Test Bank Ham's Primary Care Geriatrics A Case-Based Approach 6th Edition

Test Bank Ham's Primary Care Geriatrics A Case-Based Approach 6th Edition Table of Contents Chapter 1. Principles of Primary Care of Older Adults .......................................................................................... 3 Chapter 2. Interprofessional Team Care ............................................................................................................. 10 Chapter 3. Assessment ...................................................................................................................................... 19 Chapter 4. Wellness and Prevention .................................................................................................................. 27 Chapter 5. Advanced Cultural Competency in Caring for Geriatric Patients ........................................................ 35 Chapter 6. Appropriate Prescribing .................................................................................................................... 42 Chapter 7. Ethics ................................................................................................................................................ 50 Chapter 8. Financing and Organization of Health Care ....................................................................................... 58 Chapter 9. Billing and Coding ............................................................................................................................. 62 Chapter 10. Hospital Care .................................................................................................................................. 71 Chapter 11. Long-Term Care ............................................................................................................................. 76 Chapter 12. Home Care ..................................................................................................................................... 89 Chapter 13. Rehabilitation .................................................................................................................................. 98 Chapter 14. Palliative Care ............................................................................................................................... 106 Chapter 15. Emergency Care ........................................................................................................................... 112 Chapter 16. Delirium ........................................................................................................................................ 123 Chapter 17. Alzheimer’s Disease and Other Dementias ................................................................................... 127 Chapter 18. Depression ................................................................................................................................... 135 Chapter 19. Balance, Gait and Mobility ............................................................................................................ 139 Chapter 20. Falls .............................................................................................................................................. 147 Chapter 21. Dizziness ...................................................................................................................................... 155 Chapter 22. Syncope ........................................................................................................................................ 157 Chapter 23. Urinary Incontinence ..................................................................................................................... 158 Chapter 24. Constipation and Fecal Incontinence ............................................................................................ 166 Chapter 25. Hearing Impairment ...................................................................................................................... 173 Chapter 26. Visual Impairment and Eye Problems ........................................................................................... 186 Chapter 27. Persistent Pain .............................................................................................................................. 198 Chapter 28. Malnutrition and Feeding Problems ............................................................................................... 206 Chapter 29. Frailty ............................................................................................................................................ 213 Chapter 30. Pressure Ulcers ............................................................................................................................ 221 Chapter 31. Sleep Disorders ............................................................................................................................ 228 Chapter 32. Sexual Health ............................................................................................................................... 236 Chapter 33. Mistreatment and Neglect ............................................................................................................. 244 Chapter 34. Alcoholism .................................................................................................................................... 246 Chapter 35. Driving .......................................................................................................................................... 251 Chapter 36. Hypertension ................................................................................................................................. 253 Chapter 37. Coronary Artery Disease and Atrial Fibrillation .............................................................................. 267 1 | P a g eChapter 38. Congestive Heart Failure .............................................................................................................. 275 Chapter 39. Peripheral Vascular Disease ......................................................................................................... 