Chapter 14: Older Adult Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 7th Edition

Test Bank

MULTIPLE CHOICE

1. A nurse is performing a physical examination on an older-adult client in an assisted living facility. On completion of the examination, the nurse compares the results to findings expected for individuals in this age-group. An expected finding for this client is:

1.

Increased tactile responsiveness

2.

Increased sensitivity to visual glare

3.

Increased hearing acuity for higher tones

4.

Increased thoracic expansion during ventilation

ANS: 2

A common physiological change in the older-adult client is an increased sensitivity to glare. Increased tactile responsiveness would not be an expected finding in the older-adult client. An expected physiological change in the older adult-client is a loss of hearing acuity for high-frequency tones (presbycusis). The older adult has decreased thoracic expansion during ventilation because of musculoskeletal changes.

DIF: A REF: 198 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Integrity/System Specific Assessment

2. A 70-year-old client asks the nurse to explain her hypertension as she is to have her blood pressure checked each shift. An appropriate response by the nurse as to why older clients often experience hypertension is because of:

1.

Myocardial muscle damage

2.

Reduction in physical activity

3.

Ingestion of foods high in sodium

4.

Accumulation of plaque on arterial walls

ANS: 4

Although hypertension is not a normal physiological change of aging, older adults often experience hypertension because of vascular changes and accumulation of plaque on arterial walls, both of which reduce contractility. Vascular changes include thickening of vessel walls, narrowing of vessel lumen, and loss of vessel elasticity. Myocardial damage is not the reason for older adults commonly experiencing hypertension. Hypertension is not caused by a reduction in physical activity. Older adults with hypertension should be counseled on limiting fat and salt in their diet. However, ingestion of processed foods high in salt is not the reason why older clients often experience hypertension.

DIF: A REF: 199 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Adaptation/Alteration in Body Systems

3. In reviewing changes in the older adult, the nurse recognizes that which of the following statements related to cognitive functioning in the older client is true?

1.

Delirium is usually easily distinguished from irreversible dementia.

2.

Therapeutic drug intoxication is a common cause of senile dementia.

3.

Reversible systemic disorders are often implicated as a cause of delirium.

4.

Cognitive deterioration is an inevitable outcome of the human aging process.

ANS: 3

Delirium is a potentially reversible cognitive impairment that is often due to a physiological cause such as an electrolyte imbalance, cerebral anoxia, hypoglycemia, medications, tumors, cerebrovascular infection, or hemorrhage. Delirium is not always easily distinguishable from irreversible dementia. Because of the close resemblance between delirium and dementia, the presence of delirium must be ruled out whenever dementia is suspected. The cause of senile dementia (e.g., Alzheimers disease) is not known. Medications and drug effects can cause delirium. Dementia is not an inevitable outcome of aging.

DIF: A REF: 202 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

4. A client has been recently diagnosed with Alzheimers disease. When teaching the family about the prognosis, the nurse must explain that:

1.

Diet and exercise can slow the process considerably

2.

Few clients live more than 3 years after the diagnosis

3.

Many individuals can be cured if the diagnosis is made early

4.

It usually progresses gradually with a deterioration of function

ANS: 4

Alzheimers disease usually progresses gradually with a deterioration in function. Medications, not diet and exercise, can slow the process of Alzheimers disease considerably. Clients may live years after the diagnosis of Alzheimers disease. There is no cure for Alzheimers disease but medications can be given to slow the progression of symptoms.

DIF: A REF: 202 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Adaptation/Alteration in Body Systems

5. Which of the following statements accurately reflects data that the nurse should use in planning care to meet the needs of the older adult?

1.

50% of older adults have two chronic health problems.

2.

Cancer is the most common cause of death among older adults.

3.

Nutritional needs for both younger and older adults are essentially the same.

4.

Adults older than 65 comprise the greatest users of prescription medications.

