Gerontological Possible Question

1. The term geriatric refers to what type of adult patient?

a. Those in nursing homes

b. Nursing home patients over 65
c. Any adult patient 65 or older
d. Adult patients 85 or older
Rationale: The term geriatric refers to what type of adult patient?

2. Which group has the highest rate of depression, and suicide?

a. Men 65 and older
b. Women 65 and older
c. Men 65 and older who are widowers
d. Women 65 and older who are widows
3. The average number of medications taken daily by an older adult patient who does not
live in an institution is ____.
a. 2-3
b. 8-9
c. 4-5
d. 6
4. What percent of all sensory information is received through the eyes.
a. 70
b. 45
c. 91
d. 57
5. A 66-year-old recently widowed patient with limited income is planning to move into the
home of her daughter and son-in-law and their two adolescent children in order to share
expenses, and she is concerned about the transition and a lack of independence. The
best advice is for the patient to
a. Accept the changes in her life.
b. Apply for low-cost housing elsewhere.
c. Set the ground rules for living together.
d. Have a frank discussion with the family.
Rationale: D: If a 66-year-old recently widowed patient with limited income is planning to move
into the home of her daughter and son-in-law and their two adolescent children in order to share
expenses and is concerned about the transition and lack of independence, the best advice is for
the patient to have a frank discussion with the family. Before the move, the patient and family
should discuss such issues as how expenses, duties, and responsibilities will be shared; how
private space will be allocated; and how privacy will be respected.
6. If a patient is severely dehydrated, what effect will this have on the complete blood count
(CBC)?
a. Increased hemoglobin and hematocrit, decreased blood volume, and stable
red blood cell (RBC) count.
b. Decreased hemoglobin and hematocrit, decreased blood volume, and increased
RBC count.
c. Decreased hemoglobin and hematocrit, decreased blood volume, and decreased
RBC count.
d. Stable hemoglobin and hematocrit decreased blood volume and stable RBC
count.
Rationale: A: If a patient is severely dehydrated, the effect this will have on the complete blood
count (CBC) includes the following:
• Increased hemoglobin and hematocrit because the blood is more concentrated.

• Decreased blood volume because of the lack of adequate body fluids.
• Stable red blood cell (RBC) count.
7. The gerontological nurse is working in a mobile clinic to provide care to a homeless

population. Among the older adults in this population, the health problems that the
gerontological nurse most expects to find include.
a. psychiatric/substance abuse disorders.

b. neurological disorders.
c. digestive disorders.
d. traumatic injuries.
Rationale: A: Although older homeless adults often have myriad health problems, the most
common are psychiatric and substance abuse disorders. Many older adults initially became
homeless because of psychiatric disorders, such as schizophrenia, and they self-medicate
with drugs and/or alcohol. The substance abuse, in turn, leads to malnutrition, liver
disorders, digestive disorders, diabetes, and cardiovascular disorders and impacts
treatment because patients are often not reliable reporters and may be noncompliant with
treatment. The homeless may also move around, making follow-up difficult.
8. The woman in question 1 has no orthostatic drop in her blood pressures, and her
clinical exam does not reveal a cause for her fall (no focal neurological findings,
normal heart, lung, abdominal and musculoskeletal exam). The most appropriate
next step is:
a. A timed Get Up and Go Test.
b. referral to physical therapy.
c. A referral to occupational therapy.
d. Home safety evaluation
Rationale: A. A Timed Get Up and Go test (TGUAG) is a simple test that can be performed
quickly in a clinical setting. A patient is asked to sit on a standard non-wheeled chair, to fold
his/her arms, rise, walk 3 meters, turn around, and sit back down. This test evaluates lower
extremity and trunk muscle function, balance, gait speed, and neurological function. A time
of <20 seconds is adequate for independent transfers and mobility. A time of >30 seconds
suggests a higher risk of falls and functional dependence. Gait examination is a must in a
faller. The other measures may be appropriate, pending the gait assessment.
9. The nurse is performing an assessment on an older client who is having difficulty
sleeping at night. Which statement by the client indicates the need for further
teaching regarding measures to improve sleep?
a. "I swim three times a week."
b. "I have stopped smoking cigars."
c. "I drink hot chocolate before bedtime."
d. "I read for 40 minutes before bedtime."
Rationale: c) "I drink hot chocolate before bedtime."
Many nonpharmacological sleep aids can be used to influence sleep. However, the client
should avoid caffeinated beverages and stimulants such as tea, cola, and chocolate. The
client should exercise regularly, because exercise promotes sleep by burning off tension
that accumulates during the day. A 20-to 30-minute walk, swim, or bicycle ride three times a
week is helpful. The client should sleep on a bed with a firm mattress. Smoking and alcohol
should be avoided. The client should avoid large meals; peanuts, beans, fruit, raw
vegetables, and other foods that produce gas; and snacks that are high in fat because they
are difficult to digest.
- Test-Taking Strategy: Note the strategic words need for further teaching . These words
indicate a negative event query and ask you to select an option that is an incorrect
statement. Options A, B, and D are positive statements indicating that the client
understands the methods of improving sleep.
10. A visiting nurse who observes that the older male client is confined by his daughter-
in-law to his room. When the nurse suggests that he walk to the den and join the
family, he says, "I'm in everyone's way; my daughter-in-law needs me to stay
here." Which is the most important action for the nurse to take?
a. Say to the daughter-in-law, "Confining your father-in-law to his room is

inhumane."
b. Suggest to the client and daughter-in-law that they consider a nursing home
for the client.
c. Say nothing, because it is best for the nurse to remain neutral and wait to be
asked for help.
d. Suggest appropriate resources to the client and daughter-in-law, such
as respite care and a senior citizens' center.
Rationale: d) Suggest appropriate resources to the client and daughter-in-law, such as
respite care and a senior citizens' center.
Assisting clients and families to become aware of available community support

systems is a role and responsibility of the nurse. Observing that the client has begun to
be confined to his room makes it necessary for the nurse to intervene legally and ethically,
so option C is not appropriate and is passive in terms of advocacy. Option B suggests
committing the client to a nursing home and is a premature action on the nurse's part.
Although the data provided tell the nurse that this client requires nursing care, the nurse
does not know the extent of the nursing care required. Option A is incorrect and
judgmental.
- Test-Taking Strategy: Note the strategic words most important. Using principles related to
the ethical and legal responsibility of the nurse and knowledge of the nurse's role will
direct you to the correct option. Option A is a nontherapeutic statement, option B is a
premature action, and option C avoids the situation.
11. The nurse is performing an assessment on an older adult client. Which assessment
data would indicate a potential complication associated with the skin?
a. Crusting
b. Wrinkling
c. Deepening of expression lines
d. Thinning and loss of elasticity in the skin
Rationale: a) Crusting
The normal physiological changes that occur in the skin of older adults include thinning of
the skin, loss of elasticity, deepening of expression lines, and wrinkling. Crusting noted on
the skin would indicate a potential complication.
- Geriatric Nursing Exam Questions Test-Taking Strategy: Note the subject , a potential
complication. Think about the normal physiological changes that occur in the aging process
to direct you to the correct option.
12. The home health nurse is visiting a client for the first time. While assessing the
client's medication history, it is noted that there are 19 prescriptions and several
over-the-counter medications that the client has been taking. Which intervention
should the nurse take first?
a. Check for medication interactions.

b. Determine whether there are medication duplications.
c. Call the prescribing health care provider (HCP) and report
polypharmacy.
d. Determine whether a family member supervises medication administration
Rationale: c) Call the prescribing health care provider (HCP) and report polypharmacy.
Polypharmacy is a concern in the older client. Duplication of medications needs to be

identified before medication interactions can be determined because the nurse needs to
know what the client is taking. Asking about medication administration supervision may be
part of the assessment but is not a first action. The phone call to the HCP is the intervention
after all other information has been collected.
- Test-Taking Strategy: Note the strategic word first . Also note that the nurse is visiting the
client for the first time. Options A, C, and D should be done after possible medication
duplication has been identified.
13. The long-term care nurse is performing assessments on several of the residents.
Which are normal age-related physiological change(s) the nurse expects to note?
Select all that apply.
a. Increased heart rate
b. Decline in visual acuity
c. Decreased respiratory rate
d. Decline in long-term memory
e. Increased susceptibility to urinary tract infections
f. Increased incidence of awakening after sleep onset
Geriatric Nursing Exam Questions Rationale: Anatomical changes to the eye affect the individual's
visual ability, leading to potential problems with activities of daily living. Light adaptation and visual
fields are reduced. Although lung function may decrease, the respiratory rate usually remains
unchanged. Heart rate decreases and heart valves thicken. Age-related changes that affect the
urinary tract increase an older client's susceptibility to urinary tract infections. Short-term memory
may decline with age, but long-term memory usually is maintained. Change in sleep patterns is a
consistent, age-related change. Older persons experience an increased incidence of awakening
after sleep onset.
- Test-Taking Strategy: Focus on the subject , normal age-related changes. Read each characteristic
carefully and think about the physiological changes that occur with aging to select the correct items.
14. The healthcare provider is performing an assessment on a patient who is taking

propranolol (Inderal) for supraventricular tachycardia. Which assessment finding is an
indication the patient is experiencing an adverse effect of this drug?
a. Dry mouth
b. Bradycardia
c. Urinary retention
d. Paresthesia
Rationale: b) Bradycardia- Propranolol is a nonselective beta-adrenergic antagonist
15. Which medication will decrease the heart rate and prolong the action potential and
refractory period?
a. Potassium channel blocker
b. Adrenergic agonist
c. Sodium channel blocker
d. Sympathomimetic
16. A patient is being discharged after the insertion of a permanent pacemaker. Which
statement made by the patient indicates an understanding regarding appropriate self-
care?
a. Every morning I will perform arm and shoulder stretches
b. Each day I'll take my pulse and record it in a log
c. I'll have to get rid of my microwave oven
d. I won't be able to use my electrical blanket anymore.
Rationale: b) Each day I'll take my pulse and record it in a log Initially, patients should limit arm
and shoulder activity on the operative side to prevent dislodgment of the pacing leads.
Microwave ovens and electric blankets will not adversely affect the pacemaker. Tracking one's
pulse can help the patient know if the pacemaker is working properly
17. A patient who has experienced atrial fibrillation for the past 3 days is admitted to the
cardiac care unit. In addition to administering an antidysrhythmia medication, the
healthcare provider should anticipate which of these orders?
a. Initiate a heparin infusion
b. Give atropine IV push
c. Prepare for immediate cardioversion
d. Prepare the pt for AV node ablation
Rationale: a) Initiate a heparin infusion
The antidysrhythmic will help control rhythm and rate, so atropine (an anticholinergic) is not
indicated. Cardioversion or ablation is usually reserved for patients who have not responded to
antidysrhythmic medications. Because blood tends to pool and clot in the fibrillating atria,
patients with atrial fibrillation are at high risk for embolic stroke, so heparin will be given
18. The healthcare provider is caring for a patient with a diagnosis of hypomagnesemia and
a QT interval of 0.50 seconds. Which of these, if noted on the cardiac monitor, is an
indication the patient's condition is worsening?
a. Premature ventricular contractions
b. Narrow QRS complexes
c. An R-R interval of 1 second
d. A polymorphic ventricular tachycardia
Rationale: d) A polymorphic ventricular tachycardia

