Ch 23- 24

For which older patient should the nurse suspect a decline in the responsiveness of the immune system? 1. 78-year-old patient with pneumonia and temperature of 99.5°F 2. 68-year-old patient with a red itchy rash from contact with poison ivy 3. 80-year-old patient with swelling and redness around an abdominal incision 4. 66-year-old patient with 8 mm induration from a mumps skin test 72 hours earlier

1 The febrile response that signals infections may be blunted in the older person. The baseline body temperature in older people is approximately 1°F lower than the normal temperature in younger people. A rise in body temperature may not be immediately evident.

The physician orders a pneumococcal vaccination for a 70-year-old patient. How does the nurse best describe this immunization? 1. Antibody response is lower in the older person 2. Cellular response in the immune system increases 3. Aging causes a decreased antibody production to self 4. Increased production of IgE leads to greater risk of pneumonia

1 To prevent serious complications, all people 65 years of age and older should receive a pneumococcal vaccine. Antibody response is often lower in the older person and may decline after 5 to 10 years.

An older patient experienced an anaphylactic reaction after eating shrimp. How would the nurse best describe this response? 1. Type I hypersensitivity response 2. Type II hypersensitivity response 3. Type III hypersensitivity response 4. Type IV hypersensitivity response

1 Type I hypersensitivity responses occur immediately and include anaphylactic reactions.

An older patient with diabetes is prescribed high-dose antibiotic therapy for a wound infection. Which effects of antibiotic therapy should the nurse further assess in relation to the patient? 1. Diarrhea 2. Dizziness 3. Headaches 4. Lethargy

1 When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism. These higher doses place the person at risk for medication side effects and drug interactions, including development of antibiotic-associated diarrhea.

An older patient is diagnosed with tuberculosis. What should be included in the nurse's disease process instruction? Select all that apply. 1. It can affect other body tissues. 2. It is uncommon in nursing homes. 3. It spreads by airborne transmission. 4. It is a chronic infection of the lungs. 5. Older people are at higher risk for the disease.

1, 3,4,5 1. Tuberculosis is a chronic extrapulmonary infectious disease which means it affects body tissues other than the lungs. 3. Tuberculosis spreads from person to person by airborne transmission. 4. Tuberculosis is a chronic pulmonary infectious disease. 5. The number of cases of tuberculosis is highest in people over 65 years of age.

The nurse is preparing a presentation to senior citizens about the influenza vaccination. Which information should the nurse include? Select all that apply. 1. A new vaccination is needed annually. 2. It is contraindicated to those with an allergy to eggs. 3. It should not be taken if a chronic disease is present. 4. The vaccination is given once after the age of 65 years. 5. Most people who receive the pneumonia vaccination do not need the influenza vaccine.

1,2 1. The flu virus changes annually necessitating a vaccination every year. 2. The flu vaccination should not be taken by those with an allergy to eggs.

An older patient with rheumatoid arthritis rates current pain as being a 3 on a scale from 1 to 10. Which nonpharmacological interventions can the nurse provide to help this patient? Select all that apply. 1. Massage 2. Warm soaks 3. Diversion activities 4. Relaxation techniques 5. Immobilization of painful areas

1,2,3,4 1. Nonpharmacological comfort measures include massage. 2. Nonpharmacological comfort measures include warm soaks. 3. Nonpharmacological comfort measures include diversion activities. 4. Nonpharmacological comfort measures include relaxation techniques.

A multidisciplinary team in a long-term care facility is meeting with the family of a frail older patient to discuss care issues and concerns. What key issues should be addressed in the conference? Select all that apply. 1. Consistency with policy 2. The patient's preferences 3. Avoidance of doing harm to the patient 4. Focus on cost-effective methods 5. The needs and wishes of the family

1,2,3,5 1. The provision of care for the seriously ill long-term care resident should be consistent with accepted public policy. 2. The provision of care for the seriously ill long-term care resident should honor the resident's preferences. 3. The provision of care for the seriously ill long-term care resident should not inflict undue burden or harm to the resident without a reasonable chance of success. 5. The provision of care for the seriously ill long-term care resident should reflect the needs and wishes of families.

An older patient is diagnosed with asthma. What should the nurse teach the patient about this health problem? Select all that apply. 1. It is a type I hypersensitivity response. 2. Items that precipitate attacks must be identified. 3. It is not particularly prevalent in the older person. 4. Symptoms of the disorder likely were present earlier in life. 5. Medications to treat may aggravate other medical problems.

1,2,4,5 1. Asthma is a common hypersensitivity type I problem that is often underdiagnosed in the older person. 2. Interventions should be aimed at identifying allergens that precipitate attacks and reducing them in the home. 4. Patients with asthma are more likely to have had symptoms earlier in life. 5. Asthma medications may aggravate coexisting medical conditions.

An older patient is diagnosed with cardiovascular disease. The nurse is planning care for him; which factors can contribute to frailty? Select all that apply. 1. Decreased sense of thirst 2. Electrolyte imbalance 3. Digestive abnormalities 4. Inability to walk 10 feet 5. Multiple prescribed medications

1,2,4,5 1. Cardiovascular factors that can contribute to frailty include the risk for dehydration. 2. Cardiovascular factors that can contribute to frailty include electrolyte imbalances. 4. Cardiovascular factors that can contribute to frailty include fatigue and activity intolerance. 5. Cardiovascular factors that can contribute to frailty include multiple prescribed medications.

