Gerontological Nursing The Essential Guide to Clinical Practice,  2nd Edition by Patricia A. – Test Bank

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Gerontological Nursing The Essential Guide to Clinical Practice,  2nd Edition by Patricia A. – Test Bank

 

Sample  Questions

 

Origin:  Chapter 5- Common Aging Changes, 1

Chapter:  5

Client Needs:  D4

Cognitive Level:  Comprehension

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  1

Page and Header:  52, Physical Appearance

1. During an assessment of an 82-year-old woman, a gerontological nurse learns that the woman has lost over 4 inches in height over the last several years. Which of the following factors have likely contributed to this phenomenon? Select all that apply.
A) The woman’s overall proportion of body water has decreased.
B) The client has experienced a loss of cartilage.
C) The woman’s thyroid hormone levels have declined since the sixth decade.
D) The client’s vertebrae have thinned.
E) Loss of stature is a consequence of the woman’s diet.
F) The woman’s long bones have decreased in length.
Ans: A, B, D
Feedback:
Reduced hydration, loss of cartilage, and thinning of vertebrae can all contribute to loss of stature. Decreased levels of TH, shortening of long bones, and diet are not noted to contribute to this phenomenon.

 

 

Origin:  Chapter 5- Common Aging Changes, 2

Chapter:  5

Client Needs:  D4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  52, Respiratory System

2. A 78-year-old man has received a recent diagnosis of community-acquired pneumonia. Potential pathological findings on a recent chest x-ray have prompted his physician to order a bronchoscopy and lung function tests. Which of the following findings would be most likely suggestive of pathological processes rather than normal, age-related respiratory changes?
A) The client has fewer cilia than would be found in a younger client.
B) Lung function tests reveal that both maximum breathing and vital capacity are diminished since his last test.
C) There is an accumulation of serous fluid between the lungs and the pleural membrane.
D) The lungs are smaller than younger adults’ and there are fewer alveoli.
Ans: C
Feedback:
While decreases in the number of cilia, alveoli, lung size, and lung capacities are commonly associated with aging, an accumulation of serous fluid would not be considered a normal consequence of the aging process.

 

 

Origin:  Chapter 5- Common Aging Changes, 3

Chapter:  5

Client Needs:  D4

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/learning

Objective:  1

Page and Header:  54, Cardiovascular System

3. An 80-year-old resident of an assisted living facility is proud of the fact that he was an elite athlete during his younger years. Despite his concerted efforts to remain physically active and maintain his stamina, he is lamenting his loss of exercise tolerance in recent years. How can his nurse best respond to these concerns?
A) “It’s inevitable that your heart increases in size as you age, and this is associated with a loss of cardiac efficiency.”
B) “It’s normal for your heart to contract less strongly as you age, and this makes you somewhat less able to exercise vigorously.”
C) “As you age, it’s common for your heart rate becomes less regular and this often results in fatigue.”
D) “The normal increase in blood pressure that accompanies aging leaves you with less cardiac reserve capacity than when you were young.”
Ans: B
Feedback:
Cardiac contractility decreases as a part of normal aging. An increase in heart size, irregular heart rate, and increased blood pressure would be considered pathological conditions regardless of age.

 

 

Origin:  Chapter 5- Common Aging Changes, 4

Chapter:  5

Client Needs:  D4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  57, Urinary System

4. Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation?
A) An 81-year-old woman’s glomerular filtration rate (GFR) is low.
B) A 78-year-old male’s stomach pH is increased.
C) A 71-year-old male client’s echocardiogram reveals slight left ventricular hypertrophy.
D) A 78-year-old man has recently developed urinary incontinence.
Ans: D
Feedback:
While a decrease in GFR, increase in stomach pH, and slight left ventricular hypertrophy are considered normal accompaniments to aging, urinary incontinence should be considered a pathological finding that necessitates further assessment.

 

 

Origin:  Chapter 5- Common Aging Changes, 5

Chapter:  5

Client Needs:  D4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  57, Reproductive System

5. A 66-year-old man has undergone a digital-rectal exam (DRE) during a visit to his family physician. The exam reveals that the client’s prostate has become enlarged since his last DRE. The most accurate conclusion that his care provider will draw from these findings is that they suggest:
A) Prostate cancer
B) A risk of malignancy that should be followed up
C) A normal age-related change unlikely to have consequences
D) A urinary tract infection
Ans: B
Feedback:
Prostatic enlargement is exceedingly common among older men, but represents a risk of malignancy that necessitates further assessment and follow-up. It is not a definitive sign of prostate cancer and is not indicative of a urinary tract infection.

 

 

Origin:  Chapter 5- Common Aging Changes, 6

Chapter:  5

Client Needs:  D4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  58, Musculoskeletal System

6. A 74-year-old woman has presented to the emergency department with a suspected hip fracture following a fall on the sidewalk outside her home. The nurse’s assessment of the client would recognize which of the following factors as most likely contributed to the suspected injury?
A) Bone remodeling in long bones ceases in the seventh or eighth decade.
B) Bone minerals and mass are reduced as part of the aging process.
C) Bone marrow production of cellular components declines with age.
D) Thinning disks and shortened vertebrae are common assessment findings in older adults.
Ans: B
Feedback:
A decrease in bone minerals and mass is common later in life. Bone remodeling does not, however, cease. Neither thinning disks, shortened vertebrae, nor marrow production of blood cellular components is likely to directly contribute to the client’s suspected fracture.

 

 

Origin:  Chapter 5- Common Aging Changes, 7

Chapter:  5

Client Needs:  D4

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  1

Page and Header:  62, Endocrine System

7. A hospital client, aged 82 years, is presently undergoing an endocrine diagnostic workup in an effort to diagnose his increasing fatigue of unknown etiology. Which of the following findings would his care team recognize as potentially pathological?
A) Apparent decreased thyroid gland activity.
B) Decreased somatotropic growth hormone (GH) levels.
C) Delayed and insufficient release of insulin by the b-cells.
D) Decreased erythropoietin production by the kidneys.
Ans: D
Feedback:
While decreases in thyroid gland activity, GH, and insulin are often associated with aging, a decrease in erythropoietin production would be considered problematic and pathological.

 

 

Origin:  Chapter 5- Common Aging Changes, 8

Chapter:  5

Client Needs:  D4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Teaching/learning

Objective:  2

Page and Header:  64, Memory

8. A care aide at a long-term care facility has assured the family of a resident that their father’s increasing forgetfulness is a normal part of the aging process. How can the nurse best respond to the care aide’s statement to the family?
A) “It’s actually a myth that older people experience changes to their memory.”
B) “Memory losses are a normal age-related change many people experience.”
C) “Older adults have less working memory and slower retrieval, but this still requires further assessment.”
D) “There is no reason for healthy older adults to experience changes in their memory unless they are experiencing dementia.”
Ans: C
Feedback:
Older adults often experience delays in retrieval of memories and working memory. Some changes in memory, even in the absence of delirium or dementia, are to be expected but they should not be discounted and would require further assessment.

