Chapter 01: Introduction to Healthy Aging
Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 2nd Canadian Edition

MULTIPLE CHOICE

	1.	A man is terminally ill with end-stage prostate cancer. What is the best statement about this man’s wellness?
a.	Wellness is possible, even if the patient uses medication to assist in management of his medical care.	
b.	Wellness is unfortunately not a real option for the patient.	
c.	Wellness is the same thing as faith healing, and if the patient were more receptive, he could be back at work in a few weeks.	
d.	Nursing interventions can help empower a patient to achieve a higher level of wellness.	

ANS:	D

	Feedback	
A	Incorrect. An individual must work hard to achieve wellness, just as in a job.	
B	Incorrect. All persons, regardless of age or life–health situation, can be helped to achieve a higher level of wellness.	
C	Incorrect. Biomedical approaches and other treatments and techniques are used to achieve realistic improvements in wellness.	
D	Correct. A nurse can foster wellness at all levels of the needs hierarchy.	

DIF:	Application	REF:	8	OBJ:	2	
TOP:	NCLEX: Health Promotion and Maintenance

	2.	In differentiating between health and wellness in health care, which of the following statements is true?
a.	Health is a broad term encompassing attitudes and behaviours.	
b.	The concept of wellness was rarely or never considered by previous generations.	
c.	Wellness and self-actualization develop through learning and compromise.	
d.	It is impossible to have wellness when one’s health is compromised.	

ANS:	A

	Feedback	
A	Correct. Holistically, health includes wellness, which involves one’s whole being.	
B	Incorrect. Throughout history, basic self-care requirements have been recognized.	
C	Incorrect. As basic needs are met, higher level needs can be satisfied in turn, with ever-deepening richness to life.	
D	Incorrect. Even with chronic illness, with multiple disabilities, or in dying, movement toward higher wellness is possible.	

DIF:	Comprehension		REF:	4	OBJ:	2
TOP:	NCLEX: Health Promotion and Maintenance

	3.	Which province or territory is predicted to have the fastest growing older-person population in Canada between the years 2006 and 2031?
a.	Ontario	
b.	British Columbia	
c.	Yukon	
d.	Newfoundland	

ANS:	C

	Feedback	
A	Incorrect. As shown in Figure 1-1 in your text, the older-person population of Ontario does not rise as rapidly as the older-person population of Yukon between 2006 and 2031.	
B	Incorrect. As shown in Figure 1-1 in your text, the older-person population of British Columbia does not rise as rapidly as the older-person population of Yukon between 2006 and 2031.	
C	Correct. As shown in Figure 1-1 in your text, the older-person population of Yukon rises faster than any of the other provinces and territories between 2006 and 2031.	
D	Incorrect. As shown in Figure 1-1 in your text, the older-person population of Newfoundland does not rise as rapidly as the older-person population of Yukon between 2006 and 2031.	

DIF:	Knowledge	REF:	3 (Figure 1-1)			OBJ:	3
TOP:	NCLEX: Health Promotion and Maintenance

	4.	Historical influences that have shaped the lives of the majority of the middle-old in Canada today include which of the following?
a.	Influenza epidemic of 1918	
b.	Immigration from Communist Europe	
c.	Child-rearing during the Depression	
d.	World War II	

ANS:	D

	Feedback	
A	Incorrect. A person who survived the influenza epidemic would be at least 93 years old in 2011 and therefore be considered old-old, or centenarian.	
B	Incorrect. Those who are middle-old in 2011 were born between 1920 and 1930, before Communism swept Europe.	
C	Incorrect. Most of those who are middle-old in 2011 had not reached childbearing age by the end of the Depression.	
D	Correct. Those who are middle-old in 2011 were in their teens and twenties during the war; in particular, the men were very likely to have fought in it.	

