Geriatric nursing review questions Part I

1. In assessing the aging client, it is important 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
2. Medications, slower mobility, lack of proper fluid intake, and poor diet can contribute to what
common symptom in the elder population?
a) Urinary incontinence
b) Skin changes
c) Mental changes
d) Depression
3. 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
4. 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?
5. Which disease or ailment is often under diagnosed and undertreated in the aging population?
a) Schizophrenia
b) Depression
c) Associative disorders
d) Attention deficit disorder
6. 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
7. Dementia 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
8. 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
9. The absorption of medication in the geriatric client is most often affected by:
a) A decrease in body fat
b) An increase in serum albumin
c) A decrease in body water and lean body weight
d) An increase in body water
10. 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
11. 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
12. Which statement is true regarding adverse drug reactions (ADRs) in older adults?
a) The rate of ADRs in geriatric clients is seven times that of younger adults and poses serious
health problems
b) Older adults rarely have adverse reactions to prescribed medications becuase they are
monitored
c) Adverse reactions are minimal in older adults and require no intervention
d) Only about 1% of older adults require hospitalization for ADRs
13. Which substance(s) show changes through aging by becoming less pliable and stiffer?
a) Lipofuscin
b) Collagen and elastin
c) Epithelial tissue
d) Cytoplasm
14. 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
15. An 80-year-old female asks the nurse about over-the-counter vitamin supplements. The most
appropriate advice would include:
a) No vitamin supplements are needed with a balanced diet
b) Any multivitamin will do
c) Take only a calcium supplement
d) Take a multivitamin for those over the age of 50, which should include the recommended
vitamins for the aging adult
16. Which theories on aging were introduced in the early 1900s?
a) Wear-and-tear theory and autointoxication theory
b) Evolution theory
c) Molecular theory
d) Cellular theory
17. Systems theory includes which components about aging?
a) Gene regulation ideas
b) Nutation accumulation on aging
c) Neuroendocrine and immunological ideas
d) Free radical ideas
18. What is the most noticeable change in tissue as it ages?
a) Decrease in lipids
b) Increase in subcutaneous tissue
c) Decrease in wrinkles
d) Accumulation of pigmented material called lipofuscin
19. 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
20. What benefit does evidnce-based practice offer clients over the age of 60?
a) No actual benefits have been noted when evidence-based practice is the model for geriatric
care
b) Evidence-based practice offers the client improved health care in all settings
c) Evidence-based pracrice is only used as a model in acute care settings
 d) Minimal changes in geriatric care have arisen from the use of evidnece-baseed practice
models
21. What is the purpose of Rogers' diffusion of innovation model in relation to evidnece-based
practice (EBP)?
a) There is no relation to EBP
b) It offers an explanation of aging
c) It is used to open communication around issues of implementing changes in practice when
EBP research has shown that change would improve outcomes
d) It is the model that contradicts the EBP theory
22. Which of the following statements defines who is appropriate for gerontological nursing care as
stated by Orem (1991)?
a) Orem (1991) refers to advanced epdistric nursing care
b) Any aged client whose self-care demands exceed their ability to meet those demands is
appropriate
c) Orem (1991) refers to young adult nursing care in preparation for a healthyolder adult life
stage
d) Any client who needs nursing care for whatever reason at any age is appropriate
23. 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, diagnose along with the team, identify outcomes, plan, implement, evaluate
d) Assess, evaluate, plan, implement, and look at outcomes
24. Which choice best explains the practice setting for the gerontological nurse?
a) In the home of the client
b) Only in acute care settings
c) Clinics and long-term care facilities
d) Home of the client, acute care facilities, long-term care settings, and clinics or anywhere
clients over the age of 65 seek health care and health education
25. 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
26. 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?
27. Which topic should NOT be omitted when assessign the aging client?
a) Sexual history
b) Caridac history
c) History of abuse
d) All of the above
28. For an individual with age-related hearing loss, which sound is most difficult to hear:
a) A recording of a march played softly
b) A young child talking in a cafeteria line
c) Hammering during construction of a house next door
d) The voice of a man speaking in an elevator
29. 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.
30. The progression of intermittent claudication is measured by the:
1. distance walked before leg pain starts.
 2. pedal edema after dangling the legs for 20 minutes.
3. peripheral pulses in the affected leg.
4. skin temperature and color of the feet.
31. An early sign of alcohol withdrawal is:
1. auditory hallucinations.
2. decreased blood pressure.
3. depression.
4. diaphoresis.
32. A stage III pressure ulcer is characterized by:
1. blisters, abrasions, or shallow craters.
2. deep craters with or without undermining and full-thickness skin loss involving
subcutaneous tissue.
3. full-thickness skin loss with tissue necrosis or damage to muscle or bone.
4. partial-thickness skin loss involving the dermis or epidermis.
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.
34. An 80-year-old resident of a retirement center states that something is wrong with the
lighting in the room because colored rings appear around the light bulbs. The resident
most likely has:
1. cataracts.
2. delusions.
3. glaucoma.
4. increased intracranial pressure.
35. The most common cause of chronic pain in older adults is:
1. arthritis.
2. fractures.
3. headaches.
4. neuropathy.
36. A 72-year-old man with asthma, chronic obstructive pulmonary disease, and chronic
anxiety is admitted to a nursing home. Care plan objectives for this man include:
1. adherence to his medication regimen, inhalation therapy, and instruction about
methods of conserving energy.
2. an exercise program to increase the vital capacity of his lungs.
3. instruction in respiratory exercises with emphasis on forced inhalation.
4. oxygen therapy at 3 L/min as needed and deep-breathing exercises for
relaxation.
37. A 65-year-old man with a 45-year history of smoking complains of a change in his
cough pattern, a nonproductive cough, and an ache in his chest. The man's chest x-ray
reveals an infiltrate. The gerontological nurse suspects:
1. a lung tumor.
2. chronic obstructive pulmonary disease.
3. pulmonary edema.
4. tuberculosis.
38. Which symptom in older adults is most indicative of a urinary tract infection?
1. Confusion
2. Dysuria
3. Fever
4. Frequency
39. Which is a risk factor for vaginitis in older adult women?
1. Anticoagulation therapy
2. Increased sexual activity
3. Poor nutrition
4. Prolonged antibiotic therapy
40. Which condition might be indicated by an increase in hemoglobin values?
1. Dehydration
 2. Infection
3. Malnutrition
4. Opiate use
41. An 83-year-old female patient underwent a total hip replacement three days ago. She
should not cross her legs because:
1. abduction of the hip can cause dislocation of the prosthesis.
2. adduction of the hip can cause dislocation of the prosthesis.
3. blood clots often result from pressure on arteries in the legs.
4. contracture can be prevented by avoiding acute flexion of the hip.
42. A 76-year-old patient with osteoarthritis complains of pain, stiffness, and deformities of
the fingers. The gerontological nurse recommends:
1. cold packs.
2. exercise.
3. meditation therapy.
4. vitamin therapy.
43. A factor that contributes to hypothermia in older adults is:
1. decreased activity.
2. decreased vulnerability to cold.
3. increased perception of cold.
4. increased subcutaneous fat.
44. Heat stroke is a serious form of hyperthermia that is characterized by:
1. absence of sweating.
2. decrease in body temperature.
3. increase in sweating.
4. nausea and vomiting.
45. A gerontological nurse is teaching dressing techniques to a patient with right hemiplegia
and a severe speech impairment. An appropriate first step in the nurse's teaching would
be to:
1. ask the patient to put on a shirt.
2. demonstrate the proper way to put on a shirt.
3. explain the difficulties in putting on a shirt.
4. give verbal instructions on dressing procedures.
46. Older adults with Parkinson disease exhibit:
1. confusion and depression.
2. dementia and hyperkinesia.
3. rigidity and tremor at rest.
4. weakness and tremor with movement.
47. To prevent injury, a gerontological nurse advises an older adult who is taking tricyclic
antidepressants to:
1. eat a diet high in roughage.
2. get an additional night light.
3. provide lubrication for the oral mucosa.
4. stand up slowly from sitting or lying positions.
48. Persons who are taking anticholinergic drugs are at high risk for:
1. cardiac arrhythmias.
2. dry mouth.
3. orthostatic hypotension.
4. slurred speech.
49. Age-related changes in which two organs most affect an older adult's reaction to
medication?
1. Heart and lungs
2. Intestines and spleen
3. Liver and kidneys
4. Pancreas and gall bladder
50. Sildenafil citrate (Viagra) is hazardous for patients with:
1. a history of coronary artery bypass graft.
2. a history of shingles.
 3. heart failure and borderline hypotension.
4. Paget disease and hypertension.
51. A 78-year-old patient calls a telephone triage nurse and reports several falls after taking
over-the-counter medication for a recent cold. Which medication contributed to the falls?
1. Diphenhydramine (Benadryl)
2. Ferrous sulfate
3. Guaifenesin (Robitussin)
4. Loratadine (Claritin)
52. Older adults who take the herbal supplement cascara sagrada are monitored for the
presence of:
1. fever.
2. hypokalemia.
3. jaundice.
4. vertigo.
53. A nursing home conducts a survey to evaluate nursing care. However, some residents
did not express their concerns due to fear of reprisal by the staff. Which aspect of the
evaluation is most affected?
1. Generalizability
2. Reliability
3. Statistical significance
4. Validity
54. A common side effect of angiotensin-converting enzyme inhibitors that frequently results
in discontinuation of therapy is:
1. a dry, persistent cough.
2. exacerbation of heart failure.
3. sedation.
4. urinary incontinence.
55. A patient with Stage 2 Alzheimer disease visits the mental health clinic. During the
interview, the patient becomes hostile and refuses to answer further questions. The
gerontological nurse's best action is to:
1. ask if the questions upset the patient in any way.
2. discontinue the interview.
3. explain that the information is needed to plan the patient's care.
4. ignore the patient's reaction and proceed.
56. A gerontological nurse at a nursing home conducts a reminiscence therapy group for
residents with confusion. A member of the group stands up and says, "I just heard my
cow. I have to go and milk her now." The nurse's most therapeutic response is:
1. "All right, you may leave the group now."
2. "Please tell us about your cow."
3. "That wasn't a cow; maybe you heard a vacuum cleaner."
4. "You live here at the nursing home now, not on the farm."
57. Reminiscence therapy promotes an older adult's sense of security by:
1. increasing socialization skills.
2. meshing the past with the future.
3. providing praise and recognition.
4. reviewing comforting memories.
58. A physician has just informed an older adult patient that test results indicate that the
patient has cancer and will require extensive surgery. The patient says, "I know the
tests are wrong. I feel fine." The gerontological nurse's most appropriate response is to:
1. acknowledge that the patient looks healthy and encourage seeking a second
opinion.
2. advise the patient to join a support group.
3. convey availability to talk to the patient.
4. tell the patient that the tests are reliable and accurate.
59. A 75-year-old patient who sustained a stroke has residual left-sided weakness. From
the first day of hospitalization, the patient has been combative and demanding, and has
refused to swallow any medication. The most constructive nursing action is to:
1. continue to attempt to follow the physician's orders.
 2. determine the patient's premorbid personality.
3. restrain the patient and request a change in the route of medication.
4. wait for the patient to become more cooperative.
60. A healthy 80-year-old female patient complains that her skin feels dry and sometimes
itchy. The gerontological nurse advises her to:
1. avoid scratching since breaks in the skin increase the risk of infection.
2. drink more liquids and take showers instead of baths.
3. take fewer baths, use soap sparingly, and apply skin cream afterward.
4. wear cotton clothing and try a different brand of soap.
