Chapter 01: Trends and Issues
Williams: Basic Geriatric Nursing, 8th Edition

MULTIPLE CHOICE

	1.	Which fact explains the shift of health care focus toward the older adult in the late 1960s?
a.	Disability was viewed as unavoidable.	
b.	Complications from disease increased mortality.	
c.	Older adults’ needs are similar to those of all adults.	
d.	Preventive health care practices increased longevity.	

ANS:	D
Increased preventive health care practices, disease control, and focus on wellness helped people live longer.

PTS:	1	DIF:	4	REF:	p. 2	OBJ:	2
TOP:	Aging Trends			KEY:	Nursing Process Step: Data Collection
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development
NOT:	Understanding		

	2.	To which age group does the term “aged” apply?
a.	55–64 years of age	
b.	65–74 years of age	
c.	75–84 years of age	
d.	85 and older	

ANS:	C
The term aged refers to persons who are 75–84 years of age.

PTS:	1	DIF:	1	REF:	p. 2 |  Table 1.1	
OBJ:	1	TOP:	Age Categories		
KEY:	Nursing Process Step: Data Collection		
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development
NOT:	Remembering		

	3.	Which is true of ageism?
a.	It is discrimination against persons solely on the basis of age.	
b.	It causes a person to fear aging.	
c.	It involves the use of cultural sensitivity to address concerns of aging.	
d.	It focuses on resources for the older adult.	

ANS:	A
Ageism is a negative belief pattern that influences persons to discriminate against persons solely on the basis of age and can lead to destructive behaviors toward the older adult.

PTS:	1	DIF:	4	REF:	p. 4	OBJ:	3
TOP:	Ageism	KEY:	Nursing Process Step: Data Collection	
MSC:	NCLEX: Psychosocial Integrity: Psychosocial Adaptation		
NOT:	Understanding		

	4.	Which legislation has been the most beneficial legislation that has influenced health care for the older adult?
a.	Medicare and Medicaid	
b.	Elimination of the mandatory retirement age	
c.	The Americans with Disabilities Act	
d.	The Drug Benefit Program	

ANS:	A
The broadest sweeping legislation beneficial to the older adult is Medicare and Medicaid. The elimination of the mandatory retirement age does not apply to health care. The Americans with Disabilities Act deals with all Americans with disabilities, not just the older adult. The Drug Benefit Program was added to Medicare, but deals only with medications.

PTS:	1	DIF:	4	REF:	p. 11	OBJ:	6
TOP:	Legislation	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: N/A			NOT:	Understanding		

	5.	Which housing option for the older adult offers the privacy of an apartment with restaurant-style meals and some medical and personal care services?
a.	Government-subsidized housing	
b.	Long-term care facility	
c.	Assisted-living center	
d.	Group housing plan	

ANS:	C
Assisted-living arrangements offer the privacy of an apartment or condominium with meals prepared and served, limited medical care, and a variety of personal services.

PTS:	1	DIF:	3	REF:	p. 14	OBJ:	9
TOP:	Housing Options		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Physiological Integrity: Physiological Adaptation		
NOT:	Remembering		

	6.	The 75-year-old man who has been hospitalized following a severe case of pneumonia is concerned about his mounting hospital bill and asks if his Medicare coverage will pay for his care. Which would be the most helpful response by the nurse?
a.	Medicare Part C pays 50% of all medical costs for persons older than 65.	
b.	Medicare Part B pays hospital costs and physician fees.	
c.	Medicare Part A pays for inpatient hospital costs.	
d.	Medicare Part D pays 80% of the charges made by physicians.	

ANS:	C
Medicare Part A pays inpatient hospital costs, Part B pays 80% of physician’s charges, and Part D helps defray prescription drug costs. Medicare Part C allows individuals to receive health insurance through private insurance companies and typically pays entire costs.

