Andersons Caring for Older Adults Holistically 6th Edition by Tamara R. Dahlkemper  – Test Bank



Sample  Questions



Chapter 1: Holistic Caring


Multiple Choice

Identify the choice that best completes the statement or answers the question.


____    1.   According to the 2010 U.S. Census, approximately how many Americans are older than age 65?

1) 2%
2) 5%
3) 13%
4) 20%



____    2.   What is the average life expectancy today?

1) 70.2 years
2) 75 years
3) 81.1 years for women and 76.3 years for men
4) Longer for men than for women



____    3.   Which statement is NOT true about holistic nursing?

1) Holistic nursing focuses on the specific disease or disorder a person has in order to treat it effectively.
2) Holistic nursing aims to treat the whole person, not just a specific disease or disorder the person may have.
3) Holistic nursing focuses on the individual patient and uses many techniques, such as empathetic listening, music, and imagery, as well as specific clinical skills.
4) Holistic nursing weaves the technical skills of nursing with the social science skills that enhance communication and rapport between the nurse and the person receiving care.



____    4.   The Science of Human Caring theory was developed by

1) Florence Nightingale
2) Clara Barton
3) Jean Watson
4) Savage and Money



____    5.   Which is NOT emphasized in The Science of Human Caring?

1) Providing transpersonal caring
2) Focusing on the person while you are with him or her
3) Ensuring that all nonessential tasks, such as bathing, are given according to a strict schedule
4) Reaching out to the patient, making eye contact, touching if appropriate, speaking softly



____    6.   Which of the following is included as a basic concept of holistic nursing?

1) Using your developed clinical expertise
2) Developing a close relationship with the patient’s family members and significant others
3) Remembering the personal intuition and creativity of patients in your nursing plan
4) All of the above



____    7.   Most elderly people having a heart attack have

1) Pain diffused over the entire chest area
2) No pain
3) Crushing sternal pain
4) Pain on the left side of the chest and pain that radiates down the left arm



____    8.   Compared with the doses of medication given to a young adult, the doses given to an old-old person are usually

1) Smaller
2) Larger, because the old-old person is probably sicker
3) The same
4) Minimal, because the person is very old and probably near death



____    9.   What communication technique has been developed specifically for dealing with demented elderly persons?

1) Cognitive therapy
2) Validation therapy
3) Geriatric Depression Scale
4) Mini-Mental Status Examination (MMSE)



____  10.   An 82-year-old patient is diagnosed with liver cancer and has long-standing cardiovascular problems. The patient begins screaming and pushes his meal tray away. What would be an appropriate response?

1) Take the meal tray and leave the room without saying anything.
2) Tell him to stop screaming in a loud voice.
3) Calmly ask him what he is upset about and listen carefully to him.
4) Call your supervisor.



____  11.   The nurse is overhead addressing an 87-year-old patient as “honey.” What is this an example of?

1) Beneficence
2) Paternalism
3) Caring
4) Malfeasance



____  12.   The term “elite-old” is used for people

1) 65 to 74 years old
2) 75 to 84 years old
3) 85 to 100 years old
4) Older than 100 years



____  13.   Which is a key concept in holistic nursing?

1) Following physician instructions and follow-up with the physician
2) Developing a relationship with family members of the patient
3) Using what you have learned—your clinical experience
4) All of the above



____  14.   How should the nursing instructor explain the term “gerontology” to a new class of students?

1) It means the use of older medications to treat illnesses.
2) It comes from a Greek word that means “related to old age.”
3) It focuses on the housing needs of people who are underserved.
4) It is a way of explaining health problems of people over age 50.



____  15.   Which term should the nurse use when explaining medical care that an older patient requires?

1) Genetics
2) Geriatrics
3) Gerontology
4) Gentrification



____  16.   During lunch a nursing colleague states that she never wants to be assigned to care for an older patient. What behavior is this nurse demonstrating?

1) Ageism
2) Stereotyping
3) Ethnocentricity
4) Personal preference



____  17.   How should a nursing instructor explain the term “baby boomers” to new students?

1) People who have large families
2) People who advocate for the care of infants
3) People who have decided not to have large families
4) People born between 1946 and 1965 after World War II



____  18.   What explains the decline in the elderly black population since 1980?

1) Diabetes
2) Homicides
3) Hypertension
4) Heart disease



____  19.   Why are older people more likely to participate in exercise programs?

1) They have more time to exercise.
2) They are trying to avoid boredom.
3) They initiated the fitness movement.
4) They want to spend time with their grandchildren.



____  20.   What information would be helpful when explaining Social Security to a group of new nursing students?

1) It is a federal and state supported process that provides health care to financially disadvantaged people.
2) It is federal regulation providing health care for individuals older than age 65 or individuals who are permanently disabled.
3) It is a federal benefit check paid to persons older than age 65 or persons with disabilities who  are unable to work.
4) It is a federal benefit check paid to retired workers of a specific age, disabled workers of any age, and spouses and minor children of deceased workers.



____  21.   What should be used to describe a nursing philosophy to a new nursing student?

1) It is a personal concept.
2) It defines goals and aspirations.
3) It outlines steps to a successful career.
4) It recognizes the importance of education.



____  22.   Which behavior demonstrates that a nurse is developing a healing relationship with a patient?

1) Answering a call light using the intercom system
2) Telling a patient that there is no time to try something new
3) Sitting down in the patient’s room to discuss the plan of care
4) Reminding a patient that other patients are waiting for the nurse



____  23.   Which skill is essential to promote holistic nursing?

1) Critical thinking
2) Active listening
3) Time management
4) Care coordination



____  24.   Who should the nurse identify as being members of the holistic health-care team for an older patient?

1) The nurse, doctor, and pharmacist
2) The nurse, dietician, and discharge planner
3) Those who will help meet the patient’s needs
4) The social worker, physical therapist, and nurse



____  25.   Which action demonstrates a safe environment?

1) Telephoning a patient prior to arriving for a home visit
2) Mounting grab bars near the commode and in the shower
3) Ensuring that a patient receives a requested daily newspaper
4) Making sure that the television in the room has adequate volume



____  26.   What action should a nurse take who desires to become a more caring nurse?

1) Become a caring person.
2) Ensure adequate daily rest.
3) Set aside time for personal activities.
4) Consume nutritious meals and exercise.



____  27.   An older patient with heart failure refuses any diagnostic tests and does not want to take any medication because of having limited health insurance. Which action should the nurse take that demonstrates caring?

1) Recommend that the patient be discharged home as soon as possible.
2) Ask family members if they are willing to help pay for the patient’s care.
3) Contact a social worker to talk with the patient about health insurance coverage.
4) Find out if the patient has any resources that can be liquidated to pay for the care.



____  28.   During a home visit, an older patient is planning to have dinner with a close friend and then see a movie. What does this behavior indicate to the nurse?

1) Industry
2) Self-absorption
3) Identity diffusion
4) Gerotranscendence



Multiple Response

Identify one or more choices that best complete the statement or answer the question.


____  29.   The home health nurse is completing an admission assessment of an older patient. Which health problems should the nurse identify as being leading chronic diseases of older adults? Select all that apply.

1) Cancer
2) Diabetes
3) Heart disease
4) Hypertension
5) Multiple sclerosis



____  30.   What should be identified as reasons for the increased number of older adults in today’s society? Select all that apply.

1) Better nutrition
2) Earlier retirement
3) Increased exercise
4) Improved health care
5) Consistent sanitation



____  31.   What should the instructor emphasize as being essential elements of a nursing philosophy with beginning students? Select all that apply.

1) Simple
2) Popular
3) Specific
4) Meaningful
5) Inexpensive

Chapter 3: Supporting Life Transitions and Spirituality in the Elderly


Multiple Choice

Identify the choice that best completes the statement or answers the question.


____    1.   Which statement is LEAST true about life transitions?

1) A person usually experiences only one transition in a lifetime.
2) Sometimes there is more than one transition occurring at the same time in a person’s life.
3) Challenging experiences that accompany aging may require life transitions.
4) Each loss or change requires transitional effort from the person experiencing it.



____    2.   A 76-year-old patient recovering from hip replacement surgery is upset and does not feel at peace because of her inability to attend church as a result of the injury. What is the best response by the nurse?

1) Encourage her to read a book, magazine, or newspaper.
2) Suggest that she watch television to keep her mind distracted.
3) Offer to call the hospital’s chaplain or clergyman to come pray with her.
4) Tell her to sleep so that her body can heal and return to a state of peacefulness.



____    3.   Which would NOT be considered a transitional event?

1) Marriage
2) Losing a job
3) Moving to a new home
4) Visiting an amusement park



____    4.   Which is NOT an identified feature of a transition?

1) A stage of denial
2) A phase of turmoil
3) An altered time perspective
4) A disturbance in body function



____    5.   The nurse respects an older patient’s decision and right to refuse treatment and returns at a later time to offer previously refused medication. Which factor influencing transitional outcomes applies to this patient’s situation?

1) Degree of choice
2) Perception of change
3) Preparation for the change
4) Extent or degree of change



____    6.   Which action would LEAST likely support the degree of change that an older person has to make when preparing to move?

1) Selecting a home that meets the physical needs of the person
2) Ensuring the new home is located near a senior citizen’s center
3) Choosing a smaller apartment so the person has fewer items to move
4) Finding a home with a grocery store within walking distance



____    7.   Which approach is LEAST appropriate when helping patients prepare for transitions?

1) Avoid discussing difficult topics with patients.
2) Repeat all necessary information about the transition.
3) Involve family members when discussing future transitions.
4) Talk to patients and residents about changes to be anticipated.



____    8.   Which characteristics should be considered when a person is transitioning?

1) Gender
2) Vital signs
3) Past experiences
4) Height and weight



____    9.   What aspects of the environment in a hospital room would most likely allow for smooth transitioning?

1) Warm and dark
2) Clean and colorful
3) Restrictive and demanding
4) Cheerful and relaxing



____  10.   Which is NOT a common transition for an older adult?

1) Marriage
2) Health changes
3) Family role changes
4) Job changes and retirement



____  11.   A 68-year-old patient has just been admitted to the oncology unit with a new diagnosis of lung cancer. This is the patient’s first hospital admission and she knows very little about the diagnosis. Which action should the nurse take to make this patient’s transition easier?

1) Administer an antianxiety agent to keep her calm.
2) Leave a printout about lung cancer at her bedside.
3) Talk with her about her fears, questions, or concerns.
4) Tell her a physician will be in to explain what is going on.



