Gerontological Nursing The Essential Guide to Clinical Practice, 2nd Edition by Patricia A. – Test Bank

 

 

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Sample Test

Chapter 3- Diversity

 

	Origin:  Chapter 3- Diversity, 1 Chapter:  3 Client Needs:  A1 Cognitive Level:  Comprehension Difficulty:  Moderate Integrated Process:  Nursing process Objective:  1 Page and Header:  24, Increasing Diversity of the Older Adult Population
1.	Which of the following projections of future demographics of older Americans is most accurate?
	A)	By 2020, more than 50% of older Americans will belong to a non-Hispanic white group.
	B)	The percentage of black older adults will decrease slightly due to lower life expectancies.
	C)	The number of Hispanic older adults is projected to grow dramatically.
	D)	Within 40 years, a minority of older Americans will be white related to immigration.
	Ans:	C
	Feedback:
	Whereas in 2000, approximately 84% of older Americans were non-Hispanic white, it is projected that this population will decrease to 64% by 2050. During this same period, there will be dramatic growth among Hispanic older adults, who will represent 16% of the older population. Black individuals will grow from 8% to 12% of the older population during this time. By 2020, one-quarter of America’s older population will belong to a minority racial or ethnic group.

 

 

	Origin:  Chapter 3- Diversity, 2 Chapter:  3 Client Needs:  C Cognitive Level:  Comprehension Difficulty:  Easy Integrated Process:  Nursing process Objective:  2 Page and Header:  25, Hispanic Americans
2.	A nurse is providing care for an 81-year-old Hispanic woman in the context of a geriatric medicine unit of a hospital. Which of the following phenomena should the nurse anticipate?
	A)	The client’s family is likely to advocate for her placement in a nursing home at an early stage.
	B)	The client is likely to prioritize the role of spirituality in the healing process.
	C)	She is likely to forego medical or traditional treatment due to a fatalistic view of health and illness.
	D)	The woman’s family will most likely delegate responsibility for her care to the hospital care team.
	Ans:	B
	Feedback:
	Hispanic elders often emphasize the role of spirituality in both the etiology and treatment of disease. Nursing home admissions are proportionately low and while health and illness are often seen as the actions of God, this does not translate into a rejection of treatment. The family is likely to play a central role in care planning and recovery.

 

 

	Origin:  Chapter 3- Diversity, 3 Chapter:  3 Client Needs:  B Cognitive Level:  Application Difficulty:  Moderate Integrated Process:  Nursing process Objective:  2 Page and Header:  26, Black Americans
3.	A nurse who works in an inner-city clinic provides care for a large number of the older black clients. Which of the following health promotion activities best reflects the particular health needs of this population?
	A)	A blood sugar and blood pressure monitoring program.
	B)	An education session on the positive health effects of good nutrition.
	C)	A screening mammography campaign for older black women.
	D)	A program that teaches black men the importance of prostate health screening.
	Ans:	A
	Feedback:
	Diabetes and hypertension are disproportionately prevalent among black American elders. While teaching on nutrition and breast cancer and prostate screening may be beneficial, these are not linked to the particular health needs of this population.

 

 

	Origin:  Chapter 3- Diversity, 4 Chapter:  3 Client Needs:  D1 Cognitive Level:  Application Difficulty:  Moderate Integrated Process:  Nursing process Objective:  3 Page and Header:  26, Black Americans
4.	Nurse Y works in the emergency department of a large, urban hospital. When assessing the following older black adults who have recently presented to the department, which of the following assessments would the nurse want to modify for this population?
	A)	Assessment of the strength and gait of an 80-year-old male client with a history of failure to thrive.
	B)	Assessment of peripheral sensation in a 76-year-old male client with poorly controlled diabetes mellitus.
	C)	Assessment of cyanosis in a 78-year-old female with peripheral vascular disease and Raynaud disease.
	D)	Assessment of a client’s chest pain who has a history of myocardial infarction.
	Ans:	C
	Feedback:
	Assessment of cyanosis can be complicated by the high melanin content of black adults’ skin. Musculoskeletal assessment, assessment of sensation, and assessment of chest pain would not necessitate modification.