61. A 90-year-old patient with multiple medical problems is admitted to the hospital's
geriatric care unit. The nursing assessment reveals lethargy, poor capillary perfusion,
and urinary incontinence. These findings alert the gerontological nurse to the potential
for:
1. aspiration.
2. contractures.
3. dehydration.
4. skin breakdown.
62. An 80-year-old patient complains of sleeping less despite spending more time in bed.
The patient does not use alcohol, caffeine, or any medications other than
acetaminophen for arthritis pain. The patient goes to bed at 11:00 pm, falls asleep in 15
minutes, awakens several times during the night, and promptly goes back to sleep. The
patient feels refreshed in the morning and works five days a week as a volunteer. The
gerontological nurse's most appropriate response is to:
1. recommend that the patient eliminate fluid intake after 6:00 pm.
2. recommend that the patient go to bed one hour earlier.
3. suggest that the patient enroll in a sleep study.
4. tell the patient that the sleeping pattern is a normal age-related change.
63. Which signs are characteristic of deep vein thrombosis?
1. A cool, non-tender limb
2. Limb numbness with diaphoresis
3. Rapid onset of unilateral leg swelling with dependent edema
4. Vertigo with an abrupt onset of blurred vision
64. Unusual symptoms of pneumonia often found in long-term care residents include:
1. anorexia and new behavioral problems.
2. headache and difficulty breathing.
3. muscle aches and fever.
4. nonproductive cough and chest pain.
65. Which symptom is exhibited first by an older adult with a urinary tract infection?
1. Anorexia
2. Confusion
3. Fever
4. Restlessness
66. Which assessment tool measures economic resources, mental health, and activities of
daily living?
1. Lawton's Physical Self-Maintenance Scale
2. Older Americans Resources and Services Assessment
3. Problem Oriented Medical Record
4. Short Portable Mental Status Questionnaire
67. All care plans for older adult patients include:
1. a bowel and bladder program.
2. a fall prevention program.
3. discharge planning.
4. reminiscence therapy.
68. An older adult patient, who is recovering from surgery, has a sodium level of 128 mEq/L
and is confused. The physician diagnoses syndrome of inappropriate secretion of
antidiuretic hormone. The gerontological nurse's primary goal for this patient is to:
1. decrease edema by restricting free water intake.
2. prevent complications of hyponatremia.
 3. reorient the patient to his or her surroundings.
4. restore the patient's fluid and electrolyte balance.
69. The adult children of an aging couple ask a gerontological nurse about alternative
therapies or nontraditional services to improve their parents' health. The nurse's most
appropriate response is to:
1. discuss the benefits, risks, and limitations of various therapies.
2. distinguish between folk and traditional medicine.
3. give a firm warning about alternative therapies.
4. recommend a reputable holistic health therapist.
70. A 73-year-old patient is admitted to a rehabilitation facility after sustaining a mild stroke.
After three nights in the facility, the patient begins to sleep only four to five hours a night
and to awaken frequently during the night. The patient then complains of not feeling
rested and begins to nap during the day. Which is the most appropriate nursing action?
1. Completing an assessment of the patient's sleep-wake cycle to determine
necessary interventions
2. Doing nothing since this type of sleep pattern is associated with normal aging
3. Inquiring if the patient takes a medication at bedtime and requesting that the
physician order it
4. Moving the patient further away from the nurse's station to minimize disturbances
71. A 68-year-old man calls his daughter every night to talk about his beloved wife who died
four weeks ago. During the day, he is sad and goes out frequently to get away from the
empty house. The man's most probable state is:
1. depression.
2. mourning.
3. neurosis.
4. prolonged grief.
72. The main reason that older adults with a chronic illness tolerate functional impairments
is that they:
1. are afraid to seek medical advice for fear of what they may find.
2. associate their symptoms with aging rather than an illness.
3. believe in home remedies and parental traditions.
4. relate their symptoms to conditions that resolved in the past without treatment.
73. An 87-year-old man, who has been living independently, is entering a nursing home. To
help him adjust, the most effective action is to:
1. involve him in as many activities as possible so he can meet other residents.
2. move him as quickly as possible so that he does not have time to think.
3. restrict family visits for the first two weeks to give him time to adjust.
4. suggest that he bring his favorite things from home to make his room seem
familiar.
74. An 80-year-old patient is in the terminal stage of Alzheimer disease. The treatment team
meets with the patient's who are angry and complain about a recent incident in which
their parent's dentures were misplaced. The team members realize that:
1. anger at staff is a symptom of grief and needs to be addressed.
2. anxiety about the meeting may have interfered with the children's affect.
3. material items are the focus for the children at this time.
75. When relocating from a family home to a continuing care community, the most crucial
factor in an older person's adjustment is his or her:
1. level of economic independence.
2. perceived control of the move.
3. physical proximity to remaining family.
4. risk-taking ability.
76. A 78-year-old male resident at a long-term care facility, who is a former business
executive, has been smoking and extinguishing cigarettes in a paper cup in areas
where smoking is prohibited. He has been informed repeatedly of the designated
smoking areas. The resident's behavior indicates an attempt to:
1. express self-transcendence.
2. maintain autonomy by exercising control.
 3. maintain his previous professional role.
4. react against the facility's ageism.
77. A gerontological nurse is caring for an older adult who has been confined to home for
the last 10 weeks due to illness. The patient is anxious, has multiple somatic
complaints, and has become unable to follow instructions. The nurse knows that this
phenomenon commonly occurs with:
1. environmental overload.
2. protective isolation.
3. selective inattention.
4. sensory deprivation.
78. The gerontological nurse facilitates the benefits of life review by:
1. assisting the older adult to accept death as the inevitable last stage.
2. changing the topic when a patient talks about his or her morbid past.
3. encouraging reminiscence, oral histories, and storytelling.
4. helping the older adult explore how spiritual involvement assists with stress relief.
79. The holiday season is approaching and a woman is admitted to a psychiatric unit. She
reports that her husband of 45 years passed away four weeks ago. She frequently cries,
eats poorly, periodically complains of back and stomach aches, and has begun isolating
herself. What type of grief is this woman exhibiting?
1. Acute
2. Anticipatory
3. Disenfranchising
4. Dysfunctional
80. A 92-year old patient, who recently underwent a below-the-knee leg amputation, is
resisting attempts at rehabilitation. The most likely reason for the resistance is that the
patient:
1. has goals that differ from the rehabilitation care plan.
2. has too many disabilities to realistically plan for rehabilitation.
3. is too old to undergo rehabilitation.
4. requires a psychiatrist's assistance to deal with the loss.
81. When the gerontological nurse in a clinic asks a 70-year-old man about his sexual
activity, he begins to cry and says, "I feel so bad for my wife; she is only 60, and I can't
seem to satisfy her as often as I used to." Which is the nurse's most appropriate
response?
1. "At your age, sexual activity diminishes because of changes in your circulation. I
will explain this to your wife."
2. "Certain body functions, such as erections, slow down with age. Could you tell
me more about your sexual relations? For instance, how often do you have
intercourse?"
3. "Your problem is probably an emotional one. If you could relax, you would be as
sexually active as you were 10 years ago."
4. "Your problem is probably due to a decrease in your sexual hormones. This
occurs naturally as people age."
82. An alert and oriented 82-year-old woman, who lives with her daughter, has been
admitted to the hospital with bruises about the face and head. The daughter reports that
her mother fell. Which behavior by the daughter raises the greatest suspicion of elder
abuse?
1. Becoming defensive when questions are asked
2. Complaining about care delivered by hospital staff
3. Giving an illogical account of her mother's fall
4. Refusing to leave her mother alone to answer questions
83. In teaching an older adult client, the gerontological nurse's most appropriate initial
strategy is to:
1. assess the client and individualize the teaching methods.
2. set a slow learning pace and begin teaching simple concepts.
3. teach slowly and use repetition.
4. use demonstration and provide ample opportunity for practice.
84. In preparing a presentation for older adults, a gerontological nurse keeps in mind that:
1. older adults are unlikely to participate in educational programs due to lack of
interest.
2. older adult learners are heterogeneous due to diverse educational experiences
and learning strategies.
3. the ability to acquire knowledge from a verbal presentation decreases with age
more than the ability to acquire knowledge through reasoning.
4. the age-related decline in intellectual performance creates obstacles for acquiring
new information.
85. Members of a family are caring for their father at home. Which statement by a family
member indicates a need for teaching and caregiver instruction?
1. "Dad has gotten lazy about his bathroom habits. He blames his arthritis
medication for his toileting accidents."
2. "Dad's room is close to the bathroom and we keep a light on for him at night."
3. "It's inconvenient, but we stop other activities to remind Dad to go to the
bathroom on a regular schedule."
4. "We try to avoid coffee and tea at night, but Dad really likes a cup of coffee for
breakfast."
86. When hospital quality assurance indicators are assigned, the nursing staff strives to:
1. avoid emphasizing performance deficits.
2. decrease patient falls.
3. focus on achieving 100% compliance.
4. identify high-risk, high-volume, or problem-prone areas.
87. The most appropriate environment for a person with chronic dementia is one that:
1. changes often to decrease boredom.
2. contains familiar objects.
3. is limited in color and sound.
4. is stimulating so as to challenge thought.
88. In assessing the lighting for a patient with glaucoma, the gerontological nurse knows
that:
1. ceiling lights are best.
2. drapes should be left open during the daylight hours.
3. higher levels of light are needed.
4. lower levels of light are needed.
89. A 63-year-old patient is returning home after being hospitalized for injuries received
during a robbery and home invasion. Although neighborhood robberies are rampant, the
patient has lived in the same house for 50 years and does not want to move. The
patient receives a monthly social security check. The gerontological nurse's most
appropriate step is to:
1. advise the patient to arrange for someone to visit regularly or move into the
home.
2. advise the patient to have the social security check deposited directly to the bank
and to get a dog.
3. assume that the patient is incompetent and initiate commitment proceedings.
4. take no action since the patient has a right to autonomy.
90. A gerontological nurse in a daycare program for older adults observes that the
participants have long toenails, corns, calluses, and other problems indicating a need
for better foot care. What is the nurse's best action?
1. Developing an educational program on foot health and arranging for podiatry
services at the site
2. Establishing a regular foot care plan whereby the participants' toenails would be
cut and corns and calluses shaved
3. Instructing competent family members in the proper methods of cutting toenails
and using commercial foot care products.
4. Recommending that the participants soak their feet for 10 minutes before cutting
their toenails using safe toenail clippers
91. The occurrence of tuberculosis in the older adult is significantly increased among
individuals who:
 1. are physically inactive.
2. are cigarette smokers.
3. have received the Bacile Calmette Guérin (BCG) vaccine.
4. reside in institutions.
92. Which type of fracture has the highest morbidity and mortality in the older adult?
1. Ankle
2. Hip
3. Shoulder
4. Vertebral
93. The primary reason for establishing quality improvement committees at long-term care
facilities is to:
1. facilitate staff participation.
2. initiate changes based on interdisciplinary exchange.
3. monitor and record incidents, accidents, and injuries.
4. provide quality care based on measurable data.
94. An accrediting body evaluates a nursing home by monitoring the number of residents
who developed pressure ulcers and urinary tract infections. What type of audit is being
conducted?
1. Outcomes
2. Process
3. Prospective
4. Structure
