Test Bank for Nursing for Wellness in Older Adults, 9th Edition (Chapters 1-29)

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Nursing for Wellness in Older Adults Miller9th Edition Test BankChapter 1 Seeing Older Adults Through the Eyes of Wellness1.In 2010, the revisedStandards and Scope of Gerontological Nursing Practicewas published.The nurse would use these standards to:a.promote the practice of gerontologic nursing within the acute care setting.b.define the concepts and dimensions of gerontologic nursing practice.c.elevate the practice of gerontologic nursing.d.incorporate suggested interventions from others who practice gerontologicnursing.ANS: DThe current publishing of the Standardsand Scope of Gerontological Nursing Practicein 2010incorporates the input of gerontologic nurses from across the United States. It was not intendedto promote gerontologic nursing practice within acute care settings, define concepts ordimensions of gerontologic nursing practice, or elevate the practice of gerontologic nursing.DIF: Remembering (Knowledge) REF:MCS:2 OBJ: 1-1TOP: N/A MSC: Safe and Effective Care Environment2. When attempting to minimize the effect of ageism on the practice of nursing older adults, anurse needs to first:a.recognize that nurses must act as advocates for aging patients.b.accept that this population represents a substantial portion of those requiringnursing care.c.self-reflect and formulate ones personal view of aging and the older patient.d.recognize ageism as a form of bigotry shared by many Americans.ANS: C

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Ageism is an ever-increasing prejudicial view of the effects of the aging process and of the olderpopulation as a whole. With nurses being members of a society holding such views, it is criticalthat the individual nurse self-reflect on personal feelings and determine whether such feelingswill affect the nursing care that he or she provides to the aging patient. Acting as an advocate isan important nursing role in all settings. Simply accepting a fact does not help end ageism, nordoes recognizing ageism as a form of bigotry.DIF: Applying (Application) REF: N/A OBJ: 1-9TOP: Teaching-Learning MSC: Safe and Effective Care Environment3. When discussing factors that have helped to increase the number of healthy, independent olderAmericans, the nurse includes the importance of:a.increased availability of in-home care services.b.government support of retired citizens.c.effective antibiotic therapies.d.the development of life-extending therapies.ANS: CThe health and ultimate autonomy of older Americans has been positively impacted by thedevelopment of antibiotics, better sanitation, and vaccines. These public health measures havebeen more instrumental in increasing the numbers of healthy, independent older Americans thanhave in-home care services, government programs, or life-extending therapies.DIF: Remembering (Knowledge) REF:MCS:2 OBJ: 3-3TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance4.Based on current data, when presenting an older adults discharge teaching plan, the nurseincludes the patients:a.nonrelated caretaker.b.paid caregiver.

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c.family member.d.intuitional representative.ANS: CLess than 4% of older adults live in a formal health care environment. The majority of thegeriatric population lives athome or with family members.DIF: Applying (Application) REF: N/A OBJ: 3-3TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment5. The nurse planning care for an older adult who has recently been diagnosed with rheumatoidarthritis viewsthe priority criterion for continued independence to be the patients:a.age.b.financial status.c.gender.d.functional status.ANS: DMaintaining the functional status of older adults may avert the onset of physical frailty andcognitive impairment, two conditions that increase the likelihood of institutionalization.DIF: Remembering (Knowledge) REF:MCS:8 OBJ: 1-6TOP: Nursing Process: Planning MSC: Physiologic Integrity6.A nurse working with the older adult population is most likely to assess a need for a financialsocial services referral for a(n):a.white male.b.black female.c.Hispanic male.

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d.Asian American female.ANS: BThe poverty rate among older black women is substantially higher than that seen among males orfemalesof other ethnic groups. White males had the least poverty.DIF: Applying (Application) REF: N/A OBJ: 1-4TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment7. Which of the following statements made by a nurse preparing to complete ahealth assessmentand history on an older patient reflects an understanding of the general health status of thispopulation?a.Ill need to document well regarding the medications the patient is currentlyprescribed.b.I would like to understand how supportive the patients family members are.c.Most older patients are being treated for a variety of chronic health care issues.d.It will be interesting to see whether this patient sees herself as being healthy.ANS: DIt is a misconception that old ageis synonymous with disease and illness. The nurse shouldalways determine the patients sense of wellness and independence when conducting a health andhistory assessment. An assessment of medication use and family support is important for anypatient. Many older adults do have chronic health conditions, but their perception is moreimportant than a single number.DIF: Applying (Application) REF: N/A OBJ: 1-4TOP: Nursing Process: Assessment MSC: Health Promotion8. The nurse is caring for an older adult who has been admitted to an acute care hospital fortreatment of a fractured femur. The family expresses concern about the patients pending transferto a subacute care facility. What response by the nurse is best?

