Details of TEST BANK Ebersole and Hess’ Toward Healthy Aging 9th Edition TouhyChapter 01: Health and Wellness in an Aging Society MULTIPLE CHOICE
1.
... [Show More] When asked by new parents what the life expectancy is for their African American newborn, the nurse replies that, “2010 statistics indicate that your son: a. will have a life expectancy of approximately 65 years.”
b. can realistically expect to live into his late 80s.” c. has a good chance of celebrating his 75th birthday.” d. is likely to live into his late 90s.”
ANS: C In 2010, men in the United States at age 60 can expect to live another 22 years. The life expectancy of African American men is about 4.7 years less than white men. Of the options above, C is the only response that fits into those parameters. The other options are not supported by reliable research.
DIF: Cognitive Level: Understanding REF: p. 3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
2. A nurse is planning care for a group of super-centenarians in an assisted living facility. The nurse considers which of the following? a. Most super-centenarians are functionally independent or require minimal assistance with activities of daily living
b. The majority of super-centenarians have cognitive impairment c. The number of super-centenarians is expected to decrease in coming years as a result of heart disease and stroke
d. It is theorized that super-centenarians survived as long as they have due to genetic mutations that made them less susceptible to common diseases
ANS: A Research supports that most super-centenarians are functionally and cognitively intact, requiring minimal assistance with ADLs. The number of super-centenarians is expected to increase in coming years as the number of older adults increases. The reason why individuals survived as long as they have is not known.
DIF: Cognitive Level: Remembering REF: p. 4
TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
3. One reason why many “baby boomers” have multiple chronic conditions such as heart disease, diabetes, and arthritis is that: a. they have less access to medication and other treatment regimens. b. there was a lack of importance placed on healthy living as they were growing up.
c. they did not have access to immunizations against communicable disease when
1 | P a g ethey were children.
d. they grew up in an era of rampant poverty and malnutrition.
ANS: B
The baby boomers, individuals born between 1946 and 1964, post-WWII, have better
access to medication and treatment regimens than other cohorts. They have had the
benefit of the development of immunizations against communicable diseases. They
grew up in an era of prosperity post-WWII. However, there was a lack of importance
placed on what we now consider healthy living when they were younger. Smoking, for
example, was not condoned, but was considered a symbol of status. Candy in the shape
of cigarettes was popular, and there was much secondhand smoke.
DIF: Cognitive Level: Remembering
REF: p. 6
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
4. A nurse is planning an education program on wellness in a local senior citizen center.
The nurse plans to provide education on the importance of immunizations, annual
physical examinations, screening for diabetes, and vision and hearing screening. It is
important for the nurse to understand which of the following?
a. Approximately 40% of older adults (ages 65 and older) utilize available
preventive
services
b. Preventive strategies are more widely used in the 40-64 age group than in the
65
and over age group
c. The research on health promotion strategies in older adults demonstrates that
they
have low efficacy
d. There is an abundance of research specific to health promotion and aging
ANS: A
Approximately 40% of individuals, ages 65 and older, utilize the preventive services
that are available to them. However, only 24% of those between the ages of 40 and 64
do so. There is a paucity of research specific to health promotion and aging; however,
the research that exists demonstrates that health promotion strategies are highly
effective.
DIF: Cognitive Level: Understanding REF: p. 7
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
5. A nurse is caring for an 85-year-old male client with diabetes in a community
setting. The nurse promotes functional wellness by which of the following
activities?
a. Encouraging the client maintains current levels of physical activity
b. Assisting the client to receive all the recommended preventive screenings that
are
appropriate for his age group
c. Teaching the patient how to use a rolling walker so that he can ambulate for
longer
distances
2 | P a g ed. Encouraging the client to attend his weekly chess games
ANS: A
Maintaining existing levels of physical activity is consistent with functional wellness.
Teaching the client how to use a rolling walker enables the client to remain active at
the highest level possible, which is an example of promoting functional wellness.
Receiving recommended screening is an example of promoting biological wellness.
The use of a rolling walker should be based on assessment of physical ability.
Encouraging the client to attend weekly chess games is an example of promoting
social wellness.
DIF: Cognitive Level: Applying
REF: p. 10
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
6. Based on the census reports of 2010, the typical profile of a centenarian in the
United States includes which of the following characteristics?
a. A Caucasian woman who lives in an urban area of a Southern state
b. An African American woman who lives in a rural area of a Southern
state
c. A Hispanic man who lives in an urban area of a Midwestern state
d. A Caucasian man who lives in a rural area of a Midwestern state
ANS: A
Based on the 2010 U.S. Census data, centenarians were overwhelmingly white
(82.5%), women (82.8%), and living in urban areas of the Southern states.