The nurse is planning a presentation for nursing assistants on caring for older patients. Which criteria should the nurse include when explaining frailty? Select all that apply. 1. Slowness 2. Low activity 3. Short-term memory loss 4. Weakness and exhaustion 5. Unplanned weight loss of at least 10 lbs. in a year

1,2,4,5 1. Frailty has been defined as the presence of three or more specific criteria which include slowness. 2. Frailty has been defined as the presence of three or more specific criteria which include low activity. 4. Frailty has been defined as the presence of three or more specific criteria which include weakness and exhaustion. 5. Frailty has been defined as the presence of three or more specific criteria which include an unplanned weight loss of at least 10 lbs. in one year.

The nurse is preparing a seminar on planning for a hospitalization for residents of an assisted living facility. What information should the nurse include in the seminar? Select all that apply. 1. It is important to bring a copy of advanced directives for healthcare. 2. It is important to bring a list of current medications and current labs. 3. You should bring valuable jewelry and money to avoid leaving it unattended. 4. You should bring good walking slippers, a bathrobe, and items such as books. 5. It is important to bring contact information and insurance information.

1,2,4,5 1. Patients should be encouraged to bring a copy of advance directives for healthcare when being admitted to a hospital. 2. Patients should be encouraged to bring a list of current medications and current labs when being admitted to a hospital. 4. Patients should be encouraged to bring comfort items such as slippers, a bathrobe, and reading material when being admitted to a hospital. 5. Patients should bring all of their contact information and contact information for their healthcare proxy, and insurance information, and living will.

A frail older patient is more at risk for poor treatment outcomes in an acute care setting due to what factors? Select all that apply. 1. Increased incidence of nosocomial infections 2. Increased risk of adverse outcomes from therapeutic interventions 3. A diagnosis of vague symptoms and problems 4. Acute illness and diagnosed chronic illnesses 5. Cognitive impairments

1,2,5 1. Nosocomial infections are considered complications of hospitalizations and can contribute to poor treatment outcomes in a frail older patient. 2. Careful monitoring of the older person's status and effectiveness of the overall plan of care is indicated because frail older adults with poor function are at increased risk of iatrogenesis or adverse outcomes of therapeutic interventions. 5. Older adults with cognitive impairment cannot adequately report symptoms of acute or chronic illness.

The nurse is planning care for an older patient who is newly admitted. What nursing interventions are necessary to prevent the geriatric cascade? Select all that apply. 1. Frequent assessment of pressure ulcers 2. Frequent monitoring of confusion 3. Usage of physical and chemical restraints 4. Usage of indwelling urinary catheters 5. Monitoring risk of thrombophlebitis

1,2,5 1. The cascade of illness or functional decline is the hypothesized pathway of development of complications during illness. Iatrogenesis and medical complications of these interventions include increased risk of thrombophlebitis, development of decubitus ulcers, aspiration pneumonia, urinary-tract infection, and increased confusion or delirium. 2. The cascade of illness or functional decline is the hypothesized pathway of development of complications during illness. Iatrogenesis and medical complications of these interventions include increased risk of thrombophlebitis, development of decubitus ulcers, aspiration pneumonia, urinary-tract infection, and increased confusion or delirium. 5. The cascade of illness or functional decline is the hypothesized pathway of development of complications during illness. Iatrogenesis and medical complications of these interventions include increased risk of thrombophlebitis, development of decubitus ulcers, aspiration pneumonia, urinary-tract infection, and increased confusion or delirium.

An older patient with chronic renal failure is admitted; the healthcare provider is planning modified care for this patient. Nursing interventions for modified level of care would focus on which of the following? Select all that apply. 1. Management of illness with medications 2. Symptom and pain management 3. Noninvasive testing 4. Minimally invasive surgery 5. Gentle rehabilitation

1,3,4 1. Management of illness and medications is a feature of modified care. 3. Noninvasive testing is a feature of modified care. 4. Minimally invasive surgery is a feature of modified care.

An older patient with pneumonia requests information on maintaining a healthy lifestyle for illness prevention. What should the nurse include? Select all that apply. 1. Maintain a healthy weight. 2. Restrict the intake of dairy products. 3. See the physician for any signs of an infection. 4. Take a daily multivitamin/mineral supplement. 5. Engage in regular moderate exercise 30 minutes a day, 5 days a week.

1,3,4,5 1. Actions to improve the immune system for the older patient include maintaining a healthy weight. 3. Actions to improve the immune system for the older patient include reporting increased infections to the healthcare practitioner. 4. Actions to improve the immune system for the older patient include taking a daily multivitamin/mineral supplement. 5. Actions to improve the immune system for the older patient include engaging in regular moderate exercise 30 minutes a day, 5 days a week.

The nurse is assessing an older patient's risk for developing problems while hospitalized for an acute illness. The Hospital Admission Risk Profile (HARP) tool will be utilized. Which assessment areas would alert the nurse to a risk? Select all that apply. 1. Age of 87 2. Manual dexterity score of 14 3. Cognitive function score of 7 4. Ability to self-feed score of 2 5. Independence IADL's score of 5

1,3,5 1. The HARP uses age to help determine an older patient's risk for problems while hospitalized. 3. The HARP uses cognitive function to help determine an older patient's risk for problems while hospitalized. 5. The HARP uses independence with ADLs to help determine an older patient's risk for problems while hospitalized.

