Chapter 28: Older Adults in the Community


Chapter 28: Older Adults in the Community
Test Bank


1. What percentage of the total population in the United States is older than 65 years?
a. 0% to 5%
b. 6% to 10%
c. 11% to 15%
d. 16% to 20%
Elderly persons represented 13% of the U.S. population in 2008. The elderly population is expected to increase dramatically between 2010 and 2030 because the “baby boomers” began turning 65 in 2011.

DIF: Cognitive Level: Knowledge REF: pp. 701-702

2. A 68-year-old woman had an appointment to see the public health department outreach coordinator. Where would this client most likely reside?
a. In a nursing home
b. In an assisted-living complex
c. In one of her children’s homes
d. Independently in her own housing
Only 5% of the Medicare population resides in long-term care facilities; the remaining 95% live in the community. Only 2% require assistance to remain living independently.

DIF: Cognitive Level: Synthesis REF: p. 702

3. How do most elderly people compare to younger people?
a. More elderly persons are socially isolated with few social contacts.
b. More elderly persons change jobs frequently.
c. More elderly persons are not pleased with their lives.
d. Most elderly persons engage in most normal activities.
Studies show that older working Americans change jobs less frequently, have fewer job-related accidents, and have lower rates of absenteeism. The majority report feeling satisfied most of the time, with frequent social contacts and social participation.

DIF: Cognitive Level: Comprehension REF: p. 702

4. A college student asked the nurse what the different areas of nursing were because he thought he might want to be a nurse. However, he added, he did not want to work with old people. How might you accurately respond?
a. “There are many possibilities as a nurse, so just choose a clinical specialty such as pediatrics.”
b. “Becoming a school nurse will provide the most opportunities so that you will be working with young people.”
c. “Regardless of clinical setting, most nurses care for older adults in their careers.”
d. “The population is aging rapidly, so it is likely you will find a job working with elderly persons.”
The majority of nurses will care for older adults in their career. Nurses are the largest members of hospital staffs and are the primary providers of older adult care in both hospitals and nursing homes.

DIF: Cognitive Level: Synthesis REF: p. 702

5. According to Erikson’s developmental theory, what would be a primary concern of a 68-year-old woman?
a. Developmental life events, such as loss of employment position
b. Multiple changes as her children have children
c. The meaning of her life and accepting the inevitability of death
d. The possibility of increased housing costs as property taxes keep going up
Erikson stated that the primary developmental task of old age is the achievement of integrity over despair, whereby integrity refers to a sense of wholeness and meaning in a person’s past and present experiences. Specific concerns during this developmental task center on declining health and significant alterations in major life roles and relationships.

DIF: Cognitive Level: Application REF: p. 703

6. What risks are faced by men who retire because of company downsizing?
a. Boredom
b. Depression, alcoholism, and suicide
c. Household injuries
d. Spousal abuse
Studies have shown that men, in particular, who retire unwillingly are at significant risk for alcoholism, depression, and suicide because they feel useless, unproductive, and worthless upon losing their work roles.

DIF: Cognitive Level: Comprehension REF: p. 703

7. What risks are faced by women aged 65 or older?
a. Boredom
b. Loss of spouse
c. Major health problems
d. Seriously annoying their husbands
Women are more likely than men to experience the loss of a spouse. Of women aged 65 to 74, more than 24% are widowed, whereas only 6.4% of men in that age range are widowed.

DIF: Cognitive Level: Comprehension REF: p. 703

8. Every day a 70-year-old hospitalized woman read the newspaper. She expressed to the nurse that she was saddened after this activity. What is the probable reason that reading the newspaper was upsetting her?
a. She disliked the articles about the bad things happening locally and nationally.
b. She disagrees with the political slant of the newspapers.
c. Obituaries of her friends represent the loss of part of her past.
d. Reading about recent military actions overseas was saddening.
As people age, significant others of their own age and cohort die. This loss represents a part of a person’s past and shared life history. Anger, guilt, loneliness, and depression are common outcomes.

