Nursing Care of Older Adults
Chapter Exam Questions
Course Introduction
Nursing Care of Older Adults explores the principles and practices of nursing as they relate to the unique healthcare needs of older adults. The course covers the physiological, psychological, social, and cultural aspects of aging, emphasizing common health conditions, chronic illness management, and wellness promotion in geriatric populations. Students learn to apply evidence-based nursing interventions, collaborate with multidisciplinary healthcare teams, and advocate for patient-centered care to enhance the quality of life and independence of older adults. Ethical and legal considerations, communication strategies, and family involvement in geriatric care are also thoroughly discussed.
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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Q1) The nurse is completing discharge instructions for an 88-year-old patient who is being discharged from the hospital following a myocardial infarction.She provides him with written literature on heart healthy diets,exercise,and smoking cessation.His daughter states,"I don't know why you are bothering,what difference is it going to make? He has been smoking and eating poorly for years; he isn't going to change now." This statement reflects the concept of:
A) reality orientation.
B) character assessment.
C) negative stereotyping.
D) senescence.
Answer: C
Q2) The following services are commonly offered by state Area Agencies on Aging (AAAs),except:
A) senior centers.
B) nutrition centers.
C) long-term care ombudsman.
D) primary health care.
Answer: D
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Chapter 2: Theories of Aging
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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) A 66-year-old retired professional basketball player is admitted to the hospital for a total knee replacement due to osteoarthritis.In preparing preoperative teaching for this patient,you may want to include which theory of aging to help him understand how the disease has progressed?
A) Free radical theory
B) Wear and tear theory
C) Gene theory
D) Cross-link theory
Answer: B
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4
Chapter 3: Health and Wellness
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Q1) You are on a performance improvement committee at your hospital.The committee selects a project related to influenza vaccination.What is the guideline for influenza vaccination for individuals older than age 65?
A) Annually for individuals older than age 65 with a compromised immune system,or with a respiratory or cardiac condition
B) Annually for all individuals older than age 65,whether they are well or have chronic conditions
C) Once in persons age 65 or older,with boosters given as needed every 5 years
D) Every 2 to 5 years
Answer: B
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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Q1) Which statement best describes normal changes of aging?
A) All age-related changes are the result of disease.
B) When comparing functional abilities of an elderly client,it is important to not allow social or cultural influences to cloud your assessment.
C) It is always very easy to tell the difference between normal aging and the results of one's lifelong poor habits.
D) Individual variations are enormous at every age and in every part of the body.
Q2) You are caring for an 89-year-old woman who was admitted to the hospital for weakness and a cough.In her assessment,the client describes that she has to go to the bathroom frequently and manages this by monitoring her fluid intake,especially before going to bed.She has no pain or discomfort with voiding.The nurse knows:
A) that this is normal for a woman her age.
B) that this is indicative of a urinary tract infection.
C) that this is a sign of diabetes.
D) that the patient is drinking too many fluids.
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6
Chapter 5: Laboratory Values and Diagnostics
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Q1) You are caring for an elderly male client in a long-term care facility.As part of his annual physical examination,the nurse practitioner orders some laboratory tests,including a complete blood count,serum electrolytes,and thyroid tests.The resident's wife questions these tests stating: "He seems fine to me,a little sleepy,but he is 85 years old,you know." In explaining the rationale for these tests,you base your response on your knowledge that:
A) his wife has an excellent point; you should speak to the nurse practitioner about canceling them.
B) when conducted annually,all of the tests are helpful in promoting maximum health for older adults in the long-term care setting.
C) the tests are useful,but only if clinically indicated.
D) the complete blood count and serum electrolytes are useful screening tests,but you will question the nurse practitioner about the thyroid tests.
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Chapter 6: Health Assessment in Gerontological Nursing
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Q1) What is true about instruments to assess for depression in older adults?
A) Older adults tend to score inaccurately low (indicating less depression)than younger adults on the Zung Self-Rating Depression Scale.
B) The Geriatric Depression Scale cannot be used in older adults with dementia or cognitive impairment.
C) The Beck Depression Inventory is designed for gerontological patients.
D) The Geriatric Depression Scale is administered by a health care provider in an interview with the older adult.
Q2) A 78-year-old man is being evaluated in the geriatric clinic.His daughter reports that he has been very forgetful lately,and she is concerned that he might be "senile." The advanced practice nurse administers the clock drawing test and the patient draws a distorted circular shape and places the numbers all on one side of the shape.Based on his performance,the nurse concludes that the patient:
A) probably has Alzheimer's disease.
B) needs further evaluation.
C) probably has delirium.
D) needs a functional status assessment.
