NURS 4000 Gerontology Final Review Questions and Answers,100% CORRECT

NURS 4000 Gerontology Final Review Questions and Answers Questions from the Hartsfield Institute Issue 6.2 The Epworth Sleepiness Scale (ESS) By: Carole Smyth MSN, APRN, BC, ANP/GNP, Montefiore Medical Center WHY: Sleep at night is essential for good health. Sleepiness during the day can be an antecedent to falls, declining quality of life, and less functional recovery in older adults. Sleepiness during the day may also be an indicator that hypertension and diabetes are not well controlled (Cuellar & Ratcliffe, 2008; Goldstein, Ancoli-Israel, Shapiro, 2004). Assessment of daytime sleepiness enables the nurse to intervene by implementing interventions with the client, or by referring the client for further assessment. BEST TOOL: The Epworth Sleepiness Scale (ESS) is an effective instrument used to measure average daytime sleepiness. The ESS differentiates between average sleepiness and excessive daytime sleepiness that requires intervention. The client self-rates on how likely it is that he/she would doze in eight different situations. Scoring of the answers is 0-3, with 0 being “would never doze” and 3 being “high chance of dozing”. A sum of 10 or more from the eight individual scores reflects above normal daytime sleepiness and need for further evaluation (Johns,1992). TARGET POPULATION: The ESS may be used for both initial assessment and ongoing comparative measurements with older adults across the health care continuum. The ESS is not an appropriate tool for measuring changes in sleep over a period of hours. VALIDITY AND RELIABILITY: There is a high level of internal consistency between the eight items in the ESS as measured by Cronbach’s alpha, ranging from 0.74 to 0.88. Numerous studies using the ESS have supported high validity and reliability. STRENGTHS AND LIMITATIONS: The ESS is a subjective measure of sleepiness. Self reporting by clients though empowering and revealing, may reflect inaccurate information if the client has difficulty understanding what is written, or cannot see or physically write out responses. The ESS has been translated into Spanish, Portuguese, Italian, German, Swedish, Finnish, Greek, French, Mandarin, Japanese and Turkish. The tool has not been validated for phone interviews. Issue 30 Assessment of Fatigue in Older Adults: The FACIT Fatigue Scale (Version 4) By: Kathleen F. Tennant, PhD, APRN, BC, West Liberty University, West Liberty, West Virginia WHY: Fatigue is one of the most frequent complaints of the elderly and is strongly associated with loss of independence and decreased physical activity and functional decline. Mild depression, anemia, insomnia, and poor nutrition have been associated with fatigue. However, many older persons report complaints of “fatigue” and “exhaustion” even when no underlying medical or psychiatric illness is present (Avlund et al., 2003). Thus, the lack of an “underlying illness” makes the impact of unexplained fatigue even more crucial. BEST TOOL: Although there are several validated tools for the measurement of fatigue, there is no gold standard (NIA, 2007). One self-report questionnaire that has been validated for use with older adults is the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Scale (Version 4). The FACIT Fatigue Scale is a short, 13-item, easy to administer tool that measures an individual’s level of fatigue during their usual daily activities over the past week. The level of fatigue is measured on a four point Likert scale (4 = not at all fatigued to 0 = very much fatigued) (Webster et al., 2003). The FACIT Fatigue Scale is one of many different FACIT scales that are part of a collection of health-related quality of life (HRQOL) questionnaires targeted to the management of chronic illness referred to as The FACIT Measurement System. The group tests newly constructed FACIT subscales on a sample of at least 50 subjects. The FACIT tool has been translated in more than 45 different languages permitting cross-cultural comparisons. TARGET POPULATION: Older adults who report fatigue. VALIDITY AND RELIABILITY: In a 2007 study, (Chandran et al., 2007) the FACIT Fatigue Scale was found to have high internal validity (Cronbach’s alpha = 0.96) and high test-retest reliability (ICC = 0.95). The correlation between the FACIT and Fatigue Severity Scale (FSS) was -0.79 tool comparison (Tennant et al., 2011). Thus, the FACIT has demonstrated reliability and sensitivity to change in clients with a variety of chronic health conditions and in the general population and in special populations such as the elderly and those living in rural areas. STRENGTHS AND LIMITATIONS: The FACIT Fatigue Scale is easy to complete (in 5–10 minutes) and is written at the 4th grade reading level. It has demonstrated equivalence in mode of administration (interview vs. self-report) and can be used in a variety of clinical settings (community health, inpatient, outpatient, etc). Although the FACIT has been highly correlated with the FSS (Chandran et al., 2007; Tennant et al., 2011) further evaluation of this tool with the geriatric population with regard to cut-off points is recommended. FOLLOW-UP: As needed or on a yearly basis to assess fatigue. A nurse assesses older adults at risk for pressure ulcers. Which of the following assessment tools should the nurse use to identify those who might benefit from interventions? (Select all that apply.) A) Braden Scale B) Norton Scale C) PUSH Scale D) Reverse staging E) Waterloo Scale SPICES Ans : A, B, E Pittsburgh Sleep Quality Index(PSQI)- asses sleep quality and patterns over a month, determine good to poor sleep Epworth Sleepiness Scale (ESS) - focuses on daytime sleepiness over the past week. Total of 9 or greater= too sleepy during day, not enough sleep, seek medical assistance Stages of Change Model Stage 1: Precontemplation- unaware of problem , is in denial of the need for change or is resistant to change Stage 2: Contemplation- intention to change in the foreseeable future ( person likely to ask questions and seek information) Stage 3: Preparation- some ambivalence about the unhealthy behavior but a strong inclination to change to healthier behaviors ( acknowledge need for change express serious intent to adopt health behaviors) Stage 4: Action- person has made change to behavior but behavior been practiced for less than 6 months Stage 5: Maintenance- person continued healthy behavior for 6 months or longer. A 69-year-old cigarette smoker asks the nurse questions about the potential benefits of quitting smoking, a subject avoided in past interactions. The nurse asks the client, "Would you like to quit smoking?," to which the client replies, "I will give it some serious thought.” What stage of the Stages of Change model is the client demonstrating? A) Precontemplation B) Preparation C) Contemplation D) Action Ans: C A group of community health nurses is using the Stages of Change model as the foundation of a new health promotion campaign for older adults. What goal for the participants are the nurses likely to promote when working with older adults in the program? A) A recognition of the importance of screening for common health problems B) Increased participation in exercise programs and an awareness of the relationship between exercise and wellness C) The replacement of participants' unhealthy behaviors with healthy behaviors D) An awareness of the differences between life expectancy and active life expectancy assessment tool – overall geriatric assessment Mini-cog – remember three unrelated words and ask to recall after a couple minutes/ draw the clock Elderly patient is depressed - use geriatric depression scale Braden scale – risk for skin break down A client is unresponsive, the skin is usually dry, confined to bed, with limited mobility and contractures, and