287 Chapter 40. Transient Ischemic Attacks and Stroke ......................................................................................... 301 Chapter 41. Diabetes Mellitus .......................................................................................................................... 313 Chapter 42. Thyroid Disorders .......................................................................................................................... 326 Chapter 43. Osteoporosis ................................................................................................................................. 333 Chapter 44. Arthritis and Related Disorders ...................................................................................................... 348 Chapter 45. Foot Problems .............................................................................................................................. 361 Chapter 46. Cancer .......................................................................................................................................... 372 Chapter 47. Anemia .......................................................................................................................................... 380 Chapter 48. Pulmonary Disease ....................................................................................................................... 395 Chapter 49. Infectious Diseases ....................................................................................................................... 403 Chapter 50. The Acute Abdomen ..................................................................................................................... 410 Chapter 51. Benign Prostate Disease ............................................................................................................... 426 Chapter 52. Parkinson’s Disease ..................................................................................................................... 434 Chapter 53. Oral Disorders ............................................................................................................................... 436 Chapter 54. Skin Problems ............................................................................................................................... 438 2 | P a g eChapter 1. Principles of Primary Care of Older Adults MULTIPLE CHOICE 1. In 2010, the revised Standards and Scope of Gerontological Nursing Practice was published. The nurse would use these standards to: a. promote the practice of gerontologic nursing within the acute care setting. b. c. d. define the concepts and dimensions of gerontologic nursing practice. elevate the practice of gerontologic nursing. incorporate suggested interventions from others who practice gerontologic nursing. ANS: D The current publishing of the Standards and Scope of Gerontological Nursing Practice in 2010 incorporates the input of gerontologic nurses from across the United States. It was not intended to promote gerontologic nursing practice within acute care settings, define concepts or dimensions of gerontologic nursing practice, or elevate the practice of gerontologic nursing. DIF: Remembering (Knowledge) REF: msc: 2 OBJ: 1-1 TOP: N/A MSC: Safe and Effective Care Environment 2. When attempting to minimize the effect of ageism on the practice of nursing older adults, a nurse needs to first: a. b. c. d. recognize that nurses must act as advocates for aging patients. accept that this population represents a substantial portion of those requiring nursing care. self-reflect and formulate ones personal view of aging and the older patient. recognize ageism as a form of bigotry shared by many Americans. ANS: C Ageism is an ever-increasing prejudicial view of the effects of the aging process and of the older population as a whole. With nurses being members of a society holding such views, it is critical that the individual nurse self-reflect on personal feelings and determine whether such feelings will affect the nursing care that he or she provides to the aging patient. Acting as an advocate is an important nursing role in all settings. Simply accepting a fact does not help end ageism, nor does recognizing ageism as a form of bigotry. DIF: Applying (Application) REF: N/A OBJ: 1-9 TOP: Teaching-Learning MSC: Safe and Effective Care Environment 3. When discussing factors that have helped to increase the number of healthy, independent older Americans, the nurse includes the importance of: a. increased availability of in-home care services. b. c. d. ANS: C The health and ultimate autonomy of older Americans has been positively impacted by the development of antibiotics, better sanitation, and vaccines. These public health measures have been more instrumental in increasing the numbers of healthy, independent older Americans than have in-home care 3 | P a g e government support of retired citizens. effective antibiotic therapies. the development of life-extending ces, government programs, or life-extending therapies. DIF: Remembering (Knowledge) REF: msc: 2 OBJ: 3-3 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 4. Based on current data, when presenting an older adults discharge teaching plan, the nurse includes the patients: a. nonrelated caretaker. b. c. d. paid caregiver. family member. intuitional representative. ANS: C Less than 4% of older adults live in a formal health care environment. The majority of the geriatric population lives at home or with family members. DIF: Applying (Application) REF: N/A OBJ: 3-3 TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment 5. The nurse planning care for an older adult who has recently been diagnosed with rheumatoid arthritis views the priority criterion for continued independence to be the patients: a. age. b. c. d. ANS: D Maintaining the functional status of older adults may avert the onset of physical frailty and cognitive impairment, two conditions that increase the likelihood of institutionalization. DIF: Remembering (Knowledge) REF: msc: 8 OBJ: 1-6 TOP: Nursing Process: Planning MSC: Physiologic Integrity 6. A nurse working with the older adult population is most likely to assess a need for a financial social services referral for a(n): a. white male. b. c. d. ANS: B The poverty rate among older black women is substantially higher than that seen among males or females of other ethnic groups. White males had the least poverty. DIF: Applying (Application) REF: N/A OBJ: 1-4 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment 7. Which of the following statements made by a nurse preparing to complete a health assessment and history on an older patient reflects an understanding of the general health status of this population? 