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Which statement correctly describes osteogenesis imperfecta, or brittle bone disease?
Osteogenesis imperfecta is caused by deficiencies in the synthesis of type I collagen. Explanation: Osteogenesis imperfecta (OI) is a hereditary bone disease. It is estimated that about 25,000 to 50,000 people in the United States have OI. OI is usually transmitted as an autosomal dominant trait, and it results in extreme skeletal fragility.
osteomalacia vs osteoporosis
Osteomalacia (demineralization due to vit D and calcium deficiencies) -condition characterized by soft bone -no loss of bone matrix Osteoporosis (deterioration of bone mass over time due to loss of trabeculae from cancellous bone and thinning of the cortex to such an extent that minimal stress causes fractures) -causes a loss of total bone mass
Which condition contributes to the pathology of all metabolic bone diseases?
Osteopenia Explanation: Osteopenia is a condition that is common to all metabolic bone diseases. Metabolic diseases are noninfectious and are not neoplastic. Impaired vitamin D synthesis can cause osteopenia, but this phenomenon is not common to all metabolic bone diseases.
The nurse is caring for an older adult client at increased risk for fall-related injury. Which additional condition contributes to this risk?
Osteoporosis Explanation: Osteoporosis greatly increases an older adult client's risk for fall-related fracture. Parathyroid dysfunction, and dietary calcium deficiency may contribute to the risk for osteoporosis, but do not directly affect the risk for fall-related injury. Decrease in brain mass is an age-related finding that does not increase the client's risk for fall-related injury without other complicating factors.
Gastrointestinal elimination in older adults is often characterized by which common symptom?
Constipation Explanation: Constipation or infrequent passage of hard stool is a frequently occurring phenomenon in older adults. This is associated with slower motility in the large intestine. Gas production does not necessarily change, and mucosal cells tend to atrophy.
Which vascular changes can occur in older adults because of the increase in blood pressure during the aging process?
Decreased elasticity in arterial connective tissue Explanation: With aging, the elastin fibers in the walls of the arteries are gradually replaced by collagen fibers that render the vessels stiffer and less compliant. Arterial elasticity decreases as one ages, causing increased systemic vascular resistance and increased blood pressure and afterload. Elasticity does not increase in arterial tissue or venous tissue.
In contrast to osteoporosis, osteomalacia causes which outcome, without the loss of bone matrix?
Defective mineralization Explanation: In contrast to osteoporosis (which causes a loss of total bone mass), osteomalacia and rickets cause defective mineralization but not the loss of bone matrix. The prolonged use of medications that increase calcium excretion, such as aluminum-containing antacids, also is associated with bone loss of osteoporosis. In osteoporosis, there is loss of trabeculae from cancellous bone and thinning of the cortex to such an extent that minimal stress causes fractures.
A daughter is concerned because her elderly parent has been diagnosed with osteomalacia. The daughter asks the nurse why this happened. The best response would be that:
intestinal absorption slows as natural aging occurs. Explanation: The incidence of osteomalacia is high among older adults because of diets deficient in calcium and vitamin D, a problem often compounded by the intestinal malabsorption that accompanies with aging. Melanin is extremely efficient in absorbing UVB radiation; thus, decreased skin pigmentation markedly reduces vitamin D synthesis, as does the use of sunscreens. Osteomalacia also may occur in persons on long-term treatment with medications such as anticonvulsants (e.g., phenytoin, carbamazepine, valproate) that decrease the activation of vitamin D in the liver.
The educator of a geriatric unit is orienting new staff and is teaching strategies on communicating with older adults with impaired hearing. Which teaching point is most appropriate?
"Ensure that the hearing aid is in place, turned on, and properly functioning." Explanation: Slow, direct speech is a useful communication technique when dealing with clients who are hard of hearing. The most effective treatment is hearing amplification with hearing aids, lip-reading, and assistive listening devices. One should ensure that this equipment is turned on and functioning properly. It is not necessary to avoid complex ideas or always utilize short, simple vocabulary, since hearing deficits are not synonymous with cognitive deficits. Speaking too loudly is counterproductive.
A client diagnosed with Paget disease asks the health care provider how the disease developed. The best response would be:
"It is thought to have a probable association with a viral infection: paramyxovirus." Explanation: Paget disease may be linked to both genetic and environmental influences: a positive family history; mutations in genes encoding proteins in the RANK signaling pathway; and/or a probable association with a virus, possibly a paramyxovirus, suggesting that a viral infection may serve as a trigger for development of Paget disease in genetically predisposed individuals. A more sedentary lifestyle will reduce the mechanical loading of the skeleton and may decrease the incidence and severity of Paget disease.