DIF: Cognitive Level: Applying
REF: p. 5
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. Primary prevention strategies for older adults include which of the following? (Select
all that apply.)
a. An annual influenza immunization clinic
b. A smoking cessation program
c. A prostate screening program
d. A cardiac rehabilitation program
e. A meal planning education program for type 2
diabetics
ANS: A, B
Primary prevention refers to strategies that are used to prevent an illness before it
occurs and maintaining wellness across the continuum of care. Immunizations and
smoking cessation are examples of primary prevention. Secondary prevention is the
early detection of a disease or a health problem that has already developed. Prostate
screening is an example of secondary prevention. Tertiary prevention addresses the
needs of individuals who already have their wellness challenged. Cardiac
rehabilitation and meal planning for diabetics are examples of tertiary prevention.
DIF: Cognitive Level: Applying
REF: pp. 8–9
TOP: Integrated Process: Teaching/Learning
3 | P a g eMSC: Client Needs: Management of Care
2. A nurse organizes a health fair for older adults. The nurse’s goal is to focus on the six
priority areas identified by the National Prevention Council. Which of the following
activities should the nurse include? (Select all that apply.)
a. Smoking cessation
b. Depression screening
c. Recognizing elder abuse
d. Cholesterol screening
e. Fitness training
ANS: A, B, C
The six priority areas of the National Prevention Council include tobacco-free living,
preventing drug abuse and excessive alcohol use, healthy eating, injury- and
violence-free living, reproductive and sexual health, and mental and emotional well-
being. Smoking cessation, depression screening, and recognizing elder abuse all
directly address these areas. While cholesterol screening and fitness training are
important for older adults, they do not address these six priority areas.
DIF: Cognitive Level: Analyzing
REF: p. 8
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
3. The “in-between” generation (individuals born between 1915 and 1945) were subject
to which of the following health challenges during their childhood? (Select all that
apply.)
a. Polio
b. Lack of fluoride in the water causing teeth to be soft and cavity prone
c.
“Pigeon Chest,” a malformation of the rib cage due to a lack of
vitamin D
d. Smallpox
e. HIV/AIDS
ANS: A, B, C
Polio was a major fear of this group; the polio vaccine was not available in the United
States until 1955. In many areas water was not fluoridated. “Pigeon Chest” was
common. Smallpox was a concern for the centenarians, not this generation. HIV/AIDS
had not been identified in the early years of 1915-1945.
DIF: Cognitive Level: Remembering
REF: p. 5
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
4. A nursing student is preparing a presentation on the Wellness-Based Model for Healthy
Aging. Which of the following concepts should the student include in the presentation?
(Select all that apply.)
a. Healthy aging is defined by the absence of physical illness alone
b. Healthy aging is individually defined and can change over time
c. There are many strategies to promote healthy aging that are believed to be
helpful
but do not have empirical evidence to support them
d. Healthy aging cannot be achieved by only focusing on later life. It is a lifelong
process
4 | P a g ee. According to this model, an individual with a chronic disease would not be
considered healthy
ANS: B, C, D
Healthy aging is a lifelong process that begins with birth and ends with death. The
concept of healthy aging from a wellness perspective is uniquely defined by each
individual and can change over time. There are challenges to implementing evidence-
based practices on healthy aging because there is a paucity of research on this area.
Therefore, there are many strategies that have been used and determined to be
effective but do not have research evidence supporting them. The subcomponents
with the wellness model are functional independence, self-care management of
illness, personal growth, positive outlook, and social contribution and activities that
promote one’s health.
DIF: Cognitive Level: Applying
REF: p. 7
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
Chapter 02: Gerontological Nursing: Past, Present, and
Future
MULTIPLE CHOICE
1. Serious and well-controlled research studies on aging have been available:
a. only in the past 60 years.
b. since the turn of the 20th
century.
c. following the Great Depression.
d. since the year 2000.
ANS: A
Only in the past 60 years have serious and carefully controlled research studies
flourished. Before that, anecdotal evidence was used to illustrate issues assumed to
be universal, making all the remaining options incorrect.
DIF: Cognitive Level: Remembering
REF: p. 19
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
2. The son of a nursing home resident asks a nurse: “What is the significance of being
certified in gerontology? I see that you are, but not all of the nurses are.” The best
response by the nurse is which of the following?
a.
“National certification as a gerontological nurse is a way to demonstrate
special
knowledge in caring for older adults”
b. “National certification in gerontology is required for all nurses who have
worked
in this setting for 2 or more years”
c.