the nutrition is less than adequate. Using the Braden score, which score will be assigned to this client's risk for pressure ulcers? A) 8, very high risk B) 8, at risk C) 18, high risk D) 18, moderate risk Ans: A Hendrick 2 – fall assessment tool Beers criteria – medication safety/ avoid anti-cholinergic A nurse reviews the medication list of an older adult upon transfer from the hospital to an extended care facility. Which of the following methods is most likely to reduce the occurrence of adverse effects? A) Administer medications at the same time every day with meals. B) Compare the list to the Beers criteria list and notify the health care provider of any on the list. C) Request that the client's medications be put on hold and restarted one at a time. D) Stop the administration of GI and narcotic pain medications. Ans: B Pain assessment – rate 0 to 10 A nurse assesses an older adult client with confusion related to hyponatremia who reports pain. Which of the following data should the nurse use as a guide for choosing interventions? A) Symptoms of hyponatremia do not include pain. B) The client does not manifest any outward signs of pain. C) The client is confused from the pain. D) The client rates the pain at 8 out of 10. Ans: D A home care nurse notes in the assessment that an older adult expresses anxiety and fatigue. The client sleeps 3 hours at a time at maximum and has had a 10 lb weight loss. Which of the following interventions is priority? A) Assess the client's level and intensity of pain. B) Interview the family. C) Perform an assessment of vital signs. D) Weigh the client. Ans: A Sleep Assessment – Pittsburg sleep quality index (PSQI) A nurse teaches a nursing student about pharmacologic interventions for the treatment of sleep problems among older adults. Which of the following statements by the student shows understanding of the care of those with sleep disturbances? A) "Behavioral therapies are preferable to the use of drugs." B) "Benzodiazepines are the drug group likely to have the fewest adverse effects." C) "L-Tryptophan and melatonin are chemicals the body produces that can be supplemented to improve sleep." D) "Older adults should not use hypnotics or other pharmacologic aids for sleep." Ans: A Truly Sleep Deprived – Epworth sleepiness scale Caregiver burn out? – Modified caregiver Strain index A nurse is teaching an older adult's family about the concept of caregiver burden. Which of the following points is priority for the nurse to communicate to the family? A) "Don't feel guilty about having to hire help. Most older Americans' care is currently provided by professionals and formal services." B) "If you do eventually feel overburdened, moving your loved one to a nursing home will provide you with relief." C) "You'll find it difficult to provide for your loved one's needs if you yourself don't have a strong support system." D) "You'll actually find that for you, the benefits of providing for your loved one outweigh the negative consequences." Ans: C Know vaccines –shingle, flu, and pneumonia A nurse plans interventions in a skilled nursing facility to prevent lower respiratory infections. Which of the following nursing interventions should be included in the plan? (Select all that apply.) A) Encourage annual pneumonia vaccinations. B) Encourage annual influenza vaccinations. C) Encourage annual chest radiographs to detect tuberculosis. D) Encourage influenza vaccinations every 5 years. E) Encourage hand hygiene for residents and staff. Ans: B, E Sexuality tool – plissit model A 64-year-old man had a myocardial infarction (MI) 2 months ago. He has recovered to the point that he is able to climb up two flights of stairs, but he and his spouse have not resumed sexual relations. Which of the following responses by the nurse is most appropriate? A) "Is angina interfering with your sexual functioning?" B) "This lack of libido is caused by vasoconstriction in the genital area." C) "You are safe to have sex; you can resume sexual relations when you desire." D) "You may have a problem with retrograde ejaculation." Ans: C Which of the following processes should a nurse address first when assessing sexual function in older adults? A) Identify risk factors that may interfere with the older adult's sexual functioning. B) Assess own personal attitudes toward sexuality and aging. C) Obtain permission from the individual to initiate a discussion on sexual relations. D) Provide detailed information about sexual function to the older adult. Ans: B A nurse is conducting a health education class for older adults with arthritis that will address relevant issues of sexual function. Which of the following statements indicates that the nurse's teaching has been successful? A) "I will decrease the amount of time spent in foreplay before engaging in sexual intercourse." B) "I will avoid taking a warm bath before engaging in sexual activity." C) "I will avoid experimenting with different positions during sexual relations." D) "I will use a vibrator since my ability to massage is limited." Ans: D A nurse is conducting a health education class for older adults with arthritis that will address relevant issues of sexual function. Which of the following statements indicates that the nurse's teaching has been successful? A) "I will decrease the amount of time spent in foreplay before engaging in sexual intercourse." B) "I will avoid taking a warm bath before engaging in sexual activity." C) "I will avoid experimenting with different positions during sexual relations." D) "I will use a vibrator since my ability to massage is limited." Ans: D A gerontological nurse is aware that the aging process is accompanied by numerous, multifactorial changes that affect sexual wellness in older adults. Among women, which of the following factors is usually the primary cause of changes in sexual functioning? A) Psychosocial factors B) Environmental factors C) Hormonal factors D) Spiritual factors Ans: C Mr. Thomas and Mrs. Young are residents of a long-term care facility who are both physically frail but cognitively healthy. Last night, the nurse at the facility discovered Mr. Thomas and Mrs. Young in bed together in Mr. Thomas' room and engaging in foreplay. How should care providers best respond to these residents' new sexual relationship? A) Ensure that each resident's family members are aware of this development. B) Teach Mr. Thomas and Mrs. Young about sexual health promotion. C) Accommodate the residents' relationship and provide them with appropriate privacy. D) Have each resident assessed to ensure that the relationship is medically safe and appropriate. Ans: C A 78-year-old home health client has admitted to his nurse that his level of sexual activity with his wife has declined in recent months and become wholly absent over the past several weeks. The client has implied that this is due to a lack of performance, rather than lack of desire, on his part. What assessment should the nurse prioritize in light of this revelation? A) Client's medication regimen B) Client's musculoskeletal system and active range of motion C) Client's cognitive status and level of consciousness D) Client's cardiovascular status Ans: A A nurse reviews the medications of a 58-year-old man who has erectile dysfunction. Which of the following prescribed medications can interfere with sexual functioning? (Select all that apply.) A) Acetylsalicylic acid (aspirin) B) Metoprolol (Lopressor) C) Clopidogrel (Plavix) D) Lisinopril (Prinivil) E) Ezetimibe (Zetia) Ans: B, D A nurse administrator incorporates older adults' sexuality into the policies of a long-term care facility. Which of the following should be included in this plan? (Select all that apply.) A) Allow public masturbation. B) Ask permission to enter a room. C) House spouses separately. D) Knock on door before