N421: The Gerontological Nurse Exam 54 Questions with Verified Answers
Scope of Practice - CORRECT ANSWER 1) Defined by the ANA → assessment,
... [Show More] diagnosis, planning, implementation, and evaluation
2) Key elements = quality, evidence, and safety
Major Professional Standards - CORRECT ANSWER 1) ANA Scope and Standards of Practice
2) ANA Guide to Ethics
3) ANA Guide to Social Policy Statement
What guides nursing practice at the state level? - CORRECT ANSWER State board of nursing exam (NCLEX)
Gerontological Nursing Standards - CORRECT ANSWER 1) Standards = nursing process (ADPIE)
2) Practice = address issues of access to healthcare services, quality and affordability of health care, and coordination of services by an interdisciplinary team
3) Role = patient advocate, nurse educator, nurse manager, nurse consultant, and nurse researcher
Gerontology Advanced Practice Nurse positions - CORRECT ANSWER 1) Adult Gerontology Clinical Nurse Specialist (AGCNS-BC)
2) Geriatric Nurse Practitioner (GNP-BC)
3) Adult-Gerontology Acute Care Nurse Practitioner (AGACNP-BC)
4) Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP-BC)
Quality and Safety Education for Nurses (QSEN) - CORRECT ANSWER 1) Purpose = meet the challenges of preparing future nurses who will have the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare system
QSEN: Key Components - CORRECT ANSWER 1) Patient-centered care
2) Teamwork (communication and collaboration)
3) EBP
4) Quality initiatives
5) Safety
6) Informatics
Functional Ability and the Older Adult - CORRECT ANSWER 1) Primary focus when caring for the older adult is FUNCTIONAL ABILITY
2) Want to maximize their strengths and add patient teaching or support to their weaknesses
3) If there are issues with functional ability then there may be issues with any of the blue bubbles
Functional Ability - CORRECT ANSWER 1) Functional ability is located on a continuum from fully independent to complete dependence
2) Independence and dependence vary depending on location and different areas
3) Basic activities of daily living (BADLs)
4) Instrumental activities of daily living (IADLs)
BADLs - CORRECT ANSWER 1) Dressing
2) Personal hygiene
3) Cooking and eating
4) Using the toilet
IADLs - CORRECT ANSWER 1) More complex set of skills that allow you to live independently
2) Paying bills
3) Cooking healthy meals
4) Cleaning your home
5) Being able to dial a telephone
6) Take prescribed medication correctly
Capacity vs. Actual Performance - CORRECT ANSWER 1) Capacity = ability to perform a task
2) Actual performance = amount of assistance needed, amount of time needed, level of performance
3) Eg. Hand-off report: "Will need two assists, level of performance is poor because you have to keep repeating yourself, and it will take twice the amount of time"
Diminishing Functional Ability: Risk Factors - CORRECT ANSWER 1) Developmental abnormalities
2) Age
3) Cognitive function
4) Mental health issues (substance abuse issues)
5) Physical or psychological trauma (including PTSD, interpersonal violence)
6) Illness (acute or chronic)
Functional Assessment - CORRECT ANSWER 1) Comprehensive functional assessment is time-intensive and should be an interprofessional effort
Functional Assessment: Indications - CORRECT ANSWER 1) Children with delays in developmental milestones
2) Adults with loss of functional ability, change in mental status, multiple health conditions, or frail elderly person living in a community setting
Functional Assessment Components - CORRECT ANSWER 1) Vision
2) Hearing
3) Mobility
4) Falls
5) Continence
6) Nutrition
7) Cognition
8) Affect
9) Home environment
10) Social participation
11) BADLs, IADLs
Functional Assessment: Level of Assistance/Dependency - CORRECT ANSWER 1) No assistance
2) Partial assistance
3) Total assistance
Functional Assessment: Level of Difficulty - CORRECT ANSWER 1) No difficulty
2) Some difficulty
3) Unable to perform
Goal of Care Delivery - CORRECT ANSWER 1) Maintain optimal independent function and prevent functional decline for health-related quality of life
2) Reduce risk
3) Early detection and screening
4) Management of functional activity impairment, involving multidisciplinary approach
Reducing Risk - CORRECT ANSWER NB. Regular lifestyle interventions
1) Well-balanced nutrition
2) Regular physical activity
3) Routine health checkups (covered by medicare)
4) Stress managment
5) Regular participation in meaningful activity
6) Fall prevention measures
7) Avoidance of tobacco and other substances associated with abuse
Functional Impairment: Interventions - CORRECT ANSWER 1) Multidisciplinary approach
2) Interventions depend on the underlying cause of impairment (eg. visual, mobility, cognitive, mental health, etc.)
