Ebersole And Hess' Toward Healthy Aging: Human Needs And Nursing Response, 9th Edition Test Bank

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Chapter 01: Health and Wellness in an Aging SocietyTouhy: Ebersole & Hess' Toward Healthy Aging, 9th EditionMULTIPLE CHOICE1.When asked by new parents what the life expectancy is for their African American newborn,the nurse replies that, “2010 statistics indicate that your son:a.will have a life expectancy of approximately 65 years.”b.can realistically expect to live intohis late 80s.”c.has a good chance of celebrating his 75th birthday.”d.is likely to live into his late 90s.”ANS:CIn 2010, men in the United States at age 60 can expect to live another 22 years. The lifeexpectancy of African American men is about 4.7 years less than white men. Of the optionsabove, C is the only response that fits into those parameters. The other options are notsupported by reliable research.DIF:Cognitive Level: UnderstandingREF:p. 3TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance2.A nurse is planning care for a group of super-centenarians in an assisted living facility. Thenurse considers which of the following?a.Most super-centenarians are functionally independent or require minimalassistance with activities of daily livingb.The majority of super-centenarians have cognitive impairmentc.The number of super-centenarians is expected to decrease in coming years as aresult of heart disease and stroked.It is theorized that super-centenarians survived as long as they have due to geneticmutations that made them less susceptible to common diseasesANS:AResearch supports that most super-centenarians are functionally and cognitively intact,requiring minimal assistance with ADLs. The number of super-centenarians is expected toincrease in coming years as the number of older adults increases. The reason why individualssurvived as long as they have is not known.DIF:Cognitive Level: RememberingREF:p. 4TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance3.One reason why many “baby boomers” have multiple chronic conditions such as heartdisease, diabetes, and arthritis is that:a.they have less access to medication and other treatment regimens.b.there was a lack of importance placed on healthy living as they were growing up.c.they did not have access to immunizations against communicable disease whenthey were children.d.they grew up in an era of rampant poverty and malnutrition.

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ANS:BThe baby boomers, individuals born between 1946 and 1964, post-WWII, have better accessto medication and treatment regimens than other cohorts. They have had the benefit of thedevelopment of immunizations against communicable diseases. They grew up in an era ofprosperity post-WWII. However, there was a lack of importance placed on what we nowconsider healthy living when they were younger. Smoking, for example, was not condoned,but was considered a symbol of status. Candy in the shape of cigarettes was popular, and therewas much secondhand smoke.DIF:Cognitive Level: RememberingREF:p. 6TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance4.A nurse is planning an education program on wellness in a local senior citizen center. Thenurse plans to provide education on the importance of immunizations, annual physicalexaminations, screening for diabetes, and vision and hearing screening. It is important for thenurse to understand which of the following?a.Approximately 40% of older adults (ages 65 and older) utilize available preventiveservicesb.Preventive strategies are more widely used in the 40-64 age group than in the 65and over age groupc.The research on health promotion strategies in older adults demonstrates that theyhave low efficacyd.There is an abundance of research specific to health promotion and agingANS:AApproximately 40% of individuals, ages 65 and older, utilize the preventive services that area paucity of research specific to health promotion and aging; however, the research that existsdemonstrates that health promotion strategies are highly effective.DIF:Cognitive Level: UnderstandingREF:p. 7TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance5.A nurse is caring for an 85-year-old male client with diabetes in a community setting. Thenurse promotes functional wellness by which of the following activities?a.Encouraging the client maintains current levels of physical activityb.Assisting the client to receive all the recommended preventive screenings that areappropriate for his age groupc.Teaching the patient how to use a rolling walker so that he can ambulate for longerdistancesd.Encouraging the client to attend his weekly chess gamesANS:AMaintaining existing levels of physical activity is consistent with functional wellness.Teaching the client how to use a rolling walker enables the client to remain active at thehighest level possible, which is an example of promoting functional wellness. Receivingrecommended screening is an example of promoting biological wellness. The use of a rollingwalker should be based on assessment of physical ability. Encouraging the client to attendweekly chess games is an example of promoting social wellness.available to them. However, only 24% of those between the ages of 40 and 64 do so. There is

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DIF:Cognitive Level: ApplyingREF:p. 10TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance6.Based on the census reports of 2010, the typical profile of a centenarian in the United Statesincludes which of the following characteristics?a.A Caucasian woman who lives in an urban area of a Southern stateb.An African American woman who lives in a rural area of a Southern statec.A Hispanic man who lives in an urban area of a Midwestern stated.A Caucasian man who lives in a rural area of a Midwestern stateANS:ABased on the 2010 U.S. Census data, centenarians were overwhelmingly white (82.5%),women (82.8%), and living in urban areas of the Southern states.DIF:Cognitive Level: ApplyingREF:p. 5TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and MaintenanceMULTIPLE RESPONSE1.Primary prevention strategies for older adults include which of the following?(Select all thatapply.)a.An annual influenza immunization clinicb.A smoking cessation programc.A prostate screening programd.A cardiac rehabilitation programe.A meal planning education program for type 2 diabeticsANS:A, BPrimary prevention refers to strategies that are used to prevent an illness before it occurs andmaintaining wellness across the continuum of care. Immunizations and smoking cessation areexamples of primary prevention. Secondary prevention is the early detection of a disease or ahealth problem that has already developed. Prostate screening is an example of secondaryprevention. Tertiary prevention addresses the needs of individuals who already have theirwellness challenged. Cardiac rehabilitation and meal planning for diabetics are examples oftertiary prevention.DIF:Cognitive Level: ApplyingREF:pp. 8–9TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Management of Care2.A nurse organizes a health fair for older adults. The nurse’s goal is to focus on the six priorityareas identified by the National Prevention Council. Which of the following activities shouldthe nurse include?(Select all that apply.)a.Smoking cessationb.Depression screeningc.Recognizing elder abused.Cholesterol screeninge.Fitness training