95. A gerontological nurse is creating a staff development program for a unit. To assess the
staff's learning needs, the nurse's best approach is to ask staff members:
1. "How do you want to learn new material?"
2. "What do you need to know to do your job better?"
3. "What do you think others need to learn?"
4. "What do you think others want you to learn?"
96. A comprehensive staff development program in a long-term care facility is based on the:
1. availability of educational resources.
2. nursing director's perceptions of staff learning needs.
3. philosophy, goals, and objectives of the organization.
4. recommendations of the ombudsman.
97. A gerontological charge nurse delegates the administration of a nasogastric tube
feeding to a licensed practical nurse (LPN). Which statement about this situation is most
accurate?
1. The charge nurse is responsible for delegated care.
2. The charge nurse should implement the care and not delegate the task.
3. The LPN is accountable for his or her own actions.
4. The LPN should respectfully refuse to initiate this care.
98. Which profession first developed standards of gerontological care and provided a
certification mechanism to ensure expertise?
1. Medicine
2. Nursing
3. Physical therapy
4. Social work
99. The gerontological nurses in a teaching nursing home are informed of a research
project to obtain voiding cystometrograms on all residents. The gerontological nurses'
responsibility is to ensure that the:
1. non-English speaking residents receive a complete explanation of the study in
their native languages.
2. nursing home administration know that the nurses do not support such invasive
studies on the residents.
3. research team is well staffed so that the nursing home staff can provide care as
usual.
4. residents will be properly medicated in the examining room where the tests will
be conducted.
100. Which is an accurate statement about Medicare?
1. Medicare is a health insurance program with carefully described benefits that
may restrict the length of hospital stays.
2. Medicare patients can expect to receive routine household and attendant care
under Part A of their Medicare insurance.
3. Medicare pays for the majority of nursing home care for persons who are 65
years of age or older.
4. Persons covered by Medicare must pay once-in-a-lifetime deductibles on both
the physician and hospital portions of the program.
101. Nursing facilities that receive federal funds must complete for all residents a:
1. minimum data set and care plan within seven days.
2. resident assessment instrument and care plan on admission.
3. resident assessment instrument and care plan within 14 days.
4. resident assessment instrument within 14 days and a care plan within 21 days.
102. The primary function of an ombudsman is to:
1. act as a clearinghouse for complaints and problems.
2. initiate complaints about the facility's operations.
3. question the facility administrator and the director of nursing.
4. welcome and interview patients and their families.
103. A 73-year-old patient reports "dizzy spells" for the past several weeks. The patient describes
three similar episodes during which the patient experienced "a swimming in my head," loss of
balance without falling, and numbness in the left arm. These episodes lasted 10 to 30 minutes.
This patient is experiencing:
a) carotid artery stenosis
b) Meniere's disease
c) postural hypotension
d) transient ischemic attacks
104. Which is the main principal age-related change that causes alteration in drug distribution in
older adults?
a) A decrease in absorption
b) A decrease in total body weight
c) An increase in body water
d) An increase in the ratio of body fat to lean body mass
105. An 85-year-old patient has an intestinal viral infection with severe diarrhea. Laboratory studies
are ordered. Which result confirms a diagnosis of dehydration?
a) Hyperchloremia and hypernatremia
b) Hyperglycemia and hyponatremia
c) Hyperkelemia and hypercapnia
d) Hypermagnesemia and hyponatremia
106. In older women, the onset of physical discomfort and bleeding associated with intercourse often
indicates:
a) a friable cervix with possible cellular abnormalities
b) decreased distensibility and mucosal changes of the vaginal vault
c) infrequent sexual activity
d) thickening of the vaginal mucosa with decreased lubrication
107. A gerontological clinical nurse specialist is administering a mental status examination to an 80-
year-old patient. The patient answers the more complicated questions by saying "I don't know."
Which test is included in a further assessment?
a) Barthel Index
b) Functional Independence Measure
c) Geriatric Depression Scale
d) Lawton Life Satisfaction Scale
108. The most reliable measure for assessing hydration in an older adult is:
a) Mucous membrane condition
b) Skin texture
c) Skin turgor
d) Urinary frequency
109. Differences between the IQ scores of a group of 20-year-old individuals and a group of 80-year-
old individuals suggest:
a) Cortical atrophy
b) An accumulation of lipofuscin
c) Cohort differences
d) Vascular changes
110. Which group of older adults has the highest risk for suicide?
a) African-American men
b) African-American women
c) White men
d) White women
111. In a quality review of pressure ulcers amoung nursing home residents, appropriate outcome
criteria include the:
a) Availability of supplies for wound care
b) Incidence of pressure ulcers correlated with staffing levels
c) Percentage of pressure ulcers that demonstrate healing each month
d) Rate of nurse compliance with the protocol for treating pressure ulcers
112. Ever since the death of her husband a year ago, an older woman's ability to care for herself has
significantly diminished. The older woman expresses increased feelings of inadequacy and
decreased satisfaction with life. The daughter had become the primary caregiver for the woman
and has become increasingly resentful of this role. The mother and daughter's feelings are best
explained in terms of:
a) Ego integrity versus despair
b) Role theory
c) Social exchange theory
d) Unresolved grieving
113. Persons who have chronic open-angle glaucoma are advised to wear medical alert bracelets
because they have the potential for developing acute glaucoma if they are administered:
a) angiotensin-converting enzyme (ACE) inhibitors
b) anticholinergic agents
c) adrenergic blocking agents
d) osmotic agents
114. To decrease complications of hypercalcemia caused by prolonged immobilization, the most
appropriate nursing intervention is to:
a) encourage a high fluid intake unless contraindicated
b) monitor renal function
c) monitor serum calcium and phosphorus levels
d) observe the patient for signs of muscle twitching
115. A gerontological clinical specialist is conducting a study on risk factors for osteoporosis and has
developed a questionnaire covering risk-reducing and risk-increasing behaviors of older women.
The clinical specialist asks experts in the area of osteoporosis to review the tool to establish:
a) concurrent validity
b) content validity
c) interrater reliability
d) test-retest reliability
116. A gerontological clinical nurse specialist plans to investigate the relationship between
educational levels and adherence to prescribed hypertensive medication, as measured by
changes in blood pressure readings. Which research design is most appropriate to study this
issue?
a) Descriptive correlational
b) Nonequivalent control group
c) Pretest-posttest
d) Quasi-experimental
117. A gerontological clinical nurse specialist is asked to provide consultation on ways to reduce the
use of restraints in a nursing home. In the initial meeting with the nursing home administration,
the clinical specialist's primary goal is to:
a) Complete a written contract for services that covers expected outcomes, time commitments,
support systems, and financial arrangements
 b) Conduct a force field analysis of the variables in the nursing home that includes use of
existing data on restraint use and staff strengths and weaknesses
c) Discuss the need for consultation, the overall goal of the project, and the working relationship
with the staff
d) Plan a review of how the use of restraints has been accomplished elsewhere and the models
used for education and for changing practice
118. In teaching older adults in a group setting, the gerontological clinical specialist minimizes the
impact of presbycusis by:
a) Increasing the volume of the audio system
b) Providing soft background music
c) Raising voice pitch and facing the group
d) Reducing voice pitch, speaking slowly, and enunciating
119. After presenting a talk on breast health, a gerontological clinical specialist discovers that at least
60% of the women who attend a large urban senior center do not believe in the benefits of
mammography, have never had a mammogram, or had a painful experience and refuse to get
another one. Which initial approach is most likely to motivate change?
a) Administering a survey to assess the exact nature of the women's self-care behaviors before
planning the next step
b) Arranging for reduced-cost mammograms and free transport to the local hospital
c) Planning some small group sessions with these women to allow them to explore their beliefs
and feelings
d) Presenting another educational session that includes a speech by a physician and then
distribute additional literature
120. When encouraging adult learners to use the concept of critical reflection, the gerontological
clinical specialist:
a) emphasizied the "how" and "how to" instead of the "why"
b) encourages and engages learners in problem formation and problem-solving activities
c) explains the definition of the issue or problem under discussion so the definition is understood
by all
d) focuses on the present and minimizes discussion regarding learners' past experiences
121. An 81-year-old patient has right-sided pleuritic pain with shortness of breath. The patient reports
falling during the night, and has a large ecchymosis on the right flank area. Which nursing
diagnosis is a priority for this patient?
a) Anxiety
b) Impaired skin integrity
c) Ineffective breathing pattern
d) Sleep pattern disturbance
122. The Framingham Heart Study examined the effect of blood pressure,cholesterol levels,
smoking, exercise, and other variables on the development of coronary artery disease in a
cohort of healthy men and women. The subjects were studied at specific intervals over a period
of years. The Framingham study is an example of which type of research study?
a) Cross-sectional
b) Longitudinal
c) Predictive
d) Retrospective
123. To be an effective consultant in a new setting, the gerontological clinical nurse specialist first
explains to the staff members the:
a) clinical nurse specialist's ability to plan care
b) Clinical nurse specialist's expertise as a consultant
c) need for consultation
d) rold of the consultant
124. The gerontological clinical nurse specialist is asked to speak to a chronic obstructive pulmonary
disease support group about the ethical issues surrounding physician-assisted suicide. At the
beginning of the presentation, the clinical nurse specialist asks the group to identify what they
fear most about death and dying. This technique is used to achieve objectives in which domain?
a) Affective
b) Cognitive
 c) Psychomotor
d) Spiritual
125. To ensure the successful implementation of the humanistic model of organizational theory,
nursse managers and gerontological clinical nurse specialists prioritize activities that:
a) eliminate at least one organizational level to decentralize
b) eliminate or minimize the informal "grapevine"
c) emphasize informal communication and minimize formal communication
d) emphasize job satisfaction to improve productivity
126. An 88-year-old patient is reluctant to use the call light for assistance and is often incontinent.
The gerontological clinical nurse specialist tells the staff to praise the patient each time the call
light is used to request toileting assistance. The clinical nurse specialist's suggestion is based
on which theory?
a) Behavioral learning
b) Cognitive reorganization
c) Person-environment fit
d) Social cognitive
127. A 92-year-old patient with advanced dementia has had three episodes of aspiration pneumonia
in five months. The patient has no written advanced directives. The speech therapist
recommends feeding tube placement. The patient's son would like a feeding tube placed, the
daughter is unsure, and the patient's spouse states that the patient would never want a feeding
tube. The gerontological clinical nurse specialist's next action is to:
a) bring the case to the attention fo the ethics committee
b) emphasize to the family that a feeding tube will decrease recurrent pneumonias
c) obtain a surgical consult to schedule feeding tube placement
d) organize a family and staff meeting to discuss the risks and benefits and consider the
patient's wishes
128. Which statement describes the importance of understanding nursing theory when practicing
gerontologic nursing?
a. Understanding and using tested theories offer a framework on which to base nursing practice
interventions
b. Nursing theories are vague and do not offer substance in most health-care settings
c. Theories are not proven ways onwhich to base nursing practice
d. Theory helps identify major concepts in nursing practice and offers a framework for decision
making