An R-R interval of 1111 second translates to a heart rate of 60606060 beats per minute, which is a
normal finding. A narrow QRS complex are associated with a variety of tachycardias, but is not
expected in this situation. The patient's history of hypomagnesemia and prolonged QT interval puts
the patient at risk of developing torsades de pointes, a polymorphic ventricular tachycardia that can
potentially degenerate into a ventricular fibrillation.
19. A patient with a diagnosis of Wolff-Parkinson-White syndrome is undergoing a catheter

ablation procedure. When caring for the patient after the procedure, which is the
priority intervention?
a. Assist the patient to the bathroom to void
b. Auscultate apical pulse for a full minute every hour
c. Monitor insertion site and distal pulses
d. Assess level of consciousness
Rationale: c) Monitor insertion site and distal pulses
The extremity where the catheter was inserted will be immobilized initially, so the patient will not
be allowed out of bed to use the bathroom. The patient will be on a cardiac monitor so
auscultation of the apical pulse for one minute is not a priority. Because the catheter may cause
trauma to the vessels, the healthcare provider will monitor for hematoma formation and
interference of circulation distal to the insertion site.
20. The healthcare provider is teaching a student about the cardiac cycle and how it relates
to the electrocardiogram (EKG). What will the healthcare provider tell the student about
the cardiac events that occur during the waveform contained in the shaded area of the
EKG?
T/F "Ventricular depolarization and atrial repolarization occur during this time."
Rationale: True. This is called the QRS complex The atrial repolarization occurs stimultaneously
and is masked by the Ventricular depolarization
21. The healthcare provider is examining the electrocardiogram (EKG) of a patient and
notes the PR interval is 6 small boxes in length. What is the significance of this finding?
a. Stress is causing increased sympathetic stimulation
b. This should be documented as an expected finding.
c. There may be some scar tissue in one of the ventricles.
d. There may be a delay in the conduction through the AV node.
Rationale: d) There may be a delay in the conduction through the AV node. The PR interval
reflects the time it takes for the atria to depolarize and for the action potential to travel through
the AV node and to His-Purkinje system. Each small box on the EKG graph paper equals 0.04
seconds. The normal PR interval is 0.12 - 0.20, point, 20 seconds, which is 3 to 5 small
boxes. This patient's PR interval is longer than normal, which is an indication of a delay in
impulse conduction through the AV node.
22. When caring for a patient with a cardiac dysrhythmia, which laboratory value is a priority
for the healthcare provider to monitor?
a. BUN and creatinine
b. Sodium, potassium, and calcium
c. Hemoglobin and hematocrit
d. PT and INR
Rationale: b) Sodium, potassium, and calcium. BUN and creatinine levels are always important
to monitor when giving any drug, not only antidysrhythmia drugs. The PT and INR will be
important for patients who are on warfarin (Coumadin). Because abnormalities in sodium,
potassium and calcium levels are likely to affect depolarization and repolarization of cardiac
cells, it is most important for the healthcare provider to monitor these laboratory values.
23. Risks and benefits are balanced when giving an antidysrhythmic drug to a treat a cardiac
dysrhythmia. When does the need for the drug outweigh the risks?
a. When there is impairment in cardiac output.
b. When the dysrhythmia becomes chronic.
c. If the heart rate is 50 to 60 beats per minute
d. After the heart rate reaches a rate faster than 100 beats per minute
Rationale: a) When there is impairment in cardiac output.

A heart rate less than 60 beats per minute is usually well tolerated in an otherwise healthy adult.
Because antidysrhythmic medications can cause new dysrhythmias or worsen existing
dysrhythmias, chronicity of a dysrhythmia is not the only consideration when weighing risks and
benefits. If ventricular pumping is impaired so that cardiac output is decreased, the benefits of
an antidysrhythmic mediation often outweigh the risks
24. While caring for a patient who is experiencing a postoperative hemorrhage, the
healthcare provider notes the rhythm observed on the electrocardiogram (EKG) does not
produce a pulse. Which actions should the healthcare provider initiate to resolve this
patient's problem?
a. Defibrillation
b. Administration of IV crystalloid
c. Administration of epinephrine
d. Cardiopulmonary resuscitation (CPR)
e. Administration of vasoconstrictors
f. Synchronized cardioversion
Rationale: D) Cardiopulmonary resuscitation (CPR)
The patient is experiencing pulseless electrical activity (PEA). PEA is not a shockable rhythm.
High-quality CPR should be started immediately. An important treatment for PEA is to address
the underlying cause. The underlying cause of PEA in this patient is hypovolemia, which can be
treated with IV fluids and vasoconstrictors, along with CPR and epinephrine.
https://www.khanacademy.org/test-prep/nclex-rn/nclex-practice-questions/nclex-rn-
questions/e/tachycardias-quiz-2
25. Which individual is at greatest risk for developing hypertension?

a. 45-year-old African American attorney
b. 60-year-old Asian American shop owner
c. 40-year-old Caucasian nurse
d. 55-year-old Hispanic teacher
Rationale: Answer: A: 45-year-old African American attorney The incidence of hypertension is