“National certification is only available to nurses who have a Baccalaureate
degree
in nursing”
d. “Only advanced practice nurses, like nurse practitioners, are certified in
gerontology”
ANS: A
5 | P a g eNational certification is a way to demonstrate special expertise in caring for older
adults. It is not required for practice in any setting across the continuum of care, and
it is not exclusive to nurses with Baccalaureate degrees. There is both a generalist and
a specialist gerontological nursing certification. The generalist functions in a variety of
settings providing care to older adults and their families. The specialist has advanced
gerontological education at a Masters level.
DIF: Cognitive Level: Analyzing
REF: pp. 20–21
TOP: Integrated Process: Communication and
Documentation MSC: Client Needs: Management of Care
3. The major goal of the NICHE (Nurses Improving Care for Health System Elders)
program includes which of the following?
a. Improve outcomes for hospitalized older adults
b. Increase the number of older adults cared for in hospitals
c. Increase the number of iatrogenic complications that occur in hospitalized
older
adults
6 | P a g ed. Decrease 30-day readmission rates for hospitalized older
adults
ANS: A
The goal of NICHE is to improve outcomes for hospitalized older adults. Although D is
a good outcome for hospitalized older adults, it is not one of the major goals of NICHE,
which are broader. Options b and c are not goals that would improve care for older
adults, but would be negative outcomes themselves.
DIF: Cognitive Level: Remembering
REF: p. 22
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. The impact of the Patient Protection and Affordable Care Act of 2010 on
gerontological nursing includes which of the following? (Select all that apply.)
a. Funding to support advanced education in gerontological nursing
b. Funding to support education of faculty in gerontology
c. Funding to increase the number of direct care workers in hospitals
d. Funding to increase nurse-patient ratios in long-term care
e. Funding for advanced training of direct care workers in long-term
care
ANS: A, B, E
The Patient Protection and Affordable Care Act of 2010 provides funding for advanced
education in gerontology, education for faculty in gerontology, and advanced training
for direct care workers in long-term care. The act does not address nurse-patient
ratios or staffing issues in any setting.
DIF: Cognitive Level: Understanding REF: p. 14
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
2. Which of the following are true statements about the current health care workforce?
(Select all that apply.)
a. Approximately 10% of registered nurses (RNs) are certified in gerontological
nursing
b. The number of geriatricians is expected to increase about 50% over the next
25
years
c. The professions of social work, physical therapy, and psychiatry are
demonstrating
the same trends as nursing
d. Europe and the developing countries are experiencing similar shortages in
health
care workers with geriatric expertise as in the United States
e. It is anticipated that there will be a need for approximately 3 million
additional
direct care and professional health care workers by the year 2030
ANS: C, D, E
Less than 1% of RNs are certified in gerontological nursing. The number of geriatricians
7 | P a g eis decreasing, not increasing. Responses C, D, and E are all true.
DIF: Cognitive Level: Understanding REF: p. 14
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
3. Best practice recommendations for undergraduate nursing education in relation to
gerontology include which of the following? (Select all that apply.)
a. Provision of a “stand-alone” course in gerontological nursing
b. Integration of gerontological content throughout the curriculum
c. Replacement of acute care pediatric clinical experiences with gerontological
clinical experiences
d. Recruitment of nurses with Masters and Doctoral degrees and a specialty in
gerontology to faculty roles
e. Requiring all undergraduate nursing students to obtain gerontological
certification
as a requirement for graduation
ANS: A, B, D
Best practices include providing a stand-alone gerontological nursing course as well
as integrating gerontology throughout the curriculum. Recruitment of nurses with a
specialty in gerontology and a Masters or Doctoral degree to faculty roles is a critical
step in making sure that the next generation of nurses is prepared to care for older
adults. Best practices do not recommend removing pediatric clinical experiences and
replacing them with gerontological experiences. Nursing certification is only available
to practicing nurses who meet specific education and practice requirements. It is not
applicable to nursing students.
DIF: Cognitive Level: Understanding REF: pp. 17–18
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
4. Goals of the Eldercare Workforce Alliance include which of the following? (Select all
that apply.)
a. Mandating a minimum of a Baccalaureate degree in nursing in order to
care for
older adults
b. Increasing wages of certified nursing assistants (CNAs) in nursing homes
c. Providing loan forgiveness for individuals who assume faculty roles
d. Developing a nursing certification specific to long-term care
e. Adopting cost-effective care coordination models for older adults across
the
continuum of care
ANS: B, C, E
A, B, and C are all included in the Elder Workforce Alliance goals. Options A and D are
not.
