Chapter 16: Problems of Late Adulthood Nursing School Test Banks

Chapter 16: Problems of Late Adulthood
Test Bank

MULTIPLE CHOICE

1. _____% of older adults are living at the poverty level.
a. Twelve
b. Eighteen
c. Twenty six
d. Twenty three
ANS: A
This is similar to the economic status of other ages.

DIF: Cognitive Level: Knowledge REF: p. 179 OBJ: 1
TOP: Facts and Myths of Aging KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance

2. A 55-year-old man is extremely fearful of the effects of growing old. He is experiencing:
a. Ageism
b. Gerontophobia
c. An age phobia
d. Elder phobia
ANS: B
This term also includes refusal to accept the elderly into the mainstream of society. Ageism is stereotyping the elderly as weak, dependent, and nonproductive. Age phobia and elder phobia are not used terms.

DIF: Cognitive Level: Knowledge REF: p. 179 OBJ: 1
TOP: Facts and Myths of Aging KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance

3. Physical signs of aging usually begin in the late 30s. Physical signs of aging begin to slow after one reaches the age of approximately:
a. 35
b. 45
c. 65
d. 85
ANS: D
Signs of aging continue to show themselves until around 85 years. Physical aging is affected by genetics, health care, lifestyle, and attitude.

DIF: Cognitive Level: Knowledge REF: p. 179 OBJ: N/A
TOP: Physical Health Changes KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance

4. An elderly man has serious vision problems and is no longer allowed to obtain a drivers license. He has been very independent until this time. Which nursing diagnosis is most appropriate for this situation?
a. Confusion, chronic
b. Coping, ineffective
c. Self-esteem, risk for situational low
d. Grieving, dysfunctional
ANS: C
Self-esteem, risk for situational low is most appropriate because of his previous independence. The other options are also nursing diagnoses, but the situation does not lend itself to these diagnoses.

DIF: Cognitive Level: Application REF: p. 182 OBJ: 2
TOP: Physical Adaptations KEY: Nursing Process Step: Nursing Diagnosis
MSC: Client Needs: Health Promotion and Maintenance

5. The home health nurse is caring for a 79-year-old man with the diagnosis of hypertension who is on a fixed income. He was discharged from the hospital a few weeks ago with his newly prescribed medication to keep his BP under control. His BP measurements have been gradually increasing over the last few visits, with no other changes in status assessed. Which nurse statement would be most appropriate?
a. Have you been taking your medication as often as you are supposed to?
b. I dont understand why your BP is up.
c. Maybe I should check your BP at another time.
d. I hope you are taking your medication. Otherwise, I am wasting my time.
ANS: A
Clients on fixed incomes often take less of their medications so they will last longer. None of the other options meets the need of the situation, and saying that the client is wasting the nurses time is an inappropriate statement.

DIF: Cognitive Level: Application REF: p. 183 OBJ: 3
TOP: Psychosocial Adaptations KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity

6. A 2006 survey indicates a ____% increase in elder abuse.
a. 5
b. 10
c. 19
d. 27
ANS: C
The reported 19% increase represents only documented cases; rates are most likely higher.

DIF: Cognitive Level: Knowledge REF: p. 185 OBJ: 5
TOP: Elder Abuse KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance

7. Which intervention will be most effective when one is teaching a client about his or her medications and their administration?
a. Pointing out the colors of the medications for easier identification
b. Referring to medications by name and providing written instructions
c. Quizzing the client on each medications purpose, side effects, and drug interactions
d. Encouraging the client to hold all questions until the end of the discussion so the nurse will not have to repeat information
ANS: B
Referring to the medications by name and providing written instructions will lead to less confusion. Pointing out colors can be a problem if there is visual impairment; quizzing the client is not necessary; and encouraging the client to hold questions may cause questions to be forgotten.

