(Osborn) Chapter 10 Learning Objectives (Number and Title)

[Osborn] chapter 10
Learning Objectives [Number and Title]

Learning Objective 1
Identify normal age-related changes of the head, neck, respiratory,
cardiovascular, gastrointestinal, genitourinary, musculoskeletal,
integumentary, and neurological systems when completing a nursing
assessment.
Explain the rationale for recommended immunizations and screening
exams as proposed by the U.S. Preventive Services Task Force and as
stated in the chapter for the patient over 65 years of age.
Discuss medications contraindicated in the aging patient as identified
by the Beers criteria.
Recognize signs and symptoms of elder mistreatment to determine
appropriate referrals.
Differentiate between residential, assisted living, and skilled nursing
care in accordance with the type of patient care services provided.
Provide direction and advice to the elderly by describing available
innovative housing options.
Explain the implications of technological advancements in providing
care to the elderly.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. The results of a 78-year-old patients respiratory vital capacity are decreased. The nurse realizes this
finding is consistent with:
1.
2.
3.
4.
A normal finding in an elderly person.

Chronic respiratory disease.
Neurological deterioration.
Cardiac insufficiency.
Correct Answer: A normal finding in an elderly person.

Rationale: Structural changes of the thoracic cavity are often seen with aging and can affect respiratory
function. Kyphosis, which gives the patient a stooped over appearance, is caused by osteoporosis
and collapse of vertebrae. The chest wall becomes less compliant, and changes in the breathing pattern
are seen. Inspiration tends to be shallower, and expiration requires the use of accessory muscles. As a
result, the measured vital capacity is decreased, and increased residual capacity will be seen if
pulmonary function tests are conducted. There is not enough information to determine if this patient
has chronic respiratory disease, neurological deterioration, or cardiac insufficiency.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Health Promotion and Maintenance
LO: 1
2. An elderly female patient tells the nurse that she is having trouble holding her water and doesnt
want to drink fluids anymore. Which of the following does this information provide to the nurse?
1.
2.
3.
4.
The patient is experiencing incontinence.

The patient has a urinary tract infection.
The patient has a reduced thirst reflex.
The patient needs estrogen cream.
Correct Answer: The patient is experiencing incontinence.

Rationale: One common disorder seen in the genitourinary tract of the elderly is incontinence.
Incontinence occurs when urine exceeds the bladders capacity. There is not enough evidence to
support the patient having a urinary tract infection. The patient states that she does not want to drink
fluids, which would not support a reduced thirst reflex. The use of estrogen cream would be indicated
for atrophic vaginitis or a decrease of estrogen in the vaginal tissues.
Cognitive Level: Analyzing
LO: 1
3. An elderly female patient has a sudden onset of delirium during the first night of hospitalization.
This episode suggests to the nurse:
1.
2.
3.
4.
The cause has to be determined immediately because it can signal another health problem.
The patient has Alzheimers disease.
The patient is dehydrated.
The patient has an infection.
Correct Answer: The cause has to be determined immediately because it can signal another health
problem.
Rationale: The patients onset of delirium should be investigated because it can signal another health
problem. Delirium is a sudden, fluctuating, and usually reversible cognitive disorder characterized by
a disturbance in consciousness that develops over a short period of time. It is an abnormal mental state,
not a disease, and usually a sign of a newly developed disorder that affects about one-third of
hospitalized people over the age of 70. There is not enough evidence to suggest that the patient has
Alzheimers disease or is dehydrated or has an infection.
LO: 1
4. The nurse is planning care for a 70-year-old patient. Which of the following screenings should be
included in this patients care?
1.
2.
3.
4.
Annual PSA test and digital rectal exam

Biannual eye examinations
Hearing test every 5 years
Testing for fecal occult blood every 5 years
Correct Answer: Annual PSA test and digital rectal exam

Rationale: The USPSTF recommends a yearly prostate surface antigen (PSA) test and a digital rectal
exam (DRE) in males age 65 and older. The USPSTF recommends visual screening and full eye exam
on an annual basis for all individuals age 65 and older. Hearing loss is the most common sensory
impairment in the older adult. The USPSTF recommends hearing impairment screening on a yearly
basis for all individuals age 65 and older. For those age 65 and older, fecal occult blood testing is
recommended yearly, sigmoidoscopy every 5 years, and colonoscopy every 10 years.
Nursing Process: Planning
LO: 2
5. A 68-year-old female patient has had a complete hysterectomy including the removal of the cervix.
The nurse realizes that long-term screening of this patient would include:
1.
2.
3.
4.
Pap smears no longer needed.