PTS:	1	DIF:	7	REF:	p. 16	OBJ:	6
TOP:	Medicare Provisions		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation	NOT:	Applying

	7.	The daughter of a patient who has been diagnosed with terminal cancer asks which documents are required to allow her to make health care decisions for her parent. Which response would provide the most accurate information to the daughter?
a.	Advance directives indicate the degree of intervention desired by the patient.	
b.	A ‘Do Not Resuscitate’ document signed by the patient transfers authority to the next of kin.	
c.	A durable power of attorney for health care transfers decision-making authority for health care to a designated person.	
d.	A living will transfers authority to the physician.	

ANS:	C
A durable power of attorney for health care transfers the authority for decision making to a designated person. An advance directive specifies the type of care an individual desires when he cannot speak for himself. The durable power of attorney is only one type of advance directive. A “Do Not Resuscitate” document states that the patient wishes to die naturally with no intervention. A living will prohibits the use of life-prolonging measures.

PTS:	1	DIF:	7	REF:	p. 19	OBJ:	11
TOP:	Advance Directives		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation	NOT:	Applying

	8.	The daughter of a resident in a long-term care facility is frustrated with her 80-year-old mother’s refusal to eat. Which response would be the most appropriate?
a.	The refusal to eat is an effort to maintain a portion of independence and self-direction.	
b.	The refusal to eat is an indication of approaching Alzheimer disease.	
c.	The refusal to eat is an effort to gain attention.	
d.	The refusal to eat is an indication of the dislike of the institutional food.	

ANS:	A
Loss of independence and control is a significant issue for the older adult. Some residents will exercise whatever control they may retain.

PTS:	1	DIF:	7	REF:	p. 21	OBJ:	11
TOP:	Loss of Independence		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation	NOT:	Applying

	9.	When do the conditions of a living will go into effect?
a.	When the patient declares that desire in writing	
b.	When a family member indicates the desire for curative therapy to cease	
c.	When two physicians agree in writing that the criteria in the living will have been met	
d.	When the physician and a family member agree that the criteria in the living will have been met	

ANS:	C
Two physicians must agree in writing that the criteria of the living will have been met before the document can go into effect.

PTS:	1	DIF:	4	REF:	p. 19	OBJ:	11
TOP:	Living Wills	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	
NOT:	Understanding		

	10.	In the 1980s, Medicare initiated a program of diagnosis-related groups (DRGs) to reduce hospital costs. How did the DRGs reduce hospital costs?
a.	By classifying various diagnoses as ineligible for hospitalization	
b.	By allotting a set amount of hospital days and prospective payment on the basis of the admitting diagnosis	
c.	By specifying particular physicians to treat specified diagnoses	
d.	By using frequency of a particular diagnosis to set a payment schedule	

ANS:	B
DRGs set up a system of preset hospitalization time and payment on the basis of the admitting diagnosis.

PTS:	1	DIF:	4	REF:	p. 16	OBJ:	6
TOP:	DRGs	KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A
NOT:	Understanding		

	11.	Which facility would be recommended for a patient with diabetes who has had a hip replacement and needs physical therapy?
a.	Basic care facility	
b.	Skilled care facility	
c.	Subacute care facility	
d.	Assisted-living residence	

ANS:	B
Skilled care facilities offer not only basic care but also services from experienced licensed professionals such as nurses, physical therapists, speech therapists, and occupational therapists.

PTS:	1	DIF:	7	REF:	p. 15	OBJ:	9
TOP:	Extended-Care Facilities	KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	
NOT:	Applying

	12.	The 80-year-old woman who is recovering from a stroke is being sent to a skilled care facility. She is concerned about the expense. The nurse can decrease anxiety by explaining that Medicare will cover extended-care facility costs for which period of time?
a.	A period of 30 days	
b.	A period of 45 days for physical therapy	
c.	A period of 100 days for needed skilled care	
d.	Until she is able to be discharged home	

ANS:	C
Medicare will cover skilled care costs for 100 days. After 100 days, the resident must revert to private pay or ancillary long-term care insurance.

