Basic Geriatric Nursing 5th Edition, Wold Test Bank

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Basic Geriatric Nursing 5th Edition, Wold Test Bank


Test Bank Basic Geriatric Nursing 5th Edition, Wold

Chapter 01: Trends and Issues
1. The nurse explains that in the late 1960s, health care focus was aimed at the older adult because:
a. disability was viewed as unavoidable.
b. complications from disease increased mortality.
c. older adults needs are similar to those of all adults.
d. preventive health care practices increased longevity.
2. The nurse clarifies that in the terminology defining specific age groups, the term aged refers to persons who are:
a. 55 to 64 years of age.
b. 65 to 74 years of age.
c. 75 to 84 years of age.
d. 85 and older.
3. The nurse cautions that ageism is a mindset that influences persons to:
a. discriminate against persons solely on the basis of age.
b. fear aging.
c. be culturally sensitive to concerns of aging.
d. focus on resources for the older adult.
4. The nurse points out that the most beneficial legislation that has influenced health care for the older adult is:
a. Medicare and Medicaid.
b. elimination of the mandatory retirement age.
c. the Americans with Disabilities Act.
d. the Drug Benefit Program.
5. The nurse clarifies that a housing option for the older adult that offers the privacy of an apartment with restaurant-style meals and some medical and personal care services is the:
a. government-subsidized housing.
b. long-term care facility.
c. assisted-living center.
d. group housing plan.
6. The 75-year-old man who has been hospitalized following a severe case of pneumonia is concerned about his mounting hospital bill and asks if his Medicare coverage will pay for his care. The nurses most helpful response is Yes. Medicare:
a. pays 100% of all medical costs for persons older than 65.
b. Part B pays hospital costs and physician fees.
c. Part A pays for inpatient hospital costs.
d. Part D pays 80% of the charges made by physicians.
7. The daughter of a patient who has been diagnosed with terminal cancer asks which documents are required to allow her to make health care decisions for her parent. The nurses most informative response is:
a. Advance directives indicate the degree of intervention desired by the patient.
b.A Do Not Resuscitate document signed by the patient transfers authority to the next of kin.
c.A durable power of attorney for health care transfers decision-making authority for health care to a designated person.
d. A living will transfers authority to the physician.
8. The daughter of a resident in a long-term care facility is frustrated with her 80-year-old mothers refusal to eat. The nurse explains that the refusal to eat is a behavior that is an:
a. effort to maintain a portion of independence and self direction.
b. indication of approaching Alzheimer disease.
c. effort to gain attention.
d. indication of the dislike of the institutional food.
9. The nurse clarifes that the conditions of a living will go into effect when:
a. the patient declares that desire in writing.
b. a family member indicates the desire for curative therapy to cease.
c. two physicians agree in writing that the criteria in the living will have been met.
d. the physician and a family member agree that the criteria in the living will have been met.
10. In the 1980s, Medicare initiated a program of diagnosis-related groups (DRGs) to reduce hospital costs by:
a. classifying various diagnoses as ineligible for hospitalization.
b. allotting a set amount of hospital days and prospective payment on the basis of the admitting diagnosis.
c. specifying particular physicians to treat specified diagnoses.
d. using frequency of a particular diagnosis to set a payment schedule.
Chapter 02: Theories of Aging
1. A theory diers from a fact in that a theory:
a. proves how dierent influences aect a particular phenomenon.
b. attempts to explain and give some logical order to observations.
c. is a collection of facts about a particular phenomenon.
d. shows a relationship among facts about a particular phenomenon.
2. The biological theory of aging uses a genetic perspective and suggests that aging is a programmed process in which:
a. each person will age exactly like those in the previous generation.
b. a biological clock ticks o a predetermined number of cell divisions.
c. genetic traits can overcome environmental influences.
d. age-related physical changes are controlled only by genetic factors.
3. The Gene Theory of aging proposes that:
a. the presence of a master gene prolongs youth.
b. genes interact with each other to resist aging.
c. specific genes target specific body systems to initiate system deterioration.
d. the activation of harmful genes initiates the aging process.
4. The theory that identifes an unstable molecule as the causative factor in aging is the _____ theory.
a. free radical
b. molecular
c. neuroendocrine
d. crosslink
5. The nurse assesses that the patient who uses good health maintenance practices believes in the
aging theory known as the _____ theory.
a. wear-and-tear
b. free radical
c. neuroendocrine
d. molecular
6. The nurse describes the neuroendocrine theory of aging as a complex process of:
a. relating thyroid function to age-related changes.
b. the eects of adrenal corticosteroids, which inhibit the aging process.
c. stimulation and/or inhibition of the hypothalamus, causing age-related changes.
d. adrenal medulla inhibition of epinephrine, causing age-related changes.
7. The nurse explains that psychosocial theories dier from biologic theories in that psychosocial
a. focus on methods to delay the aging process.
b. are directed at decreasing depression in the older adult.
c. are organized to enhance the perception of aging.
d. attempt to explain responses to the aging process.
8. The major objection to the disengagement theory is that the theory:
a. justifies ageism.
b. addresses the diversity of older adults.
c. does not clarify the aging process.
d. diminishes the self-esteem of the older adult.
9. The 80-year-old who teaches Sunday school every week and delivers food for Meals on Wheels is following _____ theory.
a. Newmans developmental
b. the life course
c. the activity
d. the disengagement
10. The nurse would recognize successful aging according to Jungs theory when the nurse notes that a resident at a long-term care facility:
a. takes special care to dress for dinner in a manner that pleases his tablemates.
b. asks permission to sit on the patio with other residents.
c. asks persons in his hall if his television is bothering them.
d. wears a large cowboy hat at all times because he likes it.
Chapter 03: Physiologic Changes
1. The nurse keeps the environment warmer for older adults because they are more sensitive to cold because of the age-related changes in their:
a. metabolism rate.
b. subcutaneous tissue.
c. musculoskeletal system.
d. peripheral vascular system.
2. The nurse reassures the distressed 75-year-old male that the wartlike dark macules with distinct borders are not melanomas, but the skin lesions of:
a. senile lentigo.
b. cutaneous papillomas.
c. seborrheic keratoses.
d. xerosis.
3. The nurse is accompanying a group of older adults on a July 4th outing to monitor heat prostration. Older adults are intolerant of heat because of an age-related reduction of:
a. melanin.
b. perspiration.
c. body temperature.
d. capillary fragility.
4. The nurse cautions the CNAs to use care when transferring or handling older adults because their vascular fragility will cause:
a. altered blood pressure.
b. pressure ulcers.
c. pruritus.
d. senile purpura.