DIF: Cognitive Level: Application REF: p. 187 OBJ: 8
TOP: Age-Related Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity

8. The nurse is caring for a 79-year-old client with dementia. The client worked as an obstetrics nurse before retiring. Despite her dementia, she still remembers terms and procedures and basic nursing care interventions from her past career. This is an example of:
a. Working memory
b. Reasoning
c. Information processing
d. Crystallized intelligence
ANS: D
Crystallized intelligence is specialized accumulated knowledge, and it is common for individuals to remember this specialized information, even if they experience dementia. Working memory is the random access memory to which one refers. Reasoning is the ability to solve problems and make choices, and information processing is the ability to relate to, store, and retrieve information.

DIF: Cognitive Level: Comprehension REF: p. 181 OBJ: 2
TOP: Mental Health Changes KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

9. An elderly client states that she paid $10,000 to a nice repairman for fixing her broken window and fence. This is an example of elder abuse known as:
a. Violation of rights
b. Exploitation
c. Psychological abuse
d. Neglect
ANS: B
It is estimated that approximately 10% of the elderly population are victims of this type of abuse.

DIF: Cognitive Level: Comprehension REF: p. 185 OBJ: 5
TOP: Elder Abuse KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

10. The nurse must be aware of physical signs and symptoms of depression because these are often the first, sometimes overlooked, signs of the disorder. Physical signs and symptoms of depression include:
a. Decreased or slowed memory
b. Fatigue
c. Changes in appetite
d. Abdominal pain
ANS: D
Abdominal pain, muscle aches, and dry mouth are common physical symptoms of depression in the older adult. Other physical causes of these symptoms must be ruled out, and further assessment of other signs of depression must be noted. Decreased or slowed memory is cognitive; fatigue is emotional; change in appetite is behavioral.

DIF: Cognitive Level: Comprehension REF: p. 186 OBJ: 6
TOP: Depression KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

11. The nurse is implementing validation therapy with an elderly male client to assist him in resolving old conflicts and making peace with himself. Which is one of the techniques used?
a. Sympathy
b. Empathy
c. Helping the client write a paragraph about his life
d. Contacting old acquaintances for their interpretation of the clients life
ANS: B
Empathy and several other interventions constitute validation therapy. The other options are not used in validation therapy.

DIF: Cognitive Level: Knowledge REF: p. 186 OBJ: 9
TOP: Depression KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

12. It is important for the nurse to be aware that ____% of individuals over 45 years old take prescription, over-the-counter, or a combination of these medications.
a. 35
b. 55
c. 75
d. 95
ANS: C
Seventy-five percent of individuals over 45 years old take prescription, over-the-counter, or a combination of medications. This is important to know when one is planning interventions.

DIF: Cognitive Level: Knowledge REF: p. 184 OBJ: 4
TOP: Substance Abuse KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

13. One of the ways that nursing care of the elderly is ensured is by the enactment and monitoring of:
a. DSM-IV-TR standards
b. State boards of health
c. Standards of geriatric nursing practice
d. State nurse practice acts
ANS: C
Standards of geriatric nursing practice were developed to specifically address the needs of the elderly population.

DIF: Cognitive Level: Knowledge REF: p. 187 OBJ: 7
TOP: Standards of Geriatric Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Safe and Effective Care Environment

14. What percentage of the population has reached 65 years of age?
a. 13%
b. 21%
c. 30%
d. 42%
ANS: A
As of the year 2009, 13% of the people in the United States reached age 65. This figure is estimated to double in 30 years.

DIF: Cognitive Level: Knowledge REF: p. 178 OBJ: 1
TOP: Overview of Aging KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance

15. The visiting nurse is at the home of an 88-year-old woman whose physician is concerned that she is losing weight. While performing an assessment, the nurse discovers that the clients dentures are ill-fitting and this makes eating painful. The client claimed she informed her daughter of this, but the daughter is too busy to take her to the dentist. The nurse is concerned that this is a possible sign of:
a. Abuse
b. Neglect
c. Domestic violence
d. Depression
ANS: B
Neglect is defined as failing to meet basic physical needs. Abuse and domestic violence are evidence of actual physical harm. This situation does not describe depression.