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Page 8
Chapter 7: Managing Basic Physiological Needs
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Q1) It is 3:00 AM.You are the night shift charge nurse on the east wing of a hospital.You are busy verifying that yesterday's orders were correctly transcribed when an elderly female patient who has ambulated to the desk calls your name.She seems upset when she says,"I can't sleep.I haven't gotten more than two consecutive hours' sleep since I was admitted the other day." Your response is:
A) "That's very unusual,older people tend to sleep a lot more."
B) "I will call the doctor and have him order some sleeping pills for you."
C) "Just be glad you aren't the patient in the next room.She was just diagnosed with cancer.Now that's something to lose sleep over!"
D) "Let's get some warm milk and talk about it."
Q2) In implementing your nursing care plan for your client with constipation,what will you include in your plan?
A) Bedrest
B) Limiting fluids
C) Increased fiber in the diet
D) Aluminum-containing antacids
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Chapter 8: Biological Maintenance Needs
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Q1) An 88-year-old patient has type 2 diabetes mellitus.During a routine visit to the diabetes clinic,the nurse reviews the principles of diabetic foot care.What should be included in the teaching?
A) Rub feet vigorously after washing to ensure that they are thoroughly dried.
B) Apply skin softening emollients to all areas of the feet,including between the toes.
C) Inspect feet daily for cuts,blisters,cracks,and reddened areas.
D) Soak feet daily for 10 to 15 minutes in tepid water.
Q2) An 81-year-old woman complains of pain in the right upper posterior thoracic area and has an elevated temperature (101° F).She subsequently develops clusters of fluid-filled vesicles in the same area where she reported the pain.It is likely that she has: A) seborrheic keratoses. B) rosacea.
C) herpes zoster. D) stasis dermatitis.
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Chapter 9: Nutritional Needs
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Q1) An 80-year-old patient has gout.Diet teaching should include the avoidance of alcohol and:
A) foods high in purine.
B) foods high in calcium.
C) foods high in phosphorous.
D) foods high in magnesium.
Q2) 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.
Q3) 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
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Page 11
Chapter 10: Chronic Disease in Late Life
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Q1) A 77-year-old client is newly diagnosed with type 2 diabetes mellitus.What is a priority goal for her?
A) To have an eye examination by an ophthalmologist yearly
B) To have routine foot examinations by a podiatrist
C) To maintain proper control of her blood sugar
D) To be knowledgeable about the signs and symptoms of kidney failure
Q2) An older adult with pneumonia often:
A) presents with an elevated temperature.
B) is not treated with antibiotics.
C) presents with a change in functional status and mental status.
D) presents with a markedly elevated white blood cell (WBC)count.
Q3) You are assisting your elderly client with chronic obstructive pulmonary disease (COPD)in self-care activities.Which direction provided by you will best help her achieve the goal of being able to perform self-care activities?
A) Bathe and eat slowly,allowing rest periods.
B) Attempt to walk short distances without oxygen.
C) Perform all activities of daily living at one time,and then rest.
D) Bathe right after eating,and then rest.
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Chapter 11: Pain and Comfort
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Sample Questions
Q1) Compared with acute pain,persistent pain:
A) leads to markedly altered vital signs.
B) is usually described as a burning pain.
C) is generally gone within 4 months.
D) can lead to lifestyle changes.
Q2) An 88-year-old male patient with gastric cancer with bone metastases is being discharged from the hospital where he was started on a regimen of opioid analgesics to control the metastatic pain.What should be included in the discharge teaching plan?
A) Encouraging oral fluids
B) Preventing falls
C) Increasing calories and protein in the diet
D) Preventing pressure ulcers
Q3) A 72-year-old patient is started on an analgesic regimen with opioids to treat persistent pain.What assessment is most important for the nurse to perform for all older patients on opioid analgesic regimens?
A) Integumentary
B) Genitourinary
C) Gastrointestinal
D) Cardiac
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Page 13
Chapter 12: Geropharmacology
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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) An 81-year-old patient is being discharged from the hospital to home.She is on seven different medications,which are to be taken at four different times during the day.What would be most useful in helping this patient manage her medications?
A) Providing package inserts from all of the medications for the patient to read
B) Providing a pillbox with compartments for each day and each of the doses
C) Providing a written list of the medications
D) Asking the patient's daughter to administer the patient's medications
Q3) Which pharmacokinetic/pharmacodynamic parameter is least affected by the aging process?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
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14
Chapter 13: The Use of Herbs and Supplements in Late Life
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Q1) Herbal supplements are manufactured in all but one of these forms:
A) tincture.
B) salves.
C) extracts.
D) intravenous.
Q2) 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
Q3) The profile of a usual herbal supplement client resembles:
A) inner city,lower socioeconomic status,female.
B) white,highly educated with higher income level.
C) third generation,middle income,Hispanic American.
D) men and women from small rural communities.
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Page 15
Chapter 14: Sensory Function
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Q1) A 69-year-old patient reports that she is having difficulty hearing.Which interventions would the nurse perform? (Select all that apply.)