ANS: 4

This is a true statement. Approximately two thirds of older adults use prescription and nonprescription drugs with one third of all prescriptions being written for older adults. Approximately 90% of adults older than 65 have at least one chronic health condition. Approximately 70% of older adults have multiple chronic conditions with arthritis, hypertension, heart disease, vision impairment, and diabetes mellitus being the most common in noninstitutionalized older adults. Heart disease is the leading cause of death in older adults. Nutritional needs of older adults are affected by their levels of activity and by clinical conditions.

DIF: A REF: 209 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

6. The nurse is aware that the majority of older adults:

1.

Live alone

2.

Live in institutional settings

3.

Are unable to care for themselves

4.

Are actively involved in their community

ANS: 4

The majority of adults are indeed active within their community. The majority of older adults live with a spouse or have other living arrangements such as living with a family member. Most older adults live in noninstitutional settings. Most older adults are able to care for themselves.

DIF: A REF: 193 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process

7. The nurse works with elderly clients in a wellness screening clinic on a weekly basis. Which of the following statements made by the nurse is the most therapeutic regarding their mobility?

1.

Your shoulder pain is normal for your age.

2.

Continue to exercise your joints regularly to your tolerance level.

3.

Why dont you begin walking 3 to 4 miles a day, and well evaluate how you feel next week.

4.

Dont worry about taking that combination of medications since your doctor has prescribed them.

ANS: 2

Clients in the older adult age group should be advised to exercise their joints regularly to their level of tolerance. Shoulder pain is not a normal finding in the older adult. It may indicate a condition such as arthritis. Exercise programs should begin conservatively and progress slowly. Periodic and thorough review of all medications being used is important to restrict the number of medications used to the fewest necessary. Concurrent use of medications increases the risk for adverse reactions.

DIF: A REF: 207-208 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

8. A long-term care facility sponsors a discussion group on the administration of medications. The participants have a number of questions concerning their medications. The nurse responds most appropriately by saying:

1.

Dont worry about the medications name if you can identify it by its color and shape.

2.

Unless you have severe side affects, dont worry about the minor changes in the way you feel.

3.

Feel free to ask your physician why you are receiving the medications that are prescribed for you.

4.

Remember that the hepatic system is primarily responsible for the pharmacotherapeutics of your medications.

ANS: 3

The nurse should encourage the older adult to question the physician and/or pharmacist about all prescribed drugs and over-the-counter drugs. The older adult should be taught the names of all drugs being taken, when and how to take them, and the desirable and undesirable effects of the drugs. The nurse should teach the client how to avoid adverse side effects and to report them to their care provider if they occur. If the client is disturbed by minor side effects, it could be an indication of beginning drug toxicity. Another possibility is that the client may become noncompliant with their medication because they dislike how the side effects make them feel. The hepatic system is not the only system responsible for the pharmacotherapeutics of medication. Older adults are at risk for adverse reactions because of age-related changes in the absorption, distribution, metabolism, and excretion of drugs. Changes in the GI system may affect absorption, distribution may be affected by changes in body composition and by reduced serum albumin levels, and changes in kidney functioning may impair excretion.

DIF: A REF: 209 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Pharmacological Therapies

9. Which of the following behaviors shows the greatest risk to an older adult as they attempt to minimize the effects of the aging process?

1.

Increased cosmetic use

2.

Refusing to share their actual ages

3.

Spending less time with age-related peers

4.

Refusing assistance with certain activities

ANS: 4

Some older adults may deny functional declines associated with aging and refuse to ask for assistance with tasks that place their safety at great risk. Some older adults find it difficult to accept themselves as aging and attempt to conceal physical evidence of aging with cosmetics. Older adults who find it difficult to accept themselves as aging may understate their age when asked. Spending more time with other older adults is indicative of the older adults acceptance of personal aging. Those who find it difficult to accept themselves as aging may avoid activities designed to benefit older adults, such as senior citizens centers and senior health promotion activities.

DIF: C REF: 195 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process

10. In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging?

1.

Increased perspiration

2.

Increased airway resistance

3.

Increased salivary secretions

4.