129. Kolcaba's (1994) theory of comfort supports which nursing practice standard?
a. It supports transcultural nursing practice
b. It supports basic nursing care, promoting the comfort of the patient
c. It supports the importance of social support to buffer life's stresses
d. It supports helping the patient to adapt to chronic illnesses
130. What is one important consideration when dealing with the older population when considering
safety and medications?
a. The older adult is at risk for falls, leading to an increase in morbidity and death
b. A fractured arm is the highest risk for the older adult
c. Depression is common in older adults and needs not be treated with medication
d. Most older adults are not as fragile as was previously thought
131. The gerontological nurse may prescribe corticosteroids for all but which one of these
conditions?
a. Arthritis
b. Hyperglycemia
c. Allergic reactions
d. Inflammatory states
132. An 80-year-old female decides on a do not resuscitate (DNR) status for herself after discussing
her medical concerns with her physician. Which statement best describes the reasoning behing
this decision?
a. This is ethical reasoning based on self-determination and informed consent
b. This is not a medical decision
c. This discussion would be meaningless because the family members were not involved
d. THis is not an ethical decision
133. The nurse recognizes that cumulative changes in the skin of the elderly are related to
environmental factors are termed?
a. Sunburned
b. Photoaging
c. No term exists to describe this
d. Mole or blemish
134. The major portion of the dermis consists of what substance?
a. Sebaceous glands
b. Hair follicles
c. Collagen
d. Blood vessels and nerves
135. The cosmetic side of aging poses which effect on many older adults?
a. The physical effect of sagging cheeks
b. Psychological, affecting self-esteem and causing depression
c. No notable effect
d. No effect because older adults are mature enough to understand the aging process
136. Senile purpura significantly increases with age and is most related to?
a. The aging process past the age of 60
b. Related to increase in blood vessels
c. Related to loss of subcutaneous fat and connective tissue
d. Related to medications
137. The most common cause of death from skin cancer in the elderly is:
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Malignant melanoma
d. Actinic keratosis
138. The nurse understands that the goal for treatment of leg ulcers in the elderly client should be to?
a. Relieve pain and swelling
b. Relieve immobility
c. Promote circulation
d. Alleviate swelling, eliminate infection, and promote healing
139. Changes in bone and muscle in the aging population have the greatest effect on?
a. Stature, posture, and function
b. Appearance
c. Immunity
d. Pain tolerance
140. The nurse caring for the elderly population understands that movement slows with aging. This is
most likely due to:
a. Cognitive function
b. Changes in musculoskeletal and nervous systems
c. Laziness and a feeling that life is over
d. A recent change in medical condition
141. The nurse recognizes that involuntary movements may appear in the elderly patient and be
normal. These normal involuntary movements may present as which of the following?
a. Seizures
b. Tongue protrusions
c. Resting tremors
d. Eye twitches and spasms
142. The disease affecting adults over the ages of 55 to 60 where these is excessive resorption and
deposition of bone is:
a. Paget's disease
b. Osteoporosis
c. Wright's disease
d. Scott's disease
143. A 69-year-old female presents with knee pain. The nurse hears a dry crackling or grating sound
and the client feels the same sensation on exam. The nurse reconizes this as:
a. Nothing abnormal for the age of the client
b. Crepitation, the sound of osteoarthritis in the knee joint
 c. Osteoporosis and a softening of the knee joint
d. Fluid-filled spaces in the knee joint
144. The nurse may recommend which of the following for the older client with mild arthritis?
a. Complete bedrest
b. Rest and ice for the joints affected
c. A mild exercise program including walking
d. No exercise will improve arthritis
145. A male elderly client on long-term auranofin therapy presents with oral ulcers and a pruritic rash
and complains of decreased urinary output. The nurse understands that:
a. These symptoms can be the adverse effects of gold salt therapy
b. These symptoms are unrelated to anything and need a major work-up for diagnosis
c. These symptoms represent liver failure
d. These symptoms are common when clients are treated for arthritis
146. The gerontological nurse understands that nonsteroidal anti-inflammatory drugs (NSAIDS) used
for arthritis pain may cause?
a. No side effects
b. Liver failure in the first 24 hours
c. Coagulation impairment and gastric irritation
d. Fear or anxiety
147. The nurse is evaluating a 64-year-old male for coronary artery disease (CAD). Understanding
that CAD is the leading cause of mortality, which risk factor would not be related to CAD?
a. Hypertension
b. Dyslipidemia
c. Diabetes
d. Sexual orientation
148. What is the single most cost-effective discovery made in the past 30 years that has influenced
the prevention and treatment of cardiovascular events?
a. The development of oral hypoglycemic drugs
b. Recognizing the need to lower blood pressure in older adults
c. Antismoking campaigns
d. Zero tolerance for drug and alcohol abuse in older adults
149. The nurse evaluates a 70-year-old female who has been recording her blood pressures for the
last few days. These pressures were 140/90, 146/90, 146/92, 138/88, and 150/89. The nurse
recognizes this as the beginning of which stage of hypertension?
a. Stage 2
b. High normal blood pressures
c. Stage 1
d. Stage 3
150. The nurse is doing a follow-up clinic visit for a 75-year-old female post-cerrebrovascular
accident (CVA) of two months. The nurse should be prepared to discuss all of these possible
complications except:
a. Neurogenic bladder
b. Depression
c. Financial concerns
d. Fecal incontinence
151. Which symptom is the most common with peripheral artery disease (PAD)?
a. Intermittent claudication
b. Warm extremities
c. Pain unrelieved by rest
d. Bounding pulses
152. The nurse is examining a 76-year-old female with the complaints of fatigue, ankle swelling, and
mild shortness of breath over a three-week period. An appropriate nursing diagnosis might
include:
a. Decreased cardiac output related to altered contractility and elsticity of cardiac muscle
b. Activity tolerances due to compensation of oxygen supply
c. Increased cardiac output related to an aging heart muscle
d. Decreased urinary output due to poor kidney perfusion
153. Factors that may further decrease lung finction besides aging include all but:
a. Smoking
b. Obesity
c. Immobility
d. Exercise
154. Which choice would not be a nursing goal when managing chronic obstructive pulmonary
disorder (COPD) in an older adult patient?
a. Decreasing exercise
b. Preventing and treating complications
c. Reducing mortality risks
d. Relieving symptoms
155. When caring for an older adult with pneumonia, the nurse recognizes all of the following are
appropriate interventions except:
a. Monitoring rate, rhythm, depth, and effort of respirations
b. Auscultating breath sounds
c. Monitoring blood sugars and reports BS higher than 145
d. Monitoring for increased restlessness or anxiety indicating air hunger
156. Veritgo in the older adult is best described as:
a. A vestibular disorder producing a rotational sensation
b. A dysfunction of sensory signals
c. A transient loss of consciousness
d. A light-headed feeling
157. All statements are examples of nonpharmacological nursing interventions for a patient
experiencing delirium but needing sleep except:
a. Providing adequate sleep and awake times
b. Encouraging ambulation
c. Providing a night light to prevent fears
d. Reducing noise levels during periods of sleep
158. Which statement best describes the procedure for assessing for the presence of Helicobacter
pylori in the older adult patient?
a. Colonoscopy
b. Prescribing two weeks' worth of antibiotics, and then performing a colonoscopy
c. Gastric biopsy, serum blood antibody studies, or stool assay exam
d. Fecal occult blood exams
159. The nurse evaluating an elderly male client for urinary complaints understands that the major
change in the prostate during the aging process is?
a. Hyperplasia
b. Renal stones causing obstructions
c. Hypolplasia
d. Impotence and embarrassment
160. Which statement best describes the nurse's understanding of normal expected sexual resonses
in aging female clients?
a. No changes in sexual responses are noted with aging females
b. Aging females experience a quicker arousal phase
c. An aging female will most often experience a delayed arousal phase during intercourse
d. An increas in vaginal secretions may be noted in the aging female
161. When assessing an aging client's genitourinary system, the gerontological nurse recognizes the
importance of screening for:
a. Drug addiction
b. Bladder malignancy
c. Diabetes
d. Cognitive abilities
162. The gerontological nurse understands that the purpose for prescribing Ditropan is:
a. An underactive kidney function
b. Increasing contractions of the sphincter muscles
c. Decreasing bladder muscle tone and aiding in urge incontinence
d. Improving urogenital symptoms caused by vaginitis
163. Treatment approaches for an aging adult experiencing overflow incontinence may include all of
the following except:
a. Toilet schedule
b. Positioning and the Crede maneuver
c. Clean self-catheterizations
d. Kegel exercises
164. Symptoms of hyperthyroid disease may include all of the following except:
a. Heat intolerance
b. Palpitations
c. Tremors
d. Diarrhea
165. The nurse recognizes the most common eye-related disease affecting the older adult is:
a. glaucoma
b. cataracts
c. near-sighted visual disturbances
d. far-sighted visual disturbances
166. The nurse shold be aware that the percent of aging adults in a nursing home/long-term care
setting experiencing sensory hearing loss is:
a. 40%
b. 60%
c. 30%
d. 70 to 80%
167. Which age-related psychological change is not the norm?
a. An increased ability to multi-task
b. Lower scores on tests of creativity
c. Thinking of death as a process rather than a moment in time
d. Life satisfaction is related to well-being
168. Examples of health-care reimbrusement or delivery modes include all of the following except:
a. Medicaid
b. Medicare
c. Managed care, telemedicine, and case management
d. Anthem for the elderly A/B
169. The program designed to supplement Social Security for thsoe who do not qualify for Social
Securiety or who are disabled is:
a. OAA
b. SSI
c. Medicare
d. Medicaid
170. The purpose of the Patient Self-Determination Act is:
a. To encourage patient to document their choices about life support and advance directives
b. To hel polder adults organize their finances
c. To help older adults plan for jobs after the age of 65
d. To assist older adults in naming benefactors
171. Quality improvement (QI) refers to:
a. Acute care and inpatient facilities only
b. Attention to safety and appropriate care for all
c. It has not importance to gerontological nursing
d. High-risk older adults only
172. Quality indicators for health-care research and patient safety appropriate for the older adult
would include all of the following except:
a. Wound care and decubitus ulcer prevention
b. Postoperative hip fracture care
c. Obstetric trauma
d. Fall risk assessments
173. Which statement give examples of educational programs for the older adult?
a. Community programs that focus on lifestyle modifications
b. Programs targeting specific age-related problems, such as nutrition, finances, or prevention
 c. Programs that focus on exercise for the older adult
d. All of the above
174. The role of the gerontology nurse includes all of the following except:
a. To facilitate the establishment of social support for the older adults
b. To promote independent living as much as possible
c. To educate and refer older adults to the appropriate resources
d. All of the above
175. Which best describes what guides the appropriate nursing care of an aging adult?
a. Evidence-based practice developed with ongoing research into the needs and outcomes of
older adults
b. General nursing care previously practices
c. Facility policies and procedures
d. Physician orders for patient complaints
Geriatric nursing review questions Part Ii
1. The nurse is aware the theory of aging most likely to explain why the older population is at risk for
autoimmune disorder is known as:
a.) cross-link theory.
b.) free radical theory.
c.) error theory.
d.) autoimmune theory.
The immunity theory proposes that cellular errors in the immune system have been found to lead
to an auto-aggressive phenomenon in which normal cells are misidentified as alien and are destroyed by
the body’s own immune system. This phenomenon is used to explain the increase of autoimmune
disorders as we age.
The cross-link theory describes aging in terms of the accumulation of errors of cross-linking or stiffening
of proteins in the body.
The free radical theory describes free radical errors as the result of random damage from free radicals.
The error theory is a group of theories that propose that aging is an accumulation of errors in the
synthesis of cellular DNA and RNA, which are the building blocks of the cell

