Test Bank Nursing for Wellness in Older Adults Miller 9th Edition

Test Bank Nursing for Wellness in Older Adults Miller 9th Edition Chapter 1 Seeing Older Adults Through the Eyes of Wellness 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 suggested interventions from others who practice gerontologic nursing. 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. 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 (Knowledge) REF: MCS: 2 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 ones personal view of aging and the older patient. 1d. 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-reflect on personal feelings and determine 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 (Application) REF: N/A OBJ: 1-9 TOP: Teaching-Learning MSC: Safe and Effective Care Environment 3. When discussing factors that have helped to increase the number of healthy, independent older Americans, the nurse includes the importance of: a. increased availability of in-home care services. b. government support of retired citizens. c. effective antibiotic therapies. d. the development of life-extending therapies. ANS: C The health and ultimate autonomy of older Americans has been positively impacted by the development of antibiotics, better sanitation, and vaccines. These public health measures have been more instrumental in increasing the numbers of healthy, independent older Americans than have in-home care services, government programs, or life-extending therapies. DIF: Remembering (Knowledge) REF: MCS: 2 OBJ: 3-3 TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance 4. Based on current data, when presenting an older adults discharge teaching plan, the nurse includes the patients: a. nonrelated caretaker. b. paid caregiver. c. family member. 2d. intuitional representative. ANS: C Less than 4% of older adults live in a formal health care environment. The majority of the geriatric population lives at home or with family members. DIF: Applying (Application) REF: N/A OBJ: 3-3 TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment 5. 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 patients: a. age. b. financial status. c. gender. d. functional status. ANS: D Maintaining the functional status of older adults may avert the onset of physical frailty and cognitive impairment, two conditions that increase the likelihood of institutionalization. DIF: Remembering (Knowledge) REF: MCS: 8 OBJ: 1-6 TOP: Nursing Process: Planning MSC: Physiologic Integrity 6. A nurse working with the older adult population is most likely to assess a need for a financial social services referral for a(n): a. white male. b. black female. c. Hispanic male. d. Asian American female. ANS: B 3The poverty rate among older black women is substantially higher than that seen among males or females of other ethnic groups. White males had the least poverty. DIF: Applying (Application) REF: N/A OBJ: 1-4 TOP: Nursing Process: Assessment MSC: Safe and Effective Care Environment 7. Which of the following statements made by a nurse preparing to complete a health assessment and history on an older patient reflects an understanding of the general health status of this population? a. Ill need to document well regarding the medications the patient is currently prescribed. b. I would like to understand how supportive the patients 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. The nurse should always determine the patients 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 (Application) REF: N/A OBJ: 1-4 TOP: Nursing Process: Assessment MSC: Health Promotion 8. 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 the patients pending transfer to a subacute care facility. What response by the nurse is best? a. Acute care facilities lack the long-term physical therapy support 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 maintain his independence. d. Insurance, including Medicare, will cover only a limited amount of time here. ANS: C 4The transfer of the patient to a subacute facility is based on the need to maintain the patients level of function and independence, a task the acute care facility is not prepared to address once the patient is physiologically stable. 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 (Application) REF: N/A OBJ: 1-6 TOP: Communication and Documentation MSC: Health Promotion and Maintenance 9. 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, the geriatric nurse: 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 (Application) REF: N/A OBJ: 1-2 TOP: Communication and Documentation MSC: Safe and Effective Care Environment 10. 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. 5d. 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 (Knowledge) REF: MCS: 2 OBJ: 1-2 TOP: Teaching-Learning MSC: Safe Effective Care Environment 11. 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 maintain their independence. DIF: Remembering (Knowledge) REF: MCS: 10 OBJ: 1-2 TOP: Nursing Process: Implementation MSC: Health Promotion 12. 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 6cognitive functional status as a standard by which to compare the patients current status. The other information is also important, but the basis of individualized care begins with the patients strengths and weaknesses. DIF: Applying (Application) REF: N/A OBJ: 1-6 TOP: Nursing Process: Assessment MSC: Health Promotion 13. 