 

 

Origin:  Chapter 5- Common Aging Changes, 9

Chapter:  5

Client Needs:  B

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/learning

Objective:  3

Page and Header:  65, Learning

9. A nurse practitioner is teaching a 90-year-old client about her new medication regimen. Which of the following principles should the nurse integrate into the teaching session?
A) While numerous factors can interfere with learning, learning ability itself is not seriously altered with age.
B) Older adults require simplified learning objectives and slower introduction of new directions.
C) Simple association is well executed by older adults but complex analysis is normally absent.
D) Successful learning late in life requires a multisensory teaching approach.
Ans: A
Feedback:
Learning ability is not seriously changed with age. It is not likely necessary to simplify learning objectives, and analysis abilities may slightly diminish but are not normally absent. A multisensory teaching approach is not noted to be required.

 

 

Origin:  Chapter 5- Common Aging Changes, 10

Chapter:  5

Client Needs:  D4

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  62, Hearing

10. Which of the following phenomena most likely accounts for the progressive loss of hearing that an 83-year-old man is experiencing?
A) Multiple changes in the structures of the inner ear.
B) The effect of cognitive changes on the interpretation of auditory stimuli.
C) Cellular atrophy of the cells in the outer and middle ear.
D) Age-related deterioration of the neural pathways associated with hearing acuity.
Ans: A
Feedback:
Presbycusis is progressive hearing loss that occurs as a result of age-related changes to the inner ear, including loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, and reduced production of endolymph. Cognitive changes, cellular changes in the outer and middle ear, and deterioration of neural pathways are less likely to be implicated.

 

 

Origin:  Chapter 5- Common Aging Changes, 11

Chapter:  5

Client Needs:  D4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  52, Cells

11. It is important to measure and record fluid input and output accurately because this information is used in evaluating a patient’s fluid balance and in planning care and treatment. Dehydration is a significant risk for the elderly because:
A) The number of body cells is less, and fewer cells are functioning in the body.
B) Total body fat as a proportion of the body’s composition increases with age.
C) Cellular solids and bone mass decrease with age affecting the ability to balance.
D) Extracellular fluid remains constant, but intracellular fluid decreases with age.
Ans: D
Feedback:
Although all the statements are true, only the loss of intracellular fluid is a cause of increased risk of dehydration.

 

 

Origin:  Chapter 5- Common Aging Changes, 12

Chapter:  5

Client Needs:  D4

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing process

Objective:  1

Page and Header:  64, Thermoregulation

12. With aging the skin becomes thinner and more fragile. The thinning of the skin’s subcutaneous fat layer makes older adults more sensitive to:
A) Cold
B) Heat
C) Pain
D) Pressure
Ans: A
Feedback:
Subcutaneous fat serves as an insulator. With less of it, the elderly may be more sensitive to cold temperatures. Older adults are less sensitive to pain and pressure because of decreased sensitivity of nerve endings.

 

 

Origin:  Chapter 5- Common Aging Changes, 13

Chapter:  5

Client Needs:  D4

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing process

Objective:  1

Page and Header:  54, Cardiovascular System

13. Each of the blood vessel layers is affected differently by the aging process. Which would a nurse suspect is responsible for a patient’s fibrosis?
A) Tunica intima
B) Tunica media
C) Tunica adventitia
D) Fibrosis is caused by an enlarged heart
Ans: A
Feedback:
The tunica intima, the innermost layer, experiences the most direct changes, including fibrosis, calcium and lipid accumulation, and cellular proliferation. The middle layer, the tunica media, undergoes a thinning and calcification of elastin fibers and an increase in collagen, which causes a stiffening of the vessels. The outermost layer, the tunica adventitia, is not affected by the aging process. In the absence of heart disease, heart size changes little with age.

 

 

Origin:  Chapter 5- Common Aging Changes, 14

Chapter:  5

Client Needs:  D4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  54, Cardiovascular System

14. The heart muscle commonly weakens with age. What is a consequence of this fact?
A) The heart beats faster but pumps with less force.
B) Fatty deposits and other substances clog narrowed coronary vessels.
C) Blood pressure lowers because of systemic vasodilation.
D) The time required for the heart’s diastolic–systolic cycle decreases.
Ans: A
Feedback:
The statement in choice B is true, but age-weakened heart muscle is not the cause. Blood pressure may actually rise as an effect of choice B. The opposite of the statement in choice D is true.

 

 

Origin:  Chapter 5- Common Aging Changes, 15

Chapter:  5

Client Needs:  D4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  54, Cardiovascular System

15. Older adults in good physical condition have cardiac function comparable to younger persons in poor condition. What is the most likely cause of a rise in systolic blood pressure in the elderly?
A) Postural and postprandial hypotension
B) Atherosclerosis in the innermost layer of the blood vessels
C) Impaired baroreceptor function and increased peripheral resistance
D) Cellular proliferation in the tunica intima
Ans: C
Feedback:
In the middle layer of blood vessels, impaired baroreceptor function and increased peripheral resistance lead to a rise in systolic blood pressure. Reduced sensitivity of the blood pressure regulation with baroreceptors increases problems with postural hypotension and postprandial hypotension; thus, they are an effect, not a cause. Cells proliferate in the innermost layer of vessels and atherosclerosis develops, but these are not the direct causes of increased systolic pressure.

 

 

Origin:  Chapter 5- Common Aging Changes, 16

Chapter:  5

Client Needs:  D4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  55, Gastrointestinal System

16. As a person ages, muscle tone decreases throughout the digestive system, causing a slowing movement of food through the esophagus. Delayed esophageal emptying in the elderly increases the risk of:
A) Gastric irritation
B) Aspiration
C) Irritable bowel syndrome
D) Constipation
Ans: B
Feedback:
Normal aging does not interfere with mobility through the bowel or bowel action. Gastric irritation results from a higher pH of stomach fluids. Aspiration is a risk associated with a weakened gag reflex, relaxation of the lower esophageal sphincter, and delayed esophageal emptying.

 

 

Origin:  Chapter 5- Common Aging Changes, 17

Chapter:  5

Client Needs:  D4

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing process

Objective:  1

Page and Header:  57, Urinary System

17. Which of the following is the most common urinary problem among men aged 65 years and older?
A) High urinary volume
B) Glucose in the urine
C) Stress incontinence
D) Frequent urination
Ans: D
Feedback:
Although all these conditions may occur or coexist, most common is the need for frequent urination associated with enlargement of the prostate gland. This enlargement occurs to some degree in three-fourths of men aged 65 years and older.

