Chapter 24: Older Adult NCLEX

The most common affective or mood disorder of old age is A. Dementia B. Depression C. Delirium D. Alzheimer's

B. Depression

Of the following, which describes dementia? A. Quick onset, irreversible B. Slow onset, chronic C. Acute onset, reversible D. Progressive, terminal

B. Slow onset, chronic

Which of the following client statements regarding self-medication administration by an older-adult client requires follow-up teaching by the nurse? A. "I take all the pills ordered once a day at bedtime, so I'm less likely to forget them." B. "I have one pill that needs cut in half. I am going to ask the pharmacist to do that for me." C. "The pharmacist said to keep my pills away from the sunlight, so I put them inside the kitchen cabinet." D. "My daughter comes over each morning and puts my pills into a container that stores them by the time they are due."

A. "I take all the pills ordered one a day at bedtime, so I'm less likely to forget them."

A nurse is caring for an older client preparing for discharge to a nursing center after having surgery. Which of the following nursing responses is most therapeutic with a client's concern that she will never go back home? A. "What make you think that this transfer to the nursing center will be permanent?" B. "The reason for this transfer is only to support you while you continue to recuperate." C. "The decision to stay in the nursing center is yours to make When you want to leave no one will stop you." D. "The nursing center is a lovely place with a wonderful staff of caring people. Just give it a chance. You may like it."

A. "What makes you think that this transfer to the nursing center will be permanent?"

The nurse is explaining services provided in assisted living to a couple considering a move to long-term housing for older adults. The nurse explains that assisted living includes: A. 24-hour protective oversight. B. Medications administered by staff personnel. C. Client responsibility for preparation of own medications. D. Expectation that clients are independent in all care areas.

A. 24-hour protective oversight. • Assisted living includes 24-hou oversight for clients. The clients must be mobile; they may require some assistance. All meals and snacks are provided. They may request assistance with bathing hygiene. Housekeeping and laundry services are provided. They may require occasional assistance with dressing. The client should self-administer medication or may receive personal monitoring of medication administration.

Which of the following individuals would be at greatest risk of injury? A. 80-year-old who does not have air conditioning or a fan. B. 70-year-old who has new dentures. C. 68-year-old who has difficult tasting salt in food. D. 84-year-old who needs hearing aids.

A. 80-year-old who does not have air conditioning or a fan. • Sweating decreases in older adults, predisposing them to heat stroke.

The nurse is providing an educational session to new employees, and the topic is abuse to the older client. The nurse tells the employs that which client is most characteristic of a victim of abuse. A. A 90-year old woman with advanced Parkinson's disease. B. A 68-year-old man with newly diagnosed cataracts. C. A 70-year-old woman with early diagnosed Lyme's disease D. A 74-year-old man with moderate hypertension.

A. A 90-year-old woman with advanced Parkinson's disease. • The typical abuse victim is a woman of advanced age with few social contacts and at least one physical or mental impairment that limits the ability to perform activities of daily living. In addition, the client usually lives alone or with the abuser and depends on the abuser for care.

Which of the following nursing interventions implies respect for a person's spirituality? (Select all that apply). A. Changing the position of the bed in a Muslim client's room so that it faces east. B. Contacting the chaplain to assess the client's spiritual needs. C. Saying a silent prayer with a client at the client's request. D. Praying out loud in the room of a dying patient.

A. Changing the position of the bed in a Muslim client's room so that it faces east. C. Saying a silent prayer with a client at the client's request. • Because of the highly personal quality of spirituality, an unobtrusive and sensitive presence by the nurse is needed to allow the person in any setting to achieve spiritual health. The nurse can provide an environment that is supportive to the practice of the persons spirituality. Praying out loud does not demonstrate respect for a person's spirituality but imposes the nurses belief system on the person. Nurses should be able to assess the persons spirituality initially and determine if it is necessary to further consult the chaplain.