____  12.   Spirituality is defined as

1) The service and worship of God or the supernatural
2) The organized practice of one’s belief in a higher power
3) Formal worship involving prescribed actions or practices
4) A feeling from within that communicates a higher power at work



____  13.   Which is the LEAST likely way to assess a patient’s spiritual needs?

1) Looking for any religious books in the patient’s room
2) Identifying the patient’s religious preference from the chart
3) Asking the patient’s neighbor if he or she has heard the patient praying
4) Looking for identifying jewelry or artifacts in the patient’s personal belongings



____  14.   A 73-year-old patient recovering from coronary artery bypass surgery is depressed and is continuously asking, “Why is God doing this to me?” The best response by the nurse is to

1) Ask the patient if he has any specific spiritual needs to be addressed.
2) Call for a psychiatric consultation to screen the patient for depression.
3) Reassure the patient that he did nothing wrong and everything is okay.
4) Tell the patient that sadness usually occurs after undergoing heart surgery.



____  15.   A patient asks the nurse to pray with her, however, the nurse does not usually pray. Which approach would be the LEAST supportive of the patient’s needs?

1) Hold the patient’s hands while she prays.
2) Sit near the patient and be reverent during the prayer.
3) Tell the patient to find someone else who will pray with her.
4) Find a coworker who would be willing to pray with the patient.



____  16.   Achieving gerotranscendence allows for an older person to

1) Live life without regret and die well.
2) Withdraw and disengage from life’s many hardships.
3) Become more involved with the self rather than others.
4) Reach a state of wealth and superfluous social interaction.



____  17.   Which is the LEAST likely reason to perform a life review?

1) To reflect on all the great accomplishments of one’s life
2) To identify strengths that can assist with current transitions
3) To assist older people to review their lives and appreciate them
4) To help older people prepare for life insurance and funeral expenses



____  18.   One of the purposes of a creating a life story is to

1) Ensure the patient’s memory is intact.
2) Publish it as a book and sell it for profit.
3) Keep the patient busy for long periods of time.
4) Share the life story with children and grandchildren.



____  19.   When working with older people it is important for the nurse to employ holistic nursing care by embracing the body, mind, and spirit of the patient. Which action does NOT represent embracing the body, mind, or spirit?

1) Meeting spiritual needs
2) Following the medical plan of care
3) Addressing transitional stress needs
4) Delivering a mechanistic form of care



____  20.   What role does spirituality have with transitions?

1) Estimates the number of transitions to expect in the future
2) Summarizes approaches to speed up the transition process
3) Helps explain how long the transition will take to complete
4) Provides a method to understand the losses being experienced



____  21.   Which phrase best describes a transitional moment?

1) Stress provoked by the change
2) Letting go of previous practices
3) Realizing that a change has to occur
4) Accepting new ways of doing things



____  22.   A nursing instructor has spinal fusion surgery and learns afterward that performing cardiopulmonary resuscitation and walking for long periods of time will be contraindicated in the future after recovery. What is the transitional moment for this instructor?

1) Having surgery
2) Recovering from surgery
3) Teaching nursing students
4) Learning that certain activities are not permitted to be performed



____  23.   What is interconnected with a transition?

1) Cost
2) Growth
3) Relocation
4) Change in vocation



____  24.   A middle-aged adult is having difficulty with losing one parent and then the other 5 months later. What should the nurse do to help this adult with the transition of losing both parents in a short period of time?

1) Remind the person that the parents had long lives.
2) Assure the person that the parents are in a better place now.
3) Encourage the person to move forward and resume routine activities.
4) Ask how the transition of losing a spouse a few years ago was handled.



____  25.   What is the average length of a transitional period?

1) Decades
2) A few days
3) A few hours
4) Weeks to months



____  26.   One member of an older couple is unable to walk independently and needs hemodialysis treatments three times a week. The couple is discussing the need for an extended care facility. What should be done to facilitate the ill spouse’s free choice with a transition?

1) Identify the facilities with hemodialysis treatment centers.
2) Explain how it is safer for an extended care facility admission to occur.
3) Remind the couple that as they age they should expect health problems
4) Review the importance of receiving quality care to improve physical status.



____  27.   What strategy should be used to learn how an older person perceives a transition?

1) Listen to the person talk.
2) Observe how the person lives.
3) Plan to share a meal with the person.
4) Analyze the person’s living situation and clothing.



____  28.   What is the major premise of the progressively lowered stress threshold?

1) Identify the cause of stress.
2) Strategize approaches to limit distractions.
3) Reduce the number of decisions a person has to make.
4) Provide the individual with as much control as possible.



____  29.   The aging parents of a middle-aged adult have both recently passed away. What transition will the middle-aged adult be facing?

1) Role crisis
2) Loss of identity
3) Change in employment
4) Unpreparedness for the future



____  30.   An older adult is having difficulty adjusting to needing a cane to safely ambulate. With which transitions is the person having difficulty?

1) Role crisis
2) Body image
3) Loss of identity
4) Lack of social interaction



____  31.   During a home visit, the adult daughter of an aging couple asks her father to not tell the story about “the time you were in the war and had to use sheets to cover a wound” again. What should the nurse realize that the older parent is demonstrating?

1) Delirium
2) Dementia
3) Confusion
4) Life review



____  32.   An older married couple spent a few weeks going through all photos and placing them in albums to present to their adult children. What behavior did the older couple demonstrate?

1) Creativity
2) Motivation
3) Life review
4) Storytelling



____  33.   During a community picnic, the nurse observes a middle-aged adult sitting alone on a bench. This adult is reflecting on the times spent with parents and friends and does not want to forget the memories. What should the nurse suggest to this person?

1) Write a life story.
2) Learn a new hobby.
3) Spend less time alone.
4) Share the memories with children.



Multiple Response

Identify one or more choices that best complete the statement or answer the question.


____  34.   What characteristics should be considered when assisting an older person with a transition? Select all that apply.

1) Finances
2) Nutrition
3) Personality
4) Coping skills
5) Past experiences



____  35.   What behaviors indicate that an older person is experiencing unresolved stress? Select all that apply.

1) Punching an orderly
2) Criticizing the meals
3) Sitting in a dark room
4) Arguing with the staff
5) Yelling at a family member



____  36.   What should be identified as potentially causing stress in an older patient? Select all that apply.

1) Waiting over an hour for a pain pill
2) Watching a horror movie on television
3) Having a different nurse scheduled for the day shift
4) Hearing a jackhammer breaking up concrete on the street
5) Being awakened every 2 hours during the night for blood work



____  37.   Which observation indicates that a recently retired older person is having difficulty with the transition? Select all that apply.

1) Losing weight
2) Meeting with friends
3) Downloading ebooks
4) Babysitting grandchildren
5) Skipping medication doses

Chapter 5: Legal, Ethical, and Financial Considerations Regarding Older Adults


Multiple Choice

Identify the choice that best completes the statement or answers the question.


____    1.   Which situation could cause an ethical/legal issue?

1) Allowing a resident to refuse care
2) Deciding whether to pass pills first or do a dressing change
3) Deciding whether to include the resident in planning care
4) Reporting a nursing assistant for not answering a resident’s call light



____    2.   Which situation could be a legal dilemma for nurses caring for older adults?

1) The resident requests not to be bathed.
2) The nurse passes the medications to all of the residents on time.
3) The resident signs out of the nursing facility and does not tell the staff where he or she is going.
4) The nurse gives the resident only half of the ordered dose of a medication because of side effects that the resident is experiencing.



____    3.   Which best describes ethics?

1) Legal aspects of health
2) Consequence evaluation
3) Values and moral concepts
4) Right and wrong behaviors



____    4.   Which is true about ethical decision making?

1) It is governed by the law.
2) It is beyond the legal scope of the practical nurse.
3) It is the use of personal values and beliefs to solve problems.
4) It is unnecessary if there are comprehensive physician orders.



____    5.   What is the Patient Care Partnership designed to do?

1) Protect the nurse from unfounded lawsuits.
2) Identify the individual’s ability to make decisions.
3) Support the choices of an individual who is able to read and write.
4) Protect the individual’s right to make informed choices relating to his or her health care.



____    6.   Which is true regarding laws governing health care and health-care delivery?

1) They are consistent with values systems.
2) They are fair and benefit most of the population.
3) They are man-made and capable of being changed.
4) They are developed with the rights of residents as the central theme.



____    7.   A licensed practical nurse (LPN) finds a resident unresponsive, calls for help, and instructs the staff to call 911 and bring emergency supplies while she sets up oxygen for the resident. What is this nurse guilty of doing?

1) The LPN should have called 911.
2) The LPN did not document the event.
3) The LPN functioned within the scope of practice.
4) The LPN should have requested a physician’s order for the oxygen.



____    8.   A non-intravenous (IV) certified LPN starts an IV infusion in a resident during an emergency situation. What is this nurse guilty of doing?

1) Doing someone else’s job
2) Adhering to the Nurse Practice Act
3) Being negligent because of not being IV-certified
4) Skipping resident consent for the IV insertion



____    9.   If a non-IV certified LPN starts an IV infusion what should the judge determine if this situation is reviewed in court?

1) Was the physician in attendance?
2) Who was responsible for the resident’s care?
3) Did the resident give permission for the IV?
4) Would another LPN do the same thing?



____  10.   What does the failure to notify the physician or nursing supervisor when a resident’s heart rate decreases to less than 48 describe?

1) Libel
2) Omission
3) Negligence
4) Unprofessional behavior



____  11.   An 84-year-old patient experiencing severe cancer pain is restless and refuses pain medication. Which is an ethical approach to this problem?

1) Discuss with the patient feelings about the pain and the medication.
2) Call the family to ensure that the resident’s choice is in the living will.
3) Withhold the medication, because all residents have the right to refuse care.
4) Give the medication, because the resident’s decision may be related to delirium.



____  12.   What is a positive result of a restraint-free environment?

1) Use of more medications
2) Fewer incidents of resident falls
3) Increased nursing assistant staffing
4) Development of more creative care strategies



____  13.   What may an LPN be required to do when providing ethical nursing care?

1) Examine personal beliefs and values.
2) Practice outside of the facility’s policies and procedures.
3) Practice outside of the legal scope of practical nursing practice.
4) Compromise the rights of residents as outlined in the Patient Care Partnership.



____  14.   What does NOT legally define the practice of the LPN?

1) Facility procedure outlines
2) The State Nurse Practice Act
3) Facility nursing care policies
4) Experience in providing nursing care



____  15.   Which is an example of omission?

1) Forgetting to unclamp a catheter
2) Changing a resident’s diet to increase fiber
3) Refusing to sign off on a medication that was not given
4) Adjusting a dosage schedule of an antibiotic that the pharmacy delivered late



____  16.   Why are other nurses often used as expert witnesses in lawsuits involving nurses?

1) They can review the usual job description of nurses.
2) They can learn about the Nurse Practice Act standards.
3) They can establish the definition of safe and prudent care.
4) They can validate the credentials of the nurse being charged.



