Chapter 01: Overview of Gerontologic Nursing
Meiner: Gerontologic Nursing, 6th Edition

MULTIPLE CHOICE

	1.	In 2010, the revised Standards and Scope of Gerontological Nursing Practice was published. The nurse would use these standards to
a.	promote the practice of gerontologic nursing within the acute care setting.	
b.	define the concepts and dimensions of gerontologic nursing practice.	
c.	elevate the practice of gerontologic nursing.	
d.	incorporate the concepts of health promotion, health maintenance, disease prevention, and self-care	

ANS:	D
The current publishing of the Standards and Scope of Gerontological Nursing Practice in 2010 incorporates the input of gerontologic nurses from across the United States and includes comprehensive concepts and dimensions important to those practicing gerontologic nursing. It was not intended to promote gerontologic nursing practice within acute care settings, define concepts or dimensions of gerontologic nursing practice, or elevate the practice of gerontologic nursing.

DIF:	Remembering			OBJ:	1-1	TOP:	N/A
MSC:	Safe and Effective Care Environment	

	2.	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.	

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. Acting as an advocate is an important nursing role in all settings. Simply accepting a fact does not help end ageism, nor does recognizing ageism as a form of bigotry.

DIF:	Applying	OBJ:	1-6	TOP:	Integrated Process: Teaching-Learning
MSC:	Safe and Effective Care Environment	

	3.	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.	

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.

DIF:	Remembering			OBJ:	1-4	
TOP:	Nursing Process: Planning	MSC:	Physiologic Integrity	

	4.	A 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	

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.

DIF:	Remembering			OBJ:	1-4	
TOP:	Nursing Process: Assessment	MSC:	Safe and Effective Care Environment

	5.	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.”	

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.

DIF:	Applying	OBJ:	1-4	TOP:	Nursing Process: Assessment
MSC:	Health Promotion and Maintenance		

	6.	The nurse is caring for an older adult who has been admitted to an acute care hospital for treatment of a fractured femur. The family expresses concern about their father’s pending transfer to a subacute care facility. What response by the nurse is best?
a.	“Acute care facilities lack the long-term physical therapy your dad requires.”	
b.	“Your dad will be much happier in a more serene, private environment.”	
c.	“The subacute facility will focus on helping your dad to maintain his independence.”	
d.	“Insurance, including Medicare, will cover only a limited amount of time here.”	

ANS:	C
The transfer of the patient to a subacute facility is based on the need to maintain the patient’s level of function and independence, a task the acute care facility is not prepared to address once the patient is physiologically stable. The acute care facility may or may not be able to provide long-term therapy. The patient may or may not be happier in the new setting; the nurse should not make this judgment. It is true that insurance only pays for a limited amount of time in an acute care facility, but this is not the best reason for the patient to transfer.

DIF:	Applying	OBJ:	1-4	
TOP:	Integrated Process: Communication and Documentation	
MSC:	Health Promotion and Maintenance		

	7.	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.	

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.

DIF:	Applying	OBJ:	1-5	
TOP:	Integrated Process: Communication and Documentation	
MSC:	Safe and Effective Care Environment	

	8.	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.	

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.

DIF:	Remembering			OBJ:	1-2	
TOP:	Integrated Process: Teaching-Learning		
MSC:	Safe and Effective Care Environment	

	9.	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	

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.

DIF:	Remembering			OBJ:	1-2	
TOP:	Nursing Process: Implementation	MSC:	Health Promotion and Maintenance

	10.	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	

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.

DIF:	Applying	OBJ:	1-2	TOP:	Nursing Process: Assessment
MSC:	Health Promotion and Maintenance		

	11.	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	

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.

DIF:	Remembering			OBJ:	1-3	
TOP:	Integrated Process: Teaching-Learning		
MSC:	Health Promotion and Maintenance		

	12.	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”	

ANS:	A
Although Medicare is primarily for those over the age of 65, it does cover people of any age with end-stage kidney disease. Part A covers hospital costs. Part B is medical insurance. The “donut hole” was fixed by the Affordable Care Act.

DIF:	Understanding			OBJ:	1-3	
TOP:	Integrated Process: Teaching-Learning		
MSC:	Health Promotion and Maintenance		

	13.	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.	

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.

DIF:	Applying	OBJ:	1-4	TOP:	Nursing Process: Implementation
MSC:	Physiologic Integrity	

	14.	The dean of a new nursing program wishes to ensure graduates are prepared to care for older patients. What document should guide the dean in designing the curriculum?
a.	The Nurse Practice Act for that state	
b.	The American Nurses Association (ANA) Code of Ethics for nurses	
c.	Healthy People 2020	
d.	The Recommended Baccalaureate Competencies and Curricular Guidelines	

ANS:	D
The Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults is an updated version of The Essentials of Baccalaureate Education for Professional Nursing Practice. This document was first published by the American Association of Colleges of Nursing (AACN) in 2008 and was updated in 2010. The other three documents do not have information about curricular requirements to prepare students to care for the older population.

DIF:	Applying	OBJ:	1-2	TOP:	Integrated Process: Teaching-Learning
MSC:	Health Promotion and Maintenance		

	15.	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	

ANS:	A
Older adults are demanding more programs and services aimed at health maintenance and promotion and disease and disability prevention. Based on this information, the heart healthy living presentation would be best received.

DIF:	Applying	OBJ:	1-3	TOP:	Integrated Process: Teaching-Learning
MSC:	Health Promotion and Maintenance		

MULTIPLE RESPONSE

	1.	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.	

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.

DIF:	Analyzing	OBJ:	1-4	TOP:	Nursing Process: Assessment
MSC:	Safe and Effective Care Environment	

	2.	The nurse studying the history of gerontologic nursing learns which information about the specialty? (Select all that apply.)
a.	The number of older Americans is diminishing.	
b.	The gerontologic nursing conference group was established in 1962.	
c.	The gerontologic clinical nurse specialist certification was offered in 1989.	
d.	There were no writings about the care of older persons until World War II.	
e.	The first Standards of Practice for Gerontologic Nursing was written in 1969.	

ANS:	B, C, E
The gerontologic nursing conference group was established in 1962, the gerontologic clinical nurse specialist certification was first offered in 1989, and the first Standards of Practice for Gerontologic Nursing was written in 1969. The population of older Americans is the fastest-growing subset of the population. Writings about care of the aged can be found from as early as 1900.

DIF:	Remembering			OBJ:	1-2	
TOP:	Integrated Process: Teaching-Learning		
MSC:	Nursing Process: Assessment

	3.	The student asks the gerontologic clinic nurse why so many older people are women. What information does the nurse provide? (Select all that apply.)
a.	Reduced maternal mortality	
b.	Decreased deaths from infectious diseases	
c.	More deaths from chronic disease in men	
d.	The protective role of estrogen	
e.	Women tend to smoke and drink less than men	

ANS:	A, C, D
A decrease in maternal mortality, more deaths from chronic illness in men, and the protective effects of estrogen all help account for the disparity in genders as people age.

DIF:	Understanding			OBJ:	1-4	
TOP:	Integrated Process: Teaching-Learning		
MSC:	Health Promotion and Maintenance		

	4.	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	

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.

DIF:	Remembering			OBJ:	1-5	
TOP:	Nursing Process: Analysis	MSC:	Health Promotion and Maintenance

	5.	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	

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.

DIF:	Remembering			OBJ:	1-4	
TOP:	Nursing Process: Assessment	MSC:	Health Promotion and Maintenance