performance, so don't worry."
d. "Any changes in function are a cause for worry. You need to be evaluated immediately."
ANS: A
As one ages, central processing slows down, which may make performance of tasks slower. This is not an abnormal finding in older adults. Intellectual performance without brain dysfunction remains constant. Many changes in function are part of normal aging.
1. Which ethical principle underlies nursing actions respecting each patient's values and beliefs?
A. Autonomy.
B. Beneficence.
C. Justice.
D. Responsibility.
ANS: A
An older man who resides in a nursing home has a total cholesterol level of 245 mg/dL. Which nursing intervention is most likely to assist this man in achieving his highest level of wellness?
a. Instruct him about increasing dietary fiber.
b. Ask the health care provider for a low-fat diet.
c. Schedule a consultation for him with the dietitian.
d. Review a menu with him to choose suitable foods.
ANS: D
The nurse collaborates with the older adult to choose suitable foods, which is likely to be an effective nursing intervention to help an older adult with hyperlipidemia achieve optimal health and well-being; it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol. Informing the older man about dietary fiber offers no control to him because he is not part of the decision. Nursing interventions developed with the older adult's collaboration are most likely to help the older adult achieve health and wellness. Collaborating with the health care provider for a low-fat diet is a reasonable approach to help this man with hyperlipidemia to achieve health and wellness. However, he is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has had some control. Scheduling a consultation with a dietitian is a reasonable approach to an older adult with hyperlipidemia and is a part of a multifaceted approach to optimizing his health. However, the older adult is more likely to engage in a regimen over which he has input.
3. The gerontological nurse is monitoring signs of suspected abuse in an 89-year-old patient who was admitted from home. When planning for the patient's discharge, the nurse's first action is to:
A. delay discharge by informing the provider of the suspected abuse.
B. enlist the help of family members with transitioning the patient home.
C. notify Adult Protective Services of the patient's discharge.
D. restrict the family members' access to the patient prior to discharge.
ANS: C
Which of the following considerations is most likely to be true when working with an interpreter?
a. An interpreter is never needed if the nurse speaks the same language as the patient.
b. When working with interpreters, the nurse can use technical terms or metaphors.
c. A patient's young granddaughter who speaks fluent English would make the best interpreter because she is familiar with and loves the patient.
d. The nurse should face the patient rather than the interpreter.
ANS: D
The nurse should face the patient rather than the interpreter is a true statement; the intent is to converse with the patient, not with a third party about the patient. Many reasons may prevent the patient from speaking directly to a nurse. Technical terms and metaphors may be difficult or impossible to translate. Cultural restrictions may prevent some topics from being spoken of to a grandparent or child.
The term health disparity is defined as
a. the systematic elimination of the culture of another resulting in decreased wellness.
b. differences in health outcomes among groups.
c. the difference between an expected incidence and prevalence and that which actually occurs in a comparison population group.
d. the existence of more than one group with differing values and perspective.
ANS: B
Health disparities are defined as differences in health outcomes among groups. Cultural destructiveness is defined as the systematic elimination of the culture of another. Health inequities are defined as the difference between an expected incidence and prevalence and that which actually occurs in a comparison population group. Cultural diversity is defined as the existence of more than one group with differing values and perspective.
Which racial or ethnic group has the highest life expectancy in the United States?
a. Native Americans
b. African Americans
c. Hispanic Americans
d. Asian and Pacific Island Americans
ANS: C
As shown in Figure 1.4, Hispanic men and women have the highest life expectancy of all. In 2011, for those of Hispanic origin of any race, the overall life expectancy at 65 years of age was 20.7 more years in 2011 (19.1 years for men and 21.8 years for women).
