Nursing Care of Older Adults
Chapter Exam Questions
Course Introduction
This course explores the principles and practices of nursing care for older adults, emphasizing the promotion of health, functional ability, and quality of life in aging populations. Students will examine age-related physiological and psychosocial changes, common health conditions affecting older adults, and evidence-based strategies for assessment and intervention. The course addresses holistic care approaches, including pharmacological and non-pharmacological management, safety considerations, interprofessional collaboration, and the importance of advocacy and ethical decision-making in gerontological nursing. Through case studies and clinical scenarios, students will develop critical thinking and communication skills necessary to provide compassionate, person-centered care to older adults across diverse settings.
Recommended Textbook
Toward Healthy Aging Human Needs and Nursing Response 7th Edition by Priscilla Ebersole
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Chapter 1: Gerontological Nursing and an Aging Society
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Sample Questions
Q1) The country with the oldest population,both in terms of median population and the number of persons older than age 60,is:
A) Japan.
B) Sweden.
C) China.
D) Ireland.
Answer: A
Q2) A gerontological nurse visits a local grade school to talk with the children about her career.A fourth grade boy asks,"Why do you work there? Old people are all stupid!" His comments probably indicate that he:
A) has had limited contact with the well elderly.
B) lacks intelligence.
C) probably was abused by an elderly family member.
D) had a negative experience with grandparents.
Answer: A
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Chapter 2: Theories of Aging
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Sample Questions
Q1) The family member of a patient asks you if vitamin C will prevent aging.In formulating your response,you are considering what biological theory of aging?
A) Free radical theory
B) Immunity theory
C) Clinker theory
D) Continuity theory
Answer: A
Q2) Select the true statement regarding the nonstochastic group of theories.
A) Aging events occur randomly.
B) Biological aging is genetically programmed.
C) Aging is a result of an accumulation of errors in RNA and DNA metabolism.
D) The free radical theory is an example of this type of theory.
Answer: B
Q3) Erikson's stage or task for later life is:
A) ego maturation vs.stagnation.
B) ego transcendence vs.ego preoccupation.
C) generativity.
D) ego integrity vs.despair.
Answer: D
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Page 4
Chapter 3: Health and Wellness
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Sample Questions
Q1) Select the statement about wellness that best applies to your client,who is terminally ill with end-stage prostate cancer.
A) Wellness is possible even if he refuses to assist in management of his medical care.
B) Wellness is unfortunately not a realistic option for him.
C) Wellness is the same thing as faith healing,and if he would be more receptive,he could be back at active gardening in a few weeks.
D) Your nursing interventions can help empower him to achieve a higher level of wellness.
Answer: D
Q2) What best describes nutritional alterations with aging?
A) Caloric needs and nutritional needs decrease.
B) Caloric needs increase,but nutritional needs decrease.
C) Caloric and nutritional needs increase.
D) Caloric needs decrease,but nutritional needs remain constant.
Answer: D
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Chapter 4: Physiological Changes with Aging
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Sample Questions
Q1) You have four rooms to choose from for your elderly client to be admitted this afternoon.Which room would you choose?
A) A brightly lit,blue room with cozy throw rugs
B) An orange carpeted room with soft lighting
C) A brightly lit,blue room with an EZ-Glide wax floor
D) A combination television/children's playroom with cute pastel wall hangings.
Q2) A 97-year-old patient is admitted to the medical unit with pneumonia.He was treated as an outpatient with oral antibiotics and was only admitted for intravenous antibiotics when his symptoms did not resolve.He has a productive cough and bilateral congestion and is complaining of weakness.His vital signs are 106/78,82,24,and a temperature of 97 degrees (oral).His granddaughter asks you,"Why isn't grandpa running a fever? He is so very sick." You answer her based on the knowledge that:
A) he is no longer febrile because his pneumonia is resolved.
B) in a 97-year-old,a temperature of 97 degrees is considered febrile.