An 81 year old female is attending a scheduled visit to her family physician. The client asks her doctor why it is that she and her peers seem to get sick frequently, in spite of their efforts to stay active and eat nutritiously. Which of the following responses best captures an aspect of the immune function of older adults?
"Normal, age-related changes combined with outside factors make older adults more susceptible to getting sick." Explanation: Infections are more prevalent among older adults than younger adults, a situation that results partly from compromised immune function but mostly from the interplay between environmental factors and age-related changes. Illness is not entirely attributable to decreased immune function, and older adults do not necessarily produce fewer antibodies
The adult child of a client with end-stage Alzheimer disease asks the nurse if Alzheimer disease can be passed on to him or her. What is the nurse's most accurate response?
"Research supports a possible genetic link with an early onset." Explanation: Alzheimer disease can be caused by a number of factors, and each case is unique to that individual. There is research that has identified genes that predispose a person to the development of early-onset Alzheimer disease.
The educator of a geriatric, sub-acute medical unit in a hospital is oriented new staff and teaching orientees strategies for communicating with older adults with impaired hearing. Which of the following teaching points is most justifiable?
"Speak slowly and directly to these clients." Explanation: Slow, direct speech is a useful communication technique when dealing with clients who are hard of hearing. It is not necessary to avoid complex ideas or always utilize short, simple vocabulary, since hearing deficits are not synonymous with cognitive deficits. Speaking too loudly is counterproductive.
A nurse who is visiting a senior's wellness center is teaching a group of older adult women about sexual activity among older adults. Which of the following teaching points best captures the reality of sexual activity among older adults?
"You can expect the duration and intensity of sexual response to decrease with age." Explanation: Though sexual activity by no means ceases among older adults, the duration and intensity do normally decrease. Androgen replacement therapy for men is not yet an established treatment modality. In older women, estrogen production slows but does not cease following menopause. Sexual pleasure and frequency do not normally remain consistent with younger adults.
The spouse of a client diagnosed with Alzheimer disease asks the nurse why the client often neglects to take a shower. The spouse states that the client was always diligent with hygiene in the past; however, over the past few months that has not been the case. What is the nurse's best response?
"You should remind the client to shower." Explanation: The client should be reminded to shower because most likely he or she has difficulty remembering to do so. In the moderate stage of Alzheimer disease, which can last for several years, it is not unusual for hygiene to be neglected because the person may just not remember if he or she showered. There is no information in the question to support the remaining responses.
DEXA testing reported as a T score
(DEXA determines bone density; results reported as a T score) based on the following guidelines issued by the WHO: ● Normal bone density -Bone mass greater than 833 mg/cm2 - T score more than −1.0 ● Osteopenia -Bone mass between 833 and 648 mg/cm2 -T score −1.0 to −2.5 ● Osteoporosis -Bone mass less than 648 mg/cm2 -T score less than −2.5
The nurse is caring for a client with a diagnosis of osteopenia. Which T score does the nurse expect?
-1.0 to -2.5 Explanation: The nurse should anticipate a T score for a client with osteopenia to be between -1.0 and -2.5, which denotes a bone mass between 833 and 648 mg/cm2. A T score of greater than -1.0 denotes a normal bone density. A T score of less than -2.5 is consistent with osteoporosis.
The nurse is assessing an older adult client with impaired wound healing. Which additional finding(s) contribute to this condition? (Select all that apply.)
-Altered immune function -Diminished T-cell activity -Delayed hypersensitivity response Explanation: Altered immune function, diminished T-cell activity, and delayed hypersensitivity response contribute to the finding of impaired wound healing in the older adult client. Increased autoimmune response and increased circulating antibodies may contribute to other immune-related findings, but do not directly affect wound healing.
The nurse is performing a nutritional assessment for an older adult client. Which alteration(s) in mineral metabolism should the nurse anticipate? (Select all that apply.)
-Calcium -Phosphate -Magnesium Explanation: Due to changes in hormonal and metabolic processes that occur with aging, calcium, phosphate, and magnesium metabolism is altered in the older adult client. Iron and potassium metabolism may or may not be altered in the client, depending on other complicating factors.
The nurse is reviewing the care plan of an older adult client at a routine annual exam. What should the nurse address in the plan of care? (Select all that apply.)
-Comorbid conditions -Overall physical health -Cognitive status -Functional ability Explanation: The nurse should address comorbid conditions, overall physical health, cognitive status, and functional ability in the plan of care. Since dementia is not an age-related change, it is not necessary to include this in the plan of care in the absence of a diagnosis of dementia.