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 (Knowledge) REF: MCS: 7 OBJ: 1-3 TOP: Teaching-Learning MSC: Health Promotion 14. 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 7Affordable Care Act. DIF: Understanding (Comprehension) REF: MCS: 9 OBJ: 1-3 TOP: Teaching-Learning MSC: Health Promotion 15. 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. Provide restorative therapy programs designed for this group. 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 live in a state of functional decline, which could possibly be prevented by establishing a restorative therapy program. The other actions will help the older patients cared for in the unit, but only to limited degrees. DIF: Applying (Application) REF: N/A OBJ: 1-4 TOP: Nursing Process: Implementation MSC: Physiologic Integrity: Reduction of Risk Potential 16. 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 8requirements to prepare students to care for the older population. DIF: Applying (Application) REF: N/A OBJ: 1-2 TOP: Teaching-Learning MSC: Health Promotion 17. 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 (Application) REF: N/A OBJ: 1-3 TOP: Teaching-Learning MSC: Health Promotion 18. What does the bedside nurse understand about his or her role in nursing research? a. Research is only done by doctorally prepared nurses. b. All nurses have a role in delivering research-based care. c. A bedside nurse can be part of a hospital research team. d. The bedside nurse can collect data if the nurse has been properly trained. ANS: B All nurses are charged to deliver patient-centered care based on evidence-based practice, research, quality improvement, and informatics. The bedside nurse is part of an interdisciplinary team that is responsible for redesigning the health care structure of the future. 9DIF: Understanding (Comprehension) REF: MCS: 13 TOP: Teaching-Learning MSC: Safe Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. The clinic nurse caring for an older diabetic patient with a sixth grade education anticipates that the patient may experience difficulty (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, as a population they are less educated than the general population. This deficiency can account for a lack of understanding regarding the need for medical care and the importance of following a treatment plan. These patients may also have fewer financial resources to devote to health care issues. DIF: Analyzing (Analysis) REF: N/A 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 geriatric 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 Geriatric Nursing was written in 1969. ANS: B, C, E 10The geriatric 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 Geriatric 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 (Knowledge) REF: MCS: 2-3 OBJ: 1-2 TOP: 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. More deaths in war occur in men e. Women tend to smoke and drink less than men ANS: A, C, D A decrease in maternal mortality, decreased deaths from infectious diseases, and more chronic illness in men account for the disparity in genders as people age. DIF: Understanding (Comprehension) REF: MCS: 6 OBJ: 1-5 TOP: Teaching-Learning MSC: Health Promotion 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 11ANS: 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 (Knowledge) REF: MCS: 6 OBJ: 1-5 TOP: Nursing Process: Analysis MSC: Health Promotion 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. End-stage kidney disease c. Heart disease d. Cancer e. Diabetes ANS: A, C, D The most common causes of death in the older population are cerebrovascular disease, heart conditions, and cancer. End-stage renal disease and diabetes are not among the top three causes of death. Chapter 2 Addressing Diversity of Older Adults MULTIPLE CHOICE 1. A postmenopausal black woman who has been experiencing uterine bleeding tells the nurse, I expect Ill need a total hysterectomy because when my sister had this problem thats what she had done. The nurse recognizes that this woman belongs to a cultural subgroup whose health care beliefs are most influenced by the: a. biomedical model. b. magico-religious model. c. balance/harmony model. d. personal experience. 12ANS: A The patient shows a tendency to identify with the biomedical model, which views the body as a functioning machine. When a part gives out or is functioning abnormally, traditional Western medical treatment is sought and expected. The magico-religious models believe that health is a reward from a higher power. The balance/harmony models state that illness is the result of a state of imbalance in body energies. Personal experience influences all of these models. DIF: Understanding (Comprehension) REF: MCS: 91 OBJ: 5-5 TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. A Hispanic patient explains that the Hispanic culture believes that dietary management would be just as effective in managing her problems as medication, so the patients prescription has not been filled. Which action by the nurse illustrates cultural accommodation? a. Asking the patient to give more