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ANS:A, B, CThe six priority areas of the National Prevention Council include tobacco-free living,preventing drug abuse and excessive alcohol use, healthy eating, injury- and violence-freeliving, reproductive and sexual health, and mental and emotional well-being. Smokingcessation, depression screening, and recognizing elder abuse all directly address these areas.While cholesterol screening and fitness training are important for older adults, they do notaddress these six priority areas.DIF:Cognitive Level: AnalyzingREF:p. 8TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance3.The “in-between”generation (individuals born between 1915 and 1945) were subject to whichof the following health challenges during their childhood?(Select all that apply.)a.Poliob.Lack of fluoride in the water causing teeth to be soft and cavity pronec.“Pigeon Chest,” a malformation of the rib cage due to a lack of vitamin Dd.Smallpoxe.HIV/AIDSANS:A, B, CPolio was a major fear of this group; the polio vaccine was not available in the United Statesuntil 1955. In many areas water was not fluoridated. “Pigeon Chest” was common. Smallpoxwas a concern for the centenarians, not this generation. HIV/AIDS had not been identified inthe early years of 1915-1945.DIF:Cognitive Level: RememberingREF:p. 5TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance4.A nursing student is preparing a presentation on the Wellness-Based Model for HealthyAging. Which of the following concepts should the student include in the presentation?(Select all that apply.)a.Healthy aging is defined by the absence of physical illness aloneb.Healthy aging is individually defined and can change over timec.There are many strategies to promote healthy aging that are believed to be helpfulbut do not have empirical evidence to support themd.Healthy aging cannot be achieved by only focusing on later life. It is a lifelongprocesse.According to this model, an individual with a chronic disease would not beconsidered healthyANS:B, C, D

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Healthy aging is a lifelong process that begins with birth and ends with death. The concept ofhealthy aging from a wellness perspective is uniquely defined by each individual and canchange over time. There are challenges to implementing evidence-based practices on healthyaging because there is a paucity of research on this area. Therefore, there are many strategiesthat have been used and determined to be effective but do not have research evidencesupporting them. The subcomponents with the wellness model are functional independence,self-care management of illness, personal growth, positive outlook, and social contributionand activities that promote one’s health.DIF:Cognitive Level: ApplyingREF:p. 7TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance

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Chapter 02: Gerontological Nursing: Past, Present, and FutureTouhy: Ebersole & Hess' Toward Healthy Aging, 9th EditionMULTIPLE CHOICE1.Serious and well-controlled research studies on aging have been available:a.only in the past 60 years.b.since the turn of the 20th century.c.following the Great Depression.d.since the year 2000.ANS:AOnly in the past 60 years have serious and carefully controlled research studies flourished.Before that, anecdotal evidence was used to illustrate issues assumed to be universal, makingall the remaining options incorrect.DIF:Cognitive Level: RememberingREF:p. 19TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance2.The son of a nursing home resident asks a nurse: “What is the significance of being certifiedin gerontology? I see that you are, but not all of the nurses are.” The best response by thenurse is which of the following?a.“National certification as a gerontological nurse is a way to demonstrate specialknowledge in caring for older adults”b.“National certification in gerontology is required for all nurses who have workedin this setting for 2 or more years”c.“National certification is only available to nurses who have a Baccalaureate degreein nursing”d.“Only advanced practice nurses, like nurse practitioners, are certified ingerontology”ANS:ANational certification is a way to demonstrate special expertise in caring for older adults. It isnot required for practice in any setting across the continuum of care, and it is not exclusive tonurses with Baccalaureate degrees. There is both a generalist and a specialist gerontologicalnursing certification. The generalist functions in a variety of settings providing care to olderadults and their families. The specialist has advanced gerontological education at a Masterslevel.DIF:Cognitive Level: AnalyzingREF:pp. 20–21TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Management of Care3.The major goal of the NICHE (Nurses Improving Care for Health System Elders) programincludes which of the following?a.Improve outcomes for hospitalized older adultsb.Increase the number of older adults cared for in hospitalsc.Increase the number of iatrogenic complications that occur in hospitalized olderadults

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d.Decrease 30-day readmission rates for hospitalized older adultsANS:AThe goal of NICHE is to improve outcomes for hospitalized older adults. Although D is agood outcome for hospitalized older adults, it is not one of the major goals of NICHE, whichare broader. Options b and c are not goals that would improve care for older adults, but wouldbe negative outcomes themselves.DIF:Cognitive Level: RememberingREF:p. 22TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and MaintenanceMULTIPLE RESPONSE1.The impact of the Patient Protection and Affordable Care Act of 2010 on gerontologicalnursing includes which of the following?(Select all that apply.)a.Funding to support advanced education in gerontological nursingb.Funding to support education of faculty in gerontologyc.Funding to increase the number of direct care workers in hospitalsd.Funding to increase nurse-patient ratios in long-term caree.Funding for advanced training of direct care workers in long-term careANS:A, B, EThe Patient Protection and Affordable Care Act of 2010 provides funding for advancededucation in gerontology, education for faculty in gerontology, and advanced training fordirect care workers in long-term care. The act does not address nurse-patient ratios or staffingissues in any setting.DIF:Cognitive Level: UnderstandingREF:p. 14TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance2.Which of the following are true statements about the current health care workforce?(Select allthat apply.)a.Approximately 10% of registered nurses (RNs) are certified in gerontologicalnursingb.The number of geriatricians is expected to increase about 50% over the next 25yearsc.The professions of social work, physical therapy, and psychiatry are demonstratingthe same trends as nursingd.Europe and the developing countries are experiencing similar shortages in healthcare workers with geriatric expertise as in the United Statese.It is anticipated that there will be a need for approximately 3 million additionaldirect care and professional health care workers by the year 2030ANS:C, D, ELess than 1% of RNs are certified in gerontological nursing. The number of geriatricians isdecreasing, not increasing. Responses C, D, and E are all true.DIF:Cognitive Level: UnderstandingREF:p. 14TOP:Integrated Process: Teaching/Learning

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MSC: Client Needs: Health Promotion and Maintenance3.Best practice recommendations for undergraduate nursing education in relation to gerontologyinclude which of the following?(Select all that apply.)a.Provision of a “stand-alone” course in gerontological nursingb.Integration of gerontological content throughout the curriculumc.Replacement of acute care pediatric clinical experiences with gerontologicalclinical experiencesd.Recruitment of nurses with Masters and Doctoral degrees and a specialty ingerontology to faculty rolese.Requiring all undergraduate nursing students to obtain gerontological certificationas a requirement for graduationANS:A, B, DBest practices include providing a stand-alone gerontological nursing course as well asintegrating gerontology throughout the curriculum. Recruitment of nurses with a specialty ingerontology and a Masters or Doctoral degree to faculty roles is a critical step in making surethat the next generation of nurses is prepared to care for older adults. Best practices do notrecommend removing pediatric clinical experiences and replacing them with gerontologicalexperiences. Nursing certification is only available to practicing nurses who meet specificeducation and practice requirements. It is not applicable to nursing students.DIF:Cognitive Level: UnderstandingREF:pp. 17–18TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance4.Goals of the Eldercare Workforce Alliance include which of the following?(Select all thatapply.)a.Mandating a minimum of a Baccalaureate degree in nursing in order to care forolder adultsb.Increasing wages of certified nursing assistants (CNAs) in nursing homesc.Providing loan forgiveness for individuals who assume faculty rolesd.Developing a nursing certification specific to long-term caree.Adopting cost-effective care coordination models for older adults across thecontinuum of careANS:B, C, EA, B, and C are all included in the Elder Workforce Alliance goals. Options A and D are not.DIF:Cognitive Level: UnderstandingREF:p. 14TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance5.A nurse interviews for a job in a hospital that advertises that it is “elderly friendly.” The nursewould expect to see which of the following in place?(Select all that apply.)a.An elder-assistance program to help patients remember their appointments andnavigate the hospital services.b.A long-term care facility that is affiliated with the hospitalc.Rooms furnished with foldout beds for family members/caregiversd.An initiative to provide gerontological education for all nursese.An initiative to increase the number of patients referred to long-term care facilities