The nurse is caring for an older adult client at risk for altered thermoregulation. Which age-related change(s) should the nurse address in the plan of care? (Select all that apply.)
-Diminished cold perception -Altered vasoconstriction -Impaired ability to produce body heat Explanation: The nurse should address diminished cold perception, altered vasoconstriction, and impaired ability to produce body heat in the plan of care, as these findings contribute to the risk for altered thermoregulation. Decreased calcium absorption and myelin are not expected to increase the risk for altered thermoregulation.
The community health nurse is teaching a class of older adult clients about prevention of injury and illness. Which topic(s) should the nurse cover during the teaching? (Select all that apply..)
-Exercise -Weight control -Cancer screening -Smoking cessation
The nurse is assessing a client with stage 5 Alzheimer disease. Which finding(s) does the nurse anticipate? (Select all that apply.)
-Exhibits major memory and cognitive deficits -Requires assistance in day-to-day activities Explanation: Stage 5 Alzheimer disease (AD) is characterized by exhibiting major memory and cognitive deficits, and requiring assistance in day-to-day activities. Significant personality changes, increased need for help in activities of daily living, and loss of awareness of surroundings and recent experiences are characteristic of stage 6 AD.
The nurse is assessing a client with secondary osteoporosis due to hyperthyroidism. Which additional finding(s) does the nurse expect? (Select all that apply.)
-Irritability -Palpitations -Diaphoresis -Weight loss Explanation: Irritability, palpitations, diaphoresis, weight loss, and insomnia are all symptoms consistent with hyperthyroidism, which may be present in the client with osteoporosis secondary to hyperthyroidism.
The nurse is assessing a client with stage 7 Alzheimer disease. Which finding(s) should the nurse anticipate? (Select all that apply.)
-Loss of ability to respond to the environment -Loss of communication ability -Requires increasing assistance with eating and toileting -Impaired swallowing, positioning, and reflex response Explanation: Stage 7 Alzheimer disease (AD) is characterized by loss of ability to respond to the environment, loss of communication ability, requires increasing assistance with eating and toileting, and impaired swallowing, positioning, and reflex response. Wandering and becoming lost is characteristic of stage 6 AD.
The nurse is assessing an older adult client with altered renal function. Which other finding(s) should the nurse anticipate? (Select all that apply.)
-Reduced renal blood flow -Decreased glomerular filtration rate -Decline in proximal tubular function Explanation: The nurse should anticipate reduced renal blood flow, decreased glomerular filtration rate, decline in proximal tubular function, decreased renal mass, and decreased renin and aldosterone levels.
The nurse is caring for a client undergoing treatment for osteoporosis with calcitonin therapy. For which additional conditions should the nurse monitor? Select all that apply
-Rhinorrhea (thin, mostly clear nasal discharge, inflammation of nasal tissues, runny nose) -Hypocalcemia Explanation: Calcitonin may result in rhinorrhea, and increases the risk for hypocalcemia because of its effect on calcium resorption by the bone. Dizziness and leg cramps may occur with teriparatide. Upper GI distress may result from alendronate or risedronate therapy.
The nurse is assessing an older adult client at risk for age-related changes in neurological function. For which finding(s) should the nurse monitor? (Select all that apply.)
-Sensory deficits -Motor dysfunction -Sleep disturbances -Impaired memory and cognition Explanation: The nurse should monitor for sensory deficits (taste, smell vibration, vision, and hearing), motor dysfunction (altered gait and posture), sleep disturbances, and impaired memory and cognition. Mood changes are not considered age-related.
An elderly patient suspected of having delirium will likely display which of the following clinical manifestations? Select all that apply.
-Sudden onset of agitation. -Disorganized thinking pattern. -Altered level of consciousness. Explanation Delirium has a rapid onset. Key symptoms include agitation, disorientation, and fearfulness along with disorganized thinking, and altered level of consciousness.
A client newly diagnosed with rheumatoid arthritis is crying and tells the nurse she does not know how to manage the disease. Select the most important information for the nurse to provide. Select all that apply.
-Treatment goals -Education -Posture -Physical rest -Therapeutic use of heat and cold Explanation: The treatment goals for a person with RA are to reduce pain, minimize stiffness and swelling, maintain mobility, and become an informed health care consumer. The treatment plan includes education about the disease and its treatment, physical rest, therapeutic exercises, and medications. Proper posture, positioning, body mechanics, and the use of supportive shoes can provide information about the principles of joint protection and work simplification. Some persons need assistive devices to reduce pain and improve their ability to perform activities of daily living. Instruction in the safe use of heat and cold modalities to relieve discomfort and the use of relaxation techniques also is important. Clients should take pain medication as needed and refrain from any injury.