details regarding this belief b. Discussing how to add dietary preferences into the treatment plan c. Offering to have a registered nutritionist discuss the situation with the patient d. Researching the patients proposed dietary beliefs ANS: B Cultural care accommodation or negotiation refers to those assistive, supportive, facilitative, or enabling creative professional actions and decisions that help people of a designated culture adapt to or negotiate with others for a beneficial or satisfying health outcome. The nurse can ask the patient to share more about beliefs, offer a consultation with a nutritionist, or research the beliefs, but these actions do not show accommodation. DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 3. A geriatric nurse practitioner working with a tribe of Native Americans makes the decision to acculturate in an attempt to provide culturally appropriate care. The nurse does this best by: 13a. living the values of the tribe. b. researching the tribes belief systems. c. learning the language of the tribe. d. residing among the tribe members. ANS: A Acculturation is a process that occurs when a member of one cultural group adopts the values, beliefs, expectations, and behaviors of another group, usually in an attempt to become recognized as a member of the group. The other actions might be helpful in acculturating. DIF: Applying (Application) REF: N/A OBJ: 5-3 TOP: Nursing process: Implementation MSC: Psychosocial Integrity 4. The nurse in an assisted living facility is practicing a form of cultural bias called ethnocentrism when: a. requesting the bridge group only use the game room for 2 hours at a time. b. encouraging Christian residents to attend mass or church services. c. repeatedly confiscating herbs and food products used in healing. d. telling potential patients who are Jewish that the facility does not have a kosher kitchen, ANS: C Ethnocentrism is a belief that ones own cultural group is superior to that of anothers. In nursing we have a unique culture and expect our patients to adapt to us rather than attempting to adapt to the culture of the patient. Confiscating items used in healing rituals shows ethnocentrism and disrespect to the resident. Limiting activities in a group room, encouraging people to attend church services of their religion, and letting prospective Jewish residents know that the facility does not have a kosher kitchen are not examples of ethnocentrism. DIF: Applying (Application) REF: N/A OBJ: 5-6 TOP: Nursing Process: Implementation MSC: Psychosocial Integrity 5. While caring for an older Korean patient, the nurse notes that the patient answers questions regarding health history when asked but is otherwise silent and does not maintain eye contact. Being 14culturally sensitive, the nurse recognizes that the patients actions are most likely a(n): a. sign of respect for the wisdom and expertise of the nurse. b. indication that he has no questions regarding the care he is receiving. c. expression of discomfort discussing personal matters. d. means of communicating his dissatisfaction with his care. ANS: A Asian cultures generally view eye contact as rude and are often passive in their care. The patient may or may not have further questions. It is not a sign of discomfort or dissatisfaction. DIF: Remembering (Knowledge) REF: MCS: 93 OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 6. The culturally sensitive nurse will recognize that an older adult patient with a high-context ethnic background will appreciate: a. not having a treatment scheduled during a favorite television program. b. both a written and verbal explanation describing how to monitor her blood sugar levels. c. a concise explanation as to why her physical therapy appointment has been canceled. d. having a conversation about her grandchildren while her dressing is changed. ANS: D The interactional patterns of high-context (universalism) patients refer to the characteristics of relationships and behaviors toward others. When a person from a high-context culture interacts with the nurse, a more personal relationship is expected. This is not related to television shows, teaching materials, or appointment cancellations. DIF: Understanding (Comprehension) REF: MCS: 92 OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 7. In an attempt to be sensitive to varying cultural responses to touch, before shaking a patients hand, 15the nurse will: a. offer the patient his or her upturned palm. b. wait until the patient extends his or her hand. c. establish eye contact with the patient first. d. address the patient by his or her full name. ANS: B The best way to show respect and implement the appropriate response is to follow the lead of the patient by waiting for the patient to extend a hand. DIF: Applying (Application) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 8. A older Asian patient receiving physical therapy after hip surgery has developed a low-grade fever. The patient explains that the fever will lessen if the treatment includes the principles of yin/yang. The nurse expects to support the patient by: a. providing privacy when his shaman visits. b. arranging for his diet to include cold foods and liquids. c. planning his physical therapy so