A) Perform a Rinne test.
B) Eliminate extraneous noise in the environment.
C) Speak in an extra loud tone of voice.
D) Review prescribed medications.
Q2) 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
Q3) In altered perceptual organization,disorientation usually occurs first in which domain?
A) Time
B) Person
C) Place
D) Situation
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Chapter 15: Mobility
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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) Rheumatoid arthritis:
A) is diagnosed by a positive pannus blood test.
B) results from a deficiency of vitamin D.
C) includes systemic manifestations as well as bilateral joint deformities.
D) is characterized by low bone mass and compromised bone strength.
Q3) You are answering your elderly client's questions about diet,exercise,and bone integrity.Which exercise would you inform her is the least effective in preventing bone demineralization?
A) Jogging
B) Jumping rope
C) Swimming
D) Walking
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Chapter 16: Environmental Safety and Security
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Q1) A 98-year-old female client of your home care agency resides independently in the community.You make a routine visit and you find that despite its being 90 degrees F outside,the windows are closed and the client is wearing a sweater.You understand that her behavior may be related to:
A) cognitive changes that diminish the individual's awareness of temperature changes.
B) neurosensory changes related to aging that diminish the individual's awareness of temperature changes.
C) delirium related to an acute illness.
D) self-neglect.
Q2) You are educating your elderly female client about fire safety.You answer her questions knowing that:
A) elderly women are more likely to die in fires than elderly men.
B) fire mortality for elders is twice that of any other age group except children ages 1 to 4.
C) most people who die in fires are killed by the flames.
D) most fires occur outside the home.
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18
Chapter 17: Economic,Residential,and Legal Issues
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Q1) One significant difference in the two levels of care in a nursing home-subacute (skilled)care and chronic care-is that subacute care:
A) provides 24-hour personal assistance to the resident.
B) focuses on rehabilitation or management of complex medical needs.
C) is provided in for-profit facilities only.
D) is not covered by Medicare.
Q2) The Omnibus Budget Reconciliation Act (OBRA)of 1987 included:
A) mandatory registered nurse (RN)to patient ratios in nursing homes.
B) mandatory RN continuing education.
C) elimination of the use of restraints and medications for discipline of residents.
D) mandatory daily patient assessments by physicians.
Q3) When are managed care systems most effective?
A) When a client avoids using the system until needed in an emergency situation
B) When a client avoids using primary care practitioners and routinely accesses specialists
C) When a client uses high-tech treatments before trying less costly treatments
D) When a client uses preventive primary care services to maintain his or her health
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Chapter 18: Frailty,Vulnerability,and Elder Mistreatment
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Q1) What is a true statement about mandatory reporting of elder mistreatment?
A) Nurses are mandatory reporters of elder mistreatment in all states and territories in the United States.
B) The nurse must have documented proof of elder abuse before reporting an incident.
C) Elder mistreatment reports require that the reporter identify herself in the report.
D) The standard for reporting is one of reasonable belief that a vulnerable person has been or is likely to be abused.
Q2) 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.
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Chapter 19: Intimacy and Sexuality in Late Life
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Q1) 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.
Q2) A 72-year-old widow is a newly admitted resident of a long-term care facility.She initially spends a lot of time in her room and is reluctant to socialize.She meets an 81-year-old male resident of the facility,and they begin spending a lot of time together.They are seen holding hands and sitting together in the widow's room with the door closed.Her daughter attends a care planning meeting and expresses concern over her mother's friendship with the man,stating "The next thing you know they are going to be having sex,maybe they are.This must stop." The nurse bases her response to the daughter on knowing that:
A) Sexual activity in a long-term care facility is inappropriate and must be prevented.
B) Older adults may want to have new relationships and it is normal to express love and intimacy.
C) Sexual desire is absent in older adults.
D) Sexual activity can be dangerous for older adults with chronic illnesses.
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Chapter 20: Relationships,Roles,and Transitions
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Q1) An 88-year-old resident of a long-term care facility relates that she used to be the family member who arranged family reunions.Although she was never married and had no children,her room is full of pictures of nieces and nephews and grandnieces and grandnephews,and she can tell you about all of the individuals in the pictures.You could describe the resident as:
A) preoccupied with the family.
B) matriarch of the family.
C) kin-keeper.
D) living in the past.
Q2) An 82-year-old widow with Alzheimer's disease is being cared for at home by her daughter.Twice a week,the widow goes to an adult day care program.This is an example of:
A) long-term care.
B) a PACE program.
C) transitional care.
D) respite care.
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Chapter 21: Culture,Gender,and Aging
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Q1) Which is true about health care disparities among older adults?
A) Older adults of color have equal risk factors for vulnerability as all older adults.
B) Older adults of color have equal risk factors for vulnerability as young adults of the same ethnic group.