C) a lack of fever cannot be used to rule out an infection in older adults.
D) oral temperatures are always inaccurate in older adults.
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Chapter 5: Laboratory Values and Diagnostics
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Sample Questions
Q1) What is true concerning laboratory values in older adults?
A) There are age-adjusted ranges for older adults for all of the common laboratory findings,similar to those for infants and children.
B) There are no age-adjusted ranges for older adults due to the large variations within the age group and the increasing number of factors that influence the results.
C) There are age-adjusted ranges only for the over-85 age-group; there are no expected changes in the 65- to 84-year-old age-group.
D) There are age-adjusted ranges only for the hematological tests,which are due mostly to changes in the bone marrow.
Q2) While looking at your patient's laboratory values,you note the following values.Which contains an alteration (increase or decrease)that you might expect with aging?
A) Potassium 4.5 mEq/L
B) Blood urea nitrogen (BUN)10 mg/dL
C) Creatinine 0.8 mg/dL
D) Erythrocyte sedimentation rate (ESR)20 mm/hr
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Chapter 6: Health Assessment in Gerontological Nursing
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Q1) A limitation of the Katz index of activities of daily living (ADLs)is that:
A) completion of the tool requires the joint efforts of the interdisciplinary team.
B) all ADLs are weighted equally,and the cutoff score is arbitrarily determined.
C) it puts a heavier weight on the cognitive abilities necessary to perform ADLs.
D) it is completed as a self-report by the patient.
Q2) When comparing the Older American's Resources and Services (OARS)with the Katz index of ADLs,what is true?
A) The Katz index and the OARS both measure only ADL performance.
B) The OARS is a comprehensive assessment tool that measures ability in five areas; the Katz index measures only ADL performance.
C) The OARS is used only for older adults in the long-term care setting; the Katz index is used in all settings.
D) The OARS is not valid for use in older adults who are cognitively impaired,whereas the Katz index is.
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8
Chapter 7: Managing Basic Physiological Needs
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Sample Questions
Q1) What client statement might encourage you to add the nursing diagnosis of constipation to the client's care plan?
A) "I only have a bowel movement every 2 days."
B) "I have to have my morning cup of coffee before I can move my bowels."
C) "If I don't eat enough prunes or other fruit,I sometimes have trouble."
D) "I had a bowel movement 3 days ago,but it wasn't much,and it was very hard."
Q2) A 78-year-old client in your home care agency has a history of congestive heart failure and arthritis.She lives alone in a two-story home; the bathroom is on the first level,and her bedroom is on the second level.She reports that she has something "very upsetting" to tell you,and reports that she has been wetting the bed at night.What type of incontinence does she most likely have?
A) Urge incontinence
B) Functional incontinence
C) Iatrogenic incontinence
D) Stress incontinence
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9
Chapter 8: Biological Maintenance Needs
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Sample Questions
Q1) A basal cell carcinoma is characterized by:
A) a persistent red lesion with a poorly defined base and an adherent yellow-white scale.
B) a slightly raised discolored patch that may be tan,blue,red,black,or white.
C) an open sore that bleeds,oozes,or crusts and remains for 3 weeks or more.
D) rough,scaly,sandpaper-like patches.
Q2) What skin preparations should the nurse instruct the older adult to use with caution?
A) Moisturizing soaps
B) Emollients to keep the skin moist
C) Steroid-based ointments and creams
D) Sun block
Q3) An 88-year-old resident in a long-term care facility tells the nurse she is having mouth pain.The first action the gerontological nurse should take is to:
A) notify the physician in charge about the resident's problem.
B) carefully inspect the resident's mouth,teeth,and tongue.
C) medicate the resident with a prescribed analgesic.
D) instruct the resident to begin rinsing the mouth with an antimicrobial mouthwash.
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Chapter 9: Nutritional Needs
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Sample Questions
Q1) A 78-year-old female is admitted to the long-term care facility after a hospitalization for pneumonia.She has a history of a right cerebrovascular accident and dysphagia.When preparing the room for this patient,what equipment is most important in the care of this patient?