greater among African Americans than other groups in the US. The incidence among the
Hispanic population is rising.
26. At a community health fair, the blood pressure of a 62-year-old client is 160/96 mmHg.
The client states “My blood pressure is usually much lower.” The nurse should tell the
client to
a. go get a blood pressure check within the next 48 to 72 hours
b. check blood pressure again in two (2) months
c. see the healthcare provider immediately
d. visit the health care provider within one (1) week for a BP check
Rationale: Answer: A: go get a blood pressure check within the next 48 to 72 hours
The blood pressure reading is moderately high with the need to have it rechecked in a few days.
The client states it is ‘usually much lower.’ Thus a concern exists for complications such as
stroke. However, immediate check by the provider of care is not warranted. Waiting 2 months or
a week for follow-up is too long.
27. The hospital has sounded the call for a disaster drill on the evening shift. Which of these
clients would the nurse put first on the list to be discharged in order to make a room
available for a new admission?
a. A middle-aged client with a history of being ventilator dependent for over seven
(7) years and admitted with bacterial pneumonia five days ago.
b. A young adult with diabetes mellitus Type 2 for over ten (10) years and admitted
with antibiotic-induced diarrhea 24 hours ago.
c. An elderly client with a history of hypertension, hypercholesterolemia, and lupus,
and was admitted with Stevens-Johnson syndrome that morning.
d. An adolescent with a positive HIV test and admitted for acute cellulitis of the
lower leg 48 hours ago.
Rationale: Answer: A: A middle-aged client with a history of being ventilator dependent for over
7 years and admitted with bacterial pneumonia five days ago The best candidate for discharge
is one who has had a chronic condition and is most familiar with their care. This client in option
A is most likely stable and could continue medication therapy at home.
28. An 82 YO diabetic patient has an acute coronary syndrome and needs an emergency
coronary angiogram. Despite efforts to minimize the chances of acute kidney injury, the
patient develops reduced urinary output. The patient weighs 60 kg and after 12 hours
the RN calculated the urine output to be 20 ml/hour. Using the RIFLE criteria for acute
kidney injury (AKI), which of the following stages of AKI does this patient belong to?
a. Risk
b. Injury
c. Failure
d. Loss
e. End Stage
Rationale: Answer B. Injury. A urine output 4 weeks. End stage is complete loss of kidney
function for > 3 months.
29. In a geriatric patient with an intrinsic renal cause for acute kidney injury (AKI), which of
the following is the most common reason for this presentation?
a. Acute Interstitial Nephritis
b. Acute tubular necrosis
c. Normotensive ischemic AKI
d. Renovascular disease
Rationale: Answer B. Acute Tubular Necrosis (ATN) is the most frequent cause of AKI in elderly
patients. Insults leading to ATN include nephrotoxins (radiocontrast, aminoglycosides), pigment-
induced (rhabdomyolysis can occur after a fall with a long lie), and ischemia (sepsis, surgery).
All the other choices are intrinsic renal causes of acute kidney injury, but ATN is most likely.
30. When speaking to a hearing impaired elderly patient, the nurse remembers to:
a. speak very slowly
b. speak as loudly as possible
c. speak into his or her ear
d. speak in a lower octave
Rationale: d. speak in a lower octave *high-pitched tones won't work, they will not hear you
31. An elderly patient is unusually lethargic and has a temperature of 95.4 degrees. The
nurse suspects:
a. a medication side effect
b. urinary retention
c. an infection
d. constipation
Rationale; c. an infection *you can have an infection with a low temperature *remember that
older people can present differently
32. The nurse monitors for which clinical manifestations of the elderly patient diagnosed with
delirium?
a. somnolence and fever
b. abrupt onset of confusion and hallucinations
c. feelings of hopelessness and early morning wakening
d. disorientation and word-finding difficulty
33. Which ethical principle underlies nursing actions respecting each patient’s values and
beliefs
a. Autonomy
b. Beneficence
c. Justice
d. Responsibility
34. The most common symptoms of benign prostatic hypertrophy are:
a. Chills, five, and nausea
b. Dysuria, abdominal pain, and urinary retention
c. Intermittency, hesitancy and haematuria
35. The gerontological nurse is monitoring signs of suspected abuse in 89-years old patient
who was admitted from home. When planning for the patient’s discharge, the nurse’s
first action is to:
a. Delay discharge by informing the provider of the suspected abuse
b. Enlist the help of family members with transitioning the patient home
c. Notify Adult Protective Services of the patient’s discharge
d. Restrict the family members’ access to the patient prior to discharge
36. A resident in a nursing home request a new room because he or she does not like the
view from the current room/ While the resident is away from the home on a provider visit,
the staff moves the resident’s belonging to another room with a better view. The resident
and the resident’s family later file formal complaints regarding the move. Which
statement gives the best justification on the resident’s complaint?
a. The change was made without the provider’s order
b. The resident was not included in the decision making
c. The resident’s belonging were moved without his or her assistance
d. The resident’s family was not able to include in the decision making.
37. A recently admitted nursing home resident and the resident’s family only speak Spanish.
One evening during a visit, the resident and the family begin to wall and sob loudly. The
gerontological nurse is unable to determine what is wrong. The nurse’s most appropriate
action it to:
a. Ask the supervisor to get an interpreter
b. Attempt to make the resident and the family comfortable
c. Contact the provider for orders
d. Find an escort to take the resident and the family to the chapel for privacy
38. The gerontological nurse manager involve the nursing staff in the utilization of trend data
and analysis for quality improvement by:
a. Encouraging staff to volunteer for the Joint Commission’s onsite surveys
b. Highlighting the quality improvement work of experts in the speciality area.
c. Informing how data and outcome are directly related to the staff’s daily
work
d. Using scatted diagrams to identify the root cause of unresolved concerns
39. An effective way to adequately provide nourishment to a patient with moderate dementia
is:
a. Allowing the patient to choose foods from a varied menu
b. Hand feeding the patient’s favourite food
c. Routinely reminding th patient about the need for adequate nutrition
d. Serving soup in a mug, and offering finger foods
40. An 82 year old patient has a painful, vesicular rash that burns over the left abdomen.
The patient indicates that he or se has tried multiple cream that have not helped. Which
question does the gerontological nurse first ask?
a. “Did you have pain before the rash appeared?”
b. Do you have any food or drug allergies
c. Have you been around anyone with a rash?
d. Have your grandchildren visited recently?
41. Which question does the gerontological nurse priorities for an 86 years old patient with
abdominal pain, muscle weakness, and leg cramps?
a. Do you eat a lot of meal?
b. Do you have heart problems/
c. Do you take diuretics
d. Do you walk every day?
42. When teaching an independent older adult patient how to self-administer insulin, the
most productive approach is to:
a. Facilitate involvement in a small group where the skills is being taught
b. Gather information about patient facility history
c. Provide frequent competitive skills testing to enhance learning
d. Use repeated return demonstration to promote the patient’s retention of the
involved tasks.
43. Signs and symptoms of age-related macular degeneration include:
a. Decreases in depth perception
b. Deficits in peripheral vision
c. Distortion of lines and print
d. Reports of flashes of light
44. A frail 80 year-old patient, who cares for a spouse at home without assistance, requires
minor surgery. Lacking any family members residing in the area, the patient expresses
concerns about the spouse’s concerns about th e spouse’s care while the patient is
recovering. The gerontological nurse’s recommendation is:
a. Arranging in patient respite care for the spouse
b. Having the patient remain in the hospital during the post-operative period
c. hiring around the clock help for two weeks
d. Hospitalizing the spouse.
45. An older adult patient currently takes phenytoin (dilatin) and tolterodime (Detrol). The
gerontological nurse reinforces the need for routine dental visits because these two
medications decreases:
a. Calcium level in the blood
b. Innervations of the trigeminal nerve
c. The muscle strength of the tongue
d. The production of saliva
46. A 90- year old patient comes to the clinic with a family member. During the health
history, the patient is unable to respond to the question in a logical manner. The
gerontological nurse’s action is to:
a. Ask the family member to answer the question
b. Ask the same question un a louder and lower voice
c. Determine if the patient knows the name of the current president
d. Rephrase the question slightly, and slow repeat hem in a lower voice
47. The American nurses association’s gerontological nursing: scope and standard of
practice emphasizes
a. The abnormal responses to the aging process determines the appropriate
nursing diagnosis
b. That the health status data of older adults patient be document in a
retrievable form
c. The role of the adult patient a the sole decision maker in planning his or her care
d. The unchanging nature of the goal and plans of care for adult patient
48. A state ombudsman initiates an investigation after a complaint about the care of a
nursing home resident. Which statement about the investigation process is true?
a. The ombudsman may proceed with the investigation without identifying the
individual who made the complaint, and without obtaining a court order or
written consent.
b. The ombudsman must identify the individual who made the complaint
c. The ombudsman must obtain a court order to review documentation, if the
resident describe in the complaint does not give written permission
d. The ombudsman must obtain the written permission of the resident who is
describing in a complaint.
49. Which patient is greater risk for developing arteriosclerotic heart disease?
a. A 60 year old female patient with a triglyceride of 135 mg/dl, and a high density
lipoprotein level of 68 mg/dL
b. A 70 year old male patient with a total cholesterol level of 181 mg/dl, and a low
density lipoprotein level of90 mg/dl
c. A 75 year old female patient with a triglyceride of 189 mg/dL and a lowe
density protein of 149 mg/dL
d. An 86 year old male patient with a low density lipoprotein level of 100 mg/dL and
a high density lipoprotein of level 50 mg/dL
50. A 65 year old patient exhibit symptom of hemianopia. The most appropriate nursing
intervention is to:
a. Arrange the patient meal tray so that all the food is in the patient’s field of
vision
b. Explain all the task thoroughly to help allay the patient’s fear
c. Look directly at the patient when speaking to maximize comprehension
d. Minimize the operating stimuli to reduce distraction to the patient\
51. An 80 year old patient, who lives at home with a spouse, is instructed to follow 2 g
sodium diet. The patient states. “I’ve eaten the same way all my life, and I’m not going to
change now” To promote optimal dietary adherence, the gerontological nurse’s initial
approach is to:
a. Inform the patient about the need to follow the diet
b. Inquire about the patient’s current food preferences and eating habits
c. List the variety of food they are allowed in the diet
d. Provide dietary instruction to the patient’s spouse, who prepares the meals
52. For the older adult patient who are taking neuroleptic medication, the primary concern is
the development of:
a. Lethargy
b. Nausea
c. Poor appetites
d. Tardive dyskinesia
53. The gerontological; nurse works with patients with non-insulin dependent diabetes at a
senior center in a predominantly Hispanic neighbourhood. The nurse demonstrate
competency in collaboration by:
a. Assisting and educating patient on diet restrictions
b. Delivery care by preserving and protecting patient autonomy
c. Providing written education material in Spanish
d. Working with Hispanic groups in the community
54. An older adult patient, who has end-stage multiple myeloma, is receiving hospice care.
Which situation illustrate that the principles of hospice care are being met?
a. The caregiver ask if hospice includes weekend care
b. The caregiver has been calling the provider on his or her own
c. The patient reports enjoying daily excursions
d. The patient re[ports no breakthrough pain medication are needed
55. A 79 year old retired actor, who continues to pursue lifelong interest in swimming and
singing, exemplifies which theory of aging?
a. Continuity
b. developmental
c. disengagement
d. physical
56. a 75 years old patient, who’s marriage ended in divorce after two year, has live alone for
the past 50 year. Feeling as if life has had little meaning, the patient is terrified of living
out the remaining year and of dying. The age related issue to e resolve is
a. disengagement vs. activity
b. ego-integrity vs. despair
c. self-determination vs. resignation
d. self-esteem vs. self-actualization
57. Three months ago, an older adult patient, who lives in an apartment in a housing
complex for senior citizens, began residing with an older adult patient from the same
complex. Upon learning of the situation the patient’s adult child expresses concern to the
housing administrator, who reports that both residents have reported satisfaction with
the arrangement. When the child request advice, the gerontological nurse’s initial
response is:
a. I can understand why you are upset, has her ever done something like this
before?
b. Why don’t we all talk to your parent to get his side of the story?
c. Your parent has the right to do what he wants because he is mentally competent
d. Your parents seem to be happy with the arrangement. Have you discussed
the situation with him?
58. Under the affordable care act and the national strategy for quality y improvement in
health care, which of the following represents the three national aims
a. Affordable care, universal care and health promotion
b. Preventive care, affordable care, and health promotion
c. Health promotion, affordable care, and universal care
d. Better care, healthy people/communities and affordable care
59. On the Braden scale for predicting risk of developing pressure sores, a client scores 2
(1-4 or 1-3 scales) on each of the parameter (total score 12). The patient’s risk of
developing a pressure sore is:
a. High risk
b. Breakpoint for risk
c. Extremely high risk (worst score)
d. Very minimal risk
60. According to Maslow’s hierarchy of needs, which of the patient’s need must be met first?
a. Safety and security
b. Physiological
c. Belonging and self esteem
d. Self-actualization
61. An elderly woman takes the geriatric depression scale short version and answers “no” to
8 question said “yes” to 7 questions, for a score of 7. What is the minimal score to
indicate depression
a. 15
b. =10
c. 3-4
d. >5
62. Based on the best practices, process for caring for peripherally inserted central catheter
(PICC) line have been established, and infection in PICC lines are being tracked for 4
week periods. Trends shows wild fluctuations with high levels of infection in one period,
low in a second and vacillations in a third. Because of these finding, the first strep should
be to:
a. Retrain all staff members
b. Assume they are normal variation
c. Evaluate whether processes are being followed
d. Modify process
63. According to the national center of complementary and alternative medicine, which of
the following is an example of whole medical system?
a. Meditation
b. Massage
c. Acupuncture
d. Vitamin therapy
64. When assessing a patient with dysarthria, the best approach is to:
a. Ask ye/no question
b. Use visual aids to communicate idea to patient
c. Ask information question
d. Speak loudly and clearly
65. Group instruction is most effective for older adults with diabetes for teaching:
a. Testing glucose levels
b. General diabetic care
c. Insulin administration
d. Management of hypoglycaemic reaction
66. A legal document that specifically designates someone to make decision regarding
,medical and end-of life -care if a patient is a mentally incompetent Is an:
a. Durable power of attorney
b. Advance directive
c. Do not resuscitate order
d. General power of attorney
67. When treating anxiety in an older adult , which type of medication if preferred
a. Tricyclic antidepressant
b. Short-acting benzodiazepine
c. beta-adrenergic agent
d. Long acting benzodiazepine
68. When evaluating outcome data evidence-based practice the type of data that includes
measures of mortality, longevity, and cost-effectiveness is:
a. Physiological
b. Psychological
c. Integrative
d. Clinical
69. A chronic obstructive pulmonary disease patient experiencing chronic shortness of
breath and difficulty in expiring air. Which of the following exercise is best for the COPD
patients to promote effective expulsion of trapped air from the lung a
a. Inspiratory muscles training
b. Paced walking
c. Pursed-lip breathing
d. Diaphragmatic breathing
70. 68 year old man with Parkinson disease is experiencing anticipatory grieving at the