PTS:	1	DIF:	4	REF:	p. 16	OBJ:	8
TOP:	Extended Care			KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	
NOT:	Understanding		

	13.	Which senior citizen political action group uses volunteers and lobbyists to advance the interests of older adults?
a.	American Association of Retired Persons (AARP)	
b.	National Council of Senior Citizens (NCSC)	
c.	National Alliance of Senior Citizens (NASC)	
d.	Gray Panthers	

ANS:	A
The AARP uses volunteers and lobbyists to advance the interests and welfare of older adults.

PTS:	1	DIF:	2	REF:	p. 12	OBJ:	7
TOP:	Political Action Groups	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A			NOT:	Remembering		

	14.	Which caregiver could be found guilty of elder abuse?
a.	A daughter who uses her mother’s Social Security money to purchase her mother’s medication	
b.	A son who puts an alarm on the front door to prevent his mother from wandering out of the house	
c.	A wife who allows her mentally competent husband to refuse to take a bath for a week	
d.	A son who uses his mother’s checking account funds to purchase alcohol for himself	

ANS:	D
It is financial abuse if the older person’s money is taken and spent by others for their own purposes.

PTS:	1	DIF:	8	REF:	p. 23	OBJ:	13
TOP:	Elder Abuse	KEY:	Nursing Process Step: Data Collection	
MSC:	NCLEX: Physiological Integrity: Basic Care and Comfort		
NOT:	Analyzing

	15.	Which is the most frequent response to elder abuse by the abused older adult?
a.	Anger	
b.	Physical retaliation	
c.	Notification of authorities	
d.	Nothing at all	

ANS:	D
Fear of retaliation or abandonment keeps most abused older adults silent.

PTS:	1	DIF:	5	REF:	p. 24	OBJ:	14
TOP:	Response to Abuse		KEY:	Nursing Process Step: Data Collection
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation	NOT:	Understanding

	16.	Which reason is often stated by nurses today for not seeking careers in gerontology?
a.	The physical work is too difficult.	
b.	Their technical skills are not used.	
c.	There is too much challenge.	
d.	There are limited options for employment.	

ANS:	B
Many nurses feel that their technical skills will not be used in the care of the older adult. There are many employment options that offer challenge and fulfillment.

PTS:	1	DIF:	4	REF:	p. 5	OBJ:	2
TOP:	Employment Options		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A			NOT:	Understanding		

	17.	“Baby boomers” is a term used to classify which of the following persons?
a.	Those who entered school in 1945	
b.	Those who served in the military in World War II	
c.	Those who were born between 1946 and 1964	
d.	Those who were eligible for Social Security benefits in 2000	

ANS:	C
Baby boomers are those born between 1946 and 1964. The impact of the retirement of this cohort is unprecedented in terms of the impact on society.

PTS:	1	DIF:	3	REF:	p. 8	OBJ:	5
TOP:	Baby Boomers			KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Psychosocial Integrity: Psychosocial Adaptation		
NOT:	Remembering		

	18.	The home health nurse recognizes which type of abuse is occurring when finding an older adult restrained in a recliner?
a.	Physical abuse	
b.	Neglect	
c.	Emotional abuse	
d.	Self-neglect	

ANS:	A
Physical abuse is any action that causes physical pain or injury. Inappropriate use of drugs, force-feeding, physical restraints, and punishment of any kind are examples of physical abuse.

PTS:	1	DIF:	7	REF:	p. 23	OBJ:	13
TOP:	Types of Abuse		KEY:	Nursing Process Step: Data Collection
MSC:	NCLEX: N/A			NOT:	Applying

	19.	The nurse discovers a family member has not provided prescribed medications and dressing changes for an older adult. Which type of elder abuse is demonstrated by the nonprovision of medical care?
a.	Physical abuse	
b.	Neglect	
c.	Emotional abuse	
d.	Self-neglect	

ANS:	B
Neglect is a passive form of abuse in which caregivers fail to provide for the needs of the older person under their care. Failure to provide necessary medical care may constitute neglect because with no means of going to the doctor or pharmacy, the older person may suffer or even die.

