Chapter 11: The Older Patient Nursing School Test Banks

Chapter 11: The Older Patient
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. How is the term old age or aged best defined?
a. Persons state of mind
b. Person older than 65 years of age
c. Process of growing older
d. Person of advanced age
ANS: D
Aged or old age is defined as advanced in years.

DIF: Cognitive Level: Comprehension REF: p. 137 OBJ: 2
TOP: Definitions of Old Age KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

2. How is aging recognized by gerontologists as a developmental process?
a. Measured in chronologic years
b. Directly related to heredity
c. Related to behavioral characteristics
d. Begins at the time of birth
ANS: D
Geriatrics is the science of old age and the application of knowledge related to the biologic, biomedical, behavioral, and social aspects of aging.

DIF: Cognitive Level: Knowledge REF: p. 137 OBJ: 2
TOP: Definitions of Old Age KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

3. What understanding is a prerequisite for a nurse working with the geriatric patient?
a. Specialized knowledge is needed.
b. Geriatric patients are physically impaired.
c. Most geriatric patients will develop dementia.
d. Geriatric patients need to be closely supervised.
ANS: A
Knowledge, understanding, and caring are prerequisites for working effectively with older adults. Although specialized formal education programs at the graduate level are available for gerontologic nurses, many nurses gain specials skills through on-the-job experiences.

DIF: Cognitive Level: Comprehension REF: p. 138 OBJ: 1
TOP: Roles of the Gerontologic Nurse KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

4. A 78-year-old resident of a long-term care facility insists on wearing high heels and miniskirts to the dining room for meals and will not leave her room without first applying glamorous makeup. What should the gerontologic nurse assess as the reason for this behavior?
a. Insecurity about her appearance
b. Trying to cope with the changes of aging
c. Denial concerning her advancing age
d. Her fashion consciousness
ANS: C
Some older people confront aging, but others deny it by acting in a younger manner.

DIF: Cognitive Level: Analysis REF: p. 138-139 OBJ: 2
TOP: Ageism: Myths and Stereotypes KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

5. What does Butler, a well-known gerontologist, relay regarding ageism?
a. It dehumanizes older individuals.
b. It is based on the biologic theory of aging.
c. It is based on natural and purposeful occurrences.
d. It continues to change as the population ages.
ANS: A
Ageism is the stereotyping of and discrimination against people because of their age.

DIF: Cognitive Level: Comprehension REF: p. 138-139 OBJ: 2
TOP: Ageism: Myths and Stereotypes KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

6. What are the effects of aging on the nervous system?
a. Accelerated loss of neurons in the brain
b. Gradually declining loss of intellectual capability
c. Decreased conduction speed of neurons
d. Loss of long-term memory
ANS: C
Age-related effects on body systems are integral parts of the basis of nursing care for older adults. The aging nervous system is characterized by decreased conduction speed of neurons.

DIF: Cognitive Level: Comprehension REF: p. 140-141 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. A nurse is caring for older adult patients with mild cognitive impairment (MCI). What are these patients more likely to develop?
a. Dementia, non-Alzheimer type
b. Alzheimer dementia
c. Parkinson disease
d. Psychotic disorders
ANS: B
Approximately 40% of people with MCI develop Alzheimer dementia within 3 years.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. What is the most appropriate nursing action when planning activities to improve short-term memory for an older adult patient experiencing memory deficits?
a. Maintain the same daily schedule.
b. Rehearse memory training.
c. Provide a varied and stimulating daily schedule.
d. Conduct deep-breathing exercises.
ANS: B
Using mnemonics and memory rehearsal may improve memory performance in some older individuals.

DIF: Cognitive Level: Application REF: p. 140-141 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. What is the best example of normal memory change or lapse of memory?
a. Relying on another person to remember names or important events
b. Occasional forgetfulness or inability to recall names or facts
c. Difficulty in recalling recent events
d. Difficulty in recalling past events
ANS: B
Memory lapses such as forgetting a name or misplacing an item are common, normal memory changes.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

10. Which facts are generally accepted for most older adults?
a. Intellectual capabilities are impaired.
b. Functional brain activities decrease.
c. Functional intellectual capability is maintained.
d. Creativity and judgment are severely impaired.
ANS: C
Functional ability may not be significantly affected because reserve cells are able to compensate.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

11. What factor increases the risk of respiratory infection for older adults?
a. Decreased ciliary action
b. Decreased physical activity
c. Inadequate hydration
d. Poor personal hygiene
ANS: A
The ability to perform strenuous work decreases with age. The ciliary action responsible for movement of secretions from the lung is compromised because of epithelial atrophy.

DIF: Cognitive Level: Comprehension REF: p. 141 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

12. A nurse is caring for an older person whose renal changes make it impossible to concentrate or dilute urine. For what is this patient at the greatest risk?
a. Urinary infection
b. Dehydration
c. Incontinence
d. Renal failure
ANS: B
The kidneys ability to concentrate urine is a major defense against dehydration.

DIF: Cognitive Level: Application REF: p. 142 OBJ: 3
TOP: Physiologic Renal Change KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. Which assessment is the greatest priority to report when considering the gastrointestinal (GI) changes that take place in the geriatric patient?
a. 24-hour urinary output of 1450 mL
b. 24-hour dietary intake of 75% of meals
c. Last bowel movement 4 days ago
d. Weight loss of 2 lb since admission 2 months ago
ANS: C
GI changes include bloating, diarrhea, pernicious anemia, and constipation.