 

 

Origin:  Chapter 5- Common Aging Changes, 18

Chapter:  5

Client Needs:  D4

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  58, Musculoskeletal System

18. Which of the following is a normal reflex profile for an elderly patient?
A) Knee: normal; arm: absent; abdomen: absent
B) Knee: normal; arm: reduced; abdomen: absent
C) Knee: reduced; arm: normal; abdomen: reduced
D) Knee: reduced; arm: reduced; abdomen: absent
Ans: B
Feedback:
Reflexes are lessened in the arms, are nearly totally lost in the abdomen, but are maintained in the knee.

 

 

Origin:  Chapter 5- Common Aging Changes, 19

Chapter:  5

Client Needs:  B

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing process

Objective:  1

Page and Header:  58, Musculoskeletal System

19. Bone fractures are a serious risk to the elderly. Which of the following is a contributing factor?
A) Diminished calcium absorption
B) Shortening of the long bones
C) Formation of points and spurs
D) Deterioration of cartilage surfaces
Ans: A
Feedback:
A decrease in calcium absorption in the elderly contributes to the brittleness of the bones, thus increasing the risk of fractures.

 

 

Origin:  Chapter 5- Common Aging Changes, 20

Chapter:  5

Client Needs:  D3

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  60, Nervous System

20. A gerontological nursing course syllabus includes the topic of helping elders ambulate safely. The major factor contributing to an increased risk of falls in the elderly is:
A) Decline in brain weight
B) Reduction of blood flow to the brain
C) Flawed response to changes in balance
D) Slowed nerve conduction velocity
Ans: C
Feedback:
Although all the statements are true, the major factor increasing the risk of falls is a flawed response to changes in balance.

 

 

Origin:  Chapter 5- Common Aging Changes, 21

Chapter:  5

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  1

Page and Header:  62, Endocrine System

21. A nurse is reviewing thyroid test results of her clients. Which of the following is the most likely thyroid test result for a healthy elderly patient?
A) T4: low; T3: low; thyroid function: low
B) T4: high; T3: normal; thyroid function: high
C) T4: high; T3: normal; thyroid function: low
D) T4: normal; T3: low; thyroid function: normal
Ans: D
Feedback:
With normal aging, secretion of thyroid-stimulating hormones (TSH) and the serum concentration of thyroxine (T4) do not change, although there is a significant reduction in triiodothyronine (T3), which is believed to be a result of the reduced conversion of T4 to T3. Overall, thyroid function remains adequate.

 

 

Origin:  Chapter 5- Common Aging Changes, 22

Chapter:  5

Client Needs:  D4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  62, Endocrine System

22. Which of the following blood chemistries may indicate diabetes among young adults but not among the elderly?
A) Low blood glucose level
B) High blood glucose level
C) Prolonged hypoglycemia
D) Insufficient release of insulin
Ans: B
Feedback:
Although there is a delayed and insufficient release by the b-cells of the pancreas in the elderly, what will show up in a blood chemistry report is an apparently high level of glucose in the blood. Low blood glucose and prolonged hypoglycemia are not indicators of diabetes.

 

 

Origin:  Chapter 5- Common Aging Changes, 23

Chapter:  5

Client Needs:  B

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing process

Objective:  1

Page and Header:  63, Immune System

23. The charge nurse at a nursing home impresses on a visiting class of nursing assistants the importance of hand washing, because older adults have a depressed immune response. One contributor to this depressed immune response in older adults is:
A) Decreased serum activity of the thymic hormones
B) Inactivation of varicella-zoster infections
C) Decreased serum concentrations of IgA and IgG
D) High pain sensitivity associated with inflammation
Ans: A
Feedback:
Serum activity of the thymic hormones is almost undetectable with age. Serum concentrations of IgA and IgG increase with age. Inflammation often causes minimal pain in the elderly.

 

 

Origin:  Chapter 5- Common Aging Changes, 24

Chapter:  5

Client Needs:  C2

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Communication

Objective:  2

Page and Header:  64, Personality

24. Older adults may appear rigid in their attitudes because of:
A) Changes in personality that accompany aging
B) Diminished ability to learn new information
C) Physical or mental limitations
D) Decline in morale and self-esteem
Ans: C
Feedback:
Personality, learning ability, and morale/self-esteem do not change with age. Seniors may resist change because of their physical or mental limitations—for example, rearranging the furniture when eyesight or mobility is limited.

 

 

Origin:  Chapter 5- Common Aging Changes, 25

Chapter:  5

Client Needs:  D2

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  3

Page and Header:  57, Urinary System

25. Decreased renal mass and reduced glomerular filtration make it especially important that nurses:
A) Assist elderly patients with frequent toileting
B) Ensure that age-adjusted drug dosages are prescribed
C) Look for signs of urinary tract infections
D) Frequently check urine for glucose
Ans: B
Feedback:
The need for frequent toileting is a result of decreased bladder capacity. Weaker bladder muscles increase the risk of urinary tract infections. Tests for glucose in the urine are needed on a case-by-case basis. The need most associated with decreased renal mass and reduced glomerular filtration is age-adjusted drug dosage.

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 1

Chapter:  7

Client Needs:  B

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  87, Introduction

1. Mr. C., aged 82 years, has always lived independently in the house that he and his late wife purchased over 50 years ago. Mr. C. has experienced few health problems, and for that reason his recent falls in the home comes as a surprise to himself and his children. What should the nurse who is providing primary care for Mr. C. first do in this situation?
A) Arrange a family meeting to organize supervision for Mr. C. during high-risk times.
B) Perform a comprehensive musculoskeletal assessment of Mr. C.
C) Investigate what community resources might be appropriate and available to Mr. C.
D) Elicit from Mr. C. what he perceives to be the causes of and potential solutions to his falls.
Ans: D
Feedback:
Answer D best reflects an acknowledgment that Mr. C likely has both the skills and strategies to address his problem. Answers A, B, and C are less holistic in approach and would not be the nurse’s initial response to the situation.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 2

Chapter:  7

Client Needs:  C

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication

Objective:  1

Page and Header:  88, Holistic Gerontological Care

2. A nurse who provides care on the palliative unit of a large teaching hospital has been working with an older adult client who is dying of lung cancer with liver metastases and has generated good rapport with both the client and his family. Which of the following statements best exemplifies a holistic approach to nursing care?
A) “Our goal is to keep you pain-free to the best of our ability, so don’t hesitate to request additional pain medications.”
B) “I will raise the possibility of palliative radiation treatment when your oncologist is next in.”
C) “I’m wondering what feelings you have around being at this stage of your life.”
D) “I’ll make sure that both the social worker and physical therapist come by in the next day or so.”
Ans: C
Feedback:
Answer C encompasses concerns around the client’s presence or absence of peace at this stage in life and supersedes immediate medical or logistical concerns. Answers A, B, and D represent valid nursing actions but are less indicative of the holistic scope of nursing practice.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 3