C) Older females of color have increased risk factors for vulnerability than do older males of the same ethnic group.
D) Health care disparities are only seen in older adults of color who receive care in public hospitals and clinics.
Q2) Which cultural group has the fastest growing elderly population in the United States?
A) Blacks
B) Asian/Pacific Island Americans
C) Native Americans
D) Hispanic Americans
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Chapter 22: Nursing and Aging in Rural and Frontier Settings
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Q1) A 76-year-old patient is hospitalized after falling and fracturing her hip while visiting her daughter in a large city.She lives in a small farming community about 3 hours away from the nearest urban area.She is found to have hypertension.When questioned about her preventive health care practices,she reports that she does not have a primary care physician,that the nearest physician is a 3-hour drive,and that she takes garlic for her hypertension.In analyzing her health care maintenance practices,the nurse knows that:
A) the patient is typical of rural older adults in that primary care in rural areas is scarce and rural older adults tend to use self-care strategies.
B) the patient is typical of rural older adults in that most rural older adults have hypertension due to the large amount of physical activity.
C) the patient is atypical of rural-dwelling older adults in that most do seek out primary care,but not specialty care.
D) the patient is atypical of rural-dwelling older adults in that most do not use alternative medicine or "home remedies."
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Page 24
Chapter 23: Cognition and Caring for Persons with Cognitive Impairment
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Q1) A 90-year-old client with dementia resides with his daughter in the community.When the home care nurse visits,the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him.She states,"I don't know why he hates me and wants to hurt me.I try so hard to take good care of him.I love him." What is the best response to the client's daughter?
A) "What have you done to anger your father?"
B) "Behavior is an expression of needs.Let's try to figure out what your father was trying to communicate."
C) "Scratching is usually a sign of untreated pain.Do you think your father is in pain?"
D) "Maybe you should not be providing direct care to your father,a home health aide might be more appropriate.
Q2) 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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Page 25
Chapter 24: Stress,Crises,and Health in Aging
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Q1) What is a true statement regarding crises and stress?
A) Stress always precipitates a crisis.
B) Crises always create stress.
C) Personal perception of an event is less significant than the event's magnitude.
D) Stress is time limited.
Q2) An older adult woman has recently experienced a number of stressful life events,including the loss of her brother,the burden of caring for her ailing husband,and now an impending move to an apartment across town,because an earthquake has structurally devastated her home of 35 years.She comes to the ambulatory clinic because,in her words,"On top of all of that,now I've got this flu!" In rendering care for this elderly woman,you recognize that:
A) she is exhibiting attention-seeking behaviors.
B) crisis and stressful situations may produce emotions that erode the health of the elderly.
C) she is exhibiting "learned helplessness."
D) a period of crisis will ultimately lead to a lower level of functioning.
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Chapter 25: Emotional Health in Late Life
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Q1) Electroconvulsive therapy (ECT)in older adults:
A) has been found to be effective in individuals with psychotic depression and those who do not respond to antidepressant medications.
B) has been found not to be as effective in older adults as in younger adults. C) has been found to be safe for older adults with increased intracranial pressure. D) has been found to improve symptoms of dementia in older adults.
Q2) Your elderly client has just suffered a myocardial infarction.Upon discharge,he says to you,"I watched all those heart videos and stuff,but I still insist it was just indigestion." In formulating a response,you recognize that he is showing signs of:
A) denial.
B) projection.
C) altruism.
D) deficient knowledge.
Q3) The most prevalent mental health disorder in older adults is: A) anxiety disorder.
B) depression.
C) schizophrenia. D) alcoholism.
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Chapter 26: Loss,Death,and Dying in Late Life
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Q1) A nurse was caring for a patient who died of a chronic illness.The family had been present with the patient constantly during the previous week,experiencing the dying process.The family was present when the patient stopped breathing,and had a very emotional reaction as if they were in a state of disbelief.The nurse interprets this behavior to be:
A) a normal response when experiencing the death of a loved one.
B) a maladaptive coping mechanism.
C) an irrational response.
D) an expression of anger toward the staff.
Q2) 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.
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Q1) You are admitting a new resident to your long-term care facility.In attempting to give you some background information on his wife,the resident's husband describes his wife as a "very spiritual" person.From this,you understand that:
A) a highly spiritual person has a specific religious affiliation.
B) she probably will prefer spiritual healing methods over modern medicine.
C) spiritual needs are much broader and more personal than any particular religious persuasion.
D) an important nursing role for the resident will be to make certain she attends church services on the unit weekly.
Q2) What is the role of the nurse in assisting older adults with travel interests?
A) Making their arrangements
B) Addressing potential problems and assisting in planning ahead for contingencies
C) Offering to provide pet-sitting services
D) Reassuring the client that altitude and climate are minor considerations in travel
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