entering. E) Redirect inappropriate sexual behaviors. Ans: B, D, E Wellness – attitudes of wellness aging Aging anxiety An older adult has impaired psychosocial functioning. Which of the following consequences should the nurse monitor? A) Anxiety B) Elevated blood glucose level C) Increased independence D) Resilience Ans: A Age attribution – relate certain conditions to aging An older adult has recently begun to display unprecedented lapses in short-term memory. The nurse overhears a colleague reassuring the person by saying, "Try not to worry; it's just a part of growing older." The nurse recognizes that this is an example of what phenomenon? A) Multiple jeopardy B) Gerontophobia C) Age attribution D) Implicit ageism Ans: C Sand witch generation – taking care of kids and parents A nurse identifies those who are at risk for familial stress. Which of the following persons exemplifies the sandwich generation? A) A 50-year-old who balances the care of an 82-year-old parent and a 20-year-old child B) A 58-year-old whose elderly parents have been forced to live in separate care facilities C) A 72-year-old who deals with own health problems with the care of a grandchild D) An 83-year-old who is the sole caregiver for the 79-year-old spouse Ans: A Myths of aging – Which of the following statements, made by a new nurse, are myths and need correcting? (Select all that apply.) A) "Ageism is highly influenced by stereotypes and cultural values." B) "Ageism is more common in industrialized societies." C) "In the United States, 20% of the older adults who need care are in a nursing home." D) "People consider themselves old when they are old enough to apply for Medicare." E) "With increased age, people become more diverse and people become less like their age peers." Ans: C, D Successful aging – cognitive intact, physical active, and reduce likely hood of getting disease or disabilities A nurse is teaching an older person about the concept of successful aging. Which of the nurse's questions addresses an important contributor to successful aging? A) "Are you largely free of acute or chronic illnesses?" B) "Do you feel financially secure?" C) "Do you feel like you actively engage with life?" D) "Do you have a reliable support network?" Ans: C Cultural Diversity – culturally sensitive Health disparities – don’t have money or access to health care Health literacy – more knowledgeable you are about health issues Less educated people are less likely to be healthy A nurse assesses a community of older adults. Which of the following persons is at highest risk for a shortened life expectancy? A) A college professor born in 1956 B) A homemaker born in 1957 C) A nuclear engineer born in 1958 D) A nurse born in 1959 Ans: B 116 is reasonable max of life Super centenarian – over 110 A 93-year-old asks the nurse, "I sure would like to live to get that 100 year birthday card from the president." Which of the following responses by the nurse is best? A) "Keeping fit and dealing with stress in a positive way helps your chances of living to be 100." B) "Surviving to 100 is strongly impacted by eating meat, fruits and grains." C) "Those people in your socioeconomic situation have higher chance of living to 100." D) "You have had a cancer and a stroke, so that decreases your chance of surviving to 100." Ans: A A nurse interviews a centenarian gathering data for a large study. In the interview, the centenarian says, "You're only as old as you feel, some days I feel like 'I'm 50.'" To which definition of aging does this response correspond? A) Chronologic aging B) Functional aging C) Perceived aging D) Subjective aging Ans: D Chronic pain vs acute pain A nurse assesses an older adult following the repair of an abdominal hernia. The older adult client states, "I really hate to take pain medication." Which response by the nurse is best? A) "Early treatment of pain helps now and can reduce the incidence of chronic pain." B) "Pain medication today doesn't really have any side effects." C) "Tell me about your fears regarding pain medication." D) "This pain you are having is normal, and as you heal, the pain level will decrease." Ans: A Arthritis is the number one pain the world Functional consequences of pain – immobility, decreased appetite, sleep Principles of analgesics – start with non-opioids (NSAIDS), then combination with light weight opioids, then stronger opioids A nurse is teaching an older adult about some of the risks associated with using opioid analgesics. Which of the following statements best demonstrates the individual has gained a sound knowledge base? A) "I know that if I become dependent on the drug, my doctor and I will come up with a plan to discontinue it." B) "I'll need to be careful that I don't become addicted to the drug over time." C) "If I do develop a tolerance to the drug, I can expect some withdrawal symptoms." D) "It sounds like I might have my dosages increased over time because of tolerance." Ans: D Risk factors for respiratory and cardiac problems Which of the following is the most important remediable risk factor for cardiovascular disease in older adults? A) Smoking B) Stress C) Sedentary lifestyle D) Aggressive personality Ans: A A community nurse develops wellness outcomes for those at highest risk for poor management of cardiovascular disease. Which of the following populations should the nurse target? A) African American woman B) Hindu men C) Immigrant Indian population D) Mentally ill persons Ans: A Hypertension at 135 on elderly is okay due to aging process Delirious vs depression – Level of conscious A nurse assesses an older adult using a mini-mental status examination. The client is very slow to respond to the questions. Which of the following conditions may be present and will require follow-up by the nurse? (Select all that apply.) A) Lack of education B) Dementia C) Depression D) Confabulation E) Concrete thinking Ans: B, C A nurse differentiates between dementia and depression in an older adult. Which of the following assessment findings leads the nurse to believe that the client has depression? A) The client has socially unacceptable behaviors. B) The client is negativistic. C) The client's mood fluctuates. D) The client's mood is distractible. Ans: B Depression in elderly – health problems, loss of family or ability Theoretical perspective of aging well – biological, psychological, and sociology A nurse is aware that many health care providers prioritize the role of biology in the aging process. What is a weakness of biologic theories of aging as it applies to nursing? A) Biologic theories do not account for the differences in life expectancy between men and women. B) Biologic theories are unable to explain the role of cell division in life expectancy and the aging process. C) Biologic theories of aging do not adequately address issues of wellness and quality of life. D) Biologic theories of aging are unable to explain the significant increases in life expectancy that occurred in the 20th century. Ans: C Which of the following statements best explains the relevance of psychological theories for gerontological nursing? A) Human needs theory allows the nurse to determine priorities of nursing care for older adults. B) Life span development theories support the belief that it may be difficult to initiate behavioral changes in older adults. C) Psychological theories explain why nurses should focus their discussion more on the present than on the past when talking with older adults. D) Psychological theories explain why reminiscence groups may not be beneficial for older adults. Ans: A Incontinence – stress (pressure in abdominal area), urge (have to go and not enough time) What is the cause of stress incontinence? A) Involuntary urinary leakage due to an inability to hold urine B) Involuntary detrusor muscle contractions