Concepts of Gerontology

Question 1

When attempting to minimize the effect of ageism on the practice of nursing older adults, a nurse needs to first
a. recognize that nurses must act as advocates for aging patients.
b. accept that this population represents a substantial portion of those requiring nursing care.
c. self-reflect and formulate one’s personal view of aging and the older patient.
d. recognize ageism as a form of bigotry shared by many Americans.

Answer 1

ANS: C
Ageism is an ever-increasing prejudicial view of the effects of the aging process and of the older population as a whole. With nurses being members of a society holding such views, it is critical that the individual nurse self-reflects on personal feelings and determines whether such feelings will affect the nursing care that he or she provides to the aging patient.

Question 2

The nurse planning care for an older adult who has recently been diagnosed with rheumatoid arthritis views the priority criterion for continued independence to be the patient’s
a. age.
b. financial status.
c. gender.
d. functional status.

Answer 2

ANS: D
Maintaining the functional status of older adults (especially those with chronic health conditions) may avert the onset of physical frailty and cognitive impairment, two conditions that increase the likelihood of institutionalization

Question 3

nurse working with the older adult population is most likely to assess a need for a financial social service’s referral for which person?
a. White male
b. Black female
c. Hispanic male
d. Asian American female

Answer 3

ANS: B
The poverty rate among older women is substantially higher than that seen among men. The poverty rates for people of color is higher than that of whites.

Question 4

A nurse is preparing to complete a health assessment and history on an older patient. Which statement reflects an understanding of the general health status of this population?
a. “I’ll need to document the medications the patient is currently prescribed.”
b. “I would like to understand how supportive the patient’s family members are.”
c. “Most older patients are being treated for a variety of chronic health care issues.”
d. “It will be interesting to see whether this patient sees herself as being healthy.”

Answer 4

ANS: D
It is a misconception that old age is synonymous with disease and illness. In fact, older adults already tend to view their personal health positively despite the presence of chronic illness, disease, and impairment. The nurse should always determine the patient’s sense of wellness and independence when conducting a health and history assessment. An assessment of medication use and family support is important for any patient. Many older adults do have chronic health conditions, but their perception is more important than a single number

Question 5

To best assure both the quality of care and the safety of the older adult patient who requires in-home unlicensed assistive personal (UAP) assistance, which action by the gerontologic nurse is best?
a. Evaluates the competency of the UAP staff.
b. Assumes the roles of case manager and patient advocate.
c. Arranges for the needed UAP provided services.
d. Assesses the patient for functional limitations.

Answer 5

ANS: A
As more care traditionally provided by professional nurses is being transferred to UAP, the nurse must assume more responsibility for educating, training, and evaluating the competency of UAP staff to provide safe, effective care for the older adult patient

Question 6

The nurse working with older adults understands what information about certification in gerontologic nursing?
a. It is mandatory for those in long-term care settings.
b. It is voluntary and shows clinical expertise in an area.
c. It allows nurses to be paid by third-party payers.
d. It allows nurses to advance their careers in a job.

Answer 6

ANS: B
Certification is voluntary and shows that a nurse has additional knowledge and expertise in a certain area of practice. It is not mandatory in specific care settings. It does not allow for third-party reimbursement. It may be part of a career ladder program, but that is not true of all work settings

Question 7

A nurse works in a gerontologic clinic. What action by the nurse takes highest priority?
a. Serving as a patient advocate
b. Educating patients about diseases
c. Helping patients remain independent
d. Referring patients to home health care

Answer 7

ANS: C
One of the challenges and priorities of the gerontologic nurse is helping patients to maintain their independence. While nurses do serve as patient advocates, educate patients, and make referrals, these actions are not specific to gerontologic nursing

Question 8

A nurse is caring for an older patient in the emergency department. What information about the patient will be most helpful in creating a plan of care?
a. Baseline physical and cognitive functioning
b. Living conditions and family support
c. Medications and current medical problems
d. Results of the Mini-Mental State Examination

Answer 8

ANS: A
The nurse is encouraged to view older patients as individuals and consider their baseline physical and cognitive functional status as a standard by which to compare the patient’s current status. The other information is also important, but the basis of individualized care begins with the patient’s strengths and weaknesses

Question 9

The faculty member explains to students that many older Americans continue to work past the “retirement age.” What best explains this trend?
a. Feeling healthier longer
b. Changing financial outlook
c. Becoming bored in retirement
d. A desire to give back

Answer 9

ANS: B
As financial situations may have declined as a result of many economic factors, more older adults work past their “retirement age.” The other options may be reasons for some to continue working, but financial necessity is the reason the majority continue to do so.

Question 10

What information does the faculty member teach students about Medicare?
a. Covers anyone with end-stage renal disease
b. Part A covers some prescription costs
c. Part B covers inpatient hospital costs
d. Part D eliminates the drug “donut hole”

Answer 10

ANS: A

Question 11

A nursing manager notes that many older patients are admitted to the nursing unit for acute problems. What action can the manager take to most benefit this population?
a. Provide mandatory education on the needs of the older patient.
b. Create programs that minimize functional losses.
c. Ensure staffing numbers are adequate for dependent patients.
d. Encourage all nurses to obtain gerontologic certification.