 

 

	Origin:  Chapter 3- Diversity, 5 Chapter:  3 Client Needs:  D1 Cognitive Level:  Comprehension Difficulty:  Moderate Integrated Process:  Nursing process Objective:  2 Page and Header:  27, Chinese Americans
5.	A nurse is assessing an 84-year-old female Chinese American’s pain following her left hemiarthroplasty 2 days prior. Which of the following characteristics of Chinese Americans should the nurse be aware of during this assessment?
	A)	Chinese Americans often view pain as a virtue and tend to underreport it.
	B)	Chinese Americans have a fatalistic view of pain and see analgesia as inappropriate and undeserved.
	C)	Chinese women often overstate their pain in light of health care providers’ reluctance to provide analgesia.
	D)	There is often a reluctance to acknowledge pain among older Chinese Americans.
	Ans:	D
	Feedback:
	Discomfort is not typically aggressively or openly displayed by Chinese persons. Pain is not noted to be seen as a virtue or in a fatalistic light. Pain is not commonly overstated.

 

 

	Origin:  Chapter 3- Diversity, 6 Chapter:  3 Client Needs:  C Cognitive Level:  Analysis Difficulty:  Moderate Integrated Process:  Nursing process Objective:  2 Page and Header:  29, Jewish Americans
6.	Which of the following interventions in the care that preceded the death of a female, Jewish older American was most likely to have warranted special consideration?
	A)	The client required transfusions of packed red blood cells during her care.
	B)	Assessment by a male physician was required.
	C)	An autopsy was ordered due to the client’s unique disease etiology.
	D)	A do-not-resuscitate (DNR) order was recommended by the care team when the client’s disease progressed.
	Ans:	C
	Feedback:
	Autopsy is often opposed in the context of Jewish religious and cultural beliefs. Blood transfusions, assessment by a physician of the opposite sex, and DNR orders are not noted to be particular issues in the context of this culture.

 

 

	Origin:  Chapter 3- Diversity, 7 Chapter:  3 Client Needs:  A1 Cognitive Level:  Application Difficulty:  Moderate Integrated Process:  Nursing process Objective:  2 Page and Header:  29, Native Americans
7.	A nurse is being orientated to his new position in a community adjacent to a large Indian reservation. Which of the nurse’s following statements indicates a sound understanding of the Native American population with whom he will work?
	A)	“I suppose that we will see a disproportionately high number of clients with lung and oral cancers.”
	B)	“The high prevalence of diabetes and hypertension mean that strokes are likely to be relatively frequent in the area.”
	C)	“It’s unfortunate that many of the older Native Americans are unlikely to have family members involved their care.”
	D)	“The unique skin pigmentation of Native Americans means that I’ll have to modify my assessment techniques.”
	Ans:	B
	Feedback:
	Diabetes, hypertension, and CVA are all higher than average in Native American adults. Lung and oral cancers are not noted to have a higher prevalence and family is likely to be involved in the care of these elders. The skin tone of Native Americans is not noted to require particular assessment techniques.

 

 

	Origin:  Chapter 3- Diversity, 8 Chapter:  3 Client Needs:  C Cognitive Level:  Analysis Difficulty:  Moderate Integrated Process:  Nursing process Objective:  3 Page and Header:  31, Nursing Considerations for Culturally Sensitive Care of Older Adults
8.	Which of the following statements by a nurse who provides care in an assisted living facility best conveys cultural sensitivity?
	A)	“We need to ensure that both minorities and Americans have their health needs met.”
	B)	“It’s important to remember that minority groups do not usually express their pain explicitly.”
	C)	“We need to build our knowledge of residents who belong to cultural and ethnic groups that we’re not familiar with.”
	D)	“We need to teach Hispanic and Native American residents that their health problems are necessarily the result of punishment.”
	Ans:	C
	Feedback:
	Building a knowledge base around cultural groups is a component of culturally sensitive care. Differentiating between “minorities” and “Americans” is an inaccurate dichotomy and it is inaccurate to generalize that all minorities are reticent to express pain. It would be inappropriate to counter an older adult’s perception of the cause of illness when it is culturally rooted.

