Chapter 11: Health Care of the Older Adult

Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? a) Cataract b) Presbyopia c) Glaucoma d) Presbycusis

b) Presbyopia Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. Presbycusis refers to age-related hearing loss. Cataract is the development of opacity of the eye lens. Glaucoma is a disease characterized by increased intraocular pressure.

The nurse brings the older adult patient a dinner tray and observes the patient placing excess amounts of salt on the food. What suggestions for flavoring can the nurse provide to decrease the amount of salt the patient is placing on her food? (Select all that apply.) a) Use pepper instead of salt. b) Use an alcohol-based mouthwash prior to eating. c) Use low-sodium herbs and spices. d) Drink water before the meal. e) Use lemon instead of salt to flavor food.

a) Use pepper instead of salt. c) Use low-sodium herbs and spices. e) Use lemon instead of salt to flavor food.

A nurse is preparing a presentation for a local senior center about the health status of older adults. What trends in health promotion and disease prevention activities would the nurse explain as contributing to declining death rates in the older adult population? Select all that apply. a) decreased smoking b) decreased community-based services c) early detection of elevated cholesterol levels d) improved nutrition e) screening for hypertension f) decreased exercise

a) decreased smoking c) early detection of elevated cholesterol levels d) improved nutrition e) screening for hypertension Most deaths in the United States occur in people 65 years or older, with one-half of these caused by heart disease and cancer. Decreased smoking, improved nutrition, screening for hypertension, and early detection of elevated cholesterol levels are contributing factors to a decreased death rate in older adults. Older adults are encouraged to increase exercise and increase community-based services.

Which is a factor that contributes to urinary incontinence in older female adults? a) Decreased urinary residual b) Relaxed perineal muscle c) Increased bladder capacity d) Detrusor stability

b) Relaxed perineal muscle Female older adults typically have relaxed perineal muscle. The relaxed muscle can contribute to urinary incontinence, especially when laughing, coughing, and sneezing. Decreased urinary residual would not be a contributing factor. Most older adults have an increase in urinary residual. Most older adults have a decreased bladder capacity; this contributes to an increase in frequency in urination but not incontinence. Detrusor stability is a normal finding and helps prevent incontinence.

Which characteristic distinguishes normal aging from pathological changes associated with aging? a) Morality b) Universality c) Spirituality d) Confidentiality

b) Universality Universality is the major criterion used to distinguish normal aging from pathologic changes associated with illness. Confidentiality, morality, and spirituality do not distinguish normal aging form pathological changes associated with aging.

An age-related change associated with the cardiovascular system is a) increased compliance of heart muscle. b) decreased cardiac output. c) thinner heart valves. d) decreased blood pressure.

b) decreased cardiac output. Age-related changes associated with the cardiovascular system include decreased cardiac output, increased blood pressure, decreased compliance of the heart muscle, and thickening of the heart valves.

An older adult develops sudden onset of confusion and is hospitalized. The family expresses concern that their loved one is developing Alzheimer disease. What response by the nurse is most appropriate? a) "What concerns you most about Alzheimer disease?" b) "Once the underlying cause of the confusion is found and treated, your loved one will be better than ever." c) "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." d) "Alzheimer disease can be a great burden on the family. What community resources do you know about?"

c) "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." Delirium is associated with a sudden onset of confusion, not Alzheimer disease. The family needs to be told the correct information, which is that several underlying conditions could be causing the confusion. Once the underlying cause(s) is found and treated, the confusion should subside; however, some clients may not recover from the underlying cause, so telling the family the client will be better than ever is not appropriate. Asking the family about their concerns about Alzheimer disease and what they know about community support related to it is not appropriate because the client is exhibiting symptoms related to delirium.

A nurse is assessing an older adult for depression using the Geriatric Depression Scale. Which question would the nurse ask first? a) "Do you feel your life is empty?" b) "Are you in good spirits most of the time?" c) "Do you often get bored?" d) "Are you basically satisfied with your life?"

d) "Are you basically satisfied with your life?" When using the Geriatric Depression Scale, the nurse would first question the patient about being satisfied with life. Then the nurse would continue the assessment, asking if the patient feels his or her life is empty, if the patient often gets bored, and if the patient is in good spirits most of the time.

An elderly client reports that he feels like he voids frequently during the day and at night but cannot empty his bladder. The nurse instructs the client to a) Drink no more than his current 2 to 3 ounces of alcohol each day. b) Hold his urine as long as possible before voiding. c) Decrease fluid intake. d) Limit ingestion of caffeinated beverages.

d) Limit ingestion of caffeinated beverages. Symptoms that the client describes may be indicative of benign prostatic hypertrophy. The client should limit caffeinated beverages. He does not want to decrease fluid intake; doing so may increase his susceptibility to urinary tract infections. He needs to void frequently and not wait long periods between voiding. The client also should limit his alcohol intake, preferably decreasing it.

