Concepts of Gerontology Flashcards
When attempting to minimize the effect of ageism on the practice of nursing older adults, a nurse needs to first
a. recognize that nurses must act as advocates for aging patients.
b. accept that this population represents a substantial portion of those requiring nursing care.
c. self-reflect and formulate one’s personal view of aging and the older patient.
d. 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-reflects on personal feelings and determines whether such feelings will affect the nursing care that he or she provides to the aging patient.
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 patient’s
a. age.
b. financial status.
c. gender.
d. functional status.
ANS: D
Maintaining the functional status of older adults (especially those with chronic health conditions) may avert the onset of physical frailty and cognitive impairment, two conditions that increase the likelihood of institutionalization
nurse working with the older adult population is most likely to assess a need for a financial social service’s referral for which person?
a. White male
b. Black female
c. Hispanic male
d. Asian American female
ANS: B
The poverty rate among older women is substantially higher than that seen among men. The poverty rates for people of color is higher than that of whites.
A nurse is preparing to complete a health assessment and history on an older patient. Which statement reflects an understanding of the general health status of this population?
a. “I’ll need to document the medications the patient is currently prescribed.”
b. “I would like to understand how supportive the patient’s family members are.”
c. “Most older patients are being treated for a variety of chronic health care issues.”
d. “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. In fact, older adults already tend to view their personal health positively despite the presence of chronic illness, disease, and impairment. The nurse should always determine the patient’s 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
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, which action by the gerontologic nurse is best?
a. Evaluates the competency of the UAP staff.
b. Assumes the roles of case manager and patient advocate.
c. Arranges for the needed UAP provided services.
d. 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
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. It is voluntary and shows clinical expertise in an area.
c. It allows nurses to be paid by third-party payers.
d. It allows nurses to advance their careers in a 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
A nurse works in a gerontologic clinic. What action by the nurse takes highest priority?
a. Serving as a patient advocate
b. Educating patients about diseases
c. Helping patients remain independent
d. Referring patients to home health care
ANS: C
One of the challenges and priorities of the gerontologic nurse is helping patients to maintain their independence. While nurses do serve as patient advocates, educate patients, and make referrals, these actions are not specific to gerontologic nursing
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. Living conditions and family support
c. Medications and current medical problems
d. Results of the Mini-Mental State Examination
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 patient’s current status. The other information is also important, but the basis of individualized care begins with the patient’s strengths and weaknesses
The faculty member explains to students that many older Americans continue to work past the “retirement age.” What best explains this trend?
a. Feeling healthier longer
b. Changing financial outlook
c. Becoming bored in retirement
d. A desire to give back
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.
What information does the faculty member teach students about Medicare?
a. Covers anyone with end-stage renal disease
b. Part A covers some prescription costs
c. Part B covers inpatient hospital costs
d. Part D eliminates the drug “donut hole”
ANS: A
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. Create programs that minimize functional losses.
c. Ensure staffing numbers are adequate for dependent patients.
d. Encourage all nurses to obtain gerontologic certification.
ANS: B
Many older adults need acute care for sudden illness and injury but the acute care setting is not ideal for them. Programs that prevent functional decline and promote independence would make the hospital less dangerous place for older adults. The other actions will help the older patients cared for in the unit, but only to limited degrees
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. Financial planning
c. Avoiding scams
d. Ethnic cooking classes
ANS: A
The clinic nurse caring for an older diabetic patient with a sixth-grade education anticipates that the patient may experience difficulty with which of the following? (Select all that apply.)
a. Recognizing the importance of keeping clinic appointments.
b. Following a low-carbohydrate diet.
c. Paying for insulin and syringes.
d. Deciding on a primary health care provider.
e. Naming a health care surrogate.
ANS: A, B, C
Even though the educational level of the older population has steadily increased, lower educational level and decreased literacy affects the older adults’ ability to live a healthy life, understand the importance of medical follow-up, and manage acute illness and chronic conditions. These patients may also have fewer financial resources to devote to health care issues. Choosing a primary provider and naming health care surrogates would not necessarily be affected.
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. Increased chance of living in poverty
c. Taking care of a spouse
d. Suffering many chronic diseases
e. 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.
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. Communicable diseases
c. Heart disease
d. Cancer
e. Diabetes
ANS: A, C, D, E
Nearly 75% of all deaths stem from the following 10 causes: heart disease, cancer (lung), chronic respiratory disease (COPD), accidents, stroke, Alzheimer’s disease, diabetes, influenza/pneumonia, kidney disease, and suicide
The nurse supports an older patient’s desire to discuss advance directives with the patient’s family. What action is the nurse performing with this patient?
