Test Bank for Gerontological Nursing, 9th Edition

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Gerontological Nursing 9th Edition EliopoulosTest BankChapter1 The Aging PopulationTest BankMULTIPLE CHOICE1. The nurse explains that in the late 1960s, health care focus was aimed at the older adultbecause:a.disability was viewed asunavoidable.b.complications from disease increased mortality.c.older adults needs are similar to those of all adults.d.preventive health care practices increased longevity.ANS: DIncreased preventive health care practices, disease control, andfocus on wellness helped peoplelive longer.DIF: Cognitive Level: Comprehension REF: 2 OBJ: 2TOP: Aging Trends KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Growth and Development2. The nurse clarifies that in the terminology defining specific age groups, the termagedrefers topersons who are:a.55 to 64 years of age.b.65 to 74 years of age.c.75 to 84 years of age.d.85 and older.ANS: C

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The termagedrefers to persons who are 75 to 84 years of age.DIF: Cognitive Level: Comprehension REF: 2, Table 1-1 OBJ: 1TOP: Age Categories KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Growth and Development3. The nurse cautions that ageism is a mindset that influences persons to:a.discriminate against persons solely on the basis of age.b.fear aging.c.be culturally sensitive to concerns of aging.d.focus on resources for the older adult.ANS: AAgeism is a negative belief pattern that influences persons todiscriminate against persons solelyon the basis of age and can lead to destructive behaviors toward the older adult.DIF: Cognitive Level: Comprehension REF: 5 OBJ: 3TOP: Ageism KEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation4. The nurse points out that the most beneficial legislation that has influenced health care for theolder adult is:a.Medicare and Medicaid.b.elimination of the mandatory retirement age.c.the Americans with Disabilities Act.d.the Drug Benefit Program.ANS: AThe broadest sweeping legislation beneficial to the older adult is Medicare and Medicaid.

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DIF: Cognitive Level: Application REF: 16 OBJ: 6TOP: Legislation KEY: Nursing Process Step: ImplementationMSC: NCLEX: N/A5. The nurse clarifies that a housing option for the older adult that offers the privacy of anapartment with restaurant-style meals and some medical and personal care services is the:a.government-subsidized housing.b.long-term care facility.c.assisted-living center.d.group housing plan.ANS: CAssisted-living arrangements offer the privacy of an apartment or condominium with mealsprepared and served, limited medical care, and a variety of personal services.DIF: Cognitive Level: ApplicationREF: 14 OBJ: 9TOP: Housing Options KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity: Physiological Adaptation6. The 75-year-old man who has been hospitalized following a severe case of pneumonia isconcerned about his mounting hospital bill and asks if his Medicare coverage will pay for hiscare. The nurses most helpful response is Yes. Medicare:a.pays 100% of all medical costs for persons older than 65.b.Part B pays hospital costs and physician fees.c.Part A pays forinpatient hospital costs.d.Part D pays 80% of the charges made by physicians.ANS: CMedicare Part A pays inpatient hospital costs, Part B pays 80% of physicians charges, and Part Dhelps defray prescription drug costs.

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DIF: Cognitive Level:Application REF: 16 OBJ: 6TOP: Medicare Provisions KEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity: Coping and Adaptation7. The daughter of a patient who has been diagnosed with terminal cancer asks which documentsare required to allow her to make health care decisions for her parent. The nurses mostinformative response is:a.Advance directives indicate the degree of intervention desired by the patient.b.A Do Not Resuscitate document signed by the patient transfers authority to the nextof kin.c.A durable power of attorney for health care transfers decision-making authority forhealth care to a designated person.d.A living will transfers authority to the physician.ANS: CA durable power of attorney for health caretransfers the authority for decision making to adesignated person.DIF: Cognitive Level: Application REF: 19 OBJ: 11TOP: Advance Directives KEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity: Coping and Adaptation8. Thedaughter of a resident in a long-term care facility is frustrated with her 80-year-oldmothers refusal to eat. The nurse explains that the refusal to eat is a behavior that is an:a.effort to maintain a portion of independence and self direction.b.indication of approaching Alzheimer disease.c.effort to gain attention.d.indication of the dislike of the institutional food.ANS: A