DIF: Cognitive Level: Understanding REF: p. 14
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
8 | P a g e5. A nurse interviews for a job in a hospital that advertises that it is “elderly friendly.”
The nurse would expect to see which of the following in place? (Select all that apply.)
a. An elder-assistance program to help patients remember their appointments
and
navigate the hospital services.
b. A long-term care facility that is affiliated with the hospital
c. Rooms furnished with foldout beds for family members/caregivers
d. An initiative to provide gerontological education for all nurses
e. An initiative to increase the number of patients referred to long-term care
facilities
upon discharge from the hospital
ANS: A, C, D
The guiding principles of an elder friendly facility include treating each patient as a
unique individual and accommodating the patient and family’s special needs. Other
principles include ensuring that the nurses are clinically competent in gerontological
nursing. Tailoring the environment to support the implementation of these principles
is part of this initiative. Option B is not correct as it does not relate to the concept of
an elder friendly hospital. Option E is not correct since this might not be a supportive
intervention for all patients.
DIF: Cognitive Level: Analyzing
TOP: Integrated Process: Caring
REF: p. 22, Box 2-7
MSC: Client Needs: Psychosocial Integrity
6. Significant factors contributing to the growth of community-based care include:
(Select all that apply.)
a. a decrease in the number of available nursing home beds.
b. rapidly escalating health care costs.
c. older adults’ preferences to “age in place.”
d. inadequate numbers of nurses with gerontological specialty education.
e. decreasing numbers of family caregivers.
ANS: B, C
Care will continue to move out of hospitals and long-term care facilities because of
rapidly escalating health care costs and individual preferences to “age in place.” There
has not been a decrease in nursing home beds. Although there are inadequate
numbers of nurses with gerontological specialty training, this is not a factor that has
impacted the growth of community-based care. There is projected to be a decrease in
the number of family caregivers as the caregivers themselves are aging; however, this
does not contribute to the growth of community-based care.
DIF: Cognitive Level: Remembering
REF: p. 23
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
7. Changes in certified nursing facilities in recent years include which of the following?
(Select all that apply.)
a. Increase in the number of subacute beds
b. Decrease in nursing facility length of stay
c. Increase in level of acuity of the residents
d. Decrease in cost of care in the nursing facility
e. Decrease in the number of registered nurses employed in long-term care facilities
9 | P a g eANS: A, B, C
Certified nursing facilities have evolved over recent years. Most facilities have subacute
care units that resemble hospital units caring for more patients with higher acuity than
in the past. Therefore, the average length of stay in a facility has decreased. The cost of
care in the facility has increased due to the increased complexity of illnesses treated,
and the number of registered nurses has increased in order to care for these complex
patients.
DIF: Cognitive Level: Analyzing
REF: p. 23
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
8. Which of the following factors contribute to poor outcomes for older adults during
transitions of care? (Select all that apply.)
a. Inability to read and understand discharge instructions
b. Inadequate financial resources to purchase medications
c. Lack of desire to comply with discharge instructions
d. Improved medication reconciliation during
hospitalization
e. High levels of nurse-patient engagement
ANS: A, B
Language and literacy levels and socioeconomic factors are major contributors to poor
transitions of care for older adults. A high level of nurse-patient engagement
contributes to safe and effective transitions. Medication reconciliation during
hospitalization, at discharge and after discharge, decreases medication discrepancies,
which are the most prevalent adverse event following hospital discharge. There is no
evidence that patients lack the desire to comply with discharge instructions.
DIF: Cognitive Level: Analyzing
REF: p. 24
TOP: Integrated Process: Communication and
Documentation MSC: Client Needs: Safety and Infection
Control
Chapter 04: Cross-Cultural Caring and Aging
MULTIPLE CHOICE
1. A paper on culture and illness would be likely to include the statement that:
a. culture is the same as ethnicity.
b. ethnic groups always share common geographic origin and
religion.
c. ethnicity involves recognized traditions, symbols, and literature.
d. most members of an ethnic group exhibit identical cultural
traits.
ANS: C
Ethnicity is a complex phenomenon including traditions, symbols, literature,
folklore, food preferences, and dress. It is a shared identity. Ethnicity is more than
just culture. It is social differentiation based on culture. Even within ethnic groups,
there is considerable diversity.
DIF: Cognitive Level: Remembering
REF: p. 44
TOP: Integrated Process: Teaching/Learning
10 | P a g eMSC: Client Needs: Psychosocial Integrity
2. Ethnocentrism is defined as:
a. an understanding of another’s cultural beliefs and practices.
b. a conflict that occurs when an individual interacts with another whose
beliefs
differ from his own.
c. application of limited knowledge about one person with characteristics
specific to another person.
d. a belief that one’s ethnic group is superior to that of another.
