4 older adults

ANS: C Slower reaction time is a common change in the older adult. Symptoms of cognitive impairment, such as disorientation, loss of language skills, loss of the ability to calculate, and poor judgment are not normal aging changes and require further investigation of underlying causes.

15. A nurse is assessing an older adult for cognitive changes. Which symptom will the nurse report as normal? a.Disorientation b.Poor judgment c.Slower reaction time d.Loss of language skills

ANS: D The highest priority at this time is the potential for social isolation. This woman does not know how to drive and lives in a rural community that does not have public transportation. All of these factors contribute to her social isolation. Other possible changes she may be going through right now include sexuality related to her advanced age and recent death of her spouse; however, this is not the priority at this time. She has been retired for 5 years, so this is also not an immediate need. She may eventually experience needs related to environment, but the data do not support this as an issue at this time.

A 72-year-old woman was recently widowed. She worked as a teller at a bank for 40 years and has been retired for the past 5 years. She never learned how to drive. She lives in a rural area that does not have public transportation. Which psychosocial change does the nurse focus on as a priority? a.Sexuality b.Retirement c. Environment d. Social isolation

ANS: 1 Only 3.3% of people 65 and over live in nursing homes; this rises to 15% for those over 85 years. In the United States, life expectancy at birth has risen dramatically in the past century: In 1900, average life expectancy was 49.2 years; in 2005, average life expectancy was 77.8 years. At age 65, white women led life expectancy with 20 years, followed closely by black women at 18.7 and white men at 17.2 years, whereas black men at age 65 had the lowest life expectancy at 15.2. The disparity in death rates for people of different races is less for older adults than younger ones.

Which of the following reflects an understanding of the characteristics of older adults? 1) Fewer than 5% of all older adults live in nursing homes. 2) Average life expectancy at birth has declined slightly over the past 10 years. 3)In general, males tend to live longer than do females. 4)Black men have the lowest life expectancy, but the gap decreases as a person ages.

ANS: B The universal loss for older adults usually revolves around the loss of relationships through death. Life transitions, of which loss is a major component, include retirement and the associated financial changes, changes in roles and relationships, alterations in health and functional ability, changes in one's social network, and relocation. However, these are not the universal loss.

10. A nurse is observing for the universal loss in an older-adult patient. What is the nurse assessing? a. Loss of finances through changes in income b. Loss of relationships through death c. Loss of career through retirement d. Loss of home through relocation

ANS: B Heart disease is the leading cause of death in older adults followed by cancer, chronic lung disease, and stroke (cerebrovascular accidents).

12. A nurse is teaching a health promotion class for older adults. In which order will the nurse list the most common to least common conditions that can lead to death in older adults? 1. Chronic obstructive lung disease 2. Cerebrovascular accidents 3. Heart disease 4. Cancer a.4, 1, 2, 3 b.3, 4, 1, 2 c.2, 3, 4, 1 d.1, 2, 3, 4

ANS: B In 2012, 57% of older adults in non-institutional settings lived with a spouse (45% of older women, 71% of older men); 28% lived alone (35% of older women, 19% of older men); and only 3.5% of all older adults resided in institutions such as nursing homes or centers. Most older adults have lost a spouse due to death rather than divorce.

1. A nurse is obtaining a history on an older adult. Which finding will the nurse most typically find? a. Lives in a nursing home b. Lives with a spouse c. Lives divorced d. Lives alone

ANS: B Include information about the prevention of sexually transmitted infections when appropriate. Open-ended questions inviting an older adult to explain sexual activities or concerns elicit more information than a list of closed-ended questions about specific activities or symptoms. You need to provide privacy for any discussion of sexuality and maintain a nonjudgmental attitude. Sexuality and the need to express sexual feelings remain throughout the human life span.

11. A nurse is discussing sexuality with an older adult. Which action will the nurse take? a. Ask closed-ended questions about specific symptoms the patient may experience. b. Provide information about the prevention of sexually transmitted infections. c. Discuss the issues of sexuality in a group in a private room. d. Explain that sexuality is not necessary as one ages.

ANS: C Loss of skin elasticity is a common finding in the older adult. Other common findings include pigmentation changes, glandular atrophy (oil, moisture, and sweat glands), thinning hair (facial hair: decreased in men, increased in women), slower nail growth, and atrophy of epidermal arterioles.