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Loss of independence and control is a significant issue for the older adult. Some residents willexercise whatever control they may retain.DIF: Cognitive Level: Application REF: 21 OBJ: 11TOP: Loss of Independence KEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity: Coping and Adaptation9. The nurse clarifies that the conditions of a living willgo into effect when:a.the patient declares that desire in writing.b.a family member indicates the desire for curative therapy to cease.c.two physicians agree in writing that the criteria in the living will have been met.d.the physician and afamily member agree that the criteria in the living will havebeen met.ANS: CTwo physicians must agree in writing that the criteria of the living will have been met before thedocument can go into effect.DIF: Cognitive Level: Application REF: 19 OBJ: 11TOP: Living Wills KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care10. In the 1980s, Medicare initiated a program of diagnosis-related groups (DRGs) to reducehospital costs by:a.classifyingvarious diagnoses as ineligible for hospitalization.b.allotting a set amount of hospital days and prospective payment on the basis of theadmitting diagnosis.c.specifying particular physicians to treat specified diagnoses.d.using frequency of a particular diagnosis to set a payment schedule.ANS: B

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DRGs set up a system of preset hospitalization time and payment on the basis of the admittingdiagnosis.DIF: Cognitive Level: Comprehension REF: 16 OBJ: 6TOP: DRGs KEY: Nursing Process Step: N/A MSC:NCLEX: N/A11. When discussing extended care with a patient who has had a hip replacement and needsphysical therapy, the nurse would recommend a(n):a.basic care facility.b.skilled care facility.c.subacute care facility.d.assisted-livingresidence.ANS: BSkilled care facilities offer not only basic care but also services from trained licensedprofessionals such as nurses, physical therapists, speech therapists, and occupational therapists.DIF: Cognitive Level: Application REF: 16 OBJ: 9TOP: Extended-Care Facilities KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care12. The 80-year-old woman who is recovering from a stroke is being sent to an extended-carefacility. She is concerned about the expense. The nurse can allay anxiety by explaining thatMedicare will cover extended-care facility costs:a.for a period of 30 days.b.for a period of 45 days for physical therapy.c.for a period of 100 days for needed skilled care.d.untilshe is able to be discharged home.ANS: C

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Medicare will cover extended-care costs for 100 days while skilled care is being applied to theresident. After 100 days, the resident must revert to private pay or ancillary long-term careinsurance.DIF: Cognitive Level: Application REF: 16 OBJ: 8TOP: Extended Care KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care13. The senior citizen political action group that uses volunteers and lobbyists to advance theinterests of older adults is the:a.American Association of Retired Persons (AARP).b.National Council of Senior Citizens (NCSC).c.National Alliance of Senior Citizens (NASC).d.Gray Panthers.ANS: AThe AARP uses volunteers and lobbyists toadvance the interests and welfare of older adults.DIF: Cognitive Level: Knowledge REF: 12 OBJ: 7TOP: Political Action Groups KEY: Nursing Process Step: N/AMSC: NCLEX: N/A14. The nurse gives an example of the caregiver who is guilty of elder abuse as the:a.daughter who uses her mothers Social Security money to purchase her mothersmedication.b.son who puts an alarm on the front door to prevent his mother from wandering outof the house.c.wife who allows her mentally competent husband to refuse totake a bath for aweek.d.frail spouse who is unable to bathe or change the clothes of her physicallydependent husband.

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ANS: DUnintentional abuse or neglect can occur when the caregiver lacks the stamina to meet careneeds. Even though physically unable, the frail wife is guilty of elder abuse. The wife shouldseek assistance to prevent neglect.DIF: Cognitive Level: Analysis REF: 22 OBJ: 13TOP: Elder Abuse KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity: Basic Care andComfort15. The nurse cautions that the most frequent response to elder abuse by the abused older adultis:a.anger.b.physical retaliation.c.notification of authorities.d.nothing at all.ANS: DFear of retaliation or abandonment keeps mostabused elders silent.DIF: Cognitive Level: Application REF: 25-26 OBJ: 14TOP: Response to Abuse KEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity: Coping and Adaptation16. Many nurses today do not seek careers in gerontology because:a.the physical work is too difficult.b.their technological skills are not used.c.there is not enough challenge.d.there are limited options for employment.ANS: B