5. The nurse assesses a stage I pressure ulcer on an older adults coccyx by the appearance of a:
a. clear blister.
b. nonblanchable area of erythema.
c. scaly abraded area.
d. painful reddened area.
6. The CNA caring for an older adult asks if the yellow, waxy, crusty lesions on the patients axilla and groin are contagious. The nurses most helpful response is:
a. Yes. It is cellulitis caused by bacteria.
b. No. It is seborrheic dermatitis caused by excessive sebum.
c. Yes. It is an indication of scabies.
d. No. It is the lesion seen with basal cell carcinoma.
7. The nurse leads a group of postmenopausal older women on a daily 15-minute walking tour
through the long-term care facility to:
a. improve bone strength.
b. orient them to their surroundings.
c. improve their socialization.
d. increase their appetite.
8. When the perplexed 70-year-old woman asks, How in the world can my bones be brittle when I eat
all the right foods? the nurses most informative reply is:
a. Calcium loss is expected in the older adult.
b. Calcium is continuously withdrawn from bone for nerve and muscle function.
c. Smoking and alcohol consumption speed calcium loss from the bones.
d. Walking and standing increase calcium loss from the bone.
9. When the 70-year-old woman complains, I weigh exactly the same as I did when I wore a size 10 and now I can barely squeeze into a size 16, the nurse explains:
a. Metabolism in the older adult creates increased adipose tissue.
b. Postmenopausal women gain adipose tissue related to loss of calcium.
c. Decrease in muscle mass is replaced with adipose tissue.
d. Kyphosis causes a redistribution of weight.
10. When the 70-year-old postmenopausal woman asks whether her hormone replacement therapy (HRT) will prevent bone loss, the nurses most helpful response is:
a. No. HRT is not helpful after the age of 60.
b. Yes. HRT will prevent bone loss but can cause a stroke, heart attack, or breast cancer.
c. No. HRT is reliant on some natural estrogen production from the ovaries.
d. Yes. HRT is a widely accepted therapy for prevention of bone loss.
Chapter 04: Health Promotion, Health Maintenance, and Home Health Considerations
1. The nurse reminds the 70-year-old male patient with hypertension who is on a sodium-restricted diet that the most eective health practice to reduce sodium intake is to:
a. avoid all salty foods.
b. discontinue eating at restaurants.
c. read food labels on food containers carefully.
d. limit the amount of salt added to food.
2. The nurse takes into consideration that older adults may abuse alcohol because they use it as a(n):
a. sleep aid.
b. appetite stimulant.
c. socialization activity.
d. food source.
3. When the 70-year-old female patient says, Keeping up with when to take the u vaccine is a big hassle. Im not going to add trying to keep up with a pneumonia vaccine as well. Its too expensive. The nurse explains that the patient:
a. can take both vaccines at the same time every fall.
b. needs to take the pneumonia vaccine every 10 years.
c. has Medicare coverage for both vaccines.
d. can obtain both vaccines free of charge from the Public Health Department.
4. The nurse reminds the 75-year-old that older adults should have visual and hearing examinations every:
a. 6 months.
b. 12 months.
c. 2 years.
d. 3 years.
5. To prevent polypharmacy or potential drug-drug interactions, the nurse encourages the 75-year-old male patient to:
a. seek medical care from only one physician.
b. read up on all drugs that are prescribed.
c. keep a list of drugs that he is currently taking.
d. use only one pharmacy to fill prescriptions.
6. The 65-year-old overweight, hypertensive male farmer tells the home health nurse that he eats two fried eggs, four pieces of bacon, and biscuits with cream gravy every morning for breakfast because he believes that a robust breakfast keeps him healthy. The nurses best approach would be to say:
a. That sort of food is not on your low-sodium diet.
b. You wont be healthy long with a diet like that.
c. One egg and whole wheat toast would be even healthier.
d. You should eat whole-grain cereal with fruit instead of all that fat and sodium.
7. The 60-year-old Asian man tells the home health nurse that he has stopped taking his
antihypertensive medication because it causes him to be impotent. He reports that he is using
acupuncture to control his hypertension. The nurses most eective response would be to say:
a. Uncontrolled hypertension is a real health problem.
b. Does your acupuncturist check your blood pressure?
c. Let me check your blood pressure to see how acupuncture is working.
d. You need to talk to your real doctor about stopping this drug.
8. The nurse takes into consideration that the success of instructions about a diabetic diet will be largely reliant on the:
a. clarity of the instructions.
b. severity of the disease.
c. timing of the instructions.
d. motivation of the patient.
9. The nurse is aware that the best predictor of a hypertensive patient complying with a low-sodium diet would be the fact that the patient:
a. has adequate knowledge about the diet.
b. is distressed about his illness.
c. has followed a weight reduction program and lost 15 lb.
d. does not want to have hypertensive complications.
10. An 80-year-old resident in an extended-care facility injured her foot on a piece of rusty wire. She tells the nurse she had a tetanus booster when she was 75. The nurses response will be based on the knowledge that tetanus boosters:
a. should be repeated every 5 years.
b. are not necessary for persons older than 70.
c. do little good for the older adult.
d. should be repeated with every injury, regardless of the previous booster.
Chapter 05: Communicating with Older Adults
1. The briefest explanation of therapeutic communication is that it:
a. has a specific intent or purpose.
b. is the only form of professional communication.
c. should never be used in a social setting.
d. requires no special skills, just a willingness to listen.
2. The nurse is careful in the use of medical jargon while talking with an older adult patient because the use of medical jargon might become a(n):
a. opportunity to instruct the patient.
b. eective abbreviated communication shortcut.
c. indicator of formal communication.
d. communication barrier.
3. The nurse uses superficial social conversation to initiate communication because this type of
a. lets the patient know that he or she is considered to be a person, not just a patient.
b. encourages sharing of intimate details.
c. establishes the nurses role as a health care provider.
d. blocks more meaningful therapeutic communication.
4. The nurse communicating with an older adult who has a hearing impairment will improve reception by speaking:
a. in a higher tone, standing directly in front of the patient.
b. more loudly from several feet away.
c. normally with exaggerated hand gestures.
d. in a low tone, bending close to the patient.
5. Seeing a patient with his head in his arms resting on the over-the-bed table, the nurse steps into the room and asks if the patient feels ill. The patient, without raising his head, says, Im fine. The nurse should:
a. sit down next to the bed and say, You dont act fine.
b. pat him on the shoulder and continue on rounds.
c. say, from the doorway, If you need anything, just call me.
d. assist the patient to sit up and say, Now, thats much better, isnt it?
6. When approaching an older adult to insert a catheter, the nurse should:
a. touch the patient and say, I need to insert this catheter.
b. approach the bed, turn back the cover, and announce, The doctor wants a urine specimen.
c. open catheter tray at bedside, turn back the cover, and say, Is it okay to put a tube in your bladder?
d. introduce yourself at the door and ask, May I insert this catheter for a urine specimen?