13. A nurse is observing skin integrity of an older adult. Which finding will the nurse document as a normal finding? a.Oily skin b.Faster nail growth c.Decreased elasticity d.Increased facial hair in men

ANS: D Diminished taste and smell senses are common findings in older adults. Scheduling an appointment at a smell and taste disorders clinic, testing the vestibulocochlear nerve, or an attempt to rule out cranial nerve damage is unnecessary at this time as per the information provided.

14. An older-adult patient in no acute distress reports being less able to taste and smell. What is the nurse's best response to this information? a.Notify the health care provider immediately to rule out cranial nerve damage. b.Schedule the patient for an appointment at a smell and taste disorders clinic. c.Perform testing on the vestibulocochlear nerve and a hearing test. d.Explain to the patient that diminished senses are normal findings.

ANS: A Patients with dementia need a routine. Continuing to reorient a patient with dementia is nonproductive and not advised. Patients with dementia need limited choices. Social interaction based on the patient's abilities is to be promoted.

16. An older patient with dementia and confusion is admitted to the nursing unit after hip replacement surgery. Which action will the nurse include in the plan of care? a.Keep a routine. b.Continue to reorient. c.Allow several choices. d.Socially isolate patient.

ANS: C Instrumental activities of daily living or IADLs (such as the ability to write a check, shop, prepare meals, or make phone calls) and activities of daily living or ADLs (such as bathing, dressing, and toileting) are essential to independent living.

17. A nurse is helping an older-adult patient with instrumental activities of daily living. The nurse will be assisting the patient with which activity? a.Taking a bath b.Getting dressed c.Making a phone call d.Going to the bathroom

ANS: D Aging men typically experience an erection that is less firm and shorter acting and have a less forceful ejaculation. Testosterone lessens with age and sometimes (not always) leads to a loss of libido. However, for both men and women sexual desires, thoughts, and actions continue throughout all decades of life. Sexuality involves love, warmth, sharing, and touching, not just the act of intercourse. Touch complements traditional sexual methods or serves as an alternative sexual expression when physical intercourse is not desired or possible. Clearly not all older adults are heterosexual, and there is emerging research on older adult, lesbian, gay, bisexual, and transgender individuals and their health care needs.

18. A male older-adult patient expresses concern and anxiety about decreased penile firmness during an erection. What is the nurse's best response? a. Tell the patient that libido will always decrease, as well as the sexual desires. b. Tell the patient that touching should be avoided unless intercourse is planned. c. Tell the patient that heterosexuality will help maintain stronger libido. d. Tell the patient that this change is expected in aging adults.

ANS: D Polypharmacy refers to the concurrent use of many medications. It does not have anything to do with side effects, adverse drug effects, or risks of medication use due to aging.

19. A patient asks the nurse what the term polypharmacy means. Which information should the nurse share with the patient? a. This is multiple side effects experienced when taking medications. b. This is many adverse drug effects reported to the pharmacy. c. This is the multiple risks of medication effects due to aging. d. This is concurrent use of many medications.

ANS: B Every older adult is unique, and the nurse needs to approach each one as a unique individual. The nursing care of older adults poses special challenges because of great variation in their physiological, cognitive, and psychosocial health. Aging does not automatically lead to disability and dependence. Chronological age often has little relation to the reality of aging for an older adult.

2. A nurse is developing a plan of care for an older adult. Which information will the nurse consider? a. Should be standardized because most geriatric patients have the same needs b. Needs to be individualized to the patient's unique needs c. Focuses on the disabilities that all aging persons face d.Must be based on chronological age alone

ANS: A Postural hypotension is an intrinsic factor that can cause falls. Changing positions slowly indicates a correct understanding of this concept. Environmental hazards outside and within the home such as poor lighting, slippery or wet flooring, and items on floor that are easy to trip over such as throw rugs are other factors that can lead to falls. Impaired vision and poor lighting are other risk factors for falls and should be avoided (dim lighting). Inappropriate footwear such as smooth bottom socks also contributes to falls.

