1.

You are providing care for an 82-year-old man whose signs and symptoms of Parkinson disease have become
more severe over the past several months. The man tells you that he can no longer do as many things for himself as he
used to be able to do. What factor should you recognize as impacting your patient’s life most significantly?
A) Neurologic deficits
B) Loss of independence
C) Age-related changes
D) Tremors and decreased mobility
Ans: B
Feedback:
This patient’s statement places a priority on his loss of independence. This is undoubtedly a result of the
neurologic changes associated with his disease, but this is not the focus of his statement. This is a disease process, not
an age-related physiological change.

2. A gerontologic nurse practitioner provides primary care for a large number of older adults who are living with
various forms of cardiovascular disease. This nurse is well aware that heart disease is the leading cause of death in the
aged. What is an age-related physiological change that contributes to this trend?
A) Heart muscle and arteries lose their elasticity.
B) Systolic blood pressure decreases.
C) Resting heart rate decreases with age.
D) Atrial-septal defects develop with age.
Ans: A
Feedback:
The leading cause of death for patients over the age of 65 years is cardiovascular disease. With age, heart
muscle and arteries lose their elasticity, resulting in a reduced stroke volume. As a person ages, systolic blood pressure
does not decrease, resting heart rate does not decrease, and the aged are not less likely to adopt a healthy lifestyle.

3. An occupational health nurse overhears an employee talking to his manager about a 65-year-old coworker.
What phenomenon would the nurse identify when hearing the employee state, “He should just retire and make way for
some new blood.”?
A) Intolerance
B) Ageism
C) Dependence
D) Nonspecific prejudice
Ans: B
Feedback:
Ageism refers to prejudice against the aged. Intolerance is implied by the employee’s statement, but the
intolerance is aimed at the coworker’s age. The employee’s statement does not raise concern about dependence. The
prejudice exhibited in the statement is very specific.

4. The nurse is caring for a 65-year-old patient who has previously been diagnosed with hypertension. Which of the
following blood pressure readings represents the threshold between high-normal blood pressure and hypertension?
A) 140/90 mm Hg
B) 145/95 mm Hg
C) 150/100 mm Hg
D) 160/100 mm Hg
Ans: A
Feedback:
Hypertension is the diagnosis given when the blood pressure is greater than 140/90 mm Hg. This makes the
other options incorrect.
5. You are the nurse caring for an 85-year-old patient who has been hospitalized for a fractured radius. The
patient’s daughter has accompanied the patient to the hospital and asks you what her father can do for his very dry skin,
which has become susceptible to cracking and shearing. What would be your best response?
A) “He should likely take showers rather than baths, if possible.”
B) “Make sure that he applies sunscreen each morning.”
C) “Dry skin is an age-related change that is largely inevitable.”
D) “Try to help your father increase his intake of dairy products.”
Ans: A
Feedback:
Showers are less drying than hot tub baths. Sun exposure should indeed be limited, but daily application of
sunscreen is not necessary for many patients. Dry skin is an age-related change, but this does not mean that no
appropriate interventions exist to address it. Dairy intake is unrelated.

6. An elderly patient has come in to the clinic for her twice-yearly physical. The patient tells the nurse that she is
generally enjoying good health, but that she has been having occasional episodes of constipation over the past 6
months. What intervention should the nurse first suggest?
A) Reduce the amount of stress she currently experiences.
B) Increase carbohydrate intake and reduce protein intake.
C) Take herbal laxatives, such as senna, each night at bedtime.
D) Increase daily intake of water.
Ans: D
Feedback:
Constipation is a common problem in older adults and increasing fluid intake is an appropriate early
intervention. This should likely be attempted prior to recommending senna or other laxatives. Stress reduction is
unlikely to wholly resolve the problem and there is no need to increase carbohydrate intake and reduce protein intake.

7. An 84-year-old patient has returned from the post-anesthetic care unit (PACU) following hip arthroplasty. The
patient is oriented to name only. The patient’s family is very upset because, before having surgery, the patient had no
cognitive deficits. The patient is subsequently diagnosed with postoperative delirium. What should the nurse explain to
the patient’s family?
A) This problem is self-limiting and there is nothing to worry about.
B) Delirium involves a progressive decline in memory loss and overall cognitive function.