An older adult patient is experiencing presbycusis. When interviewing the patient, the nurse would be alert for problems associated with which consonants? Select all that apply. a) D b) L c) W d) S e) P f) F

d) S e) P f) F With presbycusis, the patient loses the ability to hear high-frequency tones and often cannot follow conversations because tones of high-frequency consonants, such as f, s, th, ch, sh, b, t, and p, all sound alike.

A client who is elderly reports difficulty with reading and seeing faces. The nurse assesses the client for the following risk factors associated with age-related macular degeneration (select all options that apply): a) Sunlight exposure b) Cigarette smoking c) Family history d) Vitamin D ingestion e) Opacity of the lens

a) Sunlight exposure b) Cigarette smoking c) Family history Risk factors for age-related macular degeneration include sunlight exposure, cigarette smoking, and heredity. Ingestion of vitamin D is not a risk factor for macular degeneration. Opacity of the lens is associated with cataracts, not macular degeneration.

Why are IV solutions usually given at a slower rate to older adults? a) Older adults may have poor skin turgor. b) Older adults often find infusions painful. c) Older adults may have cardiac or renal disorders. d) Veins of older adults tend to be rigid.

c) Older adults may have cardiac or renal disorders. IV solutions usually are given at a slower rate to older adults because these clients usually have cardiac or renal disorders. Veins of older adults tend to be rigid and they have poor skin turgor, making venipuncture difficult; however, this factor does not affect infusion. Older adults do not find infusion more painful than other clients.

A nurse is preparing a health promotion class for a group of seniors at a local community center. As one part of the presentation, the nurse is planning to address sexuality and sexual function. Which statement would be least appropriate to include? a) It might take longer to complete sexual intercourse. b) Response to sexual stimulation may be less intense. c) Sexual arousal may take longer to occur. d) Sexual desire typically becomes progressively less.

d) Sexual desire typically becomes progressively less. In both older men and women, it may take longer to become sexually aroused, longer to complete intercourse, and longer before sexual arousal can occur again. Although a less intense response to sexual stimulation and a decline in sexual activity occurs with increasing age, sexual desire does not disappear.

Which action by the nurse demonstrates ageism? a) Providing the same high quality of care to all clients b) Encouraging the older adult to develop routines not associated with work c) Directing all health decisions to the older adult's child e) Allowing adequate time for the older adult to complete tasks

c) Directing all health decisions to the older adult's child When the nurse directs all health care-related decisions to the older adult's child, the nurse is not respecting the individual choice of the older adult. The nurse is also assuming that the older adult cannot understand the decisions to be made, which is a myth about the elderly. The nurse should provide high-quality care to all clients, no matter what the age of the client. Allowing the client adequate time to complete tasks is appropriate and individualized. The older adult should be encouraged to develop routines not associated with work to decrease the potential for feeling nonproductive.

Which is an age-related change associated with the nervous system? a) Increased cerebral function b) Cerebral hypertrophy c) Postural hypotension d) Increased nerve impulse conduction

c) Postural hypotension Postural hypotension, cerebral atrophy, decreased cerebral function, and decreased nerve impulse conduction are age-related changes associated with the nervous system.

nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate? a) "The most common cause of dementia in the elderly is Alzheimer's disease." b) "Drug interactions are the most common cause of dementia in the elderly." c) "Dementia is a terrible disease of the elderly." d) "Depression may manifest as dementia in elderly clients."

a) "The most common cause of dementia in the elderly is Alzheimer's disease." The nurse should inform the family member that Alzheimer's disease is the most common cause of dementia in elderly clients. Dementia is a clinical manifestation, not a disease process. Although drug interactions and overmedication are causes of dementia, these causes aren't as common as Alzheimer's disease. Depression is common in elderly clients, but it doesn't cause dementia.

Which condition is characterized by a decline in intellectual functioning? a) Depression b) Delusion c) Dementia d) Delirium

c) Dementia Dementia is an acquired syndrome in which progressive deterioration in global intellectual abilities is of such severity that it interferes with the person's customary occupational and social performance. Depression is a mood disorder that disrupts quality of life. Delirium is often called acute confusional state. Delusion is a symptom of psychoses.

A client with Alzheimer's disease is being admitted to the hospital for malnutrition and dehydration. What is the rationale for the nurse to place the client closer to the nurses' station? a) change of positions b) monitor for acquiescent behavior c) encouragement of eating d) limit wandering

d) limit wandering A client with Alzheimer's disease is at risk for injury because of the tendency to wander. Placing the client closer to the nurses' station makes it easier for the nurse to monitor wandering and better ensures the client's safety. Placing the client closer to the nurses' station won't help the client remember to eat, change position often, or modify behavior.