20. An outcome for an older-adult patient living alone is to be free from falls. Which statement indicates the patient correctly understands the teaching on safety concerns? a. "I'll take my time getting up from the bed or chair." b. "I should dim the lighting outside to decrease the glare in my eyes." c. "I'll leave my throw rugs in place so that my feet won't touch the cold tile." d. "I should wear my favorite smooth bottom socks to protect my feet when walking around."

ANS: A Strategies for reducing the risk for adverse medication effects include reviewing the medications with older adults at each visit; examining for potential interactions with food or other medications; simplifying and individualizing medication regimens; taking every opportunity to inform older adults and their families about all aspects of medication use; and encouraging older adults to question their health care providers about all prescribed and over-the-counter medications. Although polypharmacy often reflects inappropriate prescribing, the concurrent use of multiple medications is often necessary when an older adult has multiple acute and chronic conditions. Older adults are at risk for adverse drug effects because of age-related changes in the absorption, distribution, metabolism, and excretion of drugs. Work collaboratively with the older adult to ensure safe and appropriate use of all medications—both prescribed medications and over-the-counter medications and herbal options.

21. A nurse's goal for an older adult is to reduce the risk of adverse medication effects. Which action will the nurse take? a. Review the patient's list of medications at each visit. b. Teach that polypharmacy is to be avoided at all cost. c. Avoid information about adverse effects. d. Focus only on prescribed medications.

ANS: A Some sedatives and tranquilizers prescribed for acutely confused older adults sometimes cause or exacerbate confusion. Carefully administer drugs used to manage confused behaviors, taking into account age-related changes in body systems that affect pharmacokinetic activity. When confusion has a physiological cause (such as an infection), specifically treat that cause, rather than the confused behavior. When confusion varies by time of day or is related to environmental factors, nonpharmacological measures such as making the environment more meaningful, providing adequate light, etc., should be used. Making phone calls to friends or family members allows older adults to hear reassuring voices, which may be beneficial.

22. An older-adult patient has developed acute confusion. The patient has been on tranquilizers for the past week. The patient's vital signs are normal. What should the nurse do? a. Take into account age-related changes in body systems that affect pharmacokinetic activity. b. Increase the dose of tranquilizer if the cause of the confusion is an infection. c. Note when the confusion occurs and medicate before that time. d. Restrict phone calls to prevent further confusion.

ANS: A Confusion is a common manifestation in older adults with urinary tract infection; however, the cause requires further assessment. There may be another reason for the confusion. Confusion is not a normal finding in the older adult, even though it is commonly seen with concurrent infections. Difficulty hearing, presbycusis, is an expected finding in an older adult. Older adults tend to have lower core temperatures. Coping with the death of a spouse is a psychosocial concern to be addressed after the acute physiological concern in this case.

23. Which assessment finding of an older adult, who has a urinary tract infection, requires an immediate nursing intervention? a. Confusion b. Presbycusis c. Temperature of 97.9° F d. Death of a spouse 2 months ago

ANS: B General preventive measures for the nurse to recommend to older adults include keeping regular dental appointments to promote good oral hygiene, eating a low-fat, well-balanced diet, exercising regularly, and maintaining immunizations for seasonal influenza, tetanus, diphtheria and pertussis, shingles, and pneumococcal disease.

24. Which patient statement is the most reliable indicator that an older adult has the correct understanding of health promotion activities? a. "I need to increase my fat intake and limit protein." b. "I still keep my dentist appointments even though I have partials now." c. "I should discontinue my fitness club membership for safety reasons." d. "I'm up-to-date on my immunizations, but at my age, I don't need the influenza vaccine."

ANS: A Most older people remain functionally independent despite the increasing prevalence of chronic disease; therefore, this misconception should be addressed. It is critical for you to respect older adults and actively involve them in care decisions and activities. You also need to identify an older adult's strengths and abilities during the assessment and encourage independence as an integral part of your plan of care.

3. Which information from a co-worker on a gerontological unit will cause the nurse to intervene? a. Most older people have dependent functioning. b. Most older people have strengths we should focus on. c. Most older people should be involved in care decision. d. Most older people should be encouraged to have independence.

ANS: A Caregiver neglect includes unsafe and unclean living conditions, soiled bedding, and animal or insect infestation. Abandonment includes desertion at a hospital, nursing facility, or public location such as a shopping center. Self-neglect includes refusal or failure to provide oneself with basic necessities such as food, water, clothing, shelter, personal hygiene, medication, and safety. Physical abuse includes hitting, beating, pushing, slapping, kicking, physical restraint, inappropriate use of drugs, fractures, lacerations, rope burns, and untreated injuries.