C) Delirium of this type is treatable and her cognition will return to previous levels.
D) This problem can be resolved by administering antidotes to the anesthetic that was used in surgery.
Ans: C
Feedback:
Surgery is a common cause of delirium in older adults. Delirium differs from other types of dementia in that
delirium begins with confusion and progresses to disorientation. It has symptoms that are reversible with treatment,
and, with treatment, is short term in nature. It is patronizing and inaccurate to reassure the family that there is “nothing
to worry about.” The problem is not treated by the administration of antidotes to anesthetic.

8. The nurse is providing patient teaching to a patient with early stage Alzheimer’s disease (AD) and her family. The
patient has been prescribed donepezil hydrochloride (Aricept). What should the nurse explain to the patient and family
about this drug?
A) It slows the progression of AD.
B) It cures AD in a small minority of patients.
C) It removes the patient’s insight that he or she has AD.
D) It limits the physical effects of AD and other dementias.
Ans: A
Feedback:
There is no cure for AD, but several medications have been introduced to slow the progression of the disease,
including donepezil hydrochloride (Aricept). These medications do not remove the patient’s insight or address physical
symptoms of AD.
9. A nurse is caring for an 86-year-old female patient who has become increasingly frail and unsteady on her feet. During
the assessment, the patient indicates that she has fallen three times in the month, though she has not yet suffered an
injury. The nurse should take action in the knowledge that this patient is at a high risk for what health problem?
A) A hip fracture
B) A femoral fracture
C) Pelvic dysplasia
D) Tearing of a meniscus or bursa
Ans: A
Feedback:
The most common fracture resulting from a fall is a fractured hip resulting from osteoporosis and the condition
or situation that produced the fall. The other listed injuries are possible, but less likely than a hip fracture.

10. The case manager is working with an 84-year-old patient newly admitted to a rehabilitation facility. When
developing a care plan for this older adult, which factors should the nurse identify as positive attributes that benefit
coping in this age group? Select all that apply.
A) Decreased risk taking
B) Effective adaptation skills
C) Avoiding participation in untested roles
D) Increased life experience
E) Resiliency during change
Ans: B, D, E
Feedback:
Because changes in life patterns are inevitable over a lifetime, older people need resiliency and coping skills
when confronting stresses and change. It is beneficial if older adults continue to participate in risk taking and
participation in new, untested roles.
11. A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be
administering intramuscular (IM) doses of the vaccine. Of what age-related change should the nurse be aware when
planning the appropriate administration of this drug?
A) An older patient has less subcutaneous tissue and less muscle mass than a younger patient.
B) An older patient has more subcutaneous tissue and less durable skin than a younger patient.
C) An older patient has more superficial and tortuous nerve distribution than a younger patient.
D) An older patient has a higher risk of bleeding after an IM injection than a younger patient.
Ans: A
Feedback:
When administering IM injections, the nurse should remember that in an older patient, subcutaneous fat
diminishes, particularly in the extremities. Muscle mass also decreases. There are no significant differences in nerve
distribution or bleeding risk.
12. An elderly patient, while being seen in an urgent care facility for a possible respiratory infection, asks the nurse if
Medicare is going to cover the cost of the visit. What information can the nurse give the patient to help allay her
concerns?
A) Medicare has a copayment for many of the services it covers. This requires the patient to pay a part of the bill.
B) Medicare pays for 100% of the cost for acute-care services, so the cost of the visit will be covered.
C) Medicare will only pay the cost for acute-care services if the patient has a very low income.
D) Medicare will not pay for the cost of acute-care services so the patient will be billed for the services provided.
Ans: A
Feedback:
The two major programs that finance health in the United States are Medicare and Medicaid, both of which are
overseen by the Centers for Medicaid and Medicare Services (CMS). Both programs cover acute-care needs such as
inpatient hospitalization, physician care, outpatient care, home health services, and skilled nursing care in a nursing.
Medicare is a plan specifically for the elderly population, and Medicaid is a program that provides services based on
income.
13. The admissions department at a local hospital is registering an elderly man for an outpatient diagnostic test. The
admissions nurse asks the man if he has an advanced directive. The man responds that he does not want to complete an
advance directive because he does not want anyone controlling his finances. What would be appropriate information for
the nurse to share with this patient?
A) “Advance directives are not legal documents, so you have nothing to worry about.”