An elderly client reports fatigue without shortness of breath with walking 30 minutes five times each week. The nurse assesses the resting heart rate as 72 beats per minute; 10 minutes after walking, the client's heart rate is 92 beats per minute. What should the nurse instruct the client to do next? a) Continue to walk at his current level. b) Increase walking at a faster pace. c) Decrease walking frequency to three times each week. d) Refrain from any form of exercise.

a) Continue to walk at his current level. Elderly clients may report fatigue with increased activity as a result of a slower heart rate recovery, which may be a physiological response to aging. An appropriate nursing intervention is to educate the client to exercise regularly but also to pace activities. The nurse does not want to tell the client not to exercise, to walk faster, or to decrease frequency.

An elderly client experienced a cerebrovascular accident (CVA) and was unable to ambulate following his CVA. The client was transferred from a hospital and is now at a subacute care facility. For continuation of Medicare coverage, the nurse evaluates that the client must demonstrate a) Improvement in ambulation b) No available family to provide care c) Worsening of the CVA d) Continued inability to ambulate

a) Improvement in ambulation Clients recovering from an acute illness (e.g., CVA) may be placed in a skilled nursing facility if ongoing therapy is needed. This client was unable to ambulate following a CVA. For continued Medicare coverage, the client must demonstrate a persistent improvement in ambulation. Medicare coverage may be denied if the client does not show improvement in ambulation or worsening of the CVA. Whether family is available does not dictate Medicare coverage.

A nurse notes that an older female client has lost 2 inches in height since her appointment last year. The client reports lumbar back pain as unchanged. Which of the following would the nurse instructs the client? Select all answers that apply. a) Increase intake of foods that are high in calcium. b) Obtain the prescribed bone density screening. c) Decrease the frequency of any exercise. d) Take calcium and vitamin D supplements daily. e) Allow for additional phosphorus intake in her daily diet.

a) Increase intake of foods that are high in calcium. b) Obtain the prescribed bone density screening. d) Take calcium and vitamin D supplements daily. Older clients may experience decreased bone density and, thus, back pain as a result of aging. Strategies to assist them are to instruct clients to increase calcium in the diet and take calcium and vitamin D supplements. A bone density test made be done to determine the degree of bone loss. The client needs to limit phosphorus intake because a high-phosphorus blood level decreases calcium blood levels. The client needs to continue with a regular exercise program.

A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by a) Placing one food at a time in front of the client during meals b) Converting liquid foods to a gelatin texture c) Serving hot foods at a warm temperature d) Cutting the client's food into small pieces

a) Placing one food at a time in front of the client during meals Tasks should be simplified for the client with Alzheimer's disease. All options are steps the nurse can take to promote eating for the client with Alzheimer's disease. Offering one food at a time, however, helps to prevent the client from playing with food.

An elderly client recovering from a hip repair becomes disoriented and tries to get out of bed frequently. The client states, "I forget I am in the hospital." The best nursing intervention is to a) Post a sign stating "You are in the hospital" at the client's eye level. b) Place the client in a Posey chest restraint with ties attached to the bed frame. c) Raise the upper and lower side rails of the bed. d) Administer an oral dose of prescribed alprazolam (Xanax).

a) Post a sign stating "You are in the hospital" at the client's eye level Client confusion increases the risk of falls. Environmental cues include a sign stating, "You are in the hospital." Measures that are not restraining are used first. Raising the lower side rails is considered a restraint. This increases a confused client's risk for falling. Placing a client in a Posey chest restraint is a last resort. Administering an anti-anxiety medication can increase confusion in a client who is already confused.

A nurse is reviewing the medications of a client who lives alone and reports having difficulty remembering when to take them. To aid in medication compliance, which of the following measures would the nurse employ? Select all answers that apply. a) Recommend to the client to use one pharmacy for all prescriptions. b) Write down the medication schedule for the client. c) Suggest that the client use a multiple-dose medication dispenser. d) Encourage the client to use containers with safety lids. e) Remind the client to keep empty medication containers to demonstrate use.

a) Recommend to the client to use one pharmacy for all prescriptions. b) Write down the medication schedule for the client. c) Suggest that the client use a multiple-dose medication dispenser. Strategies to help clients improve medication compliance include providing a written copy of the medication schedule; encouraging the use of a multiple-day, multiple-schedule medication dispenser; and recommending the use of one pharmacy for prescriptions. If no children are in the household, then the nurse may encourage the use of standard medication containers without safety lids for ease of opening. Keeping empty medication containers will only add to confusion, so the nurse should encourage the client to dispose of them when they are finished.