DIF: Cognitive Level: Application REF: p. 703

9. A home care nurse was working with a 73-year-old woman who lives alone. What would be the most therapeutic intervention by the nurse?
a. Complimenting the client on her cooking and superb housekeeping skills
b. Conveying to the client the importance of planning and prepaying her funeral
c. Encouraging her in her hobbies of scrapbooking and writing her autobiography
d. Suggesting that the client consider buying long-term care insurance for future need
Although any of the options might be appropriate in particular situations, reminiscence therapy helps elderly persons address the meaning of their lives, assists them in identifying past coping mechanisms, helps the nurse assess for signs of depression and suicidal intention, and assists clients in grieving over any losses. Reminiscing can be encouraged through activities such as scrapbooking, photography, and writing an autobiography.

DIF: Cognitive Level: Analysis REF: p. 703

10. How do the majority of elderly people rate their own health?
a. Very poor to poor
b. Fair to average
c. Pretty good
d. Good or better
The majority of elderly persons (73%) rate their health as good or better.

DIF: Cognitive Level: Knowledge REF: p. 703

11. From whom do the majority of elderly persons obtain assistance when needed?
a. Assisted-living arrangements
b. Extended-care facilities
c. Family, friends, and neighbors
d. Nursing homes or long-term care centers
Most elderly persons obtain assistance through an informal network of family, friends, and neighbors.

DIF: Cognitive Level: Knowledge REF: p. 703

12. On whom does most of the burden for family caregiving fall?
a. Middle-aged family members
b. Paid, nonprofessional caregivers
c. Paid, professional individuals
d. Professional caregiving organizations
Middle-aged and young-old adults, called the “sandwich generation,” are juggling the support of adolescents and college-bound children with trying to care for parents.

DIF: Cognitive Level: Knowledge REF: p. 704

13. Which characteristics would a nurse anticipate when working with a family who is providing care for an aging parent?
a. An increase in closeness within family relationships
b. Having to work more hours to pay for the aged person’s needs
c. Help at home because the aged person can complete many simple household tasks
d. Increased stress coupled with loss of private time for recreation
The caregivers, many of whom are also raising children, often cut back on employment with resultant financial loss and devote many hours each day to care, which increases stress and decreases free time. Regardless of care given, there is often guilt, resentment, and frustration in trying to support the elderly person.

DIF: Cognitive Level: Application REF: pp. 704-705

14. A woman is currently caring for her mother-in-law. She is looking for a place for her mother-in-law to go during the day while she works. The mother-in-law does not have major health problems but is becoming bored, irritable, and depressed. Which choice would be best for both the caregiver and her mother-in-law?
a. A continuous care community
b. A group home
c. A multipurpose senior center with activities
d. Foster care
Because the elderly woman has no major health problems and is apparently free to stay with her son and daughter-in-law, a senior citizens center would keep her occupied, help her socialize with new friends, and serve a nutritious lunch. It may also give the mother-in-law new interests in life.

DIF: Cognitive Level: Application REF: p. 706

15. A 60-year-old woman complained to the nurse that she just could not keep caring for her 85-year-old mother much longer. What might prevent the woman from using the respite center that the nurse suggested?
a. Cost of respite care
b. Embarrassment
c. Family expectations
d. Fear of how others would care for her mother
The most important problem with respite care is the cost. Most families cannot afford it, and respite care is rarely reimbursed by private or public health insurance.

DIF: Cognitive Level: Application REF: p. 706

16. Which of the following would be the best choice for the grandmother who felt fine but was feeling depressed from sitting around the house all day while the rest of the family members were at work or school?
a. A group home with shared living arrangements, which would meet friendship needs
b. A senior citizens center, which would provide socialization, recreation, and support
c. Adult daycare with assistance with meals, medications, and transportation
d. Foster care with a family that did not have both adults working all day
According to the given facts, the grandmother was in good health but bored and depressed, with nothing to do. A social daycare program would provide entertainment and social interaction during the day. Adult daycare might also be helpful, but it would be more expensive, and nothing in the question suggested she needed that assistance.

