Chap 23 The Older Adult
The nurse is working in a long-term care facility and overhears a group of unlicensed assistive personnel (UAP) discussing some of the residents of the facility. What statement made by a UAP indicates that education regarding older adult clients is needed? "Older adult clients still enjoy sexual relations." "All old people start to deteriorate mentally." "Some of the residents still like to look their best." "Not all people that are elderly live in long-term care facilities"
"All old people start to deteriorate mentally." Explanation: Although response time may be prolonged due to a longer processing time, neither intelligence nor personality normally decreases because of aging. The older adult population may enjoy sexual relations well into their 90s. Older adult clients do care about their appearance and would like to be attractive to others. Although the largest percentage of residents in long-term care facilities are older adults, many of whom have disabilities, only about 3% of older adults live in long-term care facilities. Chapter 23: The Older Adult - Page 580
An adult child accompanies an older adult client to the clinic and states, "I am not sure what is going on with my parent but I think it is depression." What questions should the nurse ask the client to determine if he or she is depressed? Select all that apply. "Can you tell me what your sleep patterns are?" "Have you had any changes in weight recently such as a gain or loss?" "Have you been seeing things that no one else seems to see?" "What foods do you like to eat?" "Have you lost interest in things you previously found pleasurable?"
"Can you tell me what your sleep patterns are?" "Have you had any changes in weight recently such as a gain or loss?" "Have you lost interest in things you previously found pleasurable?" Explanation: Extreme or prolonged sadness in an older adult may be a warning sign of depression. Depression is not a normal part of aging. Death of a spouse or friends and changes in living environment and financial resources can precipitate feelings of grieving that, if unresolved, may result in depression. There is usually a distinct change of behavior accompanied by other specific signs and symptoms of depression, such as sleep disturbances, weight loss (sometimes gain), difficulty with concentration, irritability or anger, loss of interest in once pleasurable activities, vague pains, crying, fatigue, and suicidal thoughts or preoccupation with death. Visual hallucinations are not part of the symptoms of depression and may be indicative of another form of mental illness or have an organic cause. Finding out what foods the client eats does not ask a question that relates to finding out if the client is depressed. Chapter 23: The Older Adult - Page 583
A nurse is conducting an education session about appropriate measures to promote sleep with an older adult who is experiencing frequent awakenings at night and then awakening early in the morning. The nurse determines that the education was successful when the client states: "I should do some mild exercises about 2 hours before bedtime." "I need to try and go to bed and get up at the same time each night." "I should continue to take my sleep medication for as long as I need to." "I should avoid coffee, but tea is okay to drink before bed."
"I need to try and go to bed and get up at the same time each night." Explanation: Sleep measures include maintaining a routine, going to bed and getting up at the same time each night, avoiding exercise 3 to 4 hours before bed, using prescribed sleep medications only for the short-term (7 to 14 days), and avoiding alcohol, nicotine, and caffeine (which tea contains). Chapter 23: The Older Adult - Page 586
Which statement shows that the nurse does not practice ageism? (does not show discrimination on a person's age.) "Most older adults are lonely." "Older adults have incontinence." "Neither intelligence nor personality normally decline because of aging." "Older adults do not mind how they look."
"Neither intelligence nor personality normally decline because of aging." Explanation: Although response time may be prolonged from a longer processing time, neither intelligence nor personality normally decreases because of aging. Loneliness results from losses, just as it does for people of all ages. Many adults are active in their communities. Incontinence is not a normal part of aging and requires medical attention. Older adults want to be attractive to others. Chapter 23: The Older Adult - Page 576
A nurse is teaching an elderly client's family about the causes of mental impairment. The nurse sees that the teaching has been effective when the family says which of the following? "Dementia is an acute process and develops suddenly." "Sundowning is a common problem of dementia." "Delirium progressively affects cognitive function and is a chronic process." "Alzheimer's disease (AD) is a reversible neurologic illness."