A couple in their sixties has assumed responsibility for raising their two grandchildren ages 9 and 12 because the children's parents died in a car accident. Which of the following are priority nursing interventions that the nurse can implement to help the grandparents cope with the responsibility of raising their grandchildren? A. Connecting them with Grandparents Raising Grandchildren support group. B. Encouraging them by reinforcing how they successfully raised their own children. C. Volunteering to provide respite time for them as needed. D. Assuring them that their stress level will lessen as they gain confidence.

A. Connecting them with Grandparents Raising Grandchildren support groups. • Stress experienced by grandparents who must raise grandchildren can be lessened by counseling and participation in support groups.

As part of a community-wide flue vaccination program for older adults, the nurse is assisting at a vaccination clinic. Which of the following questions should the nurse ask before administering the vaccine? A. Do you have any food allergies? B. Have you had the pneumococcal vaccine? C. Have you had the flu in the past years? D. Do you have Medicare?

A. Do you have any food allergies? • An allergy to eggs is a contraindication to receiving flu vaccine grown in chick embryo cells.

A nurse has recently accepted the position of unit nurse manager on a long-term care unit. Which of the following directives should the nurse give to the staff nurses? A. Encourage residents to participates in unit activities such as Scrabble and bingo. B. Demonstrate the caring aspect of nursing by dressing residents before breakfast. C. Fill in missing words during conversation with the residents to avoid embarrassment. D. Instruct the aides to get residents ready for breakfast as quickly as possible to make sure they are ready to eat.

A. Encourage residents to participate in unit activities such as Scrabble and bingo. • To encourage cognitive health nurses should inspire older individuals to take classes, read, engage in stimulating conversation and entertainment, keep their minds active, and continue learning throughout their lives. They are encouraged to continue with self-care activities rather than relinquish them to caregivers. Residents should be encouraged to perform self-care activities themselves. When help is required, it should be provided in an unhurried manner. Filling in missing words makes the resident dependent on the staff and reduces motivation to communicate, and the words supplied may not be the intended words.

A nurse is conduction a home visit for an older adult in the summer. Which of the following items should the nurse locate in the home? A. Fan B. Porch Chair C. Synthetic Blend Clothing D. Thermometer

A. Fan • Older adults are susceptible to heat stroke. The availability of a fan will help cool the ambient air. Light-weight cotton clothing breathes and facilitates cooling, whereas synthetic material retains heat.

The nurse working in a retirement community for older adults is conducting a psychosocial assessment of all residents. Which of the following questions should the nurse ask during the assessment process? (Select all that apply). A. Have you thought about harming yourself? B. Are you still playing bridge every Thursday? C. How does your congestive heart failure affect your life? D. Has your financial situation changed since last year?

A. Have you thought about harming yourself? B. Are you still playing bridge every Thursday? C. How does your congestive heart failure affect your life? • Suicide ideation, loss of interest in activities, and chronic illness are signs of, or may lead to, depression. Economic difficulty is not a predictor of suicide in older adults.

Which of the following statements made by a client best identifies someone who would benefit from health promotion interventions? A. I have a new grandchild and want to be part of her life. B. My mother lived until she was 90, so a long life is in my genes. C. Some chronic illness is just a part of aging. D. I hope I'll live a lot longer, but one never knows.

A. I have a new grandchild and want to be part of her life. • Motivation to adopt a healthy lifestyle is a primary predictor of successful interventions. Feeling that illness is just part of aging or leaving health up to chance will not help the person make necessary lifestyle changes.

A nurse is talking with an older adult client about improving her nutritional status. Which of the following interventions should the nurse recommend? (Select all that apply.) A. Increase protein intake to increase muscle mass. B. Decrease fluid intake to prevent urinary incontinence. C. Increase calcium intake to prevent osteoporosis. D. Limit sodium intake to prevent edema. E. Increase fiber intake to prevent constipation.