When assessing an older adult, the nurse anticipates an increase in which component of respiratory status? a) Residual lung volume b) Vital capacity c) Gas exchange and diffusing capacity d) Cough efficiency

a) Residual lung volume With an increase in residual lung volume the client experiences fatigue and breathlessness with sustained activity. The nurse anticipates decreased vital capacity. The nurse anticipates decreased gas exchange and diffusing capacity resulting in impaired healing of tissues due to decreased oxygenation. The nurse anticipates difficulty coughing up secretions due to decreased cough efficiency.

An elderly client is hospitalized. To maintain the client's mobility, the best nursing intervention is a) Sit the client in a chair for meals. b) Assist the client with passive range-of-motion exercises. c) Encourage the client to perform active range-of-motion exercises. d) Turn the client every 2 hours.

a) Sit the client in a chair for meals. For elderly clients, bedrest should be kept to a minimum. Having the client sit in a chair for meals will help to minimize deconditioning. Other activities, if the client must maintain bedrest, include active and passive range-of-motion exercises and frequent turning.

A client reports to the nurse that her mother had macular degeneration and is concerned that she, too, may be at risk. What should the nurse tell the client? a) Wear sunglasses with ultraviolet (UV) protection when outside. b) Reduce the amount of cigarettes smoked daily from 20 to 10. c) Vision loss is not hereditary. It is related to diet. d) This condition is now curable.

a) Wear sunglasses with ultraviolet (UV) protection when outside. A risk factor for macular degeneration is sunlight exposure. Wearing sunglasses provides some protection. Cigarette smoking is another risk factor, and the client must stop smoking to reduce risk. Still another risk factor is heredity, and the client's mother had macular degeneration. Macular degeneration may be treated, but there is no cure.

The client asks the nurse why she seems to have bone changes since she has gotten older. What is the best response by the nurse? a) "Bone changes from aging result from a loss of magnesium." b) "Bone changes from aging result from a loss of calcium." c) "Bone changes from aging result from most medication therapies." d) "Bone changes from aging result from a loss of vitamin absorption."

b) "Bone changes from aging result from a loss of calcium." Age-related changes that affect mobility include alterations in bone remodeling and loss of bone calcium, leading to decreased bone density, loss of muscle mass, deterioration of muscle fibers and cell membranes, and degeneration in the function and efficiency of joints. Bone changes do not occur from loss of magnesium, most medications, and loss of vitamin absorption.

A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include? a) "Once it becomes effective, you can stop the drug." b) "The drug helps to control the symptoms of the disease." c) "This drug will help to stop the disease from getting worse." d) "The client need to take this drug for the rest of his or her life."

b) "The drug helps to control the symptoms of the disease." Donepezil hydrochloride is a cholinesterase inhibitor used to control symptoms of Alzheimer's disease. It does not cure or slow progression. Typically cognitive ability improves within 6 to 12 months of therapy, but if stopped, cognitive progression occurs. It is recommended that treatment continue at least through the moderate stage of the illness. However, it usually is not prescribed as life-long therapy.

Several staff members are taking a break in the unit's conference room when one of them states, "I dread getting old and having to retire. I don't want to just sit on the porch in my rocking chair." The statement reflects which of the following? a) Geriatrics b) Ageism c) Gerontology d) Chronological aging

b) Ageism The staff member's statement reflects ageism, attitudes based on stereotypes that reinforce negative images of older people. Gerontology is the scientific study of the aging process. Geriatrics is the practice that focuses on the physiology, pathology, diagnosis, and management of disorders and diseases of older adults. Chronological aging refers to the passage of time as one gets older.

The nurse recognizes which as the leading causes of death among older adults? Select all that apply. a) Sepsis b) Osteoporosis c) Cancer d) Pneumonia e) Heart disease

c) cancer e) heart disease Heart disease and cancer are the leading causes of death among the elderly, although in the past 60 years, there has been a significant decline in overall deaths from these two causes specifically. Osteoporosis, sepsis, and pneumonia are not leading causes of death among the elderly.

The nurse is teaching about preventing pneumonia and influenza to a group of clients in a senior citizens' wellness class. The nurse includes which of the following topics in the class? Select all options that apply. a) Avoiding all sun exposure b) Avoiding environmental smoke c) Ensuring appropriate fluid intake d) Following a high-calcium diet e) Participating in regular exercise

b) Avoiding environmental smoke e) Participating in regular exercise c) Ensuring appropriate fluid intake Activities that help elderly clients maintain good respiratory function include avoiding environmental smoke, regularly exercising, and ensuring appropriate fluid intake. Sun exposure and a high-calcium diet are health-promotion strategies for the integumentary and musculoskeletal systems respectively.