"Sundowning is a common problem of dementia." Explanation: A common problem in patients with dementia is sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated after dark. Dementia is chronic and usually develops gradually. AD is the most common degenerative illness and is irreversible. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment. Chapter 23: The Older Adult - Page 583
The nurse is caring for an older adult client who is confused and agitated. When the client's family comes to visit the nurse asks how long the client has been confused. The family states that the client has been confused for a long time and the confusion is getting worse. The client is subsequently diagnosed with dementia. What is the most common cause of dementia in an older adult client? Delirium Depression Excessive drug use Alzheimer's disease
Alzheimer's disease Explanation: Alzheimer's disease is the most common cause of dementia in older adults. Approximately 10% of people over age 65 have Alzheimer's disease; about 50% of people over age 85 have the disease. Delirium, or acute confusion, is caused by an underlying disease and is not itself a cause of dementia. Depression is common in older adults but, in many cases, manifests itself in apathy, self-deprecation, or inertia — not dementia. Excessive drug use, commonly stemming from the client seeing multiple physicians who are unaware of drugs that other physicians have prescribed, can cause dementia. Although it is a problem among older adults, it is not as common as Alzheimer's disease. Chapter 23: The Older Adult - Page 582
One of the greatest causes of death in the United States and Canada is colon cancer. The nurse instructs the community on which of the following factors? Annual screening after the age of 50 Endoscopic exam every year after 30 <20 g of fiber intake per day Administration of a stool softener daily
Annual screening after the age of 50 Explanation: Colorectal screening annually after the age of 50. Chapter 23: The Older Adult - Page 569
The nurse is evaluating a 42-year-old client who says that he is feeling stressed. Which of the following does the nurse know that could be a cause of stress for this age group? Being caught in the sandwich generation Retirement Losing driving privileges Social isolation
Being caught in the sandwich generation Explanation: Middle-aged adults may be caught in a "generation sandwich," which includes involvement with children as well as aging parents and other family members. Retirement, the loss of driving privileges, and social isolation are often stressors for the older adult. Reference Chapter 23: The Older Adult - Page 567
A gerontologic nurse practitioner has a large client population with heart disease problems. This nurse practitioner is aware that heart disease is the leading cause of death in the aging adult. What is the cause of this trend? Blood vessels lose their elasticity with age. Systolic blood pressure decreases with age. Resting heart rate decreases with age. The cardiac output is increased with age.
Blood vessels lose their elasticity with age. Explanation: In the aging adult, the blood vessels become less elastic. Because the blood vessels become more rigid, increase in blood pressure can result. The body is less able to increase heart rate and cardiac output with activity. Chapter 23: The Older Adult - Page 585
An older adult client enjoys good overall health, but has just been diagnosed with pneumonia and has begun receiving an intravenous (IV) antibiotic. Shortly after being administered the first dose, the client pulled out his IV line and is now attempting to scale his bed rails. Which of the following phenomena most likely underlies this change in the client's cognition? Delirium Dementia Disorientation Depression
Delirium Explanation: Delirium is a temporary state of confusion that is often precipitated by drug interactions or the effects of new drugs. Dementia is rooted in organic brain changes and rarely has a sudden onset. The client is not showing signs or symptoms of depression. Disorientation is a manifestation of a problem rather than a cause. Chapter 23: The Older Adult - Page 583
A nurse is preparing to medicate an older adult client with an opioid analgesic. Which information will the nurse obtain first to decide about administering the medication? Observing client behavior to determine if coincides with report of pain Taking the clients vital signs to determine if indicative of pain Determining if the client is able to communicate pain verbally or nonverbally Obtaining family feedback about client's pain level
Determining if the client is able to communicate pain verbally or nonverbally Explanation: The nurse should ascertain the level and intensity of the client's pain. The family is not able to give adequate information about the client's pain. Taking the client's vital signs can be of value as a baseline. A client may share indication of pain other than verbally, such as a grimace or moaning. Each client may exhibit different behaviors when in pain. This is not a reliable indicator as to a client's pain level. Chapter 23: The Older Adult - Page 393
When assessing an older adult client's home for safety, the nurse should recommend what? Eliminating throw rugs Using low lighting Taking tub baths Avoiding air conditioning in summer
Eliminating throw rugs (tấm thảm) Explanation: A study of community-dwelling seniors found that they typically exercised caution by depending on help, restricting activities, eliminating hazards (e.g., throw rugs), and selecting safe spaces. High level of light is beneficial for seniors. There is not a contraindication to taking a tub bath for a senior client as it does not affect safety issues. The senior client should not avoid air conditioning in summer as this can cause an increase in the home and because elderly do not sweat they are at a risk of overheating quickly. Chapter 23: The Older Adult - Page 586
Gould viewed the middle years as a time when adults increase their feelings of self-satisfaction, value their spouse as a companion, and become more concerned with health. Which nursing action best facilitates this process? Counseling a client who complains of being depressed Providing entertainment for a client on bedrest Arranging for social services to assist with meals for a homebound client Encouraging a client to have regular checkups
Encouraging a client to have regular checkups Explanation: Gould viewed the middle years as a time when adults look inward (ages 35 to 43); accept their lifespan as having definite boundaries, and have a special interest in spouse, friends, and community (ages 43 to 50); and increase their feelings of self-satisfaction, value spouse as a companion, and become more concerned with health (ages 50 to 60). The nursing action that best facilitates this process would be encouraging a client to have regular checkups. Chapter 23: The Older Adult, p. 566.