DIF:	Comprehension		REF:	2	OBJ:	3
TOP:	NCLEX: Health Promotion and Maintenance

	5.	A nurse prepares for the arrival of older persons evacuated from a forest fire in northern Manitoba to a shelter for short-term care. Which of the following is the priority nursing intervention?
a.	Demonstrate that the staff is prepared to meet their needs.	
b.	Use individual medical records to develop a medication plan.	
c.	Help older persons to display family photos and memorabilia.	
d.	Help older persons to teach one another a new skill in the shelter.	

ANS:	B

	Feedback	
A	Incorrect. Providing safety and security from the fire is evident and implied, as the older persons have been evacuated from danger. The priority nursing intervention is caring for any health concerns; e.g., medication or treatments that were left behind.	
B	Correct. The nurse prepares for short-term care by prioritizing the needs of the older persons, and this intervention helps to maintain the therapeutic plan, thereby addressing the need for physiological integrity. Furthermore, the nurse maintains continuity of care by preparing a medication schedule to prevent missed doses of medication.	
C	Incorrect. In emergency conditions, the nurse provides basic care relating to safety, security, and physical well-being. Maintaining a sense of belonging is important, but not in emergency conditions.	
D	Incorrect. A state of emergency is not the time to develop self-esteem because meeting safety, security, and physical needs is more important.	

DIF:	Analysis	REF:	6-7	OBJ:	4	
TOP:	NCLEX: Safe and Effective Care Environment

	6.	According to researchers, which characteristic will most centenarians share in the future?
a.	Being female	
b.	Having dementia	
c.	Being malnourished	
d.	Being wheelchair-bound	

ANS:	A

	Feedback	
A	Correct. Researchers expect women to comprise the majority of centenarians in the future.	
B	Incorrect. Gerontologists expect dementia to be common among older persons, but they are not predicting most centenarians will have dementia.	
C	Incorrect. Malnutrition is common among older persons, but researchers have not predicted that most centenarians will be malnourished.	
D	Incorrect. Decreased mobility is common among older persons, but researchers have not predicted that most centenarians will be confined to a wheelchair.	

DIF:	Knowledge	REF:	2	OBJ:	3	
TOP:	NCLEX: Health Promotion and Maintenance

	7.	Which statement describes aging in developing countries?
a.	Many developing countries have historically had many members live to be centenarians.	
b.	The biggest problem for older persons will be lack of food.	
c.	Most of the world’s older persons are likely to reside in developing countries.	
d.	Like fertility, life expectancy is increasing, although at a different rate.	

ANS:	C

	Feedback	
A	Incorrect. Historically only 2% of the world’s population was defined as old.	
B	Incorrect. The biggest problem of the world’s oldest persons is most likely to be lack of regular income.	
C	Correct. Developing countries contain 62% of the world’s older persons already.	
D	Incorrect. Life expectancy is increasing, but fertility is decreasing worldwide.	

DIF:	Knowledge	REF:	4	OBJ:	3	
TOP:	NCLEX: Health Promotion and Wellness	

	8.	The nurse develops a community program to promote exercise for older persons. Which of the following should the nurse include in the exercise program?
a.	Reinforce the ease of exercising every day.	
b.	Use exercise to relax any dietary restrictions.	
c.	Describe ways to resume exercise after lapses.	
d.	Teach participants that exercise achieves wellness.	

ANS:	C

	Feedback	
A	Incorrect. The nurse tells the participants that achieving wellness takes work and regular effort. Instead of offering false hope, the nurse shares practical advice about how to incorporate exercise into everyday life.	
B	Incorrect. The nurse avoids suggesting that older persons can look forward to relaxing dietary or medical restrictions by using a single method because it is unethical to offer false hope, the plan can be ineffective, and the plan can have adverse effects.	
C	Correct. Because the path to wellness includes progression as well as regression, the nurse shares information to help participants anticipate these events. The nurse encourages participants by telling them to expect periods of regression, that progress made up to that point is not lost, and how to approach resumption in progress toward wellness with exercise.	
D	Incorrect. The nurse avoids instructing older persons to rely on one method of achieving wellness because wellness is achieved by balancing emotional, spiritual, social, cultural, and physical processes.	