Increased pitch discrimination

ANS: 2

Normal physiological changes of aging include increased airway resistance in the older adult. The older adult would be expected to have decreased perspiration and drier skin as they experience glandular atrophy (oil, moisture, sweat glands) in the integumentary system. The older adult would be expected to have a decrease in saliva. A normal physiological change of the older adult related to hearing is a loss of acuity for high-frequency tones (presbycusis).

DIF: A REF: 199 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

11. There are factors that influence the musculoskeletal system associated with aging. The nurse recognizes that with age:

1.

Men have the greatest incidence of osteoporosis

2.

Muscle fibers increase in size and become tighter

3.

Weight-bearing exercise reduces the loss of bone mass

4.

Muscle strength does not diminish as much as muscle mass

ANS: 3

Older adults who exercise regularly do not lose as much bone and muscle mass or muscle tone as those who are inactive. Postmenopausal women have a greater problem with osteoporosis than older men. Muscle fibers are reduced in size with aging. Muscle strength diminishes in proportion to the decline in muscle mass.

DIF: A REF: 207-208 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

12. The nurse, preparing to discharge an 81-year-old client from the hospital, recognizes that the majority of older adults:

1.

Require institutional care

2.

Have no social or family support

3.

Are unable to afford any medical treatment

4.

Are capable of taking charge of their own lives

ANS: 4

The majority of older adults are interested in their health and are capable of taking charge of their lives. Most older adults do not require institutional care. The majority of older adults have social or family support. Most older adults live with a spouse or have other living arrangements, such as living with a family member. Most older adults receive Social Security benefits and are able to afford medical treatment.

DIF: A REF: 93 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process

13. To assist older adults to meet their needs for sexuality, the nurse should recognize that the greatest impact on the sexuality of older adults is:

1.

Therapeutic medications may alter sexual function

2.

Sexual interest declines and then fades completely with age

3.

Physiological changes do not adversely influence sexual activity

4.

Prevention of sexually transmitted diseases is no longer an issue

ANS: 1

Many older adults use prescription medications that depress sexual activity, such as antihypertensives, antidepressants, sedatives, or hypnotics. Some drugs increase libido in older adults. For example, phenothiazines increase sexual desire in women, and levodopa has a similar effect in men. It is a common misconception that older adults are not interested in sex. The older adults libido does not decrease, although frequency of sexual activity may decline. Physiological changes may have an adverse influence on sexual activity. The older man may experience decreased firmness in his erection, a decreased need for ejaculation with orgasm, or a longer recovery period between episodes of intercourse. The older woman may experience vaginal dryness. Information about the prevention of sexually transmitted diseases should be included when appropriate.

DIF: A REF: 203-204 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

14. The nurse is presenting an information session on nutritional guidelines at a senior living center. Incorporated into the discussion are the recommendations for nutritional intake for individuals of this age-group, which include a reduction in:

1.

Fiber

2.

Protein

3.

Vitamin A

4.

Refined sugars

ANS: 4

Good nutrition for older adults includes a limited intake of refined sugars. Fiber should not be reduced as it has benefits of aiding bowel elimination and lowering cholesterol. Protein should not be reduced. Protein intake may be lower than recommended if older adults have reduced financial resources or limited access to grocery stores. Difficulty chewing meat may also limit protein intake. Vitamin A does not need to be reduced in the older adult. Vitamin intake may be less than recommended if shopping for fresh fruits and vegetables is difficult.

DIF: A REF: 207 OBJ: Knowledge

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

15. The nurse is presenting an information session on nutritional guidelines at a senior living center. Which of the following foods meets the recommended nutritional guidelines for older adults?

1.

Grilled chicken

2.

Hamburger and french fries

3.

Hot dog with dill pickle relish

4.

Baked potato with cheese and bacon bits

ANS: 1

Grilled chicken would be a good source of protein that is also low in fat. A hamburger and french fries are high in fat content and calories, making them a less desirable food choice. A hot dog with pickle relish is high in fat and sodium. Good nutrition for the older adult includes a limited intake of fat and salt. A baked potato with cheese and bacon bits is higher in calories and fat. A plain baked potato would be a healthier food choice.