When administering medications to an older adult patient, which medication does the nurse understand may remain in the body longer due to increased body fat? a) Diuretics b) Barbiturates c) Digitalis glycosides d) Anticoagulants

b) Barbiturates Proportion of body fat increases with age, resulting in increased ability to store fat-soluble medications, including barbiturates; this causes drug accumulation, prolonged storage, and delayed excretion. The other medications listed are not fat-soluble.

The nurse is assessing the genitourinary status of an older adult female patient who is experiencing stress incontinence. What finding is a common gerontologic finding for this population? a) Urine is more dilute in the older population. b) Bladder capacity decreases with advanced age. c) All patients develop urinary tract infections. d) Renal filtration rate increases.

b) Bladder capacity decreases with advanced age. Certain genitourinary disorders are more common in older adults than in the general population. In the United States, almost 50% of women 80 years of age and older suffer from urinary incontinence (i.e., urine leakage or problems controlling urine flow). This condition should not be mistaken as a normal consequence of aging (Weber & Kelley, 2010). Costly and often embarrassing, it should be evaluated, because in many cases it is reversible or can be treated.

A health care team is involved in caring for a client with advanced Alzheimer's disease. During a team conference, a newly hired nurse indicates that she has never cared for a client with advanced Alzheimer's disease. Which key point about the disease should the charge nurse include when teaching this nurse? a) As long as the client receives the ordered medication, special care measures aren't necessary. b) Clients with Alzheimer's disease are at high risk for injury because of their impaired memory and poor judgment. c) Alzheimer's disease affects memory so the client doesn't need an explanation before procedures are performed. d) The nursing staff should rely on the family to assist with care because family members know the client best.

b) Clients with Alzheimer's disease are at high risk for injury because of their impaired memory and poor judgment. The charge nurse should inform the new nurse that clients with Alzheimer's disease are at high risk for injury because they have impaired memory and poor judgment. Maintaining a safe environment takes top priority. Families are an important part of the client care team; however, they shouldn't be relied upon to deliver care. Family members may take turns sitting with the hospitalized client to help maintain client safety. All procedures should be explained in simple terms that the client can understand. Medications should be administered as ordered; however, they don't typically improve symptoms. Instead, they slow disease progression.

A nurse is obtaining the health history of a 72-year-old woman who has come to the ambulatory care center for an evaluation. When obtaining information about the woman's sleep patterns, which of the following would the nurse expect to assess? a) Reports that she falls asleep more quickly b) Complaints about frequently waking up during the night c) Reports that she has trouble waking up from sleeping s) Statements that she rarely takes naps during the day

b) Complaints about frequently waking up during the night Older adults tend to take longer to fall asleep, awaken more frequently and easily, and spend less time in deep sleep. They may experience variations in their normal sleep-wake cycles. Coupled with the lack of quality of sleep at night, napping during the day is a common complaint.

nurse is preparing a presentation for a local senior citizen group about nutrition in the older adult. Which of the following recommendations would the nurse include? Select all that apply. a) Decreased protein to reduce the risk of nitrogen imbalance b) Daily calcium intake of 1200 mg c) Vitamin D intake of 600 IU per day d) Fat consumption accounting for 40% or more of daily caloric intake e) Carbohydrate intake accounting for 55% of total calories consumed

b) Daily calcium intake of 1200 mg e) Carbohydrate intake accounting for 55% of total calories consumed c) Vitamin D intake of 600 IU per day Older adults should consume carbohydrates to supply 55% to 60% of the daily caloric intake. Those older than 50 years should have a daily calcium intake of 1200 mg and vitamin D intake of 600 IU to maintain bone health. Fats should account for no more than 30% of the daily calories, and protein may need to be increased to maintain adequate nitrogen balance.

A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? a) Decreased norepinephrine level b) Decreased acetylcholine level c) Increased acetylcholine level d) Increased norepinephrine level

b) Decreased acetylcholine level A decreased acetylcholine level has been implicated as a cause of cognitive changes in healthy elderly clients and in the severity of dementia. Choline acetyltransferase, an enzyme necessary for acetylcholine synthesis, has been found to be deficient in clients with dementia. Norepinephrine is associated with aggression, sleep-wake patterns, and the regulation of physical responses to emotional stimuli, such as the increased heart and respiratory rates caused by panic.