____  17.   What is the most important factor in successfully initiating a restraint-free environment?

1) Discussing safer methods of restraining residents
2) Educating the residents and families regarding restraint-free principles
3) Providing in-service training of nursing staff about restraint policies and procedures
4) Reviewing the Patient Care Partnership with the whole staff so that they understand the right of the resident to choose to be unrestrained



____  18.   What does informed consent mean?

1) The resident has the right to refuse treatment.
2) The resident must sign a release statement before all treatments.
3) The care personnel are exempt from any lawsuit if something goes wrong during a procedure.
4) The resident has the right to know all of the information regarding procedures before consenting to treatment.



____  19.   What is the role of the LPN when elder abuse is suspected?

1) Review the care of other residents.
2) Document and investigate the incident.
3) Report the incident to the local, county, or state authorities.
4) Discuss suspicions at the next interdisciplinary team meeting.



____  20.   Who are the abusers in most cases of elder abuse?

1) Privately paid caregivers
2) Long-term care facility employees
3) Anyone who cares for an older adult
4) Family members who are living with the older adult



____  21.   What is a major barrier to reporting of elder abuse?

1) Reporting involves too much paperwork.
2) It is not a felony to abuse a competent adult.
3) Elders are reluctant to report incidents of abuse.
4) Families of elderly abuse victims seldom believe that they are abusing the elder.



____  22.   The wife of a married couple in a facility requests to be moved into a different room. How should the nurse respond to this request?

1) “Don’t you think your husband will miss you?”
2) “This must have been a difficult decision for you to make.”
3) “We will have to get your husband’s permission for you to move.”
4) “This is against the facility policy, which encourages couples to be in the same room.”



____  23.   What statement best describes a resident’s rights for sexual expression?

1) The right to use touch to express sexual feelings.
2) The right to have access to opportunities for sexual expression.
3) The right to engage in sexual relationships with other residents.
4) The right to express sexual feelings in socially appropriate ways.



____  24.   Which statement is NOT true about physical restraints?

1) They may include bed rails.
2) They restrict access to one’s body.
3) They can be removed by the resident.
4) They include anything attached to the individual that cannot be removed easily.



____  25.   A certified nursing assistant (CNA) uses soft restraints to protect a resident from falling out of bed even though there was no order for their usage. On rounds several hours later, the resident is found not breathing, tangled, with her restraints around her neck. What is the responsibility of the LPN?

1) Guilty of omission
2) Guilty of negligence
3) Not at fault because of being unaware of the restraints being used
4) Not concerned because the resident has a do not resuscitate (DNR) order



____  26.   A primary care provider orders short-term restraints for an elderly patient. Which is NOT a responsibility of the nurse regarding these restraints?

1) Remove the restraints periodically.
2) Assist with range-of-motion exercises.
3) Observe and care for the skin periodically.
4) Delay following the physician’s instructions and contact the interdisciplinary team (IDT).



____  27.   Which law was specifically designed to protect and regulate patient privacy?

1) Patient Care Partnership
2) Patient Self-Determination Act
3) Omnibus Budget Reconciliation Act (OBRA)
4) Health Insurance Portability and Accountability Act (HIPAA)



____  28.   What has research been unable to prove regarding the use of restraints?

1) Care based on the patient’s individual needs
2) A reduction in the person’s functional capacity
3) Injuries to the patient who tries to get free from the restraints
4) Problems with many body systems often resulting from immobility



____  29.   The nurse lives in Erie, Pennsylvania, but sees home care patients in New York, Pennsylvania, and Ohio. Which state licensure requirements should the nurse follow?

1) Ohio
2) New York
3) Pennsylvania
4) All of the states



____  30.   The nurse is concerned about an unsafe situation with a resident. With whom should the nurse discuss this situation first?

1) The CNAs
2) The physician
3) The charge nurse
4) The administrator



____  31.   While making afternoon rounds the charge nurse sees a resident sitting in a geriatric chair with a tray. What should the nurse do?

1) Do nothing.
2) Remove the tray.
3) Assist with ambulation.
4) Transfer to another chair.



____  32.   A resident of a nursing facility demonstrates occasional delirium. From whom should the nurse obtain consent for an invasive procedure?

1) The resident
2) The physician
3) Family attorney
4) Medical power of attorney



____  33.   What is the primary objective of an advance directive?

1) Reduce the cost of care.
2) Restrict the utilization of resources.
3) Follow the resident’s wishes for care.
4) Calm the family’s fears and concerns.



____  34.   What is the most extreme expression of ageism?

1) Negligence
2) Malpractice
3) Elder abuse
4) False imprisonment



____  35.   During morning care an older male resident begins to masturbate. What should the CNA do?

1) Ignore the action and complete the bath.
2) Ask the resident to stop until the bath is over.
3) Leave the resident to complete the action in private.
4) Stand and wait for the resident to complete the action.



____  36.   The nurse overhears several CNAs discussing a resident’s health problems in the lunch room. What should the nurse do?

1) Do nothing.
2) Participate in the discussion.
3) Listen to what they have to say.
4) Remind them that the information is confidential.



Multiple Response

Identify one or more choices that best complete the statement or answer the question.


____  37.   What information should the nurse expect to find within the Patient Care Partnership? Select all that apply.

1) Billing and collection policies
2) Access to health care and coverage
3) Acceptable nurse-resident staffing ratios
4) Intolerance of racial and ethnic disparities
5) Partnership with health-care decisions and delivery



____  38.   Which actions should the nurse take when enforcing the Patient Self-Determination Act of 1990 with a newly admitted resident of a nursing facility? Select all that apply.

1) Ask if the resident has a living will.
2) Ask if the resident has advance directives.
3) Ask if the executor of the will has been identified.
4) Ask if the resident has a durable power of attorney.
5) Ask if the resident will sign the consent to treatment form.



____  39.   The Director of Nursing is concerned that one staff nurse is at risk for liability issues when providing resident care. What did the director observe to make this decision? Select all that apply.

1) The nurse changed a medication dosage.
2) The nurse worked 32 hours over the last 2 days.
3) The nurse documented the status of a resident’s pressure ulcer.
4) The nurse did not have supplies to change a wound-vac draining system.
5) The nurse did not obtain consent before sending a resident for a surgical procedure.



____  40.   The nurse is identifying tasks to delegate to CNAs. What should the nurse use as a guide when making these decisions? Select all that apply.

1) Age of the CNAs
2) Skill level of the CNAs
3) Experience of the CNAs
4) Certification of the CNAs
5) Shift the CNAs are working



____  41.   What are the characteristics of a prudent, responsible nurse? Select all that apply.

1) Attends seminars
2) Thinks through actions
3) Applies for re-licensure
4) Reads nursing magazines
5) Carefully considers options



____  42.   What can be used in place of restraints to monitor residents who have a tendency to wander? Select all that apply.

1) Sitters hired to stay with the resident
2) Alarm doors
3) Bed alarm pads
4) Room door locks
5) Wristband alarms



____  43.   A resident is having a health-care proxy created. What should be included in this document? Select all that apply.

1) Use of feeding tubes
2) Types of medications
3) Plans for resuscitation
4) Location of will in the home
5) Desire for mechanical ventilation



____  44.   Which parts of Medicare are associated with monthly premiums? Select all that apply.

1) A
2) B
3) C
4) D
5) E



____  45.   What should the nurse explain to a resident of a nursing facility about Medicaid? Select all that apply.

1) It includes acute care.
2) It includes long-term care.
3) It has a monthly premium.
4) It has substantial co-payments.
5) It is the largest payer for skilled care.



____  46.   How did the Affordable Care Act (ACA) impact Medicare? Select all that apply.

1) Increased co-payments
2) Added deductibles for office visits
3) Included more preventive services
4) Reduced the cost of prescription drugs
5) Limited the number of skilled care days

Chapter 7: Safety


Multiple Choice

Identify the choice that best completes the statement or answers the question.


____    1.   The nurse is preparing an educational session for community members. What should the nurse include about falls in the older population?

1) After a fall the older person will need to be institutionalized.
2) Falls alter the older person’s metabolism and electrolyte balance.
3) Falls are the most prevalent cause of death due to unintentional injury.
4) Healthy People 2020 has a goal to reduce the number of falls in older adults by 50%.



____    2.   The licensed nurse is reviewing medications prescribed for an older patient. Which medication should be administered during the day to reduce the risk of falls?

1) Diuretic
2) Narcotic
3) Sedative
4) Antihypertensive



____    3.   The certified nursing assistant (CNA) is completing the bath for an older patient. What should be done to ensure for this patient’s skin integrity?

1) Apply cocoa butter.
2) Apply lotion to the skin.
3) Dry the skin well with a rough towel.
4) Sprinkle cornstarch between skin folds.



____    4.   While inspecting the skin of an older patient on bedrest the nurse notes several new long scratches along the back and buttocks. What should the nurse suspect as being the cause of these wounds?

1) Mattress tears
2) Wrinkled bed sheets
3) Rough edges on bed clothes
4) Long fingernails of the primary caregiver



____    5.   An older patient on bedrest was turned and repositioned at 1100 hours. At which time should the patient be turned next?

1) 1200 hours
2) 1300 hours
3) 1500 hours
4) 1700 hours



____    6.   When entering the home of an older patient during a hot summer day, the nurse notes that a table fan is positioned directly onto the patient’s face and chest. What should the nurse do first?

1) Measure vital signs.
2) Open all of the doors and windows.
3) Ensure cool drinking water is available.
4) Move the fan away from blowing directly onto the patient.



____    7.   An older patient in the community becomes confused and begins to wander during the evening hours. For which health problem should the nurse plan care for this patient?

1) Anxiety
2) Depression
3) Sundowning
4) Schizophrenia



____    8.   The daughter of an older patient with occasional confusion asks what can be done in the event the patient becomes confused while out shopping. What should the nurse suggest to this daughter?

1) Schedule around-the-clock in-home caregivers.
2) Obtain a memory-impaired identification bracelet.
3) Have the patient examined by a psychiatric professional.
4) Consider relocating to a personal care home in the neighborhood.



____    9.   During a home visit the nurse decides to spend additional time assessing an older patient’s mental status. What did the nurse observe to make this clinical determination?

1) Losing track of hospital discharge instructions
2) Forgetting to put the milk back in the refrigerator
3) Increasing isolation from friends, family, and activities
4) Not remembering if morning medication was taken before or after breakfast



____  10.   The intensive care unit has a policy that restricts visitors to immediate family members. What should the nurse do when a patient states that his domestic partner is his only family?