C) Urinary leakage due to relaxation of the urethra D) Involuntary leakage of urine as a result of increased abdominal pressure Ans: D Age related changes to urinary function A nurse cares for a 92-year-old woman with urinary incontinence. Which of the following age- related changes is the rationale behind assisting client to the bathroom every 2 hours? A) Decreased estrogen levels B) Degenerative changes in the cerebral cortex C) Demyelination of parasympathetic nerves D) Diminished thirst perception Ans: B A nurse presents at a conference regarding functional consequences related to urinary elimination. Which of the following statements should the nurse include? A) "Most older women will develop urinary incontinence by the age of 85." B) "Most older adults will experience hypertrophy and relaxation of muscles in the urinary tract and pelvic floor." C) "Excretion of penicillin and cimetidine are decreased in older adults." D) "Healthy older adults experience an increase in glomerular filtration rate." Ans: C Age related factors Ototoxic medication – aspirin, diuretic, salicylates, and chemo therapy A 62-year-old who has worked on an assembly line since he was 24 years old began taking aspirin for arthritis 6 months ago. The client presents to the nurse with hearing problems and ringing in the ears. Which of the following problems should the nurse suspect? A) Tinnitus B) Vertigo C) Ototoxicity D) Impacted cerumen Ans: C Talking to someone hearing impaired – speak slowly, lower tone, (above too) A new nursing assistant asks the nurse how best to approach a hearing-impaired older adult. Which of the following approaches should the nurse recommend? A) Raise the volume of your voice. B) Leave the radio on to calm the older adult. C) Lower the tone of your voice. D) Use exaggerated lip movements. Ans: C The incidence of hearing loss in a long-term care facility is high, especially among white men. What strategy should care providers adopt when communicating with older adults who have hearing loss? A) Use less complex concepts when communicating with hearing-impaired older adults. B) Use a high, consistent tone and pitch when speaking to adults with hearing loss. C) Speak at a high volume directly into the less affected ear when talking to an older adult with a hearing deficit. D) Make eye contact before and during a conversation with hearing-impaired adults. Ans: D Macular degenerate – number one cause of blindness – wet happens faster A nurse is providing an educational program about age-related macular degeneration (AMD) to a group of older adults. Which of the following statements by an older adult indicates the need for further teaching? A) "Smoking is a risk factor for AMD." B) "Macular degeneration causes a loss of central vision." C) "People with macular degeneration should have any sudden changes evaluated." D) "The dry type of macular degeneration occurs rapidly." Ans: D Hard time with glare – cataract A nurse knows teaching has been effective when the client states the following: A) "If my sensitivity to glare decreases and my contrast sensitivity increases, I will be evaluated for cataracts." B) "I wear sunglasses and a wide-brimmed hat when I am in the sun to protect my eyes and prevent the development of cataracts." C) "Having Alzheimer disease increases one's risk of developing macular degeneration." D) "If I take ototoxic medications, this will increase my risk for developing cataracts." Ans: B Hard time with peripheral vision – glaucoma (increased pressure of the eye) After a scheduled trip to her optometrist, a 70-year-old has been told that the pressure in her eye is high and she needs to be monitored and treated to prevent damage to the optic nerve. What is this person's diagnosis? A) Cataracts B) Glaucoma C) AMD D) Presbyopia Ans: B Thermoregulation – hyperthermal – dry warm and weak (not sweating) (death due to cardiac and respiratory problems… Hypothermia – lethargic and don’t shiver A recent heat wave has resulted in an increase in the number of older adults who are presenting to the emergency department with actual or suspected hyperthermia. What assessment findings are congruent with a diagnosis of hyperthermia in older adult clients? (Select all that apply.) A) Diaphoresis B) Weakness C) Warm, dry skin D) Pallor E) Bradycardia Ans: B, C It is July in Atlanta, and 90°F in the shade. An 80-year-old client who lives alone in an apartment is struggling to stay cool. What functional consequence of the aging process increases this client's susceptibility to heat exhaustion and heat stroke? A) Delayed and diminished sweating B) Impaired peripheral blood circulation C) Renal insufficiency D) Changes in endocrine regulation Ans: A A nurse monitors a group of older adults. Which of the following older adults is a high risk for functional consequences of altered thermoregulation? (Select all that apply.) A) 78-year-old adult with heart failure B) 75-year-old adult with a urinary tract infection C) 80-year-old adult with vascular-type dementia D) 71-year-old participant in a wellness center E) 72-year-old adult with peptic ulcer disease Ans: A, B, C A nurse who oversees the care in a nursing home is aware that the older adults who reside in the facility are vulnerable to impaired thermoregulation. What information source should the nurse prioritize when regulating the temperature in the facility? A) The nurse's perception of heat and cold when dressed similarly to the residents B) Readings from an accurate thermometer C) The input from nursing assistant and unlicensed care providers in the facility D) The suggestions of residents who do not have cognitive impairments Ans: B The aging process is accompanied by a number of changes in thermoregulation. Which of the following clinical phenomena in older adults is likely to result from these changes? A) Lack of detection of an acute infection B) Impaired protein synthesis during hot weather C) Susceptibility to skin breakdown on bony prominences D) Orthostatic hypotension Ans: A During heat waves, nurses can assist to prevent heat-related illnesses in older adults. Which of the following should be included in the teaching? (Select all that apply.) A) Ensure fluid intake at or above 64 ounces per day. B) Keep air-conditioning at or below 72°F. C) Take a cool shower three times a day. D) Use extra soap when bathing. E) Use ice to cool armpits up to 20 minutes. F) Wear loose-fitting clothing. Ans: A, B, C, E, F What temperature for hypothermia – 68 environmental A community care nurse plans care for older adults as the fall season sets in a cooler weather starts. Which of the following clients is at greatest risk for development of hypothermia? A) Client who lives in an apartment building B) Client who sets the thermostat at 76°F year round C) Institutionalized older adult with cancer D) Older adult who has dementia and lives alone Ans: D During a period of cold weather, an older adult has been brought to the emergency department with suspected hypothermia. Which of the following assessments should the nurse prioritize with this client? A) Palpation of the client's extremities to determine temperature B) Assessment of the client's level of consciousness C) Assessment of the client's core body temperature D) Interviewing to determine the client's sensation of cold Ans: C A nurse in the postoperative unit monitors for hypothermia. Which of the following older adults' assessment findings indicates the onset of hypothermia? A) Cool skin on buttocks B) Puffy face C) Shallow respirations D) Shivering Ans: A A nurse in the intensive care unit monitors an older adult admitted with hypothermia. Which of the following assessment findings indicates the need to notify the primary health care provider immediately? A) Shivering B) Slurred speech C) Temperature of 95.5°F (35.3°C) D) Urine