A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? a) Increased acetylcholine level b) Decreased acetylcholine level c) Decreased norepinephrine level d) Increased norepinephrine level

b) Decreased acetylcholine level A decreased acetylcholine level has been implicated as a cause of cognitive changes in healthy elderly clients and in the severity of dementia. Choline acetyltransferase, an enzyme necessary for acetylcholine synthesis, has been found to be deficient in clients with dementia. Norepinephrine is associated with aggression, sleep-wake patterns, and the regulation of physical responses to emotional stimuli, such as the increased heart and respiratory rates caused by panic.

A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate? a) Continue taking the vital signs. b) Distract the client with a familiar object or music. c) Place the client in a secluded room until calm. d) Document the inability to assess vital signs due to client's agitation.

b) Distract the client with a familiar object or music. The nurse should try to calm the patient by using distraction with a familiar object or music. Continuing to take the vital signs will cause further agitation and possible harm to the client or nurse. Placing the client in a secluded room may increase agitation and should not be used in this situation. The nurse should document the inability to assess vital signs and the reason why this should be done after the client's basic needs have been met.

A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to a) Encourage the mother to take responsibility for cooking and cleaning the house. b) Ensure that the mother does not have access to car keys or drive an automobile. c) Turn off lights at night so that the mother differentiates night and day. d) Allow the mother to smoke cigarettes outside on the porch without supervision.

b) Ensure that the mother does not have access to car keys or drive an automobile. A person with Alzheimer's disease needs to be provided with a safe environment. Driving is prohibited. Cooking and cleaning may be too much stimulation and place the client in danger. Daily activities must be simplified, short, and achievable. Smoking is allowed only with supervision. The person needs adequate lighting, and nightlights are helpful, particularly if the person has increased confusion at night.

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to a) Take daily hot showers. b) Ingest five or six small meals each day. c) Minimize the use of stool softeners. d) Use whirlpool baths for relaxation.

b) Ingest five or six small meals each day. A client who experiences orthostatic hypotension should eat five or six small meals to minimize hypotension that can occur after large meals. The client should avoid straining when having a bowel movement. A stool softener would be useful. Hot showers and whirlpools should be avoided.

The reason that governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement? a) Clients are unable to make any health care decision. b) Older adult clients are vulnerable. c) Clients lack different perspectives. d) Clients lack capacity because of cognitive impairment.

b) Older adult clients are vulnerable. Because of the vulnerability of older adults, governments have carefully regulated the treatment given in licensed health care facilities. Cognitive impairment does not automatically constitute incapacity. Older people with fluctuating cognitive status may retain sufficient ability to make some, if not all, their health care decisions. Individuals with different perspectives are required in ethics committees to resolve ethical dilemmas.

What is a nurse's role in providing home care for a client with Alzheimer disease? a) Support client with household errands. b) Provide emotional and physical support. c) Contact the Motor Vehicle Department to have driver's license revoked. d) Provide assistance with administering IV fluids.

b) Provide emotional and physical support. Home health care nurses provide emotional support and intervene if family caregivers become overburdened. The nurse also instructs the family about physical care, the disease process, and treatment. Administering IV fluids or supporting clients with household errands is not a relevant role for a home nurse. The nurse should provide education about safety, saying that the client with Alzheimer disease should not drive, but contacting the licensing department is not the nurse's responsibility.

Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse? a) BMI 24; "My family never gives me my favorite foods." b) Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore." c) Diabetic with fasting blood sugar 92; "It is difficult to afford food with all of these medication costs." d) Obvious deformity to right arm; "I tripped on the rug and fell on my arm."

b) Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore." Neglect is the most common form of elder abuse. The inability of an older adult to obtain basic care is considered neglect. If a client is not being turned or repositioned to prevent skin breakdown, then neglect is happening. A BMI of 24 is within the normal range, and the inability of the client to have his or her favorite foods would not be abuse. The client with diabetes has blood sugar within normal ranges, and the client is only expressing concern over the cost of medications; social services may need to be notified to provide help through community resources. The story provided by the older adult with the deformed arm is consistent with the injury.

A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds: a) "Start rubbing her shoulders and her back." b) "Play quiet music that your grandmother may like." c) "What precipitates the outbursts?" d) "You need to remain calm during the outbursts."

c) "What precipitates the outbursts?" A client with Alzheimer's disease may respond to exciting or confusing events with a catastrophic reaction, such as screaming, crying, or becoming abusive. The nurse needs to assess the situation and what precipitates the catastrophic reactions to best address how to prevent these events. Other nursing interventions include telling the client's granddaughter to remain calm and to distract the grandmother with quiet music, stroking, or both.

