Chapter 01: Trends and Issues
Test Bank

MULTIPLE CHOICE

	1.	What 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.

DIF:	Cognitive Level: Comprehension	REF:	p. 1	OBJ:	2
TOP:	Aging Trends			KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development

	2.	To what 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.

DIF:	Cognitive Level: Knowledge	REF:	p. 2	OBJ:	1
TOP:	Age Categories		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development

	3.	Which of the following 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.

DIF:	Cognitive Level: Comprehension	REF:	p. 4	OBJ:	3
TOP:	Ageism	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Psychosocial Integrity: Psychosocial Adaptation		

	4.	What is 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.

DIF:	Cognitive Level: Comprehension	REF:	pp. 15-16	OBJ:	6
TOP:	Legislation	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: N/A		

	5.	What 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.

DIF:	Cognitive Level: Knowledge	REF:	p. 13	OBJ:	9
TOP:	Housing Options		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Physiological Integrity: Physiological Adaptation		

	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. What 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.

DIF:	Cognitive Level: Application	REF:	p. 15	OBJ:	6
TOP:	Medicare Provisions		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation

	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 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.

DIF:	Cognitive Level: Application	REF:	p. 18	OBJ:	11
TOP:	Advance Directives		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation

	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.

DIF:	Cognitive Level: Application	REF:	p. 20	OBJ:	11
TOP:	Loss of Independence		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation

	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.

DIF:	Cognitive Level: Comprehension	REF:	p. 18	OBJ:	11
TOP:	Living Wills	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	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.

DIF:	Cognitive Level: Comprehension	REF:	pp. 15-16	OBJ:	6
TOP:	DRGs	KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A

	11.	Which of the following facilities would be recommended for a patient 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 trained licensed professionals such as nurses, physical therapists, speech therapists, and occupational therapists.

DIF:	Cognitive Level: Application	REF:	p. 15	OBJ:	9
TOP:	Extended-Care Facilities	KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	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 what 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.

DIF:	Cognitive Level: Comprehension	REF:	p. 15	OBJ:	8
TOP:	Extended Care			KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	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.

DIF:	Cognitive Level: Knowledge	REF:	p. 11	OBJ:	7
TOP:	Political Action Groups	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	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 frail spouse who is unable to bathe or change the clothes of her physically dependent husband	

ANS:	D
Unintentional abuse or neglect can occur when the caregiver lacks the stamina to meet care needs. Even though physically unable, the frail wife is guilty of elder abuse. The wife should seek assistance to prevent neglect.

DIF:	Cognitive Level: Analysis	REF:	p. 21	OBJ:	13
TOP:	Elder Abuse	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Physiological Integrity: Basic Care and Comfort		

	15.	What 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.

DIF:	Cognitive Level: Application	REF:	p. 23	OBJ:	14
TOP:	Response to Abuse		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation

	16.	What 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.

DIF:	Cognitive Level: Comprehension	REF:	p. 5	OBJ:	2
TOP:	Employment Options		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	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.

DIF:	Cognitive Level: Comprehension	REF:	p. 8	OBJ:	5
TOP:	Baby Boomers			KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Psychosocial Integrity: Psychosocial Adaptation		

	18.	What type of abuse is demonstrated by restraining an older adult 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.

DIF:	Cognitive Level: Application	REF:	p. 22	OBJ:	13
TOP:	Types of Abuse		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	19.	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.

DIF:	Cognitive Level: Application	REF:	p. 22	OBJ:	13
TOP:	Types of Abuse		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	20.	Which type of elder abuse is demonstrated by a health care worker eating a resident’s candy without permission?
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. Health care workers eating a resident’s candy without permission is an ignorant behavior that can be depersonalizing.

DIF:	Cognitive Level: Application	REF:	p. 22	OBJ:	13
TOP:	Types of Abuse		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

MULTIPLE RESPONSE

	21.	The nurse is aware that a person’s attitude about aging is influenced mainly by his or her __________. (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.