1) Discuss the issue with the hospital administrator.
2) Identify the domestic partner as being immediate family.
3) Suggest that the patient be transferred to another care area.
4) Document that the patient has no immediate family members.



____  11.   An older female patient refuses to answer questions regarding sexuality and asks, “What difference does it make?” How should the nurse respond to this patient?

1) “It’s a part of the nursing assessment.”
2) “Sexual preference is a piece of data collected on all patients.”
3) “It is used to identify potential health problems you might have.”
4) “This is one way to make sure that all of your needs are being met.”



____  12.   When an older male patient is observed kissing his partner he asks the nurse “not to tell anyone.” What should the nurse suspect that this patient’s statement means?

1) Fear that his family will find out
2) Embarrassed to be a homosexual
3) Afraid that he will receive substandard care
4) Shame that he was caught in an intimate moment



____  13.   An adult daughter of an older patient is overheard telling a friend that it’s “payback time” because the patient loved to yell and scream at the daughter when she was a child. What should the nurse be alert for when assessing this patient?

1) Neglect
2) Abandonment
3) Physical abuse
4) Psychological abuse



____  14.   An older patient holds the nurse’s hand and states, “Please don’t leave me alone here when my son comes to visit.” What should this indicate to the nurse?

1) The patient is afraid to die.
2) The patient wants the nurse to meet her son.
3) The patient is afraid of what her son might do.
4) The patient wants the nurse to answer the son’s questions.



____  15.   During a home visit, an older patient who lives with adult children is frantically going through desk drawers and purses looking for a beloved brooch that was her mother’s. The patient also cannot find money that she had taken out of the bank a few days ago and recalls not buying anything. What should the nurse suspect is occurring with this patient?

1) Delirium
2) Dementia
3) Material abuse
4) Early Alzheimer’s disease



____  16.   When entering the home of an older patient the nurse smells gas. What should be done first?

1) Call the gas company.
2) Check the stove for unlit burners.
3) Open all of the windows and doors.
4) Take the patient outside in the fresh air.



____  17.   An older patient is sitting in the kitchen with the lights out, watching the next door neighbor’s yard. When asked about this behavior, the patient states that the kids next door have BB guns and she doesn’t want to be shot. What should the nurse be concerned about with this patient?

1) Fall risk
2) Elder abuse
3) Personal safety
4) Mental health status



Multiple Response

Identify one or more choices that best complete the statement or answer the question.


____  18.   The nurse is concerned that an older patient is at risk for falling. What observations caused the nurse to have this concern? Select all that apply.

1) Urinary frequency
2) 20 lb overweight
3) Cataract forming in left eye
4) History of chronic bronchitis
5) Diagnosed with spinal stenosis



____  19.   Because of extreme heat and humidity, the nurse moves blood pressure screenings from being outdoors to the community center. Which older patients should the nurse suspect are experiencing the effects of the hot summer day? Select all that apply.

1) 90-year-old female wearing a sweater
2) 72-year-old female talking with family members
3) 77-year-old male with a headache and rapid heart rate
4) 68-year-old male who is sweating and asking for water
5) 82-year-old female experiencing nausea and calling for her dead husband



____  20.   An older patient walks to the community clinic in a snow storm. Which assessment findings should indicate to the nurse that this patient is experiencing adverse effects of being outside in the cold weather? Select all that apply.

1) Shivering
2) Heart rate 112 bpm
3) Respiratory rate 28
4) Temperature 98.1°F
5) Blood pressure 158/92 mm Hg



____  21.   The nurse is preparing a community educational program on the preparation of a safety bag. What contents should the nurse emphasize be placed in this bag? Select all that apply.

1) Money
2) Cell phone and charger
3) Medications for 10 days
4) Weapon and ammunition
5) Food and water for 3 days



____  22.   The nurse is preparing to make a visit to an older patient in the home. What should the nurse keep in mind when planning this patient’s safety? Select all that apply.

1) Obtain items to be placed in the patient’s safety bag.
2) Carry personal protective equipment in the home visit bag.
3) Visually inspect the patient’s home environment for safety hazards.
4) Listen for potential safety issues that the patient might mention in conversation.
5) Identify community resources available to the patient in the event of a safety issue.

Chapter 9: Culturally Specific Care


Multiple Choice

Identify the choice that best completes the statement or answers the question.


____    1.   Which is NOT considered an aspect of culture?

1) Religion
2) Stories from grandparents
3) Non-physical inherited traits
4) Physical traits such as hair and eye color



____    2.   Based on census data and predictions about changes in the U.S. population, which is a true statement?

1) The number of Asians living in the United States will decrease.
2) The population of the United States will become more diverse and older.
3) The population of the United States will probably become younger and more assimilated.
4) The percentage of blacks living in the United States will increase more than any other ethnic group.



____    3.   What health issue increases in black men between the ages of 15 to 34?

2) Stroke
3) Cancer
4) Unintentional injury



____    4.   A black woman is experiencing fever and severe pain in her lower back and legs after flying a long distance the previous day. Test results indicate anemia. What should the nurse consider that this patient is experiencing?

1) Infection
2) Sickle cell anemia
3) Deep venous thrombosis
4) Transient ischemic attack



____    5.   Which are the two leading causes of death among Native Americans?

1) Suicide and AIDS
2) Cirrhosis and stroke
3) Heart disease and cancer
4) Unintentional injuries and diabetes



____    6.   What might the nurse expect to see when entering the hospital room of an ill Native American?

1) Cups being applied to the patient’s back
2) The patient and family facing east and praying to Allah
3) A shaman performing a healing “sing” with family members
4) The eldest member of the patient’s family asking questions and taking notes



____    7.   Which ethnic group has the lowest cancer survival rate?

1) Blacks
2) Hispanics
3) Europeans
4) Native Americans



____    8.   With which ethnic group are the practices of acupuncture and acupressure most closely associated?

1) Asians
2) Blacks
3) Hispanics
4) Europeans



____    9.   The nurse is caring for a male Asian patient and needs permission for certain procedures to be performed. How should the nurse approach the family members?

1) Ask a translator to obtain permission from the wife.
2) Go directly to the patient’s father and act in a very friendly manner.
3) Explain the patient’s condition to his wife and ask her permission for the procedures to be done.
4) Acknowledge the wife but speak directly and formally to the patient’s father and mother who are present.



____  10.   What do many Europeans believe about health care?

1) It is an unnecessary expense.
2) It is to be avoided at all costs.
3) It is the responsibility of the government.
4) It is the responsibility of the patient and the family.



____  11.   A 75-year-old Jewish patient sends a meal tray back with much food uneaten. How should the nurse respond?

1) Ask the family about the patient’s eating habits.
2) Explain that the food must be eaten to aid in healing and recuperation.
3) Tell the dietitian to send a kosher diet without saying anything to the patient.
4) Remark that minimal intake is being noted and ask if a kosher diet is followed.



____  12.   A middle-aged Hispanic woman does not want to take penicillin for diarrhea caused by an infection. What is a likely explanation for this refusal?

1) The patient does not believe in the use of antibiotics.
2) The patient thinks penicillin would interfere with the herbs and spices routinely taken.
3) The patient considers penicillin a “hot” medication and diarrhea a “hot” disease and believes that penicillin should not be used.
4) The patient considers penicillin a “hot” medication and diarrhea a “cold” disease and believes that penicillin should not be used.



____  13.   An elderly Hispanic patient leaves after waiting for 45 minutes for an appointment that was scheduled for an hour and a half earlier. Even though the patient is annoyed, what should the nurse respond to this situation?

1) Reschedule the appointment.
2) Suggest that another physician be chosen.
3) Say that the patient must be on time for the appointment and must wait if necessary.
4) Recognize the difference in time perception and gently explain the need to be on time for appointments to receive the needed care.



____  14.   What should the nurse keep in mind when doing an initial assessment of a Native American?

1) Native Americans like to relate their personal history.
2) Many Native Americans find the personal questions asked during an initial assessment and history offensive.
3) Many Native Americans rely solely on the Indian Health Care Services for health care.
4) Native Americans who speak English are completely comfortable with the U.S. health-care system.



____  15.   A group of nurses is reviewing the care needed by a newly admitted older patient. Which statement represents an ethnocentric view of this patient’s culture and ethnicity?

1) “Remember to check his dietary preferences before submitting each day’s menu.”
2) “I think the way he wants some things done is really weird–we don’t do it that way.”
3) “Be sure to let his parish priest know he is here and wants to see him when he makes rounds.”
4) “His spouse and children are coming in later this afternoon to discuss physical therapy plans.”



____  16.   The nurse is caring for an 82-year-old black female patient. What should the nurse recall regarding this patient’s life expectancy?

1) The patient can expect to live another 5 to 10 years.
2) The patient has exceeded the expected life expectancy for black females.
3) The patient has at least 3 more years before reaching the life expectancy for white females.
4) The patient has several years before reaching the expected life expectancy for black females.



____  17.   The nurse is providing care to an older black female. Which statement should the nurse expect that explains this patient’s health beliefs?

1) “It is God’s will.”
2) “My daughter will take care of me.”
3) “I’ll do whatever it takes to get better.”
4) “My doctor knows how to keep me well.”



____  18.   An older black female lives alone in a small city apartment and receives $900 a month in Social Security benefits from which she makes Medicare payments and pays rent. How will this income impact the patient’s health?

1) Isolated
2) Overcrowded
3) Could lead to malnutrition
4) Exposed to communicable diseases



____  19.   The nurse notes that a newly admitted older patient is Asian. What should be a priority question when beginning the assessment of this patient?

1) Marital status
2) Country of origin
3) Previous profession
4) Number of children



____  20.   The nurse is caring for an older Asian American female. What should the nurse avoid doing when providing care to this patient?

1) Addressing the patient as Mrs.
2) Discussing health care with the spouse
3) Keeping body parts covered during morning care
4) Telling the patient to stop doing something



____  21.   The nurse is observing the reaction of an older Hispanic patient after learning about a chronic illness. Which response should the nurse expect the patient to make?

1) “I’m having bad luck.”
2) “I should never come to a hospital for care.”
3) “The doctors don’t know what they are doing.”
4) “It’s my husband’s fault I am the way that I am.”



____  22.   An older Hispanic patient will not take a medication because it does not work in sync with the hot infection. What should the nurse do to first help this patient?

1) Document that the patient refused the medication.
2) Ask for clarification on what are the hot and cold illnesses.
3) Explain that the concepts of hot and cold do not apply to infections.
4) Explain that the patient’s illness will get worse if the medication is not taken.