4 | P a g e black female. Hispanic male. Asian American female. financial status. gender. functional status.a. b. c. d. Ill need to document well regarding the medications the patient is currently prescribed. I would like to understand how supportive the patients family members are. Most older patients are being treated for a variety of chronic health care issues. It will be interesting to see whether this patient sees herself as being healthy. ANS: D It is a misconception that old age is synonymous with disease and illness. The nurse should always determine the patients sense of wellness and independence when conducting a health and history assessment. An assessment of medication use and family support is important for any patient. Many older adults do have chronic health conditions, but their perception is more important than a single number. DIF: Applying (Application) REF: N/A OBJ: 1-4 TOP: Nursing Process: Assessment MSC: Health Promotion 8. The nurse is caring for an older adult who has been admitted to an acute care hospital for treatment of a fractured femur. The family expresses concern about the patients pending transfer to a subacute care facility. What response by the nurse is best? a. Acute care facilities lack the long-term physical therapy support your dad requires. b. c. d. ANS: C The transfer of the patient to a subacute facility is based on the need to maintain the patients level of function and independence, a task the acute care facility is not prepared to address once the patient is physiologically stable. The patient may or may not be happier in the new setting; the nurse should not make this judgment. It is true that insurance only pays for a limited amount of time in an acute care facility, but this is not the best reason for the patient to transfer. DIF: Applying (Application) REF: N/A OBJ: 1-6 TOP: Communication and Documentation MSC: Health Promotion and Maintenance 9. To best assure both the quality of care and the safety of the older adult patient who requires in- home unlicensed assistive personal (UAP) assistance, the geriatric nurse: a. evaluates the competency of the UAP staff. b. c. d. assumes the roles of case manager and patient advocate. arranges for the needed UAP provided services. assesses the patient for functional limitations. ANS: A As more care traditionally provided by professional nurses is being transferred to UAP, the nurse must assume more responsibility for educating, training, and evaluating the competency of UAP staff to provide safe, effective care for the older adult patient. DIF: Applying (Application) REF: N/A OBJ: 1-2 5 | P a g e Your dad will be much happier in a more serene, private environment. The subacute facility will focus on helping your dad maintain his independence. Insurance, including Medicare, will cover only a limited amount of time here.TOP: Communication and Documentation MSC: Safe and Effective Care Environment 10. The nurse working with older adults understands what information about certification in gerontologic nursing? a. It is mandatory for those in long-term care settings. b. c. d. job. ANS: B Certification is voluntary and shows that a nurse has additional knowledge and expertise in a certain area of practice. It is not mandatory in specific care settings. It does not allow for third- party reimbursement. It may be part of a career ladder program, but that is not true of all work settings. DIF: Remembering (Knowledge) REF: msc: 2 OBJ: 1-2 TOP: Teaching-Learning MSC: Safe Effective Care Environment 11. A nurse works in a gerontologic clinic. What action by the nurse takes highest priority? a. Serving as a patient advocate b. c. d. care ANS: C One of the challenges and priorities of the gerontologic nurse is helping patients maintain their independence. DIF: Remembering (Knowledge) REF: msc: 10 OBJ: 1-2 TOP: Nursing Process: Implementation MSC: Health Promotion 12. A nurse is caring for an older patient in the emergency department. What information about the patient will be most helpful in creating a plan of care? a. Baseline physical and cognitive functioning b. c. d. ANS: A The nurse is encouraged to view older patients as individuals and consider their baseline physical and cognitive functional status as a standard by which to compare the patients current status. The other information is also important, but the basis of individualized care begins with the patients strengths and weaknesses. DIF: Applying (Application) REF: N/A OBJ: 1-6 TOP: Nursing Process: Assessment MSC: Health Promotion 13. The faculty member explains to students that many older Americans continue to work past the retirement age. What best explains this trend? 6 | P a g e Living conditions and family support Medications and current medical problems Results of the Mini Mental State examination Educating patients about diseases Helping patients remain independent Referring patients to home health It is voluntary and shows clinical expertise in an area. It allows nurses to be paid by third-party payers. It allows nurses to advance their careers in aa. b. c. d. ANS: B As financial situations may have declined as a result of many economic factors, more older adults work past their retirement age. The other options may be reasons for some to continue working, but financial necessity is the reason the majority continue to do so. DIF: Remembering (Knowledge) REF: msc: 7 OBJ: 1-3 TOP: Teaching-Learning MSC: Health Promotion 14. What information does the faculty member teach students about Medicare? a. Covers anyone with end stage renal disease b. c. d. hole ANS: A Although Medicare is primarily for those over the age of 65, it does cover people of any age with end-stage kidney disease. Part A covers hospital costs. Part B is medical insurance. The donut hole was fixed by the Affordable