Chapter 3 Health Promotion in Older Adults

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 3: Health Promotion in Older Adults
MULTIPLE CHOICE
1. American Association of Retired Persons (AARP) reports that the number of

Americans age 65 and older is
a. 25 million.
b. 30 million.
c. 35 million.
d. 40 million.
ANS: c
AARP reports that the older adult population in America currently is 35 million and increasing.
DIF: Cognitive Level: Knowledge REF: Text Reference: 48, Figure 3-1;
TOP: Nursing Process Step: N/A MSC: NCLEX: N/A
2. The nurse clarifies to a group of clients that the field of nursing interest that
specializes in disease prevention, increasing autonomy and self care, and maintenance
of function for older adults is
a. gerontology.
b. geriatrics.
c. developmental psychology.
d. public health.
ANS: a
Gerontology is the specialty in the care of older adults focusing on disease prevention, health
promotion, and maintenance of optimal independent functioning.
DIF: Cognitive Level: Comprehension REF: Text Reference: 48

TOP: Nursing Process Step: Intervention
MSC: NCLEX: Health Promotion and Maintenance
3. In assisting a task force to design a community health promotion program for older
persons, the nurse reminds the group that compared with the population as a whole,
the population of ethnic older adults is
a. growing at the same rate.
b. growing at a more rapid rate.
c. gradually declining.
d. remaining constant.
ANS: b
The population of ethnic older adults is expected to increase by more than 25% by the year 2030.
Elsevier items and derived items  2005 by Elsevier Inc.

Chapter 3: Health Promotion in Older Adults 2
DIF: Cognitive Level: Knowledge REF: Text Reference: 49

4. As the public health nurse examines her caseload, she identifies the client from the
community who is most likely to have decreased quality of health care as a(n)
a. 80-year-old male living alone.
b. 75-year-old male living in an assisted living community.
c. 67-year-old female living with her 68-year-old husband.
d. 72-year-old female living alone.
ANS: d
Elderly women living alone represent an at-risk population that frequently encounter
discrimination in access to and quality of health care.

TOP: Nursing Process Step: Assessment
5. The nurse designing a health promotion program for a multiethnic community area
takes into consideration that the ethnic group most likely to be already educated is
a. Hispanic.
b. Native American.
c. African American.
d. Asian.
ANS: d
Although there is great disparity in educational levels among various ethnic groups, 46% of
African Americans and 37% of Hispanics have not finished high school.

TOP: Nursing Process Step: N/A MSC: NCLEX: N/A
6. The home health nurse emphasizes to a client the need to maintain her regimen of
antihypertension medication and her follow-up blood pressure checks, because this
behavior will
a. reduce dependency.
b. decrease morbidity.
c. increase control.
d. increase autonomy.
ANS: b
Taking the medication and doing the follow-up checks will clearly decrease disease potential.
Only the client can determine levels of control, dependency, and autonomy as she continues the
antihypertensive therapy regimen.
DIF: Cognitive Level: Analysis REF: Text Reference: 49


7. The home health nurse encourages a 72-year-old client to take part in the activities of
her assisted living community in order to increase her sense of well being, because
much of the physical health decline in older adults is related to
a. osteoporosis.
b. depression.
c. elder abuse.
d. disuse.
ANS: d
Approximately half the physical deterioration of older persons is caused by disuse rather than by
the aging process or disease.

8. The home health nurse notes a 5-pound weight loss in a 66-year-old client weighing
130 pounds who lives alone, is independent, and has teacher retirement and Social
Security. The nurse is aware that the client is taking aspirin for arthritis and a diuretic
for hypertension. In the absence of disease, the factor that would most likely influence
this client’s nutritional status is
a. lack of health promotion activities.
b. inadequate income.
c. protocol of medications.
d. lack of supervision.
ANS: c
Medications influence nutrition by affecting appetite. Also, the diuretic medication may have
contributed to fluid loss, as revealed by the weight loss.