ANS: D
A belief that one’s ethnic group is superior to that of another is the definition of
ethnocentrism. Ethnocentrism does not involve an understanding of the beliefs of
others. A conflict that occurs when an individual interacts with another whose beliefs
differ from his own is the definition of cultural conflict. Application of limited
knowledge about one person with characteristics specific to another person is the
definition of stereotyping.
DIF: Cognitive Level: Remembering
REF: p. 42
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
3. Regarding health care disparities, it is true that older adults of color have:
a. equal risk factors for vulnerability as do all older adults.
b. equal risk factors for vulnerability as do the young adults of color.
c. increased risk factors for vulnerability if they are female.
d. an increase in risk factors for vulnerability if care is provided by public
facilities.
ANS: C
Older females of color have an added risk factor for vulnerability (gender) than do
males of the same age and ethnic group. Ethnicity is an added factor for vulnerability.
Age is an additional risk factor for vulnerability. Health care disparities are found
across a wide range of clinical settings.
DIF: Cognitive Level: Remembering
REF: p. 41
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
4. An older female patient tells a nurse the following: “In my culture, women are the
silent partner in the family. Men make all of the decisions. However, when we came
to the United States, all that changed. I became an American. I am in charge of my
family just like my husband.” This is an example of:
a. enculturation.
b. acculturation.
c. ethnicity.
d. culture competence.
ANS: B
Enculturation is defined as cultural beliefs passed down from one generation to the
next. Acculturation is the process by which persons from one culture adapt to
another. Ethnicity is defined as the cultural group that one identifies with. Cultural
11 | P a g ecompetence involves stepping outside our own biases and understanding that others
bring a different set of values.
DIF: Cognitive Level: Applying
REF: p. 40
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
5. A home care nurse is caring for an older patient from a different culture who is bed-
bound and high risk for development of a pressure ulcer. The nurse discusses the plan
of care with the patient’s daughter, emphasizing the importance of turning every 2
hours and posts a turning clock on the wall. When the nurse returns later in the week,
the turning clock has been removed, and the patient’s daughter reports that she turns
her mother occasionally. She states, “I am taking very good care of my mother. You just
don’t understand; our ways do not involve doing things on schedules.” The best
response by the nurse is:
a.
“You must follow my guidelines and turn her every 2 hours, or I will not be
able to
take care of her.”
b. “I understand that you value your culture, but culture cannot stop you from
providing good care to your mother.”
c.
“I understand that you care very much for your mother. Perhaps caring for
her is
too much for you.”
d. “How can we best work together to provide the best care for your mother?”
ANS: D
In providing cross-cultural care it is important that the nurse work with the patient
and family and listen carefully and find a way to include the values and beliefs of the
patient in the plan of care.
DIF: Cognitive Level: Analyzing
REF: p. 43
TOP: Integrated Process: Communication and
Documentation MSC: Client Needs: Psychosocial Integrity
6. An older patient learns that he has metastatic cancer. The patient states: “I must have
angered God.” This is an example of which type of belief?
a. Biomedical
b. Magico-religious
12 | P a g ec. Naturalistic
d. Ayurvedic
ANS: B
Magico-religious: views illness as caused by actions of a higher authority.
Biomedical: views disease as a result of abnormalities in structure and function and
disease caused by intrusion of pathogens into the body.
Naturalistic: based on the concepts of balance. Health is seen as a sign of balance.
Ayurvedic: the oldest known paradigm in the naturalistic system. Illness is seen as
an imbalance.
DIF: Cognitive Level: Remembering
REF: p. 46
TOP: Integrated Process: Communication and
Documentation MSC: Client Needs: Psychosocial Integrity
7. A female nurse is caring for an older woman from the Hasidic Jewish community. The
woman’s son is at the patient’s bedside. The nurse notes that when she communicates
with the patient and her son, the son does not maintain eye contact with her and also
notes that he withdraws when she attempts to shake his hand. The best response by
the nurse is to:
a. carry on conversation with the patient only, ignoring the
son.
b. continue conversing with both the patient and the son.
c. ask the son to leave since he is not comfortable with her.
d. ask the patient why the son will not engage with her.
ANS: B
In some cultures, direct eye contact or contact between men and women is seen as a
sexual advance. This is true in the Hasidic culture. Options A and C are disrespectful
to the patient and her son. Option D may put the son in an uncomfortable position.