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upon discharge from the hospitalANS:A, C, DThe guiding principles of an elder friendly facility include treating each patient as a uniqueindividual and accommodating the patient and family’s special needs. Other principles includeensuring that the nurses are clinically competent in gerontological nursing. Tailoring theenvironment to support the implementation of these principles is part of this initiative. OptionB is not correct as it does not relate to the concept of an elder friendly hospital. Option E isnot correct since this might not be a supportive intervention for all patients.DIF:Cognitive Level: AnalyzingREF:p. 22, Box 2-7TOP:Integrated Process: CaringMSC: Client Needs: Psychosocial Integrity6.Significant factors contributing to the growth of community-based care include:(Select allthat apply.)a.a decrease in the number of available nursing home beds.b.rapidly escalating health care costs.c.older adults’ preferences to “age in place.”d.inadequate numbers of nurses with gerontological specialty education.e.decreasing numbers of family caregivers.ANS:B, CCare will continue to move out of hospitals and long-term care facilities because of rapidlyescalating health care costs and individual preferences to “age in place.” There has not been adecrease in nursing home beds. Although there are inadequate numbers of nurses withgerontological specialty training, this is not a factor that has impacted the growth ofcommunity-based care. There is projected to be a decrease in the number of family caregiversas the caregivers themselves are aging; however, this does not contribute to the growth ofcommunity-based care.DIF:Cognitive Level: RememberingREF:p. 23TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance7.Changes in certified nursing facilities in recent years include which of the following?(Selectall that apply.)a.Increase in the number of subacute bedsb.Decrease in nursing facility length of stayc.Increase in level of acuity of the residentsd.Decrease in cost of care in the nursing facilitye.Decrease in the number of registered nurses employed in long-term care facilitiesANS:A, B, CCertified nursing facilities have evolved over recent years. Most facilities have subacute careunits that resemble hospital units caring for more patients with higher acuity than in the past.Therefore, the average length of stay in a facility has decreased. The cost of care in the facilityhas increased due to the increased complexity of illnesses treated, and the number ofregistered nurses has increased in order to care for these complex patients.DIF:Cognitive Level: AnalyzingREF:p. 23TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance

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8.Which of the following factors contribute to poor outcomes for older adults during transitionsof care?(Select all that apply.)a.Inability to read and understand discharge instructionsb.Inadequate financial resources to purchase medicationsc.Lack of desire to comply with discharge instructionsd.Improved medication reconciliation during hospitalizatione.High levels of nurse-patient engagementANS:A, BLanguage and literacy levels and socioeconomic factors are major contributors to poortransitions of care for older adults. A high level of nurse-patient engagement contributes tosafe and effective transitions. Medication reconciliation during hospitalization, at dischargeand after discharge, decreases medication discrepancies, which are the most prevalent adverseevent following hospital discharge. There is no evidence that patients lack the desire tocomply with discharge instructions.DIF:Cognitive Level: AnalyzingREF:p. 24TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Safety and Infection Control

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Chapter 03: Theories of AgingTouhy: Ebersole & Hess' Toward Healthy Aging, 9th EditionMULTIPLE CHOICE1.The nurse is aware the theory of aging most likely to explain why the older population is atrisk for autoimmune disorder is known as:a.cross-link theory.b.free radical theory.c.error theory.d.autoimmune theory.ANS:DThe immunity theory proposes that cellular errors in the immune system have been found tolead to an auto-aggressive phenomenon in which normal cells are misidentified as alien andare destroyed by the body’s own immune system. This phenomenon is used to explain theincrease of autoimmune disorders as we age. The cross-link theory describes aging in terms ofthe accumulation of errors of cross-linking or stiffening of proteins in the body. The freeradical theory describes free radical errors as the result of random damage from free radicals.The error theory is a group of theories that propose that aging is an accumulation of errors inthe synthesis of cellular DNA and RNA, which are the building blocks of the cell.DIF:Cognitive Level: UnderstandingREF:p. 34TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance2.The family member of a patient asks if vitamin C will prevent aging. In formulating anappropriate response, the nurse considers the:a.free radical theory.b.autoimmune theory.c.wear-and-tear theory.d.continuity theory.ANS:AThe free radical theory posits that aging is a result of random damage from free radicals.Research is ongoing on the ability of substances with antioxidant effects to counter the actionsof free radicals. For many years it was thought that consumption of supplemental antioxidants,such as vitamin C, could delay or minimize the effects of aging. However, it is now knownthat the intake of supplemental antioxidants can be deleterious to one’s health. Theautoimmune theory posits that the cells of the immune system become progressively morediversified with age and lose self-regulatory ability. The use of vitamin C is not associatedwith this theory. The wear-and-tear theory posits that cellular errors are the result of wearingout over time due to constant use. The continuity theory is a sociological theory that dealswith the tendency of individuals to develop and maintain consistent patterns of behaviorthroughout their lives.DIF:Cognitive Level: UnderstandingREF:pp. 32–33TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance

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3.The nurse implements the concepts of the activity theory of aging when instructing the olderclient with osteoarthritis to:a.continue her daily walking routine.b.curtail further increases in physical activity.c.document preferred end-of-life interventions.d.avoid exposing herself to crowds.ANS:AThe activity theory states that successful aging equals active aging, which is related to theperson’s need to maintain a productive life for it to be a happy life. Curtailing increases inphysical activity is diametrically opposite to continuing a daily walking routine and contraryto the tenets of the activity theory. End-of-life decisions and avoiding exposure to crowds arenot related to the activity theory since they do not directly affect the productiveness of aclient’s life.DIF:Cognitive Level: ApplyingREF:pp. 35–36TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance4.A community health nurse provides an annual flu prevention workshop at a local seniorcenter. The activities include a lecture on preventing infections, which includes hand washingand limiting exposure to individuals who are ill, as well as an influenza immunization clinic.The nurse is basing her activities on what theory of aging?a.Wear and tearb.Oxidative stressc.Autoimmuned.Free radicalANS:CThe autoimmune theory of aging describes changes in cells of the immune system, whichmake an older person more susceptible to infection. Prevention of infection is very importantin older adults and can be accomplished by education and immunization. Wear and tear,oxidative stress, and free radical are incorrect because none of these theories of aging dealwith prevention of infection.DIF:Cognitive Level: ApplyingREF:p. 34TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance5.A 66-year-old retired professional basketball player is admitted to the hospital for a total kneereplacement due to osteoarthritis. In preparing preoperative teaching for this patient, the nurseincludes which theory of aging to help him understand how the disease has progressed?a.Free radical theoryb.Wear-and-tear theoryc.Gene theoryd.Cross-link theoryANS:B

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Osteoarthritis is characteristic of degeneration that results from joint usage. This disease is agood example of the wear-and-tear theory; repeatedly injuring one organ or body system, suchas occurs during playing sports, may result in premature aging and diseases such asosteoarthritis. The free radical theory states that cell damage is a result of the accumulation ofoxygen radicals. The gene theory states that genes govern cellular mortality. The cross-linktheory is related to the accumulation of cross-linked proteins, which may cause disease.DIF:Cognitive Level: ApplyingREF:p. 32TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance6.A married couple retired to a life care community after the husband had heart surgery. Thewife has always been physically and socially active and joined an aerobic class, knittinggroups, and a book club shortly after moving to the community. She walks on a daily basisand swims twice a week. Her husband spends his days reading and watching television. Hewas never a social person and enjoys being by himself. Which of the sociological theories ofaging best describes the couple?a.Role theoryb.Disengagement theoryc.Continuity theoryd.Personality theoryANS:CThe continuity theory asserts that individuals tend to develop and maintain a consistent patternof behavior as they age. The wife was active and social and continues to be so. Her husbandwas not very social and preferred less active activities and continues to do so. The role theorydescribes that people engage in roles consistent with their chronological age. The scenarioabove describes activity levels, not roles. The disengagement theory describes withdrawal ofolder adults from roles and activities of earlier life. Personality theories are distinct anddifferent from sociological theories of aging.DIF:Cognitive Level: UnderstandingREF:p. 36TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance7.A nurse plans programs for older adults in a senior center. She organizes a series of exerciseprograms. She sets one up for clients ages 65-74, one for clients 74-85, and one for clientsover age 85. The nurse is utilizing which theory of aging?a.Gerotranscendenceb.Activity theoryc.Age-stratification theoryd.Continuity theoryANS:CAge-stratification theory considers individuals as members of cohorts with similarities toothers in the same group. The importance of the similarities exceeds that of the differences.Gerotranscendence theory posits that older adults withdraw from society, in order to give theindividual the opportunity for self-reflection and exploration. Time, material possessions, andsuperficial relationships have less meaning. Activity theory proposes that continued activitycontributes to successful aging. Continuity theory posits that individuals develop and maintaina consistent pattern of behavior over a lifetime.

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DIF:Cognitive Level: ApplyingREF:p. 36TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and MaintenanceMULTIPLE RESPONSE1.The nurse shows an understanding of the error group of aging theories when stating:(Selectall that apply.)a.“Aging occurs differently for the various ethnic groups.”b.“Our genetic makeup is responsible for how we are affected by age.”c.“Aging is a result of mistakes in our RNA and DNA metabolism.”d.“The free radical theory is an example of an error theory.”e.“Aging effects are really random and unpredictable.”ANS:C, D, EAnswers A and B are congruent with programmed (nonerror) theories. The programmedtheories are those in which the changes of aging are attributed to a process that is programmedand thought to be predetermined such as in the various ethnic groups. Research is currentlylooking at genes being responsible for aging. The programmed theories view aging aspredetermined and not random. The error theories propose that aging is the result of anaccumulation of errors in the synthesis of cellular DNA and RNA synthesis, and that changesrelated to aging are random and unpredictable. The free radical theory is an error theory.DIF:Cognitive Level: UnderstandingREF:p. 32TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance2.The nurse preparing wellness information for older adult clients is promoting interventionsconsistent with the concepts of the biological theories of aging when suggesting that they:(Select all that apply.)a.use moisturizers daily to minimize dry skin.b.discuss the use of antacids to control heartburn with their health care provider.c.stay active by interacting with family and friends regularly.d.practice stress reduction techniques on a regular basis.e.consider getting a yearly influenza vaccination.ANS:A, B, D, EInterventions that promote biological theories of aging include those that help avoid skindryness and the overuse of antacids (cross-link) as well as the minimization of stress and riskfor viral infections (oxidative stress, immunity). Remaining physically active and emotionallyconnected is consistent with the psychosocial theories of aging.DIF:Cognitive Level: ApplyingREF:p. 35, Box 3-5TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance3.A nurse demonstrates understanding of the continuity theory when the nurse provides whichof the following advice to an older client?(Select all that apply.)a.“It is important to think about the activities that have been most satisfying for youthroughout your adult life and make a plan to continue them”

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b.“Since you enjoyed teaching young children so much, perhaps you would enjoyvolunteering in the day care center”c.“It is important to save enough money so that you will have an adequate incomeduring retirement”d.“It is important to maintain an active lifestyle as you age”e.“As you get older it is natural to slowly disengage oneself from many activities”ANS:A, BContinuity theory posits that individuals develop and maintain a consistent pattern of behaviorover a lifetime. Successful aging is associated with one’s ability to maintain and continueprevious behaviors and roles or find suitable replacements. Options A and B demonstrate thistheory. Option C demonstrates the social exchange theory, which is conceptualized from aneconomic perspective. Option D demonstrates the activity theory, and Option E demonstratesthe disengagement theory.DIF:Cognitive Level: ApplyingREF:p. 36TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance4.Gerotranscendence theory posits that:(Select all that apply.)a.older adults withdraw from society in order to allow the transfer of power toyounger individuals.b.older adults withdraw from society in order to give the individual an opportunityfor self-reflection and self-exploration.c.time and superficial relationships become less important.d.material possessions have less meaning.e.status and value of elders is lost because their contributions are no longer valued.ANS:B, C, DDisengagement theory posits that older adults withdraw from society in order to allow thetransfer of power to younger adults. Gerotranscendence theory posits similarly that olderadults withdraw from society, but for different reasons. These reasons include giving theindividual the opportunity for self-reflection and exploration. Time, material possessions, andsuperficial relationships have less meaning. The modernization theory posits that the statusand value of elders is lost because their contributions are no longer valued.DIF:Cognitive Level: RememberingREF:p. 36TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance

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Chapter 04: Cross-Cultural Caring and AgingTouhy: Ebersole & Hess' Toward Healthy Aging, 9th EditionMULTIPLE CHOICE1.A paper on culture and illness would be likely to include the statement that:a.culture is the same as ethnicity.b.ethnic groups always share common geographic origin and religion.c.ethnicity involves recognized traditions, symbols, and literature.d.most members of an ethnic group exhibit identical cultural traits.ANS:CEthnicity is a complex phenomenon including traditions, symbols, literature, folklore, foodpreferences, and dress. It is a shared identity. Ethnicity is more than just culture. It is socialdifferentiation based on culture. Even within ethnic groups, there is considerable diversity.DIF:Cognitive Level: RememberingREF:p. 44TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity2.Ethnocentrismis defined as:a.an understanding of another’s cultural beliefs and practices.b.a conflict that occurs when an individual interacts with another whose beliefsdiffer from his own.c.application of limited knowledge about one person with characteristics specific toanother person.d.a belief that one’s ethnic group is superior to that of another.ANS:DA belief that one’s ethnic group is superior to that of another is the definition ofethnocentrism. Ethnocentrism does not involve an understanding of the beliefs of others. Aconflict that occurs when an individual interacts with another whose beliefs differ from hisown is the definition ofcultural conflict.Application of limited knowledge about one personwith characteristics specific to another person is the definition ofstereotyping.DIF:Cognitive Level: RememberingREF:p. 42TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity3.Regarding health care disparities, it is true that older adults of color have:a.equal risk factors for vulnerability as do all older adults.b.equal risk factors for vulnerability as do the young adults of color.c.increased risk factors for vulnerability if they are female.d.an increase in risk factors for vulnerability if care is provided by public facilities.ANS:COlder females of color have an added risk factor for vulnerability (gender) than do males ofthe same age and ethnic group. Ethnicity is an added factor for vulnerability. Age is anadditional risk factor for vulnerability. Health care disparities are found across a wide range ofclinical settings.

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DIF:Cognitive Level: RememberingREF:p. 41TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity4.An older female patient tells a nurse the following: “In my culture, women are the silentpartner in the family. Men make all of the decisions. However, when we came to the UnitedStates, all that changed. I became an American. I am in charge of my family just like myhusband.” This is an example of:a.enculturation.b.acculturation.c.ethnicity.d.culture competence.ANS:BEnculturation is defined as cultural beliefs passed down from one generation to the next.Acculturation is the process by which persons from one culture adapt to another. Ethnicity isdefined as the cultural group that one identifies with. Cultural competence involves steppingoutside our own biases and understanding that others bring a different set of values.DIF:Cognitive Level: ApplyingREF:p. 40TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity5.A home care nurse is caring for an older patient from a different culture who is bed-bound andhigh risk for development of a pressure ulcer. The nurse discusses the plan of care with thepatient’s daughter, emphasizing the importance of turning every 2 hours and posts a turningclock on the wall. When the nurse returns later in the week, the turning clock has beenremoved, and the patient’s daughter reports that she turns her mother occasionally. She states,“I am taking very good care of my mother. You just don’t understand; our ways do notinvolve doing things on schedules.” The best response by the nurse is:a.“You must follow my guidelines and turn her every 2 hours, or I will not be able totake care of her.”b.“I understand that you value your culture, but culture cannot stop you fromproviding good care to your mother.”c.“I understand that you care very much for your mother. Perhaps caring for her istoo much for you.”d.“How can we best work together to provide the best care for your mother?”ANS:DIn providing cross-cultural care it is important that the nurse work with the patient and familyand listen carefully and find a way to include the values and beliefs of the patient in the planof care.DIF:Cognitive Level: AnalyzingREF:p. 43TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Psychosocial Integrity6.An older patient learns that he has metastatic cancer. The patient states:“I must have angeredGod.” This is an example of which type of belief?a.Biomedicalb.Magico-religious

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c.Naturalisticd.AyurvedicANS:BMagico-religious: views illness as caused by actions of a higher authority.Biomedical: views disease as a result of abnormalities in structure and function and diseasecaused by intrusion of pathogens into the body.Naturalistic: based on the concepts of balance. Health is seen as a sign of balance.Ayurvedic: the oldest known paradigm in the naturalistic system. Illness is seen as animbalance.DIF:Cognitive Level: RememberingREF:p. 46TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Psychosocial Integrity7.A female nurse is caring for an older woman from the Hasidic Jewish community. Thewoman’s son is at the patient’s bedside. The nurse notes that when she communicates with thepatient and her son, the son does not maintain eye contact with her and also notes that hewithdraws when she attempts to shake his hand. The best response by the nurse is to:a.carry on conversation with the patient only, ignoring the son.b.continue conversing with both the patient and the son.c.ask the son to leave since he is not comfortable with her.d.ask the patient why the son will not engage with her.ANS:BIn some cultures, direct eye contact or contact between men and women is seen as a sexualadvance. This is true in the Hasidic culture. Options A and C are disrespectful to the patientand her son. Option D may put the son in an uncomfortable position.DIF:Cognitive Level: AnalyzingREF:p. 48TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Psychosocial IntegrityMULTIPLE RESPONSE1.The nurse in a clinic setting that provides care for an ethnically diverse population of olderclients shows an understanding of the LEARN Model to direct the assessment process when:(Select all that apply.)a.recognizing that the client’s hands are clenched as she answers the assessmentquestions.b.asking the client to describe what he thinks will help him feel better.c.explaining to the client that herbal remedies may not be sufficient treatment for hischest congestion.d.acknowledging that the client has a different view of the appropriate treatment.e.suggesting to the client that it would be beneficial if she would trust her health careprovider to prescribe the correct treatment.ANS:A, B, C, D