An older patient is surprised to learn of the diagnosis of rheumatoid arthritis. What can the nurse explain to the patient about this disorder? Select all that apply. 1. Antibodies form against the person's own IgG. 2. The onset of the disorder is slower in older adults. 3. It is a delayed hypersensitivity response to an antigen. 4. There can be abnormalities in both B and T immunity cells. 5. Inflammatory process is stimulated by T cells and destroys articular cartilage.

1,5 1. Rheumatoid arthritis is a type III hypersensitivity response where antibodies form against the person's own IgG causing the complex to be identified as foreign 5. In rheumatoid arthritis, the inflammatory process is stimulated by infiltrating T cells and gradually destroys articular cartilage.

The healthcare provider suggests that an older patient take daily vitamin supplements to enhance immunity. On which supplements should the nurse instruct the patient? Select all that apply. 1. Zinc 2. Iodine 3. Vitamin D 4. Vitamin C 5. Magnesium

1.3,4 1. Zinc is a micronutrient that helps maintain many body homeostatic mechanisms, including the effectiveness of the immune system. Zinc is required for proper production of many enzymes and proteins in the body, and for cellular proliferation. Zinc deficiency results in impaired immune response and the development of degenerative diseases. 3. Evidence is accumulating on the beneficial effects of vitamin D in improving the health of the immune system. 4. Vitamin C contributes to the cellular immune response.

The nurse is preparing a community education program focusing on cardiovascular disease in the older patient. Which information should the nurse include? 1. Breast cancer kills more women than heart disease. 2. A woman of 70 is as likely as a man to develop heart disease. 3. Women are more likely than men to develop heart disease in their middle years. 4. For most women, heart disease is a greater problem before they reach menopause.

2 2. By the time they are in their 70s, men and women get heart disease at equal rates.

A patient asks the nurse how the immune system protects the body. What is the nurse's best response? 1. "Self-recognition allows the immune system to recognize foreign parts." 2. "Memory means that the immune system develops lasting protection against specific invaders." 3. "Specificity is the ability of the immune system to react with a particular response to one antigen." 4. "Tolerance is the term for the ability of the immune system to differentiate between the person's body and foreign substances."

2 Memory means that the immune system has the capacity to develop long-lasting protection against specific invaders. A residual set of cells that are specific to each antigen remains in the body, to be stimulated when the antigen presents itself at a later time. Each successive time the antigen is encountered, a quicker and more intense reaction is stimulated by the immune system in the healthy older person.

An acute care facility is working to decrease the risk of nosocomial infections in older patients. Which preventative action should be included? 1. Limit the sanitization of equipment. 2. Adopt aspiration precautions for dysphagia. 3. Provide antibiotics as prescribed for viral infections. 4. Insert an indwelling urinary catheter for urinary incontinence.

2 Nosocomial infections are those which are acquired in an institution. Using aspiration precautions with patients who have dysphagia decreases the likelihood of aspiration and the pneumonia that often results.

The nurse manager is concerned about the increased number of medication adverse effects being observed in older patients. What should the manager do to reduce these effects? Select all that apply. 1. Conduct a monthly quality improvement study. 2. Monitor each nurse's ability to detect preparation errors. 3. Discuss the importance of not missing medication doses. 4. Review pharmacy documentation regarding drug—drug interactions. 5. Ensure that the physicians' orders are legible.

2,3,4,5 2. Adverse drug events can result from preparation errors. 3. Adverse drug events can result from missed medication doses. 4. Adverse drug events can result from drug—drug interactions. 5. Adverse drug events can result from illegible orders.

The nurse is planning interventions to help improve the immune function of an older patient. What should be included in this patient's plan of care? Select all that apply. 1. Teach to avoid alcohol. 2. Educate on the effects of stress. 3. Encourage to take daily vitamin supplements. 4. Remind to obtain a yearly influenza vaccination. 5. Encourage to utilize positive coping strategies to stress.

2,3,4,5 2. An intervention to improve the immune function of an older patient is to educate the patient on the effects of stress. 3. An intervention to improve the immune function of an older patient is to encourage the patient to take daily vitamin supplements. 4. An intervention to improve the immune function of an older patient is to remind the patient to obtain a yearly influenza vaccination. 5. An intervention to improve the immune function of an older patient is to encourage the patient to utilize positive coping strategies for stress.

A nurse assesses a client in their home and determines they are on a pathway towards frailty. What assessment findings lead the nurse to have this concern? Select all that apply. 1. Chronic use of pain medication 2. Diagnosis of diabetes and heart disease 3. Newly incontinent of urine 4. No children and recent death of spouse 5. Inability to drive to healthcare appointments

2,3,4,5 2. Diagnosis with several chronic illnesses, each of which alone and in combination with others can cause harmful effects on overall physiological function, can lead towards frailty. 3. Changes of aging and loss of organ reserve and function in the very old can lead towards frailty. 4. Change in social and psychological environments can lead towards frailty. 5. Factors, such as functional loss, can lead towards frailty.