The nurse is caring for a client undergoing treatment for osteoporosis with alendronate therapy. For which other condition(s) should the nurse monitor? Select all that apply.
-Upper GI distress -Myalgias (muscle pain) -Arthralgias (joint pain) Explanation: Alendronate therapy may cause upper GI distress, myalgias, and arthralgias. Estrogen and raloxifene therapy increase the risk for deep vein thrombosis. Hot flashes may occur with raloxifene.
The nurse is performing a skin assessment for an older adult client. Which age-related finding(s) should the nurse anticipate? (Select all that apply.)
-Varied skin pigmentation -Decreased elasticity -Dry, wrinkled appearance Explanation: Typical skin changes that occur with aging include a dry, wrinkled appearance with a varied pattern of pigmentation. Collagen changes decrease elasticity. Rough, raised skin lesions and clubbing of the nails are both abnormal findings that are not age-related changes.
The nurse is reviewing the health histories of four clients. Select the client most at risk for developing secondary osteoporosis.
A 60-year-old female taking prednisone for asthma Explanation: Corticosteroid (e.g., prednisone) use is the most common cause of drug-related osteoporosis, and long-term corticosteroid use in the treatment of disorders such as rheumatoid arthritis and chronic obstructive lung disease is associated with a high rate of fractures. The prolonged use of aluminum-containing antacids (which increase calcium excretion) and anticonvulsants (which impair vitamin D production) may also contribute to bone loss. Persons with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) who are being treated with antiretroviral therapy are also at risk. The other options would not cause osteoporosis.
Recognizing that falls are a significant source of morbidity among older adults, the manager of a geriatric medical unit is conducting a workshop for the health care team on fall prevention. Which of the following patients would the care providers be most likely to anticipate being at a potentially high risk for falls?
A 76 year old woman with diagnoses of Parkinson's disease and orthostatic hypotension. Explanation: Parkinson's disease and orthostatic hypotension are both considered common contributors to falls. The health problems cited in answers B, C and D are not as strongly correlated with falls in older adults.
A nurse provides care for a number of older adult residents of a long term care facility. Which of the following events from the last shift is most deserving of further assessment and possible interventions?
A 79 year old male client displays unprecedented forgetfulness. Explanation: While any abrupt change in status would warrant further examination, decreased strength, light sensitivity and balance problems are all considered normal accompaniments to the aging process. Cognitive changes, such as a new onset of forgetfulness, are more likely to be pathologic in nature and deserving of further assessment.
The first manifestation that a client has osteoporosis is when presenting with which condition?
A bone fracture Explanation: Osteoporosis is usually a silent disorder. Often, the first manifestations of the disorder are those that accompany a skeletal fracture—a vertebral compression fracture or fracture of the hip, pelvis, humerus, or other bones. The onset of the disease is not typically marked by pain or decreased range of motion. Clients with osteoporosis are not noted to crave foods that are high in calcium.
The nurse is teaching a prevention program on premature osteoporosis. The nurse determines the participants understand the information when they identify which cause of osteoporosis that is commonly seen in female athletes playing endurance sports?
Amenorrhea Explanation: The female athlete triad, a pattern of disordered eating that leads to amenorrhea and eventually premature osteoporosis, is being seen increasingly in female athletes because of an increased prevalence of eating disorders. Poor nutrition, combined with intense exercise training, can lead to very low percentage of body fat and an energy deficit that causes a lack of ovarian estrogen production and secondary amenorrhea. The lack of estrogen combined with the lack of calcium and vitamin D from dietary deficiencies results in a loss of bone density and increased risk of fractures. Older athletes are high risk for osteoarthritis, a degenerative joint disorder that is unrelated loss of bone density.
Which best describes metatarsus adductus?
An adducted forefoot that gives the foot a kidney-shaped appearance Explanation: Metatarsus adductus, or in-toeing, is a common congenital deformity characterized by forefoot adduction with a normal hindfoot, giving the foot a kidney-shaped appearance. It can be caused by torsion in the foot, lower leg, or entire leg. A condition of toeing-out is caused by external femoral torsion. The other answers relate to congenital hip problems.
The nurse is caring for a male client with secondary osteoporosis due to hypogonadism. For which deficiency should the nurse anticipate treatment?