A) A room close to the nursing station
B) An adjustable height bed that goes low to the floor
C) A suction machine
D) Oxygen at bedside
Q2) The following are reliable methods to evaluate obesity except:
A) BMI (body mass index).
B) WHR (waist-hip ratio).
C) weight and height evaluation using a table of desirable weight.
D) weight greater than 150% of ideal body weight.
Q3) The following are important in the management of diabetes in older adults except: A) diet.
B) physical activity.
C) eliminating all sugars from the diet.
D) testing blood sugar regularly.
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Chapter 10: Chronic Disease in Late Life
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Sample Questions
Q1) You are developing a class on stroke prevention for a local senior citizens center.What would be an important focus when teaching stroke prevention directed at modifiable risk factors?
A) Smoking cessation
B) Blood glucose control
C) Annual physical examination
D) Annual influenza immunization
Q2) A 79-year-old male client with chronic obstructive pulmonary disease (COPD)is seen in the respiratory clinic.What intervention is most important when developing his plan of care to address the long-term goal of promoting healthy respiratory aging?
A) Annual tuberculosis (TB)skin testing
B) Teaching the patient to use alternative modalities such as meditation in order to relax
C) Annual influenza immunization
D) Consuming a high-protein,high-calorie diet
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Chapter 11: Pain and Comfort
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Sample Questions
Q1) A 78-year-old client is being seen in the geriatrician's office for a blood pressure check.She has a history of hypertension and osteoarthritis,and has recently fallen and fractured two ribs.She has been prescribed extra strength Tylenol for the pain.What statement by the client requires further evaluation by the nurse?
A) "I find that when I drink herbal tea and then take my Tylenol at bedtime,I sleep through the whole night."
B) "I heard that meditation may help me deal with the pain without taking all that Tylenol."
C) "I take two extra strength Tylenol tablets (500 mg/tablet)every 4 hours around-the-clock and it helps my pain."
D) "I make sure that I take my Tylenol with breakfast when I first get up."
Q2) Adjuvant medications:
A) are used instead of opioids to decrease the likelihood of addiction.
B) have no side effects.
C) are used to eliminate the side effects of opioid medications.
D) are used in combination with analgesics to potentiate the effect of the analgesics.
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Chapter 12: Geropharmacology
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Sample Questions
Q1) What is an important contributing factor to polypharmacy in older adults?
A) Inadequate communication among medical care providers
B) Implementation of Medicare Part D prescription drug benefit
C) Use of generic medications
D) Increasing popularity of dietary and herbal supplements
Q2) A 90-year-old female patient has a PEG (percutaneous enteral gastrostomy)tube placed due to a recent cerebrovascular accident,difficulty swallowing,and repeated episodes of aspiration pneumonia.You are teaching her son to administer her medications.What advice is important to convey to the son?
A) Ask the pharmacist which of the medications are available in liquid form.
B) Crush all medications and add them to the tube feeding.
C) Medications cannot be given via the PEG tube; they should be crushed and given orally.
D) Medications should be administered via the PEG all at once,one time daily.
Q3) Which pharmacokinetic/pharmacodynamic parameter is least affected by the aging process?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
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Chapter 13: The Use of Herbs and Supplements in Late Life
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Sample Questions
Q1) An 88-year-old woman is being seen for the first time at the outpatient geriatric clinic.When the nurse completes her nursing admission history,she asks the patient about her medication list.She inquires about the use of herbs and other supplements as well as prescription medications.The reason for this inquiry is that herbs and supplements:
A) may interact with prescription medications.
B) are hazardous when used by older adults.
C) replace the need for prescription medications.
D) cause excessive sedation in older adults
Q2) A patient is admitted to a medical nursing unit.On his admission interview,he tells the nurse that he takes ginkgo biloba daily.As a nurse,you understand that this herbal supplement can cause:
A) depression with paranoia.