9. The nurse is conducting an intake interview on a 76-year-old man who has moved to a
retirement home. The nurse’s initial interview goal will be to assess
a. financial status at the time of the move.
b. presence of polypharmacy.
c. whether the move was voluntary.
d. availability of supportive family or friends.
ANS: c
Central to the client’s reaction to relocation is whether the move was voluntary or involuntary.

TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

10. In a seminar for city executives, the nurse strongly emphasizes that a major social
issue affecting older adults is
a. lack of adequate public transportation.
b. increasing evidence of neglect and abuse.
c. lack of availability of nursing home beds.
d. rising cost of prescription medications.
ANS: b
Although the other options are concerns, the only social issue listed is that of neglect and abuse.
Research suggests that abuse is widespread and underreported.

11. In an in-service session with emergency department personnel, the nurse stresses that
they must be able to differentiate between dementia and delirium, with the notable
difference being that delirium
a. affects long-term memory.
b. is associated with irreversible cognitive decline.
c. is an acute confused state.
d. has no association with pathophysiology.
ANS: c
Delirium is an acute confused state with abrupt onset that is reversible and frequently associated
with an acute pathophysiologic disorder such as pneumonia or urinary tract infection.

TOP: Nursing Process Step: Intervention MSC: NCLEX: Psychosocial Integrity
12. The public health nurse assesses fatigue, weight loss, anxiety, and a marked
preoccupation with physical health in a 70-year-old client living in a retirement
center. The nurse determines that these manifestations are evidence of
a. delirium.
b. dementia.
c. depression.
d. hypochondria.
ANS: c
Depression is a complex syndrome that manifests itself in a variety of ways in older adults, such
as insomnia, fatigue, weight loss, and preoccupation with physical health.

TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity
13. The charge nurse in a nursing home carefully reviews the medications of the
residents because older adults are at risk for toxic effects of medications. The nurse

knows that
a. most older clients take multiple long-term prescription medications.
b. most older adults do not understand the purpose of their medications.
c. mobility and general physical activity are decreased in older adults.
d. the residents do not understand the medication schedule.
ANS: a
Hepatic clearance is decreased, and most residents receive as many as eight prescription drugs
daily. The residents have no control over the schedule of medications.

TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
14. In assessing the records of six new residents, the charge nurse in a nursing home is
not surprised to note that all of them are insured by
a. Medicaid.
b. Medicare, Parts A and B.
c. Social Security.
d. Social Security Supplemental Income.
ANS: b
Medicare is a government health insurance program designed to provide medical care to
individuals age 65 and older, regardless of their financial situation.

15. The home health nurse is concerned about the fatigue of a 42-year-old woman who is
caring for her elderly parents in their home. To give the caregiver respite and to
provide programmed supervised activities for the elderly parents, the nurse
recommends using
a. a managed care system.
b. an adult day care center.
c. a long-term care facility.
d. private duty nurses.
ANS: b
Adult day care centers provide supervised activities for older clients. Managed care uses a
system to control costs of medical care. Long-term care facilities and private duty nurses are
quite expensive and not appropriate at this time.
DIF: Cognitive Level: Application REF: Text Reference: 62

16. The home health nurse encourages an 89-year-old client to designate a person who
can make decisions about the client’s health care. This is done through the legal
document of

a. a living will.
b. the power of attorney.
c. the durable power of attorney.
d. a codicil added to the client’s will.
ANS: c
With the durable power of attorney or through a proxy, health care decisions may be made about
a client if the client is unable to do so. A living will states whether the client desires the use of
extended life support techniques. General power of attorney is global over all the assets of the
client. Addition of a codicil is worthless if the client is dead.

17. When designing a private day care service for older adults, the gerontological nurse
practioner must keep in mind that the major constraint for many older persons to
choosing this service would be
a. indifference of the population.
b. lack of transportation.
c. misuderstanding the scope of the service.
d. inadequate income.
ANS: d
Almost 17% of the American elderly are classifies as “near poor.” The prevents them from using
their meager resources for anything other than the essentials.