4. A nurse suspects an older-adult patient is experiencing caregiver neglect. Which assessment findings are consistent with the nurse's suspicions? a. Flea bites and lice infestation b. Left at a grocery store c. Refuses to take a bath d. Cuts and bruises

ANS: 3 For infants born in 2005, the average total life expectancy for females is 80.4 years. Life expectancy measured at age 65 was nearly the same for men and women in 1900; however, women had a lead of about 3 years over men in 2005, narrowing the gap as men age. So the longer men live, the longer they will live. The statistics are true for white people as well as black people. The answer saying, "That is a realistic concern . . ." is only partially true. Women do have a longer life expectancy at birth, but that tends to almost disappear after men reach age 65, and it continues to lessen as they continue to age. In-migration and out-migration have nothing to do with gender differences in life expectancy, although they do affect the population distribution within a state, for example.

5 A 75-year-old white female patient says, "I've heard that women live to an older age than men do. My husband and I are the same age, so I am afraid I will have to spend some years without him. That really worries me." Which response is based on correct information? 1)"That is a realistic concern, as women do have a longer life expectancy than men. But many things can happen to change that." 2)"You need not worry, because both you and your husband are white. That statistic is true only for black men and women." 3)"It is true that women have a longer life expectancy at birth. However, life expectancy measured at age 65 is almost the same for both sexes. You are both well past 65." 4)"That is true only in certain geographical areas, such as those with a high population of newly retired persons."

ANS: C Teaching strategies include the use of past experiences to connect new learning with previous knowledge, focusing on a single topic to help the patient concentrate, giving the patient enough time in which to respond because older adults' reaction times are longer than those of younger persons, and keeping the tone of voice low; older adults are able to hear low sounds better than high-frequency sounds.

5. A nurse is teaching a group of older-adult patients. Which teaching strategy is best for the nurse to use? a. Provide several topics of discussion at once to promote independence and making choices. b. Avoid uncomfortable silences after questions by helping patients complete their statements. c. Ask patients to recall past experiences that correspond with their interests. d. Speak in a high pitch to help patients hear better.

ANS: 3 An important nursing goals for all older adults should be to maintain the person's ability to function independently for as long as possible. Encouraging self-care will help to achieve that goal. A spiritual assessment is appropriate but is not a need of older adults any more than of other age groups. Providing hygiene needs does not promote independence. Administering analgesics is appropriate but does not encourage functional independence.

6 An 86-year-old patient had prostate surgery 2 days ago. Which nursing action best meets his developmental needs? 1)Perform a spiritual assessment and make referrals as needed. 2)Provide a complete bed bath and other hygiene needs. 3)Encourage the patient to perform self-care as much as possible. 4)Administer pain medications to keep the patient comfortable.

ANS: D Nurses help older adults and their families by providing information and answering questions as they make choices among care options. Some older adults deny functional declines and refuse to ask for assistance with tasks that place their safety at great risk. The decision to enter a nursing center is never final, and a nursing center resident sometimes is discharged to home or to another less-acute residence. What defines quality of life varies and is unique for each person.

6. An older patient has fallen and suffered a hip fracture. As a consequence, the patient's family is concerned about the patient's ability to care for self, especially during this convalescence. What should the nurse do? a. Stress that older patients usually ask for help when needed. b. Inform the family that placement in a nursing center is a permanent solution. c. Tell the family to enroll the patient in a ceramics class to maintain quality of life. d. Provide information and answer questions as family members make choices among care options.

ANS: C An important step in the process of selecting a nursing home is to visit the nursing home. The nursing home should not feel like a hospital. It is a home, a place where people live. Members of the nursing home staff should focus on the person, not the task. Residents should be out of bed and dressed according to their preferences, not staff preferences.

7. What is the best suggestion a nurse could make to a family requesting help in selecting a local nursing center? a. Have the family members evaluate nursing home staff according to their ability to get tasks done efficiently and safely. b. Make sure that nursing home staff members get patients out of bed and dressed according to staff's preferences. c. Explain that it is important for the family to visit the center and inspect it personally. d. Suggest a nursing center that has standards as close to hospital standards as possible.