it does not conflict with meditation. d. keeping a magical amulet under his pillow. ANS: B The yin/yang theory proposes that health is a result of balance within the body. A principle of this theory is that an illness is either hot or cold and must be treated by elements of the opposite state in order to put the system back into balance. It is not related to shaman visits, meditation, or amulets. DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 9. The nurse in an assisted living facility is preparing to admit an older adult patient who speaks very little 16English. The nurse decides that it is most important that an interpreter be present when the patient: a. indicates a desire to talk with the physician. b. is being oriented to the facility. c. is required to sign official documents. d. begins crying and is inconsolable. ANS: C The more complex the decision making, the more important it is to have an interpreter present. Although all situations would benefit from an interpreter, the most important time is when the patient is signing official documents that have legal implications. DIF: Applying (Application) REF: N/A OBJ: 5-8 TOP: Communication and Documentation MSC: Psychosocial Integrity 10. When attempting to provide culturally sensitive care according to the explanatory model, the nurse asks the patient: a. Who will be able to help you when you go home? b. Do you think the treatment is helping? c. When did you first notice the problem? d. Has this illness changed your life? ANS: D The gerontologic nurse uses this model to explore the meaning of the health problem from the patients perspective. DIF: Applying (Application) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 11. The nurse is caring for an older adult patient in need of hospitalization. The nurse is aware this patient is a member of an ethnic group that holds a collectivist perspective on community. The nurse best addresses the patients medical needs by: 17a. calling an interpreter to assure the patient is making an informed decision. b. assuring the patient that his spiritual advisor will meet him at the hospital. c. arranging for admission to a hospital that is familiar with this patients culture. d. offering to phone the patients family and ask them to come in and discuss the hospitalization. ANS: D People with a collectivist perspective derive their identity from affiliation with and participation in a social group such as a family or clan. The needs of the group are more important than those of the individual, and decisions are made with consideration of the effect on the whole. Health care decisions may be made by a group (such as the tribal elders) or a group leader (such as the oldest son). The other options may or may not be needed depending on the specifics of the patients case. DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 12. The nurse is most effectively using the concept of future time orientation when: a. promising to help the patient call his daughter each weekend. b. offering to complete the health assessment history after the patient eats dinner. c. encouraging an older patient to keep a follow-up clinic appointment. d. arranging for a colorectal cancer screen for senior citizens. ANS: D In the concept of future orientation, people accept the idea that what is done now affects future health. This means that health screenings will help detect a problem today for potentially better health at a later time, days, weeks, or years ahead; it means that prevention may be worth pursuing. The other actions do not show a future orientation. DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 13. The student learns that which of the following is the best definition of culture? 18a. A group of similarly appearing individuals b. Shared beliefs, behaviors, and expectations of groups c. Group beliefs about what is right and wrong d. Groups that come from the same part of the world ANS: B A culture is a set of shared and learned beliefs, behaviors, and expectations among a group of people. The individuals in different cultures may or may not look similar. Group beliefs about what is right or wrong are known as values. Cultural members may come from many different parts of the world. DIF: Remembering (Knowledge) REF: MCS: 87 OBJ: 5-3 TOP: Teaching-Learning MSC: Psychosocial Integrity 14. A student nurse expresses frustration to the faculty member regarding an ethnic older adult who appears to be noncompliant. The student states, Why cant the patient just do what we teach her to do? What response by the nurse is best? a. Yes, I realize how frustrating this must be for you. b. People from her culture are never compliant. c. Maybe you can find a different way to get through. d. Culture dictates how people respond to others. ANS: D Culture is a blueprint for responding to individuals, family, and the community. Persons from strong cultural backgrounds cannot just change their behavior when instructed to do so. The nurse explains this to the student. Stating that the nurse understands the frustration is helpful but does not give the student any information that could help him or her work with this patient. Stating that people from a certain culture are never compliant is biased and