1. Facilitation of palliative care
2. Engagement in professional development
3. Collaboration with the interdisciplinary team
4. Accountability to protect patient’s rights and autonomy
Correct Answer: 4
In assessing the aging client, it is importnat for the nurse to recognize:
a) The client’s ability to perform ADLs
b) The financial status of the client
c) The job that the client held prior to aging
d) All components of well-being, including biological function, psychological function, and social function
ANS: D
The nurse assessing the older population needs to have a basic understanding of which of the following?
a) The economic status of the area
b) The difference between normal and abnormal for the older age group
c) The signs of sexual dysfunction
d) The signs of cardiac disease
ANS: B
Which statement would be most appropriate to ask when assessing an aging adult for cognitive function?
a) What is today’s date?
b) Can you count to 10 for me?
c) Have you noticed anything different about your memory or thinking in the past few months?
d) Who is the president of the United States?
ANS: C
Which disease or ailment is often under diagnosed and undertreated in the aging population?
a) Schizpphrenia
b) Depression
c) Associative disorders
d) Attention deficit disorder
ANS: B
Which statement demonstrates normal cognitive function for an aging adult?
a) Occasional memory lapses
b) Unable to recall the names of their children or siblings
c) Unable to recall current address or phone number
d) Unable to count to 10 or repeat a series of consecutive numbers
ANS: A
Denmentia and depression are strongly related to:
a) Clients over the age of 60
b) Clients over the age of 65
c) A decreased quality of life and functional deficits
d) Past economic status and job performance
ANS: C
Which statement reflects the state of drug absorption in the geriatric patient?
a) The rate of absorption is slowed
b) The rate of absorption is faster due to thinning of the mucosa
c) The percentage of the medication that is absorbed is decreased
d) There is a decrease in gastric pH as we age
ANS: C
The absorption of medication in the geriatric client is most often affected by:
a) A decrease in body fat
b) An increase in serun albumin
c) A decrease in body water and lean body weight
d) An increase in body water
ANS: C
Which organ is responsible for drug metabolism and must be considered when prescribing medicaiton for an older adult?
a) Kidneys
b) Pancreas
c) Intestines
d) Liver
ANS: D
An older adult on digoxin and furosemide is showing signs of toxicity. The gerontology nurse understands that:
a) Digoxin and furosemide are excreted by the kidneys, and the doses may need to be decreased due to impaired kidney function
b) Digoxin and furosemide are excreted through the intestinal tract, and dose changes would be ineffective
c) An increase in fluid intake will fix the symptoms, and no change in dose is needed
d) How a drug is excreted is not a consideration when dosing an older adult
ANS: A
Which factor is NOT a normal part of aging and needs to be addressed to promote nutrition in the older adult client?
a) Loss of teeth
b) Increase in gastric pH
c) Xerostoma or dry mouth
d) Decline in basal metabolic rate
ANS: C
What is the most significant change in vital organs in the aging client?
a) No change in organ tissue is noted
b) The outer appearance of an organ changes, but the functional component does not change
c) Organs show signs of decrease in function during the aging process
d) The aging process speeds up the functional capacity of major organs
ANS: C
Describe the order for the nursing process as practiced by the gerontological nurse:
a) Diagnose, implement, evaluate
b) Assess, identify expected outcomes, implement, evaluate
c) Assess, dignose along with the team, identify outcomes, plan, implement, evaluate
d) Assess, evaluate, plan, implement, and look at outcomes
ANS: C
A 70-year-old presents to the clinic stating that his family things he is losing his mind and they want to put him in a home. What would be the intial role of the gerontological nurse?
a) Begin the process of finding a qualified nursing home
b) Do a complete history,physical, and assessment
c) Speak with the family about their concerns
d) Make light of the subject until the nurse can evaluate the situation
ANS: B
Which item would not be a focus of a cognitive-perceptual pattern assessment for the older client?
a) Cognition–Have you experienced any changes in your memory?
b) Communication–Have you had any difficulty speaking or forming ideas?
c) FInancial–Have you had any financial hardships over the past several months?
d) Orientation–Do you know what day, month, and year it is?
C
Pain of gastrointestinal origin is best differentiated from pain of cardiac origin by the
presence of:
1. chest pain lasting longer than five minutes.
2. chest pain of rapid onset.
3. left flank pain.
4. substernal chest discomfort.
ANS: 4
The primary risk factor for the development of pressure ulcers in older adult patients is:
1. immobility.
2. impaired circulation.
3. incontinence.
4. malnutrition.