Which approach requires the nurse to integrate and balance all aspects of an individual's life into the plan of care?
a. Holistic nursing
b. Healthy People 2020
c. Maslow's hierarchy of human needs
d. Orem's self-care requirements
ANS: A
Holistic nursing integrates all aspects of an individual's life into the plan of care by balancing an individual's internal and external environment with psychosocial, spiritual, cultural, and physical processes. Healthy People 2020, an updated document from 2000 that outlines the goals for achieving health in this country, is a mandate for health care professionals to follow with 467 objectives in 28 focus areas. Maslow's hierarchy of human needs provides a basis for understanding individuals in context and for ranking nursing assessments, diagnoses, goals, and interventions in order of importance. Dorothea Orem's self-care requirements lists human needs, including the need for air, fluids, nutrition, hygiene, elimination, activity, comfort, relief from suffering, and skin integrity. The nurse helps individuals meet these needs to achieve optimal health and wellness.
According to Healthy People 2020, older adults have been identified as a priority, with a goal to improve their health, function, and quality of life. Identify the targeted chronic focus areas for improvement. (Select all that apply.)
a. Diabetes
b. Arthritis
c. Congestive heart failure
d. Dementia
e. Cancer
f. Pressure ulcers
ANS: A, B, C, D
In a push toward wellness, older adults were identified as a priority area for the first time. The targeted chronic areas of focus were identified as diabetes, arthritis, congestive heart failure, and dementia.
During a nursing assessment, an older adult tells the nurse about increasing loss of balance. Further assessment indicates musculoskeletal changes. Which patient teaching should the nurse implement to address musculoskeletal reasons for the loss of balance?
a. Exercise with light weights.
b. Stand on one foot at a time while supported.
c. Train with the use of sit-ups.
d. Work out in a swimming pool.
ANS: B
The loss of balance from a musculoskeletal perspective is usually caused by a loss of core muscle strength; thus, the nurse suggests standing on one foot at a time while holding onto a chair back, if necessary, and working to increase the duration of the exercise. Lifting weights helps increase muscle strength. Sit-ups are contraindicated for older adults because they put tremendous amounts of stress on the lumbar spine. Low-impact aerobic exercise helps improve conditioning and endurance
10. When teaching an independent older adult patient how to self-administer insulin, the most productive approach is to:
A. facilitate involvement in a small group where the skill is being taught.
B. gather information about the patient's family health history.
C. provide frequent, competitive skills testing to enhance learning.
D. use repeated return demonstrations to promote the patient's retention of the involved tasks.
D. use repeated return demonstrations to promote the patient's retention of the involved tasks.
Historical influences that have shaped the lives of the majority of the in-between cohort in the United States today include which of the following?
a. Influenza epidemic of 1918
b. World War I
c. Child rearing in the Depression
d. World War II
ANS: D
Those who are in the in-between cohort in 2016 were born between 1915 and 1945. The men were likely to have fought in World War II. The last of the Holocaust survivors are in this group. A person who survived the influenza epidemic would be at least 98 years old in 2016 and therefore would be considered old-old or a centenarian. Most of those who are of the in-between cohort had not reached childbearing age by the end of the Depression. Individuals in the in-between cohort would not have been old enough to fight in World War II.
The nurse plans activities for older women born between 1920 and 1930 and who reside in an assisted-living facility. Which is the best intervention for the nurse to implement?
a. Have them bake cookies twice a week.
b. Conduct interviews for specific interests.
c. Arrange dog and cat visits from volunteers.
d. Take them to the library for guest speakers.
ANS: B
The nurse conducts individual interviews with the women to determine their interests and to avoid generalizing; as people live longer, they become more and more unique. Because most of these women are in their 80s and 90s were born between 1920 and 1930 and have generally spent their lives as homemakers, the nurse presumes to know what activities they will enjoy. The nurse avoids arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older adult to a pet visit. Unless it is organized on a voluntary basis, the nurse avoids arranging visits by guest speakers. In addition, the nurse will assess each older woman before an outside visit to avoid embarrassing events, including incontinence and hearing and vision problems.
Identify the Healthy People 2020 emerging issues in the health of older adults. (Select all that apply.)
a. Coordinating care for the older adult population
b. Assisting older adults in the management of their own care
c. Identifying levels of training for those caring for older adults
d. Making community resources available for older adults
e. Increase in health disparities for rural older adults
ANS: A, B, C
According to United States Department of Health and Human Services' Healthy People 2020, emerging issues in the health of older adults include coordinating care, helping older adults manage their own care, establishing quality measures, identifying minimum levels of training for people who care for older adults, and researching and evaluating appropriate training to equip providers with the tools they need to meet the needs of older adults.