B) “Advance directives are limited only to health care instructions and directives.”
C) “Your finances cannot be managed without an advance directive.”
D) “Advance directives are implemented when you become incapacitated, and then you will use a living will to
allow the state to manage your money.”
Ans: B
Feedback:
An advance directive is a formal, legally endorsed document that provides instructions for care (living will) or
names a proxy decision maker (durable power of attorney for health care) and covers only issues related specifically to
health care, not financial issues. They do not address financial issues. Advance directives are implemented when a
patient becomes incapacitated, but financial issues are addressed with a durable power of attorney for finances, or
financial power of attorney.
14. A nurse is planning discharge teaching for an 80-year-old patient with mild short-term memory loss. The
discharge teaching will include how to perform basic wound care for the venous ulcer on his lower leg. When planning
the necessary health education for this patient, what should the nurse plan to do?
A) Set long-term goals with the patient.
B) Provide a list of useful Web sites to supplement learning.
C) Keep visual cues to a minimum to enhance the patient’s focus.
D) Keep teaching periods short.
Ans: D
Feedback:
To assist the elderly patient with short-term memory loss, the nurse should keep teaching periods short, provide
glare-free lighting, link new information with familiar information, use visual and auditory cues, and set short-term goals
with the patient. The patient may or may not be open to the use of online resources.
15. You are the nurse planning an educational event for the nurses on a subacute medical unit on the topic of
normal, age-related physiological changes. What phenomenon would you include in your teaching plan?
A) A decrease in cognition, judgment, and memory
B) A decrease in muscle mass and bone density
C) The disappearance of sexual desire for both men and women
D) An increase in sebaceous and sweat gland function in both men and women
Ans: B
Feedback:
Normal signs of aging include a decrease in the sense of smell, a decrease in muscle mass, a decline but not
disappearance of sexual desire, and decreased sebaceous and sweat glands for both men and women. Cognitive changes
are usually attributable to pathologic processes, not healthy aging.
16. A home health nurse makes a home visit to a 90-year-old patient who has cardiovascular disease. During the
visit the nurse observes that the patient has begun exhibiting subtle and unprecedented signs of confusion and
agitation. What should the home health nurse do?
A) Increase the frequency of the patient’s home care.
B) Have a family member check in on the patient in the evening.
C) Arrange for the patient to see his primary care physician.
D) Refer the patient to an adult day program.
Ans: C
Feedback:
In more than half of the cases, sudden confusion and hallucinations are evident in multi-infarct dementia. This
condition is also associated with cardiovascular disease. Having the patient’s home care increased does not address the
problem, neither does having a family member check on the patient in the evening. Referring the patient to an adult day
program may be beneficial to the patient, but it does not address the acute problem the patient is having, the nurse
should arrange for the patient to see his primary care physician.
17. The home health nurse is making an initial home visit to a 76-year-old widower. The patient takes multiple
medications for the treatment of varied chronic health problems. The patient states that he has also begun taking some
herbal remedies. What should the nurse be sure to include in the patient’s teaching?
A) Herbal remedies are consistent with holistic health care.
B) Herbal remedies are often cheaper than prescribed medication.
C) It is safest to avoid the use of herbal remedies.
D) There is a need to inform his physician and pharmacist about the herbal remedies.
Ans: D
Feedback:
Herbal remedies combined with prescribed medications can lead to interactions that may be toxic. Patients
should notify the physician and pharmacist of any herbal remedies they are using. Even though herbal remedies are
considered holistic, this is not something that is necessary to include in the patient’s teaching. Herbal remedies may be
cheaper than prescribed medicine, but this is still not something that is necessary to include in the patient’s teaching.
For most people, it is not necessary to wholly avoid herbal remedies.
18. You are the nurse caring for an elderly patient who is being treated for community-acquired pneumonia. Since
the time of admission, the patient has been disoriented and agitated to varying degrees. Appropriate referrals were
made and the patient was subsequently diagnosed with dementia. What nursing diagnosis should the nurse prioritize
when planning this patient’s care?
A) Social isolation related to dementia
B) Hopelessness related to dementia
C) Risk for infection related to dementia
D) Acute confusion related to dementia
Ans: D
Feedback:
Acute confusion is a priority problem in patients with dementia, and it is an immediate threat to their health and
safety. Hopelessness and social isolation are plausible problems, but the patient’s cognition is a priority. The patient’s
risk for infection is not directly influenced by dementia.
