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Brown Older Adult Nursing Care, 1/E
Chapter 1
Question 1
Type: MCSA
An experienced nurse is attempting to explain the term gerontology to a novice nurse. Which of the following explanations made by the experienced nurse would be accurate?
- “Gerontology involves the study of the diagnosis and treatment of diseases affecting the elderly.”
- “Gerontology encompasses the study of all areas of the aging process, including physical, psychological, social, spiritual, and financial, as well as the impact these have on the aging person.”
- “Gerontology focuses on the physical changes occurring in the elderly and the effects of these changes on all aspects of their lives.”
- “Gerontology emphasizes the study of the healthy, well, aging adult in society.”
Correct Answer: 2
Rationale 1: The study of the diagnosis and treatment of diseases affecting the elderly is not gerontology, but geriatrics.
Rationale 2: Correct. Gerontology does involve the study of all of areas of the aging process as well as their effects on the aging person.
Rationale 3: Gerontology focuses not only on physical changes but also on psychological, spiritual, and financial changes.
Rationale 4: Gerontology focuses not only on the healthy, well, aging adult in society, but also on changes occurring as a result of aging on the aging adult’s psychological, social, spiritual, physical, and financial status.
Global Rationale:
Cognitive Level: Remembering
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Differentiate between geriatrics and gerontology.
Question 2
Type: MCSA
The home health nurse visits a 75-year-old client who is homebound and uses a walker when ambulating, due to aftereffects of a stroke. Which of the following age-related terms would be the most comprehensive in describing this client?
- Old-old
- Middle-old
- Frail elderly
- Vigorous elderly
Correct Answer: 3
Rationale 1: Old-old is used to describe individuals who are chronologically 85 years and older.
Rationale 2: Middle-old describes individuals whose chronological age is between 75 and 85 years.
Rationale 3: Correct. Frail elderly describes an adult 65 years of age or older with functional impairments or poor physical health, such as the client described here.
Rationale 4: Vigorous elderly is used to describe a healthy, active, independent, older adult and not one with functional impairments or poor physical health, such as the client described here.
Global Rationale:
Cognitive Level: Understanding
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts:
Learning Outcome: Explain the terms used to describe the age groups of older adults.
Question 3
Type: MCSA
Which of the following comments made by a nurse regarding an older adult client would indicate ageism?
- “This client has several questions for his physician regarding his upcoming procedure.”
- “You are going to love working with this client. He is such a cute, funny, little old man.”
- “I think this client is depressed. He is isolating himself in his room and not speaking.”
- “This client is going to need some further sessions on how to administer his insulin.”
Correct Answer: 2
Rationale 1: This option indicates objective assessment data from the nurse.
Rationale 2: Correct. Positive as well as negative terms that stereotype the elderly in terms of their age group are now considered to be examples of ageism.
Rationale 3: This option indicates objective assessment data from the nurse.
Rationale 4: This option indicates objective assessment data from the nurse.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Discuss ageism and age discrimination.
Question 4
Type: MCMA
The nurse would recognize which of the following statements as representing myths regarding aging?
Standard Text: Select all that apply.
- More than 2/3 of older adults are active in their communities.
- The majority of older adults eventually end up in nursing homes.
- Older adults need to exercise their minds daily to stay mentally strong.
- The majority of older adults suffer from problems associated with memory loss.
- The majority of older adults have outlived their ability to contribute anything to society.
Correct Answer: 2,4
Rationale 1: It is a fact that more than 2/3 of adults are active in their communities.
Rationale 2: Correct. It is a myth that the majority of older adults eventually end up in nursing homes; less than 5% do.
Rationale 3: It is a fact that older adults need to exercise their minds daily to stay mentally strong.
Rationale 4: Correct. It is a myth that the majority of older adults suffer from problems associated with memory loss.
Rationale 5: It is a myth that the majority of adults have outlived their ability to contribute to society.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Discuss the myths and facts of aging.
Question 5
Type: MCSA
A nurse in a medical facility enters the room of a newly admitted older adult to do an admission assessment. Which of the following communication techniques employed by the nurse would indicate a general respect for the client’s cultural background?
- Sit within a foot of the client’s bed, at eye level.
- Address the client with a title and last name.
- Begin the interview with formal assessment questions.
- Address all assessment questions to the male family member.
Correct Answer: 2
Rationale 1: The nurse should ask the client where to sit prior to the interview.
Rationale 2: Correct. The nurse should always address the older adult with a formal title and last name unless client indicates otherwise.