Which action should the nurse take when addressing older adults?
a. Speak in an exaggerated pitch.
b. Use a lower quality of speech.
c. Use endearing terms such as "honey."
d. Speak clearly.
ANS: D
Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons and fewer of those who are healthy and active. Providers should not assume that all older adults are hearing or mentally impaired. The most appropriate action when addressing an older adult would be to speak clearly. Examples of unintentional ageism in language are an exaggerated pitch, a demeaning emotional tone, and a lower quality of speech.
Decreased functioning of which physical structure is likely to result in decreased metabolism in older adults?
a. Kidney
b. Thyroid gland
c. Brain
d. Skeleton
ANS: B
Secretion of thyroid hormones tends to decrease with age, resulting in a greater likelihood of a slower metabolism, hypothyroidism, and thinning hair and nails. Decreased kidney function leads to decreased glomerular filtration rate and the ability of the kidneys to concentrate urine and clear waste. Decreasing brain function tends to result in decreased cognitive functioning. Osteoclastic activity tends to decrease with age, increasing the risk for osteopenia and osteoporosis.
According to researchers, which characteristic do most centenarians share?
a. Female
b. Hispanic
c. Living in rural areas
d. Located in the Midwestern states
ANS: A
Based on the U.S. census report of 2010, centenarians were overwhelmingly white, female, and living in the urban areas of the Southern states.
Which of the following issues in the care of older adults are identified in Healthy People 2020?
a. Delineating nursing staffing levels in long term care
b. Eradicating pressure ulcers in all care settings
c. Identifying minimum levels of training for people who care for older adults
d. Instituting mandatory training in identification of elder abuse for all caregivers of older adults
ANS: C
Identifying minimum training levels for people who care for older adults is one of the issues identified in Healthy People 2020. The rest of the issues are not discussed in Healthy People 2020.
Researchers hypothesize that most super-centenarians survive and are in good health due to which of the following factors? (Select all that apply.)
a. They have a different genetic makeup than other older adults have.
b. They tend to live in wealthier areas of the world.
c. The exact cause of this phenomenon is not known.
d. Contributing factors to their good health include quality medical care and improved social conditions.
e. They have large extended families to assist in their care
ANS: C, D
The exact cause of super-centenarians' longevity is not known; researchers describe it as attributable to "rare and unpredictable reasons." Contributing factors include medical care and improved sociopolitical conditions. There is no known difference in biological or sociological factors between super-centenarians and other older adults. Super-centenarians exist all over the world.
The nurse prepares an older woman, who is Polish, for discharge through an interpreter and notes that she becomes tense during the instructions about elimination. Which intervention should the nurse implement?
a. Move on to the discussion about medication.
b. Ask the older woman how she feels about this topic.
c. Instruct the interpreter to repeat the instructions.
d. Have the older woman repeat the instructions for clarity.
ANS: B
When working with an interpreter, the nurse closely watches the older adult for nonverbal communication and emotion regarding a specific topic and therefore validates the assessment about the older adult's tension before proceeding. Because the nurse notices her tension, the nurse temporarily suspends the preparation to validate her assessment. If the nurse proceeds and the older adult is uncomfortable discussing elimination, then important instructions can be missed, leading to adverse effects for the older adult. Repeating the instructions can aggravate the older adult's discomfort. Instructing the older adult to repeat the nurse's instruction ignores her needs.
Which change in the skin is abnormal in an older person?
a. Thinner and more fragile skin
b. Red, swollen 3-day-old wound
c. Greater number of freckles
d. Loss of hair on the extremities
ANS: B
Although the skin of an older person may require 48 to 72 hours to mount an initial inflammatory response to a wound, increasing redness after that time, particularly with purulent discharge, is a sign of infection. This change is normal as ridges in the skin are lost. Melanin distribution becomes more uneven with age. Hair is commonly lost from the legs and other areas of older adults. Hair loss from the legs is not a sign of peripheral vascular disease.