Gerontological Nursing Chapter 4 Chapter 04: Life Transitions and Story Eliopoulos: Gerontological Nursing, 9th Edition

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Gerontological Nursing Chapter 4 Chapter 04: Life Transitions and Story Eliopoulos: Gerontological Nursing, 9th Edition 1.1. A nurse manager at a long-term care facility is engaged in efforts to c... hange many staff members' inaccurate and negative views of older adults. Which of the following statements made by staff is most clearly indicative of ageism? A) "Older people seem to have so many more chronic health problems than younger people." B) "Older adults' motor skills get progressively slower as they age." C) "It's normal to expect a gradual loss of memory and intelligence with age." D) "A lot of the physical changes that accompany aging are inevitable.": Ans: C Feedback: A common ageist misconception is that senility and loss of intelligence inevitably, and normally, accompany the aging process. Older adults do have more chronic conditions than younger adults, and motor skills become slower. Many of the physical changes that accompany aging are considered normal and largely inevitable. 2.2. According to Erikson, the final stage of the life cycle is centered on achieving integrity versus despair. Which of the following situations would signal to the nurse that the client in question is at risk for disappointment and despair as characterized by Erikson? A) An 81-year-old woman has needed to adopt a minced diet following a recent stroke. B) A 78-year-old man has had a pacemaker implanted to address his atrial fibrillation. C) A 90-year-old woman is grieving the recent death of her husband to whom she was married for 66 years. D) An 80-year-old man describes himself as "useless" since he can no longer help his adult children with their yard and garden work.: Ans: D Feedback: A perceived loss of useful function often constitutes a crisis for older men and can be associated with despair rather than integrity in Erikson's typology of the life cycle. A change in diet, a medical intervention, and grief at the loss of a spouse are less closely associated with this conflict. 3.3. Which of the following clients of a nurse practitioner is demonstrative of a growing trend in the role of grandparents in contemporary American society? A) A 70-year-old grandmother is raising her two grandchildren because their mother is in prison. B) An 80-year-old client of the nurse is going through a divorce with her husband of several decades. C) A 79-year-old man laments the fact that he is estranged from his son's children. D) A married couple in their seventies who refuse to provide free child care for their grandchildren on a daily basis.: Ans: A Feedback: A growing number of grandparents have primary responsibility for the care of their grandchildren, a fact that can often be attributed to teen pregnancy, incarceration, or substance abuse. Divorce late in life, estrangement from grandchildren, and refusal to provide care are not noted to be phenomena. 4.4. A nurse who works on a palliative care unit has developed a strong partnership with the 77- year-old wife of a client who has recently died of lung cancer. The woman has expressed her fears around being a widow to the nurse. How can the nurse best respond? A) "You will likely find that once you are remarried the grief will subside and you will move on." B) "It's very normal to have these fears, but antidepressant medications can help immeasurably with this difficult transition." C) "Though it might not feel like it now, many women eventually find joy in new friendships and freedom after the death of a spouse." D) "It will be important, and healthy, for you to maintain roles and routines similar to before your spouse died.": Ans: C Feedback: Widows often find positive consequences of their status in time, often in the form of new relationships. Suggesting that the grief will subside after remarriage and encouraging the woman not to change would be inappropriate, as would specific recommendations for medication. 5.5. A primary care nurse has a long-standing relationship with a 63-year-old male client who is poised to retire. Place the following phases of the client's likely transition in the correct chronological order. Use all the options. A) A euphoric period involving testing of fantasies around retirement. B) Near phase, often accompanied by fantasy regarding the retirement role. C) Disenchantment phase D) Establishment of a stable and sustainable retirement role. E) Establishment of realistic and alternative sources of satisfaction during retirement.: Ans: B, A, C, E, D Feedback: The near phase of preretirement and the accompanying fantasy is often followed by a euphoric honeymoon phase. This can be followed by a disenchanting letdown, and a subsequent reorientation that results in eventual stability. 