19. You are caring for a patient with late-stage Alzheimer’s disease. The patient’s wife tells you that the patient has
now become completely dependent and that she feels guilty if she takes any time for herself. What outcomes would be
appropriate for the nurse to develop to assist the patient’s wife?
A) The caregiver learns to explain to the patient why she needs time for herself.
B) The caregiver distinguishes essential obligations from those that can be controlled or limited.
C) The caregiver leaves the patient at home alone for short periods of time to encourage independence.
D) The caregiver prioritizes her own health over that of the patient.
Ans: B
Feedback:
For prolonged periods, it is not uncommon for caregivers to neglect their own emotional and health needs. The
caregiver must learn to distinguish obligations that she must fulfill and limit those that are not completely necessary.
The caregiver can tell the patient when she leaves, but she should not expect that the patient will remember or will not
become angry with her for leaving. The caregiver should not leave the patient home alone for any length of time
because it may compromise the patient’s safety. Being thoughtful and selective with her time and energy is not
synonymous with prioritizing her own health over than of the patient; it is more indicative of balance and sustainability.
20. A 47-year-old patient who has come to the physician’s office for his annual physical is being assessed by the
office nurse. The nurse who is performing routine health screening for this patient should be aware that one of the first
physical signs of aging is what?
A) Having more frequent aches and pains
B) Failing eyesight, especially close vision
C) Increasing loss of muscle tone
D) Accepting limitations while developing assets
Ans: B
Feedback:
 Failing eyesight, especially close vision, is one of the first signs of aging in middle life. More frequent aches and
pains begin in the “early” late years (between ages 65 and 79). Increase in loss of muscle tone occurs in later years (ages
80 and older). Accepting limitations while developing assets is socialization development that occurs in adulthood.
21. A gerontologic nurse is aware of the demographic changes that are occurring in the United States, and this
affects the way that the nurse plans and provides care. Which of the following phenomena is currently undergoing the
most rapid and profound change?
A) More families are having to provide care for their aging members.
B) Adult children find themselves participating in chronic disease management.
C) A growing number of people live to a very old age.
D) Elderly people are having more accidents, increasing the costs of health care.
Ans: C
Feedback:
As the older population increases, the number of people who live to a very old age is dramatically increasing.
The other options are all correct, but none is a factor that is most dramatically increasing in this age group.
22. As the population of the United States ages, research has shown that this aging will occur across all racial and
ethnic groups. A community health nurse is planning an initiative that will focus on the group in which the aging
population is expected to rise the fastest. What group should the nurse identify?
A) Asian-Americans
B) White non-Hispanics
C) Hispanics
D) African-Americans
Ans: C
Feedback:
Although the older population will increase in number for all racial and ethnic groups, the rate of growth is
projected to be fastest in the Hispanic population that is expected to increase from 6 million in 2004 to an estimated
17.5 million by 2050.
23. An 83-year-old woman was diagnosed with Alzheimer’s disease 2 years ago and the disease has progressed at an
increasing pace in recent months. The patient has lost 16 pounds over the past 3 months, leading to a nursing diagnosis
of Imbalanced Nutrition: Less than Body Requirements. What intervention should the nurse include in this patient’s plan
of care?
A) Offer the patient rewards for finishing all the food on her tray.
B) Offer the patient bland, low-salt foods to limit offensiveness.
C) Offer the patient only one food item at a time to promote focused eating.
D) Arrange for insertion of a gastrostomy tube and initiate enteral feeding.
Ans: C
Feedback:
To avoid any “playing” with food, one dish should be offered at a time. Foods should be familiar and appealing,
not bland. Tube feeding is not likely necessary at this time and a reward system is unlikely to be beneficial.
24. A gerontologic nurse is making an effort to address some of the misconceptions about older adults that exist
among health care providers. The nurse has made the point that most people aged 75 years remains functionally
independent. The nurse should attribute this trend to what factor?