B) gastrointestinal (GI)upset and headache.
C) impotence and sterility.
D) pneumonia and bronchitis.
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15
Chapter 14: Sensory Function
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Sample Questions
Q1) In evaluating the care plan developed for your elderly client with the diagnosis of Disturbed sensory perception: hearing,which progress notes would suggest improvement toward resolution of the diagnosis?
A) "Client refuses to wear his hearing aid."
B) "Client reported the nursing assistants were 'talking about him.'"
C) "Client attended Friendly Social Group this morning."
D) "Client read in his room and then took a nap."
Q2) Considering his sensory changes with aging,planning an ideal environment for your newly admitted elderly client would include choosing:
A) a brightly lit room with green walls,blue floor,and green cozy throw rugs.
B) a room with ivory walls,orange carpeting,and bright incandescent lighting.
C) a brightly lit room with blue walls and a blue EZ-Glide wax floor.
D) a combination television/children's playroom with cute pastel wall hangings.
Q3) What is a common pathophysiological cause of decreased olfaction in older adults?
A) Increased number of sensory cells
B) Lower thresholds for common odors
C) Injury of the olfactory mucosa
D) Increased neurotransmitters
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Chapter 15: Mobility
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Sample Questions
Q1) Parkinson's disease is characterized by which alteration in gait?
A) Wide-based gait with frequent side-stepping
B) Stooped posture and a short,rapid shuffling
C) Spastic,shuffling gait
D) Waddling gait
Q2) A nurse is making a visit to the home of an 88-year-old client.The nurse reviews safety measures with the client and screens the home environment for potential hazards that could precipitate a fall.The nurse urges the client to eliminate:
A) night lights.
B) railings on the stairway.
C) throw rugs.
D) the use of a cane.
Q3) In planning your discharge teaching for a client with osteoporosis,which precautions should you encourage her to take?
A) Avoid stressful situations.
B) Schedule monthly bone density studies with your physician.
C) Remove clutter from your home.
D) Consume a high-protein diet.
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17
Chapter 16: Environmental Safety and Security
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Q1) You notice that a newly admitted resident to the long-term care facility insists on maintaining a large collection of personal items on her bedside table,including several photographs of her deceased husband.As you are walking by the door to her room,you overhear an argument between the resident and a nursing assistant who is encouraging her to store the personal items in her dresser drawer.You intervene,realizing that:
A) this is an attempt by the resident to maintain a sense of personal space.
B) the resident is not coping well with the loss of her spouse and is using the photographs in an attempt to live in the past
C) the resident is exhibiting combative behavior,which may be an early warning sign of dementia.
D) the resident is exhibiting controlling,manipulative behavior and needs to learn the rules of the institution.
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18
Chapter 17: Economic,Residential,and Legal Issues
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Q1) When an older adult is considering long-term care insurance (LTCI),what is an important consideration?
A) The older one is when applying,the lower the rates will be.
B) It is financially better to avoid purchasing LTCI through a group policy.
C) It is wise to scrutinize all exclusions before enrolling.
D) All policies cover care at home as well as in a long-term care facility.
Q2) The original intent of Social Security was to:
A) provide a hospital insurance plan.
B) minimize the dependency of older members on younger members of society.
C) provide the blind,elderly,or disabled with adequate financial support.
D) penalize women financially for numerous zero wage years while raising children.
Q3) Your 88-year-old neighbor tells you that her daughter wants her to move to a life care community.These communities typically:
A) require that in the case of married couples,both individuals require the same level of care.
B) are decreasing in number across the United States.
C) offer a full range of residential options all in one location.
D) are for low-income seniors only.
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19
Chapter 18: Frailty,Vulnerability,and Elder Mistreatment
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Sample Questions
Q1) A nurse suspects that her next door neighbor,an elderly woman,is a victim of elder abuse by her daughter.The best action of the nurse is to:
A) not get involved because the neighbor is not one of the nurse's patients.