3) Self-care assistance for BADLs and IADLs
4) Fall prevention
5) Exercise therapy
6) Teaching safe use of assistive devices
Implementation of Nursing Care Plan (NCP): Nursing Role - CORRECT ANSWER 1) Considers information from physical, cognitive, social, psychological, and functional assessment of the patient
2) Considers patient ability for BADLs and IADLs
3) Works in collaboration with the patient to choose appropriate interventions
4) Evaluation!
Regulations and Laws - CORRECT ANSWER 1) Standards of Care
2) Joint Commission (JC)
3) Social Security Amendments of 1965
4) HIPAA
5) OBRA = Federal Nursing Home Reform → protects resident rights, restraints, etc.
Skilled Nursing Facilities (SNF)/LTC - CORRECT ANSWER 1) For residents who need some skilled services, usually after a hospital stay (prepare them to go home)
2) LTC facilities have services with OT, PT, etc. on site
Continuing Care Retirement Communities - CORRECT ANSWER 1) Aging in place
2) Older adult enters very functionally independent
3) Should their functional ability change, they are moved into assisted living
4) Very expensive ~$68,000/year
Assisted Living - CORRECT ANSWER 1) Assistance with ADLs
2) Eating in dining room with other residents
3) Have to have some level of competence
4) For individuals who have trouble with IADLs
Residential Care/Rest Homes - CORRECT ANSWER 1) Getting a room and not much else assistance
2) May get some help with laundry but very limited oversight
Adult Day Care - CORRECT ANSWER 1) Come into the home to provide assistance
2) Older adult can be dropped off while adult family member goes to work
Stay in Own Home with support - CORRECT ANSWER 1) Most older adults will stay in their own home with support
2) Least expensive option
Special Care Needs for Older Adults - CORRECT ANSWER 1) Functional ability (assistance with ADLs)
2) Cognitively impaired
3) Homebound
4) No longer able to live at home and/or homeless
Risks Related to Hospitalization - CORRECT ANSWER 1) NB. WORST PLACE FOR AN OLDER ADULT
2) Adverse drug reactions
3) Changes in cognitive status = delirium, dementia, depression (3 D's)
4) Infection, immobility, incontinence
5) Skin breakdown
6) Sleep disorders
7) Problems with eating and feeding
8) Falls
ACE unit - CORRECT ANSWER 1) Acute Care for Elderly
2) Nurses in this unit have specialties for caring for the elderly
Long-term Care (LTC) - CORRECT ANSWER 1) Minimum data set (MDS) required for LTC admission
2) Staffing standards mandate that long-term care facility residents receive at least 4.13 hours of direct nursing care each day
3) Reality = 3.5 hours/resident/day
LTC: Goals - CORRECT ANSWER 1) Preserve quality of life
2) Preserve dignity
3) Satisfaction of lifestyle preferences
Restraints - CORRECT ANSWER 1) Physical = devices that inhibit movement
2) Chemical = antipsychotics, benzodiazepines, anti-anxiety → LAST RESORT, cannot use this to control behavior, restlessness, insomnia, yelling, or screaming
3) Use of restraints requires physician order
4) Strict parameters = initiation, evaluation, continuance, and documentation
Home Care Services: Medicare Requirements - CORRECT ANSWER 1) Skilled care needed
2) Homebound
3) Unable or unwilling or have no one in the home available to provide care
4) Requires intermittent care
5) Nurse or physical therapist acts as case manager
6) Evaluation = on admission, change of status, prior to discharge