A. Increase protein intake to increase muscle mass. C. Increase calcium intake to prevent osteoporosis. D. Limit sodium intake to prevent edema. E. Increase fiber intake to prevent constipation. • Older adults should increase protein intake to increase muscle mass and improve would healing. • Older adults should increase calcium intake to reduce the risk for osteoporosis. • Older adults should limit sodium intake to reduce the risk for edema and hypertension. • Older adults should increase fiber intake to prevent constipation.

What are the two main types of dementia in older adults? (Select two that apply.) A. Multiinfarct dementia B. Parkinson-related dementia. C. Alzheimer's dementia D. Lewy body dementia E. Huntington disease

A. Multiinfarct dementia C. Alzheimer's dementia • Dementia is an illness of the cognitive system and is not accepted as a normal change of aging. Two main typed of dementia exist. The first type is multiinfarct dementia, which is caused by the death of brain tissue and diagnosed through brain imaging. Tissue death may be caused by of a lack of blood flow to the brain from a cerebral vascular accident (CVA) or from another cause. The other main tpe of dementia is Alzheimer's disease (AD), the most common type, which makes up about 50% of all dementia diagnoses. Other dementias include Parkinson-related dementia, Huntington disease, Creutzfeldt-Jakob disease, pick disease, and Lewy body dementia.

While bathing an elderly client who has limited abilities for self-care, the nurse notices several patches of dry skin on the client's heels, elbows, and coccyx. The nurse cleans and dries all the areas well and applies a moisturizing lotion. The most appropriate immediate follow-up by the nurse is to ensure appropriate nursing care for this client's skin is to: A. Revise the client's care plan to show the need for the application of moisturizing lotion. B. Assume personal responsibility to apply the moisturizing lotion daily to the client's skin. C. Encourage the client to tell whomever bathes her to apply the moisturizing lotion to her areas of dry skin.

A. Revise the client's care plan to show the need for the application of moisturizing lotion.

A man tells a nurse that he is concerned about his risk of developing cancer. Which of the following behaviors would place the man at higher risk of developing cancer? A. Smoking a half of a pack of cigarettes a day. B. Exercising three times a week. C. Consuming green, leafy vegetables several times a week. D. Visiting a chiropractor every week.

A. Smoking a half of pack of cigarettes, a day. • Habits that place older adults at a high risk for developing cancer: not following nutritional guidelines, high stress levels, not engaging in a regular exercise program, and smoking cigarettes and using other tobacco products.

The nurse councils the older adult about the benefits of regular physical activity. What are the educational points to use when promoting strength training? (Select all that apply.) A. Strength training can improve balance. B. Strength training can increase the risk of falls. C. Strength training can strengthen bones. D. Strength training can reduce the incidence of acute illness. E. Strength training reduces blood glucose levels.

A. Strength training can improve balance C. Strength training can strengthen bones. E. Strength training reduces blood glucose levels. • Regular physical activity can help or prevent many chronic health problems associated with aging, including hypertension, obesity, diabetes, and depression. Regular physical activity can increase both the years of life and the quality of those years. Strength training can improve balance and reduce the risk of falls, strengthen bones, and reduce blood glucose levels. Although exercise is not popular among this age group, no physiological or psychological explanation has been found to explain this decline in interest.

Independent seniors experience which of the following barriers to obtaining adequate nutritional intake? (Select all that apply.) A. Transportation issues B. Income C. Socialization D. Social support resources E. Cultural food preferences

A. Transportation issues B. Income D. Social support resources For independent seniors, barriers that may interfere with the ability to obtain adequate nutritional food include limited transportation, income, and social support resources. Problems with access to food are compounded by the effect of normal changes of aging. Declines in gastrointestinal organ function can lead to changes in digestive metabolism and the absorption and elimination of nutrients. A deterioration of the smell, vision, and taste senses and the high frequency of dental and swallowing problems make maintaining adequate daily nutrition and lifelong eating habits, such as diets high in fat and cholesterol, are other obstacles to maintaining optimal nutrition.

