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Chapter 05: Gerontological Nursing and Promotion of Healthy Aging
Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition
MULTIPLE CHOICE
1.Identify the best statement about gerontological nursing.
| a. | Nurses have only recently become involved in the care of older adults. |
| b. | Gerontological care was the second specialty in which the American Nurses Association (ANA) offered a certification program. |
| c. | Purposes of gerontological nursing include the promotion of health and support for maximal independence. |
| d. | ANA certification is available only for gerontological nurses in research positions. |
ANS: C
Promoting health and fostering independence are purposes of the practice, as reflected, for example, in the ANA Scope and Standards. Nurses have always cared for older patients. The ANA’s gerontological nursing certification program was the organization’s first and includes a variety of positions, such as nurse practitioners, clinical specialists, researchers, and administrators.
PTS:1DIF:RememberREF:p. 56-57, 60
TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance
2.Which gerontological nursing organization welcomes nurses from all educational backgrounds?
| a. | The National Gerontological Nursing Association (NGNA) |
| b. | The National Conference of Gerontological Nurse Practitioners (NCGNP) |
| c. | The National Association of Directors of Nursing Administration in Long-Term Care (NADONA/LTC) |
| d. | The American Society on Aging (ASA) |
ANS: A
The NGNA was formed specifically for all levels of nursing personnel: registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and certified nursing assistants (CNAs). The NCGNP is, as its name implies, limited to nurse practitioners. The NADONA/LTC is, as its name implies, limited to directors and assistant directors of nursing. The ASA is an interdisciplinary organization not limited to nurses.
PTS:1DIF:RememberREF:p. 59
TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance
3.Which is an accurate statement regarding gerontological nursing education?
| a. | Gerontological nursing content has long been integrated into the curriculum of the typical school of nursing. |
| b. | Undergraduate nursing programs extensively cover gerontological nursing in dedicated courses, comparable with the coverage of psychiatric nursing. |
| c. | When content is integrated throughout a curriculum, less than 25% is devoted to geriatric care. |
| d. | Accreditation of a nursing program guarantees that appropriate amounts of gerontological nursing content are included in the curriculum. |
ANS: C
When content is integrated throughout the curriculum, less than 25% of the content is devoted to geriatric care. Only recently has gerontological nursing content begun to appear in nursing school curricula. Most nursing schools still do not have such courses. At present, no minimum requirements exist for the coverage of care of older adults.
PTS: 1 DIF: Remember REF: p. 58 TOP: Teaching and Learning
MSC:Health Promotion and Maintenance
4.Based on current demographic data, which of the following statements identifies a predictive trend regarding the health care needs of society?
| a. | Most nurses will not need to care for older persons. |
| b. | More nursing services will be required to serve the needs of the population older than 85 years of age. |
| c. | Fewer nurses will be needed to care for older adults. |
| d. | Older adults expect their quality of life to be less than that of earlier generations at their ages. |
ANS: B
Projections are that 20% of the American population will be older than 65 years of age by 2050, with those older than 85 years showing the greatest increase in numbers. Most nurses can expect to care for older people during the course of their careers. By 2050, the United Nations predicts that more Americans will be older than the age of 60 years than those younger than the age of 15 years. Older people are better educated and more affluent and expect a higher quality of life than their elders had at their age.
PTS:1DIF:RememberREF:p. 56
TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance
5.A case manager is likely to have how many years of nursing education?
| a. | 1 to 1.5 |
| b. | 4 to 6 |
| c. | 2 |
| d. | 8 or more |
ANS: C
A case manager typically has a bachelor’s or master’s degree. This amount of training is typical for a licensed practical nurse, who typically practices at a nursing home or on a home nursing staff. This amount of training, resulting in an associate’s degree in nursing, is typical for an associate registered, who is typically found on hospital, home, and nursing home staffs. A nurse with 8 or more years of education, as well as a doctorate, is typically involved in research and teaching.
PTS: 1 DIF: Remember REF: p. 62 TOP: Teaching and Learning
MSC: Safe, Effective Care Environment
6.An older man is transferred to a hospice facility with end-stage disease. Which is a suitable nursing intervention for this older adult and his family according to the goals of long-term care?
| a. | Decrease the analgesic dose to prevent sedation. |
| b. | Provide a basin and towels for morning self-care. |
| c. | Inform family members about strict visiting hours. |
| d. | Facilitate family rituals related to death and dying. |
ANS: D
To promote comfort and dignity, the nurse facilitates the enactment of family wishes, rituals, or religious practices related to death and dying. To promote comfort, the gerontological nurse administers medications as prescribed and avoids restricting analgesic agents to patients regardless of the setting or the nurse’s personal views. Although fostering independence is within the scope of the gerontological nursing practice, the nurse should assess the older adult and family before assuming that he will want or be able to perform self-care. Although hospice can have regular visiting hours, the older adult may need his family at the bedside for comfort, strength, or companionship. Thus, to provide comfort and promote dignity, the gerontological nurse adapts visiting hours to suit the older adult’s needs.