Community-based Services - CORRECT ANSWER 1) Multipurpose senior centers
2) Adult Day Care Services
3) Respite Care
4) Homemaker services
5) Nutrition services
6) Transportation services
7) Telephone monitoring/friendly visitors
8) Personal emergency response systems
9) Home health care
10) Hospice
Medicare - CORRECT ANSWER 1) Federally funded
2) Age years 65+, individuals with a disability, or end-stage renal failure
3) In order to benefit, must have paid in
Medicare Part A - CORRECT ANSWER 1) In-patient, hospital care, skilled nursing facility, hospice, and home health
Medicare Part B - CORRECT ANSWER 1) Partial out-patient visits, some preventative services
2) Have to pay an annual premium and deductible
3) Only pays 80%, but people can buy supplemental insurance
Medicare Part C - CORRECT ANSWER 1) Medicare Advantage Plans
Medicare Part D - CORRECT ANSWER 1) Prescription drug coverage
2) Doesn't cover the whole thing
3) "Donut hole" = lack in coverage after you hit your prescription coverage ceiling
4) Patients can lack the personal funds where they cannot afford meds that fall in the donut hole → will cut meds/doses in half in order to get by until covered again
Medicaid - CORRECT ANSWER 1) For people living below the poverty line or disabled
2) State-administered and pulls from Federal funds
Life Changes with Aging - CORRECT ANSWER 1) Retirement
2) Role change
3) Life review
4) Widowhood
5) Fixed income
6) Health changes
Communication - CORRECT ANSWER 1) Ongoing, continuous, dynamic process that includes verbal and nonverbal signals
Communication Barriers - CORRECT ANSWER 1) Fear of one's own aging
2) Fear of showing emotion or being around emotional patients
3) Feeling the need to write down every detail of the encounter
4) Lack of knowledge about the patient's culture, goals, and values
5) Unresolved issues with aging relatives in the nurse's own family
6) Feeling that professional distance must be maintained at all cost
7) Being overworked or overscheduled
Patient and Family Teaching - CORRECT ANSWER 1) Older adults often underreport their symptoms
2) Rather than asking them if they are in pain, ask them in they are in any discomfort
3) Cascade of events for older adults → benign issue becomes worst issue
Beneficence/nonmaleficence - CORRECT ANSWER To do good and not harm patients
Justice - CORRECT ANSWER To be fair and distribute scarce resources equally to all in need
Autonomy - CORRECT ANSWER To respect patients' needs for self-determination, freedom, and patient rights
Veracity - CORRECT ANSWER 1) Truthfulness (within the confines of what the patient wants to know)
Important Aspects of Ethical Decision Making - CORRECT ANSWER 1) Assessment
2) Relevant contextual factors
3) Capability of the patient to make decisions
4) Patient preferences
5) Needs of the patient as a person
6) Preferences of the family
7) Issues of power or conflict
8) Opportunity for all involved to speak and be heard
Leading Causes of Death >65 yo - CORRECT ANSWER 1) Heart disease
2) Malignant neoplasms
3) Cerebrovascular
4) Bronchitis/emphysema/asthma
5) Diabetes mellitus
6) NB. people are living longer and are surviving chronic conditions
Most Common Causes of Disability in the US - CORRECT ANSWER 1) Degenerative join disease
2) Chronic back pain
3) Atherosclerosis
4) Lung or respiratory problems
5) Deafness or hearing problems
6) Mental or emotional problems
7) **Diabetes mellitus
8) Blindness or vision problems
9) Stroke [Show Less]