B) plan to visit the neighbor frequently and then confront the family with her suspicions.
C) complete a confidential report with the adult protective services in the area.
D) ask the neighbor if she is being abused.
Q2) A visitor to a nursing home witnesses an attendant scolding a client with dementia about being incontinent.The visitor reports the incident to the charge nurse.This is an example of:
A) caregiver burnout.
B) exploitation.
C) psychological abuse.
D) neglect.
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20
Chapter 19: Intimacy and Sexuality in Late Life
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Sample Questions
Q1) You are a preceptor to a new nurse on the geriatric unit of the hospital.You observe the nurse admit a new patient to the nursing unit and you are reviewing her documentation of the assessment.You note that she has left the section on the assessment form related to "sexuality" blank,and you question her about it.She states that it is "not applicable" and that the patient is 79 years old,then she draws a line through the section.What action do you take?
A) There is no action needed.The patient is 79 years old and this is not an area of concern.
B) There is no action needed.The patient would have shared information if there was anything of concern,so there is no need to ask.
C) Speak to the new nurse,because the role of the nurse is to offer an opportunity for discussion.
D) Speak to the new nurse,because this is an area for the physician to complete.
Q2) The following have been identified as benefits of therapeutic touch except:
A) provision of sensory stimulation.
B) relief of physical and psychosocial pain.
C) reduction of anxiety.
D) improved skin integrity.
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21
Chapter 20: Relationships,Roles,and Transitions
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Q1) A married couple lives in a retirement community.The husband is 76 and the wife is 73.When she attends her Tai Chi class,she shares the following with the nurse: "I expected to enjoy retirement with my husband.These were supposed to be our golden years.I am so stressed out.All I do is spend my time taking care of him; he has so many things wrong with him." The nurse bases her response on the understanding that:
A) The woman's comments are atypical of older married adults and reflect severe depression.
B) The woman's comments are typical and reflect the many stressors faced by older married couples.
C) The woman's comments are typical and reflect the financial strain faced by older married couples.
D) The woman's comments are atypical and reflect a conflict situation between her and her children.
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Chapter 21: Culture,Gender,and Aging
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Q1) Ethnocentrism is defined as:
A) an understanding of another's cultural beliefs and practices.
B) a conflict that occurs when an individual interacts with another whose beliefs differ from his own.
C) application of limited knowledge about one person with specific characteristics to another person.
D) a belief that one's ethnic group is superior to that of another.
Q2) You are assigned to write a culture and illness paper for your gerontology class.Which information will you be sure to include in your paper?
A) Culture is the same as ethnicity.
B) Ethnic groups always share common geographic origin,language,and religion.
C) Ethnicity involves culture,social status,and support systems.
D) You will expect the client you select for the paper to possess all cultural traits outlined in the textbook.
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Chapter 22: Nursing and Aging in Rural and Frontier Settings
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Q1) You are interviewing an older adult at a community health care center in a rural farm community.What typically reflects his lifelong residency in a rural farming community?
A) He requests information about long-term care due to an inability to work on his farm like he did a few years ago.
B) He states that he is getting too old to live on his own and should consider moving in with his grandson in the city.
C) He does not believe that severe arthritis in his hands and knees will cause his life to be altered.
D) He is requesting Meals on Wheels because both he and his wife have severe arthritis.
Q2) What is true regarding the health status of rural-dwelling older adults? They are:
A) a population at risk for disease and disability.
B) less likely to have mental illness.
C) able to access health care due to federal farm pension programs.
D) automatically eligible for government assistance for home care programs regardless of specific needs.
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Chapter 23: Cognition and Caring for Persons with Cognitive Impairment
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Q1) The Mini-Mental State Exam (MMSE)is a tool used to:
A) diagnose Alzheimer's disease.
B) provide a baseline mental status measurement and track changes.
C) diagnose delirium in hospitalized older adults.