DIF: Cognitive Level: Analyzing
REF: p. 48
TOP: Integrated Process: Communication and
Documentation MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
1. The nurse in a clinic setting that provides care for an ethnically diverse population of
older clients shows an understanding of the LEARN Model to direct the assessment
process when: (Select all that apply.)
a. recognizing that the client’s hands are clenched as she answers the
assessment
questions.
b. asking the client to describe what he thinks will help him feel better.
c. explaining to the client that herbal remedies may not be sufficient treatment
for his
chest congestion.
d. acknowledging that the client has a different view of the appropriate
treatment.
e. suggesting to the client that it would be beneficial if she would trust her
health care provider to prescribe the correct treatment.
13 | P a g eANS: A, B, C, D
The LEARN Model implements active listening to both the client’s verbal and
nonverbal communication as a means of obtaining insight into the client’s perspective
of his or her medical problem. This model also encourages the nurse to recognize that
the perceptions may differ and to explain the differences in perceptions to the client.
The model advocates arriving at a mutually agreed upon treatment plan rather than
encouraging the client to surrender personal autonomy in the decision-making.
DIF: Cognitive Level: Remembering
REF: p. 50
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
2. A nurse completes a cultural assessment of an older adult who is being admitted to an
assisted living facility. Reasons for completing a cultural assessment include: (Select all
that apply.)
a. culture guides decision-making about health, illness, and preventive care.
b. culture provides direction for individuals on how to interact during health
care
encounters.
c. culture impacts attitudes toward aging.
d. all members of a culture react in the same way in similar situations.
e. knowledge of culture eliminates health care disparities.
ANS: A, B, C
Although knowledge of culture has the potential to optimize care, not all individuals
will respond in the same way to a specific situation. Knowledge of an individual’s
culture will not eliminate health care disparities.
DIF: Cognitive Level: Understanding REF: pp. 49–50
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
3. A nurse in the ambulatory care setting is preparing to do an interview with a
non-English-speaking client. The nurse secures an interpreter. In order to have
the most effective interview, the nurse should do which of the following? (Select
all that apply.)
a. Look and speak to the interpreter
b. Use technical terminology to ensure accuracy
c. Allow more time for the interview
d. Watch the client’s nonverbal communication
e. Have the interpreter check whether the client understands the
communication
ANS: C, D
For the most effective interview the nurse should look and speak directly to the
client, avoid the use of jargon and technical terminology, observe the client’s
nonverbal communications, and clarify understanding by asking the client to state in
his/her own words what he or she understood, facilitated by the interpreter. The
interview will take longer.
DIF: Cognitive Level: Remembering
REF: p. 48
TOP: Integrated Process: Communication and
14 | P a g eDocumentation MSC: Client Needs: Psychosocial Integrity
Chapter 05: Cognition and Learning
MULTIPLE CHOICE
1. Health literacy is defined as:
a. the capacity to read basic health information in order to make appropriate
health
decisions.
b. the capacity to obtain, process, and understand basic health information
needed to
make appropriate health decisions.
c. the capacity to read and write in order to access health care.
d. the capacity to read and execute health care documents.
ANS: B
Health literacy involves more than basic reading and writing skills. It involves the ability
to obtain, process, and understand health information in order to make health care
decisions.
DIF: Cognitive Level: Remembering
REF: pp. 60–61
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
2. The daughter of an older hospitalized patient tells a nurse: “I am worried about my
father. His memory is sharper when he is at home. He is forgetful, but is functional.
Since he has been hospitalized his memory problems are much worse.” The best
response by the nurse is:
a.
“It is common for long-term memory to be more impacted by age-related
changes
than short-term memory.”
b. “Memory changes are often worse when an individual is in an unfamiliar or
stressful situation.”
c.
“Perhaps you are just noticing your father’s memory loss now that he is
hospitalized.”
d. “There is a lot of new information for your father to process here in the
hospital;
he is overloaded.”
ANS: B
Memory changes are often worse when the individual is in unfamiliar or stressful
situations, such as a hospitalization. Option A is not true, short-term memory is
impacted more than long-term memory. Options C and D are true; however, they do
not address the issue that the patient’s daughter is discussing.
DIF: Cognitive Level: Analyzing
REF: p. 56
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
3. An older resident in a senior community tells a nurse: “I am really worried. I joined
15 | P a g ean exercise class, and I just learned everyone’s name yesterday, and I cannot
remember them all today. Am I developing Alzheimer’s disease?” The best response
by the nurse is:
a.
“You should be concerned. It is very unusual to forget something that you
just
learned.”
b. “There is no reason to be concerned. Short-term memory decreases with
age.”
c.
