Correct Answer: A,C,D

Rationale: Slow capillary refill is a sign that the body is not circulating blood as effectively as it should be. This can be a sign that a person is actively dying. Ringing in the ears also known as tinnitus is not typically a sign that a person is actively dying. It can be caused by a variety of factors including exposure to loud noise certain medications and some health conditions. Cold hands and feet can be a sign that a person is actively dying. As the body's systems start to shut down blood flow to the extremities can decrease causing them to feel cold. Mottled and blotchy skin especially on the hands feet and knees can be a sign that a person is actively dying. This is caused by reduced blood flow to the skin.

Correct Answer: B

Rationale: Increasing attendance at community social activities may not be a realistic goal for a patient in hospice care with Stage 4 breast cancer. The patient's physical condition and energy levels may limit their ability to participate in such activities. Receiving medication to minimize episodes of breakthrough pain is a realistic and important goal for a patient in hospice care. Effective pain management is a key aspect of end-of-life care. Experiencing a weight gain of one to two pounds per week may not be a realistic goal for a patient in hospice care with Stage 4 breast cancer. Patients at this stage of illness often experience weight loss not gain. Verbalizing an understanding of the mode of disease transmission may not be a relevant goal for a patient in hospice care with Stage 4 breast cancer. The focus of care at this stage is typically on comfort and quality of life rather than disease education.

Correct Answer: A

Rationale: Installing handrails in the bathroom is a recommended strategy for reducing the risk of falls. Handrails provide support and stability particularly in slippery environments like the bathroom. Using a standard height toilet seat is not necessarily a recommended strategy for reducing the risk of falls. A toilet seat at an appropriate height for the individual would be more beneficial. Wearing backless shoes is not a recommended strategy for reducing the risk of falls. Shoes with good support and non-slip soles are typically recommended. Covering extension cords with a throw rug is not a recommended strategy for reducing the risk of falls. This could potentially create a tripping hazard.

Correct Answer: C

Rationale: While the thickness of the tympanic membranes can indeed change with age it typically increases rather than decreases. Thickening of the tympanic membranes can contribute to hearing loss by reducing the ability of the ear to transmit sound vibrations. Tinnitus or ringing in the ears is not typically decreased in older adults. In fact tinnitus is often more common in older individuals and can be a sign of age-related hearing loss. A decreased ability to hear high-frequency sounds is a common physiological change associated with aging. This is often one of the first signs of age-related hearing loss. Decreased ear wax is not typically associated with aging. In fact some older adults may produce more ear wax which can contribute to hearing problems if it becomes impacted.

Correct Answer: B,D

Rationale: This statement is incorrect. Exercise actually promotes the release of endorphins which are chemicals in the brain that act as natural painkillers and mood elevators. This statement is correct. Regular exercise can help improve sleep quality and duration. This statement is incorrect. Exercise actually increases energy levels by improving circulation and heart health. This statement is correct. Regular exercise can help decrease stress and improve mood by promoting the release of endorphins.