Chapter:  7

Client Needs:  D4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Teaching/learning

Objective:  2

Page and Header:  88, Holistic Gerontological Care

3. Mrs. D, age 77, has been recently diagnosed with type 2 diabetes mellitus. Which of the following questions by her nurse is most indicative of a holistic approach to gerontological nursing care?
A) “How do you anticipate this affecting your lifestyle and your daily routines?”
B) “Would you like me to show you a few different glucometers so that you can choose one that works for you.”
C) “Can I arrange for you to meet with a dietitian to go over some nutrition tips?”
D) “When would be a good time for me to teach you about skin care and diabetes?”
Ans: A
Feedback:
Answer A addresses the impact of the diagnosis on the client’s lifestyle and quality of life, concerns that are central to holistic nursing care. Answers B, C, and D address valid components of care for the client, but are less indicative of a holistic approach.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 4

Chapter:  7

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Teaching/learning

Objective:  2

Page and Header:  89, Health Promotion–Related Needs

4. A community health nurse has been invited to speak to a group of older adults in the context of the local community center. Which of the following nursing actions best reflects an approach that emphasizes the importance of health promotion in gerontological nursing care?
A) A teaching session on the signs and symptoms of stroke, along with current treatment modalities.
B) An educational presentation on the importance of prostate screening for men and mammography for women.
C) A class that presents the beneficial effects of regular exercise and practical methods for integrated exercise into daily routines.
D) A presentation on the issue of elder abuse and ways to identify and prevent it.
Ans: C
Feedback:
Exercise is one of the clearest examples of health promotion. Teaching on a particular diagnosis such as stroke, a screening program addressing prostate and breast health and psychosocial issues such as elder abuse are certainly valid, but are less clearly indicative of health promotion in nursing care.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 5

Chapter:  7

Client Needs:  B

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Teaching/learning

Objective:  2

Page and Header:  90, Health Challenges–Related Needs

5. After a lifetime of good health, a 72-year-old man has been found to have severe hypertension. What can his nurse do that most clearly prioritizes the role of monitoring that nurses play in the management of health challenges?
A) Liaising between his family physician and his cardiologist to ensure that appointments do not conflict and communication is maintained.
B) Guiding the client toward the purchase of a home blood pressure cuff and keeping up to date on his regular readings.
C) Teaching the client about lifestyle changes that his condition necessitates and that will ensure his high level of function.
D) Educating the client about the basic pathophysiology that underlies his condition.
Ans: B
Feedback:
Monitoring entails tracking the status of a client’s health condition, as could be done by using a BP cuff and staying abreast of results. Answer A indicates a coordination role, while answers C and D reflect coaching and education, respectively.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 6

Chapter:  7

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  3

Page and Header:  90, Knowledge, Experience, and Skills

6. Nurse J provides care for numerous older adult clients in the context of her work as a community health nurse. Which of her following clients is displaying a deficit in knowledge, experience, and skills that has the potential to compromise his or her health?
A) A 79-year-old female client who has dysphagia (difficulty swallowing) following her recent stroke.
B) Mrs. H, age 78, who states that she lost all hope since her husband’s death 5 months prior and no longer wants to stay active.
C) An 89-year-old man who has recently lost the ability to climb stairs due to the exacerbation of his congestive heart failure.
D) Mr. I, recently diagnosed with diabetes, who shows an inability to manipulate his glucometer and test strips.
Ans: D
Feedback:
Mr. I demonstrates an inability to perform the necessary skills for health care. Answers A and C indicate a lack of physical ability while answer B suggests a lack of desire to take action.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 7

Chapter:  7

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  3

Page and Header:  90, Desire and Decision to Take Action

7. In which of the following situations would the care team be most likely justified in superseding the desires of the older adult client in question?
A) Mrs. J persists in smoking cigarettes despite her emphysema and dependence on oxygen by nasal prongs.
B) Mr. L is adamantly opposed to placement in a care facility, despite his progressing dementia and tendency to leave his stove turned on.
C) Mrs. B, though denying suicidal ideation, is depressed and has cloistered herself in her apartment for many months.
D) Mr. E, despite his family’s wishes, does not want any treatment for his recently diagnosed brain tumor.
Ans: B
Feedback:
Desires of clients may be superseded by professional judgment in actual or suspected cases of mental incompetence, of which dementia may be an example. Answers A, C, and D are examples of situations where the desires of older adults, though likely detrimental, would ultimately be respected.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 8

Chapter:  7

Client Needs:  A1

Cognitive Level:  Comprehension

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  4

Page and Header:  91, Gerontological Nursing Processes

8. Which of the following statements provides the clearest justification for the performance of gerontological nursing intervention?
A) The client does not possess the requisites to meet his or her needs independently.
B) The client is deemed by health professionals, in their professional judgment, to be in a compromised health state.
C) The client expresses a desire for assistance with self-care.
D) The client engages in behaviors that are not compatible with good health.
Ans: A
Feedback:
When the older adult does not have the requisites to meet needs independently, however, nursing interventions are needed. While interventions may well be performed in situations characterized by answers B, C, and D, answer A is the broadest principle that would supersede the others cited.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 9

Chapter:  7

Client Needs:  D1

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  4

Page and Header:  91, Assessing Needs: The Case of Mr. R.

9. While working with a client who is living with progressively worsening Parkinson disease and consequent self-care deficits, Nurse P is conscious of integrating principles of holistic gerontological nursing care. Place the following steps in the application of these principles in the correct logical and chronological order. Use all the options.