An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of a)Decreased muscle mass and joint cartilage b) Degeneration in the efficiency of bone joints c) Loss of bone density d) The client's failure to exercise

c) Loss of bone density Elderly clients experience decreased bone density; they also may experience a loss of bone density from insufficient exercise. For this client, however, additional information indicates that she is taking prednisone, which may induce osteoporosis (loss of bone density). No information indicates that the client is not exercising or has experienced degeneration of bone joints. Degeneration in the efficiency of the bone joints and decreased muscle mass and joint cartilage would have more of an effect on increased pain than on decreased height.

A family of a patient with Alzheimer's disease asks the nurse what causes this condition? Which response by the nurse would be most appropriate? a) "This condition is most likely due to a stroke that the patient didn't realize he had." b) "The numerous drugs that he was taking contributed to his current confusion." c) "A specific gene is involved in the development of this disorder." d) "Evidence shows that there are changes in nerve cells and brain chemicals."

d) "Evidence shows that there are changes in nerve cells and brain chemicals." Specific neuropathologic and biochemical changes are found in patients with Alzheimer's disease. These include neurofibrillary tangles and neuritic plaques as well as altered neurotransmitter function, specifically acetylcholine. Vascular dementia is associated with a subclinical stroke. Although genetics is being studied as an underlying mechanism for Alzheimer's disease, no specific gene or genetic marker has been identified. Delirium is often the result of the interaction or use of multiple drugs.

An older adult develops sudden onset of confusion and is hospitalized. The family expresses concern that their loved one is developing Alzheimer disease. What response by the nurse is most appropriate? a) "Alzheimer disease can be a great burden on the family. What community resources do you know about?" b) "What concerns you most about Alzheimer disease?" c) "Once the underlying cause of the confusion is found and treated, your loved one will be better than ever." d) "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion."

d) "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." Delirium is associated with a sudden onset of confusion, not Alzheimer disease. The family needs to be told the correct information, which is that several underlying conditions could be causing the confusion. Once the underlying cause(s) is found and treated, the confusion should subside; however, some clients may not recover from the underlying cause, so telling the family the client will be better than ever is not appropriate. Asking the family about their concerns about Alzheimer disease and what they know about community support related to it is not appropriate because the client is exhibiting symptoms related to delirium.

Which is a true statement regarding pharmacologic aspects of aging? a) Potential for drug-drug reactions decreases with the number of drugs prescribed. b) Elderly have a decreased percentage of body fat. c) Medication compliance is a single-faceted issue among the elderly. d) Absorption may be affected by changes in gastric pH.

d) Absorption may be affected by changes in gastric pH. During the aging process, absorption may be affected by changes in gastric pH. The elderly have an increased percentage of body fat. The potential for drug-drug interaction increases with the number of drugs prescribed. The aged population tends to be less compliant with their medication regimen because of several factors, such as cost, vision changes, mobility issues, and education.

An older adult has a score of 12 on the Geriatric Depression Scale (GDS). What action should the nurse complete first? a) Encourage the client to discuss feelings. b) Notify the physician. c) Encourage the client to participate in exercise activities. d) Assess for the potential for self-harm.

d) Assess for the potential for self-harm. A score of 12 on the GDS indicates that the client may be mildly depressed, and even mildly depressed clients can have thoughts of suicide. The nurse must first assess the potential for self-harm; safety is the top concern. The other actions by the nurse would be appropriate only after the potential for self-harm is addressed.

Family members report to the nurse that their elderly grandmother has had a sudden onset of confusion and that they are having difficulty providing care for her. What is the nurse's best response? a) Inform the family that this is a result of aging b) Administer donepezil every day c) Recommends placement of the grandmother in a nursing home d) Assess the grandmother for adventitious lung sounds

d) Assess the grandmother for adventitious lung sounds Sudden onset of confusion may be the first symptom of an infection, such as pneumonia or urinary tract infection. The nurse needs to fully assess the situation before acting (such as telling the family this is a result of aging). Donepezil is used for Alzheimer's disease, which does not have acute onset. A recommendation for placement in a nursing home is premature without a full assessment at this time.

The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse? a) Instruct the client to receive at least 1 hour of sun exposure each day. b) Administer intravenous morphine for report of postoperative pain. c) Encourage physical activity of 30 minutes following breakfast daily. d) Assess the need for pneumococcal and influenza vaccinations.

d) Assess the need for pneumococcal and influenza vaccinations. Activities that help elderly people maintain respiratory function include pneumococcal and yearly influenza immunizations. The nurse is to ensure the safety of the client. It is unsafe to administer an intravenous pain medication and then immediately discharge the client. Elderly clients should limit sun exposure to 10 to 15 minutes daily, and avoid heavy activity after eating to prevent indigestion.