2. A 66-year-old retired professional basketball player is admitted to the hospital for a total knee
replacement due to osteoarthritis. In preparing preoperative teaching for this patient, the nurse includes
which theory of aging to help him understand how the disease has progressed?
a.) Free radical theory
b.) Wear-and-tear theory
c.) Gene theory
d.) Cross-link theory
Osteoarthritis is characteristic of degeneration that results from joint usage. This disease is a good
example of the wear-and-tear theory; repeatedly injuring one organ or body system, such as occurs during
playing sports, may result in premature aging and diseases such as osteoarthritis. The free radical
theory states that cell damage is a result of the accumulation of oxygen radicals. The gene theory states
that genes govern cellular mortality. The cross-link theory is related to the accumulation of cross-linked
proteins, which may cause disease.

3. A married couple retired to a life care community after the husband had heart surgery. The wife has
always been physically and socially active and joined an aerobic class, knitting groups, and a book club
shortly after moving to the community. She walks on a daily basis and swims twice a week. Her husband
spends his days reading and watching television. He was never a social person and enjoys being by
himself. Which of the sociological theories of aging best describes the couple?
a.) Role theory
b.) Disengagement theory
c.) Continuity theory
d.) Personality theory
The continuity theory asserts that individuals tend to develop and maintain a consistent pattern of
behavior as they age. The wife was active and social and continues to be so. Her husband was not very
social and preferred less active activities and continues to do so. The role theory describes that people
engage in roles consistent with their chronological age. The scenario above describes activity levels, not
roles. The disengagement theory describes withdrawal of older adults from roles and activities of earlier
life. Personality theories are distinct and different from sociological theories of aging.