A home care nurse is reviewing guidelines for health-related screenings with a 35-year-old patient. What are common screening recommendations for physical examinations? Every 3 years to age 40 and annually from age 40 Annual physical examinations from age 30 Every 2 years to age 50 and annually from age 50 Annual physical examinations from birth
Every 3 years to age 40 and annually from age 40 Explanation: Physical examinations are recommended every 3 years to age 40 and every year from age 40. Annual physical examinations are not required from birth. Chapter 23: The Older Adult - Page 569
An elderly client is becoming progressively confused due to Alzheimer's disease. The family can no longer manage the client at home due to wandering. Which of the following living arrangements could the nurse recommend? Respite care Naturally occurring retirement communities (NORCs) Extended-care facility Accessory apartment
Extended-care facility Explanation: If the older adult is cognitively impaired, family caregivers face the need for daily care giving, such as that which is provided in an extended-care facility (nursing home). Respite care is temporary housing and NORCs enable the client to remain at home. Accessory apartments are separate apartments constructed, in part, out of an existing house and do not have any health care services. Chapter 23: The Older Adult - Page 582-583
The middle adult is sometimes called the "sandwich generation". According to Erikson, the developmental task of the middle adult is what? Initiative versus guilt Ego-integrity versus despair Generativity versus stagnation Goal attainment versus crisis
Generativity versus stagnation Explanation: The developmental task of the middle adult is "generativity versus stagnation." They are in a stage of guiding the next generation, accepting their own changes and adjusting to need of aging parents, as well as evaluating their own goals and accomplishments. "Initiative versus guilt" is the developmental task for toddlers. "Ego integrity versus despair" is the developmental task for older adults. "Goal attainment versus crisis" is not a developmental task. Chapter 23: The Older Adult - Page 565
An older adult client comes to the senior center for a check-up. During the visit, the client tells the nurse that he knows he should be more active than he is. The nurse reinforces the client's statement, explaining that physical activity helps to lower the risk of which condition? Select all that apply. Heart disease Stroke Diabetes Anxiety Arthritis
Heart disease Stroke Diabetes Explanation: Physical activity is good for all people including the older adult. Being physically active (1) lowers the risk of heart disease, stroke, and diabetes, (2) reduces depression symptoms, and (3) improves thinking (Health People 2020). Staying active will increase or maintain strength and balance, allowing for continued independence and the prevention of injuries. Activity may be used to address symptoms of anxiety but it will not help lower the risk for anxiety. Arthritis can interfere with the older adult's ability to engage in physical activity. Chapter 23: The Older Adult - Page 572
Give an example of cascade iatrogenesis
Here is an example of cascade iatrogenesis: an episode of confusion and wandering at night may lead to a fall that results in a hip fracture. During the resulting hospitalization, the insertion of an indwelling catheter can precipitate a urinary tract infection that requires use of an antibiotic and possibly the development of antibiotic-resistant organisms.
Mrs. Jimenez, age 79, became a widow earlier this year and now resides alone in the house that she and her husband shared for 30 years. Her children have encouraged her to move, but she expresses a desire to remain in her home, despite some slight mobility challenges. The nurse who provides occasional home healthcare for Mrs. Jimenez should first propose which of the following? Home modification Assisted living A nursing home Homesharing
Home modification Explanation: Older adults typically express a desire to maintain their existing living relationships and this should be facilitated as long as it is safe. Consequently, the nurse should prioritize Mrs. Jimenez's wishes. Home modification may allow her to maximize her independence and maintain her current living situation in spite of some mobility challenges. Chapter 23: The Older Adult - Page 578
Incontinence. Ageism
Incontinence is lack of voluntary control over urination or defecation. Ageism is prejudice or discrimination on the grounds of a person's age.