ANS: C Some family caregivers consider nursing center placement when in-home care becomes increasingly difficult or when convalescence from hospitalization requires more assistance than the family is able to provide. An apartment setting and the use of home health visits are not appropriate because living at home is unsafe. Dementia is not a time of inactivity but an impairment of intellectual functioning.

8. A 70-year-old patient who suffers from worsening dementia is no longer able to live alone. The nurse is discussing health care services and possible long-term living arrangements with the patient's only son. What will the nurse suggest? a. An apartment setting with neighbors close by b. Having the patient utilize weekly home health visits c. A nursing center because home care is no longer safe d. That placement is irrelevant because the patient is retreating to a place of inactivity

ANS: C Adjusting to retirement is one of the developmental tasks for an older person. A young or middle-aged adult has to adjust to career and/or divorce. A middle-aged adult has to adjust to grandchildren.

9. A nurse is caring for an older adult. Which goal is priority? a. Adjusting to career b. Adjusting to divorce c. Adjusting to retirement d. Adjusting to grandchildren

ANS: 1, 2, 3 Incontinence is not a normal part of aging and should be explored further. The thinning of the layers of the skin causes older adults to feel cold—a normal part of aging. With aging, the brown fat layer, which contributes to generating and maintaining body temperature, becomes thinner as well. This is not the same type of fat as adipose, which is a white fat layer. Additionally, older adults who are sedentary often feel cooler. The elderly normally experience a decrease in saliva production, so although this is also a symptom of dehydration, dry mouth is a normal change of aging. Visual acuity decreases with age, but this, too, is a normal part of aging.

A client is concerned about the age-related changes of her mother, who is 80 years old. Which statement(s) made by the client would likely represent a normal change of aging? 1)"My mother seems to get cold very easily." 2)"My mother complains of her mouth being dry." 3)"Mother goes around the house turning on all the lights." 4)"Mother complains of leaking urine when she coughs."

ANS: 1, 3, 4 This client has the characteristics of frailty: low physical activity, muscle weakness, fatigue, and slowed performance. Clearly, the client is not able to perform ADLs adequately; therefore, a home aide is needed. Adapted physical activity programs are designed for adults in better physical health, not for frail elders. The client would be unlikely to benefit from an APA and probably could not even participate in such a group activity. Depression and impaired mental abilities tend to accompany frailty, so it is important to assess those for this client. Nutrition is essential to slow the progression of frailty, so having meals delivered is both appropriate and important.

A client lives alone. He is very weak, stays in bed most of the time, and becomes fatigued after taking only two or three steps with a walker. His personal hygiene is poor. He moves very slowly when doing even small tasks, such as eating a meal. Which of the following are appropriate interventions for this patient? Choose all that apply; assume all are possible. 1)Arrange for a home aide to assist with activities of daily living. 2)Refer the client to a senior center for an adapted physical activity (APA) program. 3)Assess the patient for symptoms of depression and memory loss. 4)Arrange for nutritious meals to be delivered to the patient's home.

ANS: 4 With aging, there is decreased pupil accommodation, decreased tear production, and thickening of the lens of the eye. All of these contribute to impaired near vision (presbyopia). Decrease in pupil accommodation allows less light into the eye, so in order to read, the person needs a good light. However, there is also increased sensitivity to glare, so the light should have a glare-free bulb. The patient should try this first, since she already has new glasses. If this doesn't help, then perhaps she should have the glasses rechecked. If her vision cannot be improved, then she could think about buying audio books and other ways to adapt to her difficulty reading.

A client tells the nurse, "I can't see well enough to read anymore. I have new glasses, but it's still hard." What should the nurse advise her to do first? 1)"Go back to the eye doctor and have him check your glasses." 2)"Buy some audio books and listen to those." 3)"Adapt to reading less and find a new leisure activity." 4)"Install a bright but glare-free light near where you read."