Care Act. DIF: Understanding (Comprehension) REF: msc: 9 OBJ: 1-3 TOP: Teaching-Learning MSC: Health Promotion 15. A nursing manager notes that many older patients are admitted to the nursing unit for acute problems. What action can the manager take to most benefit this population? a. Provide mandatory education on the needs of the older patient. b. c. d. Provide restorative therapy programs designed for this group. Ensure staffing numbers are adequate for dependent patients. Encourage all nurses to obtain gerontologic certification. ANS: B Many older adults need acute care for sudden illness and injury but live in a state of functional decline, which could possibly be prevented by establishing a restorative therapy program. The other actions will help the older patients cared for in the unit, but only to limited degrees. DIF: Applying (Application) REF: N/A OBJ: 1-4 TOP: Nursing Process: Implementation MSC: Physiologic Integrity: Reduction of Risk Potential 16. The dean of a new nursing program wishes to ensure graduates are prepared to care for older patients. What document should guide the dean in designing the curriculum? a. The Nurse Practice Act for that state b. c. d. 7 | P a g e The American Nurses Association (ANA) code of ethics for nurses Healthy People 2020 The Recommended Baccalaureate Competencies and Curricular Guidelines Part A covers some prescription costs Part B covers inpatient hospital costs Part D eliminates the drug donut Feeling healthier longer Changing financial outlook Becoming bored in retirement A desire to give backANS: D The Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults is an updated version of The Essentials of Baccalaureate Education for Professional Nursing Practice. This document was first published by the American Association of Colleges of Nursing (AACN) in 2008 and was updated in 2010. The other three documents do not have information about curricular requirements to prepare students to care for the older population. DIF: Applying (Application) REF: N/A OBJ: 1-2 TOP: Teaching-Learning MSC: Health Promotion 17. A nurse wants to plan a community event at a retirement center. What topic would most likely be best received? a. Heart healthy living b. c. d. Financial planning Avoiding scams Ethnic cooking classes ANS: A Older adults are demanding more programs and services aimed at health maintenance and promotion and disease and disability prevention. Based on this information, the heart healthy living presentation would be best received. DIF: Applying (Application) REF: N/A OBJ: 1-3 TOP: Teaching-Learning MSC: Health Promotion 18. What does the bedside nurse understand about his or her role in nursing research? a. Research is only done by doctorally prepared nurses. b. c. d. All nurses have a role in delivering research-based care. A bedside nurse can be part of a hospital research team. The bedside nurse can collect data if the nurse has been properly trained. ANS: B All nurses are charged to deliver patient-centered care based on evidence-based practice, research, quality improvement, and informatics. The bedside nurse is part of an interdisciplinary team that is responsible for redesigning the health care structure of the future. DIF: Understanding (Comprehension) REF: msc: 13 TOP: Teaching-Learning MSC: Safe Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. The clinic nurse caring for an older diabetic patient with a sixth grade education anticipates that the patient may experience difficulty (Select all that apply.) a. recognizing the importance of keeping clinic appointments. b. c. d. e. following a low-carbohydrate diet. paying for insulin and syringes. deciding on a primary health care provider. naming a health care surrogate. ANS: A, B, C Even though the educational level of the older population has steadily increased, as a population they 8 | P a g eare less educated than the general population. This deficiency can account for a lack of understanding regarding the need for medical care and the importance of following a treatment plan. These patients may also have fewer financial resources to devote to health care issues. DIF: Analyzing (Analysis) REF: N/A OBJ: 1-4 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment 2. The nurse studying the history of gerontologic nursing learns which information about the specialty? (Select all that apply.) a. The number of older Americans is diminishing. b. c. d. e. The geriatric nursing conference group was established in 1962. The gerontologic clinical nurse specialist certification was offered in 1989. There were no writings about the care of older persons until World War II. The first Standards of Practice for Geriatric Nursing was written in 1969. ANS: B, C, E The geriatric nursing conference group was established in 1962, the gerontologic clinical nurse specialist certification was first offered in 1989, and the first Standards of Practice for Geriatric Nursing was written in 1969. The population of older Americans is the fastest-growing subset of the population. Writings about care of the aged can be found from as early as 1900. DIF: Remembering (Knowledge) REF: msc: 2-3 OBJ: 1-2 TOP: Teaching-Learning MSC: Nursing Process: Assessment 3. The student asks the gerontologic clinic nurse why so many older people are women. What information does the nurse provide? (Select all that apply.) a. Reduced maternal mortality b. c. d. e. Decreased deaths from infectious diseases More deaths from chronic disease in men More deaths in war occur in men Women tend to smoke and drink less than men ANS: A, C, D A decrease in maternal mortality, decreased deaths from infectious diseases, and more chronic illness in men account for the disparity in genders as people age. DIF: Understanding (Comprehension) REF: msc: 6 OBJ: 1-5 TOP: Teaching-Learning MSC: Health Promotion 4. The gerontologic nurse plans community programming for older women, noting what facts about this population subgroup? (Select all that apply.) a. More likely to live alone b. c. d. e. Increased chance of living in poverty Taking care of a spouse Suffering many chronic diseases Living with extended families ANS: A, B, D Older women have a greater chance than men of living alone and in poverty. They also have a greater degree of functional impairment and chronic disease. 