7. The nurse is aware that for a patient with receptive aphasia, the best method of communication
would be the use of:
a. a notepad.
b. speaking slowly.
c. worded flash cards.
d. gestures.
8. The white female nurse is concerned that the 80-year-old African American male patient is not being truthful with her because of his:
a. lack of eye contact.
b. smiling facial expression.
c. tone of voice.
d. body language.
9. When asked about the severity of pain, the 93-year-old patient does not answer right away. The nurse should:
a. ask rapid questions: Is it better? Is it worse than yesterday? Is it worse than this morning?
b. repeat the question in a louder voice.
c. say, You must be feeling better because youre not complaining.
d. keep eye contact and wait for the answer.
10. When the nurse answers the call light after a delay of 5 minutes, the angry patient says, You made me wait an hour. Im in pain and no ones willing to help me. The nurses best response would be:
a. Its only been 5 minutes. What do you want?
b. Well, Im here now. What is your problem?
c. I know it must have seemed like an hour. Ill bring your medication.
d. I was attending to another patient whos really ill. Ill help you now.
Chapter 06: Maintaining Fluid Balance and Meeting Nutrition Needs
1. The nurse explains that the lowest recommended daily caloric intake to meet nutritional needs of the older adult safely is _____ calories.
a. 1000
b. 1200
c. 1400
d. 1800
2. The 65-year-old woman brags that by using the MyPyramid guidelines for nutrition, she has lost 15 lb. The nurse reminds her that in order to maintain the weight loss, she must be physically active for _____minutes a day.
a. 15 to 20
b. 20 to 30
c. 30 to 40
d. 40 to 60
3. The nurse recommends that the older man eat chicken and sh because these are complete
proteins, which have:
a. some molecules of carbohydrate.
b. all the essential amino acids.
c. high fat content.
d. soluble ber.
4. The nurse explains that high-density lipoproteins (HDLs), the so-called healthy fats, are made up of:
a. mainly proteins.
b. mostly triglycerides.
c. mainly cholesterol.
d. a variety of minerals.
5. The nurse points out that the nonhealing pressure ulcers and decreasing visual acuity in a patient on
a fat-restricted diet may be related to the patients impaired ability to metabolize vitamin:
a. A.
b. B .6
c. B .12
d. C.
6. The home health nurse does an ongoing assessment of the patient who has had a subtotal
gastrectomy for evidence of a deciency in vitamin:
a. A.
b. B .6
c. B .12
d. C.
7. The nurse giving an iron preparation in capsule form will improve its absorption by giving the patient extra:
a. orange juice.
b. milk products.
c. water.
d. caeine drinks.
8. The nurse caring for the older adult patient who is taking a diuretic for control of hypertension
should monitor the patient closely for signs of:
a. hypokalemia.
b. hypocalcemia.
c. hyponatremia.
d. hyperkalemia.
9. The older adult patient in an extended-care facility has a pressure ulcer. The nurse would encourage wound healing by increasing the patients intake of zinc from food sources such as:
a. meat.
b. citrus fruit.
c. green leafy vegetables.
d. complex carbohydrates.
10. The nurse is aware that older adults need a minimum daily uid intake of _____ mL.
a. 1000
b. 2000
c. 3000
d. 4000
Chapter 07: Medications and Older Adults
1. The nurse is aware that information derived from a pharmaceutical companys drug testing to
establish therapeutic dose ranges may not be appropriate for the older adult because testing:
a. is not done long enough.
b. does not require adequate follow-up.
c. is not well regulated by the U.S. Food and Drug Administration.
d. is usually tested on healthy young persons.
2. The nurse assesses the older adult patient for evidence of the onset of the eectiveness of an oral preparation because age-related changes in the concentration of gastric acid can:
a. change the chemical composition of the drug.
b. increase the distribution.
c. decrease the strength of the drug.
d. retard absorption.
3. The nurse is aware that age-related changes in the stomach that can cause increased drug
absorption and possibly toxicity include:
a. decreased gastric motility.
b. gastric reux disease.
c. inability of gastric cells to transport the drug.
d. decreased peristalsis.
4. To help prevent lithium toxicity in the older adult, the nurse modies the nursing care plan to include interventions to:
a. increase uid intake to 3500 mL daily.
b. have the patient ambulate for 10 minutes after the drug is administered.
c. prohibit citrus fruit in the diet.
d. administer a prescribed stool softener to ensure a daily bowel movement.
5. The nurse takes into consideration that as adipose tissue replaces muscle mass in the older adult, a person taking a fat-soluble drug such as diazepam (Valium) several times a day would exhibit:
a. tachycardia.
b. a hangover eect.
c. agitation.
d. hypertension.
6. The nurse cautions the older adult who is taking the protein-bound drug warfarin (Coumadin) that, with age-related reduced plasma protein levels, the risk of an adverse reaction is high because:
a. unbound active drug molecules continue to circulate in the bloodstream.
b. the bleeding and clotting times will decrease, as evidenced by the PT and INR.
c. the drug becomes ineective and does not deliver its intended therapeutic action.
d. renal damage can occur from the altered drug molecules.
7. The nurse frequently assesses the older adult who is on a psychotropic drug for an overdose
a. older adults are less active.
b. the older adult has fewer cognitive capabilities.
c. brain receptors have become hypersensitive.
d. receptor sites have lower perfusion.
8. The major risk of polypharmacy for the older adult is:
a. ignorance about his or her prescriptions.
b. taking over-the-counter preparations.
c. being treated by more than one physician.
d. taking old prescriptions rather than consulting a physician.
9. The home health nurse would be most concerned about self-medicating errors for the older adult living alone who is a type 1 diabetic and is:
a. aicted with early Parkinson disease.
b. visually impaired.
c. a rheumatoid arthritic with stiened hands.
d. paralyzed from the waist down.
10. The medication nurse is aware that the most reliable method of patient identification for
administration of medications is:
a. a photograph of the patient.
b. an identication bracelet.
c. asking the patient to repeat his or her name.
d. use of the patients room number.
Chapter 08: Health Assessment of Older Adults
1. The nurse clarifies that the difference between a health screening and health assessment is that a health screening:
a. identifies persons with unmet health needs who may need a referral.
b. assesses local health needs for the Public Health Department.
c. collects data that will be used for research.
d. provides appropriate treatment for identified health needs.
2. The nurse charts that the Patient stated abdominal pain is still at a level of 8 on a scale of 1 to 10 and that he is still nauseated. Patient complains of feeling cold and has an oral temperature of 97.8. The objective information recorded is the:
a. pain measurement.
b. presence of nausea.
c. sense of cold.
d. oral temperature.