 

 

	Origin:  Chapter 3- Diversity, 9 Chapter:  3 Client Needs:  A1 Cognitive Level:  Analysis Difficulty:  Easy Integrated Process:  Nursing process Objective:  2 Page and Header:  29, Native Americans
9.	Which of the following contexts would be most appropriate for a screening program for high blood pressure?
	A)	A seniors’ group that is based at a Jewish community center in Brooklyn.
	B)	An Indian reservation in rural, Western Oklahoma.
	C)	A predominantly Chinese-American neighborhood in the San Francisco Bay area.
	D)	A minimum security prison serving young, rehabilitating offenders.
	Ans:	B
	Feedback:
	Hypertension is disproportionately high among Native Americans. This is not noted to be the case among Jewish Americans, prisoners, or Americans of Chinese ancestry.

 

 

	Origin:  Chapter 3- Diversity, 10 Chapter:  3 Client Needs:  C Cognitive Level:  Comprehension Difficulty:  Moderate Integrated Process:  Nursing process Objective:  3 Page and Header:  31, Nursing Considerations for Culturally Sensitive Care of Older Adults
10.	Nursing students attending City College of Nursing are scheduled for clinical experience at facilities in various sections of the city. Their experience will expose them to a wide variety of populations. Which of the following is a major reason why nurses need to understand the general characteristics of various ethnic groups?
	A)	To ensure that clients get the respect customary in their own ethnic group
	B)	To provide individualized and culturally sensitive care
	C)	To ensure that medical treatments comply with cultural expectations
	D)	To increase compliance among minority patients
	Ans:	B
	Feedback:
	To understand the uniqueness of each older adult encountered, consideration must be given to the influences of ethnic origin.

 

 

	Origin:  Chapter 3- Diversity, 11 Chapter:  3 Client Needs:  B Cognitive Level:  Knowledge Difficulty:  Easy Integrated Process:  Nursing process Objective:  2 Page and Header:  26, Black Americans
11.	According to statistics, Baby J, born to a black American couple, has a life expectancy lower than that of Baby K, born to a white American couple. According to current demographic projections, by the seventh decade of life, Baby J’s life expectancy will:
	A)	Begin to equal that of similarly aged white elders
	B)	Exceed that of similarly aged Asian elders
	C)	Drop to less than half that of similarly aged Native American elders
	D)	Rise above that of white elders until age 75 and then drop
	Ans:	A
	Feedback:
	After reaching the seventh decade of life, black Americans can hope to enjoy a life expectancy equal to that of their white cohorts.

 

 

	Origin:  Chapter 3- Diversity, 12 Chapter:  3 Client Needs:  B Cognitive Level:  Comprehension Difficulty:  Moderate Integrated Process:  Nursing process Objective:  2 Page and Header:  26, Black Americans
12.	Although only 12% of elderly black Americans experience institutional care in their lifetimes, compared with 23% of elderly white Americans, they typically possess more health problems than their white counterparts. This difference in health status is most likely due to:
	A)	High incidence of violent crime and sexually transmitted diseases
	B)	Reliance on family for health care advice and rejection of formal service agencies
	C)	Cultural preference for unconventional medical treatments like spiritual and herbal remedies
	D)	Lower standard of living and less access to health care services
	Ans:	D
	Feedback:
	Black elders historically possess many health problems that have accumulated over a lifetime due to a poor standard of living and limited access to health care services. Although the other choices may apply to this population, they are not the major reasons for the diminished health status of many black elders.