PTS:1DIF:ApplyREF:p. 60, 62
TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment
7.A nursing home executive interviews registered nurses to fill a full-time position for direct patient care to maintain the standards of eldercare. Which nurse should the nursing home hire?
| a. | Nurse from a certified college |
| b. | Nurse with 15 years of experience |
| c. | Certified gerontological nurse |
| d. | Gerontological nurse practitioner |
ANS: B
A certified gerontological nurse receives education and training to care for older adults, assuring the nursing home and the public that the nurse has mastered the specialized skills and knowledge to care for older adults according to gerontological nursing standards. A nurse educated in a certified college does not necessarily have specialty education and training in gerontology. A nurse with 15 years of experience might have no experience with gerontology and offers no proof of specialized knowledge or skills. Although a gerontological nurse practitioner receives specialized education and training in gerontology, these nurses provide primary care in a nursing home.
PTS:1DIF:ApplyREF:p. 57
TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment
8.Mezey and Fulmer (2002) justify gerontological nursing research and the work of gerontological advanced practice nurses by concluding the following:
| a. | Other scientists devalue gerontological nursing research. |
| b. | The research influences outcomes from nursing care in a positive way. |
| c. | Gerontological care is expensive but required in long-term care. |
| d. | Gerontological nursing research is well known to practicing nurses. |
ANS: B
The practices of advanced practice nurses, who base their practice on nursing research, have resulted in positive older adult outcomes and cost effectiveness. The scientific community widely accepts the research. Advanced practice nurses generate positive outcomes and are cost effective in many settings. Mezey and Fulmer believe the goal of gerontological nursing is to disseminate the knowledge from gerontological nursing research to all nurses and to have the knowledge applied to their practices.
PTS: 1 DIF: Understand REF: p. 60-61 TOP: Nursing Process: Diagnosis
MSC:Health Promotion and Maintenance
9.The gerontological nurse collaborates with the wound care team about an older patient who has an ulcer. How is this nurse demonstrating leadership in the care of older people?
| a. | Assessing older adults effectively |
| b. | Facilitating access to eldercare programs |
| c. | Coordinating members of the health care team |
| d. | Empowering older adults to manage chronic illness |
ANS: C
The nurse demonstrates leadership in the care of older adults by initiating and coordinating collaboration with the wound care team to improve the health of an older adult. Screening and assessing are only indirectly related to collaboration. In this case, the nurse’s collaborative efforts are unrelated to facilitating access to a program. Thus far, the nurse has not educated or trained this patient in wound care.
PTS: 1 DIF: Apply REF: p. 63 TOP: Nursing Process: Evaluation
MSC:Health Promotion and Maintenance
10.Which organization had the largest role in enhancing the specialty of gerontological nursing?
| a. | American Association of Retired Persons (AARP) |
| b. | John Hartford Foundation |
| c. | Medicare |
| d. | Mutual of Omaha Insurance |
ANS: B
The most significant influence in enhancing gerontological nursing has been the work of the Hartford Institute for Geriatric Nursing, funded by the John A. Hartford Foundation. The foundation seeks to shape the quality of the nation’s health care for older Americans by promoting geriatric nursing excellence to both the nursing profession and the larger health care community. Initiatives in nursing education, nursing practice, nursing research, and nursing policy include enhancing geriatrics in nursing education programs through curricular reform and faculty development and the development of nine Centers of Geriatric Nursing Excellence. AARP is a foundation that helps struggling seniors by being a force for change on the most serious issues they face today. Medicare is a national social insurance program, administered by the U.S. federal government since 1965, that guarantees access to health insurance for Americans ages 65 years and older and younger people with disabilities. Mutual of Omaha is a Fortune 500 mutual insurance and financial services company based in Omaha, Nebraska.
PTS:1DIF:RememberREF:p. 57-59
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment
11.Which of the following is true about the Nurse Competence in Aging (NCA) initiative?
| a. | It was developed to support the professional development and leadership growth of nurses who provide care to older adults in long-term care. |
| b. | It developed resources for nurses to access evidence-based information on topics related to the care of older adults. |
| c. | It provides predoctoral and postdoctoral scholarships for study and research in geriatric nursing. |
| d. | It developed the first certification in gerontological nursing. |
ANS: B
The NCA initiative provided grant and technical assistance to more than 50 specialty nursing organizations, developed a free web-based comprehensive gerontological nursing resource center (ConsultGeriRN.org) where nurses can access evidence-based information on topics related to the care of older adults, and conducted a national gerontological nursing certification outreach. Sigma Theta Tau’s Center for Nursing Excellence in Long-Term Care sponsors the Geriatric Nursing Leadership Academy and offers a range of products and services to support the professional development and leadership growth of nurses who provide care to older adults in long-term care. The ANA developed the gerontological certification exam.