DIF: Cognitive Level: Comprehension REF: p. 185 OBJ: 5
TOP: Elder Abuse KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance

16. The nurse is completing an admission interview with an older adult on a busy medical unit. What action is most appropriate for the nurse to take?
a. Complete the admission interview with the clients son.
b. Shout at the client so he or she can hear.
c. Provide pen and paper and let the client write his answers.
d. Allow the client time to respond to the questions regarding health history.
ANS: D
Information processing speed decreases with age, and it may take longer for the client to retrieve the information and respond.

DIF: Cognitive Level: Application REF: p. 181 OBJ: 2
TOP: Mental Changes of Aging KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance

17. A 70-year-old woman who was recently widowed expresses a desire to go back to school and finish the degree she started before her children were born. What response is most appropriate?
a. Why would you want to stress yourself at your age?
b. That may not be possible. As you age, your ability to learn decreases.
c. Going back to school will keep you engaged and active.
d. Lets do a cognitive function test to see if you are eligible.
ANS: C
It is important for older adults to stay active and engaged. Encouraging the woman in her pursuit is an appropriate response. The other options may all discourage the client from remaining engaged in society.

DIF: Cognitive Level: Application REF: p. 181 OBJ: 2
TOP: Mental Changes of Aging KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance

18. A 78-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She appears to be confused and combative at times. Her daughter is concerned because her mother was alert and oriented prior to being diagnosed with pneumonia. Her altered mental status is related to:
a. The onset of Alzheimers disease
b. Alteration in oxygenation
c. Result of family neglect
d. Dysfunctional coping
ANS: B
Physical problems can lead to changes in mental status. Early assessment and intervention are key for keeping older adults minor problems from becoming major ones. An alteration of the patients oxygenation can affect a clients behavior.

DIF: Cognitive Level: Analysis REF: p. 182 OBJ: 2
TOP: Physical Adaptations KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

19. Which conditions most commonly place older adults at risk for overdose from medications and severe reactions? (Select all that apply.)
a. Depression
b. Higher rate of metabolism
c. Interaction with other medications
d. Problems with sight and memory
ANS: C, D
Older adults often are taking numerous medications prescribed by several specialists, and sight and memory can cause errors in taking medications. Depression is not a common cause of overdose, and metabolism is usually slower in this age group.

DIF: Cognitive Level: Comprehension REF: p. 184 OBJ: 4
TOP: Substance Abuse KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

20. Which emotional signs and symptoms of depression in the elderly must the nurse be aware of and monitor for? (Select all that apply.)
a. Increased anxiety or dependence
b. Fatigue
c. Feels he or she has no purpose
d. Withdraws from people
ANS: A, B, C
Increased anxiety or dependence, fatigue, and feelings of purposelessness are emotional signs and symptoms of depression. Withdrawal from people is a behavioral sign of depression.

DIF: Cognitive Level: Application REF: p. 186 OBJ: 6
TOP: Depression KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

21. To respectfully and effectively provide health teaching to the older adult, which of the following actions should be employed? (Select all that apply.)
a. Speak very loudly and in high-pitched tones.
b. Ask clients to repeat your message.
c. Break complex tasks into small, pertinent steps.
d. Refer to medications by color.
ANS: B, C
When teaching an older adult, it is important to have them repeat your message back to you to ensure that they understand. It is also helpful to break complex tasks into smaller manageable steps to help the client remember. Speaking loudly and in high-pitched tones will not assist the client in learning. A nurse should refer to medications by name rather than color.

DIF: Cognitive Level: Application REF: p. 187 OBJ: 8
TOP: Age-Related Interventions KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

COMPLETION

22. __________ refers to a state of wholeness or quality of ones character.

ANS:
Integrity
Elders who have developed a good sense of personal integrity deal with aging better than those who have not.

DIF: Cognitive Level: Knowledge REF: p. 180 OBJ: 2
TOP: Mental Health Changes KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

23. Although __________ is often a desire of older adults, it can bring loss of income and loss of opportunities for socialization.

ANS:
retirement
Retirement is a major life-changing event.

DIF: Cognitive Level: Knowledge REF: p. 180 OBJ: 2
TOP: Common Problems of Older Adults
KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

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