DIF: A REF: 207 OBJ: Knowledge

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

16. In the assessment of older-adult clients, it is often difficult to discriminate between delirium and dementia. Delirium is characterized by:

1.

A slow progression

2.

Lasting months to years

3.

A normal state of alertness

4.

Occurrences at twilight or darkness

ANS: 4

Delirium is characterized by short, diurnal fluctuations in symptoms and is worse at night, in darkness, and on awakening. Delirium has an abrupt onset. Dementia has a slow progression. Delirium lasts hours to less than 1 month, seldom longer. Dementia may last months to years. Delirium is characterized by fluctuating alertness; the client may be lethargic or hypervigilant. Alertness is generally normal with dementia.

DIF: A REF: 202 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

17. Which of the following nursing questions is best directed towards the assessment of a normal finding regarding physiological changes in an older-adult client?

1.

Any difficulty driving at night?

2.

Are you experiencing any loss of libido?

3.

Do you see yourself as becoming forgetful

4.

Have you had your cholesterol tested lately?

ANS: 1

A common physiological change in the older-adult client is an increased sensitivity to glare, which makes night driving difficult. Decreased sexual drive is not a normal physiological change of aging. Memory loss is not a normal physiological change of aging. Hyperlipidemia is not a normal physiological change of aging, nor should it be monitored only by the older adult.

DIF: C REF: 198 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health promotion and Maintenance/Aging Process; Physiological Integrity/System Specific Assessment

18. Which of the following responses by an older-adult client is most reflective of a need for further education by the nurse regarding the physiological changes associated with the older adult?

1.

I call a cab if I want to go out after dark.

2.

I cant help worrying about becoming forgetful.

3.

I have my eyes checked regularly. Cant afford to fall.

4.

I really enjoy eating good vanilla ice cream, but I have cut way down.

ANS: 2

Although some forgetfulness is accepted, memory loss is not a normal physiological change of aging. This expressed fear requires further education by the nurse so as to help eliminate the clients concerns. A common physiological change in the older-adult client is an increased sensitivity to glare, which makes night driving difficult. A common physiological change in the older-adult client is an alteration in visual acuity, which would require regular vision check-ups. Hyperlipidemia is a concern regarding cardiac health and should be considered by the older adult.

DIF: C REF: 201 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Health promotion and Maintenance/Aging Process; Physiological Integrity/System Specific Assessment

19. Which of the following statements made by a family member of a client recently diagnosed with Alzheimers disease is most reflective of an understanding of this disease process?

1.

Dad has always been a fighter; hell fight this too. He wont give up.

2.

We have an appointment with his care provider to see about medication therapy.

3.

Good thing we found out about this early so steps can be taken to keep it from getting worse.

4.

It usually progresses gradually so we are hoping it will be a while before his memory is gone.

ANS: 2

Medications can slow the process of Alzheimers disease considerably when prescribed appropriately. There is no cure for Alzheimers disease. This option suggests that the family member still clings to the hope that there is a cure. Alzheimers disease usually progresses gradually with a deterioration in function, but medications can be given to slow the progression of symptoms, not halt them. Although Alzheimers disease usually progresses gradually with a deterioration in function with some clients living years after the diagnosis of Alzheimers disease, this option does not reflect the best understanding because no mention of management is made.

DIF: C REF: 202 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Physiological Adaptation/Alteration in Body Systems; Psychosocial Integrity/Sensory Perception Alterations

20. The nurse is planning client education for an older adult being prepared for discharge home after hospitalization for a cardiac problem. Which nursing action addresses the most commonly determined need for this age-group?

1.

Suggest that he purchase an emergency in-home alert system.

2.

Arrange for the client to receive meals delivered to his home daily.

3.

Encourage the client to use a compartmentalized pill storage container for his daily medications.

4.

Provide a written document describing the medications the client is currently prescribed.