4. A community health nurse provides an annual flu prevention workshop at a local senior center. The
activities include a lecture on preventing infections, which includes hand washing and limiting exposure
to individuals who are ill, as well as an influenza immunization clinic. The nurse is basing her activities
on what theory of aging?
a.) Wear and tear
b.) Oxidative stress
c.) Autoimmune
d.) Free radical
 The autoimmune theory of aging describes changes in cells of the immune system, which make
an older person more susceptible to infection. Prevention of infection is very important in older adults and
can be accomplished by education and immunization. Wear and tear, oxidative stress, and free radical are
incorrect because none of these theories of aging deal with prevention of infection.

5. The nurse implements the concepts of the activity theory of aging when instructing the older client with
osteoarthritis to:
a.) continue her daily walking routine.
b.) curtail further increases in physical activity.
c.) document preferred end-of-life interventions.
d.) avoid exposing herself to crowds.
The activity theory states that successful aging equals active aging, which is related to the
person’s need to maintain a productive life for it to be a happy life. Curtailing increases in physical
activity is diametrically opposite to continuing a daily walking routine and contrary to the tenets of the
activity theory. End-of-life decisions and avoiding exposure to crowds are not related to the activity
theory since they do not directly affect the productiveness of a client’s life.

6. The family member of a patient asks if vitamin C will prevent aging. In formulating an appropriate
response, the nurse considers the:
a.) free radical theory.
b.) autoimmune theory.
c.) wear-and-tear theory.
d.) continuity theory
The free radical theory posits that aging is a result of random damage from free radicals.
Research is ongoing on the ability of substances with antioxidant effects to counter the actions of free
radicals. For many years it was thought that consumption of supplemental antioxidants, such as vitamin
C, could delay or minimize the effects of aging. However, it is now known that the intake of supplemental
antioxidants can be deleterious to one’s health.

7. A nurse plans programs for older adults in a senior center. She organizes a series of exercise
programs. She sets one up for clients ages 65-74, one for clients 74-85, and one for clients over age 85.
The nurse is utilizing which theory of aging?
a.) Gerotranscendence
b.) Activity theory
c.) Age-stratification theory
d.) Continuity theory
Age-stratification theory considers individuals as members of cohorts with similarities to others
in the same group. The importance of the similarities exceeds that of the differences.
Gerotranscendence theory posits that older adults withdraw from society, in order to give the individual
the opportunity for self-reflection and exploration. Time, material possessions, and superficial
relationships have less meaning. Activity theory proposes that continued activity contributes to
successful aging. Continuity theory posits that individuals develop and maintain a consistent pattern of
behavior over a lifetime.

8. The student nurse studying aging knows which theory was originally used to describe failures in
electronic equipment?

A) Error theory
B) Wear-and-tear theory
C) Run-out-of-program theory
D) Reliability theory of aging and longevity
The reliability theory of aging and longevity is a mathematical equation originally used to explain
the failure of electronic equipment. The error, wear-and-tear, and run-out-of-program theories
were not originally used with electronic equipment.
9. The patient requests information on ways to prevent the damage associated with free radicals. Information
on which antioxidants would be most appropriate for the nurse to include? (Select all that apply.)

A) Zinc
B) Copper
 C) Selenium
D) Vitamin A
E) Vitamin C
F) Vitamin B12
Antioxidants such as zinc, selenium, and vitamins A, C, and E may help decrease the damage
caused by free radicals

10. The 45-year-old patient reports to the nurse he feels he is going through a "mid-life crisis." The nurse
recognizes this phenomenon refers to the theory developed by which psychologist?

A) Jung
B) Erikson
C) Newman
D) Havighurst
Carl Jung's theory of development proposes that an individual progresses through life searching
and setting goals for him or herself in an ongoing search for one's "true self." The "mid-life crisis" is the
time in which the individual reevaluates his or her life and progresses toward his or her true self. The
theories of Erikson, Newman, and Havighurst do not include a mid-life crisis.

11. The patient in the clinic tells the nurse she can "feel her biologic clock ticking." The nurse knows the
patient views aging based on which theory?

A) Gene theory
B) Programmed theory
C) Rate of living theory
D) Somatic mutation theory
The programmed theory proposes that, at conception, a "biologic clock" begins ticking that
determines the number of cell divisions that occur before death. The rate of living theory postulates each
person has a finite number of heart beats. The gene theory discusses aging from the perspective of one or
more harmful genes that are activated over time and bring about age-related changes. The somatic
mutation proposes that aging is caused by environmental damage to DNA.

12. The nurse in the long term care facility who cares for primarily older adults knows these adults are in
which stage of Erikson's developmental tasks?