output of 25 mL per hour Ans: D Lower body temperature as they age – 98 degrees assess for infections Home health services – homebound A nurse assists an older adult who is homebound in a rural area. Which community resources might this client best benefit from? A) Skilled home nursing B) Senior center C) Personal emergency response system D) Grocery delivery Ans: C Number one payer - medicare (A – hospital, B – outpatient care, C – supplement advantage (vision and dental), D – medication) Autonomy – independence and right to make your own decisions A 78-year-old was diagnosed with colorectal cancer 18 months ago and underwent a round of chemotherapy. The most recent computed tomographic scan, however, reveals that the cancer has metastasized to the lungs and liver. The older adult states, "I feel quite well and do not wish to undergo another round of chemotherapy. " The client's children are adamantly opposed to their parent's decision to forgo treatment and have appealed to the nurse. Which factor is the priority consideration for the nurse to determine the best course of action? A) The client's prognosis B) The client's autonomy C) The family's wishes D) The client's treatment options Ans: B A series of transient ischemic attacks have caused an older adult to become dysphagic. Despite failing a swallowing assessment, the client is opposed to eating a minced and pureed diet and wishes to eat a regular diet. How should the care team respond to this request? A) Insert a feeding tube to provide nutrition while eliminating the risk of aspiration. B) Continue providing a minced and pureed diet to the client in order to ensure safety. C) Defer responsibility for feeding to the client's friends and family. D) Provide the client's requested diet after ensuring the client understands the risks. Ans: D Advanced directives – direction for care if you can’t make it yourself A 76-year-old Hispanic woman has been admitted to the hospital. There are no advance directives in the chart. Which of the following questions will best prepare the nurse to begin a dialogue with this client about advance directives? A) "With whom do you talk to about your health care decisions?" B) "I see that you have no advanced directives on your chart, could you tell me about that?" C) "Is there someone we should call to join us while we discuss your care?" D) "Tell me about your living arrangements; do you live alone or with others?" Ans: A A nurse discusses advance medical directives with a group of older adults at the senior citizens' center. Which of the following statements made by a member of the group indicates a need for further teaching about medical directives? A) "Advance directives address the person's right to refuse medical treatment." B) "It is helpful to see an attorney before completing a durable power of attorney." C) "Advance directives provide legal assurances that a person's preferences will be considered." D) "A durable power of attorney cannot be initiated before a person is incapacitated." Ans: D Living will – only when it looks like you are dying – two doctors to for DNR In which of the following situations would a living will provide clear direction to the care and treatment of the individual involved? A) Mr. Penny, age 81, has been diagnosed with bone cancer, is experiencing severe pain, and has been presented with treatment options. B) Ms. Jelic, age 78, has been brought to the emergency department after falling on an escalator. C) Mrs. Kerr, age 77, has been admitted to hospital with an electrolyte imbalance secondary to an accidental overdose of diuretics. D) Mr. Jimenez, age 84, has suffered a severe hemorrhagic stroke and is unconscious and unlikely to survive. Ans: D End of life care – A nurse manager of an intensive care unit develops plans to improve end-of-life care for clients in the unit. Which of the following actions is the priority? A) Create a script for nurses to use when discussing hospice and palliative care. B) Guide staff to improve communication with families about end-of-life decision making. C) Increase communication between professionals about end-of-life decision making. D) Survey clients and families about their end-of-life needs. Ans: B A quality control nurse for a large group of long-term care facilities assesses the quality of care at the end of life for the residents. Which of the following measures indicate quality care? (Select all that apply.) A) Increase in the number of deaths in the hospital B) Increase in the number of residents who refuse treatments at the end of life C) Increase in the percent of residents with advanced dementia D) Increase in the use of hospice services E) Increasing number of staff trained in palliative care Ans: D, E Palliative care – symptom management, active treatment A palliative care team has taken over primary responsibility for the care of an older adult who has recently experienced a stroke. A visitor asks, "What is palliative care?" Which of the following is the best response by the nurse? A) "Spiritual and psychosocial care that takes place near the end of life" B) "Nursing care and medical treatment that prioritizes the wishes of patients and families" C) "The prioritization of complementary and alternative measures over biomedical interventions" D) "The provision of holistic care to patients experiencing incurable health states" Ans: D A nurse is teaching new graduates about the nature of palliative care on her unit. Which of the following statements by a new nurse indicates a need for further teaching? A) "I can see how important it is for us to educate patients and their families and friends on the unit." B) "It certainly requires a change in thinking to understand why we don't provide any medical interventions for patients." C) "I can see how comfort and psychosocial well-being take precedence over physical functioning." D) "Purpose in life and quality of life seem to be the overarching goals of palliative care." Ans: B Hospice – comfort measures holistic, not receiving active treatment Cultural differences in how we die and the body treatment A nurse in an intensive care unit prepares to perform postmortem care on an older Jewish client. Family members are at his bedside. Which of the following actions by the nurse is appropriate? A) Allow the family to remain with the client. B) Liaise with the hospital chaplain to visit the family in the chapel. C) Address the man's oldest son when discussing the client's cares. D) Determine which family member(s) will be staying at the bedside during the cares. Ans: A A nurse cares for an 87-year-old client from India who has noted Hinduism as religious preference on admission records. This client is transferred to the hospice unit. Which of the following actions by the nurse best shows caring? A) Ask the family to tell you about Hinduism. B) Assess the client's spiritual needs. C) Notify the family's pastor. D) Pray with the client and family. Ans: B A quality care nurse assesses the care given by a hospice. Which of the following statements by the client best reflects dignified end-of-life care? A) "I'm glad that my family is making all the decisions; it's too much for me." B) "I'm not ready to die yet; I've got a few more in me." C) "It is fine sharing a room; I like the company." D) "They listened to me and stopped the therapy." Ans: D Elder abuse – physical, financial, sexual, emotional, self-neglect A nurse who works with the older population is aware that elder abuse takes many forms. Which of the following examples most clearly constitutes elder abuse? A) A paid caregiver cleans and assists with shopping for an older adult who lives alone. B) An older adult assists with child care in exchange for room and board at her niece's house. C) A daughter manages her mother's finances after the older adult granted her