ANS: 3

Approximately two thirds of older adults use prescription and nonprescription drugs with one third of all prescriptions being written for older adults. A system that allows the client to sort his medication for daily dosage would help minimize the risk of overdosing as well as missing ordered medications. While this option addresses the risk of injury in the home, it does not address the greatest need experienced by this age-groupthe risk of overmedication or undermedication of prescribed drugs. While this option does address the clients nutritional needs, it does not address the greatest need experienced by this age-groupthe risk of over- or under-medication of prescribed drugs. Although this option does address the clients need to monitor the medications he is prescribed, it does not address the greatest need experienced by this age-groupthe risk of overmedication or undermedication of prescribed drugs on a daily basis.

DIF: C REF: 209 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Safe, Effective Care Environment/Safety Promotion/Safe Home Environment

21. An assisted living facility has provided its clients with an educational program on safe administration of prescribed medications. Which statement made by an older-adult client reflects the best understanding of safe self-administration of medications?

1.

I dont seem to have problems with side effects, but Ill let my doctor know if something happens.

2.

Im lucky since my daughter is really good about keeping up with my medications.

3.

Ill be sure to read the inserts and ask the pharmacist if I dont understand something.

4.

It shouldnt be too hard to keep it straight since I dont have any really serious health issues.

ANS: 3

This option reflects an understanding of the importance to understand the various aspects of the medication and its effects on the client. The older adult should be encouraged to question the physician and/or pharmacist about all prescribed drugs and over-the-counter drugs. Although this option reflects an understanding of potential risk for side effects, it is not the best option because it focuses on only one aspect of self-medication. This option appears to have the client delegating responsibility to the daughter. This option appears to have the client minimizing the importance of informed self-administration.

DIF: C REF: 209 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Pharmacological Therapies

22. Which of the following client statements regarding self-medication administration by an older-adult client requires follow-up teaching by the nurse?

1.

I take all the pills ordered once a day at bedtime, so Im less likely to forget them.

2.

I have one pill that needs cut in half. I am going to ask the pharmacist to do that for me.

3.

The pharmacist said to keep my pills away from the sunlight, so I put them inside the kitchen cabinet.

4.

My daughter comes over each morning and puts my pills into a container that sorts them by the time they are due.

ANS: 1

There may be a concern regarding drug interactions if all the medications are taken at the same time. The nurse should have a discussion with the client to determine if this practice is appropriate. This option shows the clients willingness to deal with this issue effectively and safely. This option shows an appropriate intervention for keeping the pills out of sunlight. This option shows an appropriate intervention for dealing with multiple medication schedules.

DIF: C REF: 209 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Safe and Effective Care Environment/Safety Promotion/Safe Home Environment

23. Which of the following statements made by an older-adult client poses the greatest concern for the nurse conducting an assessment regarding the clients adjustment to the aging process?

1.

I use to enjoy dancing and jogging so much, but now I have arthritis in my knees so that its hard to even walk.

2.

Ive given my grandchildren money for college so they can live a better life than I had.

3.

Growing old certainly presents all sorts of challenges. I wish I knew then what I know now.

4.

As I age Ive found its harder to do the things I love doing, but I guess it will all be over soon enough.

ANS: 4

This option should give the nurse concern over the clients possible depression because there are indications of possible suicide. This option does reflect regret over the inability to do the things previously enjoyed and the presence of a painful condition, but it does not present the seriousness of other available options. This option does reflect regret regarding life situations, but it does not present the seriousness of other available options. This option does reflect regret over the perceived changes, but it does not present the seriousness of other available options.

DIF: C REF: 209-210 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Psychosocial Integrity/Coping Mechanisms

24. Which of the following statements made by a 75-year-old client shows the best understanding of how the aging process affects the musculoskeletal system?

1.

I drink milk and eat cheese to get my calcium.

2.

I walk 1 mile everyday to strengthen my bones.

3.

I wear sensible shoes so I wont sprain an ankle.

4.

At my age I might never fully recover from a hip fracture.