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The LEARN Model implements active listening to both the client’s verbal and nonverbalcommunication as a means of obtaining insight into the client’s perspective of his or hermedical problem. This model also encourages the nurse to recognize that the perceptions maydiffer and to explain the differences in perceptions to the client. The model advocates arrivingat a mutually agreed upon treatment plan rather than encouraging the client to surrenderpersonal autonomy in the decision-making.DIF:Cognitive Level: RememberingREF:p. 50TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity2.A nurse completes a cultural assessment of an older adult who is being admitted to an assistedliving facility. Reasons for completing a cultural assessment include:(Select all that apply.)a.culture guides decision-making about health, illness, and preventive care.b.culture provides direction for individuals on how to interact during health careencounters.c.culture impacts attitudes toward aging.d.all members of a culture react in the same way in similar situations.e.knowledge of culture eliminates health care disparities.ANS:A, B, CAlthough knowledge of culture has the potential to optimize care, not all individuals willrespond in the same way to a specific situation. Knowledge of an individual’s culture will noteliminate health care disparities.DIF:Cognitive Level: UnderstandingREF:pp. 49–50TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity3.A nurse in the ambulatory care setting is preparing to do an interview with anon-English-speaking client. The nurse secures an interpreter. In order to have the mosteffective interview, the nurse should do which of the following?(Select all that apply.)a.Look and speak to the interpreterb.Use technical terminology to ensure accuracyc.Allow more time for the interviewd.Watch the client’s nonverbal communicatione.Have the interpreter check whether the client understands the communicationANS:C, DFor the most effective interview the nurse should look and speak directly to the client, avoidthe use of jargon and technical terminology, observe the client’s nonverbal communications,and clarify understanding by asking the client to state in his/her own words what he or sheunderstood, facilitated by the interpreter. The interview will take longer.DIF:Cognitive Level: RememberingREF:p. 48TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Psychosocial Integrity

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Chapter 05: Cognition and LearningTouhy: Ebersole & Hess' Toward Healthy Aging, 9th EditionMULTIPLE CHOICE1.Health literacy is defined as:a.the capacity to read basic health information in order to make appropriate healthdecisions.b.the capacity to obtain, process, and understand basic health information needed tomake appropriate health decisions.c.the capacity to read and write in order to access health care.d.the capacity to read and execute health care documents.ANS:BHealth literacy involves more than basic reading and writing skills. It involves the ability toobtain, process, and understand health information in order to make health care decisions.DIF:Cognitive Level: RememberingREF:pp. 60–61TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance2.The daughter of an older hospitalized patient tells a nurse: “I am worried about my father. Hismemory is sharper when he is at home. He is forgetful, but is functional. Since he has beenhospitalized his memory problems are much worse.” The best responseby the nurse is:a.“It is common for long-term memory to be more impacted by age-related changesthan short-term memory.”b.“Memory changes are often worse when an individual is in an unfamiliar orstressful situation.”c.“Perhaps you are just noticing your father’s memory loss now that he ishospitalized.”d.“There is a lot of new information for your father to process here in the hospital;he is overloaded.”ANS:BMemory changes are often worse when the individual is in unfamiliar or stressful situations,such as a hospitalization. Option A is not true, short-term memory is impacted more thanlong-term memory. Options C and D are true; however, they do not address the issue that thepatient’s daughter is discussing.DIF:Cognitive Level: AnalyzingREF:p. 56TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance3.An older resident in a senior community tells a nurse: “Iam really worried. I joined anexercise class, and I just learned everyone’s name yesterday, and I cannot remember them alltoday. Am I developing Alzheimer’s disease?” The best response by the nurse is:a.“You should be concerned. It is very unusual to forget something that you justlearned.”b.“There is no reason to be concerned. Short-term memory decreases with age.”c.“Don’t worry, a decline in both short- and long-term memory is a normal part of

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getting older.”d.“Although it is normal to have some changes in memory, forgetting names is veryunusual.”ANS:BEven though some older adults show decrements in the ability to process information, themajority of functioning remains intact. Age-associated memory impairment is used todescribe memory loss that is considered normal for one’s age and educational level. It mayinclude slowness in processing, storing, and recalling new information and difficultyremembering names and words.DIF:Cognitive Level: ApplyingREF:p. 56TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and MaintenanceMULTIPLE RESPONSE1.A nurse is developing an educational session for a group of older adults at a senior center.Which of the following would the nurse include in the education?(Select all that apply.)a.Attention span, language, and communication skills typically remain stable withincreasing ageb.Older brains slow down and take longer to process constantly increasing amountsof informationc.In order to preserve brain function, it is important to engage in challengingcognitive activitiesd.Older adults are not able to develop new cognitive abilitiese.Individuals over age 100 have a higher prevalence of dementia than youngerindividualsANS:A, B, COlder adulthood is no longer seen as a period when cognitive development is halted; it is a lifestage where unique capacities are developed. Centenarians and super-centenarians have alower prevalence of dementia then those under age 100.DIF:Cognitive Level: RememberingREF:p. 56TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance2.An older female resident of an assisted living facility says the following to a nurse: “I am veryfrightened about getting dementia. I have read a lot about brain exercises, but I am not surewhat I should be doing.” The nurse formulates a response based on knowledge of which of thefollowing?(Select all that apply.)a.Individuals should engage in some type of brain fitness activity a couple of times aweek for at least 25 minutesb.Brain fitness activities are only effective if an individual has not experienced anymemory problems at allc.Brain fitness activities may include computer-based games, memory training,board games, reading, and engaging in conversationd.Physical activity is important for wellness but is unrelated to brain fitnesse.Individuals should choose brain exercise activities that are unfamiliar, challenging,

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and funANS:A, C, EBrain fitness activities are effective for individuals with normal memory or mild memoryproblems. Physical activity is important and has an impact on improving reaction time andworking memory as well as posture, balance, and socialization.DIF:Cognitive Level: ApplyingREF:p. 57TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance3.A nurse is planning a fall prevention education refresher session for the residents of along-term care facility. The individuals are all cognitively intact and range in age from 80 to100. The previous education on fall prevention was presented 2 months ago. What specialconsiderations should the nurse take in relation to teaching this group of older adults?(Selectall that apply.)a.Make sure that all pamphlets are in large readable font (14-16 points) and includeupper and lower case letteringb.Start education on falls from the beginning. It is unlikely that anyone remembersprevious materialc.Present all the information at once in one long sessiond.Ensure that there is adequate lighting in the room and that the temperature iscomfortablee.Provide ongoing positive feedback during the sessionANS:A, D, EWhen educating older adults it is important that it is pertinent and build upon information thatthey already possess. It is a myth that all older adults experience memory problems. It isimportant to provide adequate time for learning and to use self-paced techniques.DIF:Cognitive Level: ApplyingREF:pp. 57–60TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance4.A nurse hears a colleague state the following: “Can you believe that Mr. Jones’ daughter justbought him a tablet computer? He is 90 years old. It is ridiculous to think that he can learn touse it.” The nurse formulates a response based on research that shows:(Select all that apply.)a.older adults comprise the fastest growing population using computers and theInternet.b.Internet use is less prevalent in individuals over age 75 than those ages 65-74.c.older American men are the fastest growing group of social networking site users.d.older adults use the Internet only for social networking and recreational uses.e.technology has the potential to improve quality of life for older adults.ANS:A, B, EOlder adults are the fastest growing population using computers and the Internet. Internet usedoes decrease in those over age 75 as compared to older adults less than age 75. Older womenare the fastest growing group of individuals using social networking sites. Older adults usetechnology for a whole host of reasons, both social and to communicate with health careproviders and access health information. Technology has a large potential to improve qualityof life for older adults.