DIF:	Cognitive Level: Comprehension	REF:	p. 3	OBJ:	2
TOP:	Attitudes Toward Aging	KEY:	Nursing Process Step: Planning
MSC:	NCLEX: Psychosocial Integrity: Psychosocial Adaptation		

	22.	Gerontology encompasses application to __________. (Select all that apply.)
a.	appropriate housing	
b.	health care	
c.	public education	
d.	business ventures	
e.	government-sponsored pensions	

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

DIF:	Cognitive Level: Application	REF:	p. 2	OBJ:	1
TOP:	Gerontology	KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A

	23.	Medicare Part C allows eligible persons to receive Medicare benefits via the services of private insurance companies through which of the following? (Select all that apply.)
a.	Health maintenance organization (HMO)	
b.	Preferred provider organization (PPO)	
c.	Provider-sponsored organization (PSO)	
d.	Private fee for service organization (PFFS)	
e.	Medical service organization (MSO)	

ANS:	A, B, C, D
Medicare Part C allows benefits via the services of managed care organizations. Medical service organization is not one of them.

DIF:	Cognitive Level: Comprehension	REF:	p. 16	OBJ:	6
TOP:	Medicare Part C		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	24.	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.

DIF:	Cognitive Level: Application	REF:	p. 20	OBJ:	11
TOP:	Impact of Aging on the Family	KEY:	Nursing Process Step: Planning
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation

	25.	What characteristics are typical for a caregiver of an aging family member? (Select all that apply.)
a.	32 years of age	
b.	Female	
c.	Having full-time employment	
d.	Having a care recipient older than 70	
e.	Giving care for an average of 18 years	

ANS:	B, C, D, E
The average age of the caregiver is 46.

DIF:	Cognitive Level: Application	REF:	p. 19	OBJ:	11
TOP:	Characteristics of Family Caregiver			
KEY:	Nursing Process Step: Implementation		
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development

	26.	Which of the following are indicators of self-neglect in the aging person? (Select all that apply.)
a.	Misbalanced checkbook	
b.	Reduced personal hygiene	
c.	Increased alcohol consumption	
d.	Irritability	
e.	Loss of weight	

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

DIF:	Cognitive Level: Application	REF:	p. 21	OBJ:	11
TOP:	Self-Neglect	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

	27.	The nurse reminds a group of prospective caregivers that elder abuse may take the form of __________. (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.

DIF:	Cognitive Level: Application	REF:	pp. 21-23	OBJ:	13
TOP:	Elder Abuse	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Physiological Integrity: Reduction of Risk

	28.	Research by the National Institute on Aging found which of the following to be correct? (Select all that apply.)
a.	Older patients receive less information regarding health management than younger patients.	
b.	Information on lifestyle changes were directed at younger people.	
c.	Older patients were denied timely appointments for evaluation of acute illnesses.	
d.	Rehabilitation programs offered limited services to the older adult.	
e.	Older patients receive less evaluation and fewer treatment options for acute illnesses.	

ANS:	A, B, D, E
The study showed there was less information on health management and lifestyle changes. Rehabilitation programs were limited in their service to the older adult, and only 47% of physicians interviewed felt the older patient received the same evaluation for acute illnesses.

DIF:	Cognitive Level: Application	REF:	pp. 3-5	OBJ:	2
TOP:	Attitudes Toward Aging	KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

	29.	The Nursing Competence in Aging initiative advocates enhancing nurses’ __________. (Select all that apply.)
a.	knowledge in gerontics	
b.	skills in geriatrics	
c.	opportunities for employment	
d.	political sensitivity for the older adult	
e.	attitudes related to the older adult	

ANS:	A, B, E
The Nursing Competence in Aging initiative advocates for all nurses greater knowledge, skills, and broader attitudes toward the older adult.

DIF:	Cognitive Level: Comprehension	REF:	p. 5	OBJ:	12
TOP:	Attitudes Toward Aging	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

COMPLETION

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

ANS:	gerontics

DIF:	Cognitive Level: Comprehension	REF:	p. 2	OBJ:	10
TOP:	Gerontics	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development

	31.	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

DIF:	Cognitive Level: Knowledge	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

	32.	The nurse clarifies that the point at which a person on Medicaid Part D must assume full cost of medication is called the __________ __________.

ANS:	
donut hole

The “donut hole” is the point at which the insured has used up the $2850 worth of coinsurance for drugs and must pay the full cost of medication until the amount of out-of-pocket expenses reaches $4750.

DIF:	Cognitive Level: Comprehension	REF:	p. 16	OBJ:	8
TOP:	Donut Hole	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care