Rationale 3: The interview should not begin with formal assessment questions, but rather with informal conversation to show respect and make the person more comfortable.
Rationale 4: The appropriateness of addressing questions to the male family member depends on the client’s cultural background.
Global Rationale:
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Describe how different cultures view aging.
Question 6
Type: MCSA
A home-health nurse is visiting an older adult client. When performing the client’s medication review, the nurse discovers that two of the client’s prescriptions have run out and have not been refilled. At this point, which of the following nursing actions would be most prudent?
- Notify the client’s physician that the client is being noncompliant with the medications.
- Perform a mental status exam to assess whether the client is suffering from dementia.
- Ask the client for more information regarding the reasons for not refilling the prescriptions.
- Refer the client to social services in order to assist with financial support for the client’s medications.
Correct Answer: 3
Rationale 1: Notifying the client’s physician would be premature and punitive without additional information from the client.
Rationale 2: Performing a mental status exam would be premature without more information from the client.
Rationale 3: Asking the client for more information would be correct, because more information is needed for the nurse to make the proper assessment.
Rationale 4: The nurse should identify why the client did not refill the prescriptions before deciding whether to refer the client to social services.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Discuss the economic issues facing older adults.
Question 7
Type: MCSA
The nurse accompanies the physician into the room of an older adult who is scheduled to have a surgical procedure the next day. The physician explains the risks and benefits of the procedure to the client, as well as the care and medications to expect following the procedure. The physician has the client sign the consent and then leaves the room. The nurse notices that the client has a very puzzled facial expression. The client says, “What did he just say?” What should the nurse’s next action be at this point?
- Declare the client incompetent in the nurse’s progress notes.
- Explain the procedure in detail to the client’s family members.
- Report the physician to the American Medical Association (AMA).
- Notify the physician that the client does not fully understand the procedure.
Correct Answer: 4
Rationale 1: The declaration of incompetence would not be the nurse’s next action, because that is a legal procedure.
Rationale 2: Explaining the procedure would not be the nurse’s next action, because it is the physician’s role to do so.
Rationale 3: Reporting the physician would not be the nurse’s next action, because the physician did give the client information.
Rationale 4: Correct. Notifying the physician should be the nurse’s next action. The nurse should observe the client for understanding and bring questions to the physician that the client may not have felt comfortable asking.
Global Rationale:
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Explain the relationship between informed consent and competency.
Question 8
Type: MCSA
A client has been in hospital for 5 days. The case manager is discussing the client’s discharge to a skilled nursing facility with the client and the client’s family. A family member states, “He will need at least two months of care at this facility, and all he has is Medicare coverage.” The case manager would be giving correct information by making which of the following replies?
- “Medicare is all he will need no matter how long he has to stay in the skilled nursing facility.”
- “Medicare will cover the first 100 days if he requires skilled nursing care during that time.”
- “You will need to apply for Medicaid coverage immediately, as Medicare coverage won’t be sufficient.”
- “You will need to get some long-term care insurance for him as soon as possible in order to cover all of the costs.”
Correct Answer: 2
Rationale 1: Medicare will not cover more than the first 100 days of skilled nursing care.
Rationale 2: Correct. For a client who has been hospitalized for at least 72 hours for a condition, Medicare will cover 100% of the first 20 days and 80% of the remaining 80 days as long as the need for skilled nursing care is documented.
Rationale 3: Medicare will cover the two months of expected stay at the nursing facility, but Medicaid coverage will need to be applied for if the stay is expected to be beyond 100 days.
Rationale 4: Long-term care insurance may not be necessary or possible to obtain at this point.
Global Rationale:
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts:
Learning Outcome: Discuss health care assistance issues facing older adults.
Question 9
Type: MCSA
An aging adult client is being discharged from the hospital. The client has decided to enter an “aging in place” housing option upon discharge. Which of the following would be a correct definition of this type of housing option?
- Aging in place consists of a one- to two-bedroom apartment in which the monthly rent includes housekeeping, a dining package, a basic health and wellness program, and services of an on-call nurse.
- Aging in place consists of a single level garden home with a monthly home-owner’s fee which includes yard and home maintenance.
- Aging in place involves a room in a skilled nursing facility in which the client’s health care and daily living needs are fully met.
- Aging in place consists of a large room for the client in which activities of daily living are met by certified nurse’s aides, and nursing care is provided as needed.
Correct Answer: 1
Rationale 1: Correct. This describes “aging in place,” a relatively new housing concept.
Rationale 2: This option describes a retirement community.
Rationale 3: This option describes a long-term care facility.