prejudicial. Getting through to the patient implies ethnocentrism and bias. DIF: Applying (Application) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 1915. A patient from a culture that differs from that of the nurse is hospitalized and near death. What action by the nurse best demonstrates cultural care preservation? a. Allowing the family to remain at the bedside b. Pinning a healing amulet to the patients gown c. Offering the family food and drink in the room d. Giving the family time to be alone with the patient ANS: B Cultural care preservation refers to those assistive, supportive, facilitative, or enabling professional actions and decisions that help people of a particular culture to retain and maintain their well-being, to recover from illness, or to face handicaps or death. Allowing the patient to have healing artifacts important in his or her culture nearby best demonstrates this concept. The other actions are caring but do not demonstrate this principle. DIF: Applying (Application) REF: N/A OBJ: 5-9 TOP: Caring MSC: Psychosocial Integrity 16. The nurse uses the LEARN model when providing care. What event best demonstrates that this model has been successful? a. The nurse learns about the patients culture and how it impacts care. b. The patient and nurse agree on a mutually acceptable plan of action. c. The nurse listens carefully to the patients concerns and beliefs. d. The patient understands how medical care will be beneficial. ANS: B The LEARN model includes listening to the patient, explaining your own perspectives, acknowledging the similarities and differences in both viewpoints, recommending a plan of action, and negotiating a final plan. If the patient and nurse have come to an agreement on a plan of action, this model has been successful. DIF: Evaluating (Evaluation) REF: N/A OBJ: 5-7 TOP: Caring MSC: Psychosocial Integrity 2017. A new nurse is caring for a patient from Appalachia. The patient seems guarded and secretive, which frustrates the new nurse. What advice from the mentor is most appropriate? a. Maybe you should ask to change your assignment. b. This is a normal behavior for this patients cultural group. c. You could try to apologize for anything you may have done. d. Ask the patient why she is acting so strangely around you. ANS: B Patients from the Appalachian culture are typically wary and guarded around strangers and view the hospital as a place to go and die. The nurse explains this to the new nurse. Changing assignments will not help the new nurse become culturally competent. The new nurse could ask the patient if there has been some offense, but this is probably not the case. Why questions put people on the defensive and are not considered examples of therapeutic communication. DIF: Understanding (Comprehension) REF: MCS: 87 OBJ: 5-6 TOP: Caring MSC: Psychosocial Integrity 18. A nurse is caring for an Arab American patient in the hospital. The patient has many visitors who seem to be tiring the patient. What action by the nurse is best? a. Limit the number of visitors the patient can have. b. Only allow family members to visit the patient. c. Suggest shorter visits to the patients visitors. d. Require visitors to check in at the front desk. ANS: C In Arab American Muslim culture, visiting the sick is a cultural value and expectation. Although the visits may be tiring, they may also be important to the patient. The nurse can suggest shorter visits so the patient can have both the visitors and more rest. Limiting the number of visitors would violate this cultural norm as would limiting visits to family only. Checking in at the front desk serves no useful purpose. DIF: Applying (Application) REF: N/A OBJ: 5-6 TOP: 21Caring MSC: Psychosocial Integrity 19. A director of nursing works in a hospital that serves many Jehovahs Witness patients. What action by the nurse would best facilitate culturally appropriate health care? a. Establish a bloodless surgery program. b. Create an immunization clinic for children. c. Employ spiritual leaders from this faith. d. Allow faith healing ceremonies. ANS: A Jehovahs Witnesses generally are opposed to receiving all blood products. A bloodless surgery program would be a culturally competent way to improve the health care of this population. DIF: Applying (Application) REF: N/A OBJ: 5-5 TOP: Caring MSC: Psychosocial Integrity 20. An incapacitated older adult with dementia is brought to the emergency department by a rescue squad after falling and breaking an arm. When the patients children arrive, they are adamantly against the patient having any medical care and insist that prayer will heal the broken arm. What action by the nurse is most appropriate? a. Allow the family to pray with the patient then escort them to the waiting room. b. Call security to keep the family from interfering with medical care. c. Check facility policies and contact the hospital social worker. d. Call the police who can force the family to accept medical care. ANS: C This family may be Christian Scientists, who do not believe in medical care. Health crises are thought to be errors of the mind that can be altered by prayer. The nurse should check the facility policies for treating vulnerable adults and possibly notify social work, who can assist with ensuring adequate treatment occurs as allowed by policy. Allowing the family to pray with the patient is a caring action, but this complex situation requires more intervention. Calling security or the police will antagonize the family even more and demonstrates an adversarial relationship. 