prospect of becoming increasingly disabled and has exhibited social withdrawal,
depression and anger, and changes in activity level and eating habits/ After evaluating
the patient, the first action should be to
a. Refer the patient for counselling
b. Reinforce patient’s strength
c. Discuss the need for antidepressant
d. Identify possible support system
71. When the gerontological nurse interviews a patient with advance cancer, he states “I
can’t stand this pain anymore. I’m going to take my gun and shoot myself” the best
response is
a. I understand why you feel that way
b. I believe an antidepressant may help you
c. I’m sure you don’t really men that
d. let’s work together to find better ways to manage your pain
72. A 65 year old patient has suffers a stroke in the left hemisphere with right-sided
paralysis. Which of the following symptoms should the gerontological nurse anticipate?
a. Reparatory and cardiac dysfunction
b. Nausea and vomiting
c. Aphasia
d. Left sided neglect
73. Which of the cases of pica?
a. Vitamin B6 deficiency
b. Iron deficiency
c. Zinc deficiency
d. Vitamin C deficiency
74. Which option is not a common symptoms of Alzheimer disease?
a. Memory impairment
b. Bradykinesia
c. Social impairment
d. Cognitive defect
75. Select the least likely diagnosis in an elderly patient with a fours history of mental status
changes
a. Medication effects
b. Electrolyte imbalance
c. Urosepsis
d. Alzheimer disease
76. Midazolam does not cause which of the following
a. Hypertension
b. Somnolence
c. Coma
d. Dizziness
77. Which of the following has not been shown successfully lower systolic blood pressure
a. Exercise
b. DASH diet
c. Low sodium intake
d. Low fat diet
78. Association is commonly used in the remediation of which od the following
a. Spelling
b. Planning
c. Memory
d. Task
79. At what level of diastolic pressure is one considered to have prehypertension
a. 70
b. 85
c. 130
d. 160
80. Which of the following is a common side effect of albuterol
a. Hypertension
b. Tachycardia
c. tremors
d. arrhythmia
81. A medication that inhibits the activity of HMG-CoA reductase would be prescribed for
which of the following condition?
a. Hyperuricemia
b. Diabetes Mellitus
c. Hyperlipidaemia
d. Hypertension
82. Patient on bed rest may be encouraged to periodically plantar and dorsiflex their ankles.
What is the rationale for this?
a. To prevent blood clots
b. To prevent muscle atrophy
c. To promote cardiac contractility
d. To increase blood flow to the leg
83. What is the longest acting local anaesthetic?
a. Lidocaine
b. Cocaine
c. Bupivacaine
d. Procaine
84. Which of the following is the best option for smoking cessation in a patient who cannot
tolerate nicotine replacement therapy?
a. “Cold-turkey” cessation
b. Sertraline
c. Venlafaxine
d. Bupropion
85. How long should patient with severe COPD reviece oxygen therapy?
a. Only during activities
b. 18 hours a day
c. Only during rest periods
d. 24 hours a day
86. What is the most appropriate test to order in the case od a elderly male with COPD and
hypertension who take enalapril, aspirin, hydrochlorothiazide, theophylline, albuterol and
an OTC medication for heartburn which is found on exam to have a normal BP,
tachycardia, a tremors, and normal cardiac exam?
a. Urine drug screen
b. Chest x-ray
c. Theophylline level
d. Echocardiogram
87. What is the earliest symptoms of local anaesthetic toxicity
a. Convulsions
b. Respiratory depression
c. Loss of pain
d. Tongue and circumpolar numbness
88. Select the choice which most accurately describes “palliative care”
a. Care given in an emergency or intensive care settings
b. The care p[provided while waiting for admission to a hospice
c. Care given to relieve or ease the symptoms of the serious condition or
disease regardless of the prognosis
d. Care provided to those without a physician.
89. What is the mechanism of action of alendronate
a. Prevention of the bone formation
b. Promotion of bone formation
c. Prevention of bone resorption
d. Promotion of bone resorption
90. After a PPD skin test, what size of induration is considered positive in people with no
known risks
a. 1mm
b. 4 mm
c. 9 mm
d. 15 mm
91. Which of the following does not increase the risk of pressure ulcers
a. Shears
b. Malnutrition
c. Mobility
d. Heat
92. Which of the first steps in the treatment of hypoglycaemia
a. IV fluid
b. Fruit juice
c. G5NS
d. Insulin
93. Chronological age is your age based on:
a. how well you feel
b. the passage of time
c. if you floss your teeth
d. how fabulous you look
94. An experienced nurse tells a younger nurse who is working in a retirement home that
older adults have "outlived their usefulness." What is the term for this type of prejudice?
a. a) racism
b. b) agism
c. c) harassment
d. d) whistle blowing
95. A nursing instructor teaching classes in gerontology to nursing students discusses myths
related to the aging of adults. Which statement is a MYTH about older adults?
a. a) most older adults live in their own homes
b. b) healthy older adults enjoy sexual activity
c. c) old age means mental deterioration
d. d) older adults want to be attractive to others
96. Why do we separate the young-old from the old-old?
a. a) to determine social security costs
b. b) needs and resource use differs
c. c) the young-old are more heterogenous
d. d) we love statistics and graphs
97. A nursing intervention directed toward primary prevention in the older adult focuses on:
a. a) disease management
b. b) routine health screenings
c. c) controlling symptoms of illness
d. d) teaching positive health behaviors
98. Which of the following are characteristics of a chronic illness (select all that
apply)
a. a) has reversible pathologic changes
b. b) has a consistent, predictable clinical course
c. c) results in permanent deviation from normal
d. d) is associated with stable and unstable phases
e. e) always starts with an acute illness and then progresses slowly
99. An important nursing action to help a chronically ill older adult is to:
a. a) avoid discussing future lifestyle changes
b. b) assure the patient that the condition is stable
c. c) treat the patient as a competent manager of the disease
d. d) encourage the patient to "fight" the disease as long as possible
100. The nurse teaches a student nurse about health care disparities and older adult
women. Which statement, if made by the student nurse, would indicate an
understanding of the teaching?
a. a) "Women tend to have a shorter life expectancy than men."
b. b) "Women tend to have fewer financial resources than men."
c. c) "Women are less likely to be a caregiver to their spouses."
d. d) "Women are more likely to have age-related cognitive impairments."
101. Why do some older adults not seek healthcare for their complaints?
a. a) prefer to be left alone
b. b) poor health literacy
c. c) think it's a normal part of aging
d. d) hate clinic appointments
102. What is one reason polypharmacy exists among older adults?
a. a) counter act side effects
b. b) older adults are very good at taking medication
c. c) older adults like taking medication
d. d) health care providers don't coordinate the medication regimes
103. In assessing the aging client, it is importnat for the nurse to recognize:
a. a) The client's ability to perform ADLs
b. b) The financial status of the client
c. c) The job that the client held prior to aging
d. d) All components of well-being, including biological function,
psychological function, and social function
104. Medications, slower mobility, lack of proper fluid intake, and poor diet can
contribute to what common symptom in the elder population?
a. a) Urinary incontinence
b. b) Skin changes
c. c) Mental changes
d. d) Depression
105. The nurse assessing the older population needs to have a basic understanding
of which of the following?
a. a) The economic status of the area
b. b) The difference between normal and abnormal for the older age group
c. c) The signs of sexual dysfunction
d. d) The signs of cardiac disease
106. Which statement would be most appropriate to ask when assessing an aging
adult for cognitive function?
a. a) What is today's date?
b. b) Can you count to 10 for me?
c. c) Have you noticed anything different about your memory or thinking in
the past few months?
d. d) Who is the president of the United States?
107. The nurse is setting up an education session with an 85-year-old patient who will
be going home on anticoagulant therapy. Which strategy would reflect consideration of
aging changes that may exist with this patient?
a. A. Show a colorful video about anticoagulation therapy.
b. B. Present all the information in one session just before discharge.
c. C. Give the patient pamphlets about the medications to read at home.
d. D. Develop large-print handouts that reflect the verbal information
presented.
108. When developing the plan of care for an older adult who is hospitalized for
an acute illness, the nurse should
a. A. use a standardized geriatric nursing care plan.
b. B. plan for likely long-term-care transfer to allow additional time for recovery.
c. C. consider the preadmission functional abilities when setting patient
goals.
d. D. minimize activity level during hospitalization.
109. Which information obtained by the home health nurse when making a visit
to an 88-year-old with mild forgetfulness is of the most concern?
a. A. The patient's son uses a marked pillbox to set up the patient's medications
weekly.
b. B. The patient has lost 10 pounds (4.5 kg) during the last month.
c. C. The patient is cared for by a daughter during the day and stays with a son at
night.
d. D. The patient tells the nurse that a close friend recently died.
110. A 70-year-old client asks the nurse to explain to her about hypertension. An
appropriate response by the nurse as to why older clients often have
hypertension is due to:
a. A. Myocardial muscle damage
b. B. Reduction in physical activity
c. C. Ingestion of foods high in sodium
d. D. Accumulation of plaque on arterial walls
111. In reviewing changes in the older adult, the nurse recognizes that which of
the following statements related to cognitive functioning in the older client is
true?
a. A. Delirium is usually easily distinguished from irreversible dementia.
b. B. Therapeutic drug intoxication is a common cause of senile dementia.
c. C. Reversible systemic disorders are often implicated as a cause of
delirium.
d. D. Cognitive deterioration is an inevitable outcome of the human aging process.
112. Which of the following interventions should be taken to help an older client to
prevent osteoporosis?
a. A. Decrease dietary calcium intake.
b. B. Increase sedentary lifestyles
c. C. Increase dietary protein intake.
d. D. Encourage regular exercise.
113. Which of the following statements accurately reflects data that the nurse should
use in planning care to meet the needs of the older adult
a. A. 50% of older adults have two chronic health problems.
b. B. Cancer is the most common cause of death among older adults.
c. C. Nutritional needs for both younger and older adults are essentially the same.
d. D. Adults older than 65 years of age are the greatest users of prescription
medications.
114. The nurse is aware that the majority of older adults:
a. A. Live alone
b. B. Live in institutional settings
c. C. Are unable to care for themselves
d. D. Are actively involved in their community
115. The nurse works with elderly clients in a wellness screening clinic on a
weekly basis. Which of the following statements made by the nurse is the most
therapeutic regarding their mobility?
a. A. "Your shoulder pain is normal for your age."
b. B. "Continue to exercise your joints regularly to your tolerance level."
c. C. "Why don't you begin walking 3 to 4 miles a day, and we'll evaluate how you
feel next week."
d. D. "Don't worry about taking that combination of medications since your doctor
has prescribed them."
116. A long-term care facility sponsors a discussion group on the administration of
medications. The participants have a number of questions concerning their medications.
The nurse responds most appropriately by saying:
a. A. "Don't worry about the medication's name if you can identify it by its color and
shape."
b. B. "Unless you have severe side affects, don't worry about the minor changes in
the way you feel."
c. C. "Feel free to ask your physician why you are receiving the medications
that are prescribed for you."
d. D. "Remember that the hepatic system is primarily responsible for the
pharmacotherapeutics of your medications."
117. Which patient below is NOT at risk for osteoporosis?
a. a.) A 48 year old female patient who has been taking glucocorticoids for the last
6 months.
b. b.) A 50 year old female whose last menstrual period was 7 years ago.
c. c.) A 30 year old male who says he drinks alcohol a few times a month and
has a BMI of 26
d. d.) A 35 year old female who has a history of seizures and takes Dilantin
regularly.
118. A frail, elderly client is admitted to the unit with a diagnosis of pneumonia. Which
finding is most important for the registered nurse (RN) to report to the healthcare
provider?
a. A. Fever and chills
b. B. Confusion and dehydration
c. C. Crackles in the lung fields
d. D. Nausea and vomiting
119. A frail elderly couple asks the registered nurse (RN) if they have to watch their
salt intake because food does not taste as good as it used to so they have to season
most foods. What information should the RN offer the couple?
a. A. Boredom may influence how the taste of food is perceived, and different
seasonings can stimulate taste.
b. B. With age, an increase in sodium intake is needed to compensate for a
decrease in renal function.
c. C. Short-term memory loss and confusion may be the reason they want to over-
season their food.
d. D. Taste buds often are dull due to atrophy so older clients should use
other seasonings instead of salt.
120. After taking a 10-day course of an antibiotic that was ineffective, a frail, elderly
client with chronic obstructive pulmonary disease (COPD) is admitted for pneumonia.
The client has a long history of smoking and still smokes a pack of cigarettes a day.
Which finding should the registered nurse (RN) report to the healthcare provider?
a. A. Barrel chest with increased chest diameter
b. B. Crackles and pulse oximetry level of 88%
c. C. Low hemoglobin and hematocrit levels
d. D. Arterial blood gases indicating respiratory acidosis
121. An older female client recently moved to an assisted living facility. The family
explains to the registered nurse (RN) that the client is unmanageable and always
confused, disoriented and depressed. The client asks the RN repeatedly, "Where am I?".
How should the RN respond?
a. A. Explain that she is in a new home called an assisted living community
b. B. Question the client about her perception of where she might be now.
c. C. Distract the client with a scenario that she is on an outing with her family.
d. D. Reassure the client not to worry because she will meet new friends.
122. A new resident in an assisted living facility is an older client who is experiencing
short-term memory loss and confusion. Which activity should the registered nurse (RN)
schedule the client to do during the day?
a. A. Arts and crafts
b. B. Current events discussion group
c. C. Group sing-along
d. D. Daily exercise group
123. The hospice nurse is completing a focused assessment of an older female
client with end stage Alzheimer's disease, who recently fractured her hip. What
technique should the registered nurse (RN) use to determine the client's pain?
a. A. Use the FACE pain scale
b. B. Ask the client to rate pain on a scale of 1 to 10
c. C. Observe for facial grimacing
d. D. Review documentation of recent eating habits
124. An older male client arrives at the clinic for an annual physical
examination. While the nurse assesses the client, the client states that he is
having intimacy problems with his wife. Which information should the nurse
provide to elicit more information from the client?
a. A. Query client to clarify the client's idea of an intimacy problem.
b. B. Discuss benign prostatic hypertrophy (BPH) and ejaculation.
c. C. Explore the frequency that he experiences erectile dysfunction (ED)
d. D. Determine if the client's wife is young enough to get pregnant
125. The registered nurse (RN) is caring for an older female client with a 20 year
history of rheumatoid arthritis (RA), who is admitted for carpel tunnel release. Which
finding associated with RA should the RN document?
a. A. Asymmetrical joint deformity
b. B. Small joint involvement in fingers
c. C. Crepitation or grating sensation in joints
d. D. Weight bearing joint involvement
126. The registered nurse (RN) is re-enforcing discharge instructions with the family of
an older client who was recently admitted for an intestinal obstruction. Which statement
indicates that the family understands the instructions?
a. A. Increase protein and carbohydrates in the daily diet
b. B. Limit activity to bed rest for the first week and increase mobility incrementally
each week
c. C. Report abdominal distention, constipation or any other nausea and
vomiting to the healthcare provider
d. D. Drink liquids 2 hours after meals instead of during meals
127. An older client is transferred to a telemetry unit after placement of a pacemaker.
What action should the registered nurse (RN) take first?
a. A. View incision site
b. B. Obtain a blood pressure
c. C. Establish telemetry monitoring
d. D. Evaluate client for pain
128. An older patient with terminal cancer is considering hospice care but is
concerned that Medicare will stop payments if the care is provided for longer than 6
months. What can the nurse respond to this patient?
Standard Text: Select all that apply.
1. Medicare does not limit the hospice benefit.