The nurse is planning an education program for other nurses on palliative care. Which information should the nurse include in the program? Select all that apply. 1. Palliative care focuses on patients who are close to death. 2. Palliative care can provide respite care for family members. 3. Palliative care focuses on managing pain and troublesome symptoms. 4. Palliative care focuses on developing a therapeutic relationship. 5. Palliative care can be delivered long-term and throughout all phases of treatment.

2,3,4,5 2. Palliative care can provide respite care for families. 3. Palliative care focuses on alleviation of pain and management of troublesome symptoms. 4. Palliative care emphasizes development of a therapeutic relationship through the provision of stable healthcare providers, alleviation of pain and management of troublesome symptoms, respite for families, reduction in use of acute-care hospitals for death and unnecessary hospitalization, and increases in patient and family satisfaction with healthcare delivery. 5. Palliative care can be provided to seriously ill older persons at any time during the disease process.

The nurse is caring for an older patient with a disease caused by a secondary immunodeficiency disorder. Which are secondary disorders? Select all that apply. 1. HIV 2. Cirrhosis 3. Medications 4. Malnutrition 5. Diabetes mellitus

2,3,4,5 2. Secondary immunodeficiency disorders are a consequence of other disorders or treatment regimens such as cirrhosis. 3. Secondary immunodeficiency disorders are a consequence of other disorders or treatment regimens. Many factors can lead to the development of secondary immunodeficiency disorders, including pharmacological factors from medications. 4. Secondary immunodeficiency disorders are a consequence of other disorders or treatment regimens. Many factors can lead to the development of secondary immunodeficiency disorders, including nutritional disorders such as malnutrition. 5. Secondary immunodeficiency disorders are a consequence of other disorders or treatment regimens such as diabetes mellitus.

An older patient is diagnosed with bacteremia and asks what caused the condition. What should be included in the nurse's response? Select all that apply. 1. "The virus that causes chickenpox and shingles also causes bacteremia." 2. "An infected wound can introduce bacteria into the bloodstream causing bacteremia." 3. "Older patients are at risk of bacteremia caused by antibiotic use and superinfections." 4. "Bacteremia can be caused by bacteria from a urinary tract infection entering the bloodstream." 5. "Bacteremia, caused by bacteria entering the bloodstream, can be a complication of pneumonia."

2,4,5 2. Bacteremia is the introduction of bacteria into the bloodstream and can be caused by an infected leg wound. 4. Bacteremia is the introduction of bacteria into the bloodstream and can be caused by a urinary tract infection. 5. Bacteremia is the introduction of bacteria into the bloodstream and can be a complication of pneumonia.

The nurse is assessing an older patient in a skilled facility for frailty. During the assessment, the nurse determines frailty through the presence of which characteristics? Select all that apply. 1. Unplanned weight gain 2. Poor endurance 3. Increase in grip strength 4. Low activity tolerance 5. Generalized weakness

2,4,5 2. Frailty has also been defined as the presence of poor endurance and energy. 4. Frailty has also been defined as low activity tolerance. 5. Frailty has also been defined as the presence of weakness and exhaustion.

During a nursing assessment, a frail older patient with cognitive impairment has a higher level of confusion than normal. What symptoms indicative of a urinary tract infection should the nurse further assess? 1. Flank pain 2. Fall risk 3. Blood pressure 4. Increased appetite

2. A person with a mild cognitive impairment who develops a urinary tract infection might become more confused as a result of the infection. Common atypical presentations of this illness in frail older adults include a higher risk for falls

The nurse is caring for an older patient who is receiving palliative care. Which intervention is the highest priority for this patient? 1. Noninvasive testing 2. Pain management 3. Management of illness with medications 4. Invasive surgery Answer: 2

2. Palliative care improves the quality of life of older adults and their families when facing the problems associated with life-threatening illness. This is achieved through prevention and relief from suffering, early identification, impeccable assessment, and treatment of pain

The nurse is caring for an older patient recently diagnosed with HIV. What best describes the delay in diagnosis? 1. Older patients have an increased immunity to fight the infection. 2. Older patients' symptoms are less severe than younger patients with HIV/AIDS. 3. Older patients often have symptoms that may be attributed to other conditions associated with age. 4. Older patients are more likely to have contracted the disease from contaminated blood or blood products.

3 Since many symptoms of AIDS mimic those of normal aging, such as memory loss, fatigue, and weight loss, physicians can miss a diagnosis of HIV infection.

The nurse is reviewing the white blood cell count for an older patient. Which type of cell has memory and self recognition? 1. Monocytes 2. Neutrophils 3. Lymphocytes 4. Thrombocytes

3 Lymphocytes are the primary cells concerned with the development of immunity. Of all white blood cells, only lymphocytes have the ability for self-recognition, specificity, and memory.

An older patient is hesitant to receive a vaccination against shingles due to lack of knowledge. What will be included in the nurse's teaching? 1. Shingles are treated successfully with antibiotics. 2. Shingles cause vesicular lesions along spinal nerves. 3. Shingles are sometimes difficult to diagnose. 4. Shingles result from reactivation of a herpes simplex virus.