Answer 11

ANS: B
Many older adults need acute care for sudden illness and injury but the acute care setting is not ideal for them. Programs that prevent functional decline and promote independence would make the hospital less dangerous place for older adults. The other actions will help the older patients cared for in the unit, but only to limited degrees

Question 12

A nurse wants to plan a community event at a retirement center. What topic would most likely be best received?
a. Heart healthy living
b. Financial planning
c. Avoiding scams
d. Ethnic cooking classes

Answer 12

ANS: A

Question 13

The clinic nurse caring for an older diabetic patient with a sixth-grade education anticipates that the patient may experience difficulty with which of the following? (Select all that apply.)
a. Recognizing the importance of keeping clinic appointments.
b. Following a low-carbohydrate diet.
c. Paying for insulin and syringes.
d. Deciding on a primary health care provider.
e. Naming a health care surrogate.

Answer 13

ANS: A, B, C
Even though the educational level of the older population has steadily increased, lower educational level and decreased literacy affects the older adults’ ability to live a healthy life, understand the importance of medical follow-up, and manage acute illness and chronic conditions. These patients may also have fewer financial resources to devote to health care issues. Choosing a primary provider and naming health care surrogates would not necessarily be affected.

Question 14

The gerontologic nurse plans community programming for older women, noting what facts about this population subgroup? (Select all that apply.)
a. More likely to live alone
b. Increased chance of living in poverty
c. Taking care of a spouse
d. Suffering many chronic diseases
e. Living with extended families

Answer 14

ANS: A, B, D
Older women have a greater chance than men of living alone and in poverty. They also have a greater degree of functional impairment and chronic disease.

Question 15

The nurse knows that the most common causes of death in the older population result from which diseases? (Select all that apply.)
a. Cerebrovascular disease
b. Communicable diseases
c. Heart disease
d. Cancer
e. Diabetes

Answer 15

ANS: A, C, D, E
Nearly 75% of all deaths stem from the following 10 causes: heart disease, cancer (lung), chronic respiratory disease (COPD), accidents, stroke, Alzheimer’s disease, diabetes, influenza/pneumonia, kidney disease, and suicide

Question 16

The nurse supports an older patient’s desire to discuss advance directives with the patient’s family. What action is the nurse performing with this patient?
1. Facilitation of palliative care
2. Engagement in professional development
3. Collaboration with the interdisciplinary team
4. Accountability to protect patient’s rights and autonomy

Answer 16

Correct Answer: 4

Question 17

In assessing the aging client, it is importnat for the nurse to recognize:
a) The client’s ability to perform ADLs
b) The financial status of the client
c) The job that the client held prior to aging
d) All components of well-being, including biological function, psychological function, and social function

Answer 17

ANS: D

Question 18

The nurse assessing the older population needs to have a basic understanding of which of the following?
a) The economic status of the area
b) The difference between normal and abnormal for the older age group
c) The signs of sexual dysfunction
d) The signs of cardiac disease

Answer 18

ANS: B

Question 19

Which statement would be most appropriate to ask when assessing an aging adult for cognitive function?
a) What is today’s date?
b) Can you count to 10 for me?
c) Have you noticed anything different about your memory or thinking in the past few months?
d) Who is the president of the United States?

Answer 19

ANS: C

Question 20

Which disease or ailment is often under diagnosed and undertreated in the aging population?
a) Schizpphrenia
b) Depression
c) Associative disorders
d) Attention deficit disorder

Answer 20

ANS: B

Question 21

Which statement demonstrates normal cognitive function for an aging adult?
a) Occasional memory lapses
b) Unable to recall the names of their children or siblings
c) Unable to recall current address or phone number
d) Unable to count to 10 or repeat a series of consecutive numbers

Answer 21

ANS: A

Question 22

Denmentia and depression are strongly related to:
a) Clients over the age of 60
b) Clients over the age of 65
c) A decreased quality of life and functional deficits
d) Past economic status and job performance

Answer 22

ANS: C

Question 23

Which statement reflects the state of drug absorption in the geriatric patient?
a) The rate of absorption is slowed
b) The rate of absorption is faster due to thinning of the mucosa
c) The percentage of the medication that is absorbed is decreased
d) There is a decrease in gastric pH as we age

Answer 23

ANS: C

Question 24

The absorption of medication in the geriatric client is most often affected by:
a) A decrease in body fat
b) An increase in serun albumin
c) A decrease in body water and lean body weight
d) An increase in body water

Answer 24

ANS: C

Question 25

Which organ is responsible for drug metabolism and must be considered when prescribing medicaiton for an older adult? a) Kidneys b) Pancreas c) Intestines d) Liver

Answer 25

ANS: D

Question 26

An older adult on digoxin and furosemide is showing signs of toxicity. The gerontology nurse understands that: a) Digoxin and furosemide are excreted by the kidneys, and the doses may need to be decreased due to impaired kidney function b) Digoxin and furosemide are excreted through the intestinal tract, and dose changes would be ineffective c) An increase in fluid intake will fix the symptoms, and no change in dose is needed d) How a drug is excreted is not a consideration when dosing an older adult

Answer 26

ANS: A

Question 27

Which factor is NOT a normal part of aging and needs to be addressed to promote nutrition in the older adult client? a) Loss of teeth b) Increase in gastric pH c) Xerostoma or dry mouth d) Decline in basal metabolic rate

Answer 27

ANS: C

Question 28

What is the most significant change in vital organs in the aging client? a) No change in organ tissue is noted b) The outer appearance of an organ changes, but the functional component does not change c) Organs show signs of decrease in function during the aging process d) The aging process speeds up the functional capacity of major organs

Answer 28

ANS: C

Question 29

Describe the order for the nursing process as practiced by the gerontological nurse: a) Diagnose, implement, evaluate b) Assess, identify expected outcomes, implement, evaluate c) Assess, dignose along with the team, identify outcomes, plan, implement, evaluate d) Assess, evaluate, plan, implement, and look at outcomes

Answer 29

ANS: C

Question 30

A 70-year-old presents to the clinic stating that his family things he is losing his mind and they want to put him in a home. What would be the intial role of the gerontological nurse? a) Begin the process of finding a qualified nursing home b) Do a complete history,physical, and assessment c) Speak with the family about their concerns d) Make light of the subject until the nurse can evaluate the situation

Answer 30

ANS: B

Question 31

Which item would not be a focus of a cognitive-perceptual pattern assessment for the older client? a) Cognition--Have you experienced any changes in your memory? b) Communication--Have you had any difficulty speaking or forming ideas? c) FInancial--Have you had any financial hardships over the past several months? d) Orientation--Do you know what day, month, and year it is?