DIF:	Application	REF:	7	OBJ:	4	
TOP:	NCLEX: Health Promotion and Maintenance

	9.	Determinants of health are the underlying causes of illness and wellness. Which of the following describes the older person who is likely to experience the best overall health and well-being?
a.	Resides in assisted-living facility, watches television alone, uses herbal remedies, is underweight	
b.	Resides alone, was moved to a new city recently by the family for their convenience, has osteoarthritis	
c.	Has prostate cancer with metastasis to the lungs, is receiving radiation therapy, is wealthy, has a large family	
d.	Uses a wheelchair, has peripheral arterial disease, attends weekly baseball games with three friends	

ANS:	D

	Feedback	
A	Incorrect. This older person is not thriving in an assisted-living facility, despite having other people in the facility, as evidenced by television viewing habits and weight, both potential indicators of depression. Various aspects of this person’s life are unbalanced, thus inhibiting progress on the path to optimal health and wellness. In addition, the use of herbal remedies can be aggravating or precipitating the problems.	
B	Incorrect. After a move to a new region, an older person, especially one who lives alone and is moved to a new area for the family’s convenience, is likely to experience loneliness and isolation until a new social network is established. Thus, although this person has a less-acute health problem, the social isolation is likely to create significant disruption on the path to health and wellness.	
C	Incorrect. Although this older person’s financial resources are plentiful, the existence of a large family does not ensure any type of psychosocial support. Most likely, this person faces a grim prognosis because the prostate cancer has crossed the diaphragm, thus reducing the likelihood of a prolonged life.	
D	Correct. Despite a serious chronic illness and mobility restrictions, this person has a social network and planned activities with friends. Further, this older person overcomes mobility issues to pursue personal interests; thus, this person is most likely to experience the best health and well-being because of an optimal functional status.	

DIF:	Analysis	REF:	6	OBJ:	4	
TOP:	NCLEX: Health Promotion and Maintenance

	10.	Which of the following nursing interventions represent a holistic approach to caring for an older person?
a.	Performs glucose testing during the weekly worship service	
b.	Wheels ambulatory adults to exercise when running late	
c.	Assigns female nurses to older female persons who are Muslim	
d.	Allows older persons in a nursing home to eat meals alone	

ANS:	C

	Feedback	
A	Incorrect. Interrupting an older person’s worship with glucose testing can be interpreted as a lack of respect for spiritual needs. The nurse can provide for and respect the physical and spiritual aspects of the older person’s life by testing for glucose before the service begins.	
B	Incorrect. In transporting the older persons to the exercise program in a wheelchair to save time, the nurse disregards the need for self-esteem and exercise, important aspects of physical well-being. Ambulatory older persons can walk, with assistance if needed, to exercise programs and benefit from the additional activity and independence.	
C	Correct. The nurse uses a holistic approach to the care of an older female person who is Muslim because the woman and her family are more likely to be willing participants in a therapeutic regimen that respects a tenet of their culture.	
D	Incorrect. The nurse can be tempted to allow an older person to eat meals alone in his or her room if this will motivate the person to eat or if the older person has dysphagia and is embarrassed. However, while focusing on physical needs, the nurse ignores psychosocial and other aspects of health and well-being.	

DIF:	Comprehension		REF:	4	OBJ:	4
TOP:	NCLEX: Health Promotion and Maintenance

	11.	An older-person male who resides in a nursing home has very high cholesterol levels. Which nursing intervention is most likely to assist this man in achieving his highest level of wellness?
a.	Instruct him about increasing dietary fibre.	
b.	Ask the health care provider for a low-fat diet.	
c.	Schedule a consultation for him with the dietitian.	
d.	Review a menu with him to choose suitable foods.	