3. The nurse reminds the 55-year-old woman that the American Cancer Society (ACS) recommendation for persons older than 50 years is to have an annual:
a. fecal occult blood test.
b. sigmoidoscopy.
c. Pap smear.
d. pelvic examination.
4. The nurse is aware that the most common health threat for the older adult, regardless of ethnicity, is:
a. hypertension.
b. cancer.
c. diabetes.
d. glaucoma.
5. The statement that would put the older woman most at ease during the lengthy health interview
would be:
a. This interview will take about an hour.
b.Please have a seat over there across from the desk.
c.There are 75 questions we need to get answered in the next hour.
d.The bathroom is behind that green door. Well be taking a break in about 30 minutes.
6. To establish rapport, the nurse should initiate the health interview by saying:
a. Hello, Mrs. Smith. My name is Alice. Well start with a few questions before the physical exam.
b.Welcome, Sara. Im Alice. Lets get down to some questions about your health.
c.Im Alice Jones. Im here to do an interview about your health.
d.Hey, Mrs. Smith! Are you ready for some questions about your health?
7. The 94-year-old woman has come to the health assessment interview with her 70-year-old daughter, who answers all the interview questions for her mother. The nurses best approach to this situation would be to:
a. say, Im speaking to your mother. Please let her answer for herself.
b. continue to interact with the daughter to facilitate completion of the interview.
c. look directly at the patient and say, Mrs. Smith, now Id like to hear from you about your health.
d. document that all answers to the interview came from a third party.
8. The most effective method of building rapport is to open the health interview with:
a. focusing on the problems that the patient sees as important.
b. explaining the importance of health maintenance.
c. informing the patient of the number of questions that will be asked.
d. reassuring the patient that the interview is private.
9. When interviewing a 90-year-old Chinese woman who is accompanied by her daughter, the
interviewer should:
a. use direct, short questions.
b. address all the questions to the daughter.
c. use pictures of body systems rather than anatomical terms.
d. use social conversation and indirect questions.
10. The nurse appropriately uses a variety of communication techniques during the health interview,
which include:
a. using medical terminology.
b. keeping questions simple.
c. helping patients by finishing their sentences.
d. allowing patients to ramble as they respond.
Chapter 09: Meeting Safety Needs of Older Adults
1. The nurse cautions the older man who has diminished depth perception that he will have diculty:
a. judging the height of steps.
b. reading small print on food labels.
c. reading street signs.
d. seeing in dim light.
2. The home health nurse helps the family improve the safety of the environment for the 85-year-old male patient with Parkinson disease who is at risk for falls related to:
a. postural hypotension.
b. cognitive changes.
c. altered vision.
d. altered gait.
3. The nurse reminds the older adult who is taking drugs for hypertension that to prevent falls from orthostatic hypotension, the patient should:
a. ambulate with a walker.
b. avoid hot baths.
c. avoid climbing stairs.
d. sit on the side of the bed for a moment before ambulation.
4. The nurse is aware that some older adults deny that they have fallen because they fear that they will:
a. fall again.
b. be hospitalized for treatment.
c. be seen as frail and dependent.
d. be considered clumsy.
5. After the 82-year-old female patient fell in her home, the home health nurse interviewed her about the incident because the information will:
a. be reected in the home health nurses documentation.
b. help the patient gain insight into the cause of the fall.
c. be used to guarantee no further falls.
d. be collected for research purposes.
6. The nurse is aware that a fall prevention exercise program for the residents in a long-term care
facility is focused on:
a. improving balance.
b. use of assistive devices.
c. improving circulation.
d. increase in the knowledge base about falls.
7. The daughter of an older adult asks the home health nurse for advice in selecting a cane for her 80-year-old mother, who has an unsteady gait. The cane that would be least appropriate would be a:
a. wooden cane with a rubber tip.
b. four-footed cane with a rubber grip.
c. clear acrylic cane with a nonslip tip.
d. colorful carved cane with a wooden tip.
8. A caring home health nurse has given his 90-year-old patient a framed poster that says, Pride goeth before a fall to remind his patient to:
a. take care not to fall.
b. ask for assistance when needed.
c. take pride in his independence.
d. not attempt any activity without help.
9. The nurse in a long-term care facility teaches tai chi for 15 minutes a day to the residents to:
a. stimulate their intellectual activity.
b. encourage interaction.
c. improve coordination.
d. demonstrate cultural awareness.
10. The home health nurse assesses the home for potential fire hazards and identifies the hazard of:
a. baking soda near the stovetop.
b. a smoke detector in the kitchen.
c. multiple appliances plugged into one outlet.
d. extension cords coiled up behind furniture.
Chapter 10: Cognition and Perception
1. The nurse claries that perception diers from cognition in that perception refers mainly to:
a. intellect.
b. memory.
c. judgment.
d. interpretation.
2. The nurse suspects the presence of cataracts in the older adult when the patient:
a. holds the newspaper a good distance away while attempting to read small print.
b. seeks an area in a room that is free from glare in order to read the newspaper.
c. holds a hand over one eye while attempting to read small print.
d. uses only peripheral vision while attempting to read a newspaper.
3. The nurse approaching a patient who has profound hearing loss should:
a. knock on the door before entering.
b. touch the patient on the hand to gain attention.
c. give the patient a list of interventions that the nurse plans to perform.
d. speak in a higher tone of voice.
4. When attempting to communicate with a patient who is hearing-impaired, the nurse should
remember to:
a. keep the message simple.
b. provide lengthy explanations and information.
c. assume understanding if the patient does not ask for clarication.
d. use many hand gestures.
5. In adapting the environment for a person with right-sided hemianopsia, the nurse should:
a. approach the patient from the right side.
b. arrange personal articles on the left side of the bed.
c. remind the patient to avoid turning his or her head to reduce added perceptual problems.
d. touch the patient on the right side to get his or her attention.
6. The night nurse hears a high whistling noise coming from the hearing aids that are lying on the
bedside table of the sleeping patient. The nurse should:
a. replace the hearing aids in the patients ears.
b. turn o the hearing aids.
c. place the hearing aids in a drawer to prevent loss.
d. ask that an audiologist be notied of the problem.
7. The nurse interprets a patients behavior changes as being characteristic of delirium because:
a. the onset of the behavior was rapid.
b. there is no change in the level of consciousness.
c. of the absence of disorientation.
d. of the absence of hallucinations.
8. The nurse is aware that conditions that can cause delirium in the older adult include:
a. uncontrolled pain.
b. death of a loved one.
c. relocation to a long-term care facility.
d. altered sleep patterns.