“Don’t worry, a decline in both short- and long-term memory is a normal
part of
getting older.”
d. “Although it is normal to have some changes in memory, forgetting names is very
unusual.”
ANS: B
Even though some older adults show decrements in the ability to process
information, the majority of functioning remains intact. Age-associated memory
impairment is used to describe memory loss that is considered normal for one’s
age and educational level. It may include slowness in processing, storing, and
recalling new information and difficulty remembering names and words.
DIF: Cognitive Level: Applying
REF: p. 56
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. A nurse is developing an educational session for a group of older adults at a senior
center. Which of the following would the nurse include in the education? (Select all
that apply.)
a. Attention span, language, and communication skills typically remain
stable with increasing age
b. Older brains slow down and take longer to process constantly increasing
amounts of information
c. In order to preserve brain function, it is important to engage in
challenging cognitive activities
d. Older adults are not able to develop new cognitive abilities
e. Individuals over age 100 have a higher prevalence of dementia than
younger individuals
ANS: A, B, C
Older adulthood is no longer seen as a period when cognitive development is halted; it
is a life stage where unique capacities are developed. Centenarians and super-
centenarians have a lower prevalence of dementia then those under age 100.
DIF: Cognitive Level: Remembering
REF: p. 56
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
2. An older female resident of an assisted living facility says the following to a nurse: “I
am very frightened about getting dementia. I have read a lot about brain exercises, but
16 | P a g eI am not sure what I should be doing.” The nurse formulates a response based on
knowledge of which of the following? (Select all that apply.)
a. Individuals should engage in some type of brain fitness activity a couple of
times a week for at least 25 minutes
b. Brain fitness activities are only effective if an individual has not
experienced any memory problems at all
c. Brain fitness activities may include computer-based games, memory
training, board games, reading, and engaging in conversation
d. Physical activity is important for wellness but is unrelated to brain fitness
e. Individuals should choose brain exercise activities that are unfamiliar,
challenging, and fun
ANS: A, C, E
Brain fitness activities are effective for individuals with normal memory or mild
memory problems. Physical activity is important and has an impact on improving
reaction time and working memory as well as posture, balance, and socialization.
DIF: Cognitive Level: Applying
REF: p. 57
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
3. A nurse is planning a fall prevention education refresher session for the residents of a
long-term care facility. The individuals are all cognitively intact and range in age from 80
to
100. The previous education on fall prevention was presented 2 months ago. What
special considerations should the nurse take in relation to teaching this group of older
adults? (Select all that apply.)
a. Make sure that all pamphlets are in large readable font (14-16 points) and
include
upper and lower case lettering
b. Start education on falls from the beginning. It is unlikely that anyone
remembers
previous material
c. Present all the information at once in one long session
d. Ensure that there is adequate lighting in the room and that the
temperature is comfortable
e. Provide ongoing positive feedback during the session
ANS: A, D, E
When educating older adults it is important that it is pertinent and build upon
information that they already possess. It is a myth that all older adults experience
memory problems. It is important to provide adequate time for learning and to use
self-paced techniques.
DIF: Cognitive Level: Applying
REF: pp. 57–60
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
4. A nurse hears a colleague state the following: “Can you believe that Mr. Jones’
daughter just bought him a tablet computer? He is 90 years old. It is ridiculous to
think that he can learn to use it.” The nurse formulates a response based on research
that shows: (Select all that apply.)
17 | P a g ea. older adults comprise the fastest growing population using computers and
the
Internet.
b. Internet use is less prevalent in individuals over age 75 than those ages 65-
74.
c. older American men are the fastest growing group of social networking site
users.
d. older adults use the Internet only for social networking and recreational
uses.
e. technology has the potential to improve quality of life for older adults.
ANS: A, B, E
Older adults are the fastest growing population using computers and the Internet.
Internet use does decrease in those over age 75 as compared to older adults less than
age 75. Older women are the fastest growing group of individuals using social
networking sites. Older adults use technology for a whole host of reasons, both social
and to communicate with health care providers and access health information.
Technology has a large potential to improve quality of life for older adults.
DIF: Cognitive Level: Remembering
REF: p. 58
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
Chapter 06: Communicating with Older Adults
MULTIPLE CHOICE
1. When caring for an ill adult client, the nurse is particularly concerned that
the client communicates well since:
a. assessment, planning of care, and even the therapeutic relationship is based
on
effective communication.
b. it is the social connection that all individuals base interpersonal relationships
upon.
c. how well an individual communicates is a reflection on both his or her
physical
and emotional well-being.
d. the need to communicate is a basic need of all individuals.