D) predict the progression of cognitive changes.
Q2) In evaluating the plan of care for an older adult with the nursing diagnosis Risk for Injury related to delirium,which evaluative statement would best suggest that the problem is resolving?
A) Client attempted to climb over the side rails.
B) Client manipulated intravenous pump,stating "I can't get this transformer to work."
C) Client correctly stated year and month but not date.
D) Client stated,"If we don't hurry,I'll miss the bus."
Q3) A major differentiation between delirium and dementia is that the course of delirium over a 24-hour period:
A) is fairly stable but may be exacerbated by stress.
B) fluctuates and is often worse at night.
C) is fairly stable but may be worse in the morning.
D) demonstrates a steady decline.
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Chapter 24: Stress,Crises,and Health in Aging
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Q1) A 76-year-old woman was recently admitted to a nursing home.She was transferred directly from the hospital after a hospitalization for a fall and subsequent hip replacement.Her daughter was not able to accompany her on the transfer to the nursing home.She is not eating well,refuses to take her medications,and prefers to sit in her room.Her daughter visits and expresses concern to the nurse.What suggestion is most appropriate for the nurse to suggest to the daughter?
A) Visit often and bring familiar objects from the patient's home to decorate her room.
B) Do not visit for a few weeks in order to give the patient time to get used to the facility.
C) Speak with the primary physician and request a psychiatric evaluation to rule out dementia.
D) Transfer the patient to a different facility because she is not adjusting to this one.
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Chapter 25: Emotional Health in Late Life
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Q1) The goals of treatment for a depressed elderly client include the following except:
A) decreasing symptoms
B) reducing risk of relapse.
C) increasing quality of life.
D) increasing medication use.
Q2) You are assigned to the care of an 80-year-old schizophrenic client who has been admitted to your acute care facility.As you develop a plan of care for this client,you are taking into consideration what reality about being an older adult with schizophrenia?
A) The majority of mental health care for older adults is provided in long-term psychiatric facilities.
B) Mental health services for older adults are readily reimbursed by Medicare.
C) Popular managed care programs usually include in-depth assessment involving specialized expertise in mental health.
D) The mental health needs of older adults are not easily recognized or accurately reported.
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27
Chapter 26: Loss,Death,and Dying in Late Life
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Q1) The nurse aide reports to the registered nurse that her 97-year-old patient is not breathing well and that she feels "cold and clammy" and "looks blue." The patient has an advance directive that states "comfort care only" and is designated as a DNR (do not resuscitate).The registered nurse should:
A) not administer pain medication or hygiene because the patient is dying.
B) contact the physician for order to address the patient's breathing problems.
C) ask the patient's family what they want to be done for the patient.
D) instruct the nurse aide to provide personal hygiene and make the patient comfortable as outlined in the plan of care.
Q2) A woman is terminally ill.Although it has never been discussed in the family nor stated outright by her physician,she suspects that she will die because of her illness.This situation is:
A) closed awareness.
B) suspected awareness.
C) mutual pretense.
D) open awareness.
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Chapter 27: Self-Actualization,Spirituality,and Transcendence
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Q1) A 92-year-old client of an adult day care center has Alzheimer's disease.The recreation therapist recommends a painting class for the client.Her daughter attends a team meeting and begins to laugh when she hears that her mother is attending a painting class and states: "Are you talking about my mother? Did you forget that she has Alzheimer's disease?" The nurse bases her response on the knowledge that:
A) creative activities are not limited to cognitively intact elders; even individuals with dementia can benefit from creative activities.
B) individuals with dementia who have rational language skills can benefit from creative activities.
C) cognitively impaired elders cannot benefit from creative activities due to altered brain processes.
D) cognitively impaired elders are usually too agitated to participate in creative arts.
Q2) Which refers to the highest level of human functioning,according to Maslow?
A) Biological or physiological integrity
B) Safety and security
C) Self-esteem
D) Self-actualization
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