A) Early detection of disease and increased advocacy by older adults
B) Application of health-promotion and disease-prevention activities
C) Changes in the medical treatment of hypertension and hyperlipidemia
D) Genetic changes that have resulted in increased resiliency to acute infection
Ans: B
Feedback:
Even among people 75 years of age and over, most remain functionally independent, and the proportion of
older Americans with limitations in activities is declining. These declines in limitations reflect recent trends in health-
promotion and disease-prevention activities, such as improved nutrition, decreased smoking, increased exercise, and
early detection and treatment of risk factors such as hypertension and elevated serum cholesterol levels. This
phenomenon is not attributed to genetics, medical treatment, or increased advocacy.
25. After a sudden decline in cognition, a 77-year-old man who has been diagnosed with vascular dementia is
receiving care in his home. To reduce this man’s risk of future infarcts, what action should the nurse most strongly
encourage?
A) Activity limitation and falls reduction efforts
B) Adequate nutrition and fluid intake
C) Rigorous control of the patient’s blood pressure and serum lipid levels
D) Use of mobility aids to promote independence
Ans: C
Feedback:
Because vascular dementia is associated with hypertension and cardiovascular disease, risk factors (e.g.,
hypercholesterolemia, history of smoking, diabetes) are similar. Prevention and management are also similar. Therefore,
measures to decrease blood pressure and lower cholesterol levels may prevent future infarcts. Activity limitation is
unnecessary and infarcts are not prevented by nutrition or the use of mobility aids.
26. Nurses and members of other health disciplines at a state’s public health division are planning programs for the
next 5 years. The group has made the decision to focus on diseases that are experiencing the sharpest increases in their
contributions to the overall death rate in the state. This team should plan health promotion and disease prevention
activities to address what health problem?
A) Stroke
B) Cancer
C) Respiratory infections
D) Alzheimer’s disease
Ans: D
Feedback:
In the past 60 years, overall deaths, and specifically, deaths from heart disease, have declined. Recently, deaths
from cancer and cerebrovascular disease have declined. However, deaths from Alzheimer’s disease have risen more
than 50% between 1999 and 2007.
27. Mrs. Harris is an 83-year-old woman who has returned to the community following knee replacement surgery.
The community health nurse recognizes that Mrs. Harris has prescriptions for nine different medications for the
treatment of varied health problems. In addition, she has experienced occasional episodes of dizziness and
lightheadedness since her discharge. The nurse should identify which of the following nursing diagnoses?
A) Risk for infection related to polypharmacy and hypotension
B) Risk for falls related to polypharmacy and impaired balance
C) Adult failure to thrive related to chronic disease and circulatory disturbance
D) Disturbed thought processes related to adverse drug effects and hypotension
Ans: B
Feedback:
Polypharmacy and loss of balance are major contributors to falls in the elderly. This patient does not exhibit
failure to thrive or disturbed thought processes. There is no evidence of a heightened risk of infection.
28. A gerontologic nurse has been working hard to change the perceptions of the elderly, many of which are
negative, by other segments of the population. What negative perceptions of older people have been identified in the
literature? Select all that apply.
A) As being the cause of social problems
B) As not contributing to society
C) As draining economic resources
D) As competing with children for resources
E) As dominating health care research
Ans: B, C, D
Feedback:
Retirement and perceived nonproductivity are responsible for negative feelings because a younger working
person may falsely see older people as not contributing to society and as draining economic resources. Younger working
people may actually feel that older people are in competition with children for resources. However, the older population
is generally not seen as dominating health care research or causing social problems.
29. You are caring for an 82-year-old man who was recently admitted to the geriatric medical unit in which you
work. Since admission, he has spoken frequently of becoming a burden to his children and “staying afloat” financially.
When planning this patient’s care, you should recognize his heightened risk of what nursing diagnosis?
A) Disturbed thought processes
B) Impaired social interaction
C) Decisional conflict
D) Anxiety
Ans: D
Feedback:
Economic concerns and fear of becoming a burden to families often lead to high anxiety in older people. There is
no clear indication that the patient has disturbed thought processes, impaired social interaction, or decisional conflict.
30. For several years, a community health nurse has been working with a 78-year-old man who requires a
wheelchair for mobility. The nurse is aware that the interactions between disabilities and aging are not yet clearly
understood. This interaction varies, depending on what variable?
A) Socioeconomics
B) Ethnicity
C) Education
D) Pharmacotherapy
Ans: A
Feedback:
Large gaps exist in our understanding of the interaction between disabilities and aging, including how this
interaction varies, depending on the type and degree of disability, and other factors such as socioeconomics and gender.