DIF: Cognitive Level: Application REF: p. 143 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

14. Which assessment made by the nurse is a major sign of renal changes related to age?
a. Hematuria
b. Nocturia
c. Urgency incontinence
d. Renal calculi
ANS: C
Urgency incontinence is related to several age-related changes in the urinary musculature. Renal calculi and hematuria are pathologic symptoms and are not age related. Nocturia is not specifically related to aging.

DIF: Cognitive Level: Comprehension REF: p. 142 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. What should be the most significant assessment when gathering data concerning the musculoskeletal system?
a. Slow gait
b. Degree of motion of all joints
c. Enlarged joints
d. Crepitus in joints
ANS: B
Determine mobility by assessing the range of motion in all joints; in addition, look for signs of inflammation and pain associated with mobility.

DIF: Cognitive Level: Application REF: p. 143 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. What is the most appropriate nursing intervention for a patient with presbycusis?
a. Speak clearly and distinctly while facing the patient.
b. Announce your presence when entering the patients room.
c. Place needed articles within easy reach.
d. Orient the patient to time and place as needed.
ANS: A
Presbycusis is hearing loss. Get the patients attention so that the patient can concentrate on what you are saying or read lips.

DIF: Cognitive Level: Application REF: p. 143 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. What should the nurse suspect a patient is developing when he is observed holding his Bible 6 inches from his face and turns his head to read out of the corner of his eyes?
a. Cataracts
b. Glaucoma
c. Presbyopia
d. Macular degeneration
ANS: D
The leading cause of new blindness in old age is macular degeneration, which results in the loss of central vision.

DIF: Cognitive Level: Comprehension REF: p. 144 OBJ: 3
TOP: Macular Degeneration KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. What is true regarding the chemosensory changes observed in older adults?
a. They are directly related to the aging process.
b. They are most often caused by disease.
c. They begin in the fifth decade of life.
d. They affect more women than men.
ANS: B
Major changes in the ability to taste are often caused by disease or a side effect of certain drugs.

DIF: Cognitive Level: Comprehension REF: p. 144 OBJ: 3
TOP: Chemosensory Change KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

19. A nurse explains to family members that the final developmental stage is ego integrity. What should occur in the older adult, according to Erikson, if this stage is not mastered?
a. Needs to repeat a previous stage
b. Experiences despair
c. Inability to advance past the present stage
d. Experiences disappointment
ANS: B
The final developmental task is ego versus despair. This negative resolution is often seen as depression and social withdrawal.

DIF: Cognitive Level: Comprehension REF: p. 145 OBJ: 3
TOP: Psychosocial Factors KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

20. What is the best nursing action when assisting an older patient to relieve the discomfort of pruritus related to dry skin?
a. Encourage the patient to talk to the primary care physician about the problem.
b. Encourage the patient to take a tepid bath and use moisturizers.
c. Teach the patient that pruritus is an expected consequence of aging.
d. Establishing a medication regimen to control the discomfort.
ANS: B
Because pruritus is caused by loss of oils in the skin, the patient should be encouraged to take tepid baths; use moisturizers; and avoid overuse of antiperspirants, soaps, perfumes, and long hot baths.

DIF: Cognitive Level: Application REF: p. 142 OBJ: 3
TOP: Physiologic Change KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

21. A newly admitted 72-year-old resident of a long-term care facility naps frequently during the day, stating that he is tired. What is the best action by the nurse?
a. Obtain an order from the primary caregiver for a sedative.
b. Ask the patient if he is sleeping well at night.
c. Plan activities to keep the patient awake during the day.
d. Tell the patient that he cannot take any more naps.
ANS: B
Determining if or the reason why the patient is not sleeping at night will help the nurse implement the appropriate nursing actions. Depression may be interfering with adapting to the long-term facility.

DIF: Cognitive Level: Application REF: p. 146 OBJ: 4
TOP: Psychosocial Factors KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

22. What is the best reason that drug toxicity can occur as a result of an age-related change in the liver?
a. Increased liver size
b. Decreased liver enzyme activity
c. Rapid blood flow through the liver
d. Fluid accumulation in the portal vein
ANS: B
Decreased liver enzyme activity does not prepare the drug for excretion. The liver size is decreased in older persons; blood flow through the liver is also decreased.

DIF: Cognitive Level: Comprehension REF: p. 147 OBJ: 3
TOP: Decreased Liver Function KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. A 77-year-old recently admitted to a long-term care facility refuses to join in activities or go to the dining room for meals. How should the nurse interpret this behavior?
a. Stubbornness
b. Depression
c. Fear
d. Exhaustion
ANS: B
Some older people respond to loss by losing their sense of personal identity and fulfillment. They have a deterioration in self-esteem and become depressed.

DIF: Cognitive Level: Analysis REF: p. 146 OBJ: 5
TOP: Psychosocial Factors KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Physiological Adaptation

MULTIPLE RESPONSE

24. Which concepts are the basis of the error theories of aging? (Select all that apply.)
a. The rate of aging is related to the rate of living.
b. Aging is a result of purposeful events governed by genetic structure.
c. External events cause damage to cells.
d. The organism becomes immune to the bodys restorative processes.
e. Cumulative damage causes organ malfunction.
ANS: A, C, E
Aging is a result of progressive damage to cells, which results in organ failure or error.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: 3
TOP: Aging Theories KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

25. What are included in age-related cardiovascular changes? (Select all that apply.)
a. Cardiac murmurs
b. Widened pulse pressure
c. Pulse decreasing in force
d. Dyspnea
e. Chest pain
ANS: A, B, C
Murmurs, widening pulse pressure, and decreasing force of pulse are all associated with age-related changes. Dyspnea and chest pain are not anticipated changes in the cardiovascular system.

DIF: Cognitive Level: Knowledge REF: p. 141 OBJ: 3
TOP: Cardiovascular Changes KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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