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DIF:Cognitive Level: RememberingREF:p. 58TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance

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Chapter 06: Communicating with Older AdultsTouhy: Ebersole & Hess' Toward Healthy Aging, 9th EditionMULTIPLE CHOICE1.When caring for an ill adult client, the nurse is particularly concerned that the clientcommunicates well since:a.assessment, planning of care, and even the therapeutic relationship is based oneffective communication.b.it is the social connection that all individuals base interpersonal relationships upon.c.how well an individual communicates is a reflection on both his or her physicaland emotional well-being.d.the need to communicate is a basic need of all individuals.ANS:AGood communication skills are the basis for accurate assessment, care planning, and thedevelopment of therapeutic relationships between the nurse and the older person. While theother options are true they do not directly address the concerns of an ailing client.DIF:Cognitive Level: UnderstandingREF:p. 65TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Health Promotion and Maintenance2.Which statement by the nurse is the strongest example of ageism by professional nurses?a.“It takes a special nurse to provide good care to the older population of clients.”b.“It’s difficult for a nurse to develop an effective relationship with an older clientbecause of the barriers their age creates.”c.“It is so difficult to find nurses who are truly effective geriatric nurses.”d.“With the older population increasing so dramatically in numbers, nursing willhave a difficult time meeting their needs.”ANS:CAgeism affects health professionals as well as the general public and this attitude is reflectedin the lack of nurses who choose to work in the field of geriatrics. The characteristics of a“good geriatric nurse” are no different than those of any effective nurse. Assuming that ageproduces barriers to an effective nurse-client relationship is an example of ageism. Thegrowing number of older adults is not an example of ageism.DIF:Cognitive Level: UnderstandingREF:p. 66TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance3.When conducting an admissions interview with an older client, the nurse observes that theclient pauses for a period of time before responding to the questions. The nurse responds tothis client based on the assumption that the client is:a.exhibiting signs of mild cognitive impairment.b.nervous and having difficulty concentrating on the questions.c.reluctant to share information with someone with whom he or she has norelationship.d.sorting through his or her vast life experiences in order to answer appropriately.

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ANS:DBasically, elders may need more time to give information or answer questions simply becausethey have a larger life experience to draw from. Sorting through thoughts requires intervals ofsilence, and therefore listening carefully without rushing the elder is very important. It is anunfounded assumption to assume that the client’s response is due to senility based exclusivelyon his or her age. The remaining options would not be unique to an older client but might beexperienced at any age.DIF:Cognitive Level: ApplyingREF:p. 67TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Health Promotion and Maintenance4.Which technique is most effective when communicating with a client who is positioned inbed?a.Sitting in a chair at the foot of the bedb.Standing near the client’s head on his or her dominant sidec.Sitting in a chair at the bedside facing the clientd.Standing at the foot of the bedANS:CWhen communicating with individuals in a bed or wheelchair, position yourself at their leveland directly face them rather than talking over a side rail or standing above them.DIF:Cognitive Level: ApplyingREF:p. 67TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Health Promotion and Maintenance5.Which nursing statement shows a true appreciation for an older client’s willingness to tell hispersonal stories about “the war”?a.“It’s so nice to see them excited and engaged as they tell the stories.”b.“It helps their memory so much to retell theirstories.”c.“I learn so much about clients when they share their life story with me.”d.“They are so proud of the things they have accomplished in their life.”ANS:CA memory is an incredible gift given to the nurse, a sharing of a part of oneself when one mayhave little else to give, and it provides insight into who the person really is telling the story.DIF:Cognitive Level: ApplyingREF:p. 67TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and MaintenanceMULTIPLE RESPONSE1.A nurse manager is providing a novice geriatric nurse with guidelines when encouraging anolder client to reminisce about his or her life and past experiences. Which suggestions will beincluded?(Select all that apply.)a.Don’t correct the client even when you suspect the memory is incorrectb.When the focus remains on sad topics, assess the client for possible depressionc.Refrain from interjecting personal stories into the reminiscing process

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d.Expect and respect a degree of repetitione.Use close-ended questions to help focus the reminiscingANS:A, B, DSuggestions for encouraging reminiscing include listening without correction or criticism,remembering that it is the client’s recollections that are important; being patient withrepetition since sometimes people need to tell the same story often to come to terms with theexperience, especially if it was very meaningful to them; being attuned to signs of depressionin conversation (dwelling on sad topics) or changes in physical status or behavior, andproviding appropriate assessment and intervention; and keeping the conversation focused onthe person reminiscing, but not hesitating to share some of your own memories that relate tothe situation being discussed. Use open-ended questions to encourage reminiscing since theyencourage free thought.DIF:Cognitive Level: ApplyingREF:p. 68, Box 6-3TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance2.Which intervention is therapeutic when facilitating communication with a cognitivelyimpaired older client?(Select all that apply.)a.Explain a task using simple, concise phrasing and one step at a timeb.Give instructions to a group whenever possible to provide peer supportc.Allow for additional time for the client to respond to questions or directionsd.Use nonverbal as well as verbal cues to help get your message across to the cliente.Speak loudly to gain and retain the client’s attentionANS:A, C, DUseful strategies for communicating with individuals experiencing cognitive impairmentinclude giving one-step directions, allowing time for the expected response, and giving cluesand cues as to what you want the person to do. It is also helpful to interact with one person ata time and to speak slowly rather than loudly.DIF:Cognitive Level: ApplyingREF:p. 69TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Health Promotion and Maintenance3.Which of the following are examples of elderspeak?(Select all that apply.)a.A nursing assistant refers toone of her patients as “grandma”b.A nurse attempts to medicate a patient and states, “Now come on and be a goodgirl”c.A nurse explains a procedure to a patient using simple nonmedical termsd.A nurse makes sure that she is directly facing a patient who has hearing loss whenshe is speakinge.A nursing assistant tells a patient, “It is time for our bath now”ANS:A, B, EElderspeak is a form of patronizing speech. Examples include using diminutives or pet names,speaking very slowly, and speaking to older adults as if they were children, or using collectivepronouns. Option C is not an example of elderspeak; it is appropriate to explain a procedureusing nonmedical terminology. Option D is the correct manner in which to address anindividual with hearing loss; facing the patient allows the patient to read lips.