Answer 31

C

Question 32

Pain of gastrointestinal origin is best differentiated from pain of cardiac origin by the presence of: 1. chest pain lasting longer than five minutes. 2. chest pain of rapid onset. 3. left flank pain. 4. substernal chest discomfort.

Answer 32

ANS: 4

Question 33

The primary risk factor for the development of pressure ulcers in older adult patients is: 1. immobility. 2. impaired circulation. 3. incontinence. 4. malnutrition.

Answer 33

ANS: 1

Question 34

The most common cause of chronic pain in older adults is: 1. arthritis. 2. fractures. 3. headaches. 4. neuropathy.

Answer 34

ANS: 1

Question 35

Which statement is true regarding falls in the elderly? A. Most falls occur in the garage. B. Hip fractures resulting from falls are a leading cause of placement in long-term care facilities. C. Fall risk decreases with addition of medications. D. Sedatives reduce the risk of falls.

Answer 35

ANS: B

Question 36

Nurses' knowledge of sexuality in the older adult population should include: A. Chronic illness may affect the ability to participate in sexual activity. B. Sexual response time is unchanged. C. Ability to achieve orgasm declines. D. Dryness of the vaginal walls is associated with pelvic inflammatory disease.

Answer 36

ANS: A

Question 37

What should the nurse include in the teaching plan for self-medication practices of older adults? A. Eliminate unnecessary medications. B. Substitute herbal preparations for certain prescribed medications. C. Develop a drug reminder system and schedule. D. Pharmacy shop for the cheapest medications.

Answer 37

ANS: C

Question 38

Which age-related changes predispose the elderly patient to drug toxicity and extended duration of action of drugs? (Select all that apply.) A. Decreased body water B. Increased ratio of muscle to fat C. Low serum albumin D. Reduced blood flow to liver

Answer 38

A. Decreased body water C. Low serum albumin D. Reduced blood flow to the liver

Question 39

________ is the use of multiple medications, often inappropriately and excessively, at the same time.

Answer 39

Polypharmacy

Question 40

An elderly patient has acute confusion after undergoing abdominal surgery. The patient most likely has: A. delirium. B. anxiety. C. dementia. D. depression

Answer 40

ANS: A

Question 41

Alzheimer's disease may be suggested in its early stages by: A. magnetic resonance imaging (MRI). B. computed tomography (CT). C. positron emission tomography (PET). D. autopsy.

Answer 41

ANS: D

Question 42

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

Answer 42

ANS: A 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.

Question 43

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

Answer 43

ANS: C 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.

Question 44

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

Answer 44

ANS: B, E, F 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.

Question 45

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

Answer 45

ANS: B Propranolol is a nonselective beta-adrenergic antagonist

Question 46

The federal government requires the use of a specific standardized documentation tool for home nursing care. Which information must a home nurse add to the approved documentation tool? a. Activity b. Vital signs c. Functional d. Demographic

Answer 46

ANS: B The nurse must add the vital signs and information about the older adult’s health care beliefs to the OASIS. The nurse does not need to add information about the older adult’s activity level. The nurse does not need to add information about the older adult’s functional status. The nurse does not need to add demographic information about the older adult to the documentation too

Question 47

An older client presents to the geriatric practice with a 3-day history of cough, and fever. The client states “I am feeling weak and coughing a lot.” The client’s vital signs are BP 120/86, 92% SpO2, 22 bpm, and 38.6°C. What is the client’s chief complaint? a. “I am feeling weak and coughing a lot” b. Elevated BP and fever c. A 3-day history of cough and fever d. Pneumonia

Answer 47

ANS: A The chief complaint is what the client reports as the problem. Blood pressure, fever, and cough are the client’s symptoms; pneumonia is a medical diagnosis

Question 48

Which mental status assessment tool(s) would be appropriate for use in long-term care facilities? (Select all that apply.) a. Fulmer SPICES b. Clock Drawing Test c. The Mini-Cog d. Mini-Mental State Examination (MMSE) e. Montreal Cognitive Assessment (MoCA)

Answer 48

ANS: B, C, D, E The Montreal Cognitive Assessment (MoCA) was designed as a brief screening instrument to provide cues leading to the hypothesis of mild cognitive impairment. The Clock Drawing Test, which has been used since 1992, is a screening tool that helps identify those with a cognitive impairment and is used as a measure of severity. The Mini-Cog was developed as a tool that could establish cognitive status more quickly than the MMSE and the limitations of educational adjustments. It is now the recommended evidenced-based tool and combines one aspect of the MMSE (short-term memory recall) with the test of executive function of the Clock Drawing Test. It has been found to be highly sensitive to diagnosing dementia. The MMSE tool has been used most often and is a 30-item instrument that has been used to screen for cognitive difficulties and is one of the tools often used in determining a diagnosis of dementia or delirium. Fulmer SPICES is an overall assessment tool developed in 2007