Ethnicity, education, and pharmacotherapy are not identified as salient influences on this interaction.
31. Gerontologic nursing is a specialty area of nursing that provides care for the elderly in our population. What goal
of care should a gerontologic nurse prioritize when working with this population?
A) Helping older adults determine how to reduce their use of external resources
B) Helping older adults use their strengths to optimize independence
C) Helping older adults promote social integration
D) Helping older adults identify the weaknesses that most limit them
Ans: B
Feedback:
Gerontologic nursing is provided in acute care, skilled and assisted living, community, and home settings. The
goals of care include promoting and maintaining functional status and helping older adults identify and use their
strengths to achieve optimal independence. Goals of gerontologic nursing do not include helping older adults “promote
social integration” or identify their weaknesses. Optimal independence does not necessarily involve reducing the use of
available resources.
32. The presence of a gerontologic advanced practice nurse in a long-term care facility has proved beneficial to both
the patients and the larger community in which they live. Nurses in this advanced practice role have been shown to
cause what outcome?
A) Greater interaction between younger adults and older adults occurs.
B) The elderly recover more quickly from acute illnesses.
C) Less deterioration takes place in the overall health of patients.
D) The elderly are happier in long-term care facilities than at home.
Ans: C
Feedback:
The use of advanced practice nurses who have been educated in geriatric nursing concepts has proved to be
very effective when dealing with the complex care needs of an older patient. When best practices are used and current
scientific knowledge applied to clinical problems, significantly less deterioration occurs in the overall health of aging
patients. This does not necessarily mean that patients are happier in long-term care than at home, that they recover
more quickly from acute illnesses, or greater interaction occurs between younger and older adults.
33. A gerontologic nurse is basing the therapeutic programs at a long-term care facility on Miller’s Functional
Consequences Theory. To actualize this theory of aging, the nurse should prioritize what task?
A) Attempting to control age-related physiological changes
B) Lowering expectations for recovery from acute and chronic illnesses
C) Helping older adults accept the inevitability of death
D) Differentiating between age-related changes and modifiable risk factors
Ans: D
Feedback:
The Functional Consequences Theory requires the nurse to differentiate between normal, irreversible age-
related changes and modifiable risk factors. This theory does not emphasize lowering expectations, controlling age-
related changes, or helping adults accept the inevitability of death.
34. Based on a patient’s vague explanations for recurring injuries, the nurse suspects that a community-dwelling
older adult may be the victim of abuse. What is the nurse’s primary responsibility?
A) Report the findings to adult protective services.
B) Confront the suspected perpetrator.
C) Gather evidence to corroborate the abuse.
D) Work with the family to promote healthy conflict resolution.
Ans: A
Feedback:
If neglect or abuse of any kind—including physical, emotional, sexual, or financial abuse—is suspected, the local
adult protective services agency must be notified. The responsibility of the nurse is to report the suspected abuse, not to
prove it, confront the suspected perpetrator, or work with the family to promote resolution.
35. You are the nurse caring for an elderly patient with cardiovascular disease. The patient comes to the clinic with a
suspected respiratory infection and is diagnosed with pneumonia. As the nurse, what do you know about the altered
responses of older adults?
A) Treatments for older adults need to be more holistic than treatments used in the younger population.
B) The altered responses of older adults reinforce the need for the nurse to monitor all body systems to identify
possible systemic complications.
C) The altered responses of older adults define the nursing interactions with the patient.
D) Older adults become hypersensitive to antibiotic treatments for infectious disease states.
Ans: B
Feedback:
Older people may be unable to respond effectively to an acute illness, or, if a chronic health condition is present,
they may be unable to sustain appropriate responses over a long period. Furthermore, their ability to respond to
definitive treatment is impaired. The altered responses of older adults reinforce the need for nurses to monitor all body
system functions closely, being alert to signs of impending systemic complication. Holism should be integrated into all
patients’ care. Altered responses in the older adult do not define the interactions between the nurse and the patient.
Older adults do not become hypersensitive to antibiotic treatments for infectious disease states.
36. You are the nurse caring for patients in the urology clinic. A new patient, 78 years old, presents with complaints
of urinary incontinence. An anticholinergic is prescribed. Why might this type of medication be an inappropriate choice
in the elderly population?