ANS: 2 The scenario describes a retirement community. A naturally occurring retirement community is one in which the person ages in place, living in the same home as always and in a neighborhood where the neighbors have aged together and have provided support for each other through the years. A continuing care retirement community is residential living (e.g., cottages, cluster homes, apartments) into which a person must move. The person pays an entrance fee and monthly fees. In return, the contract provides for assistance with activities of daily living, coordinated social activities, health monitoring, and so on. There is usually a health clinic on site. Assisted living facilities (ALFs) are congregate residential settings that provide or coordinate personal services, 24-hour supervision and assistance (scheduled and unscheduled), activities, and health-related services. State regulations and level of services preclude residents from staying in an ALF when their needs become greater than the resources and services provided.

A couple is planning to move to a housing development that has been built to provide elder-friendly dwellings and environments for independent living. The houses are smaller and on a single level. Their purchase includes home maintenance and repair, snow and trash removal, a pool, and a walking track. Only people 60 years and older qualify to buy a house in this community. Medical and nursing care are not a part of the purchase. How would their living situation be described? 1)Naturally occurring retirement community 2)Retirement community 3)Continuing care retirement community 4)Assisted living facilities

ANS: A, B, C, D Delirium, or acute confusional state, is a potentially reversible cognitive impairment that is often due to a physiological event. Physiological causes include electrolyte imbalances, untreated pain, infection, cerebral anoxia, hypoglycemia, medication effects, tumors, subdural hematomas, and cerebrovascular infarction or hemorrhage. Sometimes it is also caused by environmental factors such as sensory deprivation or overstimulation, unfamiliar surroundings, or sleep deprivation or psychosocial factors such as emotional distress. Dementia is a gradual, progressive, and irreversible cerebral dysfunction.

A recently widowed older-adult patient is dehydrated and is admitted to the hospital for intravenous fluid replacement. During the evening shift, the patient becomes acutely confused. Which possible reversible causes will the nurse consider when assessing this patient? (Select all that apply.) a. Electrolyte imbalance b. Sensory deprivation c. Hypoglycemia d. Drug effects e. Dementia

ANS: A, D, E A. D. E. Older patients may use different treatments for ailments. Over-the-counter medications or herbal remedies may be substituted for prescribed medications. Older patients also may skip doses to save money. The nurse needs to assess the frequency with which medications are being taken as prescribed, the number of doses missed, and if other remedies are being used in place of prescribed medications. B. C. The pharmacy that filled the prescriptions and the location of the medications in the patient's home would not contribute to the patient's non-adherence to the prescribed medication regimen.

During a home visit, the nurse suspects that an older patient recovering from an acute illness is not taking medications as prescribed. What should the nurse assess to determine the patient's adherence to prescribed medications? (Select all that apply.) a. Use of over-the-counter or herbal remedies b. Pharmacy that filled the patient's prescriptions c. Location of the medications in the patient's home d. Frequency with which medication doses are being skipped e. Frequency with which medications are being taken as prescribed

ANS: 1, 3, 4 The nurse should check for sensory deficits at the beginning of the interaction so he can allow for lip reading, as needed. Because older adults sometimes have difficulty expressing themselves, body language (e.g., wringing hands, fidgeting) is especially important. Because older adults process information slowly, the nurse should speak slowly, allowing them to formulate their answers. Speaking slowly does not mean the nurse should speak loudly or at a higher pitch. Many older adults have high-pitch hearing loss.

How can the nurse facilitate communication with an older adult? 1)Assess for hearing deficit at the beginning of the interaction. 2)Speak in a more loudly than normal, and at a slightly higher pitch. 3)Pay special attention to cues from body language. 4)Speak slowly, allowing time for the patient to word his answers.

ANS: D D. With dementia, an atmosphere that provides for physical and emotional safety with consistency and calmness should be provided. A. Sensory overload should be decreased for confused patients. B. Varying the environment weekly would provide too much stimulation for the patient. C. Physically challenging environments would be too stimulating for the patient.

The nurse is caring for a patient with Alzheimer's disease. Which environment should the nurse provide to decrease the patient's symptoms? a. A variety of sensory experiences b. An environment that varies weekly c. A physically challenging environment d. A familiar, non-stimulating environment

ANS: C C. As the patient is confused, having a family member assist with the medications is the best option. Interventions that rely on the patient's memory (A, D) are not helpful. B. The patient could become more confused if expected to turn medication bottles upside down after use.

