The nurse is reviewing the care plan of an 89 yr old client who has been admitted for prostate surgery. The client is on medication for hypertension and had a recent fall at home prior to admission. The nurse would include which assessment in the care plan?

Correct Answer: B

Rationale: The correct answer is B. Checking postural blood pressures is essential to assess for orthostatic hypotension in an elderly client with a history of falls and hypertension medication. Orthostatic hypotension can lead to falls, so monitoring postural B/Ps is crucial. Checking B/P every 2 hours (choice A) is not necessary and could cause unnecessary discomfort to the client. Checking serum sodium levels (choice C) and serum creatinine levels (choice D) are not directly related to the client's risk factors for falls post-prostate surgery.

Correct Answer: A

Rationale: Holistic nursing is the correct answer because it considers the physical, emotional, social, and spiritual aspects of an individual's life in the care plan. It emphasizes treating the whole person rather than just the symptoms. Healthy People 2020 focuses on improving the overall health of the population. Maslow's hierarchy of needs prioritizes basic human needs. Orem's self-care requirements focus on the individual's ability to care for themselves. Holistic nursing is the only approach that integrates and balances all aspects of an individual's life into the care plan, making it the most comprehensive and patient-centered approach.

Correct Answer: C

Rationale: The correct answer is C: Medications and polypharmacy. In older adults, incontinence is commonly caused by medications that affect bladder control, such as diuretics, sedatives, and anticholinergics. Polypharmacy can worsen this by increasing the likelihood of drug interactions. Chronic urinary tract infections (A) can cause incontinence but are less common in older adults. Neurological disorders (B) like dementia or stroke can also lead to incontinence but are not the most common cause. Poor hydration (D) can exacerbate incontinence but is not the primary cause.

Correct Answer: B

Rationale: The correct answer is B: Cognitive decline or dementia. Elder abuse risk assessment in gerontological nursing involves considering cognitive decline or dementia as the most important factor. This is because individuals with cognitive impairments are more vulnerable and may have difficulty recognizing and reporting abuse. Family history of violence (A), history of physical ailments (C), and medication regimen (D) are important factors to consider but do not directly impact the elder abuse risk assessment as significantly as cognitive decline or dementia.

Correct Answer: A, B

Rationale: Step-by-step rationale: 1. Cultural awareness is crucial for understanding one's own biases and recognizing cultural differences. 2. Cultural knowledge involves understanding diverse cultural practices, beliefs, and values. 3. Cultural skills refer to the ability to effectively communicate and adapt care to meet individual cultural needs. 4. Cultural connections, while important, do not directly relate to providing culturally competent care. In summary, A and B are correct as they form the foundation for providing culturally competent care, while C and D do not encompass all aspects necessary for culturally competent care.

Correct Answer: A

Rationale: The correct answer is A: The National Gerontological Nursing Association (NGNA). NGNA welcomes nurses from all educational backgrounds, focusing on gerontological nursing practice. The other choices have specific focuses: B is for nurse practitioners, C is for directors of nursing administration, and D is for professionals in the field of aging. NGNA's inclusivity makes it the correct choice for nurses from all educational backgrounds interested in gerontological nursing.

Correct Answer: A

Rationale: The correct answer is A: Role theory. Role theory suggests that individuals continue to seek fulfilling roles and activities in older age to maintain a sense of purpose and identity. In this scenario, the older woman's transition from a career as a school principal to volunteering at the library aligns with the idea of seeking meaningful roles. B: Disengagement theory posits that older adults withdraw from society as they age, which contradicts the woman's active engagement in volunteering. C: Age-stratification theory focuses on how age influences opportunities and constraints within society, not on individual choices like volunteering. D: Social exchange theory emphasizes reciprocal relationships and benefits gained from social interactions, which is not the primary focus in this scenario.

Correct Answer: B

Rationale: Postural hypotension is a drop in blood pressure when standing up. Increased cholesterol levels do not directly affect blood pressure regulation or lead to postural hypotension. Medications, decreased baroreceptor sensitivity, and arterial stiffness can all contribute to postural hypotension by affecting blood pressure regulation mechanisms. Therefore, choice B, increased cholesterol level, is the correct answer as it does not directly cause postural hypotension.

Correct Answer: B

Rationale: The correct answer is B: Provide step-by-step verbal cues to assist the client. This intervention is appropriate for an older adult with dementia as it offers structured support while still promoting independence. Verbal cues can help guide the client through the self-care tasks, maintaining their dignity and autonomy. Option A is incorrect as full independence may be overwhelming and unsafe. Option C is inappropriate and neglectful. Option D may be too demanding for someone with dementia. Verbal cues strike a balance between support and autonomy, making it the best intervention in this scenario.