Anabolic androgens Explanation: A deficiency of anabolic androgens present in the client with osteoporosis secondary to hypogonadism leads to increased osteoclast activity. Deficiencies in estradiol, cortisol, and progesterone do not contribute to this etiology.
Osteoporosis Pharmacologic prevention and treatment
Bisphosphonates (promote osteoclast apoptosis; improve osteoblast and osteocyte survival) Selective estrogen receptor modulators (SERMs)(stimulate OPG production) Denosumab - monoclonal antibody (binds RANKL = blocks osteoclast maturation, function & survival) Teriparatide - parathyroid hormone (stimulates osteoblasts when admin. intermittently)
A client with confirmed low bone density asks the nurse if there is anything she can to decrease the risk of trauma. The best response would be:
Brisk walking three times per week on a flat surface Explanation: Weight-bearing exercises such as walking, jogging, rowing, and weight lifting are important in the maintenance of bone mass. The other options place the person at risk for injury if the bones are weakened.
The nurse is caring for a client considering hormone treatment for osteoporosis. Which treatment does the nurse expect?
Calcitonin Explanation: Calcitonin is a hormone given for the treatment of osteoporosis. Estrogen is a hormone given for the prevention of osteoporosis. Alendronate and risedronate are in the bisphosphonate, not hormone, class of drug.
treatment for osteoporosis with calcitonin therapy
Calcitonin is a hormone naturally produced in the thyroid. When given to patients with osteoporosis, calcitonin produces modest increases in bone mass because it slows the rate at which osteoclasts absorb bone. Only women who are at least five years past menopause can take calcitonin
Which measures should a public health nurse recommend to middle-aged women to reduce their chances of developing osteoporosis later in life?
Calcium supplementation and regular weight-bearing activity Explanation: Although the use of vitamin D supplements may be of preventive value for some clients, the primary prevention measures for osteoporosis include calcium supplementation and regular exercise. Genetic testing and increased fluid intake are not relevant measures, and corticosteroids are a risk factor for osteoporosis.
An increase in the level of receptor activator of nuclear factor kappa-β ligand (RANKL) results in which physiologic activity?
Changes in the rate of bone remodeling Explanation: Correct regulation of the RANKL/RANK/osteoprotegerin (OPG) pathway is necessary for normal bone remodeling and a balance between bone resorption and bone formation. The pathway in general, and levels of RANKL in particular, does not directly influence levels of parathyroid hormone and vitamin D. RANKL has no bearing on the fusing of epiphyses and metaphyses.
A client with Alzheimer disease (AD) is forgetful and has started to lose interest in social activities. Which treatment routine would be beneficial for the client?
Donepezil Explanation: The cholinesterase inhibitor donepezil has been effective in slowing cognitive decline in early stages of AD. Memantine is used for moderate to severe AD. Vitamin D and a diet high in protein have not been shown to impact AD, although there is some promising research indicating that anti-inflammatory elements such as Vitamins E and C and ginkgo biloba may have neuroprotective properties.
A 70-year-old female client tells the health care provider she is concerned because she is getting shorter and her posture is not as good as it used to be. The provider completes an assessment of her spine and notes a loss of height in the vertebral column and kyphosis. This assessment would be recognized as:
Dowager hump Explanation: The client has osteoporosis and is manifesting wedging and collapse of vertebrae that cause a loss of height in the vertebral column and kyphosis, a condition referred as Dowager hump. Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. Lordosis is an inward curvature of the spine.
The nurse is caring for a client at risk for osteoporosis. Which test should the nurse anticipate?
Dual-energy X-ray absorptiometry (DXA) Explanation: Risk for osteoporosis can be determined by dual-energy X-ray absorptiometry, which measures bone density. Nuclear medicine bone scan, positron emission tomography, and computed tomography do not assess for findings relevant to the risk for osteoporosis.
Osteoporosis is a disease caused by demineralization of bone. What is the clinical method of choice for diagnosing osteoporosis?
Dual-energy x-ray absorptiometry (DXA) of the spine and hip Explanation: The clinical method of choice for bone mineral density (BMD) studies is dual-energy x-ray absorptiometry (DXA) of the spine and hip. The other answers will not diagnose osteoporosis.
Disorders that affect cortical bone typically result in:
Fractures of long bones Explanation: Disorders in which cortical bone is defective or reduced in mass lead to fractures of the long bones, whereas disorders of cancellous bone lead preferentially to vertebral fractures. Neither process directly causes impaired collagen synthesis or infection.
The pediatric nurse is caring for a client exhibiting scleroderma, alopecia, loss of subcutaneous fat and muscle, and skeletal dysplasia. For which condition should the nurse anticipate treatment?