9 | P a g eDIF: Remembering (Knowledge) REF: msc: 6 OBJ: 1-5 TOP: Nursing Process: Analysis MSC: Health Promotion 5. The nurse knows that the most common causes of death in the older population result from which diseases? (Select all that apply.) a. Cerebrovascular disease b. c. d. e. End-stage kidney disease Heart disease Cancer Diabete s ANS: A, C, D The most common causes of death in the older population are cerebrovascular disease, heart conditions, and cancer. End-stage renal disease and diabetes are not among the top three causes of death. Chapter 2. Interprofessional Team Care MULTIPLE CHOICE 1. What is the correct term for a concise, one- or two-msc: summary of educational and work experience, activities and honors, and concrete skills and interests? a. Introduction b. c. d. ANS: C A rsum is a one- or two-msc: summary of the applicants education and experience. PTS: 1 DIF: Cognitive Level: Knowledge REF: msc: 2042 OBJ: 1 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 2. An employee failed to perform the duties listed in the employment contract. What is the term for this failure? a. b. c. d. ANS: C 10 | P a g e Lawsuit Termination Breach of contract Reprimand Review Rsum CompositeFailure by the nurse or employer to perform contractual duties is known as a breach of contract. A breach of contract may result in a reprimand, termination, or lawsuit. PTS: 1 DIF: Cognitive Level: Knowledge REF: msc: 2042 OBJ: 2 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 3. What is the best way to resolve most disagreements? a. b. c. d. ANS: C Most problems can best be resolved by communication at the most basic level. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2044 OBJ: 13 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 4. What is another term for promotion? a. Reward b. c. d. ANS: B Advancement may result from additional preparation or additional experience. It may be gained by learning the position more thoroughly and by assuming new and greater responsibilities. PTS: 1 DIF: Cognitive Level: Knowledge REF: msc: 2045 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 5. When a rsum reflects too many job changes, the employer may question it. How long should an employee remain at the first place of employment? a. b. c. d. ANS: C Resigning from a position properly is another skill that the LPN/LVN will need to have. Employers will sometimes question a rsum that reflects frequent job changes; therefore, it is best to remain at the first place of employment at least 1 year. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2045 OBJ: 1 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 6. Technical and scientific changes have resulted in a multiplicity and complexity of functions 11 | P a g e 6 months 3 months 1 year 2 years Advancement Lift Bubble Agreement Argument Communication Withdrawingplaced on nurses, and sometimes job descriptions have not been rewritten. What is true of the role of the LPN/LVN? a. b. c. d. ANS: B The role of the LPN/LVN is constantly changing. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2045 OBJ: 6 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 7. Which organization specifically supports and meets the needs of the LVN/LPN? a. b. c. d. ANS: A National Association for Practical Nurse Education and Service (NAPNES) is the professional organization that is specifically for LVN/LPNs. The National League for Nursing (NLN) and the American Nurses Association (ANA) are not specific to the LPN. The National Council Licensure Exam (NCLEX) is the test that is taken for licensure. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2047 OBJ: 5 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 8.A nurse may practice in another state if he or she has passed the NCLEX-PN examination in the nurses own state and meets the other states educational requirements. What is the process of transferring licensure from one state to another called? a. b. c. d. ANS: C This licensure transfer from one state to another is called endorsement. PTS: 1 DIF: Cognitive Level: Knowledge REF: msc: 2051 OBJ: 10 TOP: Licensure KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 9. What is the name of the licensing law that defines the title and regulations governing the practice of nursing and states the requirements for licensure? 12 | P a g e Auxiliary Co-licensure Endorsement Qualified licensure NAPNES NLN ANA NCLEX It is constantly enlarging It is constantly changing It is constantly improving It is constantly growinga. b. c. d. State practice act Nurse regulation act Nurse practice act Legislative act ANS: C The nurse practice act defines the title and regulations governing the practice of nursing. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2052 OBJ: 9 TOP: Licensure KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 10. What is the term for the commission of an act that a prudent nurse should not have done, or the omission of an act a prudent nurse should have done, that results in injury or harm to another person? a. b. c. d. ANS: B To qualify as negligence, it must be proved that a prudent member of the profession would have acted differently. PTS: 1 DIF: Cognitive Level: Knowledge REF: msc: 2052 OBJ: 10 TOP: Negligence KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 11. In what setting can the LPN/LVNs management and leadership skills be developed best? a. b. c. d. ANS: D Management and leadership skills of the LPN/LVN can best be developed in long-term care settings with RN supervision. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2053 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 12. Which setting provides greater nurse autonomy and continuity of care and is less costly for insurance companies? a. 13 | P a g e Hospice Acute care hospital Rehabilitation hospital Trauma center Long-term care facility Malpractice Negligence Neglect Disregardb. c. d. Hospitals Home health Long-term care ANS: C The advantages of home health are greater nurse autonomy and continuity of care, as well as less cost to insurance. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2053 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 13. Which employment setting would likely involve a daytime schedule with weekends off, and would focus on prevention and patient teaching? a. b. c. d. ANS: B Physician offices typically involve a daytime schedule with most weekends off. The setting focuses on prevention and includes opportunities for patient teaching. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2054 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 14. Which health care employment setting would provide the nurse a very good salary, the opportunity to refuse to take an assignment, and more flexibility in the personal schedule but with an uncertainty of work availability? a. b. c. d. ANS: A In a temporary agency, the salary is good, and an LPN/LVN has the right to refuse assignments. However, one disadvantage is the uncertainty of work availability. PTS: 1 DIF: Cognitive Level: Application REF: msc: 2054 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 15. In what employment setting does the nurse give total care to one patient; is totally independent; provides care in the home, hospital, or other facility; is paid directly by the patient; and is legally responsible for his or her own actions? a. b. 14 | P a g e Home health nursing Private duty nursing Temporary agency Long-term care center Outpatient clinic Adult day care center Long-term care Physicians office Hospice setting Adult day carec. d. Patient care nursing Agency care nursing ANS: B The private duty nurse gives total care to one patient and is paid directly by the patient or responsible party. The nurse is legally responsible for his or her own actions. PTS: 1 DIF: Cognitive Level: Application REF: msc: 2055 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 16.A new graduate who has achieved the goal of getting others to do something that is believed necessary has demonstrated what skill? a. b. c. d. ANS: B Leadership is the art of getting others to want to do something that is perceived as necessary. PTS: 1 DIF: Cognitive Level: Application REF: msc: 2056 OBJ: 13 TOP: New graduate KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 17. What type of leadership involves a leader who displays little trust or confidence in employees and therefore makes all the decisions? a. b. c. d. ANS: C he autocratic leader displays little trust in employees, and therefore makes all decisions. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2056 OBJ: 14 TOP: Leadership KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 18. What type of leadership uses four different stylesdirecting, coaching, supporting, and delegating? a. b. c. d. Autocratic Situational Democratic Authoritative ANS: B Situational leadership identifies four typical styles for leaders. PTS: 1 DIF: Cognitive Level: 15 | P a g e Democratic Laissez-faire Autocratic Authoritative Management Leadership Influence ControlComprehension REF: msc: 2057 OBJ: 14 TOP: Leadership KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 19. What is the physical, emotional, and spiritual exhaustion that can occur among caregivers? a. b. c. d. ANS: B Physical, emotional, and spiritual exhaustion among caregivers is sometimes called burnout. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2061 OBJ: 22 TOP: Burnout KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 20. Why is it important for new graduates to purchase their own malpractice insurance rather than depend on an institutional policy? a. b. c. d. ANS: B The new graduate should purchase private malpractice insurance in addition to that of the institution to ensure that there is personal liability coverage. The private policy will cover the new graduate at any nursing job in which they are employed. No malpractice insurance policy can guarantee that there will not be any lawsuit or loss of license. PTS: 1 DIF: Cognitive Level: Application REF: msc: 2061 OBJ: 21 TOP: Malpractice insurance KEY: Nursing Process Step: N/A MSC:NCLEX: N/A MULTIPLE RESPONSE 21. What are considered duties of a team leader? (Select all that apply.) a. b. c. d. e. ANS: A, B, C, E Receiving reports on assigned patients, making patient assignments, assessing all assigned 16 | P a g e Receiving reports on assigned patients Making patient assignments for team members Assessing all assigned patients Administering medications to all patients Conferring with team members A private policy will not cover them unless they are on their primary job. A private policy will carry personal liability coverage. A private policy will protect them against all lawsuits. A private policy will protect them from losing their license. Excessiveness Burnout Fatigue Wearinesspatients, and conferring with team members are duties of the team leader. Assisting team members with medication administration is a duty of the team leader, not actually administering the medications to all the patients. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2057 OBJ: 15 TOP: Team leading KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 22. Which actions would best aid the new nurse in coping with working the night shift? (Select all that apply.) a. b. c. d. e. ANS: B, D Dark shades or room darkening blinds will block the sunshine and allow for darkness when sleeping during the daytime hours. Wear sunglasses on the drive home from work to reduce the melatonin- reducing effect of sunshine. It is best to eat light, balanced meals during the night. Sedatives and alcohol should not be used as an aid to sleep. Allow time to unwind after work before going to bed, and try to follow the same routine daily. PTS: 1 DIF: Cognitive Level: Application REF: msc: 2040, Box 57-6 OBJ: 3 TOP: Night shift KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 23.A nursing instructor is preparing her class for the NCLEX-PN examination. Which statements by the students indicate understanding of the testing process? (Select all that apply.) a. b. c. d. e. It will be a computerized adaptive test. I will have a maximum of 265 questions. The maximum time allowed for testing is 5 hours. The minimum number of questions on the test is 60. My state board of nursing must approve my application to test. ANS: A, C, E The NCLEX-PN examination is a computerized adaptive test. The minimum number of questions for the PN examination is 85, and the maximum number of questions is 205. The maximum time allowed for the test is 5 hours. The state board of nursing must approve the applicant for testing before the authorization to test is issued. PTS: 1 DIF: Cognitive Level: Application REF: Pages OBJ: 7 TOP: NCLEX exam KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 24. Which questions should the nurse consider before delegating care to another team member? (Select all that apply.) 