The nurse works with elderly clients in a wellness screening clinic on a weekly basis. Which of the following statements made by the nurse is the most therapeutic regarding their mobility? A. "Your shoulder pain is normal for your age." B. "Continue to exercise your joints regularly to your tolerance level." C. "Why don't you begin walking 3 to 4 miles a day, and we'll evaluate how you feel next week." D. "Don't worry about taking that combination of medications since your doctor has prescribed them."

B. "Continue to exercise your joints regularly to your tolerance level."

Which of the following responses by an older-adult client is most reflective of a need for further education by the nurse regarding the physiological changes associated with the older adult? A. "I call a cab if I want to go out after dark." B. "I can't help worrying about becoming forgetful." C. "I have my eyes checked regularly. Can't afford to fall." D. "I really enjoy eating good vanilla ice cream, but I have cut way down."

B. "I can't help worrying about becoming forgetful."

Which of the following statements, made by the daughter of an older client concerning bringing her mother home to live with her family, presents the greatest concern for the nurse? A. "If this doesn't work out, she can always go to live with my sister." B. "I don't think she will reach very well to me making decisions for her." C. "I'm afraid that mom will be depressed and miss her home." D. "My children will just have to adjust to having their grandmother with us."

B. "I don't think she will react very well to making decisions for her."

Which of the following statements made by a nurse reflects the best understanding of the health value of conducting a blood pressure (BP) screening at a senior citizens centers health fair. A. "This is a high-risk group, so assessing BP allows us to identify clients at risk an sends them for treatment." B. "Older adults enjoy health fairs, so it's a good place to screen substantial numbers of clients for hypertension." C. "Hypertension doesn't present symptoms early on, so screening elder adults is a wonderful preventive measure." D. "Blood pressure problems are common among this group, so it's a good way to monitor the effectiveness of their medications."

B. "Older adults enjoy health fairs, so it's a good place to screen substantial numbers of clients for hypertension."

Which of the following statements made by a family member of a client recently diagnosed with early stages of Alzheimer's disease is most reflective of an understanding of this disease process?" A. "Dad has always been a fighter; he'll fight us too. He won't give up." B. "We have an appointment with his care provider to see about medication therapy." C. "Good thing we found about this early on, so we can prevent this from getting worse." D. "We have made arrangements to discuss nursing home placement for dad."

B. "We have an appointment with his care provider to see about medication therapy."

When caring for an older adult patient, the nurse uses the following interventions to accommodate visual changes with age: A. Eye glasses in the bedside table. B. Adequate lighting and uncluttered walkways. C. Draw drapes in room to prevent glare. D. Keep bedside rails down.

B. Adequate lighting and uncluttered walkways.

You are caring for a 78-year-old female cardiac patient. In preconference, your clinical instructor asks you what in an age-related change in the cardiac system of the older adult? Your best response would be. A. Decreased blood pressure. B. Decreased cardiac output. C. Increase ability to respond to stress D. Increased heart recovery rate.

B. Decreased cardiac output

Your patient assigned to you has pneumonia. You are reviewing the age-related changes involved with the older adult. Select all age-related changes of the respiratory system that apply. A. Decrease in residual lung volume B. Decreased gas exchange C. Decreased cough efficiency D. Increased gas exchange

B. Decreased gas exchange C. Decreased cough efficiency

A nurse is collecting data from an older adult client as part of a comprehensive physical examination. Which of the following findings should the nurse expect as associated with aging? (Select all that apply.) A. Skin thickening B. Decreased height C. Increased saliva production D. Nail thickening E. Decreased bladder capacity

B. Decreased height D. Nail thickening E. Decreased bladder capacity • Physiological changes that occur with aging can include loss in height due to the thinning of intervertebral disks. • Physiological changes that occur with aging can include thickening of the nails of the fingers and toes. • Physiological changes that occur with aging can include a reduced bladder capacity. While young adults have a bladder of about 500 to 600 mL, older adults have a capacity of about 250 mL.

One reason for medication problems in elderly is that. A. Regular use of laxatives increases absorption of medications. B. Decreased renal function slows excretion of drugs. C. Enhanced sense of taste of medications. D. Increased perception of pain from injections.