 

A) Implement specific nursing care plan actions

B) Perform an assessment of the client

C) Identify the presence of needs related to health challenges

D) Evaluate how well identified health needs are being met

E) Explore reasons underlying the client’s health needs

Ans: B, C, D, E, A
Feedback:
The holistic model begins with assessment and identification of needs, followed by an evaluation of how well these needs are being met and the reasons for their existence. Following this process, interventions would be performed.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 10

Chapter:  7

Client Needs:  D4

Cognitive Level:  Analysis

Difficulty:  Easy

Integrated Process:  Nursing process

Objective:  1

Page and Header:  89, Health Promotion–Related Needs

10. A nurse is performing a comprehensive assessment of new male client, age 76 years. Which of the following components of the nurse’s assessment relate directly to the holistic model? Select all that apply.
A) Measuring the client’s apical heart rate.
B) Asking the client about his church involvement.
C) Identifying the support systems that the client believes he possesses.
D) Eliciting the client’s immunization history.
Ans: B, C
Feedback:
Spirituality and perceived support and relationships are central components of the holistic model. Physical assessment components are undeniably necessary but are not indicative of the holistic model.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 11

Chapter:  7

Client Needs:  D3

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  90, Health Challenges–Related Needs

11. Which of the following is a holistically based nursing intervention for the nursing diagnosis Impaired Gas Exchange related to immobility?
A) Teach and encourage turning
B) Feed in the sitting position
C) Apply oxygen as needed
D) Demonstrate signs of adequate respiration
Ans: A
Feedback:
For the nursing diagnosis Impaired Gas Exchange related to immobility, teaching and encouraging turning, coughing, and deep-breathing exercises is a nursing intervention that strengthens self-care capacity and thus aligns with the holistic model. The other three choices do not achieve this to the same degree.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 12

Chapter:  7

Client Needs:  D1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Communication

Objective:  1

Page and Header:  87, Introduction

12. A gerontological nurse must seek interventions recognizing that the elderly have considerable inner resources for self-care. What are the central consequences of this approach?
A) Promotion of normalcy and individuality
B) Development of feelings of dependence and powerlessness
C) The ability to make their own decisions
D) Clients becoming active participants of care rather than passive recipients
Ans: D
Feedback:
Nurses should resist external interventions and empower the elderly to draw on their strengths. The key to holistic care is that older adults should not become passive recipients of care; they should be active participants.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 13

Chapter:  7

Client Needs:  B

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing process

Objective:  2

Page and Header:  89, Health Promotion–Related Needs

13. In the holistic model of gerontological care, health is best defined as:
A) Absence of disease and disability
B) Integration and quality of life
C) Physiological balance and anatomical normalcy
D) Prevention of disease and promotion of wellness
Ans: B
Feedback:
Health is defined as a state of wholeness: an integration of body, mind, and spirit to achieve the highest possible quality of life. Choice A offers little clarity and begs for a more positive, broad understanding. Choices C and D are components of overall health.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 14

Chapter:  7

Client Needs:  D1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  89, Health Promotion–Related Needs

14. In a busy clinical setting, which element of the holistic model of gerontological care is most in danger of being overlooked?
A) Gratification
B) Risk reduction
C) Comfort
D) Physiological balance
Ans: A
Feedback:
Optimal health of older adults rests on the degree to which the needs for physiological balance, connection, and gratification are satisfied. There is the risk in busy clinical settings that the less tangible needs of gratification and connection can be overlooked.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 15

Chapter:  7

Client Needs:  D1

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing process

Objective:  3

Page and Header:  90, Health Challenges–Related Needs

15. Older adults have the same basic health needs as others. They may also have what additional need?
A) Physiological balance
B) Connection
C) Monitoring
D) Gratification
Ans: C
Feedback:
Optimal health for older adults rests on the degree to which the needs for physiological balance, connection, and gratification are satisfied. The complexities of health care and the changing health status of aging people warrant monitoring to track progress and needs.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 16

Chapter:  7

Client Needs:  D3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication

Objective:  2

Page and Header:  90, Health Challenges–Related Needs

16. The nurse ensures that conflicting treatments are not prescribed for an elderly patient. What responsibility is he or she fulfilling for the client?
A) Education
B) Coordination
C) Coaching
D) Counseling
Ans: B
Feedback:
Although all are health challenge–related needs for the elderly, preventing conflicting treatments requires coordination among several health care providers.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 17

Chapter:  7

Client Needs:  D1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  3

Page and Header:  90, Desire and Decision to Take Action

17. Which of the following is a prerequisite for self-care?
A) Instruction
B) Desire
C) Evaluation
D) Connection
Ans: B
Feedback:
The prerequisites for self-care are skill, desire, and ability. Although connection is an element of the holistic model, it is not one of the three fundamental prerequisites for self-care, nor is instruction or evaluation.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 18

Chapter:  7

Client Needs:  D1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Communication

Objective:  4

Page and Header:  91, Assessing Needs: The Case of Mr. R.

18. Mr. S is living alone at age 82. His wife of more than 50 years died recently. Visiting his home, his nurse finds that Mr. S is eating well and maintaining his mobility but neglecting his personal hygiene. His clothes are dirty, and his body odor is strong. What should be his nurse’s first action?
A) Explain to Mr. S the health benefits of keeping clean
B) Probe the reasons why Mr. S is not bathing or doing laundry
C) Offer time-saving bathing tips and advice on easy methods for washing clothes
D) Motivate Mr. S to take the time and trouble to keep clean
Ans: B
Feedback:
Although all the choices may be important parts of the nurse’s communication with Mr. S, the necessary first step is to determine the underlying reasons for his poor hygiene. Self-care requires three elements: ability, desire, and skill. If Mr. S is unclean because he is physically unable, the nurse may take one course of action. If his poor hygiene is the result of lack of motivation, a different approach is warranted.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 19

Chapter:  7

Client Needs:  A1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  4

Page and Header:  87, Introduction

19. The inability of a patient to meet self-care needs creates a need for a nursing intervention. Which of the following interventions is the preferred first priority whenever possible?
A) Assisting the individual promptly and efficiently
B) Providing direct services by acting for or by doing for
C) Empowering the patient by strengthening her or his self-care capacities
D) Eliminating or minimizing self-care limitations
Ans: C
Feedback:
Whenever possible, the first priority is strengthening an individual’s capacity for self-care. The other steps may be taken as needed when self-care is not feasible.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 20

Chapter:  7

Client Needs:  D1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Self-care

Objective:  4

Page and Header:  91, Examples of Application

20. Which of the following is true of coaching an elder to perform a self-care task independently?
A) It requires more time and effort than letting the caregiver do the task
B) It makes the patient feel demeaned and dependent
C) It is not advised for patients who require multiple medications
D) It is not possible when a patient lacks desire or decides against self-care
Ans: A
Feedback:
Self-care coaching empowers an elder. Self-care is possible for most elders regardless of medications, and motivational coaching can increase desire or reverse a decision against self-care. It typically requires more time and effort in the short run but pays off in the long term.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 21

Chapter:  7

Client Needs:  C

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  4

Page and Header:  91, Gerontological Nursing Processes

21. Mrs. J, age 79, presents with acute abdominal pain at the ER. She is found to have an ovarian cyst. Surgery is promptly and successfully performed. Because Mrs. J lives alone, she is transferred to a short-term care facility where she can recover until her daughter can travel from another state to take her home. While in the care facility, Mrs. J, who is already underweight and frail, refuses to eat. She begins to lose weight rapidly. In developing a care plan for Mrs. J, her gerontological nurse can best strengthen Mrs. J’s self-care capacity by:
A) Making sure her meals are attractive and seasoned well
B) Planning and ordering nutritious meals for her
C) Monitoring her nutritional status through observations of skin turgor and muscle strength
D) Obtaining a menu from the facility’s kitchen from which she can order foods she prefers
Ans: D
Feedback:
The holistic model of gerontological care emphasizes promoting self-care. Therefore, empowering Mrs. J to make her own choices and control her meals is the best choice. The other options may be used if Mrs. J’s capacity is diminished.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 22

Chapter:  7

Client Needs:  D1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Communication

Objective:  4

Page and Header:  91, Assessing Needs: The Case of Mr. R.