17 | P a g e Eat large meals during the night to stay awake Use dark shades to block out light when sleeping Obtain a prescription for sedatives to aid sleep Wear sunglasses on the drive home from work Go directly to bed when arriving home from worka. b. c. d. e. Is this the right task? Is this the right time? Is this the right person? Is this the right supervision? Is this the right circumstance? ANS: A, C, D, E The five rights of delegation are right task, right circumstance, right person, right direction, and right supervision. Right time is not included in the five rights of delegation. PTS:1DIF:Cognitive Level: Comprehension REF: msc: 2050, Coordinated Care Box OBJ: 16 TOP: Delegation KEY:Nursing Process Step: N/AMSC:NCLEX: N/A 25. What data are necessary to compile an effective end-of-shift report? (Select all that apply.) a. b. c. d. e. ANS: A, B, C The patients mental status, status of lung sounds, and pertinent nursing care performed during the shift should all be included in an end-of-shift report. The patients favorite TV shows and visitors that the patient had during the shift would not normally be included in the end-of-shift report. PTS: 1 DIF: Cognitive Level: Application REF: msc: 2060 OBJ: 20 TOP: End-of-shift report KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 26.A manager is concerned that one of the nurses on the unit is experiencing burnout. Which symptoms would support the concerns? (Select all that apply.) a. b. c. d. e. habits ANS: A, B, D, E Symptoms of burnout include fatigue, forgetfulness, decreased energy, negative outlook, and 18 | P a g e Fatigue Forgetfulness Increased energy Negative outlook Changes in eating Patients mental status Status of lung sounds All pertinent nursing care The patients favorite TV shows Visitors the patient had during the shiftchanges in eating habits. PTS: 1 DIF: Cognitive Level: Comprehension REF: msc: 2060, Box 57-12 OBJ: 22 TOP: Burnout KEY: Nursing Process Step: N/A MSC:NCLEX: N/A COMPLETION 27. After transcribing each order in a list of orders, the nurse should the order. ANS: check off The nurse should check off each order as it is transcribed to ensure that each order is implemented. PTS: 1 DIF: Cognitive Level: Application REF: Pages OBJ: 19 TOP: Orders KEY: Nursing Process Step: Implementation MSC:NCLEX: Safe, Effective Care Environment 28. The experienced nurse who assists a novice to learn the skills of the profession is called a(n) . ANS: mentor The nurse who guides a novice in the skills of the profession is called a mentor. Chapter 3. Assessment MULTIPLE CHOICE 1. The geriatric nurse recognizes that the bodys homeostatic mechanisms may be compromised in the: a. 79-year-old with moderate Alzheimer disease who requires assistance with all activities of daily liv b. c. d. 73-year-old with a history of chronic bronchitis who lives with family. 86-year-old who lost a spouse and is moving into an assisted living facility. 69-year-old with peripheral vascular disease who is visited by home health care weekly. ANS: C Declining physiologic function and increased prevalence of disease, particularly in the old-old (age 85 or older), are in part a result of a reduction in the bodys ability to respond to stress through all of its homeostatic mechanisms. The important point is that older adults often encounter profound and repeated losses; the time between the occurrences of these losses is often short, resulting in an inadequate period for resolution and return to a baseline state, thus putting them at risk for illness. Although the other patients may have compromised homeostatic mechanisms, the 86-year-old patient is most likely to exhibit this phenomenon. DIF: Analyzing (Analysis) REF: N/A OBJ: 4-2 19 | P a g eTOP: Nursing Process: Diagnosis MSC: Physiologic Integrity 2. To best minimize patient anxiety and help ensure a successful history assessment interview, the geriatric nurse first: a. asks whether the patient has any questions about the interview. b. c. d. makes sure the interview area is comfortable and private. explains the reason for asking the questions. assures the patient that all answers will be kept confidential. ANS: C To ensure a successful interview, the nurse should explain the reason for the interview to the patient followed by a brief overview of the format to be followed. This helps alleviate anxiety and uncertainty, and the patient can then focus on providing the information. The other options are all important actions during the assessment interview, but they will not diminish anxiety as much as an explanation of the purpose. DIF: Applying (Application) REF: N/A OBJ: 4-1 TOP: Nursing Process: Implementation MSC: Emotional Needs Related to Health Problems 3. An older patient is admitted for bacterial pneumonia. The only abnormal assessment values include a heart rate of 102 beats per minute, slight cyanosis of the nail beds, and mild confusion. The patients daughter questions the possibility of pneumonia stating, He isnt coughing or having any difficulty breathing. The nurse responds most appropriately by saying: a. We are lucky to determine the problem in its early stage. b. c. d. ANS: D The characteristic presentation of illness in older adults is more commonly one of blunted or atypical signs and symptoms. Stating, we are lucky to determine the problem does not give any useful information. Respiratory problems are often present early on in younger people. The lack of coughing is not caused by weakness. DIF: Understanding (Comprehension) REF: msc: 57 OBJ: 4-2 TOP: Teaching-Learning MSC: Physiologic Integrity 4. A nurse aide working in the geriatric units dining room tells the nurse that a patient who was oriented to time and place this morning is now confused about what day it is