6.6. Nurse M is employed in an assisted living facility and is privy to many of the changes that accompany the aging process. An older female resident of the facility has expressed a fear that her decreased mobility will make her increasingly dependent on her daughter. How can the nurse best respond to the resident's concerns? A) "There are treatments and drugs that we can explore which might prevent this from happening." B) "This is a normal part of the aging process and you don't necessarily need to fear it." C) "Many older adults have similar concerns. We can work together to keep you independent as long as possible." D) "I'm sure this is very stressful for you, but it's fortunate that you are not experiencing severe pain or illness.": Ans: C Feedback: Answer C validates the client's concerns and expresses the possibility of addressing the issue without downplaying it or providing unrealistic promises. Answer A provides an unrealistic promise of prevention, while answers B and D downplay the severity and significance of the client's concerns. 7.7. Which of the following nursing interventions by practitioner in a long-term care facility are appropriate? Select all that apply. A) The nurse times laxative administration as to not interfere with social interaction. B) The nurse provides diuretics after, not before, recreation sessions. C) The client's need for and dosage of nighttime sedation is weighed in light of activities planned for the following morning. D) Analgesia is provided prior to physical activity but held before social activities.: Ans: A, B, C Feedback: A failure to provide adequate pain control is likely to interfere with older adults' social activity. The nursing actions in answers A, B, and C are all prudent in light of promoting social interaction. 8.8. The occupational therapist on a geriatric rehabilitation unit of a hospital has integrated a life review into a group therapy session. Which of the following statements best captures the nature of life review among older adults? A) A life review is associated with uncovering unresolved guilt and pain. B) A life review can help reflect on accomplishments but can also bring painful mistakes to light. C) A life review is a valuable diagnostic insight into personal health behaviors. D) A life review should be undertaken only with the supervision of qualified staff.: A) A life review is associated with uncovering unresolved guilt and pain. B) A life review can help reflect on accomplishments but can also bring painful mistakes to light. C) A life review is a valuable diagnostic insight into personal health behaviors. D) A life review should be undertaken only with the supervision of qualified staff. Ans: B Feedback: A life review can bring to light reflections on older adults' accomplishments but may also reveal profound disappointments and regrets. It should not be seen, however, as a purely negative experience. It is not viewed as a diagnostic tool and does not require special training. 9.9. Which of the following teaching points around the use of self-reflection with older adults is most accurate? A) Self-reflection is easier for older adults than for younger adults. B) Self-reflection is less effective for male elders than for females. C) Self-reflection often involves learning a process and is difficult for many people. D) Self-reflection is not normally possible with individuals who have cognitive deficits.: Ans: C Feedback: Self-reflection is a valuable tool for many older adults, but it does not occur easily or naturally for many people and is likely to require some teaching and guidance. It is not necessarily easier for older people or for women, and cognitive deficits do not preclude it. 10.10. Nurse S encourages older adult clients to engage in spiritual beliefs and practices that they are familiar with. How can this activity be best characterized? A) Spiritual concerns are less relevant than immediate physical and financial issues. B) Older adults raised in more religious times are more likely to spontaneously express their spirituality. C) Addressing clients' expressions of spirituality is beyond the scope of appropriate nursing. D) Spiritual expression can be useful in facilitating hope in older adults.: Ans: D Feedback: Spiritual expression is useful in fostering hope and is within the scope of nursing practice. Older adults are not necessarily more spontaneously spiritual nor is spirituality secondary to finances and physical health. 11.11. Various changes during the aging process demand multiple complex adjustments that require stamina, ability, and flexibility. In which stage of life do individuals experience the greatest number of simultaneous changes? A) Adolescence B) Young adulthood C) Middle age D) Old age: Ans: D Feedback: More simultaneous changes are experienced in old age than during any other period of life. 12.12. Mrs S is recently widowed. She worked at home as a full-time wife and mother throughout her adult life. She is now most likely to experience: A) A desire to obtain employment outside the home B) Relief at being freed from the responsibilities of childrearing C) A sense of loss of her established social roles D) An interest in meeting men her own age and remarrying: Ans: C Feedback: Unlike many of today's younger women, who may value employment and motherhood equally, the elderly women of today centered their lives on their families, from which they derived their sense of fulfillment. Having developed few roles from which to achieve satisfaction other than that of wife and mother, many of these women feel a void when their children are gone and their husbands die. 13.13. The emergence of today's nuclear family units has changed the roles and functions