power of attorney. D) A daughter changes her mother's incontinence brief only after the urine has soaked through all her clothing because she wants to save money. Ans: D An 81-year-old has been living for the past 2 years in a long-term care facility. However, financial pressures have required that the resident move in with the oldest child and spouse. Which of the following statements if made by the child's spouse should signal a potential risk for elder abuse? A) "I sure hope that we'll qualify for some home care because this seems pretty overwhelming." B) "This won't be easy for anyone. I think I might even end up having to juggle my work schedule." C) "He's used to being waited on here, but at our place he's going to have to fend for himself." D) "I'm probably going to even have to get some friends or neighbors to help out from time to time." Ans: C A wound care nurse is assessing a 76-year-old client. The client has intimated to the nurse that her son sometimes "flies off the handle and gets rough with me." Which response made by the nurse is the best response? A) "When you say 'gets rough,' what does that look like?" B) "What do you think usually provokes this to happens?" C) "I'm going to have to phone adult protective services right now." D) "Why do you think that there is that response with anger or frustration?" Ans: A A nurse in a hospital setting assesses an older adult and is unsure if the assessment data warrant notification to the authorities for elder abuse. Which action is most appropriate for the nurse at this time? A) Determine if the person has dementia. B) Discuss findings with the family. C) Follow the hospital protocol for reporting. D) Question the visitors. Ans: C A nurse prepares a presentation regarding elder abuse and neglect. Which of the following types of abuse should the nurse include? (Select all that apply.) A) Alcohol (substance) B) Financial C) Mandatory D) Physical E) Psychological F) Sexual Ans: B, D, E, F Hearing loss – psychosocial affects – less social contacts What do studies of the psychosocial consequences of hearing impairment demonstrate? A) Hearing loss is less likely to have detrimental effects for people who have a few social relationships B) Hearing loss has a greater social impact on older women C) Hearing loss has a greater emotional impact on older men D) Hearing loss has a minimal effects on psychosocial function Ans: A Emergency room because frequent lapses in memory – ask about medication first An older adult is brought to the community clinic by an adult child with the concern of increasingly frequent lapses in memory. Which assessment question is most likely to identify potential risk factors for impaired cognitive functioning? A) "What did your mother and father die of?" B) "What line of work were you in?" C) "What medications are you currently taking?" D) "Where are you currently living?" Ans: C Some occupation that cause ototoxicity – factories, music is loud, working at the airport, A 62-year-old who has worked on an assembly line since he was 24 years old began taking aspirin for arthritis 6 months ago. The client presents to the nurse with hearing problems and ringing in the ears. Which of the following problems should the nurse suspect? A) Tinnitus B) Vertigo C) Ototoxicity D) Impacted cerumen Ans: C Female talking HCP, over 65, painful sex – water soluble gel or estrogen cream A 65-year-old woman is speaking to her nurse at the primary care clinic. She states that it is very painful for her when she has sexual relations. She asks the nurse what she could do to alleviate the pain. Which of the following suggestions could the nurse make to the woman? A) Decrease the incidence of sexual relations. B) Use a water-soluble lubricant or estrogen cream. C) While engaging in intercourse, have your partner thrust his penis upward. D) Use a polyisoprene (non-latex) condom for intercourse. Ans: B Newly diagnosis diabetic – asking question – readiness for knowledge A 66-year-old has been conscientious about health as an adult and is disappointed at having been recently diagnosed with type 2 diabetes. The client had been unwilling to discuss this new diagnosis for the past several weeks but has now begun asking the nurse questions about this disease. Which of the following nursing diagnoses is most appropriate for this client? A) Readiness for enhanced knowledge B) Readiness for enhanced self-care C) Readiness for enhanced power D) Readiness for enhanced comfort Ans: A Different stages of change model – five stages A 69-year-old cigarette smoker asks the nurse questions about the potential benefits of quitting smoking, a subject avoided in past interactions. The nurse asks the client, "Would you like to quit smoking?," to which the client replies, "I will give it some serious thought.” What stage of the Stages of Change model is the client demonstrating? A) Precontemplation B) Preparation C) Contemplation D) Action Ans: C A group of community health nurses is using the Stages of Change model as the foundation of a new health promotion campaign for older adults. What goal for the participants are the nurses likely to promote when working with older adults in the program? A) A recognition of the importance of screening for common health problems B) Increased participation in exercise programs and an awareness of the relationship between exercise and wellness C) The replacement of participants' unhealthy behaviors with healthy behaviors D) An awareness of the differences between life expectancy and active life expectancy Ans: C Somebody who is smoking for 50 years – says it’s too late – health benefits are immediate A 70-year-old client has been a regular cigarette smoker since late teens and has made several attempts to quit over the years. When the nurse encourages the client to again try to quit, the client responds, "At this point in my life, I think it's probably too late." How should the nurse best respond to the client's statement? A) "You'll be able to avoid having a future heart attack if you quit smoking now." B) "Three months after your quit, you'll have the same risk of heart disease as a lifetime nonsmoker." C) "In a way that's true, but you would feel much better about yourself if you managed to quit." D) "Actually, you'll start to enjoy some health benefits almost as soon as you quit." Ans: D Osteoporosis getting worse – vitamin d and calcium A 70-year-old woman has expressed interest in preventing osteoporosis as a result of the high prevalence of the disease in her peer group. What dietary measures should the nurse recommend? A) High intake of salmon and fortified cereals B) A high-protein, low-carbohydrate diet C) High intake of organic fruits and vegetables D) Vitamin C supplements and a high-potassium diet Ans: A Eating fresh fruits and supplements to age well – free-radical theory A 74-year-old client has recently begun integrating more fresh fruit and vitamin supplements in an effort to increase the levels of antioxidants. This client's actions indicate an understanding of what theory of aging? A) Cross-linkage theory B) Program theory of aging C) Immunosenescence D) Free radical theory Ans: D The child of an 81-year-old client asks the nurse about vitamins, antioxidants, and age-related macular degeneration. Which of the following theories of aging is most appropriate to this topic? A) Free radicals theory B) Immunosenescence theory C) Program theory D) Wear-and-tear theory Ans: A Older patient with dry eyes – over the counter eye drops A 78-year-old client states, "I often have dry eyes, it is bothersome and irritating." What intervention should the nurse recommend? A) Daily rinses with tap water B) A medication vacation to determine if medications are the cause C) Use of over-the-counter artificial tears D) Keeping eyes closed for 3 to 5 minutes each hour