Hutchinson-Gilford Progeria Syndrome (HGPS) Explanation: The nurse should anticipate treatment for Hutchinson-Gilford Progeria Syndrome (HGPS), as the client's symptoms of scleroderma, alopecia, loss of subcutaneous fat and muscle, and skeletal dysplasia are consistent with this diagnosis. These symptoms are not consistent with hypoparathyroidism, Hashimoto's disease, or type I diabetes mellitus.
The nurse is caring for an older adult client with multiple myeloma. For which electrolyte imbalance should the nurse anticipate treatment?
Hypercalcemia Explanation: Multiple myeloma is a malignancy that causes cancer cells to accumulate in the bone marrow, which has an impact on calcium metabolism. This diagnosis is not expected to have a direct impact on potassium, sodium, or magnesium.
The nurse is reviewing the laboratory results of an older adult client with a diagnosis of water retention. Which additional condition should the nurse anticipate?
Hyponatremia Explanation: The nurse should anticipate hyponatremia in the older adult client with a diagnosis of water retention. The increased water retention dilutes serum sodium levels, causing hyponatremia. Hypokalemia, hypoalbuminemia, and hypocalcemia are not expected conditions for the older adult client with water retention without other complicating factors.
The practitioner is counseling an 80-year-old client who has recently lost his spouse. The practitioner is aware that the client is at risk for which of the following?
Increased incidence of depression Explanation: Loss of a spouse is a highly significant life event that commonly has negative implications for the survivor. Experts cite an increased mortality rate; increased incidence of depression, psychological distress, and loneliness; and higher rates of chronic illness.
A geriatrician has ordered an echocardiogram and stress test for an 80 year old male client in an effort to gauge the client's cardiovascular health status. Which of the following changes would the physician most likely identify as an anomaly that is not an expected age-related change?
Increased resting, supine heart rate. Explanation: In older adults, resting heart rate stays the same or decreases slightly. Answers A, B and C all capture normal, age-related cardiovascular changes.
The nurse is caring for an older adult client with osteopenia. Which additional finding should the nurse anticipate?
Increased risk for injury Explanation: The nurse should anticipate increased risk for fall-related injury in the older adult client with osteopenia, as this diagnosis places the client at risk for fractures. Decreased dietary calcium, parathyroid dysfunction, and impaired healing may or may not be present.
The nurse is caring for a client with osteoporosis. Which T score should the nurse expect to find?
Less than -2.5 Explanation: A T score of less than -2.5 is consistent with osteoporosis, and denotes a bone mass less than 648 mg/cm2
A nurse is assessing an older adult with reports of constipation, for which the client often takes over-the-counter medications. What assessment should the nurse perform to address the etiology of the client's problem?
Medication regimen for drugs like anticholinergic agents or calcium Explanation: Constipation is attributable to numerous factors, including low fluid intake and medications. Drugs such as opioids, anticholinergic agents, calcium channel blockers, diuretics, calcium, iron supplements and aluminum antacids tend to cause constipation. Diverticula, rectal fissures, and hemorrhoids are consequences rather than causes of constipation. Abdominal surgery rarely causes constipation unless it is comparatively recent.
In considering a definition of aging, a 76-year-old male would be classified into which of the following subgroups?
Middle-old Explanation: A middle-old adult is 75 to 84 years of age. A young-old adult is 65 to 74, and old-old adult is 85+ years of age. Oldest-old is not a subcategory of older adults.
An adult female client describes the pain in her hand as having an audible grinding and cracking sound, especially in her thumb with the inability to open a jar. The health care provider suspects the client has which type of joint disease?
Osteoarthritis Explanation: In osteoarthritis (OA) syndrome, crepitus and grinding may be evident when the osteoarthritic joint is moved. OA joint enlargement results from new bone formation and the joint feels hard, in contrast to the soft, spongy feeling characteristic of the joint in rheumatoid arthritis (RA). The person with ankylosing spondylitis typically reports low back pain, which becomes worse when resting, particularly when lying in bed. Systemic lupus erythematosus (SLE) is characterized by the formation of autoantibodies and immune complexes (type III hypersensitivity). SLE has the capacity to affect many different body systems, including the musculoskeletal system, skin, cardiovascular system, lungs, kidneys, central nervous system (CNS), and red blood cells and platelets.
A 75-year-old female has been admitted to the hospital with a hip fracture. She states, "All I did was fall into my chair, not even very hard." Upon diagnostic testing, the client's bones shows loss of trabeculae from cancellous bone and thinning of the cortex. Which diagnosis is most likely?