____  23.   An older white patient tells the nurse that the federation supplied all of his medications and paid for doctor visits in his native country. Which cultural group is this patient most likely a member of?

1) Black
2) Asian
3) European
4) American



____  24.   What is a defining characteristic of a person from the European culture?

1) Extremely tall and muscular
2) Blond hair and blue eyes
3) Appearance of a typical American
4) Extended family provides health care



____  25.   The nurse notes that a newly admitted older white patient speaks with an accent. What should the nurse do first to plan culturally sensitive care for this patient?

1) Obtain an interpreter.
2) Find out the patient’s country of origin.
3) Ask if a male family member is available to make health-care decisions.
4) Determine which family member plans to take care of the patient after discharge.



____  26.   The nurse is assisting in the distribution of breakfast meal trays in a nursing facility. Which food item should be removed from the tray of a Jewish patient?

1) Toast
2) Bacon
3) Oatmeal
4) Orange juice



____  27.   On Saturday afternoon an older Jewish patient has 15 family members and friends visiting. What should the nurse do to support this patient’s need for a support system?

1) Ask everyone to leave.
2) Enforce the two visitors per patient policy.
3) Suggest that everyone take 15 minutes each with the patient.
4) Invite everyone to the visitor’s lounge and transport the patient to visit there.



____  28.   During a visit to the reservation where an older Native American patient lives, the nurse observes a ceremony being conducted for the patient’s newly diagnosed illness. What should the nurse recall about this culture?

1) The ceremony is to heal the illness.
2) The ceremony is to celebrate the patient’s life.
3) The ceremony is to prepare the patient for death.
4) The ceremony is to bring the family closer together.



____  29.   The leader of a tribe of Sioux Indians is admitted to the hospital for treatment of type 2 diabetes mellitus. The tribal shaman arrives and asks for clean towels and water. What should the nurse do?

1) Provide the towels and water as requested.
2) Explain that the patient is too ill for visitors.
3) Explain that the patient was bathed earlier in the day.
4) Provide the towels but direct the shaman to use the sink for water.



Multiple Response

Identify one or more choices that best complete the statement or answer the question.


____  30.   A black Muslim male patient with diabetes is recovering from a stroke. Which would be examples of culturally sensitive nursing care? Select all that apply.

1) Provide a frankfurter instead of hamburger for lunch.
2) Substitute a ham slice with bacon on his breakfast tray.
3) Request that the pharmacy send only non-pork insulin for him.
4) Discuss his diet with him, asking him if he has any special needs.
5) Inform him that while he is in the hospital he must eat whatever is brought to him and take the insulin given to him.



____  31.   What is true about elderly care in traditional Asian families? Select all that apply.

1) They are cared for at home by their family.
2) They are sent to nursing homes routinely when they reach a certain age.
3) They are placed in nursing homes only if they do not have family members to care for them.
4) They are sent to nursing homes only if the older person does not want to be around small children.
5) They are sent to nursing homes as soon as they become infirm or unable to contribute to family life.



____  32.   Which characteristics should the nurse keep in mind that assists Asian Americans to be a healthier cultural group? Select all that apply.

1) Higher income
2) Well-educated
3) Residency status
4) Live with extended family
5) Obtain driver’s license



____  33.   During an assessment, the nurse suspects that an older Hispanic patient is at risk for diseases of poverty. Which health problems should the nurse be concerned that this patient is developing? Select all that apply.

1) Arthritis
2) Diabetes
3) Pneumonia
4) Malnutrition
5) Heart disease



____  34.   The nurse is planning care for an older Jewish patient. What should the nurse keep in mind that this patient will consider as aspects of health? Select all that apply.

1) Good health is a right.
2) The holy book is used to heal the sick.
3) Maintaining good health is an expectation.
4) Prayer is used to make treatment decisions.
5) The use of modern medicine is encouraged.


Chapter 11: End-of-Life Issues in Older Adults


Multiple Choice

Identify the choice that best completes the statement or answers the question.


____    1.   Which would NOT be included in palliative care?

1) Chemotherapy
2) Flotation mattress
3) Intravenous (IV) lines for hydration
4) Pain medication for relief of distress



____    2.   Which statement about hospice care is NOT true?

1) Hospice care has a small patient-to-worker ratio.
2) Hospice care serves the dying patient exclusively.
3) Hospice care is responsive 24 hours a day 7 days a week.
4) Hospice care encourages the involvement of the patient’s personal physician.



____    3.   An older patient who recently lost his spouse sits in the bedroom, venturing out only for brief minutes. His eyes are reddened and swollen, his appetite is decreased, and even the simplest task is too exhausting for him. In which stage of grief is this patient?

1) Denial
2) Bargaining
3) Depression
4) Acceptance



____    4.   What best defines tolerance?

1) Compassion and endurance
2) Impatience and impartiality
3) Impatience and open-mindedness
4) Closed-mindedness and impartiality



____    5.   Which behavior exemplifies empathy?

1) Crying with patients
2) Understanding patients
3) Identifying with patients
4) Making choices for patients



____    6.   Which is NOT a benchmark of a good listener?

1) Taking time
2) Not interrupting
3) Asking appropriate questions
4) Assuming what the person is going to say



____    7.   An older patient has a living will that clearly states no intubation, no IV hydration, and no feeding tube. As the end of life nears, the patient’s daughter requests a feeding tube for the patient. What should the facility do?

1) Go to court to figure out what action to take.
2) Ask the patient’s physician to make the decision.
3) Go along with the daughter and insert a feeding tube.
4) Refuse because the patient has clearly stated wishes in a legal document.



____    8.   What is the primary objective of an advance directive?

1) Prevent abuse of incompetent patients.
2) Follow the wishes of the person who wrote it.
3) Give families the right to make health-care decisions for the patient.
4) Give the state permission to make life-or-death decisions for the patient.



____    9.   What are the components of a quality hospice program?

1) Is sensitive to different cultures, has a small patient-to-worker ratio, responds Monday through Friday, 9:00 a.m. to 5:00 p.m.
2) Has community support, allows for high patient-to-caregiver ratios, responds to family and patient needs
3) Has an interdisciplinary team, is sensitive to cultural differences, responds to patient and family wants and needs
4) Has a specific religious belief structure, has small patient-to-caregiver ratios, is rigid in their ability to respond to specific needs



____  10.   Which behavior is NOT necessary when working with dying patients?

1) Flexibility
2) Immaturity
3) Sense of humor
4) Good listening skills



____  11.   An older patient who just lost her husband of 60 years is seen yelling at his picture, at the pictures of their children and grandchildren, and at the Bible in her hand. What should the nurse do?

1) Call her family members.
2) Call the physician for a restraint order.
3) Stay with her and allow her to be angry at the situation.
4) Check the medication log to see if she can have something for agitation.



____  12.   The family of a dying patient has been sitting at his bedside for hours, watching over the decreasing respirations. No one is speaking. What should the nurse say to the patient’s son?

1) Encourage him to try to feed his father.
2) Encourage him to count the respirations to pass the time.
3) Encourage him to go home because this might be a long process.
4) Encourage him to talk to the patient because hearing is the last sense to go.



____  13.   An older patient with a terminal illness is beginning hospice care. What should the nurse realize about this patient?

1) The patient should prepare a living will.
2) The patient should be admitted to a hospital.
3) The patient has approximately 6 months to live.
4) The patient will receive medications to cure the illness.



____  14.   The nurse desires to become a member of a hospice team. What should the nurse expect to do when providing hospice care?

1) Stay with the patient around-the-clock.
2) Encourage the patient to maintain independence.
3) Instruct the patient to stop eating food and fluids.
4) Provide support and education to family members.



____  15.   A terminally ill patient died 2 days after starting hospice. What should this indicate to the nurse?

1) Hospice was used too little.
2) Hospice was used too much.
3) Hospice was used appropriately.
4) Hospice was not indicated for this patient.



____  16.   The spouse of a recently deceased older patient says that he does not really remember the funeral. Which stage of the grieving process is the spouse describing?

1) Shock
2) Denial
3) Despair
4) Depression



____  17.   An older person grieving the loss of her spouse says that she doesn’t want to live anymore. What should this statement indicate to the nurse?

1) The patient is bargaining.
2) The patient may attempt suicide.
3) The patient is accepting the spouse’s death.
4) The patient is denying that the spouse has died.



____  18.   An older patient who lost her spouse a year ago is seen crying quietly in church during the singing of one hymn. What should this patient’s behavior indicate?

1) The patient is unable to complete grieving.
2) The patient is denying that the death occurred.
3) The patient is in the depression phase of grieving.
4) The patient is in the acceptance phase of grieving.



____  19.   A terminally ill older patient is finding fault with the care being provided and complaining that no one cares about him. What action should the nurse take to demonstrate tolerance?

1) Stay with the patient.
2) Leave the patient alone.
3) Say that it’s not your fault that the patient is dying.
4) Argue that the patient has received appropriate care.



____  20.   While providing morning care to a terminally ill patient the nurse observes the nursing assistant laughing with the patient. What should the nurse do?

1) Explain to the assistant that death is not a laughing matter.
2) Suggest that laughter be limited because others are trying to rest.
3) Realize that the laughter is helping the patient soothe the eventual outcome.
4) Assign the assistant to other non-patient related tasks because of inappropriate behavior.



____  21.   During a home visit, a terminally ill patient tells the nurse about his years in the Army and how he should have gone to “cooking and baking school” instead of becoming a military policeman. What should the nurse do during this story that indicates listening?

1) Say nothing.
2) Interrupt the patient to measure vital signs.
3) Remind the patient that time is limited for the visit.
4) Ask if the patient regrets not learning how to cook and bake.



____  22.   While providing morning care to a terminally ill patient the nurse notes that the patient has been incontinent of bowel and bladder for the first time since admission. What should this indicate to the nurse?

1) The patient is near death.
2) The patient’s diet needs to be adjusted.
3) The patient is receiving too much pain medication.
4) The patient should be reminded to call for help with toileting.



____  23.   The nurse notes that a terminally ill patient has cold extremities despite being saturated with sweat. What should the nurse do?

1) Place the patient on a cooling blanket.
2) Place a fan in the room, angled to cool the patient’s torso.
3) Change the gown and cover the arms and legs with a blanket.
4) Increase the room temperature and remove blankets from the patient.



____  24.   While sitting at the bedside of a dying patient, the patient’s two sons are discussing the patient’s rifle collection and state that they hope their father identified which of them was to receive the guns in the will. What should the nurse do?