Question 49

A nurse is assessing an older client. The nurse understands that in addition to the collection of physical data and the integration of spiritual and psychosocial issues, additional assessments commonly utilized for older adults include which of the following? (Select all that apply.) a. Functional status assessment b. Cognitive assessment c. Caregiver burden assessment d. Geriatric syndrome assessment e. Employment assessment

Answer 49

ANS: A, B, C, D At a minimum, health assessment includes the collection of physical data and the integration of spiritual and psychosocial, within an individual’s cultural context. When working with older adults, additional assessment areas further include functional and cognitive status, caregiver stress or burden, patterns of health and health care, advanced care planning, and the presence or absence of any of the geriatric syndromes (delirium, falls, dizziness, syncope, and urinary incontinence

Question 50

A nurse utilizes the FANCAPES to assess an older adult. Which of the following are accurate statements about this assessment? (Select all that apply.) a. The FANCAPES is utilized as guide for the comprehensive assessment of medically complex older adults. b. The FANCAPES includes a fall risk assessment of the older adult. c. The FANCAPES assesses an older adult’s activity abilities. d. The FANCAPES includes the Mini-Cog assessment to assess cognitive abilities. e. The FANCAPES assesses the older person’s current state of hydration.

Answer 50

ANS: A, C, E The FANCAPES is a comprehensive physical assessment for the frail and medically complex older adult. FANCAPES is a mnemonic for Fluids, Aeration, Nutrition, Communication, Activity, Pain, Elimination, and Socialization. There is no fall risk assessment and the Mini-Cog is not a part of this assessment.

Question 51

The nurse assesses an older adult’s cognitive status using a standard assessment instrument. Which of the following are cognitive assessment tools? (Select all that apply.) a. Mini-Cog b. Mini Mental State Exam (MMSE) c. The Barthel Index d. The Global Deterioration Scale e. Older American’s Resources and Services (OARS)

Answer 51

ANS: A, B, D The Barthel Index is an instrument utilized to assess mobility and the ability to perform ADLs. The OARS is a comprehensive geriatric assessment which covers more than just cognitive assessment.The Mini-Cog and MMSE are cognitive assessment tools, as is the Global Deterioration Scale which is a measure of the levels of cognitive changes as one passes through the process of dementia

Question 52

A nurse assesses an older person’s instrumental activities of daily living (IADL) utilizing the Lawton instrument. Which of the following are IADLs? (Select all that apply.) a. Shopping b. Cleaning c. Bathing d. Eating e. Money management

Answer 52

ANS: A, B, E Shopping, cleaning, and money management are IADLs. Bathing and eating are ADLS

Question 53

Which nursing intervention is a holistic approach to an older adult? a. Performs glucose testing during the weekly worship service b. Wheels ambulatory adults to exercise when running late c. Basing interventions on the client’s functional abilities d. Allows older adults in a nursing home to eat meals alone

Answer 53

ANS: C The nurse uses a holistic approach to the care when tailoring care needs to support the client’s optimal level of health independent. Interrupting an older adult’s worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older adult’s life by testing for glucose before the service begins.

Question 54

What are the three D’s of cognitive impairment among older adults?

Answer 54

Dementia, Delirium and Depression All frequently affect older adults. Not normal consequences of aging, but the incidence increases with age

Question 55

The average life expectancy of Canadians is 83.8 years. The life expectancy of Indigenous/Black Canadians on average is ___ years shorter

Answer 55

10 years

Question 56

Define frailty.

Answer 56

Frailty is theoretically defined as a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised.

Question 57

In the absence of a gold standard, frailty has been operationally defined by Fried et al. as meeting three out of five phenotypic criteria indicating compromised energetics: Name 3 frailty energetic indicators.

Answer 57

low grip strength, low energy, slowed walking speed, low physical activity, and/or unintentional weight loss

Question 58

Who is most at risk of frailty?

Answer 58

85+ age group Women More prevalent amongst Black older people than White older people

Question 59

What is the number one reason for injury-related death, hospitalization and emergency department visits for older adults in Canada?

Answer 59

Falls Falls among older adults cost $5.6 billion in2018 – nearly 20 per cent of the total cost of injury in Canada. 1 in 3 people aged 65 andolder are likely to fall at least once

Question 60

According to the RNAO BPG, how do we assess and prevent falls?

Answer 60

Assessment: Fall risk screening tool Prevention: Education Exercise and maintaining activity Best Practice Guidelines

Question 61

What is the Canadian Frailty Network?

Answer 61

Canadian Frailty Network (CFN) is Canada’s sole network devoted to improving care for older Canadians living with frailty and supporting their families and caregivers. They do this by increasing frailty recognition and assessment, by increasing evidence for decision-making, and by advancing evidence-based changes to care.

Question 62

Name 3 ways to gather data during a older adult health assessment.

Answer 62

Health history Observation Standardized measures/scores Functional assessment Mental status assessment Assessment of social support Comprehensive holistic assessment includes cultural, psychological, psychosocial, physical, environmental and safety considerations

Question 63

T/F: A screening tool is the same as an assessment tool.

Answer 63

False. Screening is a process for evaluating the possible presence (ie risk) of a particular problem. The outcome is normally a simple yes or no to identify those in need of further evaluation. Assessment is a more comprehensive process for defining the nature of that problem, determining a diagnosis, and developing specific treatment recommendations / care plan for addressing the problem or diagnosis.

Question 64

Name an example of an existing screening tool.

Answer 64

COVID-19 screening tool.

Question 65

The Older American’s Resources and Services (OARS) is an integrated assessment tool that evaluates...

Answer 65

the (dis)ability and capacity level at which the person is able to function. Includes five sub-scales: Social & economic resources; physical and mental health and ability to perform ADLs.