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DIF:Cognitive Level: ApplyingREF:p. 66TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Health Promotion and Maintenance

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Chapter 07: Health AssessmentTouhy: Ebersole & Hess' Toward Healthy Aging, 9th EditionMULTIPLE CHOICE1.The FANCAPES assessment tool focuses on the older adult’s:a.ability to meet personal needs to identify the amount of assistance needed.b.ability to perform instrumental activities of daily living (IADLs).c.cognitive abilities.d.level of dementia present.ANS:AThe FANCAPES assessment tool focuses on physical functioning and evaluates theindividual’s ability to meet his/her needs and how much assistance is needed to meet theneeds. FANCAPES evaluates physical functioning. IADLs involve more than just physicalfunctioning. FANCAPES does not assess cognitive function, nor does it assess dementia.DIF:Cognitive Level: RememberingREF:p. 79TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Health Promotion and Maintenance2.A limitation of the Katz Index of activities of daily living (ADLs) is that:a.completion of the tool requires the joint efforts of the interdisciplinary team.b.all ADLs are weighted equally.c.it puts a heavier weight on the cognitive abilities necessary to perform ADLs.d.it provides a range of performance for each task.ANS:BThe Katz Index assigns an equal weight to all of the ADLs, and because of that, it cannot beused to identify the particular area of need or change in any one task. Any health careprofessional can complete the Katz Index, although input from the interdisciplinary team isvaluable. The Katz Index does not address the cognitive abilities necessary to perform ADLs.The ADLs are considered in dichotomous terms only, the ability to compete the taskindependently or the complete inability to do so.DIF:Cognitive Level: RememberingREF:p. 80TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Health Promotion and Maintenance3.A 78-year-old man is being evaluated in the geriatric clinic. His daughter reports that he hasbeen very forgetful lately, and she is concerned that he might be “senile.” The advancedpractice nurse administers the clock-drawing test and the patient draws a distorted circularshape and places the numbers all on one side of the shape. Based on his performance, thenurse concludes that the patient:a.probably has Alzheimer’s disease.b.needs further evaluation.c.probably has delirium.d.needs a functional status assessment.ANS:B

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Cognitively intact persons rarely produce errors on the clock-drawing test, such as grosslydistorted contour. A low score on the clock-drawing test requires further evaluation.Alzheimer’s disease is not a diagnosis using a mental status assessment tool. It is definitivelydiagnosed with a brain biopsy. The clock-drawing test does not assess for delirium. A lowscore on the clock-drawing test does not necessarily warrant a functional status assessment.DIF:Cognitive Level: UnderstandingREF:p. 81TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Health Promotion and Maintenance4.When comparing the Older American’s Resources and Services (OARS) with the Katz Indexof ADLs, what is true?a.The Katz Index and the OARS both measure only ADL performanceb.The OARS is a comprehensive assessment tool that measures ability in five areas;the Katz Index measures only ADL performancec.The OARS is used only for older adults in the long-term care setting; the KatzIndex is used in all settingsd.The OARS is not valid for use in older adults who are cognitively impaired,whereas the Katz Index isANS:BThe OARS evaluates ability, disability, and capacity at which the person is able to function.Five dimensions are assessed: social resources, economic resources, physical health, mentalhealth, and ADLs. The Katz Index only evaluates ADL ability. Both instruments are used in avariety of care settings and are valid for use with cognitively impaired older adults.DIF:Cognitive Level: UnderstandingREF:p. 84TOP:Integrated Process: Communication and DocumentationMSC: Client Needs: Health Promotion and Maintenance5.A resident of a long-term care facility is assessed by a nurse upon admission to the facility.The assessment includes a comprehensive health, social, and functional profile. The tool thatthe nurse utilizes is:a.Outcomes and Assessment Information Set (OASIS).b.Resident Assessment Instrument (RAI).c.Older Americans Resources and Services (OARS).d.Comprehensive Geriatric Assessment (CGS).e.Mini Mental Status Examination (MMSE).ANS:BThe OASIS is used in the homecare setting. The RAI is used in the long-term care setting.OARS is a functional status instrument. Comprehensive geriatric assessment is not a specifictool but rather an approach to assessment. The MMSE is a mental status assessment tool.DIF:Cognitive Level: RememberingREF:p. 85TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance

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6.A nurse utilizes the SPICES tool (Sleep disorders, Problems with eating, Incontinence,Confusion, Evidence of falls, and Skin breakdown) to assess an older female patient in thehospital. The nurse notes that the patient has new onset urinary incontinence. The first actionby the nurse is to:a.conduct a more in-depth focused assessment of the urinary incontinence.b.call the provider and obtain an order for an antibiotic for a suspected urinary tractinfection.c.send a urine specimen for culture and sensitivity.d.develop a plan of care with the patient to control episodes of incontinence.ANS:ASPICES is an assessment tool. Anything that indicates a problem in any of the categorieswarns the nurse that a more in-depth assessment is needed. The nurse needs to further assessthe urinary incontinence prior to implementing any interventions.DIF:Cognitive Level: AnalyzingREF:p. 79TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and MaintenanceMULTIPLE RESPONSE1.A nurse identifies a need to assess a patient’s cognitive status. The nurse chooses to use theMMSE. The nurse knows that the patient must have which of the following abilities?(Selectall that apply.)a.Number fluencyb.Familiarity with analog clocksc.Ability to hear and seed.Ability to sit up for 10 minutese.Ability to speak EnglishANS:A, B, CThe MMSE requires number fluency, ability to see and hear and hold a pencil, and experiencewith analog clocks. The instrument is available in languages other than English. It is acognitive status exam and does not require that the patient be able to sit up.DIF:Cognitive Level: RememberingREF:p. 81TOP:Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance2.Factors that complicate assessment of older adults include:(Select all that apply.)a.presence of multiple comorbid conditions.b.atypical presentation of illness.c.difficulty in differentiating symptoms of disease from normal age-related changes.d.increase in iatrogenic illness.e.lack of assessment instruments specific for the older adult population.ANS:A, B, C, DFactors that complicate assessment of older adults include difficulty differentiating diseasesymptoms from normal age-related changes, the presence of multiple comorbidities, atypicalpresentations of illness, and the presence of iatrogenic illness. There are many assessmenttools that are designed specifically for use in the older adult population.

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