PTS:	1	DIF:	7	REF:	p. 23	OBJ:	13
TOP:	Types of Abuse		KEY:	Nursing Process Step: Data Collection
MSC:	NCLEX: N/A			NOT:	Applying

	20.	A patient reports to the nurse that a health care worker told the patient the call light would be taken away if it continues to be used excessively. The nurse recognizes this as which type of elder abuse?
a.	Physical abuse	
b.	Neglect	
c.	Emotional abuse	
d.	Self-neglect	

ANS:	C
Emotional abuse is more subtle and difficult to recognize than physical abuse or neglect. It often includes behaviors such as isolating, ignoring, or depersonalizing older adults. Emotional abusers can use verbal abuse to inflict damage such as threatening punishment.

PTS:	1	DIF:	7	REF:	p. 23	OBJ:	13
TOP:	Types of Abuse		KEY:	Nursing Process Step: Data Collection
MSC:	NCLEX: N/A			NOT:	Applying

MULTIPLE RESPONSE

	1.	The nurse is aware that a person’s attitude about aging is influenced mainly by which factor? __________. (Select all that apply.)
a.	Life experiences	
b.	Income level	
c.	Level of education	
d.	Current age	
e.	Occupation	

ANS:	A, D
A person’s current age and life experiences are the main influences on his or her attitude relative to aging.

PTS:	1	DIF:	7	REF:	p. 3	OBJ:	2
TOP:	Attitudes Toward Aging	KEY:	Nursing Process Step: Planning
MSC:	NCLEX: Psychosocial Integrity: Psychosocial Adaptation		
NOT:	Understanding		

	2.	Gerontology encompasses applying to which aspect? (Select all that apply.)
a.	Appropriate housing	
b.	Health care	
c.	Education	
d.	Business ventures	
e.	Government-sponsored pensions	

ANS:	A, B, C, D
Gerontological concerns extend and influence provision of appropriate housing, health care, education, business ventures, and political stands relative to the welfare of the older adult.

PTS:	1	DIF:	4	REF:	p. 2	OBJ:	1
TOP:	Gerontology	KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A
NOT:	Understanding		

	3.	Medicare Part C allows eligible persons to receive Medicare benefits via the services of private insurance companies through which program? (Select all that apply.)
a.	Health maintenance organization (HMO)	
b.	Preferred provider organization (PPO)	
c.	Medications provided free of charge (FOC)	
d.	Medicaid is supplemented with Medicare (MCD/MA)	
e.	Medical service organization (MSO)	

ANS:	A, B
Medicare Part C allows benefits via the services of managed care organizations, such as an HMO or PPO. Medications are not provided free of charge. Medicaid is not supplemented with Medicare in Medicare Part C. Medical service organization is not one of them.

PTS:	1	DIF:	7	REF:	p. 16	OBJ:	6
TOP:	Medicare Part C		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A			NOT:	Understanding		

	4.	Which emotional response would be expected from a family who is coping with an aging loved one’s diminishing abilities and increased care needs? (Select all that apply.)
a.	Grief	
b.	Anger	
c.	Frustration	
d.	Loss	
e.	Resentment	

ANS:	A, B, C, D
As the family witnesses the decline of a loved one and attempts to respond to the increasing care needs, the emotional responses are varied and changing. The responses include grief, anger, frustration, loss, and confusion.

PTS:	1	DIF:	7	REF:	p. 21	OBJ:	11
TOP:	Impact of Aging on the Family	KEY:	Nursing Process Step: Planning
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation	NOT:	Applying

	5.	Which characteristic is typical for a caregiver of an aging family member? (Select all that apply.)
a.	Average age of 32	
b.	Female	
c.	Spending about 24 hours a week giving care	
d.	Caring for a parent or parent-in-law	
e.	Giving care for an average of 4 years	

ANS:	B, C, D
The average age of the caregiver is 49 and is caring for a parent or parent-in-law. About 75% of caregivers to older adults are females, who spend about 24 hours weekly providing care. As the population ages, women will spend more time caring for their parents than they did caring for their children.