ANS: 2

Older adults who exercise regularly do not lose as much bone and muscle mass or muscle tone as those who are inactive. Walking regularly shows that this client has an understanding of and the disciple to work on health promotion habits for a healthy musculoskeletal system. While this option shows an understanding regarding osteoporosis and the need for calcium, it is not the best option because it focuses on only one aspect of musculoskeletal health. This option focuses only on safety measures, and so it is not the best option. While this option shows an understanding regarding the seriousness of a hip fracture for someone of older age, it is not the best option because it focuses on only one aspect of musculoskeletal health.

DIF: C REF: 208 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: Process/Health Promotion Programs; Physiological Adaptation/Alteration in Body Systems

25. Which statement made by an older adult would reflect the best understanding of the nutritional requirements of individuals at this developmental stage?

1.

An apple a day is my motto; always has been.

2.

I eat everything, but just a little a bit of things like sweets.

3.

Fiber is more important than ever to my digestive system.

4.

I dont need the fat so Ive taken to drinking protein shakes.

ANS: 2

Good nutrition for older adults includes a balanced diet with limited intake of refined sugars. This is not the best option because it focuses on only one aspect of nutrition. This option is not the best choice because it focuses on only one aspect of nutrition. This is not the best option because it focuses on only one aspect of nutrition.

DIF: C REF: 207 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process/Health Promotion Programs

26. Which statement made by an older adult would reflect the best understanding of the nutritional guidelines for this age-group?

1.

I can prepare grilled chicken at least 10 different, delicious ways.

2.

When I entertain, I serve healthy foods like veggies and low-fat dip.

3.

I know I need to eat nutritiously, and I have certainly been doing better.

4.

I take seriously the suggestions my health team gives me on healthy eating.

ANS: 2

This option shows an understanding of healthy eating as well as a commitment to incorporating this knowledge into everyday living. While this is a good option, it is not as encompassing regarding knowledge and commitment as other options. This option leaves some doubt as to how committed the client really is to nutritional eating. While this is a good option, it is not as encompassing regarding knowledge and commitment as other options.

DIF: C REF: 207 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process/Health Promotion Programs

27. Which of the following statements made by an older adult regarding sexuality would be of greatest concern for the nurse?

1.

Will this new medication affect my libido?

2.

What can I do to help with vaginal dryness?

3.

I really miss the intimacy my husband and I shared.

4.

Its so nice not to have to worry about an unwanted pregnancy.

ANS: 4

This option infers that the client is sexually active and not using protection because there is no longer a possibility of conception. Information about the prevention of sexually transmitted diseases should be included when appropriate because there is a growing number of older adults contracting STDs. Many older adults use prescription medications that depress sexual activity, such as antihypertensives, antidepressants, sedatives, or hypnotics. This question requires further education but the statement does not arouse concern regarding the clients safe sex practices. Physiological changes may have an adverse influence on sexual activity. The older woman may experience vaginal dryness. This question requires further education, but the statement does not arouse concern regarding the clients safe sex practices. It is a common misconception that older adults are not interested in sex. This statement would require further discussion to assess the degree of distress the situation is causing the client, but the statement does not arouse concern regarding the clients safe sex practices.

DIF: C REF: 203-204 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

28. Of the following options, which is the greatest barrier to providing quality health care to the older-adult client?

1.

Poor client compliance resulting from generalized diminished capacity

2.

Inadequate health insurance coverage for the group as a whole

3.

Insufficient research to provide a basis for effective geriatric health care

4.

Preconceived assumptions regarding the lifestyles and attitudes of this group

ANS: 4

Despite ongoing research in the field of gerontology, myths and stereotypes about older adults persist. These include false ideas about the physical and psychosocial characteristics and lifestyles of older adults. However, when health care providers hold negative stereotypes about aging, those stereotypes negatively affect the quality of the care. While there may be poor compliance related to diminished physical and cognitive capacity, it is not the primary barrier to effective care of this developmental group. While there are numbers of the older-adult population who are underinsured, it is not the primary barrier to effective care of this developmental group. A lack of research regarding the unique needs of this age-group is not the primary barrier to providing effective care.

DIF: C REF: 93 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

29. The nurse is preparing an educational program for members of the local senior center. Which of the following topics would present the greatest learning challenge for this developmental group?

1.

Exercising arthritic joints

2.