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Many nurses feel that their technical skills will not be used in the careof the older adult. Thereare many employment options that offer challenge and fulfillment.DIF: Cognitive Level: Application REF: 5 OBJ: 2TOP: Employment Options KEY: Nursing Process Step: N/AMSC: NCLEX: N/A17. The nurse clarifies that the term baby boomers refers to persons who:a.entered school in 1945.b.served in the military in World War II.c.were born between 1946 and 1964.d.were eligible for Social Security benefits in 2000.ANS: CBaby boomers are those born between 1946 and 1964. Theimpact of the retirement of thiscohort is unprecedented in terms of the impact on society.DIF: Cognitive Level: Comprehension REF: 8 OBJ: 5TOP: Baby boomers KEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation18. Restraining an older adult in a recliner to prevent wandering is an example of:a.physical abuse.b.neglect.c.emotional abuse.d.self-neglect.ANS: APhysical abuse is any action that causes physical pain or injury. Inappropriate use ofdrugs,force-feeding, physical restraints, or punishment of any kind are examples of physical abuse.

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DIF: Cognitive Level: Application REF: 23 OBJ: 13TOP: Types of Abuse KEY: Nursing Process Step: N/AMSC: NCLEX: N/A19. Nonprovision of medical care because of lack of finances is an example of:a.physical abuse.b.neglect.c.emotional abuse.d.self-neglect.ANS: BNeglect is a passive form of abuse in which caregivers fail to provide for the needs of the olderperson under their care. Failure toprovide necessary medical care may constitute neglect becausewith no means of going to the doctor or pharmacy, the older person may suffer or even die.DIF: Cognitive Level: Application REF: 23 OBJ: 13TOP: Types of Abuse KEY: Nursing Process Step: N/AMSC: NCLEX: N/A20. Health care workers eating a residents candy without permission is an example of:a.physical abuse.b.neglect.c.emotional abuse.d.self-neglect.ANS: CEmotional abuse is more subtle and difficult to recognize than physical abuseor neglect. It oftenincludes behaviors such as isolating, ignoring, or depersonalizing older adults. Health careworkers eating a residents candy without permission is an ignorant behavior that can bedepersonalizing.

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DIF: Cognitive Level: Application REF: 23 OBJ: 13TOP: Types of Abuse KEY: Nursing Process Step: N/AMSC: NCLEX: N/AMULTIPLE RESPONSE1. The nurse is aware that a persons attitude about aging is influenced mainly by his or her__________.(Select all that apply.)a.life experiencesb.income levelc.level of educationd.current agee.occupationANS: A, DA persons current age and life experiences are the main influences on his or her attitude relativeto aging.DIF: Cognitive Level: Comprehension REF: 4 OBJ: 2TOP: Attitudes towardAging KEY: Nursing Process Step: PlanningMSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation2. Gerontology encompasses application to __________.(Select all that apply.)a.appropriate housingb.health carec.public educationd.businessventurese.government-sponsored pensionsANS: A, B, C, D

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Gerontological concerns extend and influence provision of appropriate housing, health care,public education, business ventures, and political stands relative to the welfare of the older adult.DIF: Cognitive Level: Application REF: 2 OBJ: 1TOP: Gerontology KEY: Nursing Process Step: N/A MSC: NCLEX: N/A3. Medicare Part C allows eligible persons to receive Medicare benefits via the services ofprivate insurance companies through the services of a__________.(Select all that apply.)a.health maintenance organization (HMO)b.preferred provider organization (PPO)c.provider-sponsored organization (PSO)d.private fee for service organization (PFFS)e.medical service organization (MSO)ANS:A, B, C, DMedicare Part C allows benefits via the services of managed care organizations. Medical serviceorganization is not one of them.DIF: Cognitive Level: Comprehension REF: 17 OBJ: 6TOP: Medicare Part C KEY: Nursing Process Step: N/AMSC: NCLEX: N/A4. The nurse is aware that a familys emotional response to an aging loved ones attempts to copewith diminishing abilities and increased care needs would include __________.(Select all thatapply.)a.griefb.angerc.frustrationd.losse.resentment