 

 

	Origin:  Chapter 3- Diversity, 13 Chapter:  2 Client Needs:  D4 Cognitive Level:  Application Difficulty:  Moderate Integrated Process:  Nursing process Objective:  3 Page and Header:  26, Black Americans
13.	Riverdale has a small budget for community health programs aimed specifically toward its African American population. Nurse G advocates free blood pressure screening in supermarkets and shopping malls in this town because:
	A)	Many causes of morbidity and mortality among black Americans cannot be effectively controlled through lifestyle modifications
	B)	Black Americans have a higher incidence of cancer and diabetes than white Americans
	C)	Hypertension and heart disease occur at a higher rate in the black population than in the white population
	D)	Black persons experience a heightened nocturnal response that lowers blood pressure to dangerous lows during sleep
	Ans:	C
	Feedback:
	The black population has a higher prevalence of heart disease than the white population, and hypertension occurs at a higher rate. A contributing factor is a blunted nocturnal response, in which only a minor decline occurs during sleep. Even though it is true that black persons have a higher incidence of cancer and diabetes than white persons, blood pressure screening does not address those disorders. Lifestyle modifications can effectively control many causes of morbidity and mortality among all people.

 

 

	Origin:  Chapter 3- Diversity, 14 Chapter:  3 Client Needs:  C Cognitive Level:  Knowledge Difficulty:  Moderate Integrated Process:  Nursing process Objective:  2 Page and Header:  29, Native Americans
14.	Nurse A works with Native American patients at a reservation health care center. She advises a new staff member to be especially observant of these patients and tolerant of their health care requests because Native American patients:
	A)	May demand special rituals during sickness and at death
	B)	Use services from agencies as a last resort because such assistance conflicts with their belief in the Great Creator
	C)	Link the typical nursing assessment process to evil forces or to punishment
	D)	Show their absence of feeling, caring, or discomfort by appearing calm and controlled
	Ans:	A
	Feedback:
	Spiritual rituals, medicine men, herbs, homemade drugs, and mechanical interventions can be used by Native American people to treat illness. Treatment does not necessarily conflict with belief in a Great Creator and the nursing assessment process is not linked to punishment. Feeling and care are not absent among Native Americans.

 

 

	Origin:  Chapter 3- Diversity, 15 Chapter:  3 Client Needs:  D4 Cognitive Level:  Comprehension Difficulty:  Easy Integrated Process:  Nursing process Objective:  2 Page and Header:  29, Native Americans
15.	A government study investigated the incidence of diseases and their probable causes in elderly Native Americans as compared with all elderly Americans. Study results showed that Native American seniors have twice the incidence of which of the following diseases?
	A)	Arthritis
	B)	Cancer
	C)	Heart disease
	D)	Diabetes
	Ans:	D
	Feedback:
	Diabetes, a disease uncommon among American Indians at the start of the 20th century, now affects about one in five older American Indians (compared with one in ten of all elderly Americans).

 

 

	Origin:  Chapter 3- Diversity, 16 Chapter:  3 Client Needs:  C Cognitive Level:  Knowledge Difficulty:  Easy Integrated Process:  Nursing process Objective:  2 Page and Header:  29, Jewish Americans
16.	Rehabilitation Health Facility has a high percentage of Jewish patients recovering from a variety of ailments. Which of the following is important for the facility’s staff to know about medical care and the Jewish culture?
	A)	Pork and shellfish but not milk products are recommended as healthful foods in the diet.
	B)	A rabbi must be consulted before any health-related decisions can be made.
	C)	A skullcap and socks must be worn from sundown Friday to sundown Saturday.
	D)	Modern medical care is encouraged but may be opposed during the Sabbath.
	Ans:	D
	Feedback:
	In the Jewish culture, medical care is encouraged but may be opposed during the Sabbath. Exceptions may be made for the seriously ill. The other choices are not true of the Jewish culture.

 

 

	Origin:  Chapter 3- Diversity, 17 Chapter:  3 Client Needs:  A1 Cognitive Level:  Application Difficulty:  Difficult Integrated Process:  Nursing process Objective:  2 Page and Header:  27, Chinese Americans
17.	Mrs C brings her elderly Chinese grandmother to the health clinic. When Grandmother C finds out that all the clinic physicians on duty are males, she appears embarrassed and becomes quiet and withdrawn. All the office staff were schooled in traditional Western medicine. Of the following suggestions, which best describes what the staff can do to put Grandmother C more at ease about receiving health care?
	A)	Have the physician use his senses rather than machinery or invasive procedures to assess Grandmother C’s medical problem
	B)	Show Grandmother C a picture of the human body and have her point to the area of her problem
	C)	Observe Grandmother C more closely and ask specific questions
	D)	Tell Grandmother C that being seen for treatment by a physician of either gender will put her yin and yang back in balance
	Ans:	C
	Feedback:
	Chinese women may be embarrassed to receive health care from a man. Nurses should observe more closely and ask specific questions to ensure that the quiet nature of the patient is not misinterpreted to imply that no problems exist. It would be disingenuous to tell her that receiving care would right her yin and yang, and close observation and questioning would be preferable to simply asking her to point to the problematic area on a picture.