ANS: 1
The most common cause of chronic pain in older adults is:
1. arthritis.
2. fractures.
3. headaches.
4. neuropathy.
ANS: 1
Which statement is true regarding falls in the elderly?
A. Most falls occur in the garage.
B. Hip fractures resulting from falls are a leading cause of placement in long-term care facilities.
C. Fall risk decreases with addition of medications.
D. Sedatives reduce the risk of falls.
ANS: B
Nurses’ knowledge of sexuality in the older adult population should include:
A. Chronic illness may affect the ability to participate in sexual activity.
B. Sexual response time is unchanged.
C. Ability to achieve orgasm declines.
D. Dryness of the vaginal walls is associated with pelvic inflammatory disease.
ANS: A
What should the nurse include in the teaching plan for self-medication practices of older adults?
A. Eliminate unnecessary medications.
B. Substitute herbal preparations for certain prescribed medications.
C. Develop a drug reminder system and schedule.
D. Pharmacy shop for the cheapest medications.
ANS: C
Which age-related changes predispose the elderly patient to drug toxicity and extended duration of action of drugs? (Select all that apply.)
A. Decreased body water
B. Increased ratio of muscle to fat
C. Low serum albumin
D. Reduced blood flow to liver
A. Decreased body water
C. Low serum albumin
D. Reduced blood flow to the liver
________ is the use of multiple medications, often inappropriately and excessively, at the same time.
Polypharmacy
An elderly patient has acute confusion after undergoing abdominal surgery. The patient most likely has:
A. delirium.
B. anxiety.
C. dementia.
D. depression
ANS: A
Alzheimer’s disease may be suggested in its early stages by:
A. magnetic resonance imaging (MRI).
B. computed tomography (CT).
C. positron emission tomography (PET).
D. autopsy.
ANS: D
The nurse is performing an assessment on an older adult client. Which assessment data would indicate a potential complication associated with the skin?
a) Crusting
b) Wrinkling
c) Deepening of expression lines
d) Thinning and loss of elasticity in the skin
ANS: A
The normal physiological changes that occur in the skin of older adults include thinning of the skin, loss of elasticity, deepening of expression lines, and wrinkling. Crusting noted on the skin would indicate a potential complication.
The home health nurse is visiting a client for the first time. While assessing the client’s medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first?
a) Check for medication interactions.
b) Determine whether there are medication duplications.
c) Call the prescribing health care provider (HCP) and report polypharmacy.
d) Determine whether a family member supervises medication administration
ANS: C
Polypharmacy is a concern in the older client. Duplication of medications needs to be identified before medication interactions can be determined because the nurse needs to know what the client is taking. Asking about medication administration supervision may be part of the assessment but is not a first action. The phone call to the HCP is the intervention after all other information has been collected.
The long-term care nurse is performing assessments on several of the residents. Which are normal age-related physiological change(s) the nurse expects to note? Select all that apply.
a) Increased heart rate
b) Decline in visual acuity
c) Decreased respiratory rate
d) Decline in long-term memory
e) Increased susceptibility to urinary tract infections
f) Increased incidence of awakening after sleep onset
ANS: B, E, F
Anatomical changes to the eye affect the individual’s visual ability, leading to potential problems with activities of daily living. Light adaptation and visual fields are reduced. Although lung function may decrease, the respiratory rate usually remains unchanged. Heart rate decreases and heart valves thicken. Age-related changes that affect the urinary tract increase an older client’s susceptibility to urinary tract infections. Short-term memory may decline with age, but long-term memory usually is maintained. Change in sleep patterns is a consistent, age-related change. Older persons experience an increased incidence of awakening after sleep onset.
The healthcare provider is performing an assessment on a patient who is taking propranolol (Inderal) for supraventricular tachycardia. Which assessment finding is an indication the patient is experiencing an adverse effect of this drug?
a) Dry mouth
b) Bradycardia
c) Urinary retention
d) Paresthesia
ANS: B
Propranolol is a nonselective beta-adrenergic antagonist
The federal government requires the use of a specific standardized documentation tool for home nursing care. Which information must a home nurse add to the approved documentation tool?
a. Activity
b. Vital signs
c. Functional
d. Demographic
ANS: B
The nurse must add the vital signs and information about the older adult’s health care beliefs to the OASIS. The nurse does not need to add information about the older adult’s activity level. The nurse does not need to add information about the older adult’s functional status. The nurse does not need to add demographic information about the older adult to the documentation too
An older client presents to the geriatric practice with a 3-day history of cough, and fever. The client states “I am feeling weak and coughing a lot.” The client’s vital signs are BP 120/86, 92% SpO2, 22 bpm, and 38.6°C. What is the client’s chief complaint?