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a.Acute care facilities lack the long-termphysical therapy support your dadrequires.b.Your dad will be much happier in a more serene, private environment.c.The subacute facility will focus on helping your dad maintain his independence.d.Insurance, including Medicare, will cover only alimited amount of time here.ANS: CThe transfer of the patient to a subacute facility is based on the need to maintain the patientslevel of function and independence, a task the acute care facility is not prepared to address oncethe patient is physiologically stable. The patient may or may not be happier in the new setting;the nurse should not make this judgment. It is true that insurance only pays for a limited amountof time in an acute care facility, but this is not the best reason for the patient to transfer.DIF: Applying (Application) REF: N/A OBJ: 1-6TOP: Communication and DocumentationMSC: Health Promotion and Maintenance9. To best assure both the quality of care and the safety of the older adult patient who requires in-home unlicensed assistive personal (UAP) assistance, the geriatric nurse:a.evaluates the competency of the UAP staff.b.assumes the roles of case manager and patient advocate.c.arranges for the needed UAP provided services.d.assesses the patient for functional limitations.ANS: AAs more care traditionally provided by professional nurses is being transferred to UAP, the nursemust assume more responsibility for educating, training, and evaluating the competency of UAPstaff to provide safe, effective care for theolder adult patient.DIF: Applying (Application) REF: N/A OBJ: 1-2

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TOP: Communication and DocumentationMSC: Safe and Effective Care Environment10. The nurse working with older adults understands what information about certification ingerontologic nursing?a.It is mandatory for those in long-term care settings.b.It is voluntary and shows clinical expertise in an area.c.It allows nurses to be paid by third-party payers.d.It allows nurses to advance their careers in a job.ANS: BCertification is voluntary and shows that a nurse has additional knowledge and expertise in acertain area of practice. It is not mandatory in specific care settings. It does not allow for third-party reimbursement. It may be part of a career ladder program, but that is not true of all worksettings.DIF: Remembering (Knowledge) REF:MCS:2 OBJ: 1-2TOP: Teaching-Learning MSC: Safe Effective Care Environment11.A nurse works in a gerontologic clinic. What action by the nurse takes highest priority?a.Serving as a patient advocateb.Educating patients about diseasesc.Helping patients remain independentd.Referring patients to home health careANS: COne of the challenges and priorities of the gerontologic nurse is helping patients maintain theirindependence.

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DIF: Remembering (Knowledge) REF:MCS:10 OBJ: 1-2TOP: Nursing Process: Implementation MSC: Health Promotion12. A nurse is caring for an older patient in the emergency department. What information aboutthe patient will be most helpful in creating a plan of care?a.Baseline physical and cognitive functioningb.Living conditions and family supportc.Medications and current medical problemsd.Results of the Mini Mental State examinationANS: AThe nurse is encouraged to view older patients as individuals and consider their baseline physicaland cognitive functional status as a standard by which to compare the patients current status. Theother information is also important, but the basis of individualized care begins with the patientsstrengths and weaknesses.DIF: Applying (Application) REF: N/A OBJ: 1-6TOP: Nursing Process: Assessment MSC: Health Promotion13. The faculty member explains to students that many older Americans continue to work pastthe retirement age. What best explains this trend?a.Feeling healthier longerb.Changing financial outlookc.Becoming bored in retirementd.A desire to give backANS: B