22. Mrs. J, age 79, presents with acute abdominal pain at the ER. She is found to have an ovarian cyst. Surgery is performed promptly and successfully. Because Mrs. J lives alone, she is transferred to a short-term care facility where she can recover until her daughter can travel from another state to take her home. While in the care facility, Mrs. J, who is already underweight and frail, refuses to eat. She begins to lose weight rapidly. In developing a care plan for Mrs. J, what does the nurse most need to know before undertaking any action to strengthen Mrs. J’s self-care capacity?
A) What medications the physician has ordered?
B) When Mrs. J’s daughter will arrive?
C) Mrs. J’s reasons for rejecting food
D) Developing a care plan for “Nutrition and Hydration”
Ans: C
Feedback:
Self-care requires three elements: ability, desire, and skill. For example, if Mrs. J is not eating because she is not hungry, the nurse may take one course of action; if she is not eating because of a fear of her strange environment, a different approach is warranted.

 

 

Origin:  Chapter 7- Holistic Model for Gerontological Nursing, 23

Chapter:  7

Client Needs:  D3

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  4

Page and Header:  90, Health Challenges–Related Needs

23. Which of the following best describes a nursing intervention for the nursing diagnosis Risk for Infection which is congruent with the holistic model of gerontological nursing care?
A) Assist in the selection of foods to improve nutritional status
B) Prevent complications associated with immobility
C) Observe for and detect respiratory problems early
D) Teach the importance of cleansing the perineal region after elimination
Ans: D
Feedback:
This nursing intervention helps reduce Risk for Infection by strengthening self-care for elimination. The other choices, though important interventions, are not directly related to the diagnosis Risk for Infection.

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 1

Chapter:  9

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  1

Page and Header:  113, Philosophies Guiding Ethical Thinking

1. A nurse manager who provides leadership in a long-term care facility prioritizes the need for residents to have current and relevant immunizations, stating, “it’s inconvenient and costly, but it provides protection not only to the person getting the vaccine but to all those that they’re in contact with.” Which of the following ethical philosophies most likely underlies the nurse’s statement?
A) Nonmaleficence
B) Absolutism
C) Utilitarianism
D) Relativism
Ans: C
Feedback:
The nurse’s emphasis on providing a perceived good to a maximum number of individuals is typical of a utilitarian outlook.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 2

Chapter:  9

Client Needs:  A1

Cognitive Level:  Analysis

Difficulty:  Easy

Integrated Process:  Communication and documentation

Objective:  1

Page and Header:  113, Philosophies Guiding Ethical Thinking

2. Due to a bed shortage in the area, the head nurse on a busy geriatric medicine unit is under significant pressure to minimize client lengths of stay and speed up discharge planning. An older adult client who is convalescing after recent falls is adamant that he is not ready for discharge, and tells the nurse, “It doesn’t matter who or how many people are waiting in the emergency department for this bed; I’m simply not healthy enough to go home yet.” Of which philosophy of ethics is the patient’s statement most indicative?
A) Absolutism
B) Relativism
C) Egoism
D) Beneficence
Ans: C
Feedback:
An emphasis on one’s personal interests is characteristic of egoism.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 3

Chapter:  9

Client Needs:  A1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  2

Page and Header:  114, Ethical Principles

3. Despite the wishes of her family and the recommendations of the care team, a 70-year-old client with a diagnosis of congestive heart failure, but who is otherwise healthy, wants to have a no-code order in place. Which of the following statements by the care team most clearly prioritizes the patient’s autonomy?
A) “If this is what is best for everyone then we need to go ahead with the order.”
B) “Provided it can be demonstrated that she has a potentially poor prognosis, we should certainly consider doing this.”
C) “It’s best that social work get involved at this point to reconcile the family’s and the patient’s wishes.”
D) “If that’s what she wants, then ultimately we’re obliged to respect her wishes.”
Ans: D
Feedback:
Answer D most clearly prioritizes the patient’s individual freedom, preference, and rights in this case, and these considerations would override the family’s or the care team’s conflicting interests.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 4

Chapter:  9

Client Needs:  A1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  2

Page and Header:  114, Ethical Principles

4. Nurse H is providing care in the hospital for a 71-year-old male patient who is in the late stages of cancer and who has painful bone metastases. The client is non-responsive but groans and grimaces intermittently. Nurse H is drawing up a breakthrough dose of morphine for the patient, but Nurse R cautions that, “sure, that will address his pain, but it could depress his respiratory drive and actually kill him at this stage.” Which of the following ethical principles is Nurse R prioritizing?
A) Nonmaleficence
B) Justice
C) Beneficence
D) Fidelity
Ans: A
Feedback:
Nurse R’s emphasis on preventing harm to the patient, even during an act that may be motivated by altruism, is characteristic of the principle of nonmaleficence.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 5

Chapter:  9

Client Needs:  A1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Communication and documentation

Objective:  2

Page and Header:  114, Ethical Principles

5. Nurse T promised an 81-year-old female client that he would liaise with the physiotherapy team and ensure that her rehabilitation would commence soon, since it was apparent that she was being overlooked. Due to a busy shift during which another patient declined rapidly, the nurse did not follow up. Which ethical principle has Nurse T most clearly violated?
A) Beneficence
B) Fidelity
C) Veracity
D) Justice
Ans: B
Feedback:
Central to the principle of fidelity is respecting words and duties to patients, such as following up when promised. The nurse’s actions are less indicative of deficits in beneficence, veracity (since he did not overtly lie to the patient), or justice.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 6