The nurse is concerned about medication safety for a patient with confusion. Which action should the nurse recommend be included in the patient's plan of care to address this issue? a. Instruct the patient to take all of the medications together. b. Have the patient set up the medications for an entire week. c. Have a family member set up and administer the medications. d. Have the patient turn medication bottles upside down after taking medication.

ANS: A, B, D A. B. D. Depression is the most common psychiatric problem among older adults. This psychological condition, which includes a disturbance in mood, increases the risk for physical health complaints, and sleep disturbances. C. Reminiscing about past events is not a manifestation of depression. E. The inability to recall events from a week ago indicates a change in short-term memory.

The nurse is concerned that an older patient is demonstrating signs of depression. What did the nurse observe to come to this conclusion? (Select all that apply.) a. Difficulty sleeping b. Change in behavior c. Reminiscing about past events d. Increase in physical complaints e. Inability to recall events from a week ago

ANS: A A. An aging-related change in the integumentary system is decreased subcutaneous fat layer of skin, so older patients have less insulation to maintain temperature. B. Older patients do not have an increased layer of subcutaneous fat. C. D. The feeling of cold is not related to muscle function.

The nurse is contributing to a patient's plan of care for comfort needs. What age-related change would explain why an 84-year-old patient is chronically cold even with the thermostat set at 80°F (26.6°C)? a. Decreased subcutaneous fat layer b. Increased layer of subcutaneous fat c. Increased muscular retention of heat d. Decreased muscular retention of heat

ANS: A, B, E A. B. E. Some key age-related changes in the skeletal system include osteoporosis, eroding cartilage, and shortening of height. C. D. F. Age-related changes in bone structure include exaggerated bony prominences. Flexibility decreases with aging. Bone density decreases with aging.

The nurse is contributing to a staff education program about the physical changes of aging. What should the nurse include as a common change in the skeletal system of an older adult? (Select all that apply.) a. Osteoporosis b. Eroded cartilage c. Thickening of bone d. Increased flexibility e. Shortening in height f. Increasing bone density

ANS: D D. With aging, muscle response slows, so more time is required to perform tasks. This leads to increased reaction times. A. B. D. The aging process does not cause an increase in reflexes, joint flexibility, or nerve transmission.

The nurse is making recommendations to an older patient's plan of care for safety measures. Which musculoskeletal change should the nurse consider as contributing to a reduction in the older adult's ability to safely perform routine tasks? a. Increased reflexes b. Increased joint flexibility c. Rapid nerve transmissions d. Slower muscle response time

ANS: 2 Older adults have many losses to deal with, including the development of chronic health concerns and loss of independence. During the older adult years, children often provide care for their aging parents. Loss of short-term memory is more common than recollection of events involving long-term memory. Older adults have vivid memories of past events. Intellectual abilities do not become impaired with age; short-term memory and reaction time decline.

Which of the following is the most common major challenge for older adults? 1) Dealing with the needs of their children 2) Chronic health problems leading to the loss of independence 3) Loss of the ability to reminisce about the past 4) The decline of intellectual abilities

ANS: 1 Chronic diseases, including cancer, are major health problems for older adults. In fact, cancer is the second leading cause of deaths for older adults. Older adults should also have an annual physical exam; they should receive cancer screening at that time. Habits for seat belt use should have already been established; although it may be important to reinforce seat belt use, the most important assessment is cancer screening. Eating disorders are more common in adolescence and young adulthood. Although loss of bone density is fairly common in older adults and can be pathological, it does not assume the status as cancer with regard to mortality for older adults.

Which of the following would be the most important health assessment focus for older adulthood? 1) Cancer screening with the annual health examinations 2) Seeking information about consistent use of seat belts 3) Screening for eating disorders 4) A bone scan (DEXA test) for osteoporosis

ANS: 2, 3 Because of changes in bladder capacity and changes in blood flow to the kidneys, many older adults wake at least once during the night to void. Sexual response changes are also normal; it is common for older adult men to have less firm erections. A man who has difficulty starting his urine stream and voiding likely has an enlarged prostate, which is physiologically not normal. Burning on urination is indicative of a bladder infection and is not normal.

Which older adult is experiencing normal aging changes of the urinary system? 1)A man who has difficulty voiding, especially when starting his stream 2) A woman who wakes up to void once during the night 3) A man who has difficulty getting a hard erection 4) A man who says he has burning when he urinates