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As financial situations may have declined as a result of many economic factors, more olderadults work past their retirement age. The other options may be reasons for some to continueworking, but financial necessity is the reason the majority continue to do so.DIF: Remembering (Knowledge) REF:MCS:7 OBJ: 1-3TOP: Teaching-Learning MSC: Health Promotion14.What information does the faculty member teach students about Medicare?a.Covers anyone with end stage renal diseaseb.Part A covers some prescription costsc.Part B covers inpatient hospital costsd.Part D eliminates the drug donut holeANS: AAlthough Medicare is primarily for those over the age of 65, it does cover people of any age withend-stage kidney disease. Part A covers hospital costs. Part B is medical insurance. The donuthole was fixed by the Affordable Care Act.DIF: Understanding (Comprehension) REF:MCS:9 OBJ: 1-3TOP: Teaching-Learning MSC: Health Promotion15.A nursing manager notes that many older patients are admitted to the nursing unit for acuteproblems. What action can the manager take to most benefit this population?a.Provide mandatory education on the needs of the older patient.b.Provide restorative therapy programs designed for this group.c.Ensure staffing numbers are adequate for dependent patients.d.Encourage all nurses to obtain gerontologic certification.ANS: B

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Many older adultsneed acute care for sudden illness and injury but live in a state of functionaldecline, which could possibly be prevented by establishing a restorative therapy program. Theother actions will help the older patients cared for in the unit, but only to limited degrees.DIF: Applying (Application) REF: N/A OBJ: 1-4TOP: Nursing Process: Implementation MSC: Physiologic Integrity: Reduction of Risk Potential16. The dean of a new nursing program wishes to ensure graduates are prepared to care for olderpatients. What document should guide the dean in designing the curriculum?a.The Nurse Practice Act for that stateb.The American Nurses Association (ANA) code of ethics for nursesc.Healthy People 2020d.TheRecommended Baccalaureate Competencies and Curricular GuidelinesANS: DTheRecommended Baccalaureate Competencies and Curricular Guidelines for the NursingCare of Older Adultsis an updated version ofTheEssentials of Baccalaureate Education forProfessional Nursing Practice.This document was first published by the American Associationof Colleges of Nursing (AACN) in 2008 and was updated in 2010. The other three documents donot have information about curricular requirements to prepare students to care for the olderpopulation.DIF: Applying (Application) REF: N/A OBJ: 1-2TOP: Teaching-Learning MSC: Health Promotion17. A nurse wants to plan a community event at a retirement center. What topic would mostlikely be best received?a.Heart healthy livingb.Financial planningc.Avoiding scams

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d.Ethnic cooking classesANS: AOlder adults are demanding more programs and services aimed at health maintenance andpromotion and disease and disability prevention. Based on this information, the hearthealthyliving presentation would be best received.DIF: Applying (Application) REF: N/A OBJ: 1-3TOP: Teaching-Learning MSC: Health Promotion18. What does the bedside nurse understand about his or her role in nursing research?a.Research is only done bydoctorally prepared nurses.b.All nurses have a role in delivering research-based care.c.A bedside nurse can be part of a hospital research team.d.The bedside nurse can collect data if the nurse has been properly trained.ANS: BAll nurses are charged to deliver patient-centered care based on evidence-based practice,research, quality improvement, and informatics. The bedside nurse is part of an interdisciplinaryteam that is responsible for redesigning the health care structure of the future.DIF: Understanding (Comprehension) REF:MCS:13 TOP: Teaching-LearningMSC: Safe Effective Care Environment: Management of CareMULTIPLE RESPONSE1.The clinic nurse caring for an older diabetic patient with a sixth grade education anticipatesthat the patient may experience difficulty(Select all that apply.)a.recognizing the importance of keeping clinic appointments.b.following a low-carbohydrate diet.

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c.paying for insulin and syringes.d.deciding on a primary health care provider.e.naming ahealth care surrogate.ANS: A, B, CEven though the educational level of the older population has steadily increased, as a populationthey are less educated than the general population. This deficiency can account for a lack ofunderstanding regarding theneed for medical care and the importance of following a treatmentplan. These patients may also have fewer financial resources to devote to health care issues.DIF: Analyzing (Analysis) REF: N/A OBJ: 1-4TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment2. The nurse studying the history of gerontologic nursing learns which information about thespecialty?(Select all that apply.)a.The number of older Americans is diminishing.b.The geriatric nursing conference group was established in 1962.c.The gerontologic clinical nurse specialist certification was offered in 1989.d.There were no writings about the care of older persons until World War II.e.The firstStandards of Practice for Geriatric Nursingwas written in 1969.ANS: B, C, EThe geriatric nursing conference group was established in 1962, the gerontologic clinical nursespecialist certification was first offered in 1989, and the firstStandards of Practice for GeriatricNursingwas written in 1969. The population of older Americans is the fastest-growing subset ofthe population. Writings about care of the aged can be found from as early as 1900.DIF: Remembering (Knowledge) REF:MCS:2-3 OBJ: 1-2TOP: Teaching-Learning MSC: Nursing Process: Assessment