A) Gastrointestinal hypermotility can be an adverse effect of this medication.
B) Detrusor instability can be an adverse effect of this medication.
C) Confusion can be an adverse effect of this medication.
D) Increased symptoms of urge incontinence can be an adverse effect of this medication.
Ans: C
Feedback:
Although medications such as anticholinergics may decrease some of the symptoms of urge incontinence
(detrusor instability), the adverse effects of these medications (dry mouth, slowed gastrointestinal motility, and
confusion) may make them inappropriate choices for the elderly.
37. A gerontologic nurse is overseeing the care that is provided in a large, long-term care facility. The nurse is
educating staff about the significant threat posed by influenza in older, frail adults. What action should the nurse
prioritize to reduce the incidence and prevalence of influenza in the facility?
A) Teach staff how to administer prophylactic antiviral medications effectively.
B) Ensure that residents receive a high-calorie, high-protein diet during the winter.
C) Make arrangements for residents to limit social interaction during winter months.
D) Ensure that residents receive influenza vaccinations in the fall of each year.
Ans: D
Feedback:
The influenza and the pneumococcal vaccinations lower the risks of hospitalization and death in elderly people.
The influenza vaccine, which is prepared yearly to adjust for the specific immunologic characteristics of the influenza
viruses at that time, should be administered annually in autumn. Prophylactic antiviral medications are not used.
Limiting social interaction is not required in most instances. Nutrition enhances immune response, but this is not specific
to influenza prevention.
38. Falls, which are a major health problem in the elderly population, occur from multifactorial causes. When
implementing a comprehensive plan to reduce the incidence of falls on a geriatric unit, what risk factors should nurses
identify? Select all that apply.
A) Medication effects
B) Overdependence on assistive devices
C) Poor lighting
D) Sensory impairment
E) Ineffective use of coping strategies
Ans: A, C, D
Feedback:
Causes of falls are multifactorial. Both extrinsic factors, such as changes in the environment or poor lighting, and
intrinsic factors, such as physical illness, neurologic changes, or sensory impairment, play a role. Mobility difficulties,
medication effects, foot problems or unsafe footwear, postural hypotension, visual problems, and tripping hazards are
common, treatable causes. Overdependence on assistive devices and ineffective use of coping strategies have not been
shown to be factors in the rate of falls in the elderly population.
39. Older people have many altered reactions to disease that are based on age-related physiological changes. When
the nurse observes physical indicators of illness in the older population, that nurse must remember which of the
following principles?
A) Potential life-threatening problems in the older adult population are not as serious as they are in a middle-aged
population.
B) Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-
threatening problems in older adults.
C) The same physiological processes that indicate serious health care problems in a younger population indicate
mild disease states in the elderly.
D) Middle-aged people do not react to disease states the same as a younger population does.
Ans: B
Feedback:
Physical indicators of illness that are useful and reliable in young and middle-aged people cannot be relied on for
the diagnosis of potential life-threatening problems in older adults. Option A is incorrect because a potentially life-
threatening problem in an older person is more serious than it would be in a middle-aged person because the older
adult does not have the physical resources of the middle-aged person. Physical indicators of serious health care
problems in a young or middle-aged population do not indicate disease states that are considered “mild” in the elderly
population. It is true that middle-aged people do not react to disease states the same as a younger population, but this
option does not answer the question.
40. You are the nurse caring for a 91-year-old patient admitted to the hospital for a fall. The patient complains of
urge incontinence and tells you he most often falls when he tries to get to the bathroom in his home. You identify the
nursing diagnosis of risk for falls related to impaired mobility and urinary incontinence. The older adult’s risk for falls is
considered to be which of the following?
A) The result of impaired cognitive functioning
B) The accumulation of environmental hazards
C) A geriatric syndrome
D) An age-related health deficit
Ans: C
Feedback:
 A number of problems commonly experienced by the elderly are becoming recognized as geriatric syndromes.
These conditions do not fit into discrete disease categories. Examples include frailty, delirium, falls, urinary incontinence,
and pressure ulcers. Impaired cognitive functioning, environmental hazards in the home, and an age-related health
deficit may all play a part in the episodes in this patient’s life that led to falls, but they are not diagnoses and are,
therefore, incorrect.