3 Shingles are sometimes difficult to diagnose.

The nurse is caring for an older patient recently diagnosed with cancer. The nurse is concerned about the patient moving towards a trajectory of frailty. What laboratory findings support the nurse's concern? 1. Hemoglobin 12 g/dL 2. Hematocrit 40 g/dL 3. Serum albumin less than 2.5 g/100 dL 4. Serum albumin greater than 2.5 g/100 dL

3 Signs and symptoms of frailty in a person with cancer include serum albumin level less than 2.5 g/100 dL.

An older patient admitted for treatment of pneumonia has severe osteoarthritis. The nurse notices that the client is progressing on a trajectory towards frailty. What nursing assessment findings support this? 1. Poor appetite 2. Frequent requests for pain medication 3. Decreased stamina and deconditioning 4. Compliance with prescribed breathing treatments

3 Signs of frailty in an older person with musculoskeletal problems may include decreased stamina and physical deconditioning.

An older patient is demonstrating delirium since being admitted from a nursing home for treatment of a wound infection. What should the nurse identify as the most likely cause for the patient's delirium? 1. High television volume 2. Intravenous fluid therapy 3. Windowless hospital room 4. Assessments every 4 hours

3 Some evidence suggests that sensory deprivation experienced by older adults placed in windowless hospital rooms is associated with higher rates of delirium.

The nurse planning to implement a Tai Chi program at a senior center is meeting resistance by program attendees. How should the nurse respond to the resistance? 1. "Tai Chi is a popular Chinese exercise." 2. "Getting out and moving around helps." 3. "Studies have been shown that Tai Chi is beneficial to the immune system." 4. "Studies have shown that Tai Chi will help reduce the levels of IgG and IgM."

3 Studies have shown that Tai Chi is beneficial to cardiorespiratory function, mental control, flexibility, balance control, muscle strength, and the immune system.

An older patient experiences an allergic reaction to latex. Which should the nurse explain to the patient about this allergy? 1. "You probably never realized that you had a latex allergy." 2. "Allergic reactions happen more often when you are sick." 3. "Allergic reactions can take up to 2 weeks with a latex allergy." 4. "You were receiving medication that caused the reaction to latex."

3 Type IV hypersensitivity is also called delayed hypersensitivity. The normal reaction occurs within 1 to 14 days after exposure but it is slower in older adults. A latex allergy is type IV hypersensitivity.

An older patient has been hospitalized twice in one year for a lung infection. How should the nurse describe the relationship between aging and risk of infection? 1. "With aging, the immune system diminishes and then stops working." 2. "With aging, there is an overall increase in the speed of the immune response." 3. "With aging, there is an increase in the number of B cells, which hinders the immune response." 4. "With aging, there is a decrease in the strength of the immune system, increasing the risk for infection."

4 As a person grows older, there is an overall decrease in the speed and strength of the immune response. This is called immunosenescence.

The nurse is concerned that an older patient with a chronic illness is on a trajectory towards frailty and dependence. From the nursing assessment findings listed, which is the priority? 1. Sustained cognitive impairment 2. Conditions controlled with medications 3. Family that phones several times a day 4. A decline in functional ability

4 Disabling effects and progression of symptoms may be controlled or halted with careful treatment and monitoring, but if the client is declining in these areas, they may be on a trajectory towards frailty.

The charge nurse is planning an inservice for nursing staff on the theories of aging. What information should the instructor include about immune dysregulation? 1. Immune cells attack the normal body tissues. 2. The immune system is not able to defend the body from foreign invaders as we age. 3. The ability to differentiate between invaders and normal tissues diminishes with age. 4. Changes in the immune system disrupt the regulation of immune process components.

4 Immune dysregulation is caused by changes in the immune system that disrupt the regulation between the components of the immune process.

The nurse is planning care for an older patient recently diagnosed with HIV who wants to remain sexually active. Which would be a priority nursing diagnosis for this patient? 1. Self-care deficit related to depression 2. Social isolation related to fear of AIDS 3. Risk for infection related to immunodeficiency 4. Knowledge deficit related to preventing transmission of HIV

4 Knowledge deficit related to preventing transmission of HIV would be the priority diagnosis for this patient due to the statement of wanting to remain sexually active.

The nurse is caring for a patient with shingles. How does the nurse best explain its etiology? 1. Erysipelas 2. HIV/AIDS 3. Bacteremia 4. Herpes zoster

4 The reactivation of the herpes zoster virus that has lingered in nerve tissue for years following a chickenpox infection can lead to shingles.

A frail older patient with diabetes is diagnosed with a urinary tract infection. Which statement from the patient would concern the nurse to further assess for complications? 1. "My stomach is aching." 2. "I feel nauseated." 3. "I have a headache." 4. "My vaginal area is itching." Answer: 4

4 When antibiotics are used in older adults with diabetes, they are usually prescribed at higher doses for longer periods of time to ensure complete eradication of the offending organism. These higher doses place the person at risk for medication side effects and drug interactions, including development of antibiotic-associated diarrhea, fungal infections, decreases in renal excretion of all prescribed medications, and development of hypo- or hyperglycemia.