1) Close the patient’s room door.
2) Remind the sons that their father needs rest and that they should leave.
3) Suggest that the sons get a copy of the will so that their questions will be answered.
4) Take the sons into the hallway to remind them that their father hears what they are saying.



____  25.   The spouse of a terminally ill patient asks why antibiotics are being prescribed for an infection when the patient is going to die anyway. How should the nurse respond?

1) “The infection could cause discomfort.”
2) “The antibiotics will add days to the patient’s life.”
3) “Permitting the patient to die is a form of assisted suicide.”
4) “I’ll ask the physician why the medication was prescribed.”



____  26.   The nurse desires to work for a hospice agency. Which type of care should the nurse expect to provide to assigned patients?

1) Curative
2) Palliative
3) Restorative
4) Rehabilitative



____  27.   A dying patient tells the nurse that he does not want any more renal dialysis treatments and just wants to be permitted to die. What should the nurse do with medications prescribed to control the patient’s edema?

1) Mark them as refused.
2) Provide them to the patient.
3) Throw the medications in the trash.
4) Place the medications in another patient’s medication drawer.



____  28.   An older patient tells the nurse that he does not want to create a living will because he does not want to die. What should the nurse say in response to this patient?

1) “A living will is not a death sentence.”
2) “That’s probably a good idea. Don’t tempt fate.”
3) “I know what you mean. I don’t have one either.”
4) “Having a living will makes sure that you receive the care that you want when death approaches.”



____  29.   The graduate nurse has relocated to another state and is beginning a position in a skilled nursing facility. Where should the nurse obtain information regarding advance directives for the new state of residence?

1) Ask the nurse manager.
2) Discuss it with the administrator.
3) Contact the new state board of nursing.
4) Ask the school of nursing about the information.



Multiple Response

Identify one or more choices that best complete the statement or answer the question.


____  30.   Which is true about end-of-life care? Select all that apply.

1) It is the same for all people
2) Includes managing symptoms
3) Considers referrals to support the patient
4) Includes communication and education about choices
5) Requires the nurse to be in touch with individual beliefs



____  31.   What describes terminal restlessness? Select all that apply.

1) Could include yelling or moaning
2) Involuntary thrashing or agitation
3) Rarely occurs during the dying process
4) A common occurrence at the end of life
5) Occurs as a result of progressive shutdown of body systems



____  32.   When are the stages of grief present? Select all that apply.

1) When a pet dies
2) During a divorce
3) Starting a new job
4) After a mastectomy
5) When someone dies



____  33.   Which are advance directives? Select all that apply.

1) A will
2) A living will
3) A health-care proxy
4) A durable power of attorney
5) Assignment of an estate executor



____  34.   Which are signs of impending death? Select all that apply.

1) Cold extremities
2) Frequent coughing
3) Weak, rapid pulse
4) Profuse perspiration
5) Slow pupil response to light



____  35.   The nurse is helping a patient think about things to include in a living will. What should the nurse suggest to the patient? Select all that apply.

1) Feeding tube
2) Breathing tube
3) Food and fluids
4) Pacemaker insertion
5) Mechanical ventilation

Chapter 13: Management and Leadership Role of the Licensed Practical/Vocational Nurse


Multiple Choice

Identify the choice that best completes the statement or answers the question.


____    1.   What defines the scope of practice of the licensed practical nurse (LPN)?

1) State Nurse Practice Act
2) Shift-related responsibilities
3) Needs of the facility or hospital
4) Registered nurse (RN) charge nurse, supervisor, or director of nursing



____    2.   Which is an example of an authoritarian style of leadership?

1) Nursing assistants are not assigned to breaks and lunches.
2) The practical nurse designs a rotating schedule for assigning breaks and lunch.
3) The practical nurse assigns the nursing assistants to specific times for their breaks and lunch.
4) Nursing assistants sign up for the break and lunch that they prefer and negotiate if there are any conflicts.



____    3.   What best describes the work environment with a democratic leader?

1) Teamwork
2) Following orders
3) Structured time and task responsibilities
4) Individual accountability and responsibility



____    4.   While dealing with an acute patient care situation the charge nurse starts giving orders to staff and directs others to pick up supplies. What type of management style is this nurse using?

1) Permissive
2) Democratic
3) Laissez-faire
4) Authoritarian



____    5.   The charge nurse gathers the nursing staff in the conference room to discuss a patient care situation. A subcommittee of team members is formed to implement specific recommendations. What type of management style is being used by the charge nurse?

1) Permissive
2) Democratic
3) Laissez-faire
4) Authoritarian



____    6.   A nurse manager wants to feel good, wants the staff to always feel good, and has this as her primary goal. What type of management style is this manager practicing?

1) Permissive
2) Democratic
3) Participative
4) Authoritarian



____    7.   Staff nurses are overheard saying that they don’t care about the unit or the work that needs to be done because nothing is ever good enough. Which type of style is most likely being used to manage these employees?

1) Multicratic
2) Democratic
3) Laissez-faire
4) Authoritarian



____    8.   The nurse manager follows the multicratic leadership style. For which situation would this style be LEAST effective?

1) Manager directs staff during an emergency situation
2) Manager encourages staff to self-schedule for shifts
3) Manager insists that a resident get dressed for breakfast
4) Manager asks staff for opinions on implementing a new policy



____    9.   Which does NOT describe nonverbal communication?

1) Body posture
2) Sharing messages using words
3) The kind of clothes a person wears
4) The most honest communication method



____  10.   Which is NOT an appropriate strategy for communicating with older adults?

1) Shout loudly.
2) Sit at eye level with the older adult.
3) Close the door to shut out background noises.
4) Listen carefully and verify the older adult’s statements.



____  11.   Which strategy would facilitate communication with families?

1) Referring the family to a social worker
2) Being available to talk at the nurses’ station
3) Asking the family to telephone to ask questions
4) Meeting in a quiet room away from the care area



____  12.   How does presbycusis affect communication?

1) Difficulty speaking
2) Difficulty seeing near objects
3) Difficulty discriminating sounds
4) An abnormal change for older adults



____  13.   How does presbyopia affect communication?

1) Difficulty speaking
2) Difficulty seeing near objects.
3) Difficulty discriminating sounds
4) An abnormal finding in older adults



____  14.   Which facilitates communication in interdisciplinary team (IDT) conferences?

1) Setting time limits on the discussion of each resident
2) Requiring that all members attend on time and are prepared
3) Writing the needed changes in the plan of care before the meeting
4) Inviting the family to meet with individual members of the team rather than coming to IDT meetings



____  15.   What type of communication includes the words “I feel”?

1) Active listening
2) Passive communication
3) Assertive communication
4) Aggressive communication



____  16.   Which is an assertive response to being embarrassed by another nurse in front of a family?

1) “Could you just shut up?”
2) “I feel you are out of line.”
3) “You are so insensitive to my feelings.”
4) “When you yell at me in front of family members, I feel very humiliated.”



____  17.   What type of communication does this statement demonstrate? “When you take responsibility for my tasks, I feel threatened and unprofessional. We should try to talk about events that occur so that we can resolve them together.”

1) Passive
2) Assertive
3) Nonverbal
4) Aggressive



____  18.   What is the major block to active listening with an angry resident?

1) Lack of time to listen
2) Tendency to prepare a defense
3) Amount of anger being expressed
4) Unwillingness of the angry person to negotiate solutions



____  19.   The family of a nursing home resident is yelling at the nurse’s station about the substandard care being provided to the resident. What action should the nurse take first?

1) Listen to the family member.
2) Move the conversation to a private area.
3) Offer the family member a chair to sit down.
4) Tell the family member to wait in the resident’s room.



____  20.   What is a characteristic of a good nurse manager?

1) Always doing
2) Always planning
3) Relying on crisis management to attain results
4) Evaluating subordinates only when required to by organization rules



____  21.   What is essential for the nurse manager to understand about planning?

1) It is the act of sitting in an office with the door shut to think things through clearly.
2) It is the ability to make a plan and have the strength to never change it despite what happens.
3) It is the process of making decisions based on facts and information rather than emotions and wishes.
4) It is developing the flexibility to keep making changes in the plan in each of the four critical aspects of the planning loop.



____  22.   What causes the need for crisis management?

1) Budget cuts
2) Poor planning
3) Lack of supplies
4) Inappropriate workloads



____  23.   What is crisis management?

1) Something that cannot be avoided
2) An effective method of resolving problems
3) Instilling a feeling of trust in staff members
4) Something that can be prevented by anticipating problems and planning



____  24.   The nurse is testing a plan of care. Which step of the planning loop is the nurse performing?

1) Assessment
2) Planning
3) Implementation
4) Evaluation



____  25.   The staff development trainer is preparing materials to instruct new charge nurses about the planning loop. What should the trainer use to help explain this loop?

1) Nursing process
2) Care planning process
3) Discharge planning process
4) Policies and procedures



____  26.   The charge nurse intends to use the planning loop for a staff scheduling issue. What information should the nurse collect first?

1) Number of staff available to work
2) Dates for the next charge nurse meetings
3) Number of care plans completed on residents
4) Expected time the pharmacy will deliver medications



____  27.   The nurse manager must know how to determine priorities to be effective. When identifying priorities what needs should the manager think of?

1) Upper management
2) The entire organization
3) The staff, because happy staff give good care
4) The person most likely to sue the organization



____  28.   Nursing assistants who work the day shift have requested that they be assigned the same group of residents every day that they work. What is a negative aspect of this proposal?

1) Potential for residents to become accustomed to a certain routine
2) Potential for residents to have increased interpersonal bonding with a nursing assistant
3) Potential for residents to develop a sense of being part of the team that plans their individual care
4) Potential for a demanding resident to “burn out” a nursing assistant who is routinely assigned to care for him or her



____  29.   Which is NOT a category of nursing staff according to Benner?

1) Expert
2) Novice
3) Proficient
4) Incompetent



____  30.   The nurse manager has one expert certified nursing assistant (CNA), two advanced beginner CNAs, two proficient CNAs, one competent CNA, and one novice CNA assigned for the day shift. Who should be paired with the novice CNA?

1) Expert CNA
2) Proficient CNA
3) Competent CNA
4) Advanced beginner CNA



____  31.   A resident is being moved to a room at the other end of the hall. What should the nurse manager do about the assignment for this resident?

1) Keep the same CNA.
2) Reassign to another CNA.
3) Assign to the charge nurse.
4) Nothing, because all care should be completed.



____  32.   A resident who has a body mass index of 33 must be transferred to a chair. The charge nurse assigns a novice CNA who is 5 foot 1 inch tall and of slight build. What should be done about this situation?