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ANS: A, B, C, DAs the family witnesses the decline of a loved one and attempts to respond to the increasing careneeds, the emotional responses are varied and changing. The responses include grief, anger,frustration, loss, and confusion.DIF:Cognitive Level: Application REF: 21 OBJ: 11TOP: Impact of Aging on the Family KEY: Nursing Process Step: PlanningMSC: NCLEX: Psychosocial Integrity: Coping and Adaptation5. The nurse outlines the characteristics of the typical caregiver for an aging family member as__________.(Select all that apply.)a.32 years of ageb.femalec.having full-time employmentd.having a care recipient older than 70e.giving care for an average of 18 yearsANS: B, C, D, EThe average age of the caregiver is 46.DIF: Cognitive Level: Application REF: 20 OBJ: 11TOP: Characteristics of Family CaregiverKEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Growth and Development6. The nurse reminds a family that indicators of self-neglect in the aging person include__________.(Select all that apply.)a.misbalanced check bookb.reduced personal hygiene

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c.increased alcohol consumptiond.irritabilitye.loss of weightANS: A, B, C, EIndicators may be to manage personalfinances, reduced hygiene, substance abuse, and loss ofweight due to inability to obtain adequate food. Irritability is not a consistent characteristic.DIF: Cognitive Level: Application REF: 22 OBJ: 11TOP: Self-Neglect KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease7. The nurse reminds a group of prospective caregivers that elder abuse may take the form of__________.(Select all that apply.)a.causing physical harmb.misappropriation of financesc.psychological intimidationd.emotional depersonalizatione.abandonmentANS: A, B, C, D, EElder abuse may take the form of physical injury, misusing the older persons finances forpersonal gain, psychological intimidation, and depersonalization and abandonment.DIF: Cognitive Level: Application REF: 25-26 OBJ: 13TOP: Elder Abuse KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity: Reduction of Risk8. The nurse explains that research done by the National Institute on Aging found that__________.(Select all that apply.)

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a.older patients receive less information regarding health management than youngerpatientsb.information on lifestyle changes were directed at younger peoplec.older patients were denied timely appointments for evaluation of acute illnessesd.rehabilitation programs offered limited services to the older adulte.older patients receive less evaluation and fewer treatment options for acute illnessesANS: A, B, D, EThe study showed there was less information on health management and lifestyle changes.Rehabilitation programs were limited in their service to the older adult, and only 47% ofphysicians interviewed felt the olderpatient received the same evaluation for acute illnesses.DIF: Cognitive Level: Application REF: 5 OBJ: 2TOP: Attitudes toward Aging KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection ofDisease9. The Nursing Competence in Aging initiative advocates enhancing nurses __________.(Selectall that apply.)a.knowledge in geronticsb.skills in geriatricsc.opportunities for employmentd.political sensitivity for the older adulte.attitudes related to the older adultANS: A, B, EThe Nursing Competence in Aging initiative advocates for all nurses greater knowledge, skills,and broader attitudes toward the older adult.Chapter2 Theories of AgingMULTIPLE CHOICE

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1. A theory differsfrom a fact in that a theory:a.proves how different influences affect a particular phenomenon.b.attempts to explain and give some logical order to observations.c.is a collection of facts about a particular phenomenon.d.shows a relationshipamong facts about a particular phenomenon.ANS: BA theory is an unproven concept that attempts to explain and give some logical order toobservations. For a theory to become a fact, there must be reproducible evidence.DIF: Cognitive Level: ComprehensionREF: 28 OBJ: 1TOP: Fact vs. Theory KEY: Nursing Process Step: N/AMSC: NCLEX: N/A2. The biological theory of aging uses a genetic perspective and suggests that aging is aprogrammed process in which:a.each person will age exactly like those in the previous generation.b.a biological clock ticks off a predetermined number of cell divisions.c.genetic traits can overcome environmental influences.d.age-related physical changes are controlled only by genetic factors.ANS: BThe biological theory ofprogrammed process suggests that there is a biologic clock set with apredetermined number of cell divisions that will occur before the introduction of the agingprocess.DIF: Cognitive Level: Application REF: 28 OBJ: 2TOP: Biological Theory KEY: NursingProcess Step: N/AMSC: NCLEX: N/A

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3. The Gene Theory of aging proposes that:a.the presence of a master gene prolongs youth.b.genes interact with each other to resist aging.c.specific genes target specific body systems to initiate system deterioration.d.the activation of harmful genes initiates the aging process.ANS: DThe Gene Theory suggests that there is an activation of harmful genes that initiate the agingprocess.DIF: Cognitive Level: Application REF: 28 OBJ: 2TOP: Gene Theory KEY:Nursing Process Step: N/AMSC: NCLEX: N/A4. The theory that identifies an unstable molecule as the causative factor in aging is the _____theory.a.free radicalb.molecularc.neuroendocrined.crosslinkANS: AThe free radical theory identifies free radicalsunstable moleculesthat will cause aging afteraccumulation in the body.DIF: Cognitive Level: Application REF: 29 OBJ: 2TOP: Free Radical Theory KEY: Nursing Process Step: N/AMSC: NCLEX: N/A

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5. The nurse assesses that the patient who uses good health maintenance practices believes in theaging theory known as the _____ theory.a.wear-and-tearb.free radicalc.neuroendocrined.molecularANS: AThe wear-and-tear theory suggests that health maintenancepractices will prevent wear and tearon the cells of the body and will delay the aging process.DIF: Cognitive Level: Analysis REF: 29 OBJ: 2TOP: Wear-and-Tear Theory KEY: Nursing Process Step: AssessmentMSC: NCLEX: Health Promotion and Maintenance:Prevention and Early Detection of Disease6. The nurse describes the neuroendocrine theory of aging as a complex process of:a.relating thyroid function to age-related changes.b.the effects of adrenal corticosteroids, which inhibit the aging process.c.stimulation and/or inhibition of the hypothalamus, causing age-related changes.d.adrenal medulla inhibition of epinephrine, causing age-related changes.ANS: CThe neuroendocrine theory proposes that the hypothalamus stimulates or inhibits the pituitarygland to produce hormones that initiate the aging process.DIF: Cognitive Level: Application REF: 29 OBJ: 2TOP: Neuroendocrine Theory KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Prevention and EarlyDetection of Disease

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7. The nurse explains that psychosocial theories differ from biologic theories in that psychosocialtheories:a.focus on methods to delay the aging process.b.are directed at decreasing depression in the older adult.c.are organized to enhance the perception of aging.d.attempt to explain responses to the aging process.ANS: DPsychosocial theories attempt to explain the various responses of persons to the aging process.DIF: Cognitive Level: Comprehension REF: 30 OBJ: 3TOP: Focus of Psychosocial Therapies KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Growth and Development8. The major objection to the disengagement theory is that the theory:a.justifies ageism.b.addresses thediversity of older adults.c.does not clarify the aging process.d.diminishes the self-esteem of the older adult.ANS: AThe disengagement theory seems to justify ageism by proposing that there is a mutual desirebetween the community and the older adult to be disengaged. According to the theory, this desireapparently does not diminish self-esteem because the older adult desires to be disengaged.DIF: Cognitive Level: Application REF: 30 OBJ: 3TOP: Disengagement Theory KEY: Nursing Process Step: N/AMSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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9. The 80-year-old who teaches Sunday school every week and delivers food for Meals onWheels is following _____ theory.a.Newmans developmentalb.the life coursec.the activityd.thedisengagementANS: CPurposeful activity increases self-esteem and maintains cognitive function well into older age.DIF: Cognitive Level: Application REF: 30 OBJ: 3TOP: Activity Theory KEY: Nursing Process Step: N/AMSC: NCLEX: N/A10. The nurse would recognize successful aging according to Jungs theory when the nurse notesthat a resident at a long-term care facility:a.takes special care to dress for dinner in a manner that pleases his tablemates.b.asks permission to sit on the patio with otherresidents.c.asks persons in his hall if his television is bothering them.d.wears a large cowboy hat at all times because he likes it.ANS: DJung describes a successful adjustment to aging as being accepting and valuing of self regardlessof the view of others.DIF: Cognitive Level: Application REF: 30 OBJ: 3TOP: Jungs Developmental Theory KEY: Nursing Process Step: EvaluationMSC: NCLEX: Health Promotion and Maintenance: Growth and Development

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11. The older adult female patient is positive that thefree radicallipofuscincan be counteractedby:a.avoiding animal fat.b.use of antioxidants.c.building up muscle mass.d.outdoor exercise.ANS: BIndividuals who follow this theory believe that free radicals can be reduced by antioxidants suchas vitamins A, C, E, zinc, and phytochemicals.DIF: Cognitive Level: Comprehension REF: 29 OBJ: 2TOP: Antioxidants KEY: Nursing Process Step: PlanningMSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease12. A recently widowed woman moved to an assisted living community because of herhypertension and joined a group to learn how to do water color painting with other women herage. The nurse assesses that the patient is following the aging theory of:a.Jung.b.Havighurst.c.Erikson.d.Newmon.ANS: BHavighurst proposes that the process of aging is defined by adjusting to the loss of a spouse,establishing a relationship with ones own age group, and establishing a satisfactory livingarrangement.DIF: Cognitive Level: Application REF: 30 OBJ: 3TOP: Havighurst KEY: Nursing Process Step: Assessment

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MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of DiseaseMULTIPLE RESPONSE1. The nurses list of age-related illnesses thought to cause the accumulation of free radicalsincludes __________.(Select all that apply.)a.arthritisb.colon cancerc.osteoporosisd.diabetese.atherosclerosisANS: A, D, ECancer andosteoporosis are not considered to be diseases that accumulate free radicals.DIF: Cognitive Level: Application REF: 29 OBJ: 2TOP: Free Radical Influence KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease2. The nurse emphasizes that the relatively new theory that correlates restricted caloric intake toslowing of the aging process would probably extend the life span of the person, provided that theperson __________.(Select allthat apply.)a.consistently eats high-nutrient, low-calorie foodsb.maintains a regular exercise programc.consumes 2000 to 3000 mL of fluid a dayd.supports the diet with adequate fat-soluble vitaminse.eats only organically grown foodsANS: A,BThis new theory encourages high-nutrient, low-calorie foods combined with regular exercise todelay the aging process.

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DIF: Cognitive Level: Application REF: 30 OBJ: 2TOP: Calorie Restriction Theory KEY: Nursing Process Step: ImplementationMSC: NCLEX:Health Promotion and Maintenance: Prevention and Early Detection of Disease3. The nurse points out that the positive outcomes from a life review, according to Erikson,would include __________.(Select all that apply.)a.wisdom and integrated self-imageb.comparing self with othersc.understanding self and relationshipsd.seeking anothers opinion of his or her achievemente.acceptance of selfANS: A, C, EAcceptance of self and understanding self and relationships with accumulated wisdom is thegoalof Erikson. Seeking the opinion of others suggests that the older adult is experiencing doubt andgloom, which are negative outcomes according to Erikson.DIF: Cognitive Level: Application REF: 30 OBJ: 2TOP: EriksonsDevelopmental Theory KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Growth and Development4. When a patient asks what can be done to neutralize the free radicals in his system, the nurseresponds that antioxidanttherapy is thought to inhibit free radicals. Antioxidants include__________.(Select all that apply.)a.fruitsb.vegetablesc.organ meatd.folic acide.vitamin D

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ANS: A, B, DAntioxidants can be obtained largely from fruits and vegetables. Organmeat and vitamin D arenot antioxidants.Chapter3 DiversityMULTIPLE CHOICE1. A postmenopausal black woman who has been experiencing uterine bleeding tells the nurse, Iexpect Ill need a total hysterectomy because when my sister had this problem thatswhat she haddone. The nurse recognizes that this woman belongs to a cultural subgroup whose health carebeliefs are most influenced by the:a.biomedical model.b.magico-religious model.c.balance/harmony model.d.personal experience.ANS: AThepatient shows a tendency to identify with the biomedical model, which views the body as afunctioning machine. When a part gives out or is functioning abnormally, traditional Westernmedical treatment is sought and expected. The magico-religious models believe that health is areward from a higher power. The balance/harmony models state that illness is the result of a stateof imbalance in body energies. Personal experience influences all of these models.DIF: Understanding (Comprehension) REF: Page 91 OBJ:5-5TOP: Nursing Process: Assessment MSC: Psychosocial Integrity2. A Hispanic patient explains that the Hispanic culture believes that dietary management wouldbe just as effective in managing her problems as medication, so the patients prescription hasnotbeen filled. Which action by the nurse illustrates cultural accommodation?

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a.Asking the patient to give more details regarding this beliefb.Discussing how to add dietary preferencesinto the treatment planc.Offering to have a registerednutritionist discuss the situation with the patientd.Researching the patients proposed dietary beliefsANS: BCultural care accommodation or negotiation refers to those assistive, supportive, facilitative, orenabling creative professional actions anddecisions that help people of a designated cultureadapt to or negotiate with others for a beneficial or satisfying health outcome. The nurse can askthe patient to share more about beliefs, offer a consultation with a nutritionist, or research thebeliefs, but these actions do not show accommodation.DIF: Applying (Application) REF: N/A OBJ: 5-9TOP: Caring MSC: Psychosocial Integrity3. A geriatric nurse practitioner working with a tribe of Native Americans makes the decision toacculturate in an attemptto provide culturally appropriate care. The nurse does this best by:a.living the values of the tribe.b.researching the tribes belief systems.c.learning the language of the tribe.d.residing among the tribe members.ANS: AAcculturation is a process that occurs when a member of one cultural group adopts the values,beliefs, expectations, and behaviors of another group, usually in an attempt to becomerecognized as a member of the group. The other actions might be helpful in acculturating.DIF: Applying (Application) REF: N/A OBJ: 5-3TOP: Nursing process: Implementation MSC: Psychosocial Integrity

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4. The nurse in an assisted living facility is practicing a form of cultural bias calledethnocentrismwhen:a.requesting the bridge group only use thegame room for 2 hours at a time.b.encouraging Christian residents to attend mass or church services.c.repeatedly confiscating herbs and food products used in healing.d.telling potential patients who are Jewish that the facility does not have akosherkitchen,ANS: CEthnocentrism is a belief that ones own cultural group is superior to that of anothers. In nursingwe have a unique culture and expect our patients to adapt to us rather than attempting to adapt tothe culture of the patient. Confiscating items used in healing rituals shows ethnocentrism anddisrespect to the resident. Limiting activities in a group room, encouraging people to attendchurch services of their religion, and letting prospective Jewish residents know that the facilitydoes not have a kosher kitchen are not examples of ethnocentrism.DIF: Applying (Application) REF: N/A OBJ: 5-6TOP: Nursing Process: Implementation MSC: Psychosocial Integrity5. While caring for an older Korean patient, the nurse notes that the patient answers questionsregarding health history when asked but is otherwise silent and does not maintain eye contact.Being culturally sensitive, the nurse recognizes that the patients actions are most likely a(n):a.sign of respect for the wisdom and expertiseof the nurse.b.indication that he has no questions regarding the care he is receiving.c.expression of discomfort discussing personal matters.d.means of communicating his dissatisfaction with his care.ANS: AAsian cultures generally view eye contact as rude and are often passive in their care. The patientmay or may not have further questions. It is not a sign of discomfort or dissatisfaction.

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DIF: Remembering (Knowledge) REF: Page 93 OBJ: 5-7TOP: Caring MSC: Psychosocial Integrity6. The culturally sensitive nurse will recognize that an older adult patient with a high-contextethnic background will appreciate:a.not having a treatment scheduled during a favorite television program.b.both a written and verbal explanation describing how tomonitor her blood sugarlevels.c.a concise explanation as to why her physical therapy appointment has beencanceled.d.having a conversation about her grandchildren while her dressing is changed.ANS: DThe interactional patterns of high-context (universalism) patients refer to the characteristics ofrelationships and behaviors toward others. When a person from a high-context culture interactswith the nurse, a more personal relationship is expected. This is not related to television shows,teaching materials, or appointment cancellations.DIF: Understanding (Comprehension) REF: Page 92 OBJ: 5-7TOP: Caring MSC: Psychosocial Integrity7. In an attempt to be sensitive to varying cultural responses to touch, before shaking a patientshand, the nursewill:a.offer the patient his or her upturned palm.b.wait until the patient extends his or her hand.c.establish eye contact with the patient first.d.address the patient by his or her full name.ANS: B

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The best way to show respect and implementthe appropriate response is to follow the lead of thepatient by waiting for the patient to extend a hand.DIF: Applying (Application) REF: N/A OBJ: 5-7TOP: Caring MSC: Psychosocial Integrity8. A older Asian patient receiving physical therapy after hip surgery has developed a low-gradefever. The patient explains that the fever will lessen if the treatment includes the principles ofyin/yang. The nurse expects to support the patient by:a.providing privacy when his shaman visits.b.arranging for his diet to include cold foods and liquids.c.planning his physical therapy so it does not conflict with meditation.d.keeping a magical amulet under his pillow.ANS: BThe yin/yang theory proposes that health is a result of balance within the body. Aprinciple ofthis theory is that an illness is either hot or cold and must be treated by elements of the oppositestate in order to put the system back into balance. It is not related to shaman visits, meditation, oramulets.DIF: Applying (Application) REF: N/A OBJ: 5-9TOP: Caring MSC: Psychosocial Integrity9. The nurse in an assisted living facility is preparing to admit an older adult patient who speaksvery little English. The nurse decides that it is most important that an interpreter be present whenthe patient:a.indicates a desire to talk with the physician.b.is being oriented to the facility.c.is required to sign official documents.d.begins crying and is inconsolable.

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ANS: CThe more complex the decision making, the more important it isto have an interpreter present.Although all situations would benefit from an interpreter, the most important time is when thepatient is signing official documents that have legal implications.DIF: Applying (Application) REF: N/A OBJ: 5-8TOP: Communication and Documentation MSC: Psychosocial Integrity10. When attempting to provide culturally sensitive care according to the explanatory model, thenurse asks the patient:a.Who will be able to help you when you go home?b.Do you think the treatment ishelping?c.When did you first notice the problem?d.Has this illness changed your life?ANS: DThe gerontologic nurse uses this model to explore the meaning of the health problem from thepatients perspective.DIF: Applying (Application) REF: N/A OBJ:5-7TOP: Caring MSC: Psychosocial Integrity11. The nurse is caring for an older adult patient in need of hospitalization. The nurse is awarethis patient is a member of an ethnic group that holds a collectivist perspective on community.The nurse best addresses the patients medical needs by:a.calling an interpreter to assure the patient is making an informed decision.b.assuring the patient that his spiritual advisor will meet him at the hospital.c.arranging for admission to a hospital that is familiar with this patients culture.

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d.offering to phone the patients family and ask them to come in and discuss thehospitalization.ANS: DPeople with a collectivist perspective derive their identity from affiliation with and participationin a socialgroup such as a family or clan. The needs of the group are more important than thoseof the individual, and decisions are made with consideration of the effect on the whole. Healthcare decisions may be made by a group (such as the tribal elders) or a group leader (such as theoldest son). The other options may or may not be needed depending on the specifics of thepatients case.DIF: Applying (Application) REF: N/A OBJ: 5-9TOP: Caring MSC: Psychosocial Integrity12. The nurse is most effectively using theconcept of future time orientation when:a.promising to help the patient call his daughter each weekend.b.offering to complete the health assessment history after the patient eats dinner.c.encouraging an older patient to keep a follow-up clinicappointment.d.arranging for a colorectal cancer screen for senior citizens.ANS: DIn the concept of future orientation, people accept the idea that what is done now affects futurehealth. This means that health screenings will help detect a problem today for potentially betterhealth at a later time, days, weeks, or years ahead; it means that prevention may be worthpursuing. The other actions do not show a future orientation.DIF: Applying (Application) REF: N/A OBJ: 5-9TOP: Caring MSC: PsychosocialIntegrity13. The student learns that which of the following is the best definition of culture?

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