The daughter of an older frail patient recovering from receiving the wrong medication asks what the hospital can do to prevent this from happening again. How should the nurse respond to the daughter? 1. "There isn't much that can be done; accidents happen." 2. "Medication errors sometimes happen because we are so short-staffed." 3. "The physician's handwriting was misread; we are talking to him about this issue." 4. "We are discussing installing a bar-code system to identify patients and medications."

4. There is much that can be done to prevent medication errors. The use of computerized entry systems, monitoring of prescriptions by a clinical pharmacist, and identification of the correct patient and drug using bar-code technology are methods that have been shown to decrease the frequency of medication errors

An older client asks the nurse what they can do to live to a healthy old age. Which response by the nurse promotes healthy aging? 1. "You should not receive influenza and pneumococcal vaccines." 2. "You should decrease nutritional intake of dairy products." 3. "You should avoid any weightlifting." 4. "You should use available preventive and screening services."

4. Americans can improve their chances for a healthy old age by simply taking advantage of recommended preventive health services and by making healthy lifestyle changes. About 70% of the physical decline that occurs with aging is related to modifiable factors such as smoking, poor nutrition, physical inactivity, and failure to use preventive and screening services.

The nurse administers an annual flu vaccination to an older patient who asks if they need the pneumonia vaccination too. What is the nurse's best response? 1. "Pneumonia can develop as a complication of the flu." 2. "Everyone needs a flu vaccination and pneumococcal vaccination annually." 3. "Older people should receive either the influenza or the pneumococcal vaccine annually." 4. "Two pneumococcal vaccinations, one year apart, are recommended for persons over the age of 65.

4. More than 90% of the deaths during previous U.S. influenza epidemics were attributed to pneumonia as a complication of influenza. The vaccine reduces influenza-related morbidity and mortality by 70% to 90% among vaccinated individuals.

A hospital is planning to implement a unit that focuses on acute care of the elderly (ACE). How should the hospital administrator explain this unit to the nursing staff? 1. "An ACE unit will be run just like a nursing home, except it's in the hospital." 2. "An ACE unit isn't any different than any other unit in the hospital." 3. "The key concept of an ACE unit is to return the patients to their nursing homes." 4. "An ACE will be guided by nurse-driven protocols."

4. One key concept of an ACE unit is to provide patient-centered interdisciplinary care guided by nurse-driven protocols to address key nursing issues such as mobility, skin care, nutrition, and continence.

The nurse is admitting an older frail patient with dementia as a resident in a long-term care facility. Which problem is a priority when planning interventions for this patient's care? 1. Agitation 2. Wandering behaviors 3. Sleep disturbances 4. Polypharmacy

4. Polypharmacy and overmedication are serious problems inherent in the care of the older person with dementia.

An older person reports swelling after receiving an insect sting that occurred much quicker than the last time a similar sting occurred. Which aspect of the person's immune system does the nurse realize is functioning appropriately? A. Memory B. Self-recognition C. Specificity D. Categorization

A. Memory means that the immune system has the capacity to develop long-lasting protection against specific invaders. A residual set of cells that are specific to each antigen remains in the body, to be stimulated when the antigen presents itself at a later time. Each successive time the antigen is encountered, a quicker and more intense reaction is stimulated by the immune system in the healthy older person. Specificity means that the immune response reacts only to one antigen. Each time a new antigen is identified, a different immune response is stimulated. Categorization is not a characteristic of the immune system. Self-recognition means the immune system differentiates between substances that are normal constituents of a person's body and those that are not

The nurse is concerned that an older frail person is at risk for developing skin tears. Which age-related change is contributing to this person's potential integumentary problem? A. Decrease in collagen B. Malfunctioning eccrine glands C. Increase number of apocrine glands D. Relocation of subcutaneous fat

A. Rationale: The older frail person is at risk for skin tears because of a decrease in collagen. Eccrine glands are decreased in the older person. Subcutaneous tissue is lost with aging. The number of apocrine glands decrease with aging.

An older person reports an increase in chest colds over the last several months. What should the nurse recommend helping reduce this person's incidence of infection? A. Increase the intake of vitamin supplements B. Restrict the intake of carbohydrates and fats C. Restrict the amount of activity when ill D. Increase the intake of omega-3 fatty acids

A. Adequate intake of vitamins and trace elements is required for the immune system to function effectively. However, deficiencies of vitamins and trace elements are observed in almost one third of all older adults, inducing low immune responses and increasing susceptibility to infections. Studies suggest that supplements containing micronutrients assist in preventing infections. Restricting activity, increasing omega-3 fatty acids, or restricting carbohydrates and fats are not identified as actions to reduce susceptibility to infections.

An older person is admitted to an acute care for the elderly (ACE) care area for treatment of atrial fibrillation and cardiomyopathy. What should the nurse make a priority when caring for this person? A. Early discharge to a rehabilitation facility B. Interdisciplinary intervention to support nutrition C. Reduce the number of post-hospitalization medications D. Environmental controls to maximize independence

B. Rationale: One of the key concepts of an ACE unit is person-centered interdisciplinary care to address key nursing issues such as nutrition. The goal of care for an ACE unit is for the older person to return to the former living status and not a rehabilitation facility. The environment should support the person's needs. Independence would depend upon the person's health status. The number of medications will depend upon the person's health status.