A) Trust versus mistrust

B) Integrity versus despair
C) Industry versus inferiority
D) Generativity versus stagnation
The developmental stage for the older adult is integrity versus despair, where the individual looks
back on his or her life with pride that he or she had a positive impact or despair that his or her impact was
negative. Trust versus mistrust, integrity versus despair, and industry versus inferiority are stages for
younger individuals

13. The nurse working in the long term care facility plans care based on Havighurst's theory of aging. Which
task(s) should the nurse facilitate his patients to achieve? (Select all that apply.)

A) Adjusting to the loss of a spouse

B) Preserving and increasing strength
C) Adjusting to a decrease in income
D) Stabilizing one's self in one's social roles
E) Looking back on one's life with pride and contentment
Havighurst's theory of aging proposes tasks for older adults including adjusting to the loss of a
spouse and a decrease in income, adapting to new social roles flexibly, and establishing relationships with
other individuals of one's own age. Achieving the task of looking back on one's life with pride and
contentment is a part of Erikson's theory

14. The nurse in the long term care facility frequently observes older adults being separated from their friends
and family and excluded from society. This phenomenon is described in which psychosocial theory of
aging?

A) Activity theory
 B) Life-course theory
C) Developmental theory
D) Disengagement theory
The disengagement theory describes the phenomenon in which older adults are separated from
their friends and become disengaged from society because they are perceived to no longer be a benefit to
society. The activity theory states successful aging requires continued activity. The life-course theories
include theories by Erikson, Havighurst, Newman, and Jung. The developmental theory uses Erikson's
eight stages of developmental tasks to describe aging

15. The aging patient requests information on the causes for the age-related changes he sees in his body. In
order to educate the patient using the neuroendocrine theory of aging, the nurse should discuss which
structure in the brain?

A) Cerebellum
B) Hippocampus
C) Hypothalamus
D) Anterior pituitary gland
The neuroendocrine theory of aging proposes that age-related changes are caused by chemical
interactions in the hypothalamus of the brain. The cerebellum, hippocampus, and anterior pituitary gland
are not the focus of the neuroendocrine theory of aging.

16. The patient in the clinic tells the nurse she has heard about the dangers of free radicals and requests more
information. The nurse bases his response on an understanding that free radicals have been associated
with which age related change(s)?
Select all that apply.

A) Hypothyroidism
B) Atherosclerosis
C) Rheumatoid arthritis
D) Type 2 diabetes mellitus
E) Peripheral vascular disease
F) Chronic obstructive pulmonary disease (COPD)
Free radicals have been associated with atherosclerosis, diabetes, circulatory diseases such as
peripheral vascular disease, and arthritis. Rheumatoid arthritis is an autoimmune disease. Hypothyroidism
and COPD are not associated with free radicals.

17. The nurse working with aging individuals knows the use of antioxidants to slow the aging process
corresponds to which theory?

A) Crosslink theory
B) Free radical theory
C) Somatic mutation theory
D) Connective tissue theory
Antioxidants are thought by some to reduce or prevent the damage to DNA caused by free
radicals, which are the cause of aging in the free radical theory. The crosslink theory and connective
tissue theories are the same. The somatic mutation theory discusses DNA mutations caused by exposure
to radiation and chemicals.

18. The nurse is doing patient teaching for a 50-year-old woman. Based on the application of the programmed
theory of aging, which brochure is the nurse most likely to offer the patient?

A) "Perimenopause and Menopause: Most Frequently Asked Questions"

B) "Do the Benefits Outweigh the Risks of Antioxidant Supplements?"
C) "Exercise, Food, Sleep, and Fun: Healthy Lifestyle Tips for Older Adults"
D) "Healthy Nutrition Is More Than Just Counting Calories and Losing Weight"
The programmed theory suggests that a person experiences predictable changes according to a
biologic clock, such as menopause and graying of the hair. The free radical theory proposes that excess
free radicals in the body cause physiologic aging. The use of antioxidants is
thought to reduce the number of free radicals. The wear-and-tear theory suggests that good health
maintenance practices may slow the rate of wear on the body parts. A fairly new theory of aging
correlates aging to calorie intake, but the theory is based on animal studies.
19. Two nursing students are exhausted after studying about the biologic theories of aging. They decide to
have some fun and perform an action that is based on the rate of living theory. Which action do they
perform?

A) Go for a leisurely walk in the sunshine

B) Hold their breath for as long as they can
C) Share an apple and an orange
D) Give each other a facial and then use anti-aging cream
The rate of living theory proposes that individuals have a finite number of breaths or heartbeats
that are used up over time. The students are just having fun with this theory, by saving the number of
breaths. 

20. According to the disengagement theory, what is the nurse most likely to observe while assessing an older
adult?

A) Dryness of the skin with wrinkles and loss of elasticity

B) Decreased muscle mass and increased body fat
C) Decreased interest and involvement in social interactions
D) Adjustment to retirement and loss of income
The disengagement theory is a highly controversial psychosocial theory that
proposes that older adults desire to withdraw and society also withdraws for the mutual benefit of both.
Changes in skin or body composition are addressed by biologic theories. Havighurst's theory suggests that
adjustment to retirement and loss of income are tasks of aging. 

21. The nurse is designing a group activity for a group of older women who have mild loss of self-esteem and
a reluctance to socialize. None have serious cognitive or physical impairments. Based on the activity
theory, which activity will the nurse suggest?

A) A weekly knitting group to make hats for premature infants

B) A daily game of unfolding and refolding a stack of towels
C) A weekly activity to sort buttons into different color groups
D) A daily group discussion about local politics
Knitting hats for infants is purposeful; this raises self-esteem, and sitting in a group while knitting
allows time for socialization. The knitting can stimulate conversation as the women help and compliment
each other. Sorting buttons and folding towels are more appropriate for persons with significant cognitive
impairment. These busywork activities will not stimulate intellect or increase self-esteem. A daily group
discussion about local politics may be very suitable for some, but for participants who show reluctance to
socialize, or for those whose self-esteem is further threatened by disagreement, the nurse is more likely to
start with other themes or topics for discussion.

22. According to Jung's theory, which statement by an older adult indicates successful aging?

A) "I have a strong belief that there is life after death. So I am not afraid of dying"
B) "I never experienced travel around the world, but I traveled in my imagination"
C) "I lost my wife several years ago; I still miss her, but I focus on the good memories"
D) "Well, when I look back at my life, I am happy to say that I did it my way
Successful aging, according to Jung, includes acceptance and valuing of the self without regard to
the view of others.

23. A friend asks the nurse what would be done to improve the chance of a long life. Using current biologic
theories of aging, the nurse recommended that her friend discuss this first with her physician, but advises
that the approach more likely to cause harm than good is which one?

A) Intake of antioxidants, such as vitamins A, B6, B12, C, and E

B) Replacing of hormones, such as HGH, DHEA, and Estrogen
C) Calorie-restricted diet
D) Intake of herbal and nutritional supplements
Hormone therapy includes hormones such as dehydroepiandrosterone (DHEA), estrogen,
testosterone, melatonin, and human growth hormone (HGH). Hormone therapy may actually cause more
harm than benefits in improving the chance of a long life according to current theories of aging.
24. The same friend asks how long humans can live. What is the nurse's best reply?

A) 100 years
B) 105 years
C) 110 years
D) 120 years
The activity theory proposes that activity is necessary for successful aging. Active participation in
physical and mental activities, such as participation in a current events game, helps maintain functioning
well into old age. Purposeful activities and interactions that promote self-esteem improve overall
satisfaction with life, even at an older age. "Busywork" activities and casual interaction with others were
not shown to improve the self-esteem in older adults.

25. According to Erikson, what is the primary developmental task of the older adult population?

A) Generativity versus stagnation

B) Trust versus mistrust
C) Intimacy versus isolation
D) Integrity versus despair
Erikson's theory identifies eight stages of developmental tasks that an individual must confront
throughout the life span. The last of these stages is the domain of late adulthood (integrity versus despair),
but failure to achieve success in tasks earlier in life can cause problems later in life. Late adulthood is the
time when people normally review their lives and determine whether they have been negative or positive
overall. The most positive outcomes in this life review are wisdom, understanding, and acceptance; the
most negative outcomes are doubt, gloom, and despair. The statement "I have done the best I could, and
I'm pretty content about how I've lived my life. I really wouldn't change very many things I've done"
indicates that this person has successfully achieved the developmental task of integrity.

26. A friend tells you she thinks her father is experiencing a "midlife crisis," because he purchased a new red
sports car, started wearing trendy clothing, and is considering a career change. Whose theory explains this
behavior?