DIF: Cognitive Level: Application REF: p. 706

17. A family is considering nursing home placement for their elderly parent. Which of the following interventions would be most appropriate for a nurse?
a. Suggesting the purchase of a nursing home insurance policy
b. Suggesting the use of a specific checklist to collect data about potential facilities
c. Suggesting having a family service worker to help with placement
d. Suggesting consideration of using more in-home services
Many resources are currently available to help with making nursing home choices. Using specific checklists or tools along with information gathered during a visit to the nursing home would be most helpful in allowing the family to make a good choice.

DIF: Cognitive Level: Application REF: p. 707

18. What is the most frequent reason for an elderly person to be hospitalized?
a. Auto accidents
b. Back pain
c. Falls
d. Heart attack
Falls are the most frequent injury and cause of hospital admission for trauma among elderly people.

DIF: Cognitive Level: Knowledge REF: pp. 708-709

19. A home health nurse is teaching a client and family about how to perform a dressing change. The nurse discussed the dressing change with them, provided written instructions, and left them an agency business card in case they had any questions. What is one reason that the nurse provided such extensive instructions?
a. Elderly people are slow to understand and learn.
b. Legal requirements for teaching must be met through these methods.
c. Role modeling for the procedure is necessary.
d. Senses become less acute with age.
The senses become less acute with age. Sensory impairments affect the ability to hear and to see, so the nurse was giving information in several different ways to ensure that it was being communicated.

DIF: Cognitive Level: Synthesis REF: p. 709

20. At the request of a family, a nurse returned for a follow-up visit a month after the patient was discharged from care. He had been doing quite well, but at this visit the home care nurse noticed that the client was extremely confused and disoriented. What should the nurse discuss with the family before contacting the client’s physician?
a. Current prescription and over-the-counter drugs the client is taking
b. Family history of Alzheimer disease
c. Financial resources available to the client
d. Results of the laboratory values from the client’s last blood test
Clients are often noncompliant with their medication regimens; levels of compliance range from not taking all the doses because of cost or confusion over the schedule to avoiding medications because of adverse drug reactions. Clients may also obtain medications from several physicians without any coordination. People have also been known to share drugs and take over-the-counter drugs without sharing that information with their care providers. Consequently, the medications being taken or given should be carefully determined. Pseudodementia, a mental disorder that is reversible when the underlying cause is treated, may be caused by the side effects of medications. Alzheimer disease generally has a slow, gradual onset, and so the potential medical diagnosis of Alzheimer disease is highly unlikely. It would not be a priority to discuss the client’s financial resources before the physician is contacted. The results of laboratory values from the client’s last blood test are not significant at this time as the client has experienced a change in condition since the test.

DIF: Cognitive Level: Synthesis REF: p. 710

21. What is the most frequent reason for placement in a nursing home?
a. Dementia, primarily from Alzheimer disease
b. Inability of the family to care for the family member any longer
c. Hip fracture that necessitates long-term convalescence
d. Social interaction with other residents
Alzheimer disease is responsible for most cases of dementia. It is the leading reason for nursing home placement. Approximately 45% of nursing home beds are occupied by clients with dementia.

DIF: Cognitive Level: Knowledge REF: p. 709 | p. 712

22. A nurse was very frustrated: It had taken a great deal of time and effort to get an elderly gentleman a hearing aid, and now he was not wearing it. Why would the client not wear a hearing aid after obtaining it?
a. The client decided he could hear fairly well without the hearing aid.
b. Background noise was so loud that he could not understand conversations.
c. He does not know how to use the hearing aid and does not want to ask for assistance.
d. Senses become more acute with age, so he no longer needed it.
Hearing aids amplify all sounds and do not distinguish between distant and near sounds. One of the most common problems is background noise. Loud conversations or music make it very difficult to communicate verbally. Elderly persons often give up and do not wear their hearing aids.

DIF: Cognitive Level: Application REF: pp. 711-712

23. What is one of the most common forms of elder abuse?
a. Criminal victimization (crime)
b. Neglecting to provide basic hygienic care
c. Refusal to feed the elderly person
d. Self-neglect by the elderly person
One of the most common forms of elder abuse is self-neglect. Social isolation places older adults, especially those who are depressed and living alone, at risk for neglecting themselves and their living space.