ANS: A
Good communication skills are the basis for accurate assessment, care planning, and
the development of therapeutic relationships between the nurse and the older
person. While the other options are true they do not directly address the concerns of
an ailing client.
DIF: Cognitive Level: Understanding REF: p. 65
TOP: Integrated Process: Communication and
Documentation MSC: Client Needs: Health Promotion and
Maintenance
2. Which statement by the nurse is the strongest example of ageism by professional
18 | P a g enurses?
a.
“It takes a special nurse to provide good care to the older population of
clients.”
b. “It’s difficult for a nurse to develop an effective relationship with an older
client
because of the barriers their age creates.”
c.
“It is so difficult to find nurses who are truly effective geriatric nurses.”
d. “With the older population increasing so dramatically in numbers, nursing
will
have a difficult time meeting their needs.”
ANS: C
Ageism affects health professionals as well as the general public and this attitude is
reflected in the lack of nurses who choose to work in the field of geriatrics. The
characteristics of a “good geriatric nurse” are no different than those of any effective
nurse. Assuming that age produces barriers to an effective nurse-client relationship is
an example of ageism. The growing number of older adults is not an example of
ageism.
DIF: Cognitive Level: Understanding REF: p. 66
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
3. When conducting an admissions interview with an older client, the nurse observes
that the client pauses for a period of time before responding to the questions. The
nurse responds to this client based on the assumption that the client is:
a. exhibiting signs of mild cognitive impairment.
b. nervous and having difficulty concentrating on the questions.
c. reluctant to share information with someone with whom he or she has no
relationship.
d. sorting through his or her vast life experiences in order to answer
appropriately.
ANS: D
Basically, elders may need more time to give information or answer questions simply
because they have a larger life experience to draw from. Sorting through thoughts
requires intervals of silence, and therefore listening carefully without rushing the elder
is very important. It is an unfounded assumption to assume that the client’s response
is due to senility based exclusively on his or her age. The remaining options would not
be unique to an older client but might be experienced at any age.
DIF: Cognitive Level: Applying
REF: p. 67
TOP: Integrated Process: Communication and
Documentation MSC: Client Needs: Health Promotion and
Maintenance
4. Which technique is most effective when communicating with a client who is
positioned in bed?
a. Sitting in a chair at the foot of the bed
b. Standing near the client’s head on his or her dominant
side
c. Sitting in a chair at the bedside facing the client
19 | P a g ed. Standing at the foot of the bed
ANS: C
When communicating with individuals in a bed or wheelchair, position yourself at their
level and directly face them rather than talking over a side rail or standing above them.
DIF: Cognitive Level: Applying
REF: p. 67
TOP: Integrated Process: Communication and
Documentation MSC: Client Needs: Health Promotion and
Maintenance
5. Which nursing statement shows a true appreciation for an older client’s willingness
to tell his personal stories about “the war”?
a.
“It’s so nice to see them excited and engaged as they tell the
stories.”
b. “It helps their memory so much to retell their stories.”
c.
“I learn so much about clients when they share their life story with
me.”
d. “They are so proud of the things they have accomplished in their
life.”
ANS: C
A memory is an incredible gift given to the nurse, a sharing of a part of oneself when
one may have little else to give, and it provides insight into who the person really is
telling the story.
DIF: Cognitive Level: Applying
REF: p. 67
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. A nurse manager is providing a novice geriatric nurse with guidelines when
encouraging an older client to reminisce about his or her life and past experiences.
Which suggestions will be included? (Select all that apply.)
a. Don’t correct the client even when you suspect the memory is incorrect
b. When the focus remains on sad topics, assess the client for possible
depression
c. Refrain from interjecting personal stories into the reminiscing process
d. Expect and respect a degree of repetition
20 | P a g ee. Use close-ended questions to help focus the reminiscing
ANS: A, B, D Suggestions for encouraging reminiscing include listening without correction or criticism, remembering that it is the client’s recollections that are important; being patient with repetition since sometimes people need to tell the same story often to come to terms with the experience, especially if it was very meaningful to them; being attuned to signs of depression in conversation (dwelling on sad topics) or changes in physical status or behavior, and providing appropriate assessment and intervention; and keeping the conversation focused on the person reminiscing, but not hesitating to share some of your own memories that relate to the situation being discussed. Use open-ended questions to encourage reminiscing since they encourage free thought.
DIF: Cognitive Level: Applying REF: p. 68, Box 6-3
TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
2. Which intervention is therapeutic when facilitating communication with a cognitively impaired older client? (Select all that apply.) [Show Less]