Question 66

Fulmer SPICES stands for six common syndromes of the older person that require nursing interventions. Name all 6 letters.

Answer 66

Sleep disorders Problems with eating or feeding Incontinence Confusion Evidence of falls Skin breakdown

Question 67

Give an example of an intrinsic and extrinsic safety issue specific to older adults.

Answer 67

Intrinsic safety issues: Mobility concerns Vision and hearing impairment Cognition Extrinsic safety: Fire hazards Poisoning Medication (Beers) Fall hazards Temperature regulation Crime and abuse

Question 68

Which assessment tool is the gold standard in best practice for managing frailty in older adults?

Answer 68

Comprehensive Geriatric Assessment - Used in diverse practice settings - CGA is conducted by an interdisciplinary team, RNs are often team leaders

Question 69

Name the four steps of the CGA (comprehensive geriatric assessment).

Answer 69

1. Screening 2. Assessment 3. Creation of a Problem List 4. Planning Goal-Directed

Question 70

What is the goal of performing a comprehensive geriatric assessment?

Answer 70

The goal of CGA is to optimize health and well-being in older adults – a holistic approach

Question 71

What factors would we prioritize in an older adult assessment?

Answer 71

Hx of Falls Cognition Sleep Pain Risk for Polypharmacy Mood / Mental Health Nutrition- Continence

Question 72

Define FANCAPES. (answer according to the linked document on BB)

Answer 72

Fluids Aeration Nutrition Communication Activity Pain Elimination Socialization

Question 73

The FANCAPES assessment tool focuses on the older adult's: a. ability to meet personal needs to identify the amount of assistance needed. b. ability to perform instrumental activities of daily living (IADLs). c. cognitive abilities. d. level of dementia present.

Answer 73

ANS: A The FANCAPES assessment tool focuses on physical functioning and evaluates the individual's ability to meet his/her needs and how much assistance is needed to meet the needs. FANCAPES evaluates physical functioning. IADLs involve more than just physical functioning. FANCAPES does not assess cognitive function, nor does it assess dementia.

Question 74

Define the Mini-Mental Status Exam (MMSE)

Answer 74

Standardized assessment tool. Consists of a set of 11 questions that assess for cognitive impairment (problems with thinking, communication, understanding and memory).

Question 75

When comparing the Older American's Resources and Services (OARS) with the Katz Index of ADLs, what is true? a. The Katz Index and the OARS both measure only ADL performance b. The OARS is a comprehensive assessment tool that measures ability in five areas; the Katz Index measures only ADL performance c. The OARS is used only for older adults in the long-term care setting; the Katz Index is used in all settings d. The OARS is not valid for use in older adults who are cognitively impaired, whereas the Katz Index is

Answer 75

ANS: B The OARS evaluates ability, disability, and capacity at which the person is able to function. Five dimensions are assessed: social resources, economic resources, physical health, mental health, and ADLs. The Katz Index only evaluates ADL ability. Both instruments are used in a variety of care settings and are valid for use with cognitively impaired older adults.

Question 76

A 78-year-old man is being evaluated in the geriatric clinic. His daughter reports that he has been very forgetful lately, and she is concerned that he might be "senile." The advanced practice nurse administers the clock-drawing test and the patient draws a distorted circular shape and places the numbers all on one side of the shape. Based on his performance, the nurse concludes that the patient: a. probably has Alzheimer's disease. b. needs further evaluation. c. probably has delirium. d. needs a functional status assessment.

Answer 76

ANS: B Cognitively intact persons rarely produce errors on the clock-drawing test, such as grossly distorted contour. A low score on the clock-drawing test requires further evaluation. Alzheimer's disease is not a diagnosis using a mental status assessment tool. It is definitively diagnosed with a brain biopsy. The clock-drawing test does not assess for delirium. A low score on the clock-drawing test does not necessarily warrant a functional status assessment.

Question 77

A resident of a long-term care facility is assessed by a nurse upon admission to the facility. The assessment includes a comprehensive health, social, and functional profile. The tool that the nurse utilizes is: a. Outcomes and Assessment Information Set (OASIS). b. Resident Assessment Instrument (RAI). c. Older Americans Resources and Services (OARS). d. Comprehensive Geriatric Assessment (CGS). e. Mini Mental Status Examination (MMSE).

Answer 77

ANS: B The OASIS is used in the homecare setting. The RAI is used in the long-term care setting. OARS is a functional status instrument. Comprehensive geriatric assessment is not a specific tool but rather an approach to assessment. The MMSE is a mental status assessment tool.

Question 78

A nurse utilizes the SPICES tool (Sleep disorders, Problems with eating, Incontinence, Confusion, Evidence of falls, and Skin breakdown) to assess an older female patient in the hospital. The nurse notes that the patient has new onset urinary incontinence. The first action by the nurse is to: a. conduct a more in-depth focused assessment of the urinary incontinence. b. call the provider and obtain an order for an antibiotic for a suspected urinary tract infection. c. send a urine specimen for culture and sensitivity. d. develop a plan of care with the patient to control episodes of incontinence.

Answer 78

ANS: A SPICES is an assessment tool. Anything that indicates a problem in any of the categories warns the nurse that a more in-depth assessment is needed. The nurse needs to further assess the urinary incontinence prior to implementing any interventions.

Question 79

A nurse identifies a need to assess a patient's cognitive status. The nurse chooses to use the MMSE. The nurse knows that the patient must have which of the following abilities? (Select all that apply.) a. Number fluency b. Familiarity with analog clocks c. Ability to hear and see d. Ability to sit up for 10 minutes e. Ability to speak English

Answer 79

ANS: A, B, C The MMSE requires number fluency, ability to see and hear and hold a pencil, and experience with analog clocks. The instrument is available in languages other than English. It is a cognitive status exam and does not require that the patient be able to sit up.