Osteoporosis Explanation: Osteoporotic changes occur in the diaphysis and metaphysis where a loss of trabeculae from cancellous bone and thinning of the cortex is to such an extent that minimal stress causes fractures. Osteonecrosis is due to ischemia, osteomyelitis is an infection, and osteomalacia is a metabolic disorder caused by phosphate deficiency.
A physiotherapist (PT) at an assisted living facility for older adults is leading an exercise class for the residents. Part of the PT's introductory class is an explanation of the health problems that can be mitigated by physical activity and those which are considered inevitabilities of the aging process. Which of the following phenomena would the PT most justifiably characterize as modifiable?
Overall reduction in muscle strength. Explanation: While a general reduction in muscle strength is a normal, age-related change, this can be slowed significantly by regular physical activity. Loss of bone density in the trabecular bone, decreases in reaction time and loss of height are less modifiable.
Which of the following pathophysiological processes would a clinician most likely expect in a client with a diagnosis of dementia rather than delirium?
Plaques have developed between neurons and neurofibrillary tangles have developed within neurons. Explanation: In Alzheimer's disease, there are senile plaques that develop between neurons and neurofibrillary tangles that develop within neurons. There is a decline in synaptic levels of acetylcholine rather than accumulation. Dehydration and hypothyroidism would be associated with delirium, not dementia.
Which structural change can contribute to mixed sensorimotor deficit?
Polyneuropathies involving demyelination of peripheral nerves Explanation: As the brain ages, there is a decrease in myelin. Polyneuropathies involve demyelination or axonal degeneration of multiple nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits. Typically the longest axons are involved first, with symptoms beginning in the distal part of the extremities. The other changes do not happen; there are no increases in mass, neurons, or dendritic processes. Decreased myelin can lead to impaired synaptic connections.
The nurse should anticipate that which type of anti-depressant agent may be prescribed for an elderly patient that has a history of numerous cardiac events and who prefers to take medication only once/day?
Sertraline, a selective serotonin reuptake inhibitor. Explanation: SSRIs provide high specificity by blocking or slowing serotonin reuptake without the antagonism of neurotransmitter receptors or direct cardiac effects. Dosing is usually once/day, creating ease of administration. Tricyclic antidepressants have a high suicide rate. The anticholinergic and CV side effects are problematic. SNRIs are similar to SSRI. However they can be associated with sedation.
Multiple theories have attempted to explain the biology of aging. Which of the following theories proposes that aging is caused by random events or from environmental influences?
Stochastic Explanation: Rationale: Stochastic theories maintain that aging changes result from an accumulation of random events or damage from environmental agents or influences. All other theories are intrinsic and suggest that aging changes are genetically programmed.
An occupational therapist (OT) is assessing an 80 year old male client who is poised to return to his assisted living residence following a 14 day hospital stay with a diagnosis of bilateral pneumonia. As part of the OT's functional assessment, the client's activities of daily living (ADL) and instrumental activities of daily living (IADL) are being assessed. Which of the following assessment findings is most indicative of a deficit in ADLs?
The client requires help with dressing himself in the morning. Explanation: Dressing is considered a core ADL. Cleaning, dressing and climbing stairs are considered IADLs.
A postmenopausal client questions the nurse about the diagnosis of osteoporosis. Which statement describes the pathology of osteoporosis?
The process of bone renewal after menopause is slowed in relation to the occurrence of bone breakdown. Explanation: With aging, the process of bone formation (renewal) is slowed in relation to bone resorption (breakdown). Estrogen levels decrease with menopause and contribute to bone loss. Multiple infections are not a factor in bone loss. Osteoporosis cannot be resolved with increasing calcium.
One of the residents in a long-term care facility has developed numbness, tremor, and gross lack of coordination of muscle movements in their lower limbs. The nurse knows that his may be caused by:
Vitamin B12 deficiency. Explanation: Vitamin B12 deficiency also can cause neurologic abnormalities such as peripheral neuropathy (numbness and tremor), ataxia (loss of coordination of muscle movements) and even dementia. Lack of hydrochloric acid secretions result in impaired gastric absorption. Loss of parietal cells cause a decrease in HCl acid production.