A) Newman's
B) Jung's
C) Havighurst's
D) Erikson's
Jung's theory proposes that development continues throughout life by a process of searching,
questioning, and setting goals that are consistent with the individual's personality. Thus, life becomes an
ongoing search for the "true self." As individuals age, they go through a reevaluation stage at midlife, at
which point they realize there are many things they have not done. At this stage, they begin to question
whether the decisions and choices they have made were the right choices for them. This is the so-called
midlife crisis, which can lead to radical career or lifestyle changes or to the acceptance of the self as is.

27. The cumulative effects of drugs in the elderly could be due to all of the following except:
A. Increased peristalsis
B. Inadequate absorbtion
C. impaired distribution
D. slower metabolism
28. All of the following can cause mental impairment in older adults except:
A. anticholinergics
B. benzodiazepines
C. antibiotics
D. sedative hypnotics
29. The following types of drugs produce significant anticholinergenic effects in the elderly except:
A. antispasmodics
B. antacids
C. antipsychotics
D. antiparkinson
30. Drugs for arthritis (NSAIDs) can cause which of the following conditions?
A. gastric problems
B. GI bleeding
C. other bleeding problems
D. all choices are correct
31. Which of the following is the major site of drug metabolism?
A. stomach
B. liver
C. kidneys
D. colon
32. Patient education regarding NSAID therapy would include all of the following except:
A. do not exceed the prescribed dosage
B. administer on an empty stomach
C. do not take with aspirin or alcohol
D. the possibility of ¨silent¨ bleeding
33. A group of physicians conducted a survey to determine the most inappropriate drugs for ambulatory
nursing home residents over the age of 65. The result came to be called:

The Beers List

34. As an individual ages, the gastric pH: increases
35. Polypharmacy can result in all of the following except:
A. Better patient compliance
B. More medication errors
C. overdose
D. dangerous interaction
36. Older adults should be instructed to do all of the following except:
A. use pillbox organizer
B. stop medications abruptly
C. list medicines
D. report problems
37. What is Polypharmacy? The use of multiple drugs
38. Anticholinergic effects include all of the following except:
A. blurred vision
B. confusion
C. urinary frequency
D. constipation
39. Drugs that produce significant anticholinergic effects include all of the following except:
A. Cogentin
B. Tylenol
C. Cogentin
D. Phenergan
40. Studies indicate an increased risk of cardiovascular problems with the use of
A. COX-2 inhibitors
B. NSAIDS
C. both choices are correct
D. neither choice is correct
41. Which oral antidiabetic agent is contraindicted for older adults with heart failure?
A. tolterodine
B. Cogentin
C Actos
D. Benadryl
42. Which category of drugs is most likely to cause dizziness or motor impairment, increase the risk of
syncope/falls, and impact sexual functioning in older adults?
A. anticoagulants
B. antidiabetics
C. anti-intectives
D.antidepressants
43. Which organ's function decreases with age, resulting in a decline of creatinine clearance?
A. liver
B. kidney
C. small intestine
D. large intestine
44. Which two categories of drug therapy are responsible for more than two-thirds of drug related
hospitalizations in older adult patients?
A. antidiabetic/ antithrombotic
B. antihypertensive/ anticoagulants
 C. antidiabetic/ antihypertensive
D. antidepressant/ antihypertensive
45. Medication related problems (MRPs) cause approximately how many deaths annually?
100,000
46. The nurse will monitor which laboratory result closely when administering medications to an older adult
patient while assessing for adverse drug reactions (ADRs)?
A) Serum creatinine levels
B) Creatinine clearance
C) Serum albumin levels
D) Liver function tests
Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in
the elderly. Creatinine clearance, not serum creatinine levels, is the proper index of renal function in older
adult patients.

47. The nurse is caring for a group of older adult patients who are all receiving multiple medications. The
nurse understands that it is essential to individualize each patient's therapy. Which is the best rationale for
this practice?
A) The percentage of drug absorbed often is decreased in older adults.
B) Most older adults have decreased body fat and increased lean mass.
C) Hepatic metabolism tends to increase in older adults, resulting in decreased drug levels.
D) Renal function declines with age, leading to decreased drug excretion
Renal function declines in older adults, leading to decreased excretion and potential drug
accumulation. Although absorption may be delayed in older adults, the percentage absorbed does not
change. Most older adult patients have increased body fat and decreased lean mass. Hepatic metabolism
tends to decline with age.

48. When preparing a teaching session for residents at an assisted living facility, the nurse will include what?
A) The importance of avoiding intentional underdosing
B) The importance of using multiple pharmacies for cost-effective savings on prescription drugs
C) The importance of taking double amounts of missed doses to maintain therapeutic levels of
medications
D) The importance of reducing protein intake while taking prescription medications
Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing
among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's
conviction that the drug was simply not needed or because of unpleasant side effects. Polypharmacy
should be avoided, as should doubling missed doses. Doubling a dose could result in intentional
overdosing. Reducing protein intake can result in decreased drug binding to albumin; consequently, the
amount of free drug is increased, which could result in drug toxicity

49. When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest
concern?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation
secondary to reduced renal excretion is the most important cause of ADRs in the older adult

50. Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the
incidence of ADRs? (Select all that apply.)
A) Taking a thorough drug history, including over-the-counter (OTC) medications.
B) Monitoring clinical response and laboratory results to help determine proper dosage.
C) Using as many drugs as possible to reduce symptoms and improve outcome.
D) Regularly monitoring patients for drug-drug and drug-nutrient interactions.
E) Helping patients to avoid prescriptions for drugs on the Beers list
A thorough drug history and careful monitoring can help reduce ADRs. Nurses should help
patients use the simplest regimen possible to reduce the risk of ADRs. Monitoring patients for
interactions reduces ADRs. The Beers list identifies drugs with a high likelihood of causing adverse
effects in the elderly.

51. All of the following are examples of increased drug sensitivity in the elderly except:
a. changes in concentrations of drug at receptor
 b. changes in receptor number and affinity
c. post-receptor alterations
d. impairment of homeostatic mechanisms
e. increased drug clearance and reduced drug halflife
52. All of the following are CNS/CV changes that can cause drug sensitivity except
a. cardiovascular changes
b. cross BBB more easily
c. changes in neurotransmitters
d. increase in brain size and weight
e. reduction in brain size and weight
53. These drugs cause elderly to be more susceptible to orthostatic hypotension
a. benzos, anticholinergics, TCAs
b. beta blockers, alpha blockers, vasodilators
c. anticoagulants
54. These drugs cause elderly to be more susceptible to confusion, somnolence and falls
a. benzos, anticholinergics, TCAs
b. beta blockers, alpha blockers, vasodilators
c. anticoagulants
55. These drugs cause elderly to be more susceptible to bleeding
a. benzos, anticholinergics, TCAs
b. beta blockers, alpha blockers, vasodilators
c. anticoagulants
56. Which of the following are risk factors for drug related problems in the elderly (choose multiple)
a. polypharmacy
b. inappropriate prescribing
c. underuse
d. nonadherence
57. Which of the following are ways to combat drug related problems in terms of adherence and compliance
a. minimize multiple times per day dosing
b. utilize pillboxes, aid from caregiver
c. provide pt. with update copy of meds list
d. all of the above
58. In order to minimize drug related problems there must be a therapy assessment for ________,
__________ and monitoring therapy for _________/__________
overuse
underuse
efficacy/safety

59. What are 3 goals of geriatric pharmacotherapy

cure disease
palliate disease
enhance quality of life

60. Concomitant use of multiple medications or high quantity of a medication is considered ________
polypharmacy

61. In a patient with 2 or more chronic conditions how many medications is considered polypharmacy
6 or more

62. in a long-term care setting what is the benchmark number of meds for polypharmacy
9 or more
63. All of the following are drug related problems associated with polypharmacy except
a. ADEs
b. events associated with withdrawal
c. inadequate or inappropriate drug therapy
d. medication overuse
e. inappropriate prescribing
f. compliance
64. All of the following are effects of polypharmacy and ADEs except
A. confusion and delirium
b. depression
c. dizziness and falls
 d. incontinence
e. insomnia
d. elation
f. malnutrition
g. memory loss
65. What is the term for a process to determine if medication is correct dose, directions, effective, indicated,
least expensive, duplicative, correct duration etc.
medication appropriateness index

66. Which of the following are tools to assess drug therapy (Choose multiple)
a. Beer's criteria
b. STOPP
c. START
d. Wine's criteria
67. Which of the following are Beers criteria categories (choose multiple)
A. Potentially inappropriate Meds (PIMS)
B. PIMS due to drug-disease interactions
C. drugs to be used with caution in older adults
D. drug-drug interactions that should be avoided
E. Drugs that should be avoided or reduced with varying levels of Kidney function
68. All of the following are steps to performing the med rec except
a. assemble list of meds
b. ascertain accuracy
c. reconcile meds
d. formulate decision
e. optimize care
f. delete old records
g. check patient understanding