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3. The student asks the gerontologic clinic nurse why so many older people are women. Whatinformation does the nurse provide?(Select all that apply.)a.Reduced maternal mortalityb.Decreased deaths from infectious diseasesc.More deaths from chronic disease in mend.More deaths in war occur in mene.Women tend to smoke and drink less than menANS: A, C, DA decrease in maternal mortality, decreased deaths from infectious diseases, and more chronicillness in men account for the disparity in genders as people age.DIF: Understanding (Comprehension) REF:MCS:6 OBJ: 1-5TOP: Teaching-Learning MSC: Health Promotion4.The gerontologic nurse plans community programming for older women, noting what factsabout this population subgroup?(Select all that apply.)a.More likely to live aloneb.Increased chance of living in povertyc.Taking care of a spoused.Suffering many chronic diseasese.Living with extended familiesANS: A, B, DOlder women have a greater chance than men of living alone and in poverty. They also have agreater degree of functional impairment and chronic disease.DIF: Remembering (Knowledge) REF:MCS:6 OBJ: 1-5TOP: Nursing Process: Analysis MSC: Health Promotion

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5. The nurse knows that the most common causes of death in the older population result fromwhich diseases?(Select all that apply.)a.Cerebrovascular diseaseb.End-stage kidney diseasec.Heart diseased.Cancere.DiabetesANS: A, C, DThe most common causes of death in the older population are cerebrovascular disease,heartconditions, and cancer. End-stage renal disease and diabetes are not among the top three causesof death.Chapter 2 Addressing Diversity of Older AdultsMULTIPLE CHOICE1. A postmenopausal black woman who has been experiencing uterine bleeding tellsthe nurse, Iexpect Ill need a total hysterectomy because when my sister had this problem thats what 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: AThe patient 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 Western

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medical 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:MCS: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 has notbeen filled. Which action by the nurse illustrates cultural accommodation?a.Asking the patient to give more details regarding this beliefb.Discussing how to add dietary preferencesinto the treatment planc.Offering to have a registered nutritionist 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 and decisions 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 attempt to 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.

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d.residing among the tribe members.ANS: AAcculturation is aprocess 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 Integrity4. The nurse in an assisted living facility is practicing a form of cultural bias calledethnocentrismwhen:a.requesting the bridge group only usethe game 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 Integrity

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5. 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.DIF: Remembering (Knowledge) REF:MCS: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 to monitor 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.

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DIF: Understanding (Comprehension) REF:MCS: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 nurse will: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: BThe best way to show respect and implement the 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. A principle ofthis theory is that an illness is either hot or cold and must be treated by elements of the opposite

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state 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 whenthepatient: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.ANS: CThe more complex the decision making, the more important it is tohave 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: Communicationand 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: D

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The 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 isfamiliar with this patients culture.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 the concept 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.

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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?a.A group of similarly appearing individualsb.Shared beliefs, behaviors, and expectations of groupsc.Group beliefs about what is right and wrongd.Groups that come from the same part of the worldANS: BA culture is a set of shared and learned beliefs, behaviors, and expectations among a group ofpeople. The individuals in different cultures may or may not look similar. Group beliefs aboutwhat is right or wrong are known as values. Cultural members may come from many differentparts of the world.DIF: Remembering (Knowledge) REF:MCS:87 OBJ: 5-3TOP: Teaching-Learning MSC: Psychosocial Integrity14.A student nurse expresses frustration to the faculty member regarding an ethnic older adultwho appears to be noncompliant. The student states, Why cant the patient just do what we teachher to do? What response by the nurse is best?a.Yes, I realize how frustrating this must be for you.