Ans: C Older man and wife is concerned with mental status and weakness – assess for UTI and pneumonia A 78-year-old client has been brought to the emergency department from home with a sudden change in mental status accompanied by significant weakness. For which condition should the health care providers assess? A) Alzheimer disease B) Lung cancer C) Pneumonia D) Tuberculosis Ans: C Lung cancer or TB – no cognitive changes Exercising autonomy by refusing treatment in the right mind A 78-year-old was diagnosed with colorectal cancer 18 months ago and underwent a round of chemotherapy. The most recent computed tomographic scan, however, reveals that the cancer has metastasized to the lungs and liver. The older adult states, "I feel quite well and do not wish to undergo another round of chemotherapy. " The client's children are adamantly opposed to their parent's decision to forgo treatment and have appealed to the nurse. Which factor is the priority consideration for the nurse to determine the best course of action? A) The client's prognosis B) The client's autonomy C) The family's wishes D) The client's treatment options Ans: B Long term care with Alzheimer’s – functional assessment – tool specifically developed for cognitively impaired patient A 79-year-old client has been admitted to a long-term care facility because of the progression of Alzheimer disease from mild to the moderate stage. How should the nurse proceed with functional assessment? A) Document the fact that it is not possible to accurately gauge the woman's ADLs. B) Obtain assessment data from the woman's family members and friends. C) Perform assessment passively by observing and recording the woman's behavior and actions over the next several days. D) Use an assessment tool that is specifically designed for use with cognitively impaired clients. The nurse cares for a client with advanced Alzheimer disease who is not mobile. The nurse has assessed the client as high risk for falls. Which of the following should be included in the fall- prevention program? (Select all that apply.) A) Bright orange sticker on the resident's door B) Padded mattress on the floor next to the resident's bed C) Use of chest restraints when in the wheelchair D) Frequent assessment of resident for toileting needs E) Keep lights on in room and bathroom F) Place sensor pad alarm on bed Ans: A, B, D, F Lab test for malnourish – low albumin and low red blood cells A nurse assesses a client admitted to the subacute care unit. The client is weak and underweight. Which of the following laboratory abnormalities would be related to undernutrition in this client? (Select all that apply.) A) Low albumin B) High hematocrit hemoglobin ratio C) Low serum iron and ferritin levels D) Decreased platelet count E) Elevated sedimentation rate Ans: A, C History of falls and grabs the nurse – fears of falling A nurse was recently assisting an 84-year-old resident of a nursing home with the resident's biweekly bath. While the nurse was helping the resident transfer out of the bathtub, the resident grabbed on to the nurse forcefully, became rigid, and exclaimed, "Help me quick," despite the fact that the nurse was performing a safe and controlled transfer. Why might this resident have exhibited sudden anxiety during the transfer? A) The resident may be developing a cognitive deficit. B) The resident is experiencing age-related changes. C) The resident may have a fear of falling. D) The resident is ensuring safety. Ans: C A nursing home has been the site of numerous falls by residents in recent months. Which of the following environmental factors should the nurse manager change? (Select all that apply.) A) The hallways that lead to the dining room and common areas do not have handrails. B) Each room has a private sink and toilet but there are only two designated rooms for bathing in the facility. C) The bedrails on each resident's bed are kept in a raised position whenever the resident is in bed. D) The majority of care is provided by nursing assistants, with one registered nurse overseeing the care team. E) Medications are administered at each room by the nurse from a rolling cart. Ans: A, C Braden Scale – lower number for high risk of skin breakdown 9 or lower A client is unresponsive, the skin is usually dry, confined to bed, with limited mobility and contractures, and the nutrition is less than adequate. Using the Braden score, which score will be assigned to this client's risk for pressure ulcers? A) 8, very high risk B) 8, at risk C) 18, high risk D) 18, moderate risk Ans: A Less calories as you get older A nurse counsels an older adult regarding nutritional requirements. Which of the following teaching points is priority when discussing age-related changes in nutritional requirements? A) "If possible, try to eliminate animal fats from your diet." B) "You should try to eat less meat and proteins than you did when you were younger." C) "Overall, you don't need to take in as many calories as you used to." D) "As an older adult, you don't need to eat as many starches and complex carbohydrates." Ans: C 65 and up, end stage renal failure, two years on Medicaid for two years – qualify for Medicare Major factors sexual function in woman – hormones A gerontological nurse is aware that the aging process is accompanied by numerous, multifactorial changes that affect sexual wellness in older adults. Among women, which of the following factors is usually the primary cause of changes in sexual functioning? A) Psychosocial factors B) Environmental factors C) Hormonal factors D) Spiritual factors Ans: C Different groups of older people – single women are more likely to be living in poverty A nurse assesses the risk of the members of the community. Which of the following are most likely to be living at or below the poverty line? A) An 83-year-old single woman B) A couple who are both 72 years old C) A white 73-year-old man D) A Hispanic couple in their 60s Ans: A Huge economic disparity in older adults A nurse hears a colleague make the statement, "Most older adults have nothing to worry about financially." Which of the following responses is most appropriate? A) "You have to remember that there's a huge economic disparity among older adults." B) "Actually, the number of older people living below the poverty line has been increasing, not decreasing." C) "This isn't really true now, but it is true that the gaps that disadvantaged groups live with are expected to shrink." D) "This is true for some groups, but not for minorities who are less likely to be living with their relatives." Ans: A Not growing older but wiser – healthy aging A nurse interviews a centenarian gathering data for a large study. In the interview, the centenarian defines aging as not growing older, but growing wiser. Which of the following is the best response to this definition by the nurse? A) "Aging might make you wiser, but it does lead to eventual death." B) "Healthy maturity is characterized by wisdom." C) "How did you get to live to this old?" D) "I will never make it to be 100 like you." Ans: B A nurse leads a "Healthy Aging" class at a community health center. Which question should the nurse use to generate discussion among participants in this setting? A) "How did you adjust to your move from your house to the assisted living facility Irma?" B) "Are you satisfied with the care that you're getting from your family doctor, Elizabeth?" C) "Donald, could you tell us why your grandson is living with you?" D) "Have you had any tests done on your heart since we last met, Marie?" Ans: A Comprehensive psychosocial assessment – assess motor function? Watch her do stuff A nurse is conducting a comprehensive psychosocial assessment of an older adult who has recently moved to the long-term care facility. How should the nurse best assess the client's motor