Ch 14-Older Adult

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: 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.

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: 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.

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 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.

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: 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.

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 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.

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 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.

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 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.

1. 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, 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.

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: 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.

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: 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.

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

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 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.

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: 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.

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 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.

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: 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.

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 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.

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: 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.

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: 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.

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: 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.

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 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.

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: 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.

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 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.

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: 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.

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: 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.

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: 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.

25. 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: 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.