DIF: Cognitive Level: Knowledge REF: p. 712

24. What is the source of income for the majority of elderly persons?
a. Investments and personal savings
b. Support from family members
c. Private pensions
d. Social Security
The Employee Benefit Research Institute reported that 41% of older adult income comes from Social Security, 25.7% from earnings, and only 18.4% from pensions. For 22% of married and 43% of unmarried persons aged 65 or older, Social Security payments are the source of 90% to 100% of their income. The number of elderly persons dependent on Social Security income has increased 13% since 1995.

DIF: Cognitive Level: Knowledge REF: p. 713

25. An elderly woman was debating all possible futures she might confront. She asked the nurse the typical cost of 1 year in a nursing home. How should the nurse respond?
a. “About $30,000 a year.”
b. “Don’t worry about it. Medicare will pay it.”
c. “Don’t worry about it. Medicaid will pay it.”
d. “About $75,000 a year.”
Medicaid will pay for nursing home care only for impoverished persons, and Medicare offers only limited coverage. The most accurate response is about $75,000 per year. According to the Alzheimer’s Association, the average cost is between $74,239 and $82,113 per year.

DIF: Cognitive Level: Application REF: pp. 713-714

26. A 79-year-old man stops at a local pharmacy to fill his prescription for an antihypertensive medication. How would he pay for this prescription?
a. Medicare Part B
b. Medicare Part A
c. Medicare Part D
d. Medicare Part C
Medicare Part D provides prescription drug coverage for elderly people who are on Medicare.

DIF: Cognitive Level: Application REF: p. 714

27. Which is the largest and most well-known interest group for elderly persons?
a. The National Council of Senior Citizens
b. The American Association of Aged (AAA)
c. The American Association of Retired Persons (AARP)
d. Gray Panthers
The most notable group is the AARP, the nation’s largest nonprofit, nonpartisan organization of people 50 years and older, with more than 38 million members. Because elderly persons vote at a higher percentage than do younger people, the elderly population is a political force. The National Council of Senior Citizens and Gray Panthers are not as large as AARP; they work independently or in cooperation with other organizations to advocate for the needs of the older adult population.

DIF: Cognitive Level: Knowledge REF: p. 716

28. Which of the following is an appropriate primary nursing intervention to help meet the health care needs of elderly people?
a. Advocacy by lobbying for appropriate community resources
b. Case management with the client and family in setting goals
c. Teaching the family how to care for the elderly person in the family
d. Screening applications for nursing home placement
All of the actions are appropriate, but only advocacy is a primary intervention. Primary intervention is undertaken to prevent a problem from occurring. Case management, teaching a family how to care for an elderly person, and screening are interventions that are occurring at the secondary or tertiary level.

DIF: Cognitive Level: Analysis REF: p. 716


1. Which of the following issues would the nurse want to assess at the initial visit for a 70-year-old client who lives at home alone and is being seen for a follow-up visit after an outpatient surgical procedure? (Select all that apply.)
a. Ability to ambulate for about 30 minutes a day
b. Problems with constipation or need for laxatives
c. Appetite and appeal of food both visually and in taste
d. Use of prescription drugs and over-the-counter medications
e. Financial resources
f. Family involvement in care
ANS: A, B, C, D
The most common complaint among elderly people is of arthritis, which may decrease mobility. Decreases in hearing, vision, and taste may decrease food appeal. Decrease in intestinal motility may predispose clients to constipation and overuse of laxatives. There is nothing in the question that suggests any problem with finances or needing family involvement in the client’s care.

DIF: Cognitive Level: Application REF: p. 716

2. What has been the general effect of the legislative changes affecting payment for health care since the 1980s? (Select all that apply.)
a. The needs of elderly clients were better met.
b. The changes created concern over the quality of care.
c. Funding was increased to meet increased need.
d. State flexibility in determining eligibility and services increased.
e. The cost of health care to government was reduced.
f. The length of stay in hospitals or in nursing homes was reduced.
ANS: B, D, E, F
Overall, the federal actions were designed to cut costs in service programs. They also allowed states more latitude in determining eligibility and services; as a result, fewer people were eligible for assistance. The legislation decreased the length of stay in both hospitals and nursing homes. Overall, the changes increased concern about quality of care.

DIF: Cognitive Level: Comprehension REF: p. 719