of family members in many ways. In counseling elders and their families, which of the following beliefs about aging should a nurse be aware as one of these ways? A) Children are expected to provide financial support for their aging parents B) Grandparents are spending more time with their grandchildren than ever before C) Older adults enjoy freedom from responsibility for their adult children's welfare D) Older parents and their children grow apart, seldom developing satisfying adult-to-adult relationships: Ans: C Feedback: Children are no longer expected to provide financially for their aging parents, and grandparenting— although important and satisfying—is a long-distance undertaking in families that live many miles apart. Today's parents do, however, often enjoy satisfying adult-to-adult relationships with their grown children. Today's parents are free from responsibilities for their adult children more than any generation before, and many actively enjoy that freedom in middle age and later life. 14.14. A group of young student nursing assistants is getting clinical experience at a nursing home. In her introductory meeting with this group, the supervising nurse determines that the students harbor some misconceptions about the elderly. Four of the students' comments are listed below. Three of them are misconceptions about the elderly. Which comment is true? A) Most old people are sick or disabled B) Most seniors have a private pension plan C) Senility comes with old age D) Old people are still interested in sex: Ans: D Feedback: Most old people are well, only a small minority are senile, and only a minority have income from a private pension plan. Many retain a healthy interest in sex. 15.15. A young couple are looking for a new home. They want to move into a neighborhood that has no elderly neighbors. Such ageism carries several consequences. By separating themselves from the elderly, the couple: A) Are less likely to see the similarities between themselves and older adults B) Will lose their insights into aging C) Will not experience the challenges of old age D) May have an easier time minimizing their socioeconomic challenges: Ans: A Feedback: Separation from the elderly means people are less likely to see the similarities between themselves and older adults. This separation leads to lack of understanding of the elderly and reduces the opportunities for the young to gain realistic insights into aging. 16.16. The children of an elderly resident at a nursing home are concerned that their parent is alone and lonely. A staff nurse can assure the family that the elderly should be allowed periods of solitude because such times: A) Are essential for reflecting, analyzing, and better understanding the dynamics of life B) Decrease loneliness, insecurity, and self-imposed isolation C) Help the elderly face the misfortunes of growing old D) Affect displays of anxiety, depression, and anorexia: Ans: A Feedback: Being alone and being lonely are not the same thing. Periods of isolation are essential at all ages for the reason listed in choice A. 17.17. Most older women become widows. Widows must adjust to the significant loss of loved ones and the new task of living alone. Studies show that most widows: A) Require short-term treatment for depression B) Adjust well, finding new friends, interests, and activities C) Turn to their still-married female friends for advice and support D) Move in with their adult children for a period of time: Ans: B Feedback: Most widows adjust well. The friendships of the past between married couples become less important, and friendships with other widows develop. Most widows successfully live alone, and relatively few require treatment for depression. 18.18. Gerontology instructors at City College of Nursing impress upon their students that gerontological nurses should be concerned with the welfare of both the current aged population and future ones. The best way nurses can help young and middle-aged adults prepare for their retirement is to promote: A) Meaningful leisure time activities B) Freedom from family responsibilities C) Achievement in a worthwhile occupation D) Maximal use of community health resources: Ans: A Feedback: Retirement is facilitated by learning how to use, appreciate, and gain satisfaction from leisure time throughout an employed lifetime. Occupational achievement may actually hinder a successful retirement if the work role proves difficult to abandon or replace. Although the use of community health resources and freedom from family responsibilities can contribute to a healthful old age, they are not the major sources of satisfaction to be cultivated earlier in life. 19.19. After an initial period of enthusiasm, Mr J feels disappointed with his retirement. He cannot afford to travel as much as he had dreamed, and arthritis limits his mobility. Mr J's nurse can help him most by assisting him in entering which phase of retirement? A) Stability, in which he accepts his limitations B) Termination, in which he resumes a productive work role C) Reorientation, in which he assesses alternative sources of satisfaction D) Disenchantment, in which his hidden depression can be openly diagnosed and treated: Ans: C Feedback: Mr J has passed through the honeymoon phase of his retirement and has entered