22DIF: Applying (Application) REF: N/A OBJ: 5-6 TOP: Communication and Documentation MSC: Safe Effective Care Environment MULTIPLE RESPONSE 1. When attempting to reflect about personal cultural awareness, the nurse asks himself or herself which of the following quetions? (Select all that apply.) a. What image do I want to project to members of other cultures? b. What makes a culture worthy of biased treatment? c. Have my life experiences contributed to any biases regarding other cultures? d. Am I uncomfortable when interacting with members of other cultures? e. Does the patients culture rely on solid science to direct health care? ANS: A, C, D Self-reflection implies thinking that regards how I, the individual, perceives/believes/behaves. Awareness of ones thoughts and feelings about others who are culturally different from oneself is necessary to become culturally aware. No culture is worthy of biased treatment. Solid science is an ethnocentric principle. DIF: Applying (Application) REF: N/A OBJ: 5-4 TOP: Caring MSC: Psychosocial Integrity 2. What does the nurse working with older adults from many different cultures know about the demographics of culture in the United States? (Select all that apply.) a. Hispanics will become the largest minority group by 2030. b. Many persons of color are not counted in the census. c. The percentage of Native Americans/Native Alaskans will decrease. d. The number of refugees and immigrants is expected to decrease. e. Some Native Americans want to identify as specific tribal members. 23ANS: A, B, C Hispanics are expected to be the largest minority group in the United States by 2030. Many persons of color are not represented in the census, and this underestimates their presence. The percentage of Native Alaskans and Native Americans will rise, as will the number of immigrants/refugees. Some Native Americans may not view themselves as part of this larger group, preferring to identify as a member of a specific tribe. DIF: Remembering (Knowledge) REF: MCS: 83 OBJ: 5-1 TOP: Communication and Documentation MSC: Psychosocial Integrity 3. A nurse working in the emergency department is seeing an older patient who does not speak English well. The nurse calls for an interpreter. The student wants to know why the patients minor child, who speaks English, cannot interpret. What response by the nurse is best? (Select all that apply.) a. The child may not accurately translate. b. The child and older adult may be embarrassed. c. The patient has the right to interpretation. d. Having a child interpret takes too much time. e. Privacy laws prohibit this practice. ANS: A, B, C Although in a true emergency the nurse may have to use a child interpreter, this practice is not recommended. The child may not have the vocabulary to translate, the child may edit the comments, the child or older adult may be embarrassed by the medical condition, and patients have a legal right to professional interpretation. Using an interpreter always takes more time and privacy laws do not prohibit this practice. Chapter 3 Applying a Nursing Model for Promoting Wellness in Older Adults MULTIPLE CHOICE 1. When the home health nurse assists the older adult patient with rearranging furniture within the home to prevent the patient from falling, the nurse is demonstrating: 24a. health promotion. b. health protection. c. health prevention. d. disease prevention. ANS: B The overarching goals are to attain high-quality, long lives free of preventable disease, disability, and injury; to eliminate disparities; create social and physical environments that promote health; and optimize quality of life across the life span. Health protection targets five areas including unintentional injury. Rearranging furniture to prevent falls is a health protection activity. DIF: Applying (Application) REF: N/A OBJ: 8-1 TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment 2. The primary focus of the health belief model of health promotion is addressed when the nurse: a. accompanies the assisted living residents on a walk before dinner. b. asks a senior citizens group what health screening they want to have. c. plans a program on cooking diabetic-friendly meals in cooperation with a dietician. d. asks the patient if he believes smoking puts him at risk for lung cancer. ANS: D The health belief model, which was developed to determine the likelihood of an individuals participation in health promotion, health protection, and disease prevention services, includes assessing an individuals perception of his or her susceptibility to developing an illness. Asking the patient about beliefs related to tobacco use and health is an activity that falls within this model. The other activities do not. DIF: Understanding (Comprehension) REF: MCS: 141 OBJ: 8-2 TOP: Nursing Process: Assessment MSC: Health Promotion 3. Financial considerations are a major barrier to the older adults participation in health promotion because: