NSG 4067: HEALTH CARE SETTINGS FOR OLDER ADULTS
1. A hospital nurse is discussing with an older adult the possibility transfer to a nursing home for
skilled care after pneumonia. Which statement by the client indicates an understanding of this
possible transfer?
A) Old people who go to the nursing home don't get out.
B) They will take my home if I go to the nursing home.
C) I don't qualify for skilled care, I only had pneumonia.
D) I have already used 45 Medicare days this year.
Ans: D
Feedback:
Medicare and other insurance programs will cover all or part of the care for up to 100 days of
care. Typical diagnoses associated with skilled care in a nursing home are stroke, fractured hip,
congestive heart failure, and rehabilitation after acute illnesses (e.g., pneumonia and myocardial
infarction). About 65% of older adults spend some time in a nursing home.
2. A nursing case manager monitors admissions into an acute care unit. Which of the following
clients would be the most appropriate candidate for in-home skilled nursing care?
A) A client requiring twice-daily dressing changes for a coccyx wound
B) A client who has been admitted to the emergency department with a recent stroke
C) A client with reoccurring urinary retention of unknown etiology
D) A client who is scheduled for hip replacement surgery tomorrow
Ans: A
Feedback:
Skilled home care is most appropriate for older adults who are recovering from an illness or
injury and have potential for returning to their previous level of functioning. Following a stroke,
a client requires hospitalization. A client with a poorly understood or undiagnosed health
problem would not be an ideal candidate for home care, nor would a preoperative client.
3. A nurse is teaching a family of an older adult about the role of adult day centers. Which of the
statements by the family member indicates a need for further teaching?
A) "The day center can give me respite."
B) "The day center can improve our quality of life."
C) "The day center can be a useful alternative to medical care."
D) "The day center can contribute to an actual improvement in dementia symptoms."
Ans: C
, Feedback:
Adult day centers are a community-based resource providing food, supervision, and activity, but
are not designed to provide acute medical care. They provide caregiver relief and have been
linked to improved quality of life and decreased symptoms of dementia.
4. A nurse is teaching an older adult about possible involvement in Programs of All-inclusive
Care for the Elderly (PACE). Which of the following statements by the older adult shows
understanding?
A) PACE programs provide several social and medical services on a managed care basis.
B) PACE programs provide a cost-effective alternative to hospital-based acute care.
C) PACE programs are more expensive than fee-for-service models but offer better health
outcomes.
D) There is pressure for Medicare and Medicaid to begin funding PACE programs.
Ans: A
Feedback:
PACE programs provide a range of services using a capitated managed care model. They are
focused on meeting the needs of adults with chronic conditions and are not an alternative to in-
hospital treatment of acute illness. They are less expensive than fee-for-service models and
presently are receiving funding under both Medicare and Medicaid. The 2010 Affordable Care
Act provides incentives for further expansion of PACE programs.
5. A client has recently begun receiving Social Security benefits and is asking the nurse about
what services might be included or excluded under Medicare. Which of the following services is
most likely to be excluded from Medicare funding?
A) Hospital care
B) Hospice care
C) Rehabilitation care
D) Nursing home care
Ans: D
Feedback:
Medicare was established as a means of funding some types of direct client medical care, hospice
and rehabilitation care may be covered, but nursing home residence is not.
6. A nurse assists an older adult who is homebound in a rural area. Which community resources
might this client best benefit from?
1. A hospital nurse is discussing with an older adult the possibility transfer to a nursing home for
skilled care after pneumonia. Which statement by the client indicates an understanding of this
possible transfer?
A) Old people who go to the nursing home don't get out.
B) They will take my home if I go to the nursing home.
C) I don't qualify for skilled care, I only had pneumonia.
D) I have already used 45 Medicare days this year.
Ans: D
Feedback:
Medicare and other insurance programs will cover all or part of the care for up to 100 days of
care. Typical diagnoses associated with skilled care in a nursing home are stroke, fractured hip,
congestive heart failure, and rehabilitation after acute illnesses (e.g., pneumonia and myocardial
infarction). About 65% of older adults spend some time in a nursing home.
2. A nursing case manager monitors admissions into an acute care unit. Which of the following
clients would be the most appropriate candidate for in-home skilled nursing care?
A) A client requiring twice-daily dressing changes for a coccyx wound
B) A client who has been admitted to the emergency department with a recent stroke
C) A client with reoccurring urinary retention of unknown etiology
D) A client who is scheduled for hip replacement surgery tomorrow
Ans: A
Feedback:
Skilled home care is most appropriate for older adults who are recovering from an illness or
injury and have potential for returning to their previous level of functioning. Following a stroke,
a client requires hospitalization. A client with a poorly understood or undiagnosed health
problem would not be an ideal candidate for home care, nor would a preoperative client.
3. A nurse is teaching a family of an older adult about the role of adult day centers. Which of the
statements by the family member indicates a need for further teaching?
A) "The day center can give me respite."
B) "The day center can improve our quality of life."
C) "The day center can be a useful alternative to medical care."
D) "The day center can contribute to an actual improvement in dementia symptoms."
Ans: C
, Feedback:
Adult day centers are a community-based resource providing food, supervision, and activity, but
are not designed to provide acute medical care. They provide caregiver relief and have been
linked to improved quality of life and decreased symptoms of dementia.
4. A nurse is teaching an older adult about possible involvement in Programs of All-inclusive
Care for the Elderly (PACE). Which of the following statements by the older adult shows
understanding?
A) PACE programs provide several social and medical services on a managed care basis.
B) PACE programs provide a cost-effective alternative to hospital-based acute care.
C) PACE programs are more expensive than fee-for-service models but offer better health
outcomes.
D) There is pressure for Medicare and Medicaid to begin funding PACE programs.
Ans: A
Feedback:
PACE programs provide a range of services using a capitated managed care model. They are
focused on meeting the needs of adults with chronic conditions and are not an alternative to in-
hospital treatment of acute illness. They are less expensive than fee-for-service models and
presently are receiving funding under both Medicare and Medicaid. The 2010 Affordable Care
Act provides incentives for further expansion of PACE programs.
5. A client has recently begun receiving Social Security benefits and is asking the nurse about
what services might be included or excluded under Medicare. Which of the following services is
most likely to be excluded from Medicare funding?
A) Hospital care
B) Hospice care
C) Rehabilitation care
D) Nursing home care
Ans: D
Feedback:
Medicare was established as a means of funding some types of direct client medical care, hospice
and rehabilitation care may be covered, but nursing home residence is not.
6. A nurse assists an older adult who is homebound in a rural area. Which community resources
might this client best benefit from?