the disenchantment phase. In this phase, the retiree feels let down, and depression may or may not be experienced. Mr J's nurse can help him take the next step into the reorientation phase, in which he develops a lifestyle that gives him satisfaction based on realistic choices. The stability phase may follow, although some retirees never achieve it. Termination is the end of retirement brought about by illness, disability, or a return to work. 20.20. Mr B, age 73, has a terminal illness. He has entered a nursing home, where he will reside until his death. Until age 70, he worked as a successful bank president and was an active community leader. His nurse should be alert for signs that he most resents his: A) Mortality B) Unemployment C) Family D) Dependency: Ans: D Feedback: The elderly often fear that their illness or disability may cause them to lose their independence. Becoming a burden to their families, being unable to meet the demands of daily living, and having to enter a nursing home are some of the fears associated with dependency. Physical pain from an illness may not be as intolerable as the dependency it causes. In Mr B's case, his rapid change from great independence to near total dependence may distress him more than family relationships, the loss of his work role, or his impending death. 21.21. Younger individuals know that they will not live forever, but their behaviors may indicate that they deny their mortality. One major indication of this denial is their failure to: A) Establish a financial plan for retirement B) Provide adequately for their family's health care needs C) Make a will and set up a burial plan D) Form strong relationships with family and friends: Ans: C Feedback: Those who deny old age fail to establish retirement plans. People fail to provide for health care needs for many reasons, and acceptance of mortality may or may not influence personal relationships. The major sign of denial of mortality is failure to make a will and make plans for death. 22.22. What is the best action a busy nurse can take to help with the desire of elderly clients to reminisce about their past lives? A) Refer clients to senior centers, where they can share their stories with others of their own age group B) Encourage the recording of stories through diaries and scrapbooks to be shared with younger family members C) Introduce older clients to members of local historical societies who can record their stories for posterity D) Look for ways to steer discussion toward health-promoting habits such as good exercise and adequate nutrition: Ans: B Feedback: It is always important to listen to the stories of seniors and to honor their life histories. Changing the subject is seldom appropriate, and although referrals to senior centers and historical societies may be beneficial in some cases, encouraging elders to record and share their stories with the younger generation is always a good idea. 23.23. In old age, the body's efficiency declines. Which of the following is a typical response to that decline? A) An attempt to push the body to perform physically at the same level as in the past B) A neglect of personal appearance and other hygiene practices C) A failure to restrict lifestyle choices in a health-appropriate way D) An expressed desire to enter a nursing home to receive daily care and assistance: Ans: A Feedback: Some seniors deny age-related changes and push themselves physically. Others invest in expensive beauty treatments that promise to subvert the aging process. Others go to the opposite extreme and overestimate their deficiencies, adopting an unnecessarily restrictive lifestyle. An expressed desire for greater dependency is rare. 24.24. The bodily changes that occur during the aging process can affect an older person's body image and self-concept. The nurse can gain insight into the emotional well-being and self- concept of older persons by: A) Uncovering any unresolved guilt and perceived failures B) Reviewing how they interpret and refine their past experiences C) Examining what roles they accept and what roles they reject D) Determining which work roles they forfeit: Ans: C Feedback: The way persons perceive themselves and function can determine the roles they play. And the roles they accept and reject are important indicators of their self-concepts. 25.25. A state health investigator surveyed the residents of a retirement housing complex to determine how their financial resources affected their lives and influenced their choices. Which of the following did the investigator most likely find to be true of most of the retired residents? A) Most older people depend on their life savings through their retirement years B) Inflation in the past decades increased retirement benefits for today's seniors C) Nearly three-quarters of all seniors are financially comfortable D) More than half of all seniors retire with only Social Security benefits: Ans: D Feedback: Only a minority of the older population has an income from a private pension plan. Few have significant savings, and inflation has decreased the value of their retirement funds. Of the workers who are currently active in the labor force, more than half will not have pension plans when they retire. [Show More]

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