A frail older person with dementia is experiencing frequent episodes of combativeness and disorientation. Which intervention should the nurse implement to support this person's behavioral needs? A. Assign to a private room away from the nurse's stations B. Assign the same caregiver to support the person's care needs C. Set limits on the person's behavioral outbursts D. Vary the activities that need to be completed from day to day

B. Rationale: The nurse can greatly improve the quality of an older person's life by providing a safe and consistent environment, predictable pleasures and things to look forward to, avoidance of pain and invasive interventions when possible, and abundant and generous reassurance and support in times of stress. The best intervention would be for the nurse to assign the same caregiver to support the person's care needs. Setting limits does not provide reassurance or support. Assigning the person to a private room away from the nurse's station may exacerbate confusion and disorientation because of limited contact with care providing staff. Varying routine activities could exacerbate confusion and lead to additional combativeness.

The nurse prepares teaching material to explain the pathology of an HIV infection to a group of senior community members. Which information should the nurse include during this educational session? A. Increases humeral immunity B. Decreases cellular immunity C. Decreases humeral immunity D. Increases cellular immunity

B. Infection with the human immunodeficiency virus (HIV) and the resulting acquired immunodeficiency syndrome (AIDS) is the best example of a primary immunodeficiency disorder. The hallmark of this infection is a decrease in cellular (T-cell) immunity. Helper T (CD4) cells are primarily affected by the virus. These T cells mediate between the antigen presenting cells (macrophages) and other B and T cells. This infection does not increase cellular immunity and does not directly affect humeral immunity.

An older person seeks medical attention for a new peeling rash that has occurred on both hands since using a new type of catheter to perform self-urinary catheterization at home. Which type of hypersensitivity reaction should the nurse consider this person is experiencing? A. Type III B. Type IV C. Type I D. Type II

B. A type IV hypersensitivity reaction is a cell-mediated reaction caused by sensitized T cells. This type of reaction occurs with allergic contact dermatitis. A type I reaction is an immediate reaction causing a systemic allergic response. A type II reaction is a cytotoxic reaction that occurs in drug and blood transfusions. A type III reaction is an immune complex reaction that causes serum sickness or a localized arthus reaction.

An older person reports having a history of immunologic illnesses. Which body organ should the nurse consider as possibly being underdeveloped in this person? A. Lymphatic tissue B. Thymus gland C. Spleen D. Red bone marrow

B. During the process of maturation in the thymus gland, T cells begin producing several types of new proteins that become attached to the surface of the T cell. The two major types of mature T cells are helper T cells and cytotoxic cells. Helper cells have CD4 proteins on their surface. When presented with an antigen, helper T cells produce signaling substances that stimulate other T cells and B cells in such a way that inflammation and other body activities are promoted. Even though the immune system consists of the spleen, lymphatic tissue, and red bone marrow, the thymus gland is the organ where T cells are produced.

During a home visit, the nurse assesses a frail older person with repeated hospitalizations for exacerbation of heart failure. Which action should the nurse take to improve this person's health and prevent additional hospitalizations? A. Review the current advance directive and recommend changes B. Emphasize the need for resting throughout the day C. Analyze medication taking approach used by the person D. Suggest relocation to an assisted living facility

C. Rationale: A reason for repeated hospitalizations for exacerbation of heart failure may be due to inaccurate or incorrect taking of prescribed medications. The nurse should focus on the approach that the person follows when taking medication to ensure they are being taken as directed. Relocation to an assisted living facility would not necessarily reduce the number of hospitalizations. Rest should be planned along with activity. Resting throughout the day would encourage further deconditioning post-hospitalization. Reviewing an advance directive would not help prevent further hospitalizations for treatment of the same health problem.

An older person who maintains an independent lifestyle is hospitalized for injuries sustained after falling. Which information is most important when determining treatment decisions for this person? A. Living arrangements B. Age C. Baseline functioning D. Community activities

C. Rationale: Optimum care of the older person is achieved by an overall understanding of the person's current health problems, past health history, baseline levels of physical and cognitive function, financial and family support systems, and expectations and goals of care. Because of the variability in aging and uniqueness of each person's compensatory ability, chrono-logical age should never serve as a sole marker for making treatment decisions. Living arrangement and community activities should not be used to identify treatment decisions for the older person.

An older person with end stage renal disease wants to live as along as possible. Which intervention should the nurse expect to be prescribed to help achieve this person's goal? A. Fluid restriction B. Pain medication C. Surgery to create an arteriovenous fistula D. Subcutaneous erythropoietin injections

C. Rationale: The person wants to extend life which necessitates aggressive treatment. Radical surgery such as the placement of an arteriovenous fistula for hemodialysis treatments would be expected to achieve this goal. Pain medication and a fluid restriction would support palliative care or hospice care level of treatment. Subcutaneous erythropoietin injections would help manage the illness as a modified level of treatment.

The nurse is providing wellness care to members of a senior center. Which older person should the nurse identify as benefiting the most from interventions to support immune functioning? A. Older person who participates in tai chi sessions twice a week B. Older person who routinely takes low-dose vitamin supplements C. Older person whose spouse died two months ago D. Older person who receives an annual influenza vaccination

C. The older person whose spouse died two months ago is most at risk. If the person has assistance coping with the stress-inducing event for a period of approximately 6 months after the event, resolution and stabilization of the immune system is likely to occur. Receiving an annual influenza vaccination, participating in tai chi sessions, and routinely taking low-dose vitamin supplements all support healthy immune functioning in an older person.