function? A) Observe the client walking into or out of the room. B) Assess the client's deep tendon reflexes using a hammer. C) Perform passive range of motion exercises on the client's arms and legs. D) Position the client supine and ask the client to perform a leg lift with each leg separately. Ans: A Over counter medication that can cause falls – antihistamines A nurse is teaching older adults at a senior center how to reduce the incidence of falls. Which of the following statements indicates that the nurse's teaching has been effective? A) "Benadryl is a safe medication to take for sleep." B) "It is safe to have rugs in my kitchen and bathroom." C) "It is safe to take a low dose of Ativan when I am anxious." D) "I understand that over-the-counter medications can cause falls." Ans: D Not good thermoregulation – use an accurate thermometer A nurse who oversees the care in a nursing home is aware that the older adults who reside in the facility are vulnerable to impaired thermoregulation. What information source should the nurse prioritize when regulating the temperature in the facility? A) The nurse's perception of heat and cold when dressed similarly to the residents B) Readings from an accurate thermometer C) The input from nursing assistant and unlicensed care providers in the facility D) The suggestions of residents who do not have cognitive impairments Ans: B Keeping older residents cognitively stimulated – puzzles, reading, discussions, A nurse in an assisted living facility develops interventions that focus on improving cognitive abilities in the residents. Which of the following interventions should the nurse include in the plan? (Select all that apply.) A) Book club B) Calisthenics C) Christmas caroling D) Letter writing E) Reminiscence therapy F) Shopping trip Ans: A, D A nurse plans activities each month at an assisted living facility. Which of the following activities is most cognitively stimulating? A) Book discussions B) Movie night C) Exercise D) Reminiscence therapy Ans: A A nurse providing care in a long-term care setting is aware that the cognitive function of older adults does not necessarily decline on an inevitable trajectory. Which action has the greatest potential to enhance the cognitive function of residents and prevent cognitive declines? A) Encourage older adults to openly express their emotions and opinions. B) Provide residents with four or five low-fat, high-protein meals during the day. C) Encourage older adults to participate in mentally stimulating activities. D) Present older adults with numerous opportunities to make autonomous decisions. Ans: C Good death – do it the way the family and patient wants A nurse who works in a palliative setting is aware of the need to facilitate a "good death" for as many clients as possible. Which of the following interventions should be included? A) Discuss openly and explicitly the client's strengths and weaknesses. B) Ensure that a minimum of nursing interventions are performed. C) Empower the client and family to maintain as much control as possible. D) Emphasize spiritual needs rather than physical comfort and medical needs. Ans: C Adjust to coming to term with their own mortality A nurse assists adults to prepare for the changes that often occur in late adulthood. Which of the following psychosocial consequences occur because of life events during that period? (Select all that apply.) A) A broadening of social networks B) Adjusting to relocation from home C) Adjustment to a lower income D) Adaptation to chronic illnesses E) Coming to terms with one's mortality Ans: B, C, D, E Cultural background influence what you consider normal A nurse who provides care in a large, inner-city hospital comes into contact with older adults from a wide variety of cultural groups. How is culture most likely to influence the assessment and management of pain? A) Cultural differences affect the intensity of pain. B) Culture can dictate the appropriate expression of pain. C) Culture should determine the choice of analgesia when treating pain. D) Culture is unrelated to pain because pain is a physiological, rather than psychosocial, phenomenon. Ans: B Bone density test - -3.5 or lower for osteoporosis Undernourished – long term care facility Be aware of your own attitudes towards to the elderly Surrender things or give up things – giving up the driving is a major event A nurse discusses driving with an older adult who continues to drive, but is probably unsafe on the road. Which statement made by the nurse is most appropriate? A) I am calling your child to take your keys. B) I am concerned about your safety, as well as the safety of others. C) We just don't want you to crash when you drive across the state. D) You shouldn't drive anymore. Ans: B TDAP is given throughout life Hospice eligible – cancer patient with only a few months to live A nurse explores resources available to assist a client. Which of the following older adults meets the eligibility requirements for hospice care? A) A client who is immobilized and unable to afford specialized nursing care B) A client who has experienced a stroke and been given 3 months to live C) A client with cancer who is living with uncontrolled persistent pain D) A client with acquired immunodeficiency syndrome who lacks family support to provide needed care Ans: B Sternum is the best place to assess skin on older adults The nurse assesses the fluid volume status of a 72-year-old client who takes Lasix (furosemide) and Pacerone (amiodarone). Which of the following is the most reliable method for assessing this client's skin turgor? A) Ask the client to open the mouth and examine the oral mucous membranes for dryness. B) Examine the skin on the lower legs and look for dry, scaly, or rough skin. C) Gently pinch the skin on the abdomen to see how long it takes to return to normal. D) Squeeze the skin on back of hand to see if it remains pinched or is slow to return to normal. Ans: C Using herbal supplements – look for the USP mark A nurse is conducting a medication assessment of an older adult. Which of the statements by the older adult indicates a need for further education? A) "Overall, I much prefer to prevent getting sick than having to rely on different drugs to stay healthy." B) "I've made a reminder system for myself so that I don't miss any of my pills during the day." C) "My family doctor has me on so many different pills now, so I want to talk about whether they're all necessary." D) "I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural." Ans: D FDA does NOT regulate herbal products Electrolyte imbalance for urinary problems – hyperkalemia Which electrolyte imbalance may occur related to altered homeostasis and urinary function in the older adult population? A) Hypercalcemia B) Hypernatremia C) Hyperkalemia D) Hperchloremia Ans: C Letters of the alphabet that harder for the elderly – b, d, k, p, t Which letters of the alphabet become distorted as hearing loss progresses? A) F,n,s,v,y B) B,d,k,p,t C) A,e,I,o,u D) C,g,j,m,w Ans: B Corticosteroids – osteoporosis, cataracts Which of the following older adults is most at risk to develop osteoporosis? A) A 65-year-old white woman with chronic obstructive pulmonary disease who takes corticosteroids B) A 65-year-old white man with rheumatoid arthritis C) A 70-year-old African American man with a seizure disorder D) A 68-year-old Hispanic woman who recently had a partial hysterectomy Ans: A 85 year old with bruises and tears – review the clients medication A nurse assesses an 85-year-old client and finds bruises on the arms and shins and a skin tear on the right hand. Which action is the priority for further nursing assessment? A) Consider the family as a reliable source of information. B) Determine if the person is depressed. C) Follow the protocol for reporting elder abuse. D) Revi