Tips for living with GERD

3.

Importance of the human touch

4.

Principles of heart-healthy eating

ANS: 3

Of the available topics, Importance of the human touch is possibly the most abstract in nature. Older adults are lifelong learners, but concrete rather than abstract material appears to be a better choice for the learning style of most older adults. This option is concrete in nature and so a better choice for the learning style of most older adults. This option is concrete in nature and so a better choice for the learning style of most older adults. This option is concrete in nature and so a better choice for the learning style of most older adults.

DIF: C REF: 210 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process/Health Promotion Programs

30. When presenting information to the older adult, the client will be most likely to engage with the nurse in the learning process if:

1.

Client feedback is encouraged and valued

2.

Physical disabilities are accommodated for

3.

The topic or information is valued by the learner

4.

New knowledge is connected to knowledge already processed

ANS: 3

The older adult learner will be more interested and willing to participate actively in the learning if they have been given the opportunity to determine the values of the information to them personally.

DIF: C REF: 193 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process;

31. Of the following client statements made by an older adult client which best reflects an understanding the educational materials on nutrition presented by the nurse?

1.

Ill keep this literature and read it again later.

2.

I love rye bread. Its good to know its high in fiber.

3.

Nutrition and cooking has always been passions of mine.

4.

Now I can see the connection between food and my health.

ANS: 2

The correct option shows the client making a connection between a type of food, its nutritional value, and its impact on personal health

DIF: C REF: 193 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

32. The nurse defines ageism most accurately as:

1.

The undervaluing of individuals based on their age.

2.

Perception of a persons worth based on productivity

3.

Biases directed towards individuals considered aged

4.

Discrimination based on an individuals increasing age

ANS: 4

The correct option best describes ageism since it identifies discrimination towards a person based solely on the persons age. Devaluing is one aspect of ageism but this option failed to identify discrimination as the goal. While perception of a persons worth is a criteria used to judge, it is not the most complete description of the term. Bias and discrimination are the outcomes of ageism.

DIF: C REF: 207 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process

33. Which of the following statements made by a nurse best reflects an understanding of the negative impact of ageism regarding client care?

1.

If I dont value the older client, I will never be able to provide the care they are entitled too.

2.

Everyone, regardless of age or position, always deserves effective, appropriate nursing care.

3.

As a society we lose so much valuable wisdom and knowledge when we devalue our older members.

4.

If older clients do not feel valued, they are less likely to seek the health care they need and deserve.

ANS: 1

According to experts in the field of gerontology, unopposed ageism has the potential to undermine the self-confidence of older adults, limit their access to care, and distort caregivers understanding of the uniqueness of each older adult. Health care providers must be free of such an unethical attitude so that client care will never be compromised. This is a truism that is not specific to ageism

DIF: C REF: 193 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process

34. Which of the following statements made by a nurse best reflects an understanding of the adaptation required of nursing to assure quality nursing care for the older adult client?

1.

Remember to ask the client when she prefers to have her bath.

2.

I hope that I am that alert and interested in life when Im her age.

3.

My client is in her 90s, so I dont expect her to respond to the therapy like a 50- year-old does.

4.

I just finished reading a great article on caring for the client newly diagnosed with Alzheimers disease.

ANS: 3

Given the increasing number of older adults in health care settings, cultivation of positive attitudes toward older adults and specialized knowledge about aging and the health care needs of older adults are priorities for nurses. This statement reflects that the nurse understands that older clients may respond differently than younger adults to certain therapies

DIF: C REF: 193 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process

35. Which of the following statements made by an older adult client best reflects a healthy adjustment to the aging process and its physical limitations?

1.

I use to run in marathons, but now I truly enjoy a 1 mile walk around the park.

2.

I see friends my age just rocking on the porch. Not me; I want to stay physically active.

3.

When I cant get around like I do now, Ill watch TV and catch up on my favorite programs.

4.

Ill miss working in my garden when the arthritis gets bad, but Ill find something else to keep me busy.