9. The nurse recognizes a cardinal indicator that the patient with stage 1 dementia has deteriorated to stage 2 by the presence of:
a. inability to communicate.
b. incontinent episodes.
c. total dependency.
d. forgetfulness.
10. The nurse can provide continuity for the demented patient in a general hospital by:
a. keeping the patient in the room.
b. reducing environmental stimuli such as the TV or radio.
c. assigning the same personnel every day for care.
d. attaching a bed alarm to the patient.
Chapter 11: Self-Perception and Self-Concept
1. The nurse cautions a group of older adults that the greatest damage to self-worth is measuring self against:
a. internal ideals.
b. individual values.
c. external standards.
d. expressions of positive feedback.
2. The nurse is aware that a positive self-perception is largely dependent on the:
a. ability to control lifes choices.
b. financial success attained in life.
c. family relationships.
d. degree of wellness.
3. The nurse recognizes that a major indicator of a positive self-image in an older adult living in a long-term care facility is:
a. feeding self independently.
b. maintaining urinary continence.
c. having family visitors every week.
d. neat grooming and wearing fresh clothing.
4. The nurse explains that older adults often resort to cosmetic surgery to maintain the appearance of youth and self-worth because the concept of ageism has painted old age as:
a. an inactive population of self-indulgent persons.
b. a group that has opted to isolate themselves.
c. physically inept and nonproductive.
d. an antisocial but active group.
5. The long-term care facility nurse sees evidence that the most devastating blow to the self-concept of the older adult is institutional placement because persons in a long-term care facility:
a. are perceived as a single group.
b. have individual needs that are not met.
c. have lost many belongings that made up their identity.
d. have lost social contact.
6. The nurse explains that the loss of emotional support of loved ones through death or separation makes the older adult feel:
a. unloved and unlovable.
b. angry with the isolation.
c. unworthy for attention.
d. determined to be his or her own support.
7. The nurse explains that long-term care facility placement for the older adult usually makes the older adult feel a sense of:
a. rejection.
b. safety.
c. making a fresh start.
d. immediate assistance at hand.
8. The admission nurse at the long-term care facility suggests that to help the older adult make an easier transition to relocation, the family should:
a. send cards or gifts instead of personal visits.
b. visit and call often to remind the resident that she or he is cared for.
c. limit contact for several weeks to encourage independence.
d. communicate with the long-term facilitys staff to inquire about the residents well-being.
9. The nurse takes into consideration that depression affects almost 50% of older adults who:
a. live at home with a spouse.
b. live alone.
c. live in a long-term care facility.
d. are hospitalized.
10. The nurse in a long-term care facility notes signs of depression in a resident who is ordinarily positive. The nurse suspects this new affective change is related to the initiation of a drug protocol of:
a. erythropoietin.
b. corticosteroids.
c. calcium replacement.
d. broad-spectrum antibiotics.
Chapter 12: Roles and Relationships
1. The nurse defines a role as a(n):
a. positive standard of behavior.
b. accepted behavior standard.
c. sexually linked standard.
d. unchangeable standard.
2. The nurse is aware that the status of any role is based on:
a. age.
b. responsibility.
c. society.
d. health.
3. The nurse points out that a homogeneous society is one in which members:
a. share a common cultural history.
b. are diverse in role expectation.
c. have conflicted role status.
d. may choose or change role performance.
4. The man who has the role of father, husband, professional businessman, son, and community leader may experience:
a. role confusion.
b. isolation.
c. internal role conflict.
d. diminished self-esteem.
5. The nurse is aware that the older man who retires from his work and changes his role status will have fewer adjustment problems primarily on the basis of whether he:
a. is financially secure.
b. has other roles and relationships.
c. is healthy.
d. has a supportive family.
6. The nurse assesses that although the college professor has retired, he still perceives himself as an educator and retains his academic title and professional association membership as a support to his:
a. altered self-image.
b. unchanged role as an educator.
c. substitution for employment.
d. habitual professional behavior.
7. The nurse identifies the older adult who is most likely to experience problems with role changes as the:
a. 65-year-old grandmother who cares for her grandchildren while the mother works.
b. 70-year-old retired business owner who comes to help his son run the business.
c. 75-year-old retired physician who volunteers at a medical screening clinic.
d. 80-year-old retired school administrator who takes educational foreign cruises several times a year.
8. The recently widowed 65-year-old man has told the nurse that he is so lost without his wife that he is planning to retire, sell his home, and move to a retirement village in another state. The nurse is aware that such a plan is:
a. positive, because it represents a new beginning.
b. positive, because it allows him more time to resolve his grief.
c. risky, because he is giving up significant supports to his self-image and grief resolution process.
d. negative, because he has not thought his plan through.
9. The older adult asks the nurse what is meant by the term roleless role. The nurse explains that it refers to persons who perceive:
a. that the roles that gave life meaning are gone.
b. old age as freedom to design new roles and relationships.
c. that roles must be maintained, regardless of their lack of significance.
d. that roles can be altered to meet and diminish damage to the self-image.
10. The nurse recognizes that the bereaved widow has entered the searching and yearning stage of grief when she exhibits:
a. renewed interest in social activities.
b. signs of depression.
c. making plans for the future.
d. denial of the loss of her husband.
Chapter 13: Copin and Stress
1. The nurse is aware that stress-related physical, behavioral, and cognitive changes are more likely to occur when the stress:
a. has a sudden onset.
b. is low level but constant.
c. is varied and cumulative.
d. is suppressed or denied.
2. The nurse is aware that in the first stage of the general adaptation syndrome (GAS), the body responds by:
a. decreasing the heart rate.
b. constricting peripheral vessels.
c. decreasing blood glucose levels.
d. decreasing blood pressure.
3. An extremely stressed woman is in the emergency department after a car wreck. She is breathing rapidly and complains of dizziness and tingling in her extremities. She says, I think Im having a heart attack! The nurse recognizes these complaints as being related to:
a. a transient ischemic attack.
b. hyperventilation.
c. hypotension.
d. asthma.
4. The student sitting in class waiting for the final examination develops nausea and excessive gas. The nursing instructor is aware that these symptoms are caused by a stress-related:
a. increase in the blood glucose level.
b. release of hormones.
c. reduction of peristalsis.
d. decrease in adrenalin.
5. The nurse recognizes a stress-related urinary symptom when the patient complains:
a. I have to urinate every 10 minutes, and there are only a few drops.
b. I havent had to urinate for the past 8 hours.
c. I void large amounts of urine every 2 hours.
d. My urine has absolutely no color. It looks like water.
6. The nurse explains that mild stress can cause a person to be:
a. indecisive.
b. excessively alert.
c. unable to focus.
d. ineffective in problem solving.