a. “I am feeling weak and coughing a lot”
b. Elevated BP and fever
c. A 3-day history of cough and fever
d. Pneumonia
ANS: A
The chief complaint is what the client reports as the problem. Blood pressure, fever, and cough are the client’s symptoms; pneumonia is a medical diagnosis
Which mental status assessment tool(s) would be appropriate for use in long-term care facilities? (Select all that apply.)
a. Fulmer SPICES
b. Clock Drawing Test
c. The Mini-Cog
d. Mini-Mental State Examination (MMSE)
e. Montreal Cognitive Assessment (MoCA)
ANS: B, C, D, E
The Montreal Cognitive Assessment (MoCA) was designed as a brief screening instrument to provide cues leading to the hypothesis of mild cognitive impairment. The Clock Drawing Test, which has been used since 1992, is a screening tool that helps identify those with a cognitive impairment and is used as a measure of severity. The Mini-Cog was developed as a tool that could establish cognitive status more quickly than the MMSE and the limitations of educational adjustments. It is now the recommended evidenced-based tool and combines one aspect of the MMSE (short-term memory recall) with the test of executive function of the Clock Drawing Test. It has been found to be highly sensitive to diagnosing dementia. The MMSE tool has been used most often and is a 30-item instrument that has been used to screen for cognitive difficulties and is one of the tools often used in determining a diagnosis of dementia or delirium. Fulmer SPICES is an overall assessment tool developed in 2007
A nurse is assessing an older client. The nurse understands that in addition to the collection of physical data and the integration of spiritual and psychosocial issues, additional assessments commonly utilized for older adults include which of the following? (Select all that apply.)
a. Functional status assessment
b. Cognitive assessment
c. Caregiver burden assessment
d. Geriatric syndrome assessment
e. Employment assessment
ANS: A, B, C, D
At a minimum, health assessment includes the collection of physical data and the integration of spiritual and psychosocial, within an individual’s cultural context. When working with older adults, additional assessment areas further include functional and cognitive status, caregiver stress or burden, patterns of health and health care, advanced care planning, and the presence or absence of any of the geriatric syndromes (delirium, falls, dizziness, syncope, and urinary incontinence
A nurse utilizes the FANCAPES to assess an older adult. Which of the following are accurate statements about this assessment? (Select all that apply.)
a. The FANCAPES is utilized as guide for the comprehensive assessment of medically complex older adults.
b. The FANCAPES includes a fall risk assessment of the older adult.
c. The FANCAPES assesses an older adult’s activity abilities.
d. The FANCAPES includes the Mini-Cog assessment to assess cognitive abilities.
e. The FANCAPES assesses the older person’s current state of hydration.
ANS: A, C, E
The FANCAPES is a comprehensive physical assessment for the frail and medically complex older adult. FANCAPES is a mnemonic for Fluids, Aeration, Nutrition, Communication, Activity, Pain, Elimination, and Socialization. There is no fall risk assessment and the Mini-Cog is not a part of this assessment.
The nurse assesses an older adult’s cognitive status using a standard assessment instrument. Which of the following are cognitive assessment tools? (Select all that apply.)
a. Mini-Cog
b. Mini Mental State Exam (MMSE)
c. The Barthel Index
d. The Global Deterioration Scale
e. Older American’s Resources and Services (OARS)
ANS: A, B, D
The Barthel Index is an instrument utilized to assess mobility and the ability to perform ADLs. The OARS is a comprehensive geriatric assessment which covers more than just cognitive assessment.The Mini-Cog and MMSE are cognitive assessment tools, as is the Global Deterioration Scale which is a measure of the levels of cognitive changes as one passes through the process of dementia
A nurse assesses an older person’s instrumental activities of daily living (IADL) utilizing the Lawton instrument. Which of the following are IADLs? (Select all that apply.)
a. Shopping
b. Cleaning
c. Bathing
d. Eating
e. Money management
ANS: A, B, E
Shopping, cleaning, and money management are IADLs. Bathing and eating are ADLS
Which nursing intervention is a holistic approach to an older adult?
a. Performs glucose testing during the weekly worship service
b. Wheels ambulatory adults to exercise when running late
c. Basing interventions on the client’s functional abilities
d. Allows older adults in a nursing home to eat meals alone
ANS: C
The nurse uses a holistic approach to the care when tailoring care needs to support the client’s optimal level of health independent. Interrupting an older adult’s worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older adult’s life by testing for glucose before the service begins.