 

 

	Origin:  Chapter 3- Diversity, 18 Chapter:  3 Client Needs:  A1 Cognitive Level:  Knowledge Difficulty:  Moderate Integrated Process:  Nursing process Objective:  2 Page and Header:  27, Chinese Americans
18.	A statistical analysis of City Health Clinic’s patient base shows that few of its patients are elderly Asian Americans. Nurse K, a second-generation Asian American, offers a probable cause for this phenomenon. She knows that Asian American groups, though different from each other:
	A)	Value a strong family network and expect that family members will care for their elders at home
	B)	Subscribe to traditional health practices and reject modern technology
	C)	Do not express their feelings openly or challenge the health professional
	D)	Have preserved many of their homeland traditions and tend to live in isolated pockets
	Ans:	A
	Feedback:
	Although differences among various Asian American groups exist, two similarities are strong family networks and the expectation that family members will care for their elders at home. They do not necessarily reject modern technology and neither reluctance to express feelings nor the tendency to preserve traditions would account for the phenomenon noted.

 

 

	Origin:  Chapter 3- Diversity, 19 Chapter:  3 Client Needs:  C Cognitive Level:  Analysis Difficulty:  Difficult Integrated Process:  Nursing process Objective:  2 Page and Header:  29, Native Americans
19.	When talking with elderly Native Americans and Asian Americans, it is important for gerontological nurses to recognize that:
	A)	Both cultures are in the process of replacing traditional values with modern medicine
	B)	These clients may be reluctant to express their thoughts and feelings openly
	C)	Ritualistic and spiritual healing methods are preferred over modern medical services
	D)	These clients expect to be treated and cared for by family members exclusively.
	Ans:	B
	Feedback:
	In both cultures, traditional attitudes and values persist, although both are willing to accept mainstream medical services in the United States. Ritualistic and spiritual methods may be employed, but they are not necessarily preferred. Family ties are strong, but home care is not necessarily expected. What these groups share is their reticence to reveal personal information to strangers or to speak openly about their health or family problems.

 

 

	Origin:  Chapter 3- Diversity, 20 Chapter:  3 Client Needs:  C Cognitive Level:  Knowledge Difficulty:  Easy Integrated Process:  Nursing process Objective:  2 Page and Header:  25, Hispanic Americans
20.	To receive government money, County Hospital is required to provide demographic statistics on its patient base. In checking off the Ethnic Group boxes on the obligatory forms, office workers must be able to distinguish terminology. Which of the following best defines the term Hispanic?
	A)	Immigrant workers who entered the United States and their descendants
	B)	Puerto Ricans who emigrated from the United States and their descendants
	C)	Any Spanish-speaking people living in the United States
	D)	Illegal immigrants from Spain, Mexico, Puerto Rico, and Brazil
	Ans:	C
	Feedback:
	The term Hispanic encompasses a variety of Spanish-speaking persons in America, including Spaniards, Cubans, Mexicans, and Puerto Ricans. Hispanic people now represent approximately 6% of the older population.