PTS:	1	DIF:	7	REF:	p. 20 |  Box 1.5	
OBJ:	11	TOP:	Characteristics of Family Caregiver		
KEY:	Nursing Process Step: Data Collection		
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development
NOT:	Understanding		

	6.	Which factor is an indicator of self-neglect in the aging person? (Select all that apply.)
a.	Unpaid bills	
b.	Reduced personal hygiene	
c.	Increased alcohol consumption	
d.	Irritability	
e.	Loss of weight	

ANS:	A, B, C, E
Indicators may be mismanagement of personal finances, reduced hygiene, substance abuse, and loss of weight due to inability to obtain adequate food. Irritability is not a consistent characteristic.

PTS:	1	DIF:	8	REF:	p. 22	OBJ:	11
TOP:	Self-Neglect	KEY:	Nursing Process Step: Data Collection	
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
NOT:	Applying

	7.	The nurse reminds a group of prospective caregivers that elder abuse may take which form? (Select all that apply.)
a.	Caring for physical needs	
b.	Misappropriation of finances	
c.	Psychological intimidation	
d.	Emotional depersonalization	
e.	Abandonment	

ANS:	B, C, D, E
Elder abuse may take the form of physical injury, misusing the older person’s finances for personal gain, psychological intimidation, and depersonalization and abandonment.

PTS:	1	DIF:	7	REF:	pp. 22-24	OBJ:	13
TOP:	Elder Abuse	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Physiological Integrity: Reduction of Risk	NOT:	Applying

	8.	The nurse is planning an on-line educational program to promote health among older adults. Which is factual regarding older adults and their use of technology? (Select all that apply.)
a.	Very few older adults have access to the internet.	
b.	Older adults rarely use social networking sites such as Facebook.	
c.	About 45% of adults in their 60s use some type of smart phone.	
d.	Google maps are sometimes used by older adults for parking spot reminders.	
e.	Apps such as Medisafe can be used as a mobile medication management system.	

ANS:	D, E
Apps such as Google maps help older adults with parking spot reminders. Medisafe is an app used as a mobile medication management system. About 70% of adults over age 65 use the internet. There is a growing percentage of older adults using social media such as Facebook. About 81% of adults in their 60s use some type of smart phone.

PTS:	1	DIF:	7	REF:	p. 9	OBJ:	5
TOP:	Trends	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Health Promotion and Maintenance	NOT:	Understanding

COMPLETION

	1.	The nurse clarifies that the term that refers to the promotion of high-level functioning and supportive care to older adults is __________.

ANS:	
gerontics

Gerontics comprises a holistic view of aging, with the goal of increasing health, providing comfort, and caring for the older adult’s needs.

PTS:	1	DIF:	2	REF:	p. 2	OBJ:	10
TOP:	Gerontics	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development
NOT:	Remembering		

	2.	The nurse reminds a patient who was born in 1965 that eligibility for full Social Security benefits for persons of this age is now the age of __________.

ANS:	
67

Individuals born in 1960 or later must wait until age 67 to qualify for full benefits.

PTS:	1	DIF:	1	REF:	p. 3	OBJ:	2
TOP:	Change of Social Security Benefits			
KEY:	Nursing Process Step: Implementation		
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development
NOT:	Remembering		

	3.	_____________ is a voluntary plan for prescription drug coverage.

ANS:	
Medicare Part D

Medicare Part D is a voluntary plan for prescription drug coverage. It is available to anyone enrolled in Part A or B of Medicare.

PTS:	1	DIF:	2	REF:	p. 16	OBJ:	8
TOP:	Donut Hole	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	
NOT:	Remembering