Annual Pap smears.
Pap smears every 3 years.
Annual Pap smears until a negative and then every 3 years.
Correct Answer: Pap smears no longer needed.

Rationale: Women without a cervix should not have Pap smears. The USPSTF recommends a Pap
smear at least every 3 years in women age 65 and older. However, Pap smears can be stopped after age
65 if there is one negative result at age 65 and the woman is considered at low risk.
LO: 2
6. An 85-year-old male patient is aware of the need for a colonoscopy; however, he has a history of
severe electrolyte imbalances associated with bowel preps for diagnostic tests. The nurse realizes that
this patient should probably:
1.
2.
3.
4.
Talk to his doctor about not having the colonoscopy because the prep might be harmful.
Have the colonoscopy and take medication afterward for the electrolyte imbalances.
Wait a year and have the colonoscopy done then.
Have a flexible sigmoidoscopy instead.
Correct Answer: Talk to his doctor about not having the colonoscopy because the prep might be
harmful.
Rationale: The age to discontinue colorectal cancer screening is unknown; however, the burden of
screening may outweigh the potential benefits in patients with advanced age and comorbid conditions
that limit life expectancy. The patient should discuss the benefits and potential harms associated with
the colonoscopy with his health care provider. There is not enough information to determine that the
patient should have the colonoscopy and be treated for electrolyte imbalances afterward. It is not a
recommendation to wait a year and have the colonoscopy done then. It is not a U.S. Preventive
Services Task Force recommendation to substitute a flexible sigmoidoscopy for a colonoscopy.
LO: 2
7. A 72-year-old patient wants to know where her digoxin pill is because she always takes it for her
heart. Which of the following is the best response by the nurse?
1.
2.
3.
4.
The health care provider will likely order a different heart medication pill.
Digoxin doesnt work as well as it used to.
Digoxin is a bad medication to take.
Digoxin is no longer manufactured.
Correct Answer: The health care provider will likely order a different heart medication pill.
Rationale: The nurse should inform the patient that the health care provider will order a different heart
pill than the digoxin. Digoxin is one of several medications or medication classes that should generally
be avoided in persons 65 or older because the medications are ineffective or pose unnecessarily high
risks for this group, and safer alternatives exist. While it is true that digoxin is not beneficial to a
patient of the clients age, telling the patient that the medicine does not work as well as it used to does
not address what will be done to replace the medication. The nurse should not tell the patient that
digoxin is a bad medication to take, nor that digoxin is no longer manufactured.
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 3
8. An elderly patient with arthritis is admitted to the unit with acute gastrointestinal bleeding. Which of
the following medications taken by the patient is known to cause this type of bleeding?
1.
2.
3.
4.
Naproxen
Clonidine
Doxazosin
Amitriptyline
Correct Answer: Naproxen

Rationale: Long-term use of a nonsteroidal anti-inflammatory medication such as Naproxen has the
potential to induce gastrointestinal bleeding. Clonidine, Doxazosin, and Amitriptyline do not have the
potential to cause gastrointestinal bleeding in the elderly.
LO: 3
9. The nurse is caring for an elderly patient with a history of blood clots. Which of the following
medications would be the most effective for this patient?
1.
2.
3.
4.
Aspirin
Ticlopidine
Amiodarone
Amitriptyline
Correct Answer: Aspirin

Rationale: Aspirin is better to prevent clotting than ticlopidine in the elderly and is less toxic.
Amiodarone is a cardiac medication and is not used to prevent blood clots. Amitriptyline is an
antidepressant and is not used to prevent blood clots.
LO: 3
10. A 75-year-old female has been brought into the emergency department. She tells the nurse that her
son, who has taken care of her, said he would be right back, but she has not seen him for weeks. The
nurse realizes this patient is describing:
1.
2.
3.
4.
Abandonment.
Neglect.
Physical abuse.
Self-neglect.
Correct Answer: Abandonment.