1) Tell the staff nurse to transfer the resident to the chair.
2) Nothing, because the CNA must learn to manage all types of residents.
3) Remind the charge nurse of the resident’s size so the assignment can be changed.
4) Consider terminating the CNA for inability to provide care to all types of residents.



____  33.   Which is NOT a part of the Five Rights of Delegation?

1) Right patient
2) Right direction
3) Right supervision
4) Right circumstances



____  34.   Which task should NOT be assigned to a CNA?

1) Assist a frail older adult to the bathroom.
2) Decide how often the pulse reading should be taken.
3) Help an older adult with personal grooming.
4) Take an apical pulse and report the reading to the nurse.



____  35.   Before delegating, what should the licensed nurse do?

1) Select the nursing assistant to delegate tasks to.
2) Ask the nursing assistants if they are willing to perform extra tasks.
3) Ask the charge nurse if there is anything in particular that is a priority.
4) Learn permissible delegation behaviors from the State Nurse Practice Act.



____  36.   What is the priority when delegating tasks to certified or unlicensed assistive personnel?

1) Resident safety
2) Task completion
3) Cost effectiveness
4) Time management



____  37.   What opportunity does the employment interview serve?

1) Exchange information with qualified applicants.
2) Determine if the applicant has the necessary physical attributes for the job.
3) Determine if the applicant has the necessary education or training for the position.
4) Ensure that the applicant’s race and ethnic heritage are congruent with the resident population.



____  38.   Which statement is inappropriate during a job interview?

1) “Have you ever worked night shifts?”
2) “Where did you receive your CNA training?”
3) “Tell me about your last nursing assistant position.”
4) “You have a lovely name. Were you born in the United States?”



____  39.   The nurse hears about an afternoon shift nursing assistant using the telephone in one of the resident’s rooms to talk to friends and not completing assigned resident care duties. What is the most important action of the nurse before confronting the assistant?

1) Review the facility’s guidelines for probation.
2) Visit each of the residents in the assistant’s care assignment.
3) Call the nursing supervisor to initiate the termination process.
4) Write a detailed narrative of the nursing assistant’s complaints.



____  40.   A nursing assistant is having trouble staying awake on the night shift and is found sleeping in the day room. What should the nurse do?

1) Encourage the nursing assistant to work day shifts.
2) Ask the other assistants to cover for the employee who is sleeping.
3) Review options and provide the employee with a written warning.
4) Suggest changing daytime activities so sleep can occur when not working.



____  41.   A reliable CNA who is liked by most staff and some patients is very loud and gregarious while at work, which frequently causes a problem. During the annual evaluation, this issue is not addressed. What does this say about the employee’s behavior?

1) This is appropriate because the employee is reliable.
2) This is appropriate because the employee cannot change his personality.
3) This should be ignored because for the last 2 weeks it has not been a problem.
4) This is inappropriate because the manager is not helping the employee improve and is being too lenient.



____  42.   A nursing assistant with an evaluation due in 2 weeks came in early to help with a staffing crisis and saved a choking family member by performing the Heimlich maneuver. The evaluation is certain to be full of high praise for skills and teamwork. Is this an appropriate evaluation?

1) This is a fair evaluation because of care provided over the last 2 weeks.
2) This is a situation in which a halo effect is influencing the entire evaluation.
3) This is a situation in which a leniency error is influencing the entire evaluation.
4) This is a fair evaluation because of no problems with the employee over the entire year.



Multiple Response

Identify one or more choices that best complete the statement or answer the question.


____  43.   The nurse manager is planning to hire additional CNAs to begin September 1. When should the manager expect the new staff to have completed orientation?

1) October 1
2) November 1
3) December 1
4) January 1



____  44.   Why should the manager assign an expert nursing assistant to serve as a mentor for newly hired assistants?

1) To reduce the amount of overtime pay
2) To have the expert assistant serve as a role model
3) To give the expert assistant a break with resident care
4) To determine if the new hire is appropriate for the role



____  45.   Which is NOT a component of total quality management (TQM)?

1) Employee focus
2) Total organizational involvement
3) Identifying processes for improvement
4) Using quality tools for outcome measurement



____  46.   What comment made by nursing staff indicates additional education about TQM would be beneficial?

1) “I’ll be right there.”
2) “That’s not my job.”
3) “We work together.”
4) “What can I do to help?”



____  47.   For which characteristic of TQM would the Plan-Do-Check-Act (PDCA) Cycle be appropriate?

1) Customer/patient focus
2) Total organizational involvement
3) Identify key processes to improve
4) Use of quality tools and statistics for measurement



____  48.   The licensed nurse is considering delegating tasks to assistive personnel. What needs to be done before performing this delegation? Select all that apply.

1) Review position descriptions.
2) Check for appropriate supplies.
3) Study the policy and procedure manual.
4) Ask the medical director for permission.
5) Analyze the times scheduled for staff lunches.



____  49.   The administrator of a skilled nursing facility is implementing a clinical ladder for licensed and certified staff. What should the administrator expect as benefits of this model? Select all that apply.

1) Improved morale
2) Less overtime pay
3) Improved staff health
4) Improved patient care
5) Less employee turnover



____  50.   The manager is preparing materials to explain TQM to the care staff. What should the manager emphasize as the overall purpose of TQM? Select all that apply.

1) Improve quality of service.
2) Ensure customer satisfaction.
3) Increase access to health care.
4) Reduce the cost of health care.
5) Eliminate overlapping positions.

Chapter 15: Common Medical Diagnoses


Multiple Choice

Identify the choice that best completes the statement or answers the question.


____    1.   Which statement is true about chronic conditions in an older patient?

1) Chronic conditions are stable and unchangeable over time.
2) Chronic conditions are often cured when they are detected.
3) Chronic conditions develop rapidly and respond to prompt medical intervention.
4) Chronic conditions often are not evident until they negatively affect an older person’s functional ability.



____    2.   What are the three most common chronic health conditions of older adults?

1) Diabetes mellitus, arthritis, influenza
2) Arthritis, heart disease, diabetes mellitus
3) Arthritis, heart disease, sensory changes
4) Diabetes mellitus, heart disease, pneumonia



____    3.   Which nursing focus is appropriate when dealing with chronic conditions?

1) Base care on the ability to cure.
2) Allow patients to deny a disability because it will pass.
3) Use more sophisticated, high-technology interventions to assist the patient.
4) Assist the patient to attain the highest possible level physically, socially, psychologically, and spiritually.



____    4.   An older person with chronic obstructive pulmonary disease (COPD) asks why the pneumococcal vaccination is necessary. How should the nurse respond to this person?

1) “It will prevent the development of pneumonia.”
2) “It will improve your lung functioning as you age.”
3) “It will reduce shortness of breath and fatigue when exercising.”
4) “It will prevent the COPD from getting worse.”



____    5.   While attending a community health fair, an older person says that she doesn’t know when arthritis developed. One day she was able to bend over to tie her shoes and the next day she couldn’t. How should the nurse respond to this person?

1) “Maybe you don’t have arthritis.”
2) “Have you been to see your doctor?”
3) “Chronic conditions develop over time.”
4) “The stiffness will resolve in a few months.”



____    6.   When calling on an older community member, the nurse is greeted at the door by a non-family member who identifies herself as the caregiver. What should the nurse focus on when assessing this community member?

1) Financial status
2) Environmental safety
3) Potential for elder abuse
4) Chronic health problems



____    7.   The nurse reviews ways to help an older person maintain independence with osteoarthritis. Which patient statement indicates that additional teaching about the chronic condition is required?

1) “I’ll take my medications and in a few months the arthritis will be healed.”
2) “If I get up from bed slowly and move deliberately the joint pain will ease.”
3) “I understand the importance of walking every day to keep my muscles strong.”
4) “I will use pillows to support my joints so that I can get adequate rest each night.”



____    8.   Which statement describes a goal for the review of systems?

1) Analyze older adults’ awareness of their bodies.
2) Increase the speed and efficiency of the physical examination.
3) Identify symptoms that affect the current health status of the older adult.
4) Relax older adults so that they are less nervous for the actual examination.



____    9.   The nurse is preparing to conduct a review of systems with an older patient. Which observation should indicate to the nurse that questions about the respiratory system are a priority?

1) Burping
2) Dry skin
3) Coughing
4) Walking slowly



____  10.   An older patient is experiencing shortness of breath during the night. How should the nurse document this finding?

1) Orthopnea
2) Dyspnea on exertion
3) Paroxysmal nocturnal dyspnea
4) Shortness of breath during sleep



____  11.   During the review of systems, an older patient explains experiencing increased hunger, frequent urination, and a 5-lb weight loss in the last month. Which body system should the nurse focus on when assessing for additional information?

1) Endocrine
2) Pulmonary
3) Genitourinary
4) Gastrointestinal



____  12.   What is the underlying problem in a myocardial infarction (MI)?

1) The heart stops pumping blood.
2) The heart valves have become stiff and do not close properly.
3) The heart muscle is not receiving enough blood to operate properly.
4) The major blood vessels bringing blood to the heart become occluded, causing peripheral edema and lung congestion.



____  13.   What manifestations of an MI might be assessed in an older patient?

1) Pain in the joints
2) Severe constipation
3) Nausea and dyspnea
4) Headache and intense hunger



____  14.   Which are possible complications of an MI in an older adult?

1) Deconditioning, nausea, and congestive heart failure (CHF)
2) Tuberculosis, nausea, and vomiting
3) Emboli, extension of the infarct, and CHF
4) Diabetes, CHF, and thrombi



____  15.   Which statement best describes CHF?

1) It is commonly associated with birth defects that do not manifest until old age.
2) It is a congested and overloaded cardiovascular system that requires the heart to work harder.
3) It is heart failure associated with the heart’s loss of muscle mass and efficiency in conduction of electrical impulses.
4) The major blood vessels bringing blood to the heart become occluded, causing peripheral edema and lung congestion.



____  16.   Which would NOT be a nursing responsibility in caring for an older adult with CHF?

1) Provide a low-salt diet.
2) Weigh at the same time every day.
3) Assess for signs of pedal or other dependent edema.
4) Increase fluid intake to compensate for potential fluid depletion with the use of diuretics.



____  17.   Which is NOT a common cause of CHF in an older adult?

1) Anemia
2) Diabetes
3) Thyroid disease
4) Heart valve calcification



____  18.   What technique should the nurse use to check for postural hypertension?

1) Blood pressure (BP) and pulse while lying, sitting, and standing with no rest period
2) BP and respirations lying, sitting, and standing at 5-minute intervals
3) BP and respirations after 20 minutes of rest in a flat position, then with 5 minutes of sitting and again 5 minutes after standing
4) BP and pulse after 5 to 10 minutes of rest in a flat position, then within 1 minute of sitting and again after 1 minute of standing



____  19.   An older patient is prescribed digoxin. What is NOT essential for the nurse to keep in mind for this medication?