PTS:1DIF:RememberREF:p. 57
TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment
12.The vision of Nurses Improving Care for Health System Elders (NICHE) is
| a. | to ensure that all older adults are only cared for by nurses who are certified in gerontological nursing. |
| b. | to decrease the cost of care for hospitalized older adults. |
| c. | to increase access to care for adults age 64 years and older. |
| d. | for patients 65 years and older to be given sensitive and exemplary care. |
ANS: D
The vision of NICHE is for all patients 65 years and older to be given sensitive and exemplary care.
PTS:1DIF:RememberREF:p. 61
TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment
MULTIPLE RESPONSE
1.Advanced practice nurses have demonstrated the most significant impact in improving which of the following for older adults? (Select all that apply.)
| a. | Health outcomes |
| b. | Length of stay |
| c. | Cost effectiveness |
| d. | Reimbursement measures |
| e. | Interprofessional communication |
ANS: A, C
Advanced practice nurses have demonstrated their skill in improving health outcomes and cost effectiveness. Many of these advanced practice nurses have nursing facility practices managing complex care of frail older adults in collaboration with interprofessional teams. This role is well established, and positive outcomes include increased patient and family satisfaction, decreased costs, less frequent hospitalizations and emergency department visits, and improved quality of care. Reimbursement measures and interprofessional communication have not been identified as areas that advanced practice nurses have demonstrated their skill in improving.
PTS: 1 DIF: Remember REF: p. 60 TOP: Nursing Process: Evaluation
MSC: Safe, Effective Care Environment
2.The ANA Scope and Standards of Gerontological Nursing (2010) addresses which of the following? (Select all that apply.)
| a. | The skills and knowledge required to address gerontological patient needs |
| b. | The levels of gerontological nursing practice |
| c. | Requirements for certification as a gerontological nurse |
| d. | Standards of gerontological nursing practice |
| e. | Continuing education requirements for gerontological nurses |
ANS: A, B, D
The ANA Scope and Standards of Gerontological Nursing (2010) provides a comprehensive overview of the scope of gerontological nursing, the skills and knowledge required to address the full range of needs related to the process of aging, and the specialized care of older adults as a group and as individuals. The document also identifies levels of gerontological nursing practice (basic and advanced) and standards of clinical gerontological nursing care and gerontological nursing performance. Certification requirements and continuing education requirements are not addressed.
PTS:1DIF:RememberREF:p. 57
TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment
3.In the document “Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults” developed by the American Association of Colleges of Nursing and the Hartford Institute for Geriatric Nursing, New York University, recommendations include which of the following? (Select all that apply.)
| a. | Provision of a free-standing course in gerontology within the curriculum |
| b. | Integration of gerontological content throughout the curriculum |
| c. | Requirement of gerontological certification for all students before completion of a BSN program |
| d. | Structured clinical experiences with older adults across the continuum of care |
| e. | Faculty with expertise in gerontological nursing |
ANS: A, B, D, E
Best practice recommendations for nursing education include provision of a stand-alone course, as well as integration of content throughout the curriculum so that gerontology is valued and viewed as an integral part of nursing care. It is important to provide students with nursing practice experiences caring for elders across the health–wellness continuum. Faculty with expertise in gerontological nursing is an important recommendation.
PTS:1DIF:RememberREF:p. 58
TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment
4.Which of the following organizations have interdisciplinary membership? (Select all that apply.)
| a. | Gerontological Society of America |
| b. | National Gerontological Nurses Association |
| c. | American Society on Aging |
| d. | Association of Gerontology in Higher Education |
| e. | National Association Directors of Nursing Administration in Long-Term Care |
ANS: A, C, D
The Gerontological Society of America, American Society on Aging, and Association of Gerontology in Higher Education are all interdisciplinary organizations. The National Gerontological Nurses Association and National Association Directors of Nursing Administration in Long-Term Care are nursing organizations.
PTS:1DIF:RememberREF:p. 58-59
TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment
5.Common iatrogenic complications for hospitalized older adults include (Select all that apply.)
| a. | delirium. |
| b. | new-onset incontinence. |
| c. | acute myocardial infarction. |
| d. | hip fracture. |
| e. | falls. |
ANS: A, B, E
Common iatrogenic complications include functional decline, pneumonia, delirium, new-onset incontinence, malnutrition, pressure ulcers, medication reactions, and falls.
PTS:1DIF:RememberREF:p. 61
TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment
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