2. Medicare regulations discourage a longer use of the benefit.
3. Hospice costs more than traditional hospital or long-term care.
4. Patient may enroll when the life expectancy is 6 months or less.
5. Hospice supports the family for 6 months after the patients death.
129. During an assessment the nurse determines that an older patient dying from a
terminal illness is experiencing common fears. What fears did this nurse assess in
the patient?
1. Dying alone
2. Loss of consciousness
3. Loss of bladder control
4. Leaving loved ones behind
5. Becoming a burden to others
130. An older patient dying of end-stage pulmonary disease and dementia

receives narcotic medication for chronic pain. Currently the patient is restless and
grimacing. How should the nurse interpret these assessment findings?
a) The patient is in pain.
b) The patient has an undiagnosed personality disorder.
c) The patient needs nonpharmacological pain management approaches.
d) The patient is not experiencing any difference in pain level and no adjustments
are needed.
131. An older patient dying from a terminal illness reports that the last dose of
pain medication provided barely reduced the level of pain. What should the nurse
do to help this patient?
1. Give the patient pain medication every hour.
2. Contact the physician for an adjustment in pain medication.
3. Provide the pain medication at the next scheduled dose time.
4. Give the patient another dose of the medication even though it is before the
scheduled time.
132. The nurse is planning oral hygiene for an older patient with a terminal illness
who has an intact swallowing reflex. Which interventions would be appropriate for this
patient?
a. 1. Offer ice chips frequently.

b. 2. Provide care with soft swabs.
c. 3. Apply petroleum jelly to the lips.
d. 4. Brush the teeth three times a day.
e. 5. Avoid using alcohol-based solutions.
133. The family of an older patient dying of liver cancer is concerned that the
patient will not eat or drink. The patient is alert and oriented, and expresses no desire
to eat. What action would the nurse take?
a. 1. Force fluids.
b. 2. Consult the dietician for feeding supplements.
c. 3. Contact the physician for an order for tube feedings.
d. 4. Comply with the patients wishes despite the familys concern.
134. An older patient with end-stage renal and heart failure is experiencing odd
dreams and is talking with people who are not present in the room. What does this
finding indicate to the nurse?
a. 1. Pending death
b. 2. Ineffective pain medication
c. 3. Overdose of narcotic medication
d. 4. Normal visual and auditory hallucinations at the end of life
135. An older patient is not breathing well and has cold, mottled skin. The patient has
a living will and requests comfort measures only. What should the nurse do to care for
this patient?
a. 1. Ask the family what they want to be done for the patient.
b. 2. Contact the physician for orders to control the patients breathing.
c. 3. Provide personal hygiene and skin care as outlined in the care plan.
d. 4. Withhold pain medication, hygiene, and nutrition until the patient dies.
136. The family of an older patient with a terminal illness has been aware of the
patients pending death and is present when the patient dies. The familys reaction to
the patients death was very emotional and demonstrated a state of disbelief. How
should the nurse interpret this familys behavior?
a. 1. Irrational behavior
b. 2. Expression of anger
c. 3. Maladaptive coping of the family
d. 4. Normal shock when experiencing the loss of a loved one
137. The nurse is planning care for an older patient who is dying. Which interventions
will ensure the patient dies with dignity?
a. 1. Relieving suffering
b. 2. Controlling pain and symptoms
c. 3. Making decisions for the patient and family
d. 4. Clarifying goals of treatment and the patients values
e. 5. Communicating patient needs between healthcare providers
138. The nurse, caring for an older patient who is nearing death, has never taken
care of a dying patient before. What is the first thing that the nurse must do prior to
caring for this patient?
a. 1. Confirm the patients code status.
b. 2. Review the facilitys policy on postmortem care.
c. 3. Confront personal feelings and fears about death.
d. 4. Confirm that the family has made funeral arrangements.’
139. The health status of an older patient with liver disease is rapidly deteriorating.
There is no documentation on the medical record regarding the patients care
wishes. What should the nurse do to ensure the patient receives care that is desired at
the end of life?
a. 1. Ask social services to provide an advance directive for the patient to complete.
b. 2. Talk with the patient regarding what the patient wants after the hospitalization
ends.
c. 3. Call a meeting with the patient, family, and primary care physician to
discuss care goals.
d. 4. Discuss the patients dire situation with the family and find out what their
wishes might be.’
140. An older patient who is terminally ill is receiving hospice care at home. What
suggestion should the hospice nurse make in preparation for the patients death?
a. 1. Discuss being admitted to a hospital.
b. 2. Suggest transferring to a long-term care facility.
c. 3. Recommend admission to an inpatient hospice setting.
d. 4. Find out what the patient needs to be comfortable at home.
141. The hospice nurse has provided a presentation to long-term care nurses on
barriers to excellent end-of-life care. Which statement made by a participating nurse
indicates that additional teaching is needed?
a. 1. Most patients have good pain control when they die.
b. 2. Referrals to hospice or palliative care often arent made.
c. 3. When a client is dying, there can be disagreements about the goal of care.
d. 4. In general, healthcare professionals have difficulty in being honest with
patients when discussing a poor prognosis.
142. An older patient with terminal cancer asks the nurse to explain palliative care.
How should the nurse respond to this patient?

a. 1. It is the same as hospice care.
b. 2. It is always provided in the home.
c. 3. It can be provided along with life-prolonging care.
d. 4. It is helpful for chronic health problems for which there is no cure.
e. 5. It improves the quality of life while facing a life-threatening illness.
143. The home care nurse is planning a visit to an older patient whose daughter
died 6 months ago and the spouse died last month. For which potential health
problem should the nurse assess the patient during the visit?
a. 1. Normal grief
b. 2. Complicated grief
c. 3. Anticipatory grief
d. 4. Uncompleted grief
144. The family of an older patient who is terminally ill wants to know if the patient
can have a massage to help with the pain. How should the nurse respond to the
family?
a. 1. It might reduce the patients anxiety.

b. 2. It might help reduce the patients pain.
c. 3. It might help the patient breathe better.
d. 4. It could help improve the patients mood.
e. 5. It could cause the patient more discomfort.
145. An older patient who is dying starts yelling,I cant believe this. I am a good
person. Why is this happening to me? The nurse identifies that the patient is in which
stage of dying?
a. 1. Anger
b. 2. Denial
c. 3. Bargaining
d. 4. Depression
146. During a home visit an older patient who is terminally ill can no longer talk. What
assessment data will the nurse use to determine if the patient is in pain?
a. 1. Cool, dry skin
b. 2. Moaning while being turned
c. 3. Cyanotic feet and lower legs
d. 4. Cheyne-Stokes respiratory pattern
147. The hospice nurse is discussing the addition of adjuvant medication to help
an older patient with cancer pain. Which types of medications would the considered as
adjuvant for this type of pain?
a. 1. Antiemetics
b. 2. Corticosteroids
c. 3. Antidepressants
d. 4. Anticonvulsants
e. 5. Muscle relaxants
148. An older patient who is dying has complained of ongoing pain for several
days. What is the best way for this patients pain to be treated at the end of life?
a. 1. Give immediate-release medications routinely.
b. 2. Use long-acting medications that are given routinely.
c. 3. Give immediate-release medications when the patient complains of pain.
d. 4. Give long-acting medications routinely and immediate-release doses
with breakthrough pain.
149. An older patient experiencing cancer pain is prescribed intravenous pain

medication. What actions will the nurse take when providing the patient with this
medication?
a. 1. Use the smallest amount of fluid possible.

b. 2. Use the appropriate fluid delivery system.
c. 3. Offer oral medications for breakthrough pain.
d. 4. Provide pain medication when it is the most severe.
e. 5. Ensure the intravenous site does not become infected.
150. An older patient who is dying is unable to fully close the eyes. What can the
nurse do to protect the patients eyes from irritation?
a. 1. Apply eye guards.
b. 2. Apply artificial tears.
c. 3. Tape the eyes closed.
d. 4. Reduce the room lighting.
e.
151. During a home visit, the nurse is concerned that an older patient is
experiencing caregiver neglect. What did the nurse assess in this patient?
a. 1. Agitation
b. 2. Listlessness
c. 3. Dry, cracked skin
d. 4. Bruises on both arms
e. 5. Skin irritation on both inner thighs
Rationale: Correct Answer: 2,3,5
• Rationale 1: Agitation is a manifestation of psychological or emotional abuse.