Rationale: Abandonment is defined as desertion of an elderly person by an individual deemed
responsible for the elders care. An example is a caregiver leaving a dependent elderly person alone for
a week while the caregiver takes a vacation out of town. Neglect is the refusal or failure to fulfill
duties to an elder including failing to provide necessary personal care. Physical abuse is the use of
force that may result in injury, pain, or impairment. Self-neglect is the refusal or failure of an elderly
person to provide him- or herself with adequate food, water, shelter, and health care to the point that
personal health or safety is threatened.
Client Need: Psychosocial Integrity
LO: 4
11. A patient tells the nurse that she does not bother to bathe anymore and has no appetite so only eats
a few times a week. The nurse realizes this patient is demonstrating signs of:
1.
2.
3.
4.
Self-neglect.
Abandonment.
Emotional abuse.
Physical abuse.
Correct Answer: Self-neglect.

Rationale: Self-neglect is the refusal or failure of an elderly person to provide him- or herself with
adequate food, water, shelter, and health care to the point that personal health or safety is threatened.
This patient is demonstrating signs of self-neglect. Abandonment is defined as desertion of an elderly
person by an individual deemed responsible for the elders care. Emotional abuse involves inflicting
pain or distress through verbal or nonverbal means and includes insults, threats, or forced social
isolation. Physical abuse is the use of physical force that may result in injury, pain, or impairment.
LO: 4
12. An elderly patient tells the nurse that her son cashes her Social Security checks but tells her he does
not have enough money to buy her medications. The nurse should investigate this situation because it
could be which of the following?
1.
2.
3.
4.
Financial exploitation
Emotional abuse
Physical abuse
Neglect
Correct Answer: Financial exploitation

Rationale: Financial exploitation is defined as misuse of an elders money, property, or assets. The
patients son is cashing the Social Security check but telling her he does not have the money to buy her
medications. Emotional abuse involves inflicting pain or distress through verbal or nonverbal means
such as insults, threats, or forced social isolation. Physical abuse is the use of physical force that may
result in injury, pain, or impairment. Neglect is the refusal or failure to fulfill duties to an elder.
LO: 4
13. A patient says that she cannot go home until she can walk independently because she might get
kicked out of the apartment. The nurse realizes this patient is describing which type of living facility?
1.
2.
3.
4.
Assisted living facility

Adult day care
Residential living facility
A skilled nursing care facility
Correct Answer: Assisted living facility

Rationale: Assisted living facilities also are licensed as residential care facilities, but tend to be larger
in size, often with 50 to 200 residents. Most require individuals to be ambulatory, use a walker, or be
able to propel their wheelchairs to a common dining area. These facilities cannot accommodate
individuals who are bedbound. If an individual requires daily nursing care for problems such as
pressure ulcers or an indwelling urinary catheter, the facility must apply for a special waiver to allow
the person to remain in the facility. Adult day care is a type of program that focuses on socialization
among elderly people. A residential living facility, also termed a board and care facility, is where
care is provided by unlicensed personnel and services such as meals, social activities, housekeeping,
laundry, and limited transportation are provided. A skilled nursing care facility provides care for a
short period of time to recover from an acute illness or injury after a hospitalization. Care is provided
by licensed nurses, and many individuals in this type of facility receive daily physical therapy.
Client Need: Safe Effective Care Environment
LO: 5
14. A patient tells the nurse he does not want to go to a nursing home and knows that he needs some
help with preparing meals and transportation but does not want to be with a lot of sick people.
Which of the following should the nurse suggest to this patient?
1.
2.
3.
4.
Residential care facility

Assisted living facility
Intermediate care facility
Skilled nursing care facility
Correct Answer: Residential care facility