Rationale 4: This option describes an assisted living housing option.
Global Rationale:
Cognitive Level: Understanding
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts:
Learning Outcome: Describe the housing options available to older adults.
Question 10
Type: MCSA
A new nurse’s supervisor overhears her complain, “I don’t know why we have to work with so many old people! I’m tired of seeing their wrinkled bodies.” Which of the following responses by the supervisor would give the novice nurse accurate, timely information beneficial to the nurse’s practice?
- “You need to develop a ‘poker face,’ and get on with your work. Everyone does not have a gorgeous body.”
- “The aging population is growing. As a professional, your role is that of an advocate for the aged adult patient. You need to treat each patient with dignity and respect.”
- “Your role is to be kind and sweet to each of your patients. The elderly are so needy, and you are able to use a lot of your nursing skills with them.”
- “Perhaps you should think about leaving the nursing profession. You are going to be seeing a lot more older adult patients in the coming years.”
Correct Answer: 2
Rationale 1: This response does not take into account any accurate, timely information regarding the nurse’s role with the aging population.
Rationale 2: Correct. This response incorporates factual information along with advice that will assist the nurse in the profession.
Rationale 3: This response contains only partially true information along with some aspects of ageism.
Rationale 4: This response would not be beneficial to the novice nurse’s career.
Global Rationale:
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Explain the effect of the growing aging population on the practice of nursing.
Question 11
Type: MCMA
Which of the following principles would be appropriate for the nurse to implement when communicating with an older adult client?
Standard Text: Select all that apply.
- Speak clearly.
- Face the client while speaking.
- Talk at an angle above the client’s head.
- Always address the client by his or her first name.
- Make certain that necessary assistive devices are in use.
Correct Answer: 1,2,5
Rationale 1: Correct. The nurse should speak clearly.
Rationale 2: Correct. The nurse should face the client while speaking.
Rationale 3: The nurse should not talk at an angle above the client’s head, but rather face the client, at eye level and speak clearly.
Rationale 4: The nurse should not always address the client by his or her first name, but rather use the name the client prefers in order to show respect.
Rationale 5: Correct. The nurse should make certain that assistive devices are in place so that the client will be more apt to hear and understand the nurse.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Discuss the effect of the aging population on nursing practice.
Question 12
Type: MCMA
An aging adult female client is being assessed for nursing home placement. Which factors would contribute to this client’s placement in a nursing home?
Standard Text: Select all that apply.
- A substantial income
- Being a widow
- Incontinence
- Cognitive intactness
- Multiple chronic disorders
Correct Answer: 2,3,5
Rationale 1: Incorrect. Having a reduced income actually contributes to nursing home placement.
Rationale 2: Correct. A spouse who has been widowed is more likely to be in a nursing home.
Rationale 3: Correct. A person who is incontinent is more likely to be in a nursing home.
Rationale 4: Incorrect. Having cognitive impairment is a contributing factor to nursing home placement.
Rationale 5: Correct. A person with multiple chronic disorders is more likely to be in a nursing home.
Global Rationale:
Cognitive Level: Remembering
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts:
Learning Outcome: Discuss the effect of the aging population on nursing practice.
Question 13
Type: MCMA
Which of the following older adult clients would be able to give informed consent for a medical procedure?
Standard Text: Select all that apply.
- Clients over the age of 85
- Anyone with late-stage dementia
- Clients declared incompetent
- Mildly mentally retarded clients
- Appointed power of attorney
Correct Answer: 1,4,5
Rationale 1: Correct. Unless the court has declared them incompetent, older adult clients can give informed consent.
Rationale 2: A client with late-stage dementia would not be able to give informed consent. A client with mild dementia may be able to do so.
Rationale 3: If the court declares a client incompetent, then he or she cannot give informed consent.
Rationale 4: Correct. A mildly mentally retarded clients may be able to give consent.
Rationale 5: Correct. An appointed power of attorney can give informed consent.
Global Rationale:
Cognitive Level: Understanding
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Discuss the effect of the aging population on nursing practice.
Question 14
Type: MCMA
The following list represents assessment data collected by an admitting nurse on an older adult client. Identify the data associated with a decreased life expectancy.
Standard Text: Select all that apply.
- Current weight : 205 pounds; (ideal weight: 184.5)
- Smokes 1 1/2 packs of cigarettes daily
- African American ethnicity
- Sedentary life style
- Diet low in sugar and saturated fat
Correct Answer: 2,3,4
Rationale 1: Weighing 20% or more over ideal body weight (IBW) is associated with a decreased life expectancy, but this adult client’s weight is only 10% over IBW.