A nurse caring for older adults in a long-term care facility is teaching a novice nurse characteristic behaviors of older adults. Which statement is not considered ageism? Old age begins at age 65. Personality is not changed by chronologic aging. Most older adults are ill and institutionalized. Intelligence declines with age.
Personality is not changed by chronologic aging. Explanation: Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in only a few members of their group. Fundamental to ageism is the view that older people are different and will remain different; therefore, they do not experience the same desires, needs, and concerns as other adults. The statement not considered ageism would be that personality is not changed by chronologic aging. Most older adults are not ill and institutionalized. Intelligence does not decline with age. Old age does not begin at age 65. Chapter 23: The Older Adult - Page 571
An 80-year-old client tells the nurse that he has been dizzy since starting to take an herbal remedy for arthritis in addition to prescribed medications. The nurse recognizes that the client may be experiencing the effects of which of the following? Polypharmacy Fluid volume overload Sleep disorder Cascade iatrogenesis
Polypharmacy Explanation: Polypharmacy, the use of many medications at the same time, can pose many hazards for older adults. Alternative therapies, such as herbal remedies, have the potential to interact with prescribed drugs. Fluid volume overload and sleep disorders are not the cause of dizziness. Cascade iatrogenesis is a sequence of adverse events in a frail, older adult. Chapter 23: The Older Adult - Page 580
An client 81 years of age is in a long-term-care facility. His family could no longer cope with his progressing senile dementia, including wandering away and unpredictable behavior. Late one night the nurse finds the client wandering in the hall. He says he is looking for his wife. What should the nursing approach should be? Use a matter-of-fact attitude and gently help him back to his room. Remind him that he must not get up unassisted and should stay in his room at night. Remind him of where he is and assess why he is having difficulty sleeping. Allow him to sleep in the recliner in the day-room, so he will not disturb other clients.
Remind him of where he is and assess why he is having difficulty sleeping. Explanation: Reminding the client where he is will help orient him to his surroundings. Assessment is needed to determine any need that may be disturbing the client, such as the need to use the bathroom, feeling cold/warm, etc. The other responses do not include orienting the disoriented/confused client. Chapter 23: The Older Adult - Page 582-583
The home care nurse is visiting an older adult client in the home to assess a leg wound and change the dressings. The nurse is aware that the client receives money monthly but there is no food in the house, no adequate heat, and the client states, "My sister takes my check and cashes it every month." What is the correct action by the nurse? Call the police and tell them to swear a warrant for the arrest of the sister. Report the incident to social service informing them the client has no food or heat. Tell the client to talk with the sister and have her replace the money she has stolen. Take the client to the local hospital Emergency Department.
Report the incident to social service informing them the client has no food or heat. Explanation: The client is apparently a victim of financial abuse and is being left without resources in order to live comfortably and to have basic needs cared for. The nurse should not confront the sister or have the client confront her due to the potential for violence. The incident must be reported to social service to have them involved with obtaining immediate resources for the client. Taking the client to the Emergency department would be against regulations for home health nurses and the client is not in need of immediate medical attention. Chapter 23: The Older Adult - Page 584
In a report, the night nurse tells the incoming nurse that one client with dementia has sundowning syndrome. Which of the following nursing diagnoses would be most appropriate for this client? Sleep deprivation Social isolation Grieving Noncompliance
Sleep deprivation Explanation: A common problem in clients with dementia is sundowning syndrome in which an older adult habitually becomes confused, restless, and agitated after dark and does not sleep. Implementing the nursing diagnosis of sleep deprivation will help the client obtain adequate sleep at night and awaken refreshed. Social isolation, grieving, and noncompliance are diagnoses that could be related to dementia but not sundowning. Chapter 23: The Older Adult - Page 582-583
A nurse has attended an inservice workshop that addressed the phenomenon of ageism in the health care system. Which of the following practices is indicative of ageism? Implementing falls prevention measures in a setting where older adults receive care Providing slightly smaller servings of food for clients who are elderly Speaking to older adults with the presumption that they have mild cognitive deficits Assessing the skin turgor of an older adult differently than that of a younger adult