Reference: Page 234
• Rationale 2: Listlessness is a manifestation of caregiver neglect. Reference:
Page 234
• Rationale 3: Dry, cracked skin could indicate dehydration, which is a
manifestation of caregiver neglect. Reference: Page 234
• Rationale 4: Bruises on both arms is a manifestation of physical abuse.
Reference: Page 234
• Rationale 5: Skin irritation on both inner thighs could indicate urine burns, which
is a manifestation of caregiver neglect.
• Reference: Page 234
152. An older patient who just celebrated an 85th birthday comes into the
emergency department with a fractured arm and bruises over the chest and back.
The nurse suspects the patient is a victim of physical abuse. Which individuals will
the nurse specifically assess the patient as being the abuser?
a. 1. Spouse
b. 2. Nephew
c. 3. Granddaughter
d. 4. Next door neighbor
e. 5. Adult daughter caregiver
Rationale: Correct Answer: 1,2,3,5
• Rationale 1: Spouses account for 11.3% of abuse cases. Reference: Page 233
• Rationale 2: Family members account for 21.5% of abuse cases. Reference: Page 233
• Rationale 3: Family members account for 21.5% of abuse cases. Reference: Page 233
• Rationale 4: Next door neighbors are not identified as individuals who cause abuse
cases. Reference: Page 233
• Rationale 5: The typical abuser is an adult child, accounting for 32.6% of abuse cases.
Reference: Page 233
153. An older patient is accompanied by an adult daughter who is the patient's
primary caregiver for a routine clinic visit. While in the waiting room, the adult
daughter is observed sitting quietly and not talking with the patient. During the
examination, what should the nurse assess the adult daughter for?
a. 1. Employment
b. 2. Physical status
c. 3. Caregiver stress
d. 4. Substance abuse
e. 5. History of psychopathology
• Rationale 1: Caregivers of older adults should be assessed at each primary care visit for
caregiver stress, substance abuse, and a history of psychopathology. Employment is not
something that needs to be assessed in the caregivers of older adults.
caregiver stress, substance abuse, and a history of psychopathology. Physical status is
not something that needs to be assessed in the caregivers of older adults.
caregiver stress. Reference: Page 236
substance abuse. Reference: Page 236
a history of psychopathology.
154. Which patients seen by a nurse working in the emergency department identify a
situation that suggests a case of elder mistreatment?
a. 1. An 86-year-old patient who has three dime-size burned areas on the
upper inner thigh
b. 2. A 77-year-old patient who fell at home after tripping over the dog and broke an
arm about 30 minutes earlier
c. 3. A 73-year-old patient with a history of gastric ulcers who is found to be anemic
after vomiting blood 3 hours earlier
d. 4. An 85-year-old patient who has several small areas of bruising on the back of
the hands and is taking medication for platelets and coagulation
Rationale: Correct Answer: 1

• Rationale 1: The patient who has skin burns suggestive of cigarette burns in an area
normally covered by clothing is suggestive of abuse.
• Rationale 2: A patient with a broken bone that is consistent with an injury event and
seeks medical attention promptly is not generally suspect for elder abuse.
• Rationale 3: The patient with a positive history of gastric ulcers and active bleeding
would be expected to have anemia.
• Rationale 4: Bruising is common in patients taking medication that affects the blood, who
have thin skin, and in the hands, which is an area that is easily bumped.
155. The nurse suspects that an older patient has been physically abused. What
must be included in the medical workup for this patient?
a. 1. Pelvic examination
b. 2. Toxicological screening
c. 3. Complete blood count and blood chemistries
d. 4. Complete visual examination with clothing removed
• Rationale 1: A pelvic examination is indicated for suspected sexual abuse. Reference:

Page 241
• Rationale 2: Toxicological screening is indicated for suspected drug abuse. Reference:
Page 241
• Rationale 3: Complete blood count and blood chemistries would be indicated if concerns
included neglect reflected by malnutrition and dehydration.
• Rationale 4: If you suspect elder mistreatment or abuse, a complete visual examination
of the older person without clothing is necessary. Abusers may strike where clothing
hides the resulting bruises. You can protect privacy by assessing the older person's
body one area at a time from head to toe.
156. The nurse is concerned that specific families in a community are at increased risk
for transgenerational violence. Which family situation exemplifies the
transgenerational theory of violence?
a. 1. Family with a daughter who abuses alcohol
b. 2. Family with a daughter who has severe arthritis and finds it increasingly
difficult to deal with her forgetful, frailmother
c. 3. Family with a son who, as a teenager and young adult, had serious
arguments with his parents, who were emotionally abusive to him
d. 4. Family with a daughter who is working two jobs with significant debts and
cares for her father, who is becoming more confused and dependent
Ratonale: Correct Answer: 3
• Rationale 1: The theory of psychopathology of the abuser refers to caregivers who have
preexisting conditions that impair their abilities to provide proper care, as in the case of
an adult child who has an ongoing alcohol abuse problem.
• Rationale 2: The theory of psychopathology of the abuser refers to caregivers who have
preexisting conditions that impair their abilities to provide proper care, as in the case of
an adult child with severe arthritis. Reference: Page 233
• Rationale 3: The theory of transgenerational violence involves a continuum of family
violence. A child grows up in a home where a contentious family relationship and some
form of abuse is the norm. The child who was abused grows up and later becomes
aggressive and abusive to the elderly parent.
• Rationale 4: Situational theory or caregiver stress involves care burdens that outweigh
the caregiver's abilities to deliver care. Examples of caregiver stress are severe financial
or time constraints paired with the older adult requirements for more physical care or
supervision.
157. An older patient tearfully tells a nurse that she must buy the neighbor's groceries
or the neighbor will not drive the patient to the store. The nurse recognizes this situation
as being which type of elder mistreatment?
a. 1. Abuse
b. 2. Neglect
c. 3. Exploitation
d. 4. Abandonment
• Rationale 1: Abuse is any action or inaction harming or endangering the welfare of an

older adult. Reference: Page 234
• Rationale 2: Neglect involves failure to provide adequate care or services for an older
adult. Reference: Page 234
• Rationale 3: Elder mistreatment by exploitation involves the abuser taking advantage of
the older person for monetary or personal benefit. This is the case in which the older
patient is being coerced to buy the neighbor's groceries.
• Rationale 4: Abandonment is the desertion or willful forsaking of an older person.
Reference: Page 234
158. In which situations is institutional mistreatment of older patients most likely to

occur?
a. 1. Staff burnout
b. 2. Staffing shortage
c. 3. Patient aggressiveness
d. 4. Inadequate staff training
e. 5. Family members frequently visit
• Rationale 1: Staff burnout may be a precipitating factor in the mistreatment of nursing

home residents. Reference: Page 236
• Rationale 2: Staffing shortages may be a precipitating factor in the mistreatment of
nursing home residents. Reference: Page 236
• Rationale 3: Patient aggressiveness was found to be a predictor of physical and
psychological abuse by staff members.
• Rationale 4: Inadequate staff training may be a precipitating factor in the mistreatment of
nursing home residents. Reference: Page 236
• Rationale 5: Frequent family visits are not identified as being a precipitating factor in the
mistreatment of nursing home residents.
159. Which older patient is at greatest risk for mistreatment in the home?
a. 1. An active older patient with well-controlled diabetes who lives alone
b. 2. A healthy older patient who is retired from owning a business and lives with an
adult son
c. 3. An older patient with a history of coronary bypass surgery, is active, and lives
with the spouse
d. 4. An older patient with severe osteoarthritis and macular degeneration
who lives with a single daughter who has an adult son with cerebral palsy
• Rationale 1: Risk factors for elder mistreatment include being female, over the age of 75,
having a dependent functional status, having a poor social network, poverty, minority,
cognitive impairment, and having less than an 8th grade education. An active older
patient who has a chronic illness and lives alone is not at risk for mistreatment in the
home.
• Rationale 2: A healthy older patient who is retired from owning a business and living with
an adult son is not at risk for mistreatment in the home.
cognitive impairment, and having less than an 8th grade education. An older patient with
a history of coronary bypass surgery and lives with the spouse is not at risk for
mistreatment in the home.
cognitive impairment, and having less than an 8th grade education. An older patient with
severe osteoarthritis and macular degeneration who lives with a single daughter who
has a son with a health problem is at the greatest risk for mistreatment in the home.
160. An older patient lives alone and has not bathed or changed clothing for
several days. An investigator for adult protective services visits and determines this
patient is experiencing which type of elder mistreatment?
a) Self-neglect
b) Physical abuse
c) Psychological abuse
d) Financial exploitation
Rationale 1: Self-neglect occurs when mentally competent patients engage in behaviors that
threaten their own safety and well-being. Failure to maintain proper hygiene practices falls into
this category of elder mistreatment. Reference: Page 234
161. A visitor to a long-term care institution witnesses an attendant scolding a

patient with dementia about being incontinent. What type of abuse is the visitor
witnessing?
a. 1. Neglect
b. 2. Exploitation
c. 3. Caregiver burnout
d. 4. Psychological abuse