7. The nurse explains that in the general adaptation syndrome (GAS), after the first alarm reaction has been successfully resolved, the following stage, when the body systems return to normal, is the state of:
a. regeneration.
b. resistance.
c. restoration.
d. reorganization.
8. An 80-year-old man recently became widowed, moved into a long-term care facility, and had to quit driving. He complains of fatigue and is irritable when questioned about his health. The nurse should:
a. suggest he take a daytime nap and go to bed early.
b. report the complaints as expected adjustments to relocation.
c. approach him to talk about his perceptions related to his relocation.
d. suggest that he find some quiet time in the facilitys library and read a book.
9. The nurse assesses a behavior as a sign of depression in the new admission to a long-term care facility when the resident exhibits disorganization and:
a. frequently comes to breakfast only partially dressed.
b. eats excessive amounts of food at mealtime.
c. socializes with only three or four other residents.
d. arranges daily activities in order to able to watch Jeopardy at 4:30.
10. The nurse is aware that physical illness increases stress in many older adults because physical illness:
a. is an acceptable reason to request relief.
b. takes away energy to cope with new stressors.
c. stimulates the family to be more attentive.
d. most often has a clear pharmaceutical remedy.
Chapter 14: Values and Beliefs
1. It is believed that a persons value system is well established by age:
a. 5.
b. 8.
c. 10.
d. 12.
2. The culturally sensitive nurse is aware that in caring for a patient with a different value system, the nurse should:
a. be open and nonjudgmental.
b. treat all patients the same without concern for their value system.
c. explain the differences between the two value systems.
d. abandon their own value system.
3. When the 80-year-old Orthodox Jewish man dies in the hospital, the nurse should:
a. notify the rabbi to send a member of the synagogue to stay with the body.
b. inform the mortuary about the desire of the patient to be cremated.
c. prepare the body for the ritual bath by temple members before embalming.
d. facilitate removal of the body because the burial must take place 48 hours after death.
4. The nurse is careful not to remove the yarmulke from the head of the Jewish man during care because it is a symbol of:
a. having been circumcised.
b. the belief that God is higher than man.
c. Gods endless love and protection.
d. the justice of Talmudic law.
5. When checking the diet trays, the nurse identifies a menu choice that would be culturally inappropriate for the Muslim patient as:
a. fish and tomatoes.
b. liver and onions.
c. chicken and broccoli.
d. pork chops and sweet potatoes.
6. The home health nurse caring for an 85-year-old Hispanic woman anticipates that the patient will want to seek health advice from the:
a. local pharmacist for prescription drugs.
b. folk healer (curandero).
c. priest of her church.
d. close family members.
7. Included in the Native Americans spiritual beliefs is that:
a. there is no life after death.
b. all things in the world have a spirit.
c. after death, the spirit stays as part of the tribe.
d. the spirit world is the protector of health.
8. The nurse anticipates that the 80-year-old African American woman believes that her health will be improved by:
a. eating fresh fruits and vegetables.
b. daily Bible reading.
c. a visit from her pastor to pray for her recovery.
d. the close attendance of her family.
9. The basic and most important way for the nurse to become culturally sensitive is:
a. interaction with persons of another culture.
b. increasing personal knowledge of another culture.
c. remaining open-minded.
d. reading materials about other cultures.
10. The home health nurse is aware that the conservative economic values of the 85-year-old will lead the older adult to:
a. use credit cards rather than cash.
b. hoard old prescription drugs for later use.
c. seek the care of a physician frequently.
d. seek to qualify for food stamps.
Chapter 15: End-of-Life Care
1. The home health nurse encourages the older adult to file an advance directive to indicate:
a. the degree of intervention desired for life support.
b. who is to manage medical decisions in case of debilitating illness.
c. who will manage finances in case of debilitating illness.
d. the mortuary to be used in the case of death.
2. The patient is attempting to make an informed decision about whether to have a life-extending treatment done. The essential piece of information that is significant in the decision is:
a. whether the quality of life will improve after the procedure is done.
b. the cost of the treatment.
c. the amount of time treatment will take.
d. whether insurance will cover the cost of treatment.
3. The totally competent 76year-old female with terminal cancer is fatigued and tearful about the ineffectiveness of her treatment. She tells the nurse that she wishes she had never started it but now feels obligated to continue. The nurse explains that:
a. once treatment has begun, the doctor should decide about any changes.
b. she may change her mind about treatment at any time.
c. decisions about treatment should be made by the person who is her medical power of attorney.
d. cessation of treatment will shorten her life.
4. Professional health care providers may neglect to educate patients about end-of-life care because they:
a. fear that patients will perceive that they are giving up.
b. do not want to influence the patient in any decision.
c. want to keep up the patients morale.
d. believe that death is a personal failure on their part.
5. The home health nurse is firm with an 86year-old man with terminal illness that he needs to file an advance directive to:
a. demonstrate understanding of his imminent death.
b. comply with most hospital policies.
c. clarify treatment protocols.
d. spare his family the burden of making end-of-life decisions.
6. The nurse is aware that hospice care can be made available to terminal patients who:
a. have a life expectancy of only 12 months.
b. are Medicaid-qualified.
c. agree to palliative measures.
d. are hospitalized.
7. The dying patient with terminal liver cancer says to the nurse, Im going to take a long time to die, arent I? Im going to get sicker and weaker every day. The nurses best response would be:
a. Your type of cancer is usually fatal in 4 to 6 months.
b. I dont want to hear this kind of negative talk. Make use of the time you have.
c. We have many medications that can make you feel better.
d. What concerns you the most about dying?
8. The distraught wife of a terminally ill patient complains to the nurse, My husband has not been shaved, and he has that miserable gown on instead of his own pajamas. Dont you people care about things like that? The nurses best response would be:
a. I delayed his morning care because he was sleeping comfortably. Ill complete his care now that hes awake.
b. Were running late today and I have six other patients to care for. What do you want?
c. Of course we care! Someone will come to do his care before lunch.
d. Im sorry you feel were doing such a poor job. Im doing my best.
9. When the nurse becomes tearful at the death of a patient, the nurse should:
a. leave the room so that the family will not witness the unprofessional behavior.
b. touch the hand of the daughter and say, Well miss your dad.
c. become occupied with rearranging a floral bouquet until emotions are under control.
d. discontinue the oxygen, turn off the IV, and say, Im sorry for your loss.
10. The nurse notes that a cardiovascular sign of impending death is:
a. Cheyne-Stokes respiration.
b. bounding pulse.
c. bluish mottling of extremities.
d. widening pulse pressure.
Chapter 16: Sexuality and Aging
1. The nurse is aware that sexuality:
a. becomes absent with age.
b. remains part of life until death.
c. as expressed through intercourse is not possible after the age of 65 years.
d. must be expressed in sexual intercourse.