An older person hospitalized for pneumonia develops acute renal failure. Which pharmacological issue should the nurse consider as causing the onset of this person's new health problem? A. Inappropriate use of an antibiotic to treat pneumonia B. Undiagnosed allergy to prescribed medications to treat pneumonia C. Change in renal clearance of antibiotics to treat pneumonia D. Exposure of a renal problem which potentiated the symptoms of pneumonia

C. Rationale: Older adults are inherently at higher risk of adverse drug events due to normal changes of aging and the resulting impact on drug metabolism and distribution. There is no reason to suspect that the medications used to treat the pneumonia were inappropriate. It is unlikely that a drug allergy is causing the change in renal functioning. There is no direct correlation between renal failure and the development of pneumonia.

The nurse notes that an older person has been experiencing an increased number of skin and respiratory infections over the last several months. Which observation should the nurse consider as contributing to this person's increased infections? A. Shops for groceries and household items every week B. Plays bridge every week at the local library C. Serves as the sole caregiver for a spouse with Alzheimer disease D. Attends religious services every Wednesday and Sunday

C. It is generally believed that the stress response, resulting in sympathetic nervous system stimulation and hormonal changes, can suppress the immune system in older adults. In some illnesses, such as respiratory infections, a short-term change in immune function may be all that is required to increase susceptibility. Being the sole caregiver for a spouse with Alzheimer disease is most likely contributing to this person's frequency of infections. Social, religious, and household activities most likely are not contributing to this person's increase in infections.

The nurse notes that an older frail resident in a skilled facility is increasingly irritable and naps throughout the day. Which body system should the nurse identify that is causing this person's behavior change? A. Respiratory B. Musculoskeletal C. Immune D. Neurological

D. Rationale: Changes to the neurologic system in a frail older person decreases the person's ability to interact effectively with environment. This can lead to daytime irritability and chronic fatigue. Changes to the immune system lead to the development of infections and possibly cancer. Changes to the respiratory system can lead to the development of sleep apnea. Changes to the musculoskeletal system increase the risk of falls through deconditioning.

A frail older person admitted to an acute care facility for evaluation after a fall at home is incontinent of urine because of the inability to walk safely to the bathroom. Which action should the nurse take to improve this person's safety and reduce the episodes of incontinence? A. Restrict ambulation to be with assistance only B. Apply additional padding to the bed C. Discuss the use of an indwelling urinary catheter with the health care provider D. Place a portable commode at the person's bedside

D. Rationale: The most logical intervention is to have a portable commode placed at the person's bedside. This will reduce the distance that the person must walk to the bathroom, reducing the episodes of incontinence. Additional bed padding assumes incontinence will continue. Restricting ambulation to be with assistance only may lead to additional episodes of incontinence if assistance is not provided when it is needed. Indwelling urinary catheters are a risk factor for hospital-acquired infections and could encourage the development of an additional problem in the older person.

The nurse plans interventions for an older frail person to address age-related changes in the cardiovascular system. Which health problem caused the nurse to make this clinical determination for the person's care? A. Early satiety B. Slow reaction time C. Wide based gait D. Dizzy with position change

D. Rationale: Dizziness with position changes indicates the development of postural hypotension. Early satiety is an indication of a change in the gastrointestinal system. A wide based gait is a change in either the musculoskeletal or neurologic system. A slowing of reaction time is a change in the neurologic system.

An older person is diagnosed with a second urinary tract infection in 6 months. Which intervention should the nurse consider helping to prevent additional infections in this person? A. Recommend using a straight catheter at home to ensure complete bladder drainage B. Remind to restrict fluid several hours before bedtime C. Encourage to increase the intake of carbohydrate foods D. Instruct to complete the entire course of prescribed antibiotics

D. A short course of oral antibiotic therapy is often an effective treatment for a urinary tract infection. The person should be reminded to take the entire prescription. Fluid restriction at bedtime may encourage urinary stasis and enhance bacterial growth in the urinary tract. Carbohydrate foods will not affect the growth of bacteria in the urinary tract. Catheterization should be avoided since this is a major reason for the development of urinary tract infections.

An older person's latest blood specimen indicates the development of leukopenia. Which medication should the nurse consider as causing this person's health problem? A. Prednisone B. Gentamicin C. Penicillin D. NSAIDs

D. High dose NSAIDs can cause leukopenia. Penicillin and gentamicin can cause agranulocytosis. Prednisone can cause overall immunosuppression.

An older person receives an injection of an immunoglobulin to inactivate an antigen that is causing an immunologic illness. Which aspect of the humoral response is this immunoglobulin assisting? A. Precipitation B. Opsonization C. Agglutination D. Neutralization

D. The antibodies function in many ways to enhance the removal of antigens from the body. These functions are precipitation, agglutination, neutralization, opsonization, and complement activation. Antibodies that inactivate an antigen by binding with it before it can interact with body cells describes neutralization. Antibodies and antigens that bind together describes agglutination. Large insoluble complexes that are formed during the antigen-antibody response describes precipitation. Coating the foreign antigen to prevent it from causing bodily harm describes opsonization.