18. The nurse working for the Indian Service must be sensitive to the use of the term
“elder” because the Native American culture recognizespersons as “elders” at the
age of
a. 40.
b. 50.
c. 60.
d. 70.
ANS: a
The Native American recognizes persons age 40 and older as “elders.”

19. The gerontological nurse practioner reminds a group of county health executives that
to be successful, a health promotion program for older adults should
a. increase life expectancy.
b. maintain morbitiy at the present level.

c. decrease functional independence.

d. maintain quality of life.
ANS: d
Desired outcomes of a health promotion progam include increased independence, quality of life,
and productivity and decreased mobidity and mortality through promotion of behavior change.

20. The home health nurse urges an overweight 68-year-old client to take water aerobics
at the pool in her retirement facility, emphasizing health benefits that include
a. using up energy to ensure sound sleep.
b. increasing long-term pulse rate.
c. decreasing stress.
d. reducing appetite.
ANS: c
Exercise should increase energy through endorphins, decrease pulse and blood pressure, and
increase appetite. Stress reduction is a benefit of regular exercise.

21. When the home health nurse notices that the pantry of a 72-year-old woman living
independently in her own apartment has only fresh fruit, crackers, cereal, and bread,
with no canned or bottled items, the nurse would suspect that the client lacks
a. money to purchase more food.
b. strength to carry heavy loads.
c. transportation to shopping center.
d. interest in adequate nutrition.
ANS: b
Because the client has some healthy food and is living independently in an apartment, the
probable cause is inability to carry heavy loads of groceries.

22. The home health nurse is preparing a lesson on nutritional menus for a group of older
adults at a day care center. To enhance the learning potential of his presentation, the
nurse will
a. raise the pitch of his voice.
b. build up to the most important fact.
c. use blue or green felt-tip markers on a white board.

d. use nonverbal cues.

ANS: d
Nonverbal cues encourages audience participation and clarifies the meaning of the spoken
presentation. The voice should be lowered, with the most important fact presented first. The use
of black markers is preferable to blue or green markers because black is easier to see on a white
board.
DIF: Cognitive Level: Application REF: Text Reference: 52, Box 3-2;
23. When a usually quiet, reserved 89-year-old resident in a long-term facility becomes
agitated and loud, cursing and striking out at the caregivers, the nurse makes specific
assessments relative to
a. a developing level of dementia.
b. an increasing level of paranoia.
c. an undiagnosed central nervous system disturbance.
d. the presence of a urinary infection.
ANS: d
Elderly persons present an altered picture of disease. Such behavioral manifestations may herald
a urinary tract infection (UTI) or an upper respiratory infection (URI).

24. The home health nurse does a functional assessment of an 82-year-old client. This
test includes assessment of activities of daily living (ADL) and instrumental ADL
(IADL). An IADL that the nurse will assess is the client’s ability in
a. toileting.
b. bathing.
c. ambulation.
d. transportation.
ANS: d
IADL are instrumental abilities such as transportation, cooking, shopping, and managing money.

25. The nurse at a long-term care facility observes that a client appears tired. The nurse
assesses the client relative to his sleep patterns because the sleep patterns of older
clients may differ from the “norm” in that older adults
a. fall asleep with more difficulty.
b. wake less readily.
c. have short “drowsy” periods.

d. have long periods of deep sleep.

ANS: a
Sleep patterns in older adults may differ from the “norm” in that they wake readily, have long
drowsy periods, and usually do not have long periods of deep sleep.

26. In completing a functional assessment on an 80-year-old client, the home health

nurse is sensitive to the fact that in this assessment, the major cause of the client
scoring poorly in the IADL portion can be attributed frequently to
a. depression.
b. sensory deficit.
c. reduced mobility.
d. poor nutritional intake.
ANS: b
Although all the options can affect performance on a functional assessment, sensory deficits
impact IADL more specifically.

27. The nurse at a long-term care facility would expect that the attention span of a client
with dementia would be
a. essentially intact.
b. consistently impaired, with client easily distracted.
c. concentrated.
d. hampered by hallucinations.
ANS: a
Strangely, the demented client can focus attention but cannot concentrate. Hallucinations are
usually held at bay if the demented client is engaged.