2. The nurse counsels the 70year-old female who has remained on hormone replacement therapy (HRT) that she needs to have a:
a. semiweekly douche to wash out cervical debris.
b. liver function assessment annually.
c. mammogram biannually.
d. Pap smear annually.
3. The nurse evaluates a need for further instruction to reduce the symptoms of vaginal dryness when the 70year-old patient says:
a. Vaseline was good enough for my mother. Its good enough for me.
b. I use a water-soluble lubricant to aid intercourse.
c. Im trying an estrogen cream to see if it works.
d. Ill let you know how wild yams work for vaginal dryness.
4. The nurse identifies the person most likely to experience erectile dysfunction as the 65year-old who has _____ sexually active in earlier years.
a. diabetes and was very
b. irritable bowel syndrome and was minimally
c. chronic pancreatitis and was very
d. osteoarthritis and was moderately
5. The 65-year-old male who, although he is having painful symptoms related to a benign enlargement of the prostate, refuses to consider a prostatectomy because he fears that the surgery will make him impotent. The nurse reassures him that:
a. a prostatectomy will enhance sexual function.
b. new techniques for a prostatectomy do not damage nerves.
c. the prostate has nothing to do with erection or seminal fluid production.
d. impotence following a prostatectomy is entirely psychological.
6. The 70-year-old woman who is considering coming off of hormone replacement therapy (HRT) for the reduction of postmenopausal discomfort asks the nurse what advantage is offered by tamoxifen, also called a designer estrogen. The nurses best response is that tamoxifen:
a. provides estrogen to some tissues while acting as an antiestrogen to others.
b. has no side effects.
c. needs to be taken only once a week.
d. improves the skin turgor and complexion.
7. The nurse teaches that some persons have found relief from postmenopausal discomfort by using phytoestrogens, which act as estrogens on some tissue and antiestrogens on others. Phytoestrogens are found in:
a. mangos.
b. soybeans.
c. broccoli.
d. lima beans.
8. The nurse recognizes a need for further instruction about sexual activity when the 65year-old man who had a myocardial infarction 6 months ago says:
a. Im enjoying the same sexual activities now as I did before my heart attack.
b. Im still pretty cautious, but our sex lives are very satisfactory.
c. Ive been told that Im at risk for another heart attack if we have sex.
d. My heart medications have made me impotent, but weve found other methods of sexual expression.
9. The nurse makes it clear to older adults in a long-term care facility that condoms are available from the medicine cart on request to:
a. guarantee safe sex practices.
b. reduce the incidence of sexually transmitted diseases (STDs).
c. show acceptance of sexual expression.
d. prevent soiling bed linens or furniture.
10. The home health nurse stresses to the 70-year-old gay man who has been in a monogamous relationship for 20 years that it is especially important to name his partner as his medical power of attorney (POA) and file advance directives because:
a. all persons older than 60 years should have a medical POA and advance directives.
b. gay and lesbian couples are estranged from their families.
c. life partners frequently abandon unions when terminal illness occurs.
d. life partners have no legal standing and can be prohibited from medical decisions by family.
Chapter 17: Care of Aging Skin and Mucous Membranes
1. When the older adult complains of the multiple raspberry-colored bruises on his extremities (senile purpura), the nurse explains that these colorful marks of increasing age are the result of:
a. arteriosclerotic changes in the vessels.
b. prolonged clotting time.
c. fragility of capillary walls.
d. reduction of subcutaneous fat.
2. The nurse assesses an area of skin on the patients upper thigh that is different in appearance than the surrounding skin. The documentation that is most informative is:
a. red area on upper right thigh. Patient denies discomfort.
b. erythematous scaly patch 2 2 cm on lateral aspect of right thigh. Patient denies pain.
c. painless red patch on right thigh 2 2 cm.
d. medium-size red scaly patch on right thigh. 0 drainage. 0 pain.
3. The nurse is aware that progressively graying hair is caused by:
a. reduced melanocytes.
b. altered blood circulation to the scalp.
c. decreased density of hair.
d. environmental factors.
4. When the assessment of a patients toenails reveals brittle thick nails with longitudinal lines in the nail, the nurse should assess for:
a. fungal infection of the toenails.
b. pedal pulses.
c. history of gout.
d. intake of dietary calcium.
5. The 80-year-old woman newly admitted to a long-term care facility complains of intense itching in her axillae and antecubital fossa. There are small red lesions in linear patterns. These are all signs of:
a. rosacea.
b. keratosis.
c. pruritus.
d. scabies.
6. The nurse reminds the CNAs that to prevent skin trauma from shearing force, the patients must:
a. be slid across the bed linens to change position.
b. have generous amounts of lotion applied to the skin.
c. be lifted on draw sheets when being pulled up in bed.
d. have frequent tub baths to soften the skin.
7. To prevent pressure ulcers in the bedridden patient, the most effective intervention would be to:
a. perform skin assessment every day.
b. use a drawsheet to move the patient.
c. change the patients position every 2 hours.
d. remove wet bed linen promptly.
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
8. The admitting nurse gives the new long-term care facility resident a score of 20 on both the Norton Risk Assessment Scale and the Braden Scale for Predicting Pressure Sore Risk. These scores indicate that the resident has:
a. a high probability of developing a pressure ulcer.
b. a moderate risk of developing a pressure ulcer.
c. a low risk of developing a pressure ulcer.
d. at least one pressure ulcer at the time of admission.
9. On the admission assessment of an 80-year-old to a long-term care facility, the nurse notes that the residents toenails are dark, thick, and brittle; extremely misshapen; and growing at an angle from the toe. The nurse recognizes these as signs of _____ nails.
a. fungal infection of the
b. rams horn
c. ingrown
d. expected age-related changes in the
10. The home health nurse suggests to the 80-year-old woman that to reduce the pruritus from dry skin, the patient should change her bathing schedule to:
a. a hot shower every night before going to bed.
b. a cool shower every morning using a detergent soap.
c. a soak in a warm sudsy bath, leaving a film of soap on the skin.
d. one shower a week, with sponge baths in between.
Chapter 18: Elimination
1. To encourage a normal daily bowel movement, the nurse can aid the older adult by:
a. decreasing fluid intake.
b. providing a warm beverage at breakfast.
c. medicating with a mild laxative at bedtime.
d. providing a warm shower each morning.
2. The nurse assesses constipation in the patient who passes:
a. firm stool without difficulty every 3 days.
b. hard stool without difficulty every 2 days.
c. soft brown stool with difficulty every 2 days.
d. hard dry stool with difficulty every 3 days.
