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Chapter 6- Diverse Health Care Settings for Older Adults
| 1. | The nurse is discussing with the older adult’s family the possibility of admitting the older adult to a nursing home. Which of the following statements is true of nursing homes? | |
| A) | Medicare will cover the costs associated with long-term nursing care. | |
| B) | Appropriate older adults require continuous nursing care but do not warrant hospital admission. | |
| C) | Minority women with higher incomes are the group most likely to reside in a nursing home. | |
| D) | Posthospital rehabilitation is not normally performed in nursing homes. | |
| 2. | The nurse is providing care for several older adults on an acute care unit. The nurse recognizes that a patient with which of the following problems would be the most appropriate candidate for transfer to a subacute unit? | |
| A) | A patient requiring twice-daily dressing changes for a coccyx wound | |
| B) | A patient who has been admitted from the emergency department with a recent stroke | |
| C) | A patient with urinary retention of unknown etiology | |
| D) | A patient who will soon undergo hip replacement surgery | |
| 3. | The nurse is teaching a colleague about the role of adult day centers. Which of the colleague’s statements indicates a need for further teaching? | |
| A) | “Day centers can give relief to overworked family members who provide care for an older adult.” | |
| B) | “Day centers can improve the quality of life of both older adults and their families.” | |
| C) | “Day centers can be a useful alternative to acute medical care.” | |
| D) | “Day centers can contribute to an actual improvement in dementia symptoms.” | |
| 4. | The nurse is teaching an older adult about possible involvement in Programs of All-inclusive Care for the Elderly (PACE). Which of the following teaching points is most accurate? | |
| A) | PACE programs provide several social and medical services on a managed care basis. | |
| B) | PACE programs provide a cost-effective alternative to hospital-based acute care. | |
| C) | PACE programs are more expensive than fee-for-service models but offer better health outcomes. | |
| D) | There is pressure for Medicare and Medicaid to begin funding PACE programs. | |
| 5. | The client has recently begun receiving Social Security benefits and is asking the nurse about what services might be included or excluded under Medicare. Which of the following services is most likely to be excluded from Medicare funding? | |
| A) | Hospital stays | |
| B) | Visits to a physician | |
| C) | Prescription drugs | |
| D) | Exercise classes | |
| 6. | The administrators of a managed care system are considering whether to fund aspects of a hospital-at-home model. Which of the following statements is true of this model of care? | |
| A) | It is designed to address the functional needs of clients who do not have serious chronic or acute medical problems. | |
| B) | It is an alternative to hospital admission that can facilitate active medical treatment at a lower cost. | |
| C) | It is a form of assisted living that includes assessment by a multidisciplinary team. | |
| D) | It is a Medicare-funded program that is available to most Americans older than 65. | |
| 7. | An 84-year-old woman has been living in an assisted living facility for several years but is now faced with the prospect of relocating to a nursing home. Which of the following characteristics of the woman’s current situation is most likely to prompt this move? | |
| A) | The development of a severe, acute health problem | |
| B) | A decrease in the woman’s level of function and activities of daily living (ADLs) | |
| C) | Exacerbation of a chronic health problem that may require medical treatment | |
| D) | A change in the level of the woman’s social support | |
| 8. | Active care management is often necessary in order to maintain wellness among older adults. Which of these older adults is most likely to require care management? | |
| A) | A 90-year-old man who lives alone and has no living family members | |
| B) | A 77-year-old woman who enjoyed good health until she suffered a severe stroke 3 days earlier | |
| C) | An 81-year-old resident of a nursing home whose Alzheimer’s disease is progressing rapidly | |
| D) | A 90-year-old man who has recently been transferred from an assisted living facility to an acute care setting | |
| 9. | A gerontological nurse is aware that out-of-pocket expenses for care can be onerous for many older adults. What action can the nurse take to potentially minimize these expenses for patients and clients? | |
| A) | Become familiar with the various funding sources and their eligibility requirements. | |
| B) | Teach older adults to be astute with their spending and saving patterns. | |
| C) | Encourage older adults to make care providers aware of each chronic condition they live with. | |
| D) | Provide care that is primarily focused on acute, rather than chronic, health problems. | |
| 10. | Admission to long-term care is typically a culmination in a long series of health problems and functional limitations. Which of the following problems is most likely to precipitate admission to long-term care? | |
| A) | Kidney disease | |
| B) | Traumatic injury | |
| C) | Chronic obstructive pulmonary disease | |
| D) | Dementia | |
Answer Key
| 1. | B |
| 2. | A |
| 3. | C |
| 4. | A |
| 5. | D |
| 6. | B |
| 7. | B |
| 8. | A |
| 9. | A |
| 10. | D |
Chapter 7- Assessment of Health and Functioning
| 1. | The nurse is responsible for assessing an older adult in an acute care setting. Which of the following statements most accurately captures the complexity involved in assessing the older adult? | |