Chapter:  9

Client Needs:  A1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  2

Page and Header:  114, Ethical Principles

6. Mr. L’s health insurance has just expired though he is still in the recovery stages of a serious exacerbation of his chronic obstructive pulmonary disease. Backdating the paperwork by only 2 days will spare Mr. L the out-of-pocket expense of home oxygen therapy. The nurse who is organizing Mr. L’s care on discharge has chosen a course of action that prioritizes the principle of veracity. Which of the following courses of action best exemplifies this principle?
A) Backdating the paperwork to ensure that Mr. L does not sustain harm from having to pay or having to go without oxygen therapy.
B) Backdating the paperwork because it will clearly maximize Mr. L’s well-being at a nominal cost to the insurer.
C) Refusing to backdate the paperwork because to do so would be untruthful.
D) Refusing to backdate the paperwork because to do so would be an unjust act toward the insurance company.
Ans: C
Feedback:
The principle of veracity emphasizes truthfulness, and the nurse’s refusal to lie on the insurance documentation is indicative of this principle. Consideration for the consequences to either the patient or the insurance company would be secondary.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 7

Chapter:  9

Client Needs:  A1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  3

Page and Header:  115, Changes Increasing Ethical Dilemmas for Nurses

7. Which of the following phenomena have contributed to recent increases in the number and complexity of ethical dilemmas for gerontological nurses? Select all that apply.
A) The scope of practice goes beyond simply following doctors’ orders.
B) Nurses’ levels of responsibility are higher than in past years.
C) Medical technology has made significant advances.
D) The Internet has made patients and their families more informed about health.
E) Deaths from heart disease are declining while deaths from cancer are increasing.
F) Conflicts between cost effectiveness and quality of care
Ans: A, B, C, F
Feedback:
The increasing scope and responsibility that nurses bring to practice contribute to ethical dilemmas, while advances in medical technology and fiscal constraints bring a new series of issues to care. Increasingly informed patients and changes in causes of death do not directly increase the number of ethical dilemmas faced by nurses.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 8

Chapter:  9

Client Needs:  A1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Communication and documentation

Objective:  4

Page and Header:  117, Measures to Help Nurses Make Ethical Decisions

8. Which of the following statements that nurses on a hospital unit made about ethical decision making is most accurate?
A) “Instead of making ethical decisions in isolation we should enlist the help of people like ethics committees and clergy.”
B) “We should ensure that contributors to our ethical decision making have direct experience with the types of hands-on care we provide.”
C) “Decisions that we make involve complex realities so we have to avoid specific philosophies of ethics.”
D) “The need for confidentiality means that we shouldn’t be discussing particular ethical issues with anyone other than patients themselves.”
Ans: A
Feedback:
Ethical decision making should include individuals apart from the situation, including ethics committees, lawyers, and clergy, many of whom will not have direct health-care experience. Specific philosophies of ethics can provide a useful framework for decision making.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 9

Chapter:  9

Client Needs:  A1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  4

Page and Header:  117, Measures to Help Nurses Make Ethical Decisions

9. Which of the following statements most accurately captures an aspect of the use of ethics committees in the ethical decision-making process?
A) It is important that lawyers be excluded from ethics committees.
B) Ethics committees should originate within academic and religious contexts rather than health care organizations themselves.
C) Multiple ethics committees are often necessary in order to gain a holistic and balanced perspective on issues.
D) Evaluation by ethics committees of decisions that have been made can lead to the development of policies and better decision making in the future.
Ans: D
Feedback:
The outcomes of ethical decision making should be assessed, a process that can result in the development of improved policies and procedures. Lawyers are valid members of ethics committees and while they should draw from various professions and perspectives, ethics committees can justifiably exist in health care contexts. It is not necessary to have multiple, coexisting ethics committees, but rather to ensure that any given committee have a variety of perspectives and backgrounds.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 10

Chapter:  9

Client Needs:  A1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  2

Page and Header:  114, Ethical Principles

10. The ethics committee of a hospital has decided that it is unethical to prioritize patients who possess more comprehensive insurance plans than those with minimal or no insurance. Which of the following principles most clearly underlies this decision?
A) Beneficence
B) Justice
C) Fidelity
D) Veracity
Ans: B
Feedback:
The principle of justice includes treating individuals fairly and giving patients the service they need, emphasizing service based on need rather than the ability to pay. This perspective is not central to the principles of beneficence, fidelity, or veracity.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 11

Chapter:  9

Client Needs:  C

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing process

Objective:  3

Page and Header:  117, Greater Numbers of Older Adults

11. Which of the following social changes is increasing the number and complexity of ethical dilemmas that nurses face?
A) Outdated medical technologies
B) Diminished fiscal constraints
C) Greater numbers of older adults
D) Expansion of the hospice movement
Ans: C
Feedback:
Nurses face more ethical dilemmas as a result of new medical technologies and increased fiscal constraints. The complexity is increased by larger numbers of older adults to serve. The expansion of hospice care helps nurses deal with ethical dilemmas.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 12

Chapter:  9

Client Needs:  A1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  3

Page and Header:  116, Medical Technology

12. Artificial organs, genetic screening, ultrasound, and other innovations today save lives that once would have been given no hope. These advances have raised ethical questions related to which of the following issues?
A) For whom and when technology should be used
B) How procedures should be monitored and outcomes measured
C) How judgments about patients’ health status can be kept objective
D) The limits of medical practice in diagnosing and treating disease
Ans: A
Feedback:
Although all the choices listed may be of concern, the greatest ethical conflict lies in deciding who can have access to a limited resource.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 13

Chapter:  9

Client Needs:  A1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  3

Page and Header:  117, Greater Numbers of Older Adults

13. Which of the following factors most contributes to the fact that society is experiencing an increased burden for entitlement programs for the elderly?
A) The rights of older citizens to receive health services unavailable to other age groups
B) The increasing ratio of dependent elderly to productive workers
C) Growing public attention to policy and reimbursement decisions that are not in the best interest of elders
D) The widening scope and increased accountability of gerontological nurses
Ans: B
Feedback:
The impact of entitlement programs and services for older adults was felt less severely when only a small portion of the population was old; but with growing numbers of people spending more time in old age and the ratio of dependent individuals to productive workers increasing, society is beginning to feel burdened.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 14

Chapter:  9

Client Needs:  A1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Caring

Objective:  2

Page and Header:  114, Ethical Principles

14. Which of the following is the best example of the ethical principle of beneficence?
A) The nurses at City Hospital answer patients’ call buttons “with all deliberate speed”
B) The nursing supervisor fires an incompetent part-time nursing assistant, leaving a less than full complement of staff
C) At a nursing home, the staff closes residents’ doors before the body of a deceased resident is wheeled out
D) The charge nurse documents all reported incidents at the end of the shift
Ans: A
Feedback:
Beneficence means to do good for patients. Of the examples given, A is the best demonstration of this principle.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 15