Rationale 2: Correct. Smoking is linked to a lower life expectancy.
Rationale 3: Correct. African Americans by heredity have a lower life expectancy.
Rationale 4: Correct. A sedentary lifestyle is associated with a lower life expectancy.
Rationale 5: A diet low in sugar and saturated fat is healthy and is associated with a longer life expectancy.
Global Rationale:
Cognitive Level: Remembering
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Explain how the theories of aging have led to current research on prolonging life.
Question 15
Type: MCMA
A nurse on a long-term care unit is about to begin a “Reminiscence Group” with several older adult clients. A student nurse on the unit asks the nurse what the primary goals are of this type of group. The nurse correctly identifies which of the following goals?
Standard Text: Select all that apply.
- Make clients aware of current events.
- Increase interaction among clients.
- Increase the clients’ levels of self-esteem.
- Aid in the nurse’s detection of cognitive deficits.
- Encourage sharing of memories among clients.
Correct Answer: 2,3,5
Rationale 1: Making clients aware of current events is not a goal of reminiscence.
Rationale 2: Increasing interaction among clients is a goal of reminiscence.
Rationale 3: Increasing the clients’ levels of self-esteem is a goal of reminiscence.
Rationale 4: Aiding in the nurse’s detection of cognitive deficits is the focus of a mental status exam, not a goal of reminiscence.
Rationale 5: Encouraging sharing of memories among clients is a goal of reminiscence.
Global Rationale:
Cognitive Level: Understanding
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Discuss the effect of the aging population on nursing practice.
Brown Older Adult Nursing Care, 1/E
Chapter 5
Question 1
Type: MCSA
When assessing the integumentary system of an older adult, which of the following observed changes would the nurse consider abnormal?
- Edema
- Pale, cool skin
- Loss of hair
- Thick toenails
Correct Answer: 1
Rationale 1: Correct. Edema is not considered a normal sign of aging of the integumentary system.
Rationale 2: Pale, cool skin is an expected sign of aging due to thinning of the layers of the skin.
Rationale 3: Loss of hair is an expected sign of aging due to hair follicles becoming inactive.
Rationale 4: Thickening of toenails is an expected sign of aging.
Global Rationale:
Cognitive Level: Remembering
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
Nursing/Integrated Concepts:
Learning Outcome: Describe the normal changes of aging in the integumentary system.
Question 2
Type: MCMA
The nurse manager is discussing the rationale for the susceptibility of the older adult client to skin breakdown with a group of nursing assistants. What reasons should the nurse manager include in the teaching?
Standard Text: Select all that apply.
- Increase in nerve endings
- Thinning of layers of skin
- Increased pain perception
- Decrease in blood flow
- Decrease in melanocytes
Correct Answer: 2,4
Rationale 1: Shortening, not increase, of nerve endings occurs with normal aging.
Rationale 2: Correct. Thinning of layers of skin makes the client more susceptible to the development of pressure ulcers because there is less padding at bony prominences.
Rationale 3: Because of the shortening of nerve endings, the older adult client is less, not more, sensitive to pain caused by pressure.
Rationale 4: Correct. Decrease in blood flow occurs.
Rationale 5: Decrease in melanocytes affects coloration of skin, not susceptibility to damage.
Global Rationale:
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
Nursing/Integrated Concepts:
Learning Outcome: Describe the normal changes of aging in the integumentary system.
Question 3
Type: Matching
Match the expected skin change found in an older adult client identified in the left column below with the correct description of the expected skin change found in the right column.
- Xerosis
- Seborrheic keratosis
- Senile lentigo
- Actinic keratosis
- Senile purpura
| _____ | 1. Concentrated areas of melanocytes commonly found on the backs of the hands and on the face, arms, and legs |
| _____ | 2. Small, flat, scaly, red, yellow, or brown patch associated with years of sun exposure |
| _____ | 3. Dry and scaly skin |
| _____ | 4. Slightly elevated brown, gray, or yellow lesion |
| _____ | 5. A rashlike collection of bruises and petechiae |
Correct Answer: A–3, B-4, C-1, D-2, E-5
Global Rationale:
Cognitive Level: Understanding
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Describe the normal changes of aging in the integumentary system.
Question 4
Type: MCSA
To promote daily skin care for the older adult, the nurse would include which of the following suggestions in the teaching?