Question 80

Factors that complicate assessment of older adults include: (Select all that apply.) a. presence of multiple comorbid conditions. b. atypical presentation of illness. c. difficulty in differentiating symptoms of disease from normal age-related changes. d. increase in iatrogenic illness. e. lack of assessment instruments specific for the older adult population

Answer 80

ANS: A, B, C, D Factors that complicate assessment of older adults include difficulty differentiating disease symptoms from normal age-related changes, the presence of multiple comorbidities, atypical presentations of illness, and the presence of iatrogenic illness. There are many assessment tools that are designed specifically for use in the older adult population.

Question 81

A nurse is assessing a patient's activities of daily living. The nurse will assess which of the following? (Select all that apply.) a. Eating b. Continence c. Toileting d. Self-medication administration e. Bathing

Answer 81

ANS: A, B, C, E The basic activities of daily living include eating, transfer, toileting, bathing, continence, and dressing. Self-medication administration is an independent activity of daily living (IADL).

Question 82

The FANCAPES assessment tool focuses on the older adult’s: a. ) ability to meet personal needs to identify the amount of assistance needed. b. ) ability to perform instrumental activities of daily living (IADLs). c. ) cognitive abilities. d. ) level of dementia present.

Answer 82

ANS: A The FANCAPES assessment tool focuses on physical functioning and evaluates the individual’s ability to meet his/her needs and how much assistance is needed to meet the needs. FANCAPES evaluates physical functioning. IADLs involve more than just physical functioning. FANCAPES does not assess cognitive function, nor does it assess dementia.

Question 83

How is the Mini-Mental Status Exam (MMSE) scored?

Answer 83

30 is the best score score of 26-30 = could be normal 0 is the worst score score of 0-9 = severe cognitive impairement

Question 84

What is the Instrument Activities of Daily Living assessment used for?

Answer 84

The Lawton Instrumental Activities of Daily Living (IADL) Scale assesses a person's ability to perform tasks such as using a telephone, doing laundry, and handling finances. Measuring eight domains, it can be administered in 10 to 15 minutes.

Question 85

How is the Lawton iADL assessment scored?

Answer 85

Each categories presents ADL tasks: 0 being dependent ADL function 1 being independent ADL function A summary score ranges from 0 (low function, dependent) to 8 (high function, independent) for women and 0 through 5 for men to avoid potential gender bias.

Question 86

How is the Geriatric Depression Scale scored?

Answer 86

Questionnaire asking various questions, answer key indicating which answers are positive for a depressive symptom is included in the assessment package. A score greater of 5 bolded answers or "correct" answers indicates depression.

Question 87

What is BEERS?

Answer 87

A set of criteria for potentially inappropriate medication use in older adults.

Question 88

A limitation of the Katz Index of activities of daily living (ADLs) is that: a. completion of the tool requires the joint efforts of the interdisciplinary team. b. all ADLs are weighted equally. c. it puts a heavier weight on the cognitive abilities necessary to perform ADLs. d. it provides a range of performance for each task.

Answer 88

ANS: B The Katz Index assigns an equal weight to all of the ADLs, and because of that, it cannot be used to identify the particular area of need or change in any one task. Any health care professional can complete the Katz Index, although input from the interdisciplinary team is valuable. The Katz Index does not address the cognitive abilities necessary to perform ADLs. The ADLs are considered in dichotomous terms only, the ability to compete the task independently or the complete inability to do so.

Question 89

nurse completes a functional status assessment of an older person using the Lawton IADL instrument, a self-reported instrument. The nurse knows that limitations of self-reported measures include that: (Select all that apply.) a. individuals tend to overestimate their functional ability. b. self-reports often differ from that of proxy reports. c. self-reports are not indicative of small changes in function. d. self-reports do not provide a valid measurement of function. e. older adults are not able to complete self-reported measurements.

Answer 89

ANS: A, B Individuals tend to overestimate their functional ability and often self-reported measures differ from proxy reports. Self-reported measures are a valid measurement of function, and older adults are able to complete them. The choice of tool and the type of scoring of the tool is the factor that determines if the small changes in function can be detected.

Question 90

What is the Delirium Index? How is it scored?

Answer 90

\An instrument for measuring the severity of delirium. 7 categories offering answers scored 0-3. zero is expected normal finding and three indicates severe symptoms of delirium. If total score is 7 or above, the test is positive.

Question 91

Name a screening tool and name a comprehensive assessment tool.

Answer 91

Screening tools: MoCA, Frailty Scale, Geriatric Depression scale Comprehensive assessments: FANCAPES, FULMER SPICES, Comprehensive Geriatric Assessment

Question 92

What is the CAT tool? How is it scored?

Answer 92

COPD Assessment Tool Used to help HCPs measure the impact of COPD on patients wellbeing and impact on ADLs. score of 0 = lowest score of 40 = max What is a CAT score 31 for COPD? Scores of 0–10, 11–20, 21–30, 31–40 represent mild, moderate, severe or very severe clinical impact.

Question 93

What is the MoCA and what does it assess?

Answer 93

Montreal Cognitive Assessment The sensitivity of MoCA for detecting MCI is 90%, compared to 18% for the MMSE. MoCA accurately and quickly assesses: Short term memory Visuospatial abilities Executive functions Attention, concentration and working memory Language Orientation to time and place

Question 94

Describe the Clinical Frailty Scale and how it is scored.

Answer 94

Scale begins at 1, indicating a very fit individual, and progresses to a max score of 9, which indicates a terminally ill individual.