Rationale: A residential care facility is another term for a facility that offers board and care to the
residents. Services typically include meals, social activities, housekeeping, laundry services, and
limited transportation. This patient is a candidate for a residential care facility. Assisted living facilities
have 50 to 200 residents and the residents need to be ambulatory to be able to arrive independently to
the dining area. The patient does not want to be with a large number of people, so this type of facility
would not be to the patients liking. Intermediate care and skilled care facilities are sometimes referred
to as nursing homes. The patient does not need intermediate or skilled care and is therefore not a
candidate for either of these types of facilities.
LO: 5
15. A patient who was a resident at an assisted living facility now has an indwelling urinary catheter.
The nurse realizes that which of the following will need to be done to help this patient with living
needs?
1. Find out if the facility can apply for a special waiver to permit the patient to return to the
assisted living facility.
2. Explain to the patient that he cannot return to the assisted living facility and plan to transfer
him to a skilled nursing facility.
3. Explain to the patient that he cannot return to the assisted living facility and plan to transfer
him to an intermediate care facility.
4. Ask the patient if any family members would be willing to have him live with them because
there is no other facility where he can live.
Correct Answer: Find out if the facility can apply for a special waiver to permit the patient to return to
the assisted living facility.
Rationale: Assisted living facilities cannot typically accommodate individuals who need daily nursing
care such as an indwelling urinary catheter unless the facility applies for a special waiver to allow the
person to remain in the facility. The nurse should find out if the facility can obtain such a waiver. The
nurse should not tell the patient that he needs to live in an intermediate care or skilled nursing care
facility. The nurse should also not ask the patient if there are any family members he can live with
since there is no other place for him to reside.
LO: 5
16. A patient adamantly refuses to go to a nursing home. The nurse asks if the patient would be
willing to live in a place that has a doctors office and other health care providers as well as a place for
all residents to congregate and socialize. This nurse is describing which of the following housing
options?
1.
2.
3.
4.
PACE program
Green House project
Elder cohousing
Team-based primary care in the home
Correct Answer: PACE program

Rationale: The Program of All-inclusive Care for the Elderly (PACE) is based on the British day
hospital model of care. PACE programs provide preventive, primary, acute, and long-term services for
their enrolled members all under one roof. With a nursing focus, PACE programs include the medical
component of care, working from a clinic that is open 5 or 6 days a week, where participants receive
care from a clinic provider. These services are offered along with an adult day care program, where
participants gather for socialization, recreation, and nursing care. The Green House project describes a
group of suburban homes used to house the elderly; meals are served at a community dining table.
Elder cohousing is similar to a townhouse or condominium community where all residents enjoy
living and doing things together. Team-based primary care in the home is an approach where the
patient stays at home and receives health care provider care when needed. The goal is to reduce
unnecessary and costly hospitalizations.
LO: 6
17. A 76-year-old patient tells the nurse that she is too young to go to any kind of nursing home and
just wants to live among other people of the same age and activity level to enjoy meals, activities, and
social functions. The nurse realizes this patient would be an ideal candidate for which of the following
housing options?
1.
2.
3.
4.
Elder cohousing
Team-based primary care
PACE program
Green House project
Correct Answer: Elder cohousing