 

 

	Origin:  Chapter 3- Diversity, 21 Chapter:  2 Client Needs:  C Cognitive Level:  Application Difficulty:  Moderate Integrated Process:  Nursing process Objective:  3 Page and Header:  31, Nursing Considerations for Culturally Sensitive Care of Older Adults
21.	Which of the following is the most direct way for nurses to accommodate ethnic diversity among their clients?
	A)	Explain how scientific research evidence supports medical treatment
	B)	Provide standardized diets that meet patients’ nutritional needs
	C)	Listen to the life stories of elderly patients
	D)	Take a foreign language class or travel abroad
	Ans:	C
	Feedback:
	Although the research base underlying treatments may be important to some patients, relating it does not help the nurse understand or address ethnic diversity among patients. Standardized diets ignore patients’ food choice preferences, which are often culturally related. Although travel and language study may broaden a nurse’s appreciation for other cultures, the most direct step is to value and respect the life stories that patients share.

 

 

	Origin:  Chapter 3- Diversity, 22 Chapter:  3 Client Needs:  B Cognitive Level:  Comprehension Difficulty:  Moderate Integrated Process:  Nursing process Objective:  3 Page and Header:  26, Black Americans
22.	Some health conditions are more prevalent in the black population than in the white population. It is important that nurses pay particular attention to identifying those health conditions. Which of the following health assessments and reasons is the most important in working with black patients?
	A)	Control their lifestyle changes because of a lower life expectancy
	B)	Monitor their blood pressure because of a blunted nocturnal response
	C)	Examine their buccal mucosa because black skin color can complicate the use of skin color for assessment of health problems
	D)	Monitor for HIV/AIDS as this is a leading cause of death among African Americans
	Ans:	B
	Feedback:
	Hypertension is the most prevalent health problem among black Americans, and a blunted nocturnal response is one factor responsible for this problem. The serious consequences of high blood pressure would supersede the alterations in skin assessment, and highlighting test results and controlling lifestyle changes would be inappropriate actions.

 

 

	Origin:  Chapter 3- Diversity, 23 Chapter:  3 Client Needs:  C Cognitive Level:  Analysis Difficulty:  Difficult Integrated Process:  Communication Objective:  3 Page and Header:  31, Nursing Considerations for Culturally Sensitive Care of Older Adults
23.	An elderly Chinese patient tells the nurse that blockage of qi in one of her meridians is causing her severe headaches. Her doctor has diagnosed migraines and has prescribed a triptan drug. The nurse’s best course of action is to:
	A)	Suggest that the prescribed medicine may stimulate the flow of qi
	B)	Explain the vasoconstrictive and serotonin-moderating action of triptan
	C)	Recommend acupuncture or acupressure treatments as an adjunct to the triptan
	D)	Caution her that her headaches will grow worse if she fails to take her medication
	Ans:	A
	Feedback:
	Although explaining the scientific principles underlying drug action is often appropriate, the same objective can be achieved through the use of culturally relevant terms and concepts. Recommending additional treatments is unnecessary and may be inappropriate. Threats or predictions of dire consequences may impede the communication process.

 

	Origin:  Chapter 4- Life Transitions and Story, 1 Chapter:  4 Client Needs:  C Cognitive Level:  Analysis Difficulty:  Moderate Integrated Process:  Teaching/learning Objective:  1 Page and Header:  36, Ageism
1.	A nurse manager at a long-term care facility is engaged in efforts to change 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.

 

 

	Origin:  Chapter 4- Life Transitions and Story, 2 Chapter:  4 Client Needs:  C Cognitive Level:  Analysis Difficulty:  Moderate Integrated Process:  Nursing process Objective:  2 Page and Header:  37, Parenting
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.

 

 

	Origin:  Chapter 4- Life Transitions and Story, 3 Chapter:  4 Client Needs:  C Cognitive Level:  Analysis Difficulty:  Moderate Integrated Process:  Nursing process Objective:  2 Page and Header:  37, Grandparenting
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.

 

 

	Origin:  Chapter 4- Life Transitions and Story, 4 Chapter:  4 Client Needs:  C Cognitive Level:  Application Difficulty:  Moderate Integrated Process:  Nursing process Objective:  3 Page and Header:  39, Loss of Spouse
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.

 

 

	Origin:  Chapter 4- Life Transitions and Story, 5 Chapter:  4 Client Needs:  C Cognitive Level:  Comprehension Difficulty:  Moderate Integrated Process:  Nursing process Objective:  4 Page and Header:  40, Loss of the Work Role
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.