| A) | Older adults manifest fewer symptoms of illness than do younger patients. | |
| B) | Signs and symptoms of illness are often obscure and less predictable among older adults. | |
| C) | Care must be taken to avoid assessing normal, age-related changes. | |
| D) | Older adults experience fewer acute health problems but more chronic illnesses than do younger patients. | |
| 2. | An 82-year-old man is getting advice from a family member on how to drive safely. What piece of advice should the older adult follow? | |
| A) | “Avoid modifying your vehicle with devices that were not supplied by the manufacturer.” | |
| B) | “Realize that normal, age-related changes should not affect your ability to drive safely.” | |
| C) | “You can consider timing your medications to avoid their interfering with safe driving.” | |
| D) | “You should transition from driving to using public transportation as soon as possible.” | |
| 3. | The nurse is conducting a functional assessment of a resident who has recently moved to the assisted-living facility. Which of the following statements best describes functional assessment? | |
| A) | It excludes information on the resident’s medical diagnoses and health problems. | |
| B) | It is a rehabilitative approach focused on the resident’s ability to perform self-care tasks. | |
| C) | It is an alternative to assessing the resident’s activities of daily living (ADLs). | |
| D) | It prioritizes the resident’s ability to perform roles in relationships and in society. | |
| 4. | As part of a functional assessment, the nurse is assessing an older adult’s activities of daily living (ADLs) and instrumental activities of daily living (IADLs). What piece of assessment data would most likely be considered an IADL rather than an ADL? | |
| A) | The older adult is able to ambulate to and from the bathroom at home. | |
| B) | The older adult can feed herself independently. | |
| C) | The older adult can dress in the morning without assistance. | |
| D) | The older adult is able to clean and maintain her own apartment. | |
| 5. | The nurse is employed in a Medicare- and Medicaid-funded nursing home. Which of these statements is true of the functional assessments the nurse is likely to perform? | |
| A) | The nurse will address core activities of daily living (ADLs) but not more complex instrumental activities of daily living (IADLs). | |
| B) | The nurse will identify changes in the older adult’s function over time. | |
| C) | The nurse will utilize various functional assessment models. | |
| D) | The main goal of functional assessments will be to ensure older adult safety. | |
| 6. | A nurse who provides care in a nursing home has completed the admission assessment of an 84-year-old man who has just moved from an assisted living facility. The nurse would document a deficit in the resident’s activities of daily living (ADLs) in light of what assessment finding? | |
| A) | The man experiences chronic pain as a result of rheumatoid arthritis. | |
| B) | The man is able to ambulate with a wheeled walker for 60 ft but then requires a rest break. | |
| C) | The man is able to wash himself but requires assistance entering and leaving the bathtub. | |
| D) | The man is unable to explain the rationale for each of the medications that he receives. | |
| 7. | A 79-year-old woman has been admitted to a nursing home primarily because her diagnosis of Alzheimer disease has progressed from the mild stage to the moderate stage. How should the nurse proceed with functional assessment in light of the woman’s cognitive deficits? | |
| A) | Obtain assessment data from the woman’s family members and friends. | |
| B) | Utilize an assessment tool that is specifically designed for use with cognitively impaired clients. | |
| C) | Perform assessment passively by observing and recording the woman’s behavior and actions over the next several days. | |
| D) | Document the fact that it is not possible to accurately gauge the woman’s activities of daily living. | |
| 8. | A nurse who works in an acute care for elders (ACE) unit has observed that a female patient on the unit frequently stumbles when she ambulates with her walker. How should the nurse best follow up this observation? | |
| A) | Provide a wheelchair for the patient to use for the duration of her hospital stay. | |
| B) | Ask the patient to remain in her bed or in a chair as much as possible and teach her about falls risks. | |
| C) | Place a chair in the hallway so the patient can take a rest break when she feels unsteady on her feet. | |
| D) | Liaise with an occupational therapist to ensure that the woman’s mobility is thoroughly assessed and an appropriate assistive device is provided. | |
| 9. | Staff members at a nursing home have been reminded by management of their responsibility to utilize the Minimum Data Set (MDS) for Resident Assessment and Care Screening. When should the MDS be used? | |
| A) | Upon resident admission and every 3 months after that | |
| B) | Once per week for the first month after admission and once per month after that | |
| C) | Whenever a registered nurse or physician documents a significant change in a resident’s level of function | |
| D) | Daily, as part of routine assessment in the facility | |
| 10. | Assessment of an older adult’s activities of daily living (ADLs) addresses parameters such as mobility, dressing, and elimination. In addition to such functional parameters, assessment of ADLs should also address | |
| A) | pain and range of motion. | |
| B) | mental status. | |
| C) | previous medical history. | |
| D) | integumentary assessment. | |
Answer Key
| 1. | B |
| 2. | C |
| 3. | B |
| 4. | D |
| 5. | B |
| 6. | C |
| 7. | B |
| 8. | D |
| 9. | A |
| 10. | B |
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