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b.People fromher culture are never compliant.c.Maybe you can find a different way to get through.d.Culture dictates how people respond to others.ANS: DCulture is a blueprint for responding to individuals, family, and the community. Persons fromstrongcultural backgrounds cannot just change their behavior when instructed to do so. Thenurse explains this to the student. Stating that the nurse understands the frustration is helpful butdoes not give the student any information that could help him or herwork with this patient.Stating that people from a certain culture are never compliant is biased and prejudicial. Gettingthrough to the patient implies ethnocentrism and bias.DIF: Applying (Application) REF: N/A OBJ: 5-7TOP: Caring MSC: Psychosocial Integrity15. A patient from a culture that differs from that of the nurse is hospitalized and near death.What action by the nurse best demonstrates cultural care preservation?a.Allowing the family to remain at the bedsideb.Pinning a healing amulet to the patients gownc.Offering the family food and drink in the roomd.Giving the family time to be alone with the patientANS: BCultural care preservation refers to those assistive, supportive, facilitative, or enablingprofessional actions anddecisions that help people of a particular culture to retain and maintaintheir well-being, to recover from illness, or to face handicaps or death. Allowing the patient tohave healing artifacts important in his or her culture nearby best demonstrates thisconcept. Theother actions are caring but do not demonstrate this principle.DIF: Applying (Application) REF: N/A OBJ: 5-9

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TOP: Caring MSC: Psychosocial Integrity16. The nurse uses the LEARN model when providing care. What event best demonstrates thatthis model has been successful?a.The nurse learns about the patients culture and how it impacts care.b.The patient and nurse agree on a mutually acceptable plan of action.c.The nurse listens carefully to the patients concerns and beliefs.d.The patient understands how medical care will be beneficial.ANS: BThe LEARN model includes listening to the patient, explaining your own perspectives,acknowledging the similarities and differences in both viewpoints, recommending a plan ofaction, and negotiating a final plan. If the patient and nurse have come to an agreement on a planof action, this model has been successful.DIF: Evaluating (Evaluation) REF: N/A OBJ: 5-7TOP: Caring MSC: Psychosocial Integrity17. A new nurse is caring for a patient fromAppalachia. The patient seems guarded andsecretive, which frustrates the new nurse. What advice from the mentor is most appropriate?a.Maybe you should ask to change your assignment.b.This is a normal behavior for this patients cultural group.c.Youcould try to apologize for anything you may have done.d.Ask the patient why she is acting so strangely around you.ANS: BPatients from the Appalachian culture are typically wary and guarded around strangers and viewthe hospital as a place to go anddie. The nurse explains this to the new nurse. Changingassignments will not help the new nurse become culturally competent. The new nurse could ask

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the patient if there has been some offense, but this is probably not the case. Why questions putpeople on the defensive and are not considered examples of therapeutic communication.DIF: Understanding (Comprehension) REF:MCS:87 OBJ: 5-6TOP: Caring MSC: Psychosocial Integrity18.A nurse is caring for an Arab American patient in the hospital. The patient has many visitorswho seem to be tiring the patient. What action by the nurse is best?a.Limit the number of visitors the patient can have.b.Only allow family members to visit the patient.c.Suggest shorter visits to the patients visitors.d.Require visitors to check in at the front desk.ANS: CIn Arab American Muslim culture, visiting the sick is a cultural value and expectation. Althoughthe visits may be tiring, they may also be important to the patient. The nurse can suggest shortervisits so the patient can have both the visitors and more rest. Limiting the number of visitorswould violate this cultural norm as would limiting visits to family only. Checking in at the frontdesk serves no useful purpose.DIF: Applying (Application) REF: N/A OBJ: 5-6TOP: Caring MSC: Psychosocial Integrity19. A director of nursing works in a hospital that serves many Jehovahs Witness patients. Whataction by the nurse would best facilitate culturally appropriate health care?a.Establish a bloodless surgery program.b.Create an immunization clinic for children.c.Employ spiritual leaders from this faith.d.Allow faith healing ceremonies.

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ANS: AJehovahs Witnesses generally are opposed to receiving all blood products. A bloodless surgeryprogram would be a culturally competent way to improve the health care of this population.DIF: Applying (Application) REF: N/A OBJ: 5-5TOP: Caring MSC: Psychosocial Integrity20. An incapacitated older adult with dementia is brought to the emergency department by arescue squad after falling and breaking an arm. When the patients children arrive, they areadamantly against the patient having any medical care and insist that prayer will heal the brokenarm. What action by the nurse is most appropriate?a.Allow the family to pray with the patient then escort them to the waiting room.b.Call security to keep the family from interfering with medical care.c.Check facility policies and contact the hospital social worker.d.Call the police who can force the family toaccept medical care.ANS: CThis family may be Christian Scientists, who do not believe in medical care. Health crises arethought to be errors of the mind that can be altered by prayer. The nurse should check the facilitypolicies for treating vulnerableadults and possibly notify social work, who can assist withensuring adequate treatment occurs as allowed by policy. Allowing the family to pray with thepatient is a caring action, but this complex situation requires more intervention. Calling securityor the police will antagonize the family even more and demonstrates an adversarial relationship.DIF: Applying (Application) REF: N/A OBJ: 5-6TOP: Communication and DocumentationMSC: Safe Effective Care EnvironmentMULTIPLE RESPONSE

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1. When attempting toreflect about personal cultural awareness, the nurse asks himself or herselfwhich of the following quetions?(Select all that apply.)a.What image do I want to project to members of other cultures?b.What makes a culture worthy of biased treatment?c.Have my life experiences contributed to any biases regarding other cultures?d.Am I uncomfortable when interacting with members of other cultures?e.Does the patients culture rely on solid science to direct health care?ANS: A, C, DSelf-reflection implies thinking that regards how I, the individual, perceives/believes/behaves.Awareness of ones thoughts and feelings about others who are culturally different from oneself isnecessary to become culturally aware. No culture is worthy of biased treatment. Solid science isan ethnocentric principle.DIF: Applying (Application) REF: N/A OBJ: 5-4TOP: Caring MSC: Psychosocial Integrity2. What does the nurse working with older adults from many different cultures know about thedemographics of culture in theUnited States?(Select all that apply.)a.Hispanics will become the largest minority group by 2030.b.Many persons of color are not counted in the census.c.The percentage of Native Americans/Native Alaskans will decrease.d.The number of refugeesand immigrants is expected to decrease.e.Some Native Americans want to identify as specific tribal members.ANS: A, B, CHispanics are expected to be the largest minority group in the United States by 2030. Manypersons of color are not represented in the census, and this underestimates their presence. Thepercentage of Native Alaskans and Native Americans will rise, as willthe number of

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immigrants/refugees. Some Native Americans may not view themselves as part of this largergroup, preferring to identify as a member of a specific tribe.DIF: Remembering (Knowledge) REF:MCS:83 OBJ: 5-1TOP: Communication and Documentation MSC: Psychosocial Integrity3.A nurse working in the emergency department is seeing an older patient who does not speakEnglish well. The nurse calls for an interpreter. The student wants to know why the patientsminor child, who speaks English, cannot interpret. What response by the nurse is best?(Select allthat apply.)a.The child may not accurately translate.b.The child and older adult may be embarrassed.c.The patient has the right to interpretation.d.Having a child interpret takes too much time.e.Privacy laws prohibit this practice.ANS: A, B, CAlthough in a true emergency the nurse may have to use a child interpreter, this practice is notrecommended. The child may not have the vocabulary to translate, the child may edit thecomments, the child or older adult may be embarrassed by the medical condition, and patientshave a legal right to professional interpretation. Using an interpreter always takes more time andprivacy laws do not prohibit this practice.Chapter 3 Applying a Nursing Model for Promoting Wellness in Older AdultsMULTIPLE CHOICE1. When the home health nurse assists the older adult patient with rearranging furniture withinthe home to prevent the patient from falling, the nurse is demonstrating:a.health promotion.

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b.health protection.c.health prevention.d.disease prevention.ANS: BThe overarching goals are to attain high-quality, long lives free of preventable disease, disability,and injury; to eliminate disparities; create social and physical environments that promote health;and optimize quality of life across the life span. Health protection targets five areas includingunintentional injury. Rearranging furniture to prevent falls is a health protection activity.DIF: Applying (Application) REF: N/A OBJ: 8-1TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment2. The primary focus of the health belief model of health promotion is addressed when the nurse:a.accompanies the assisted living residents on a walk before dinner.b.asks asenior citizens group what health screening they want to have.c.plans a program on cooking diabetic-friendly meals in cooperation with adietician.d.asks the patient if he believes smoking puts him at risk for lung cancer.ANS: DThe health belief model, which was developed to determine the likelihood of an individualsparticipation in health promotion, health protection, and disease prevention services, includesassessing an individuals perception of his or her susceptibility to developing an illness. Askingthe patient about beliefs related to tobacco use and health is an activity that falls within thismodel. The other activities do not.DIF: Understanding (Comprehension) REF:MCS:141 OBJ: 8-2TOP: Nursing Process: Assessment MSC: Health Promotion

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3. Financial considerations are a major barrier to the older adults participation in healthpromotion because:a.most older adults have accepted poor health as a part of growing older.b.Medicare often does not cover the cost of preventive services.c.many already have been diagnosed with chronic illnesses.d.they generally place more value on saving their disposable income.ANS: BOlder adults must incur the cost of many preventive services because Medicare does not coverthem all. This can be hard on the fixed, limited income of many older adults. It is not true thatolder adults accept poor health as inevitable. Health promotion activities can occur in thepresence of chronic illnesses. Some older adults do place high value on saving money, but not allolder adults are influenced by this desire.DIF: Understanding (Comprehension) REF:MCS:148 OBJ: 8-4TOP: Nursing Process: Assessment MSC: Health Promotion4.To engage the older adults who frequently attend a senior citizens center in primary diseaseprevention, the nurse:a.immunizes those attending a weekly luncheon against the H1N1 virus.b.arranges for a colorectal cancer screening at the center.c.schedules a speaker to discuss cooking for diabetic patients.d.surveys the members to identify health issues of interest to them.ANS: APrimarypreventionrefers to specific action taken to optimize the health of the older individualby helping him or her to become more resistant to disease or to ensure that the environment willbe less harmful. Providing immunizations would be included in this level of prevention.

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Colorectal cancer screening is secondary prevention. Cooking for diabetic patients is tertiaryprevention. Surveying patients does not fall into any level of prevention.DIF: Applying (Application) REF: N/A OBJ: 8-5TOP: Nursing Process: Implementation MSC: Health Promotion5. The nurse has the greatest impact on a patients health promotion when:a.evaluating a diabetic patients ability to administer his insulin injections.b.encouraging an obese patient to limit both fat and carbohydrate intake.c.volunteering to take blood pressures at a community health fair.d.educating the patient about vitamin D and calcium to prevent bone loss.ANS: DHealth promotion includesinterventions that help prevent disease and disability in a patient.Education regarding health promotion issues has the greatest impact on the health of a patient.The other patients already have established diseases.DIF: Applying (Application) REF: N/AOBJ: 8-1TOP: Teaching-Learning MSC: Health Promotion6. A nurse is assessing a patients ability to manage existing health problems. What question bythe nurse is most helpful?a.Can you tell me why its important to test your blood glucose level at leastdaily?b.What were the results of your most recent A1Cblood test?c.Which pharmacy do you use when your prescription needs to be refilled?d.Have you been experiencing pain in your feet?ANS: B

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The results of a laboratory test used to monitorglucose control will show how well the patienthas been managing the various aspects of his or her treatment plan. This information is collectedin the health perception/health management functional health pattern. The other questions do notdemonstrate the patients knowledge level.DIF: Applying (Application) REF: N/A OBJ: 8-5TOP: Nursing Process: Assessment MSC: Health Promotion7. During a home visit, a nurse is assessing the nutritional awareness of an older adult patientwho lives alone. The nurse ismost effective in obtaining objective information when:a.asking to see what types of foods the patient keeps readily available.b.reviewing the components of a healthy diet with the patient.c.asking the patient to describe what he or she ate for allthree meals yesterday.d.observing the patient eat a meal that he or she has prepared.ANS: DObjective information is best obtained when observing general appearance and various bodysystem indicators of nutritional status. Note height, weight, andfit of clothes. If possible, observethe older adult eating a meal. Food available in the home does not indicate the patientsknowledge, as someone else may have bought the food. Asking the patient for information isrequesting subjective data. Reviewing ahealthy diet does not allow the patient to demonstrateknowledge.DIF: Applying (Application) REF: N/A OBJ: 8-5TOP: Nursing Process: Assessment MSC: Physiologic Integrity8. The nurse is discussing an older adults past marital history during the admission assessment.The nurse can best determine that the patient has a healthy ability to cope with emotionalstressors when the patient states:

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