Rationale: Elder cohousing is a concept where elderly individuals live in townhouses or
condominiums, with the goal being to encourage aging in the home. Residents enjoy living and doing
things together. This patient would be a candidate for elder cohousing. Team-based primary care is an
approach to care where health care providers provide 24-hour home visits to the patient when needed.
The care is designed to improve the quality of care for those with chronic illnesses. The PACE
program provides preventive, primary, acute, and long-term care all within the same location. The
PACE program usually provides care in a clinic. The Green House project is a philosophy where
elderly patients live in a community of suburban homes and helps reduce the fears of being
institutionalized in a nursing home.
Client Need: Safe, Effective Care Environment
LO: 6
18. An elderly patient is eligible for a PACE program. Which of the following should the nurse instruct
this patient about the program?
1. Health services are provided in one location that also has social activities. Transportation is
provided if you need it.
2. A doctor will come to your home if you become ill.
3. It is a housing community where everyone eats their meals together.
4. It is a townhouse community where everyone socializes together and you can get home care if
you need it.
Correct Answer: Health services are provided in one location that also has social activities.
Transportation is provided if you need it.
Rationale: PACE programs provide health care services in addition to social activities all within one
location. Transportation is provided. Health care providers who see patients in their own homes
describes team-based primary care. A housing community where everyone eats their meals together
describes the Green House project. A townhouse community where the residents socialize and receive
home care if needed describes elderly cohousing.
LO: 6
19. A patient tells the nurse that he is moving to a smaller apartment in an assisted living complex, but
he has so many boxes of records and receipts that he does not think it will all fit. Which of the
following could the nurse suggest to help this patient?
1. Computerize the records.
2. Store the records in another facility.
3. Discard the records.
4. Contact a company to have the records destroyed.
Correct Answer: Computerize the records.
Rationale: Computers continue to offer an opportunity for seniors to apply technology in their lives to
simplify record keeping, even when they are no longer able to live at home. Many seniors keep track
of their medical care and health history using notebooks, filing systems, or, in some cases, no
particular system. Even though storing the records in another facility appears to be an option, it might
prove to be costly for the person in addition to not having access to the records when needed. While
some of the records and receipts may no longer be needed, the patient may not want to discard them;
computerizing the material allows the patient to maintain the information.
LO: 7
20. An elderly patient told the nurse that her daughter bought her a system that will call for help if she
falls. The nurse realizes this patient is describing:
1.
2.
3.
4.
Continuous body monitoring.

Direct dial to the local ambulance company.
Computerized communication.
A home alarm system.
Correct Answer: Continuous body monitoring.

Rationale: Continuous body monitoring is available in many different types. Most body monitoring
systems include a device that the elderly person wears that communicates to an ambulance company or
other family member that the patient needs help or assistance. There is no way of knowing if the
patient has direct dialing to the ambulance company. Computerized communication would mean the
patient has a computer at home and would need to access it to communicate health needs. The nurse
has no way of knowing if the patient has a home alarm system.
LO: 7
21. An elderly female patient tells the nurse that her daughter bought her a small computer that she
uses instead of a telephone because the conversation is typed out in words and she only has to read
what everyone is saying instead of straining to hear the conversation. The nurse realizes this patient is
using a:
1.
2.
3.
4.
Voice over Internet program.

Cell phone.
Smart phone.
Continuous body monitoring device.
Correct Answer: Voice over Internet program.

Rationale: The patient is describing a Voice over Internet program. A Voice over Internet program
involves the use of the Internet instead of a traditional phone line to carry voices. Through this
program, communication can occur through either voice or text. This type of technology is not
available through the use of a cell phone. A smart phone may or may not include the Voice over
Internet technology. Continuous body monitoring devices do not typically include a phone to
communicate in text mode.
LO: 7

(Osborn) Chapter 10 Learning Objectives (Number and Title)

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(Osborn) Chapter 10 Learning Objectives (Number and Title)

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[Osborn] chapter 10

Learning Objectives [Number and Title]

A normal finding in an elderly person.

Correct Answer: A normal finding in an elderly person.

The patient is experiencing incontinence.

Correct Answer: The patient is experiencing incontinence.

Annual PSA test and digital rectal exam

Correct Answer: Annual PSA test and digital rectal exam

Pap smears no longer needed.

Correct Answer: Pap smears no longer needed.

Correct Answer: Naproxen

Correct Answer: Aspirin

Correct Answer: Abandonment.

Correct Answer: Self-neglect.

Correct Answer: Financial exploitation

Assisted living facility

Correct Answer: Assisted living facility

Residential care facility

Correct Answer: Residential care facility

Correct Answer: PACE program

Correct Answer: Elder cohousing

Continuous body monitoring.

Correct Answer: Continuous body monitoring.

Voice over Internet program.

Correct Answer: Voice over Internet program.

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