Question 95

What is the most common chronic risk factor for CVD?

Answer 95

Hypertension is the most common chronic risk factor for CVD. Is diagnosed whenever the diastolic blood pressure (BP) is consistently ≥90 mm Hg or the systolic BP is consistently ≥140 mm Hg Older adults often have isolated systolic HTN, unlike younger people, whoare more likely to have an elevation of just the diastolic BP or elevationindicated by both systolic and diastolic BP readings

Question 96

Who is most at risk of developing pancreatic cancer?

Answer 96

Risk of developing pancreatic cancer increases with age, 2/3 are >65 years Slightly more men than women are affected by pancreatic cancer Cigarette smoking is one of the biggest risk factors for pancreatic cancer Pancreatic cancer is seldom detected in the early, most curable stages, because it doesn’t cause symptoms until it has spread to other organs. Combined five-year survival rate for pancreatic cancer—is very low at just 5 to 10 percent.

Question 97

What is a Whipple procedure?

Answer 97

Primary surgical treatment for pancreatic cancer that occurs within the head of the gland. Removal of the head of the pancreas, most of the duodenum (a part of the small intestine), a portion of the bile duct, the gallbladder and associated lymph nodes. Takes six hours to complete and most patients stay in the hospital for one to two weeks following the Whipple procedure

Question 98

What are the main reasons/ underlying causes for confusionin older people?

Answer 98

Infection Hypoglycaemia Side effects of drugs Untreated pain Dehydration Hypoxia Anxiety, depression, psychosis Delirium Underlying pathophysiology: dementia

Question 99

Possible causes for your patient’s confusion? (DELIRIUM acronym).

Answer 99

Dehydration Electrolyte imbalance/emotional stress Lung, liver, heart, kidney, brain disorders Infection, especially UTI, pneumonia, sepsis Rx* drugs Immobility Untreated pain, unfamiliar environment Metabolic disorders

Question 100

What assessments should you perform for a patient experiencing delirium?

Answer 100

Comprehensive assessment: FANCAPES or similar Full physical assessment Vital signs and oximetry; lab results Specific assessments: Medications, mental and neurologic status

Question 101

What does s CAM assessment consist of and what does it assess?

Answer 101

Nine categories of questions Four features for diagnostic algorithm: Feature 1: Acute Onset and Fluctuating Course Feature 2: Inattention Feature 3: Disorganized Thinking Feature 4: Altered Level of Consciousness 1+2 and either 3 or 4 are considered a diagnosis of delirium until proved otherwise

Question 102

T/F: Delirium is often misdiagnosed as mood disorder or dementia.

Answer 102

TRUE Frequently unrecognized or misdiagnosed in up to 70% of older patients.

Question 103

Name the three types of delirium.

Answer 103

Three types of delirium: Hyperactive: Restless, agitated and aggressive They may hallucinate and removed tubes or fall out of bed Hypoactive: Inactive, withdrawn, quiet and sleepy Mixed: Fluctuate between hypo and hyperactive symptoms

Question 104

Which medication are most likely related to his change in mental status?

Answer 104

Morphine Sulphate Drug induced delirium is most likely linked to benzodiazepines, opiates, anti-depressants and anticonvulsants

Question 105

Physiologic age-related changes in an older adult can influencecognitive functioning. Name and discuss one.

Answer 105

Sensory changes: Eg decreased visual acuity and accommodation, can result indecreased ability to process visual cues. Yellowing and flattening of thecornea can lead to difficulty distinguishing colors. Hearing loss affectswhat one hears in conversations

Question 106

Among the characteristics listed, which ones are specific to Delirium? ______ a. Gradual and insidious onset ______ b. Hallucinations or delusions ______ c. A sudden, acute onset of symptoms ______ d. Progressive functional impairment ______ e. Personality changes with emotional lability ______ f. Incoherent interactions with others ______ g. Possible wandering behavior ______ h. Lucid at times, but often worsens at night

Answer 106

Delirium: b,c,f,h

Question 107

Among the characteristics listed, which ones are specific to Dementia? ______ a. Gradual and insidious onset ______ b. Hallucinations or delusions ______ c. A sudden, acute onset of symptoms ______ d. Progressive functional impairment ______ e. Personality changes with emotional lability ______ f. Incoherent interactions with others ______ g. Possible wandering behavior ______ h. Lucid at times, but often worsens at night

Answer 107

Dementia: a,d,e,g

Question 108

You know there are several types of dementia that causecognitive changes. List 3 of these types of dementia.

Answer 108

Alzheimer’s disease Diffuse Lewy body dementia Frontotemporal dementia (FTD) Posterior Corticoid Atrophy Progressive primary aphasia Young onset Alzheimer's disease (YOAD) Vascular dementia

Question 109

Describe the rare or young onset dementia below: Posterior cortical atrophy (PCA)

Answer 109

mainly affecting visual and spatial perception

Question 110

Describe the rare or young onset dementia below: Frontotemporal dementia (FTD):

Answer 110

mainly affects behaviour, personality and language

Question 111

Describe the rare or young onset dementia below: Familial AD

Answer 111

inherited – similar symptoms to late onset AD but can occur as young as 30

Question 112

Describe the rare or young onset dementia below: Primary progressive aphasia (PPA):

Answer 112

predominately affects language skills

Question 113

Describe the rare or young onset dementia below: Lewy body dementia

Answer 113

Closely related to Parkinson's Disease affecting movement andcan cause hallucinations. May present with PCA

Question 114

Name 4 common cognitive assessment tools.