• Rationale 4: A caregiver who scolds and ridicules a patient who is unable to care
for him- or herself is committing psychological abuse by inflicting anguish and
psychological pain.
162. An older patient is being abused by family members in the home and asks
about adult protective services. What should the nurse explain about these
services?
a. 1. They punish persons who abuse the elderly.
b. 2. They provide services to protect older people who may be abused or
neglected.
c. 3. They provide a way to permanently keep the older patient separated from the
abuser.
d. 4. They place older patients who cannot adequately care for themselves in
nursing homes.
• Rationale 2: Adult protective services (APS) programs are social services organized to
protect vulnerable older adults who may be abused, neglected, or exploited.
163. What will the nurse keep in mind when documenting the suspected abuse of an
older patient?
a. 1. Photo documentation is not usually included as part of the documentation.
b. 2. Documentation should include objective data of the older patient's
reaction when the suspected abuser is present.
c. 3. It is important to include the nurse's personal opinion of the suspected abuser
and the nurse's prior experience in similar cases.
d. 4. The details of the documentation should not be reported to the adult protective
services; it is important that they come to an independent conclusion about the
issue of abuse.
• Rationale 2: Older adults who appear fearful when in the presence of a suspected
abuser will need careful assessment as this may be a warning sign of mistreatment.
Physical indicators of elder mistreatment that are clearly described will assist
interdisciplinary members with diagnosis as well as with planning goals of patient care.
164. An older patient is accompanied to a physician's office visit with an adult

daughter who walks with an assistive device. The older patient is hard of hearing,
has osteoarthritis, and has difficulty completing activities of daily living. Which nursing
diagnosis would the nurse identify as being the priority at this time?
a. 1. Social isolation
b. 2. Caregiver role strain
c. 3. Ineffective protection
d. 4. Situational low self-esteem
• Rationale 2: Caregiver role strain is the priority since the daughter walks with an
assistive device and needs to help the older patient who is hard of hearing, has
osteoarthritis, and has difficulty completing activities of daily living. The daughter may
become stressed with having to help the older patient as well as herself with care needs.
Reference: Page 241
165. An older patient has been brought into the emergency department with
injuries caused by suspected physical abuse. Which tools could the nurse use to
assess this patient's injuries?
a. 1. Indicators of abuse screen

b. 2. AMA assessment protocol
c. 3. Adult protective services report
d. 4. Brief abuse screen for the elderly
e. 5. Hwalek-Sengstock elder abuse screening test
• Rationale 1: The indicators of abuse screen is a 29-item set of indicators for use by
social service agency practitioners to identify elder mistreatment.
• Rationale 2: The AMA assessment protocol is a checklist used if abuse is suspected.
Reference: Page 238
• Rationale 3: Adult protective services do not use a specific format. Intake forms are used
to document calls of suspected elder mistreatment from public hotlines and state
agencies.
• Rationale 4: The brief abuse screen for the elderly asks five standard questions that
focus on abuse. Reference: Page 238
• Rationale 5: The Hwalek-Sengstock elder abuse screening test is one 15-item
assessment screen for detecting suspected elder abuse and neglect.
166. The home healthcare nurse is preparing an educational program for other
healthcare providers regarding elder abuse. What information should the nurse
include?
a. 1. The typical abuser is the spouse.

b. 2. The typical abuser is the adult child.
c. 3. The typical elder who is abused is a woman.
d. 4. The majority of abuse occurs in the home setting.
e. 5. The majority of abuse occurs in the long-term care setting.
• Rationale 1: Spouses account for only 11.3% of abuse. Reference: Page 233
• Rationale 2: Adult children account for 32.6% of abuse. Reference: Page 233
• Rationale 3: The typical older person who is abused is a Caucasian woman. Reference:
Page 233
• Rationale 4: The vast majority of abuse and neglect occurs in the domestic setting.
Reference: Page 233
• Rationale 5: Although institutional abuse can occur, the vast majority of abuse occurs in
the home setting. Reference: Page 233
167. The home care nurse is preparing to visit an older female patient who lives
in her son's home. Prior to the visit, which risk factors for elder abuse will the nurse
review?
a. 1. Male gender
b. 2. Hispanic race
c. 3. Impaired cognitive status
d. 4. High socioeconomic status
• Rationale 3: Cognitive impairment is a risk factor for elder abuse. Reference: Page 236
168. The adult daughter of an older patient is researching viable skilled facilities
to have the patient admitted for long- term care needs. This research has not
revealed much information about institutional abuse. Why is this information not
readily available to the daughter?
a. 1. Residents may fear retribution.

b. 2. Managers fear adverse publicity.
c. 3. Staff members fear losing their jobs.
d. 4. Family members fear having to find a new agency for the patient.
e. 5. Billing department members fear not getting paid for services provided to
patients.
• Rationale 1: A federal report revealed large delays in the reporting of incidents of elder
mistreatment in nursing homes. One reason for this delay is that residents may fear
retribution if they report the abuse.
mistreatment in nursing homes. One reason for this delay is that the managers of the
facilities may fear adverse publicity about the abuse. Reference: Page 236
mistreatment in nursing homes. One reason for this delay is that staff members may fear
losing their jobs if they report abuse of residents. Reference: Page 236
mistreatment in nursing homes. One reason for this delay is that families may fear
having to find a new agency for the patient. Reference: Page 236
mistreatment in nursing homes. Billing or payment issues are not reasons why incidents
of elder abuse in nursing homes are not being reported.
169. The nurse is caring for an older patient who has been the victim of elder abuse
by an adult son. According to the transgenerational violence theory of elder
mistreatment, which situation would have occurred with the patient?
a. 1. The son is an alcoholic.
b. 2. The care of the patient has overwhelmed the son.
c. 3. The patient was abusive to the son when he was a child.
d. 4. As a child, the son witnessed the father beating the mother.
• Rationale 3: The transgenerational violence theory suggests that elder mistreatment is

thought to be part of the family violence continuum. It begins with child abuse and ends
with elder abuse.
170. The home care nurse asks an older patient's caregiver to complete a
questionnaire regarding caregiver strain. The caregiver states, "You are here to see my
mom. Why do you need information about me?" Which is the most appropriate
response by the nurse?
a. 1. "We fill out this paperwork for all caregivers."
b. 2. "We need to make sure you don't abuse your mother."
c. 3. "It's just something that the insurance companies make us fill out."
d. 4. "We need information about how you are dealing with caring for your
mother. We don't want you to become overwhelmed."
• Rationale 4: It has been documented that fewer older adults report mistreatment by
family members, which may be a protective act. Caregivers of older adults should be
assessed at each primary care visit for caregiver stress, substance abuse, and a history
of psychopathology. The Modified Caregiver Strain Index has been recommended by the
Hartford Institute of Geriatric Nursing as the best practice in the nursing care of older
adults. This instrument is a valid and reliable screening tool and can identify caregivers
in need of support.
171. An emergency room nurse is caring for an older patient brought in by a

neighbor. The neighbor states that the patient lives with a son who "drinks a lot."
What does the nurse assess that suggests elder neglect?
a. 1. Thick, yellow fingernails

b. 2. Pressure ulcer on the sacrum
c. 3. Dry, cracked lips and tongue
d. 4. Small skin tears to the right elbow
e. 5. Cracked, dry skin on the lower legs bilaterally
Rationale: Correct Answer: 2,3
• Rationale 1: Thick, yellow fingernails could be an expected finding in an older patient

and not indicative of neglect.
• Rationale 2: A pressure ulcer on the sacrum is a manifestation of caregiver neglect.
Reference: Page 234
• Rationale 3: Common signs and symptoms of neglect include dehydration, which would
be manifested as dry, cracked lips and tongue.
• Rationale 4: Small skin tears to the right elbow do not necessarily indicate caregiver
neglect and could have occurred during routine activities in the home.
• Rationale 5: Cracked dry skin on both lower legs does not necessarily indicate caregiver
neglect. This could be an expected finding in an older patient.
172. The nurse is caring for a patient who has been the victim of elder abuse by
her son. According to the situational violence theory of elder mistreatment, which
situation would have occurred?
a. 1. The son is unemployed.
b. 2. The care of the patient has overwhelmed the son.
c. 3. The patient sent the son to live at boarding school.
d. 4. The son witnessed several young boys being beat up in the neighborhood.
• Rationale 2: The situational violence theory suggests that elder mistreatment is thought
to be a result of the caregiver becoming overwhelmed by the care the patient requires.
173. The nurse is concerned that an older patient is at risk for abuse because the
patient lives with an adult son who is an alcoholic. Which theory of elder
mistreatment is this nurse basing this concern for the patient?
a. 1. Isolation
b. 2. Situational
c. 3. Psychopathology
d. 4. Transgenerational
• Rationale 3: In the psychopathological theory of elder abuse, caregivers who have

preexisting conditions may have impaired capacity to give appropriate care, such as a
caregiver with alcohol dependency may not be able to exercise appropriate judgment in
caregiving of an older adult, which can ultimately lead to abuse or neglect. Reference:
Page 233
174. An older patient with a black eye is diagnosed with a broken arm that is
reported as being caused by falling on a shovel while clearing snow from a
walkway. Why should the nurse suspect physical abuse with this patient?
a. 1. The patient is confused.
b. 2. The patient is 65 years old.
c. 3. The patient is African American.
d. 4. The patient's testing results are inconsistent with the history given.
• Rationale 4: One sign of elder mistreatment includes diagnostic testing results

inconsistent with the history given. Reference: Page 237
175. The daughter of an older patient who is a resident of a nursing home

suspects the patient is a victim of abuse. What should the nurse suggest that the
daughter do about this situation?
a. 1. Visit the facility at varied times.

b. 2. Do nothing until evidence is obtained.
c. 3. Realize that the patient can be confused.
d. 4. Participate in the resident's council.
e. 5. Actively participate in care plan meetings.
• Rationale 1: For the older adult living in long-term care facilities, the California
Advocates for Nursing Home Reform recommend that family should visit the facility at
varied times.
• Rationale 2: The nurse should not recommend that the daughter do nothing about the
situation until evidence is obtained. The older patient could be drastically harmed.
• Rationale 3: There is no evidence that the older patient is confused. The nurse should
not make this recommendation to the daughter.
Advocates for Nursing Home Reform recommend that the family participate in the
resident's council.
Advocates for Nursing Home Reform recommend that the family actively participate in
care plan meetings for the older patient.
176. An older patient with terminal cancer is considering hospice care but is
concerned that Medicare will stop payments if the care is provided for longer than 6
months. What can the nurse respond to this patient?