Speaking to older adults with the presumption that they have mild cognitive deficits Explanation: Accommodation of normal, age-related changes such as decreased skin turgor and slightly decreased nutritional needs is not an indication of ageism. Similarly, safety measures are unlikely to be motivated by ageist beliefs. Assuming that all older adults have cognitively deficits, however, is an indication of ageism. Chapter 23: The Older Adult - Page 571
SPICES identifying common problems experienced in older adults that can lead to negative outcomes
S—Sleep disorders P—Problems with eating or feeding I—Incontinence C—Confusion E—Evidence of falls S—Skin breakdown
When providing nursing care to the elderly, it is most important to provide comfort due to which of the following changes? Dementia Isolation Thermoregulation Sexuality
Thermoregulation Explanation: The body can adapt to environmental temperatures within broad limits, but age and health status greatly affect this capacity. Thus, in the provision of nursing care that focuses on comfort, the nurse must be aware of changes in thermoregulation. Chapter 23: The Older Adult - Page 583
Which group of individuals in the older adult population is most likely to be widowed? Women under the age of 65 Men under the age of 70 Men over the age of 75 Women over the age of 75
Women over the age of 75 Explanation: Loss and grief are a significant factor in the older adult population. In 2008, almost half of women (42%) were widowed by age 65, compared with 14% of men. Of women 75 years or older, only 28.9% lived with a spouse (AOA, 2009). Chapter 23: The Older Adult - Page 572
A nurse arrives at the home of an older adult client. The agency was called because a neighbor noticed that the client was home alone. The nurse finds the client alone in the living room. When asked about the client's daughter who lives there and has been caring for her, the client says, "She went on vacation for about a month. She'll be back soon." Further assessment reveals that there are no other family members or services currently involved. The nurse would identify this situation as: abandonment. exploitation. neglect. emotional abuse.
abandonment. Explanation: The client is alone and without any support or caregivers. Therefore, abandonment, which is the desertion of a vulnerable older adult by anyone who has assumed responsibility for that adult's care, would apply. Exploitation involves illegally taking or misusing funds, property, or assets of a vulnerable older adult. Neglect involves refusal or failure by those responsible to provide food, shelter, protection, or health care for a vulnerable older adult. Emotional abuse involves verbally or nonverbally causing mental pain, anguish or distress on the older adult. Chapter 23: The Older Adult - Page 585
When creating a nursing care plan, what information should the nurse elicit from a client having difficulty sleeping? amount of caffeine consumed per day where the client has sexual intercourse when the client performs personal hygiene the client's family medical history
amount of caffeine consumed per day Explanation: In order to develop a plan of care, the nurse should ask about the amount of caffeine consumed per day, as this may influence the quality of sleep. Clients who are having difficulty sleeping should consider changes in sleep hygiene. Asking the client what activities the bed is used for (such as reading or watching television) is important, but specifically asking where sexual intercourse occurs may be seen as inappropriate. Asking when the client performs personal hygiene is not relevant to sleeping habits. Family medical history would not be necessary to develop a plan of care regarding sleep. Chapter 23: The Older Adult - Page 586
The nurse is caring for an older adult client on the medical unit admitted for diagnostic testing. The client is alert and oriented and lives independently. The client was wearing glasses upon admission. Which nursing intervention will be most effective in the prevention of falls for this client? using a gait belt each time the client ambulates ensuring the client's glasses are close by the bed placing a bed alarm on the bed moving the client to a room close to the nurse's station
ensuring the client's glasses are close by the bed Explanation: This client does not require aggressive fall prevention measures since the client lives independently, is only having diagnostic testing, and is alert and oriented. Keeping the client's glasses close by will ensure the use of sensory appliances necessary to prevent falls. Chapter 23: The Older Adult - Page 578
Based on an understanding of the cognitive changes that normally occur with aging, what might the nurse expect a newly hospitalized older adult to do? talk rapidly but be confused withdraw from strangers interrupt with frequent questions take longer to respond and react
take longer to respond and react Explanation: The nurse would expect a newly hospitalized older adult to take longer to respond and react. It is normal for an older adult to take longer to respond and react, particularly in new or unfamiliar surroundings. Knowing this, the nurse should slow the pace of care and allow older clients extra time to ask questions or complete activities. Chapter 23: The Older Adult - Page 574