ANS:	D

	Feedback	
A	Incorrect. Informing the older person about dietary fibre offers no control to the older person because he is not part of the decision. Nursing interventions developed with the older person’s collaboration are most likely to help him achieve health and wellness.	
B	Incorrect. Collaborating with the health care provider for a low-fat diet is a reasonable approach to help this man with dyslipidemia achieve health and wellness. However, the older person is more likely to have motivation and enthusiasm for a therapeutic regimen over which he has some control.	
C	Incorrect. This is a reasonable approach for an older person with dyslipidemia and is a part of a multifaceted approach to optimizing his health. However, he is more likely to engage in a regimen over which he has input.	
D	Correct. The nurse collaborates with the older person to choose suitable foods. This is likely to be an effective nursing intervention to help an older person with dyslipidemia achieve optimal health and well-being because it gives him some control over the regimen and thus engages him in the process of lowering serum cholesterol.	

DIF:	Analysis	REF:	7-8	OBJ:	2	
TOP:	NCLEX: Health Promotion and Maintenance

	12.	An older-person male living in an adult community becomes a widower one month after retirement. Two months later, he has not resumed a weekly outing with his fishing club. Which of the following should the nurse implement?
a.	Ask the older person why he is not fishing.	
b.	Have club members visit him at home.	
c.	Meet with him to assess his interests.	
d.	Enroll him in a weekly card game.	

ANS:	C

	Feedback	
A	Incorrect. The nurse avoids confronting the older person, even in a gentle manner. “Why” questions can be interpreted as confrontational, and the man may be unable or unwilling to articulate a reason.	
B	Incorrect. The nurse avoids asking club members to visit him because it removes the older person from the decision making. Although this effort can be well-meaning, it can be misinterpreted as an invasion of privacy.	
C	Correct. The nurse meets with the older person to determine how and when to establish new relationships and social activities in light of his wife’s death. Even though the man engaged in fishing beforehand, the nurse respects the older person’s wishes and needs as he transitions to a different life.	
D	Incorrect. The older person is much more likely to participate in an activity in which he has input. In addition, the nurse’s action can be misinterpreted as disrespectful because an adult has the right to control his own life.	

DIF:	Application	REF:	7-8	OBJ:	2	
TOP:	NCLEX: Psychosocial Integrity

	13.	The nurse plans activities for female older persons born between 1930 and 1940 who reside in an assisted-living facility. Which is the best intervention for the nurse to implement?
a.	Have them bake cookies twice a week.	
b.	Conduct interviews for specific interests.	
c.	Arrange dog and cat visits from volunteers.	
d.	Take them to the library for guest speakers.	

ANS:	B

	Feedback	
A	Incorrect. The nurse incorrectly presumes to know what activities they will enjoy because most of these women are in their 80s, and women born between 1930 and 1940 generally spent their lives as homemakers.	
B	Correct. The nurse conducts individual interviews with the older persons to determine their interests and avoids generalizing, because as people live longer, they become more and more unique.	
C	Incorrect. The nurse should avoid arranging group activities until individual interests are determined. In addition, the nurse must assess for allergies and individual fears of animals before exposing an older person to a pet visit.	
D	Incorrect. Unless it is done on a voluntary basis, the nurse should avoid arranging visits by guest speakers. In addition, the nurse assesses each older person before outside visits, to avoid embarrassing events related to incontinence and hearing and vision problems.	

DIF:	Analysis	REF:	8	OBJ:	1	
TOP:	NCLEX: Health Promotion and Maintenance

	14.	The nurse plans care for an older male adult who lives on Old Age Security pension and a small pension after retirement, and has type 2 diabetes mellitus. Which aspect of this man’s life should the nurse integrate into a positive approach to his health and well-being?
a.	He practises effective glucose control.	
b.	He lives alone in a high-rise apartment.	
c.	He lacks low-cost, reliable transportation.	
d.	He attends weekly lunches at his local diner.	

ANS:	A

	Feedback	
A	Correct. Practising effective glucose control demonstrates this man’s resilience and capacity to effectively manage the challenges associated with a chronic illness, and thus is a strength the nurse uses in a positive approach toward his health and well-being.	
B	Incorrect. Living alone is not ideal for an older person, especially one with diabetes, because of the potential for loneliness and complications from diabetes such as hypoglycemia. This is a negative aspect of this man’s life and one which has to be resolved for his safety and well-being.	
C	Incorrect. The nurse cannot include this man’s transportation issues into a positive plan because it is a problem to overcome, not a strength on which to capitalize.	
D	Incorrect. Going out to lunch is a positive approach to maintaining good mental health, although eating at a local diner may not be the best approach for controlling his diabetes mellitus.	