Osteopenia
a condition that begins as you lose bone mass and your bones get weaker. This happens when the inside of your bones become brittle from a loss of calcium. It's very common as you age. -Total bone mass peaks around age 35 -People who have osteopenia are at a higher risk of having osteoporosis
osteoporosis
an imbalance in the bone remodeling process; bone resorption by osteoclasts is favored over bone formation by osteoblasts, resulting in loss of bone mass
The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer disease. What intervention will be implemented to slow cognitive decline?
cholinesterase inhibitors Explanation: Cognitive function in Alzheimer disease can be enhanced by the use of medications to slow progression and improve depression, agitation, or sleep disorders. The cholinesterase inhibitors have been shown to be effective in slowing the progression of the disease by potentiating the action of available ACh and inhibiting acetylcholinesterase. There has been no demonstrated improvement of cognitive function with use of lipid-lowering statins or antioxidant nutritional supplement therapy. Psychotherapy is appropriate for depression.
metatarsus adductus
common foot deformity noted at birth, causes a condition where the metatarsal bones are turned toward the middle of the body. This causes a visible deformity, and both feet are often affected
osteopenia
condition that begins as you lose bone mass and your bones get weaker -occurs when the inside of your bones become brittle from a loss of calcium -is very common as you age
osteomalacia
disease marked by softening of the bone caused by calcium and vitamin D deficiency -rickets's
cortical bone
hard, dense, strong bone that forms the outer layer of bone (compact bone) -makes up nearly 80% of skeletal mass and is imperative to body structure and weight bearing because of its high resistance to bending and torsion
immunologic theory of aging
immunologic theory of aging. Reduced resistance to disease secondary to reduced T-cell function and enhanced autoimmune responses
Hutchinson-Gilford Progeria Syndrome (HGPS)
rare, fatal, genetic condition of childhood with striking features resembling premature aging as a result of DNA damage
An older adult client is diagnosed with depression. Which medication category will the nurse anticipate will be prescribed for this client?
selective serotonin reuptake inhibitor (SSRI) Explanation: Antidepressants target increasing the activity of norepinephrine and serotonin at postsynaptic membrane receptors. The most widely used mechanism of action of antidepressants is to inhibit the reuptake of serotonin at the presynaptic space. Selective serotonin reuptake inhibitors (SSRI) are an attractive first choice for pharmacotherapy for depression in older adults. Gamma-aminobutyric acid (GABA) receptors may help clients with an anxiety disorder. Antipsychotics and some anticonvulsants can stabilize mood for bipolar clients.
antagonistic pleiotropy theory
suggests that genes may have beneficial effects during early life but harmful effects as the individual ages
accumulated mutations theory
suggests that over time, the accumulation of genetic mutations during cell division may contribute to altered cellular function associated with aging
neuroendocrine theory
the interrelationship between neurons and associated hormones as the stimulus for aging ie: menopause
stochastic theories of aging
theories suggesting that the body ages as a result of assaults from both internal and external environments; also referred to as "wear-and-tear" theories
Osteopenia
thinner than average bone density/ reduction in bone mass -a condition that is common to all metabolic bone diseases
Donepezil (Aricept)
used to treat confusion (dementia) related to Alzheimer's disease. It does not cure Alzheimer's disease, but it may improve memory, awareness, and the ability to function. This medication is an enzyme blocker that works by restoring the balance of natural substances (neurotransmitters) in the brain.
7 stages of Alzheimer's
● Stage 1 -Minimal cognitive impairment ● Stage 2 -Mild cognitive impairment (evident only to self) -Memory lapse -Forgetfulness of familiar words -Altered memory of location of everyday objects ● Stage 3 -Mild cognitive impairment (evident among friends, family, coworkers) -Difficulty with word or name finding -Decreased performance at work or home -Difficulty with reading retention -Misplacing valuable objects -Impaired organization or planning ● Stage 4 -Moderate cognitive decline (evident by examiner) -Decline in knowledge of current events or occasions -Impaired mathematical ability -Impaired performance of complex tasks (e.g., bill paying, planning meals) -Difficulty remembering personal history -Change in personality (subdued or withdrawn) ● Stage 5 -Moderately severe cognitive decline -Exhibits major memory and cognitive deficits -Requires assistance in day-to-day activities ● Stage 6 -Severe cognitive decline -Significant personality changes -Increased need for help in activities of daily living -Worsening memory -Loss of awareness of surroundings and recent experiences -Occasional loss of memory of spouse's/primary caregiver's name -Disrupted sleep/wake cycle -Assistance needed with toileting details -Increasing episodes of incontinence -Sense of paranoia, delusions, hallucinations -May wander or become lost ● Stage 7 -Very severe cognitive decline -Loss of ability to respond to the environment, including speech and movement -Loss of communication ability -Requires increasing assistance with eating and toileting -Impaired swallowing, positioning, and reflex response