1) High doses may cause confusion as a side effect.
2) Falling from orthopnea is a common and frequent side effect.
3) It requires periodic monitoring of drug blood levels to prevent toxicity.
4) It is used in the treatment of CHF to strengthen the force of the heart contraction.



____  20.   An older patient who is being treated with high-volume intravenous fluids for dehydration is prescribed propranolol (Inderal) for migraines and cimetidine for gastric ulcers. The patient currently has bilateral edema of the lower extremities, edema of the periorbital area, and a respiratory rate of 26. What should the nurse suspect is occurring with this patient?

1) CHF
2) Gout
3) Medication reaction
4) Impending MI



____  21.   Which would NOT be wise to instruct as a health promotion nursing intervention for older adults with hypertension?

1) Encouraging a physician-ordered exercise plan
2) Monitoring blood pressure changes associated with positional hypotension
3) Making diet changes to encourage weight loss, reduced salt intake, and lowered cholesterol intake
4) Tapering older adults off of antihypertensive medications as soon as their blood pressure returns to normal range



____  22.   Which patient is at a higher risk for hypertension?

1) White man, age 55, height 6 feet, weight 210 lb
2) White woman, age 70, height 5 feet 1 inch, weight 130 lb
3) African-American man, age 70, height 6 feet, weight 250 lb
4) African-American man, age 72, height 6 feet 2 inches, weight 190 lb



____  23.   What causes leg ulcers in older adults with peripheral vascular disease (PVD)?

1) Poor hygiene practices
2) Pressure from bed-bound status
3) Dryness of the skin
4) Impaired circulation to lower extremities



____  24.   What should the nurse include when teaching a patient with PVD?

1) Uncrossing legs, avoiding temperature extremes, using cotton socks
2) Avoiding constricting clothing, avoiding infection, having one glass of red wine per day
3) Keeping legs dependent, avoiding temperature extremes, and avoiding constricting clothing
4) Applying salve with gauze and tape to open areas, having one glass of red wine per day, avoiding temperature extremes



____  25.   Which are characteristics of a right hemisphere stroke not typically associated with a left hemisphere stroke?

1) Weakness and paralysis
2) Hemiparesis and hemiparalysis
3) Poor judgment and overestimation of abilities
4) Need for support for ambulation and activities of daily living (ADLs)



____  26.   What causes unilateral neglect?

1) Brainstem involvement
2) Left hemisphere stroke
3) Total loss of movement or sensation
4) Loss of visual fields related to the stroke



____  27.   An older patient who has had a stroke insists on doing things for herself. This is creating safety concerns. Which type of stroke did this patient most likely experience?

1) Brainstem
2) Cerebellar
3) Left hemisphere
4) Right hemisphere



____  28.   What should the nurse do to prevent the risk of deconditioning with an older adult who has had a stroke?

1) Increase fluid intake.
2) Monitor medications.
3) Initiate a mobility program.
4) Promote a regular toileting schedule.



____  29.   What would least likely reduce the risk of complications after a stroke?

1) Monitoring medications
2) Ensuring adequate hydration
3) Providing immunizations for pneumonia, flu, and tetanus
4) Encouraging dependence on family members and caregivers



____  30.   What is the primary nursing goal for an older person with Parkinson’s disease (PD)?

1) Maintain continence.
2) Maintain function and self-care.
3) Facilitate taking medications as ordered.
4) Avoid development of the characteristic shuffling gait.



____  31.   Which is NOT true of Parkinson’s disease (PD)?

1) It most commonly affects women.
2) The primary treatment is medication.
3) It usually appears between 60 and 80 years of age.
4) It is characterized as a progressive disease with slow movement, rigidity, unstable posture, and tremors at rest.



____  32.   Which is considered a major cause of blindness?

1) Glaucoma
2) Presbyopia
3) Cataract development
4) Macular degeneration



____  33.   Which statement is true about hearing loss in older people?

1) It is uncommon.
2) It cannot be treated or compensated for.
3) It may affect high-frequency tones in particular.
4) It occurs more frequently in women than in men.



____  34.   Which are primary symptoms of chronic obstructive pulmonary disease (COPD)?

1) Cough, joint pain, and peripheral edema
2) Heart palpitations and difficulty breathing
3) Cough, shortness of breath, and dyspnea on exertion
4) Peripheral edema, cyanotic nail beds, and heart palpitations



____  35.   Which would NOT be a helpful self-care measure for an older adult with COPD?

1) Keep track of a medication schedule.
2) Obtain influenza and pneumococcal immunizations to prevent infections.
3) Recognize signs and symptoms of infection, such as cough or changes in sputum.
4) Engage in an aggressive aerobic exercise program to promote effective oxygen use.



____  36.   An older patient with end-stage COPD is anxious and claims that the oxygen tubing is clogged and not providing enough oxygen. Which self-care strategy would assist this patient to be more comfortable?

1) Quitting smoking
2) Increasing the liter flow on the oxygen
3) Increasing the dosage of narcotic pain relievers
4) Teaching strategies to deal with anxiety and obstruction of air flow



____  37.   An older patient is experiencing morning stiffness in the back, hips, and knees, along with enlarged joints. What should the nurse explain about these manifestations?

1) Joint replacement surgery is contraindicated.
2) These problems are associated with degenerative joint disease.
3) These problems are an expected consequence of aging.
4) Less exercise and weight-bearing activities is recommended.



____  38.   What is the major goal of nursing care for an older person with osteoporosis?

1) Limitation of activities
2) Changing of dietary practices
3) Prevention of further bone demineralization
4) Prevention of injuries, especially related to falls



____  39.   Which would NOT be helpful to teach patients with osteoporosis and their family members?

1) Limiting caffeine, tobacco, and alcohol
2) Decreasing the intake of yogurt and milk
3) Removal of scatter rugs and other trip items
4) Installing grab bars in the shower and toilet areas



____  40.   Which would NOT be a part of the teaching plan for an older adult who has type 2 diabetes mellitus?

1) Care of feet
2) Limitation of activity
3) Need for regular eye examinations
4) Recognition of signs and symptoms of infection



____  41.   What are the nursing considerations for an older adult who has been started on thyroid replacement therapy?

1) Schedule for weekly blood glucose levels.
2) Schedule for a drug blood level done in 4 weeks and teach how to monitor heart rate.
3) Schedule for a complete blood count (CBC) and electrolyte level within 1 month and teach the signs and symptoms of infection.
4) Schedule for weekly blood glucose levels and encourage doing daily self-blood glucose monitoring.



____  42.   What is hypothyroidism often confused with?

1) Emphysema
2) Characteristics of aging
3) Congestive heart failure
4) Degenerative joint disease



____  43.   An older person with hypertension is being started on an aerobic exercise program. What should the nurse emphasize when teaching the patient about this program?

1) Be sure to stretch after walking.
2) Take a cool shower after walking.
3) Perform 15 minutes of aerobic walking five times a week.
4) Perform 10 minutes of aerobic walking two to three times a week.



____  44.   An older person prescribed an angiotensin-converting enzyme inhibitor has stopped taking the medication. For which adverse effect of the medication should the nurse assess in this patient?

1) Anxiety
2) Insomnia
3) Palpitations
4) Nonproductive cough



____  45.   The nurse is preparing an education session for older community members on actions to prevent a stroke. What should the nurse emphasize as being the most important modifiable risk factor for stroke?

1) Arthritis
2) Pneumonia
3) High blood pressure
4) Gastroesophageal reflux disease



____  46.   An older patient recovering from a stroke coughs when drinking fluids. What should the nurse consider to prevent this patient from aspirating?

1) Thickening the fluids
2) Increasing intravenous fluid infusion
3) Making the patient nothing by mouth status
4) Providing all nourishment through tube feedings



____  47.   An older patient with CHF talks with adult children about the future and what they should focus on to take care of their family home once she passes away. What should the nurse realize that this conversation indicates?

1) The patient has financial difficulty.
2) The adult children are unemployed.
3) The adult children still live at home.
4) The patient has achieved gerotranscendence.



____  48.   The nurse is assessing a newly admitted older resident to a skilled nursing facility. Which statement indicates that the patient has achieved gerotranscendence?

1) “I worked too much during my life.”
2) “I’m so angry with my family for putting me here.”
3) “I can’t wait to get better so I can go to bingo with my friends.”
4) “I have enjoyed a wonderful life and know I won’t live forever.”



Multiple Response

Identify one or more choices that best complete the statement or answer the question.


____  49.   An older person says that she does not want to become sick like many of her friends and just sit around talking about illnesses. What should the nurse suggest to help this person prevent the development of chronic health problems? Select all that apply.

1) Don’t smoke.
2) Eat a healthy diet.
3) Engage with family and friends.
4) Enjoy alcohol with every dinner.
5) Have routine physical examinations.



____  50.   Why is a review of systems when assessing and taking the history particularly useful with an older adult? Select all that apply.

1) Older adults often have nonspecific atypical symptoms.
2) The review cuts into the amount of time the patient needs to be examined.
3) Changes associated with aging may affect more than one body system.
4) The review determines if prescribed medications are appropriate for the health problems.
5) Older adults often have a complex history and a review can help relate past experiences with the present.



____  51.   When conducting a nursing assessment of the gastrointestinal tract, which questions would be helpful? Select all that apply.

1) Sexual activity
2) Use of laxatives
3) Food intolerances
4) Burning or pain with urination
5) Abdominal distress before or after meals



____  52.   Which immunizations should the nurse assess for when conducting a review of systems with an older patient? Select all that apply.

1) Polio
2) Shingles
3) Influenza
4) Hepatitis B
5) Pneumococcal



____  53.   The nurse is beginning a review of systems with an older patient. What areas should be included when assessing this patient’s neurological system? Select all that apply.

1) Gait
2) Vision
3) Hearing
4) Bruising
5) Nocturia



____  54.   What are symptoms of diabetes in an older person? Select all that apply.

1) Thirst
2) Fatigue
3) Weakness
4) Confusion
5) Weight loss



____  55.   Which blood tests are used to help diagnose an acute MI? Select all that apply.

1) Troponin
2) Phosphokinase
3) Serum albumin
4) Creatine kinase
5) Hemoglobin A1c



____  56.   An older patient is newly diagnosed with CHF. Which medication should the nurse expect to be prescribed for this patient? Select all that apply.

1) Digoxin
2) Diuretics
3) Antibiotics
4) Anticoagulants
5) Angiotensin-converting enzyme inhibitors