DIF:	Analysis	REF:	7-8	OBJ:	2	
TOP:	NCLEX: Health Promotion and Maintenance

	15.	Mrs. McCloud, 70 years old, lives in Attawapiskat and speaks mostly Cree. She is transferred to a hospital in a larger city in Ontario for hemodialysis. While Mrs. M. is in hospital, what should the nurse take into account when developing nursing interventions based on health promotion?
a.	Instruct the older person to monitor her fluid intake on an hourly basis.	
b.	Demonstrate, through pictures, how to eat a healthy, well-balanced diet.	
c.	Ask the older person about her home and how she accesses health care.	
d.	Ask the older person why she did not seek help sooner, to prevent the need for hemodialysis.	

ANS:	C

	Feedback	
A	Incorrect. The nurse avoids instructing older persons to monitor their own health, because patients are more likely to engage if they are asked if they are able or want to do so.	
B	Incorrect. Even though pictures might be a creative way to engage someone who speaks another language, in isolated communities it is often challenging and expensive to eat a healthy, well-balanced diet.	
C	Correct. When the nurse asks the older person about her home, the nurse creates a personal connection with the older person. Finding out about accessibility to health care is important, because services for older persons are limited in rural and remote regions.	
D	Incorrect. Asking clients “why” questions can be construed as measuring, evaluating, or confronting, and the older person may not be able to articulate a reason.	

DIF:	Analysis	REF:	7	OBJ:	4	
TOP:	NCLEX: Health Promotion and Maintenance

	16.	Mr. Levesque, 65 years old, has been living on the street and in homeless shelters for the last three years after having lost his job as a maintenance attendant at a local store. He suffers from alcoholism and appears malnourished upon arrival at the hospital, after falling on the sidewalk and injuring his left shoulder. When implementing a primary health care approach, what is the main principle the nurse should consider with this older person?
a.	Health promotion	
b.	Accessibility	
c.	Primary care	
d.	Public participation	

ANS:	A

	Feedback	
A	Correct. Health promotion is the process of enabling people to increase control over and improve their health. Health promotion addresses the determinants of health. It includes health education, public education, nutrition, sanitation, and prevention and control of diseases.	
B	Incorrect. Accessibility looks solely at access to health care services and how they can be made more accessible; arriving at hospital indicates that accessibility is not necessarily an issue for Mr. Levesque.	
C	Incorrect. Primary care is not a principle of primary health care. Primary care is the first contact people have with the health care system. Principles of primary health care include accessibility, public participation, health promotion, appropriate technology, and intersectoral collaboration.	
D	Incorrect. Public participation implies that older persons are active partners in making decisions about their health care and the health of their communities. It is difficult to determine if this patient is able to make decisions at this time about becoming an active participant in the health needs of the community.	

DIF:	Application	REF:	7	OBJ:	4	
TOP:	NCLEX: Health Promotion and Maintenance

	17.	To help meet the needs of an increasingly ethnoculturally diverse older-person population, which of the following should be done?
a.	Hire more male nurses.	
b.	Offer more second-language courses in nursing schools.	
c.	Provide more reading material in various languages.	
d.	Increase the number of health care providers from various cultures.	

ANS:	D

	Feedback	
A	Incorrect. Gender specific hiring would not address changes in ethnocultural needs.	
B	Incorrect. Offering courses in languages other than English would not ensure various cultural needs have been met.	
C	Incorrect. Reading materials are not often well utilized for teaching purposes and also would not serve to meet a variety of ethnocultural needs.	
D	Correct. Having more HCPs from various cultures would help address the variety of cultures represented in the older-person age group and increase understanding as well as comfort levels.	

DIF:	Knowledge	REF:	7	OBJ:	3	
TOP:	NCLEX: Safe and Effective Care Environment