Chapter 01: Gerontological Nursing and Promotion of Healthy Aging
Touhy: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 6th Edition

MULTIPLE CHOICE

	1.	Which statement best relates information regarding characteristics of acute care for the elderly (ACE) units?
a.	They are seldom a part of a hospital facility.	
b.	They facilitate admission to nursing home situations. Association (ANA) offered a certification program.	
c.	They support promotion of health and support for maximal independence.	
d.	Their purpose is to rehabilitate any hospital incurred functional disability.	

ANS:	C
ACE units are distinct areas of a hospital specifically designed to reduce the incidence of functional disability of older adults occurring during hospitalization for acute medical illness by proactively identifying and managing geriatric syndromes to help maintain the patient’s function, reducing admission to nursing homes, and lowering the cost of hospitalizations.

PTS:	1	DIF:	Remember	REF:	6	
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:	1	DIF:	Remember	REF:	3 | 4	
TOP:	Nursing Process: Assessment	MSC:	Health Promotion and Maintenance

	3.	Which statement accurately describes 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.	The Hartford Foundation has funded significant work regarding the specialty of gerontological nursing.	
d.	Accreditation of a nursing program guarantees that appropriate amounts of gerontological nursing content are included in the curriculum.	

ANS:	C
The most significant influence in enhancing the specialty of gerontological nursing has been the work of The Hartford Institute for Geriatric Nursing, established in 1996 and funded by the John A. Hartford Foundation. 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:	3	TOP:	Teaching/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 since the older population is healthier.	
d.	Older adults expect their quality of life to be less than that of earlier generations at their ages.	

ANS:	B
Gerontological nursing will be the most needed specialty in nursing as the number of older adults continues to increase and the need for our specialized knowledge becomes even more critical in every specialty and every health care setting. 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 over the age of 60 years than those under 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:	1	DIF:	Remember	REF:	4 | 5	
TOP:	Nursing Process: Assessment	MSC:	Health Promotion and Maintenance

	5.	What is the primary purpose of geriatric nursing certifications?
a.	Assuring the basic competency of the geriatric nurse	
b.	Raising the level of professionalism for the geriatric facility	
c.	Addressing the current shortage of specialized geriatric nurses	
d.	Demonstrating commitment to the special needs of the geriatric client	

ANS:	D
Certification assures the public of nurses’ commitment to specialized education and qualification for the care of older adults. None of the other options accurately identify the primary purpose of geriatric nursing certification.

PTS:	1	DIF:	Remember	REF:	10 | 11	TOP:	Teaching/Learning
MSC:	Safe, Effective Care Environment

	6.	An older adult client 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 hospice?
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 clients, 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:	1	DIF:	Apply	REF:	9	
TOP:	Nursing Process: Implementation	MSC:	Safe, Effective Care Environment

	7.	A nursing home executive interviews RNs to fill a full-time position for direct client care to maintain the standards of elder care. Which nurse should the nursing home hire?
a.	Nurse from a certified college	
b.	Certified gerontological nurse	
c.	Nurse with 15 years of experience	
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:	1	DIF:	Apply	REF:	9	
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:	5	TOP:	Nursing Process: Diagnosis
MSC:	Health Promotion and Maintenance		

	9.	The gerontological nurse collaborates with the wound care team about an older client 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 elder care 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 client in wound care.

PTS:	1	DIF:	Apply	REF:	5	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 US 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:	1	DIF:	Remember	REF:	3	
TOP:	Nursing Process: Assessment	MSC:	Safe, Effective Care Environment

	11.	Which of the following statements is true about the National Hartford Centers of Gerontological Nursing Excellence 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 offers a Distinguished Educator in Gerontological Nursing Program.	
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 National Hartford Center of Gerontological Nursing Excellence offers a Distinguished Educator in Gerontological Nursing Program. Sigma Theta Tau’s Center for Nursing Excellence in Long-Term Care sponsors the Geriatric Nursing Leadership Academy (GNLA) 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:	1	DIF:	Remember	REF:	3	
TOP:	Nursing Process: Implementation	MSC:	Safe, Effective Care Environment

	12.	What is one of the goals of Nurses Improving Care for Health System Elders-Long Term Care (NICHE-LTC)?
a.	To insure 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 and older.	
d.	To promote the role of the Geriatric Certified Nursing Assistant.	

ANS:	D
The vision of NICHE is for all clients 65 and over to be given sensitive and exemplary care.

PTS:	1	DIF:	Remember	REF:	7 | 9	
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 client 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:	11	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 client 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 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:	1	DIF:	Remember	REF:	2 | 3	
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 AACN 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 prior to 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:	1	DIF:	Remember	REF:	4	
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
Gerontological Society of America, American Society on Aging, and Association of Gerontology in Higher Education are all interdisciplinary organizations. National Gerontological Nurses Association and National Association Directors of Nursing Administration in Long Term Care are nursing organizations.

PTS:	1	DIF:	Remember	REF:	4	
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:	1	DIF:	Remember	REF:	7	
TOP:	Nursing Process: Implementation	MSC:	Safe, Effective Care Environment