- Daily bathing
- Use of a sunscreen with at least 8 SPF (sun protection factor)
- Limiting daily sun exposure from 10 AM to 3 PM only
- Routine moisturizing of the skin
Correct Answer: 4
Rationale 1: Older adult skin tends to be drier, and daily bathing would dry it further. Bathing 2 to 3 times per week is recommended.
Rationale 2: It is recommended that the older adult use a sunscreen with at least 30 SPF.
Rationale 3: The time from 10 AM to 3 PM is the time of day when the sun’s ultraviolet rays are the most dangerous; it is the time the older adult needs to avoid the sun.
Rationale 4: Correct. An older adult’s skin tends to be drier, and regular moisturizing helps alleviate dryness.
Global Rationale:
Cognitive Level: Understanding
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Discuss methods of health promotion for the integumentary system.
Question 5
Type: MCSA
An older adult client comes to a long-term care facility with a beginning pressure ulcer developing in the sacral area. Which of the following nursing interventions would be appropriate for tertiary preventive care for this client?
- Daily inspection of the sacral area
- Weekly moisturizing of the skin
- Implementation of a turning schedule
- Addition of vitamin D to the diet
Correct Answer: 3
Rationale 1: Although daily inspection of wound healing needs to occur, it does not constitute treatment for an existing condition.
Rationale 2: Daily, not weekly, moisturizing of the skin is recommended for care of older adult skin.
Rationale 3: Correct. Implementation of a turning schedule would be appropriate for both primary and tertiary prevention of pressure ulcers.
Rationale 4: Vitamin C and zinc are recommended for healing of wounds in the skin, but vitamin D is recommended to help prevent osteoporosis.
Global Rationale:
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
Nursing/Integrated Concepts:
Learning Outcome: Discuss methods of health promotion for the integumentary system.
Question 6
Type: MCSA
A nurse is assessing the feet of an older adult client, paying particular attention to evidence of which potential unexpected issue?
- Lunulae
- Thickening of the toenails
- Flattening of toenail beds
- Toenail fungal infection
Correct Answer: 4
Rationale 1: Lunulae are an expected finding in an older adult.
Rationale 2: Thickening of toenails is an expected finding in an older adult.
Rationale 3: Flattening of toenail beds is an expected finding in an older adult.
Rationale 4: Older adults are more susceptible to development of fungal infections, but this would be an unexpected finding.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
Nursing/Integrated Concepts:
Learning Outcome: Discuss methods of health promotion for the integumentary system.
Question 7
Type: MCSA
An older adult client presents to the emergency room with what is diagnosed by the physician as herpes zoster. Which of the following infection control precautions should the nurse implement in caring for this client?
- Use of N-95 Respirator
- No particular precautions
- Wearing gloves with direct contact
- Use of mask, gloves, shoe covers, and gown
Correct Answer: 3
Rationale 1: Guidelines indicate use of gloves with direct contact, but no other precautions are necessary.
Rationale 2: Guidelines indicate use of gloves with direct contact.
Rationale 3: Correct. Wearing gloves is the recommended isolation technique for herpes zoster.
Rationale 4: Guidelines indicate only use of gloves with direct contact.
Global Rationale:
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Safety and Infection Control
Nursing/Integrated Concepts:
Learning Outcome: Discuss common skin conditions that occur in older adults.
Question 8
Type: MCSA
An older adult client comes to a walk-in clinic complaining of pain coming from an open ulcer on the ventral aspect of the left foot. The client states that there is also intermittent pain in the left calf when walking. The nurse assesses the client’s left foot, which is a bluish-whitish color with a faint pedal pulse. The nurse suspects that the client is suffering from which of the following disorders?
- Cellulitis of the left foot
- An ischemic ulcer of the left foot
- A pressure ulcer of the left foot
- Basal cell carcinoma of the left foot
Correct Answer: 2
Rationale 1: The signs and symptoms of cellulitis include redness/edema of the affected area (usually the legs), along with possible blistering, streaking, and systemic signs; signs in this client indicate ischemic ulcer.
Rationale 2: Correct. The client is exhibiting signs of arterial insufficiency in the left foot, along with intermittent claudication. These, along with the blue-white color, are signs/symptoms of an arterial or ischemic ulcer.
Rationale 3: The signs and symptoms of a pressure ulcer are associated with immobility and would be determined by the stage; signs in this client indicate ischemic ulcer.
Rationale 4: The signs and symptoms of basal cell carcinoma involve the presence of a pearly papule found most commonly on the head, neck, or back of the hands; signs in this client indicate ischemic ulcer.
Global Rationale:
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts:
Learning Outcome: Discuss common skin conditions that occur in older adults.
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