The nurse is working in a long-term care facility. When assessing her patients, what body system dysfunction should the nurse look for as the leading cause of morbidity and mortality in the older adult population? a) Genitourinary b) Respiratory c) Gastrointestinal d) Cardiovascular

d) Cardiovascular Most deaths in the United States occur in people 65 years of age and older; 48% of these are caused by heart disease and cancer (Kochanek et al., 2011).

A nurse is teaching nursing assistants in an extended-care facility measures to protect the skin of elderly clients. Which of the following measures is the nurse likely to recommend? a) Taking the clients outside for sun exposure daily b) Assisting clients to soak in the bathtub several times each week c) Instructing clients to use perfumed skin creams d) Encouraging clients to avoid cigarette smoking

d) Encouraging clients to avoid cigarette smoking Measures to promote healthy skin function in elderly clients include not smoking. Other measures include avoiding exposure to the sun, using emollient skin cream containing petrolatum or mineral oil, and avoiding hot soaks in the bathtub.

When assessing an older adult's gastrointestinal system, the nurse would identify an increase in which of the following as normal? a) Calcium absorption b) Gastric motility c) Stomach emptying d) Feeling of fullness

d) Feeling of fullness In an older adult, gastric motility slows modestly, which results in delayed stomach emptying, which in turn leads to early satiety (feeling of fullness). Calcium absorption is also decreased.

A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching? a) As an older adult, you will not be able to learn new skills or knowledge. b) A decline in sexual activity is a normal occurrence as you age. c) Most older adults reside in a long-term care facility. d) How old you feel will be determined by your physical and cognitive abilities.

d) How old you feel will be determined by your physical and cognitive abilities. The physical health and cognitive abilities of older adults are directly related to quality of life and how "old" one really feels. Older adults can maintain healthy sexual activity and are able to learn new skills and knowledge. Of older adults, 90% live in the community, not in long-term care facilities.

An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to a) Allow the toddler to remain in the room if a family member wipes the toddler's nose. b) Inform the family to either wash their hands or use the hand sanitizer. c) Ask the family to leave the client's room. d) Instruct the family to remove the toddler from the room for the protection of the client.

d) Instruct the family to remove the toddler from the room for the protection of the client. Elderly clients, particularly those who may be immunocompromised, need to avoid exposure to those who may have upper respiratory tract infections. The toddler needs to be removed from the client's room, not the whole family. It is appropriate for the family to wash their hands or use the hand sanitizer. However, it does not address the runny nose of the toddler, and it is not the most important action of the nurse.

The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The client continuously yells, "It's 1999 and you are going to hurt me!" What action should the nurse do first? a) Take the vital signs. b) Assess for infection. c) Notify the physician. d) Reorient the patient.

d) Reorient the patient. The client is likely experiencing delirium after surgery. The first action that should be taken by the nurse is to reorient the patient. Hospitalized older adults are at risk for disorientation and confusion. Although the nurse will still need to take the vital signs and assess for infection, reorienting the client remains the first action. If the client can be reoriented, then the nurse may be able to complete the other actions without difficulty or potentially harming the client. The nurse may need to notify the physician if the client is unable to be oriented or if the assessment is abnormal.

Which neurotransmitter is implicated in depression? a) Acetylcholine b) Atropine c) Epinephrine d) Serotonin

d) Serotonin Serotonin is implicated in the development of depression. Atropine, acetylcholine, and epinephrine are not implicated in the development of depression.

The most common affective or mood disorder of old age is a) anxiety disorder. b) phobias. c) schizophrenia. d) depression.

d) depression. Depression is the most common affective or mood disorder of old age. Anxiety disorders, schizophrenia, and phobias are not a common affective or mood disorder of old age.

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should: a) help the client fill out his menu. b) give the client privacy during meals. c) fill out the menu for the client. d) stay with the client and encourage him to eat.

d) stay with the client and encourage him to eat. Staying with the client and encouraging him to feed himself will ensure adequate food intake. A client with Alzheimer's disease can forget how to eat. Allowing privacy during meals, filling out the menu, or helping the client to complete the menu doesn't ensure adequate nutritional intake.

A nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply. a) Keeping the patient awake as much as possible b) Using familiar cues about the environment c) Administering psychoactive drugs d) Supervising nutritional intake e) Providing a calm, quiet environment

e) Providing a calm, quiet environment d) Supervising nutritional intake b) Using familiar cues about the environment Appropriate interventions when caring for a patient with delirium include maintaining a calm, quiet environment, supervising and monitoring nutritional and fluid intake, and using familiar environmental cues. Psychoactive drugs should be minimized to reduce the possibility of delirium. Keeping the patient awake as much as possible would lead to sleep deprivation, which would increase the patient's risk for delirium