and why shes here. The nurse appropriately directs the nurse aide to: a. take the patient back to her room and put her safely in bed. b. c. d. place a falls risk identification bracelet on the patient and add the status care plan. immediately take the patients vital signs and report them to her. reorient the patient to time and place frequently and document the patients response. ANS: C A sudden change in an older adult patients cognitive status is likely a symptom of a physiologic stressor such as an infection. The vital signs will allow the nurse to determine the presence of a fever or 20 | P a g e Respiratory problems develop only after the infection is well established. People your dads age often lack the muscular strength to cough. Older adults frequently lack the typical signs of a respiratory deviation from the patients baseline vitals. The patient may or may not need or wish to go to bed, but this does not provide any data for the nurse to evaluate. An ill patient may need to be on fall precautions, but again this does not provide data. Reorientation may be necessary, but if the patient has an illness, this needs to be taken care of. DIF: Applying (Application) REF: N/A OBJ: 4-2 TOP: Nursing Process: Implementation MSC: Physiologic Integrity 5. The nurse most effectively implements guided reminiscence during a patient interview by: a. reminding the patient to share important memories of the past. b. c. d. scheduling several short interviews rather than one long one. controlling the interview by selecting the memories to be discussed. encouraging the patient to relive his or her memories while maintaining focus. ANS: D This goal-directed interviewing process helps the patient share pertinent information through remembering. The tendency to reminisce may make it difficult for the patient to stay focused on the topic, so it is the nurses responsibility to refocus the interview when necessary. Reminding the patient to share memories, using several short interviews, and controlling the interview do not make best use of this technique. DIF: Applying (Application) REF: N/A OBJ: 4-4 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 6. To establish a mutually respectful relationship with an older adult patient being admitted to a skilled nursing unit, the nurse first introduces himself and then asks: a. how the patient would like to be addressed. b. c. d. if the patient has any specific requests to make of the staff. the patient to share a little about his or her personal likes and dislikes. the patient to read the orientation materials that the facility provides. ANS: A Respect is shown best by acquiring knowledge regarding the preferences held by a patient; using the patients surname is preferred unless the patient directs the staff to do otherwise. The other options are too narrow in focus to establish a mutually respectful relationship. DIF: Applying (Application) REF: N/A OBJ: 4-4 TOP: Integrated Process: Caring MSC: Psychosocial Integrity 7. The nurse showing the best understanding of how personal attitude affects the interview process during a health assessment of an older adult patient is one who: a. proceeds with the interview as if the patient were not an older adult. b. c. d. incorporates therapeutic communication into the assessment process. treats all patients with respect regardless of age. has self-reflected on his or her own feelings regarding aging. ANS: D The nurses own anxiety and fear of personal aging as well as a lack of knowledge regarding 21 | P a g eolder people contribute to commonly held negative attitudes, myths, and stereotypes about older people that interfere with a successful, effective assessment interview. The nurse must acknowledge the agerelated differences in this patient. The nurse does use therapeutic communication, but this may be hampered by unrealized stereotypes. The nurse should treat all patients with respect, but this statement does not give specific information on how to do so. DIF: Applying (Application) REF: N/A OBJ: 4-4 TOP: Nursing Process: Assessment MSC: Communication and Documentation 8. An older patient is being admitted to a long-term care facility. The nurse recognizes that the primary purpose of the initial geriatric health assessment is to: a. identify the patients physiologic baselines. b. c. d. ultimately create a plan of care that prevents disability and dependence. initiate the therapeutic nurse-patient relationship. document self-care deficiencies that the patient exhibits. ANS: B Specifically, the purpose of older adult assessment is to identify patient strengths and limitations so that effective and appropriate interventions can be delivered to support, promote, or restore optimum function and to prevent disability and dependence. Physiologic baseline, therapeutic nurse-patient relationship, and self-care deficits are all important aspects of the assessment but not the major purpose for it. DIF: Remembering (Knowledge) REF: msc: 55 OBJ: 4-8 TOP: Nursing Process: Assessment MSC: Physiologic Integrity 9. A 76-year-old postsurgical diabetic patient has reported feeling dizzy and clammy. The daily serum glucose level shows the patients levels to be within normal limits. The geriatric nurse shows an understanding of established health norms for the older adult when stating: a. This patients normal may not be within the typical lab norms. b. c. d. Ill ask the lab to rerun the test so we can double-check the results. There must be another reason for the symptoms. Ill compare the patients baseline lab work with todays results. ANS: A Relying on established norms for laboratory values when analyzing the assessment data of older adults could lead to incorrect conclusions. The nurse should try to determine what the patients normal range is after stabilizing the patient. DIF: Understanding (Comprehension) REF: msc: 56 OBJ: 4-1 TOP: Nursing Process: Evaluation MSC: Physiologic Integrity 10. A patient is being admitted after a fall that has caused a painful leg injury. In preparing to interview the patient for a health history, the nurse is initially concerned that: a. the family should be present to help answer questions. b. c. d. 22 | P a g e a therapeutic nurse-patient relationship should be established