a. 1. Medicare does not limit the hospice benefit.
b. 2. Medicare regulations discourage a longer use of the benefit.
c. 3. Hospice costs more than traditional hospital or long-term care.
d. 4. Patient may enroll when the life expectancy is 6 months or less.
e. 5. Hospice supports the family for 6 months after the patient's death.
• Rationale 1: Medicare law does not limit the hospice benefit. Reference: Page 255
• Rationale 2: Medicare regulations often discourage a patient from using hospice for
longer than 6 months. Reference: Page 255
• Rationale 3: Hospice costs less than traditional hospital or long-term care. Reference:
Page 255
• Rationale 4: Patients may enroll when their physician judges their life expectancy to be 6
months or less. Reference: Page 255
• Rationale 5: Hospice supports all family members during the illness and supports the
family for 1 year after the death.
177. During an assessment the nurse determines that an older patient dying from a
terminal illness is experiencing common fears. What fears did this nurse assess in the
patient?
1. Dying alone
2. Loss of consciousness
3. Loss of bladder control
4. Leaving loved ones behind
5. Becoming a burden to others
• Rationale 1: Common fears and concerns of the dying include dying alone. Reference:
Page 257
• Rationale 2: Common fears and concerns of the dying include loss of consciousness.
Reference: Page 257
• Rationale 3: Common fears and concerns of the dying include loss of bladder control.
Reference: Page 257
• Rationale 4: Common fears and concerns of the dying do not include leaving loved ones
behind. Reference: Page 257
• Rationale 5: Common fears and concerns of the dying include becoming a burden to
others. Reference: Page 257
178. An older patient dying of end-stage pulmonary disease and dementia receives
narcotic medication for chronic pain. Currently the patient is restless and grimacing. How
should the nurse interpret these assessment findings?
a. 1. The patient is in pain.
b. 2. The patient has an undiagnosed personality disorder.
c. 3. The patient needs nonpharmacological pain management approaches.
d. 4. The patient is not experiencing any difference in pain level and no adjustments
are needed.
• Rationale 1: When an older adult is unable to speak or self-report the level of pain, the
nurse should carefully observe the patient for behavioral symptoms of pain that may
include restlessness and grimacing.
179. An older patient dying from a terminal illness reports that the last dose of pain
medication provided barely reduced the level of pain. What should the nurse do to
help this patient?
a. 1. Give the patient pain medication every hour.
b. 2. Contact the physician for an adjustment in pain medication.
c. 3. Provide the pain medication at the next scheduled dose time.
d. 4. Give the patient another dose of the medication even though it is before the
scheduled time.
• Rationale 2: Dying patients may need more pain medication than the normal range for
the prescribed drug. Organic changes are occurring rapidly within the body and systems
are shutting down, decreasing the absorption levels of drugs.
180. The nurse is planning oral hygiene for an older patient with a terminal illness who
has an intact swallowing reflex. Which interventions would be appropriate for this
patient?
a. 1. Offer ice chips frequently.

b. 2. Provide care with soft swabs.
c. 3. Apply petroleum jelly to the lips.
d. 4. Brush the teeth three times a day.
e. 5. Avoid using alcohol-based solutions.
• Rationale 1: Ice chips to relieve the feeling of dryness may be offered as long as the
swallowing reflex is present. Reference: Page 262
• Rationale 2: Oral care with soft swabs should be provided several times a day and
whenever the mouth has a foul odor or appears uncomfortable for the patient.
• Rationale 3: Soothing ointments or petroleum jelly may be applied to the lips to prevent
painful cracking or drying.
• Rationale 4: The patient's oral hygiene should be provided with soft oral swabs or
moistened cloths. A toothbrush would be too harsh for the patient's delicate oral tissues.
• Rationale 5: Alcohol-based products can be irritating and drying and their use is
discouraged. Reference: Page 262
181. The family of an older patient dying of liver cancer is concerned that the patient
will not eat or drink. The patient is alert and oriented, and expresses no desire to eat.
What action would the nurse take?
a. 1. Force fluids.
b. 2. Consult the dietician for feeding supplements.
c. 3. Contact the physician for an order for tube feedings.
d. 4. Comply with the patient's wishes despite the family's concern.
• Rationale 4: Anorexia and dehydration are common and normal with the patient with a
terminal illness. The patient's wishes should be respected. The nurse should educate the
family and reassure them that anorexia may result in ketosis that can lead to a peaceful
state of mind and decreased pain.
182. An older patient with end-stage renal and heart failure is experiencing odd
dreams and is talking with people who are not present in the room. What does this
finding indicate to the nurse?
a. 1. Pending death
b. 2. Ineffective pain medication
c. 3. Overdose of narcotic medication
d. 4. Normal visual and auditory hallucinations at the end of life

• Rationale 4: Terminal delirium presents as confusion, restlessness, and/or agitation, with
or without day-night reversal. Visual, auditory, and olfactory hallucinations may occur
during this time. It is important for the nurse to understand that this condition is often
irreversible, and that the patient's experience of the delirium may be very different from
what is witnessed by caregivers.
183. While providing postmortem care to a patient who has died the patient elicits a
respiratory sound when turned. What should the nurse do?
a. 1. Check for a pulse.
b. 2. Reposition the airway.
c. 3. Continue with the postmortem care.
d. 4. Report to the physician the patient is still breathing.
• Rationale 3: When the body is moved or the extremities repositioned, the body may
produce respiratory-type sounds or the chest may appear to rise and fall. This can be
alarming, but is only the sound of air leaving the lungs. Reference: Page 266
184. An older patient is not breathing well and has cold, mottled skin. The patient
has a living will and requests comfort measures only. What should the nurse do to
care for this patient?
a. 1. Ask the family what they want to be done for the patient.
b. 2. Contact the physician for orders to control the patient's breathing.
c. 3. Provide personal hygiene and skin care as outlined in the care plan.
d. 4. Withhold pain medication, hygiene, and nutrition until the patient dies.
• Rationale 3: Comfort measures only indicate that the patient does not want extraordinary
measures to sustain life. This does not mean that nursing care ceases but that nursing
care to provide patient comfort is intensified and maintained through the end stages of
the patient's life.
185. The family of an older patient with a terminal illness has been aware of the
patient's pending death and is present when the patient dies. The family's reaction to the
patient's death was very emotional and demonstrated a state of disbelief. How should
the nurse interpret this family's behavior?
a. 1. Irrational behavior
b. 2. Expression of anger
c. 3. Maladaptive coping of the family
d. 4. Normal shock when experiencing the loss of a loved one
• Rationale 4: Even if the family is expecting the death, the actual notification may be
shocking to the family and needs to be handled gently and with empathy. There is
disbelief that death has occurred and may be marked by shock, emotional dullness, and
restless behavior that may include stupor and withdrawal. It may include physical
characteristics such as nausea or insomnia.
186. The nurse is planning care for an older patient who is dying. Which interventions
will ensure the patient dies with dignity?
a. 1. Relieving suffering
b. 2. Controlling pain and symptoms
c. 3. Making decisions for the patient and family
d. 4. Clarifying goals of treatment and the patient's values
e. 5. Communicating patient needs between healthcare providers
187. A newly licensed nurse is preparing to provide postmortem care for the first time
and asks for help. How should the assisting nurse respond to this request?
a. 1. "It's just a dead body, it can't hurt you."
b. 2. "The families typically don't care about the body once the person is dead."
c. 3. "You can delegate this to the nursing assistant. Tell her to clean the body up
when she is finished with her other work."
d. 4. "It is an important part of care; we need to show the family that the
person was valued and respected. I can understand that you are nervous."
• Rationale 4: Postmortem care needs to be done promptly, quietly, efficiently, and with
dignity, so that it is communicated to the family that the deceased one was valued and
respected.
188. An older female patient is experiencing fatigue, nausea, vague complaint of
intermittent chest discomfort, and not sleeping well. How should the nurse interpret
these symptoms?
a. 1. Signs of anemia
b. 2. Pancreatic disease
c. 3. Myocardial infarction
d. 4. Normal changes of aging
• Rationale 3: Many older women will complain of vague symptoms when having a
myocardial infarction, including fatigue, sleep disturbances, and epigastric pain.
189. During a blood pressure screening at a pharmacy an older person experiences a

fluttering in the chest. What should the nurse interpret this finding as being?
a. 1. Hypothyroidism
b. 2. Exercise intolerance
c. 3. Nonspecific cardiac changes with aging
d. 4. Underlying illness that requires a medical evaluation

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What are some common health problems among older homeless adults?

What are some common health problems among older homeless adults?

What is the appropriate nursing response when a family expresses shock after an expected death?

What is the appropriate nursing response when a family expresses shock after an expected death?

1. The term geriatric refers to what type of adult patient?

a. Those in nursing homes

Rationale: The term geriatric refers to what type of adult patient?

2. Which group has the highest rate of depression, and suicide?

• Increased hemoglobin and hematocrit because the blood is more concentrated.

7. The gerontological nurse is working in a mobile clinic to provide care to a homeless

a. psychiatric/substance abuse disorders.

Rationale: c) "I drink hot chocolate before bedtime."

a. Say to the daughter-in-law, "Confining your father-in-law to his room is

Assisting clients and families to become aware of available community support

a. Check for medication interactions.

Polypharmacy is a concern in the older client. Duplication of medications needs to be

14. The healthcare provider is performing an assessment on a patient who is taking

Rationale: b) Bradycardia- Propranolol is a nonselective beta-adrenergic antagonist

Rationale: a) Initiate a heparin infusion

Rationale: d) A polymorphic ventricular tachycardia

19. A patient with a diagnosis of Wolff-Parkinson-White syndrome is undergoing a catheter

Rationale: c) Monitor insertion site and distal pulses

Rationale: a) When there is impairment in cardiac output.

Rationale: D) Cardiopulmonary resuscitation (CPR)

25. Which individual is at greatest risk for developing hypertension?

Rationale: Answer: A: 45-year-old African American attorney The incidence of hypertension is

Standard Text: Select all that apply.

1. Medicare does not limit the hospice benefit.

Standard Text: Select all that apply.

130. An older patient dying of end-stage pulmonary disease and dementia

Standard Text: Select all that apply.

a. 1. Offer ice chips frequently.

Standard Text: Select all that apply.

Standard Text: Select all that apply.

Standard Text: Select all that apply.

a. 1. It might reduce the patients anxiety.

Standard Text: Select all that apply.

149. An older patient experiencing cancer pain is prescribed intravenous pain

Standard Text: Select all that apply.

a. 1. Use the smallest amount of fluid possible.

Rationale: Correct Answer: 2,3,5

• Rationale 1: Agitation is a manifestation of psychological or emotional abuse.

Standard Text: Select all that apply.

Rationale: Correct Answer: 1,2,3,5

Standard Text: Select all that apply.

Rationale: Correct Answer: 3,4,5

Rationale: Correct Answer: 1

Rationale: Correct Answer: 4

• Rationale 1: A pelvic examination is indicated for suspected sexual abuse. Reference:

Ratonale: Correct Answer: 3

Rationale: Correct Answer: 3

• Rationale 1: Abuse is any action or inaction harming or endangering the welfare of an

158. In which situations is institutional mistreatment of older patients most likely to

Standard Text: Select all that apply.

Rationale: Correct Answer: 1,2,3,4

• Rationale 1: Staff burnout may be a precipitating factor in the mistreatment of nursing

Rationale: Correct Answer: 4

Rationale: Correct Answer: 1

161. A visitor to a long-term care institution witnesses an attendant scolding a