Chapter:  9

Client Needs:  C

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  2

Page and Header:  113, Philosophies Guiding Ethical Thinking

15. Which of the following actions is viewed as ethically acceptable under the philosophy of relativism?
A) An older adult’s children propose that she split her life savings between them before she needs care.
B) A lottery winner donates money to a hospital only if the hospital’s new wing is named after him.
C) A millionaire finds a wallet in her physician’s waiting room and keeps the money inside.
D) A poor man steals medicine and diabetic supplies from a pharmacy to help his ill child.
Ans: D
Feedback:
The act of stealing is ethically wrong in some philosophies, but condoned under the philosophy of relativism, or situational ethics, because of the circumstances—in this case, need. Choice A exemplifies utilitarianism; B and C, egoism.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 16

Chapter:  9

Client Needs:  C

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  2

Page and Header:  114, Ethical Principles

16. When advocating the rights of patients to receive health care regardless of ability to pay, a nurse is applying which of the following ethical principles?
A) Holistics
B) Justice
C) Fidelity
D) Autonomy
Ans: B
Feedback:
Justice argues that people should be treated equally regardless of their circumstances. Thus, medical treatments available to the rich should also be available to the poor. The other choices are not directly related to the situation.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 17

Chapter:  9

Client Needs:  C

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  2

Page and Header:  114, Ethical Principles

17. Patient P refuses a blood test that Nurse N believes P desperately needs. Nurse N ignores the patient’s wishes and sends a blood sample to the lab without P’s knowledge. The ethical conflict between Patient P and Nurse N involves:
A) P: nonmaleficence; N: veracity
B) P: beneficence; N: relativism
C) P: egoism; N: utilitarianism
D) P: autonomy; N: paternalism
Ans: D
Feedback:
P is asserting his autonomy, but N is ignoring his wishes and acting “for P’s own good” as Nurse N perceives it.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 18

Chapter:  9

Client Needs:  C

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  2

Page and Header:  114, Ethical Principles

18. Patient R is seriously injured in an automobile accident, and his chances of survival are slim. During his diagnostic workup, lab tests reveal that he is HIV positive. The health care professional who decides to withhold the test results from R is violating the ethical principle of:
A) Veracity
B) Nonmaleficence
C) Beneficence
D) Autonomy
Ans: A
Feedback:
This principle is central to all nurse–patient interactions because the quality of this relationship depends on trust and integrity. Veracity is truthfulness; withholding information violates it.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 19

Chapter:  9

Client Needs:  C

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  4

Page and Header:  117, Measures to Help Nurses Make Ethical Decisions

19. Which of the following is the best way for nurses to minimize their struggles in making ethical decisions?
A) Take no action unless an advance directive, will, and other legally binding documents are in effect
B) Act on the recommendations of a patient’s healthcare provider, friends, and family members
C) Consult the guidelines of the American Nurses Association and the institution’s ethics committee
D) Maintain nursing’s traditional focus on following physicians’ orders and providing care and comfort for the patient
Ans: C
Feedback:
Although legal documents and the views of family members should be taken into account, a nurse may be called on to make ethical decisions without them or occasionally in opposition to them. Retreating into a “care-only’ mode does not resolve ethical dilemmas. The best choice among those listed is to seek guidance from professional organizations and committees charged with establishing ethical guidelines for institutions.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 20

Chapter:  9

Client Needs:  A1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  3

Page and Header:  117, New Fiscal Constraints

20. In which of the following cases is the ethical conflict between cost containment and quality care most obvious?
A) The termination of an incompetent aide who is the sole support of his family
B) The conversion of a community playground into a senior citizen center
C) An insurance company that denies reimbursement for dialysis of patients older than age 70
D) The decision to remove the feeding tube from a comatose patient
Ans: C
Feedback:
Although all choices involve ethical dilemmas, the most direct opposition between cost containment and quality care arises in the denial of expensive treatments to elderly patients.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 21

Chapter:  9

Client Needs:  A2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and documentation

Objective:  4

Page and Header:  114, Box 9-1

21. A patient with a terminal illness confides in his nurse that he plans to commit suicide. The nurse struggles with whether to report his intent. In the “Code of Ethics for Nurses” of the American Nurses Association, the nurse reads the following statement: “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” In this case, the nurse perceives the greatest ethical conflict between:
A) Advocacy and protection
B) Safety and patient rights
C) Health and terminal illness
D) The patient and the nurse
Ans: B
Feedback:
In this case, the right of the patient (patient rights) to confidentiality and the nurse’s commitment to sustaining his life (safety) are in direct conflict.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 22

Chapter:  9

Client Needs:  A2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  4

Page and Header:  114, Box 9-1

22. Nurse G is a practicing alcoholic, but continues in the job without seeking treatment. Nurse G is most in violation of which provision of the American Nurses Association “Code of Ethics for Nurses”?
A) The nurse practices with respect for the inherent dignity of every individual
B) The nurse is responsible and accountable for determining the appropriate delegation of tasks
C) The nurse owes the same duties to self as to others, including the responsibility to preserve integrity
D) The nurse participates in maintaining conditions of employment conducive to the provision of quality care
Ans: C
Feedback:
A nurse who is a practicing alcoholic is attempting to perform with his or her integrity compromised. Nurse G is violating duties to self and to patients.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 23

Chapter:  9

Client Needs:  C

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Communication and documentation

Objective:  4

Page and Header:  114, Box 9-1

23. Which of the following responsibilities is included in the “Code of Ethics for Nurses” of the American Nurses Association?
A) Advancing nursing research
B) Meeting continuing education requirements
C) Shaping social policy
D) Defending colleagues accused of ethical violations
Ans: C
Feedback:
Nurses are expected to articulate nursing values, maintain the integrity of the profession and its practice, and shape social policy.

 

 

Origin:  Chapter 9- Ethical Aspects of Gerontological Nursing, 24

Chapter:  9

Client Needs:  A1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  4

Page and Header:  113, External and Internal Ethical Standards

24. Mrs. J’s insurance company reimburses for a maximum of four physical therapy sessions annually. At age 62, Mrs. J is recovering slowly from hip surgery, and her nurse believes that additional sessions would enhance Mrs. J’s self-care capacity. Mrs. J cannot afford to pay for additional sessions. Which of the following is the nurse’s major ethical concern?
A) Do I increase financial risks for health care institutions by insisting that nonreimbursed therapy be provided?
B) Is the insurance company reimbursing in a manner that threatens my patient’s well-being?
C) Have meta-analyses shown that additional therapy sessions are cost-effective?
D) Am I in compliance with the integrity requirement of the “Code of Ethics for Nurses” of the American Nurses Association?
Ans: B
Feedback:
The nurse’s first priority is quality care for the patient. If an insurance company is reimbursing in a manner that threatens a patient’s well-being, the nurse faces a difficult ethical conflict.