Answer 114

General Practitioner Assessment of Cognition (GPCOG) Memory Impairment Screen Mini-Cog, Mini-Mental State Examination (MMSE) 7-Minute Screen Clinical Dementia Rating Global Deterioration Scale Brief Cognitive Rating Scale MOCA- Montreal Cognitive Assessment CAM

Question 115

What neuroanatomic changes are seen in persons with AD?

Answer 115

Changes seen in the brain include destruction of the proteins of nerve cells ofthe cerebral cortex by diffuse infiltration with neurofibrillary tangles and plaques(nonfunctional tissue). These tangles and plaques are a result of the death ofnerve cells within the brain

Question 116

What do you need to teach K.B. and his family about donepezil? Select all that apply. a) “The best time to take donepezil is in the morning.” b) “Swallow each tablet whole. Drink a glass of water afterward.” c) “Notify the provider if you have trouble urinating or muscle weakness.” d) “You may have some nausea. Taking the medication with food may help.” e) “Keep the tablet in the blister pack until you are ready to take the medicine.”

Answer 116

Correct answers are: a, c, d, e The tablet should not be swallowed whole but allowed to dissolve on the tongue. After itdissolves completely, the patient should drink a glass of water. Taking donepezil in the morninglessens the common side effect of insomnia

Question 117

What is the Canadian Charter of Rights for People with Dementia?

Answer 117

People living with dementia in Canada are entitled to the same human rights as any other person in Canada, as outlined in the Canadian Charter of Rights and Freedoms. However, stigma and discrimination are huge barriers for people with dementia and often contravene these rights. As a person living with dementia, the Charter can help you assert your rights to live free of stigma, benefit from all of Canada's civic and legal rights, participate in policies that affect you and more.

Question 118

What are the experiences and support needs from the perspective of people living with Alzheimer’s Disease?

Answer 118

Exclusion Rushed and task based approaches* Poor communication Uncertainty (care partners) Caregiver as “hostage” (care partners) Lack of support for care partners

Question 119

How does climate change have an impact on older people (see 2020 Lancet report)?

Answer 119

During the past 20 years, there has been a 53.7% increase in heat-related mortality in people older than 65 years. Index for heat vulnerability Food insecurity will change nutrition and may increase cardiovascular disease (eg. lack of omega 3 for prevention of CVD) eg, 1·4 million deaths due to cardiovascular disease in 2017 were attributed to diets low in seafood omega-3 fatty acids Increased pollution increases exacerbations of cardiovascular and respiratory disease

Question 120

T/F: Both low and high temperatures are associated with cardiovascular and respiratory disease mortality rates

Answer 120

TRUE

Question 121

What is left sided HF?

Answer 121

The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs) Weakness, hacking cough/ worse at night, exertional dyspnea, S3/S4 gallop, crackles/wheezesin the lungs

Question 122

Right sided HF?

Answer 122

The heart's right ventricle is too weak to pump enough blood to the lungs. As blood builds up in the veins, fluid gets pushed out into the tissues in the body. Jugular neck distention, dependent oedema, enlarged liver and spleen, distended abdomen,weight gain

Question 123

A screening tool is useful to: A) make a definitive diagnosis B) rule out any problems C) identify those at risk for a health condition & indicate further assessment D) is just a different name for an assessment tool

Answer 123

ANS: C

Question 124

Which of these are underlying causes for confusion in older people? a. Hypoxia, infection, untreated pain b. It's a normal part of ageing c. Side effects of drugs, gender, level of activity d. Dehydration, hypoglycaemia, advanced age

Answer 124

ANS: A

Question 125

What are the signs of left sided heart failure? (select all that apply) a. Hacking cough which is worse at night b. Distended abdomen c. Crackles in the lungs d. Exertional dyspnoea

Answer 125

ANS: A, C, D

Question 126

Which of these medications puts an older person most likely at risk for delirium? a. Codeine Phosphate b. Acetaminophen c. Metformin d. Penicillin

Answer 126

ANS: A

Question 127

You are working as an RN on a long-term care unit. Which of these activities would you delegate to the PSW (select all that apply): a. Sitting with an older person who has dementia and is wandering b. Completing an assessment for a new resident c. Performing a skin assessment during a bed bath for an immobile resident d. Emptying a catheter and record the results of urinalysis

Answer 127

ANS: A, C

Question 128

T/F: An MMSE score of 17 indicates likely cognitive impairment.

Answer 128

TRUE

Question 129

An 84 yr old woman had a fall, she is bleeding from a facial injury & is confused which are priority assessments? a. Vital signs b. Geriatric Comprehensive Assessment (GCA) c. MMSE d. Medication review

Answer 129

ANS: A

Question 130

T/F: When you delegate nursing care you are no longer accountable.

Answer 130

FALSE

Question 131

Which of these would a comprehensive assessment NOT assess? a. pain b. COPD c. dehydration d. mobility

Answer 131

ANS: B

Question 132

An 83 yr old patient has been prescribed digoxin. Which of these would you teach patient to monitor? (select all that apply) A. Potassium levels B. Urine output C. Neurological function D. Heart rate

Answer 132

ANS: B, C, D

Question 133

Which of these types of dementia may present initially with behavioural and personality changes and at a younger age? a. Posterior Cortical Athrophy b. Frontotemporal dementia c. Lewy Body Dementia d. Primary progressive aphasia

Answer 133

ANS: B

Question 134

Safety assesssments for an older person typically includes which of these areas? a. Intrinsic safety concerns such as mobility, cognition b. Only risk of falls and wandering c. Extrinsic safety concerns such as fire hazards, medications, falls, d. Crime and abuse, high-risk sports activities

Answer 134

ANS: A, C