3. The nurse recognizes a need for instruction about prevention of constipation when the patient says:
a. I eat bran flakes or oatmeal every day to add bulk to my diet.
b. Since I started eating three servings of fruit a day, I havent been constipated.
c. Im never constipated. I take a gentle laxative every night.
d. My daily walks have kept my bowels working regularly.
4. The nurse explains that a diet low in dietary fiber results in a small stool that:
a. moves rapidly through the intestines.
b. becomes excessively dry.
c. overstimulates the defecation reflex.
d. contributes to frequent bowel movements.
5. The nurse would be especially observant for the indication of constipation in the patient who is taking:
a. antibiotics for an upper respiratory infection.
b. hormones for postmenopausal symptoms.
c. iron supplements for anemia.
d. nonsteroidal inhalants for chronic obstructive pulmonary disease (COPD).
6. The nurse explains that the urge to defecate (defecation reflex) can be destroyed by:
a. frequent episodes of diarrhea.
b. long-term use of vitamin A and vitamin B complex.
c. repeatedly ignoring the urge.
d. excessive fiber and bulk in the diet.
7. The nurse recognizes a need to make a focused bowel assessment when the 80-year-old resident complains of:
a. the inability to have a bowel movement every day.
b. feeling pressure and fullness in the rectum but is unable to defecate.
c. having had one loose stool after breakfast.
d. ingestion and flatulence.
8. The nurse uses special caution when performing a rectal digital examination on a patient with:
a. chronic obstructive pulmonary disease (COPD).
b. diabetes.
c. Parkinson disease.
d. congestive heart failure.
9. To assist an 85-year-old older adult with weak abdominal muscles to defecate, the nurse would:
a. encourage the use of a bedpan before getting up in the morning.
b. place a footstool under the feet of the patient when seated on the toilet.
c. insert a finger in the patients rectum to stimulate the urge to defecate.
d. instruct the patient to do isometric exercises to strengthen the abdominal muscles.
10. The nurse tells the older adult that a food with the double action of providing fiber and being a natural laxative is:
a. oatmeal.
b. pineapple.
c. prunes.
d. raw apple.
Chapter 19: Activity and Exercise
1. The nurse explains that the slowed speed of nerve impulses will cause the older adult to:
a. get a scrambled message in the brain.
b. take longer to complete an activity.
c. become confused.
d. forget how to complete the activity.
2. The nurse takes into consideration that the arthritic patient may be less likely to exercise because:
a. fragility of the bones puts the patient at risk for fractures.
b. numbness in the feet and legs puts the patient at risk for a fall.
c. stiffened ligaments and tendons put the patient at risk for reduced flexibility.
d. moving heavy edematous limbs puts the patient at risk for fatigue.
3. The home health nurse recognizes that the 75-year-old male patient has made an adjustment to reduced stamina when he:
a. moved his home office to a downstairs location.
b. used public transportation rather than driving his own car.
c. tilled the garden plot with a motor-driven tiller.
d. went to a senior center twice in 1 week to play dominoes.
4. The nurse explains that the focus of aerobic exercises such as walking and biking is to:
a. improve cardiovascular function.
b. build muscle mass.
c. improve dexterity.
d. enhance balance.
5. The nurse suggests to the 70-year-old woman who has painful arthritic joints that a beneficial exercise for her because of disability would be:
a. training with hand weights.
b. walking on a treadmill.
c. low-impact aerobics.
d. swimming.
6. When the older adult confides to the home health nurse that he wants to build muscle mass so that he can look good at the apartment pool, the nurse recommends _____ exercise.
a. aerobic
b. stretching
c. resistance
d. tai chi
7. When the 65-year-old patient who is a type 1 diabetic informs the home health nurse that he now exercises for 1 hour a day at a club, the nurse cautions him to be sure to:
a. drink plenty of fluids.
b. wear clothing that allows ventilation.
c. take hard candy to the gym when he exercises.
d. give himself less insulin than is prescribed.
8. The nurse directs an 80-year-old recovering from a fractured pelvis to participate in several isometric exercises to maintain muscle strength, such as:
a. alternately tightening and relaxing the abdominal muscles.
b. lifting the body up off the bed using an overhead trapeze.
c. pushing against the bed to lift the buttocks off the bed a few inches.
d. pressing the sole of the foot against a footboard.
9. Because isometric and isotonic exercises can cause the patient to perform an accidental Valsalva maneuver, the nurse coaches the patient to:
a. hold the breath during an exercise cycle.
b. breathe through the mouth.
c. breathe deeply and rhythmically during an exercise cycle.
d. breathe in through the nose and out through the mouth.
10. Balance training will help the older adult recovering from a prolonged period of immobility related to a broken hip to:
a. increase peripheral circulation.
b. increase strength.
c. decrease the incidence of falls.
d. eliminate the need for ambulatory assistive devices.
Chapter 20: Sleep and Rest
1. The nurse is aware that the initial entry to deep sleep is:
a. stage 1 nonrapid eye movement (NREM).
b. stage 3 NREM.
c. stage 5 NREM.
d. rapid eye movement (REM) sleep.
2. The phenomenon of sleep walking is most likely to occur in the sleep stage of:
a. stage 1 NREM.
b. stage 2 NREM.
c. stage 4 NREM.
d. REM sleep.
3. The nurse explains that older adults often experience a disturbed sleep-wake cycle because of hormonal changes, which include a(n) _____ level.
a. increase in angiotensin
b. decrease in insulin
c. increase in growth hormone
d. decrease in melatonin
4. The older man in a long-term care facility consistently wakes at 3 AM and does not return to sleep. The nurse records this behavior as _____ insomnia.
a. sleep initiation
b. sleep maintenance
c. terminal
d. undifferentiated
5. The newly admitted older adult who cannot fall asleep and asks for a sedative every night is most probably experiencing a difficulty with sleep:
a. initiation related to anxiety of relocation.
b. maintenance related to unfamiliar environment.
c. initiation related to depression associated with relocation.
d. maintenance related to episodes of nocturnal movement disorders.
6. The home health nurse assesses that the patient is probably experiencing myoclonus when his wife says:
a. His loud snoring and jerking awake wakes me up, too.
b. I am black and blue from his kicking me every night.
c. He wakes up at 2 AM every morning and walks around the house.
d. His constant leg movements tear up the covers and keep me awake.
7. The nurse would question the order for lorazepam (Ativan), 5 mg at bedtime, for a patient with:
a. chronic obstructive pulmonary disease (COPD).
b. any form of dementia.
c. hypertension.
d. sleep apnea.
8. In order to assist a 75-year-old male resident in a long-term care facility to decrease his problems with sleep initiation, the nurse would:
a. provide a heavy snack at bedtime.
b. reschedule the 8 PM albuterol inhalation treatment to 4 PM.
c. coach the resident in 10

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