ANS: 1

Acceptance of personal aging does not mean retreat into inactivity, but it does require a realistic review of strengths and limitations. This option shows a healthy adaptation to physical limitations by continuing to engage in the favorite activity but at a more realistic level.

DIF: C REF: 194 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

36. Which of the following statements, made by the daughter of an older adult client concerning bring her mother home to live with her family, presents the greatest concern for the nurse?

1.

If this doesnt work out, she can always go to live with my sister.

2.

I dont think she will react very well to me making decisions for her.

3.

Im afraid that mom will be depressed and really miss her home terribly.

4.

My children will just have to adjust to having their grandmother with us.

ANS: 2

The redefining of relationships with children occurs as older adults experience the challenges of aging. A variety of issues sometimes occur, including, but not limited to, role reversal, control of decision making, dependence, conflict, guilt, and loss. This option reflects the daughters expectation of becoming her mothers decision maker and this may be problematic to the relationship and the living arrangements.

DIF: C REF: 194 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process; Physiological Adaptation/Alteration in Body Systems

37. A nurse is caring for an older adult client preparing for discharge to a nursing center after having hip surgery. Which of the following nursing responses is most therapeutic when dealing with the clients concern that she, will never go back home?

1.

What makes you think that this transfer to the nursing center will be permanent?

2.

The reason for this transfer is only to support you while you continue to recuperate.

3.

The decision to stay in the nursing center is yours to make. When you want to leave no one will stop you.

4.

The nursing center is a lovely place with a wonderful staff of caring people. Just give it a chance. You may like it.

ANS: 1

Although the decision to enter a nursing center is never final and a nursing center resident is sometimes discharged to home or another less-acute-care facility, many older adults view the nursing home as their final residence. This option is an open-ended question that encourages the client to express his or her concerns and fears.

DIF: C REF: 195 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process

38. A nurse caring for older adults in an assistive living facility recognizes that a clients quality of life needs are best determined by:

1.

Excellent physical, social, and emotional nursing assessments

2.

A working knowledge of this age-groups developmental needs

3.

A therapeutic nurse-client relationship that facilitates communication

4.

The clients ever-changing physical, emotional, and cognitive abilities

ANS: 3

What defines quality of life varies from person to person. Nurses must listen to what the older adult considers to be most important rather than making assumptions about that individuals priorities.

DIF: C REF: 205 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process

39. A nurse is preparing to perform an assessment on an older adult client newly admitted to a nursing center. Which of the following statements made by the nurse best reflects the unique needs of this client regarding the assessment process?

1.

I will be back after you are settled in and we can devote enough time to this assessment process.

2.

We will need to move you to the examination room so that you will be comfortable during the assessment.

3.

I have to perform an assessment as part of the admission process, is this a good time for you to help me with it?

4.

Since this move has been both physical and emotionally stressful, I will make this assessment as concise and brief as possible.

ANS: 1

Obtaining a comprehensive assessment of an older adult takes more time than the assessment of a younger adult because of the longer life and medical history and the potential complexity of that history. Plan to spend extra time with the assessment.

DIF: C REF: 197 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process

MULTIPLE RESPONSE

1. The nurse is preparing to present an educational program to residences of an assisted-living facility. Which teaching strategies would be most appropriate for the learning needs of this age-group? (Select all that apply.)

1.

Speak in a slow but well-articulated manner.

2.

Present a variety of ideas so as to have broad appeal.

3.

Speak in soft, low voice so as to help the audience focus.

4.

Small groups allow for more speaker-listener interaction.

5.

End the program if there are signs of poor concentration or fatigue.

6.

Present the material in a fast-paced manner to keep hold their attention.

ANS: 1, 4, 5

The correct options address the older adults learning needs involving their hearing, vision, and stamina issues. It is preferable to limit the presentation to one topic or idea to allow the older adult learner time to absorb and digest the information. The older adult usually hears high tones better than low ones. The presentation of material should be tailored to accommodate the older adults need for time to absorb and digest the information.

DIF: C REF: 196 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Health Promotion and Maintenance/Aging Process/Principles of Teaching and Learning.

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

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