28. The nurse at an assisted living facility notes that a resident has remained in her room
for the last 2 weeks, attending meals only in the company of other residents, but
otherwise seems her normal self. The nurse interviews the client, with specific focus
on whether the client has
a. lost her appetite.
b. a UTI or URI.
c. had an onset of delirium.
d. fallen recently.

ANS: d
The fear of falling and the consequences of that fall frequently cause older adults to isolate
themselves in the “safety” of their home or room to minimize the possibility of a fall.

29. A 90-year-old Parkinson’s disease resident in an assisted living facility has made
suicidal remarks. The nurse’s most appropriate approach would be to say
a. “Why do you want to kill yourself?”
b. “I’m going to call your daughter to come talk to you about this.”
c. “What are your concerns about your Parkinson’s?”
d. “Come on and get in the van with the group to see the spring flowers.”
ANS: c
The elderly have an increasing suicidal rate. Concerns about losses, diminished health status, and
lifestyle changes may stimulate suicidal ideation.

30. The charge nurse at a long-term facililty warns the staff that there will be an increase
in the number of residents who are substance abusers because of
a. the impact of multiphamacy and drug interactions.
b. “baby boomers” coming into retirement age.
c. family facilitators bringing illicit substances to the facility.
d. relaxed attitudes about substance abuse.
ANS: b
“Baby boomers” are reaching retirement age and will bring with them their previous drug use
habits.


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Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 7th Edition

Chapter 3: Health Promotion in Older Adults

1. American Association of Retired Persons (AARP) reports that the number of

DIF: Cognitive Level: Comprehension REF: Text Reference: 48

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 49

DIF: Cognitive Level: Comprehension REF: Text Reference: 49

DIF: Cognitive Level: Comprehension REF: Text Reference: 49

DIF: Cognitive Level: Analysis REF: Text Reference: 49

Elsevier items and derived items  2005 by Elsevier Inc.

MSC: NCLEX: Health Promotion and Maintenance

DIF: Cognitive Level: Knowledge REF: Text Reference: 50

DIF: Cognitive Level: Analysis REF: Text Reference: 51

DIF: Cognitive Level: Comprehension REF: Text Reference: 56

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Analysis REF: Text Reference: 56

DIF: Cognitive Level: Comprehension REF: Text Reference: 57

DIF: Cognitive Level: Analysis REF: Text Reference: 57

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Analysis REF: Text Reference: 58

DIF: Cognitive Level: Comprehension REF: Text Reference: 61

DIF: Cognitive Level: Application REF: Text Reference: 62

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 63

DIF: Cognitive Level: Comprehension REF: Text Reference: 48

DIF: Cognitive Level: Comprehension REF: Text Reference: 49

Elsevier items and derived items  2005 by Elsevier Inc.

c. decrease functional independence.

DIF: Cognitive Level: Comprehension REF: Text Reference: 49

DIF: Cognitive Level: Comprehension REF: Text Reference: 50

DIF: Cognitive Level: Analysis REF: Text Reference: 51

Elsevier items and derived items  2005 by Elsevier Inc.

d. use nonverbal cues.

DIF: Cognitive Level: Analysis REF: Text Reference: 52

DIF: Cognitive Level: Application REF: Text Reference: 54

Elsevier items and derived items  2005 by Elsevier Inc.

d. have long periods of deep sleep.

DIF: Cognitive Level: Application REF: Text Reference: 54

26. In completing a functional assessment on an 80-year-old client, the home health

DIF: Cognitive Level: Analysis REF: Text Reference: 54

DIF: Cognitive Level: Comprehension REF: Text Reference: 56

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Analysis REF: Text Reference: 55

DIF: Cognitive Level: Analysis REF: Text Reference: 57

DIF: Cognitive Level: Comprehension REF: Text Reference: 58

Elsevier items and derived items  2005 by Elsevier Inc.

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