B. Decreased renal function slows excretion of drugs.

Which of the following interventions will have the greatest impact on reducing constipation in older adults? (Select all that apply). A. Offering pureed foods that are easy to digest. B. Encouraging fluids between meals. C. Administering laxatives daily. D. Assisting with ambulation.

B. Encouraging fluids between meals. D. Assisting with ambulation. • Nurses can help reduce the incidence of constipation by encouraging older adults to exercise and increase their fluid and dietary intake. Dietary modifications, such as increasing fiber and fluid intake, can stimulate the colon and resolve constipation. Pureed foods do not contain adequate fiber. Increased fluid intake and exercise should be implemented before relying on medication to relieve constipation.

According to the Centers for Disease Control, what are the leading cause of death in the older population? A. Diabetes B. Heart disease C. Cancer D. Stroke E. Alzheimer's disease.

B. Heart disease C. Cancer • The Centers for Disease Control (2012) report that the five major racial groups; African Americans, Asian Americans, Hispanic Americans, Native Americans; and White Americans, share eight leading causes of death. Heart disease and cancer are the first and second leading causes, respectively, with stroke, respiratory disease, flu, pneumonia, Alzheimer's disease, diabetes, and other causes following with varying disease rates depending on the racial background.

Which is a major concern when providing drug therapy for older adults? A. Alcohol is used by older adults to cope with the multiple problems of aging. B. Hepatic clearance is reduced in older adults. C. Older adults have difficulty in swallowing larger tablets. D. Older adults may chew on tablets instead of swallowing them.

B. Hepatic clearance is reduced I older adults.

In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging? A. Increased perspiration. B. Increased airway resistance. C. Increased salivary secretions. D. Increased pitch discrimination.

B. Increased airway resistance • Normal physiological changes of aging include increased airway resistance in the older adult. The older adult would be expected to have decreased perspiration and drier skin as they experience glandular atrophy (oil, moisture, sweat glands) in the integumentary system. The older adult would be expected to have a decrease in saliva. A normal physiological change of the older adult related to hearing is a loss of acuity for high-frequency tones.

A client has been recently diagnosed with Alzheimer's disease. When teaching the family about the prognosis, the nurse must explain that: A. Diet and exercise can slow the process considerably. B. It usually progresses gradually with a deterioration of function. C. Many individuals can be cured if the diagnosis is made early. D. Few clients live more than 3 years after the diagnosis.

B. It usually progresses gradually with a deterioration of function.

A nurse has accepted a position as director of health services in a retirement community. Which of the following statements about retirees is important for the nurse to consider as she plans programs? (Select all that apply). A. Depressed and inactive. B. Left their job to spend more time with family. C. Left their job because of ill health. D. Happy and well-adjusted to retirement.

B. Left their job to spend more time with family. D. Happy and well-adjusted to retirement. • Research has demonstrated that the majority of retirees are in good health and happy with their decision to leave work so as to spend more time with their families.

A nurse is planning a presentation for a group of older adults about health promotion and disease prevention. Which of the following interventions should the nurse plan to recommend? (Select all that apply.) A. Human papilloma virus (HPV) immunization B. Pneumococcal immunization C. Yearly eye examination D. Periodic mental health screening E. Annual fecal occult blood test. F. Dual-energy x-ray absorptiometry (DEXA) scanning.

B. Pneumococcal immunization C. Yearly eye examination D. Periodic mental health screening B. Annual fecal occult blood test. C. Dual-energy x-ray absorptiometry (DEXA) scanning • Pneumococcal vaccine is recommended for older adult clients. • A yearly eye examination to screen for glaucoma and vision changes is recommended for older adults. • Periodic mental health assessments are recommended for older adult clients to screen for depression. • An annual fecal occult blood test is recommended for older adults.

A 76-year-old adult female is brought to a neighborhood client after being found wandering around the local park. The client appears disheveled and reports being hungry. Which of the following assessment and interview findings would cause the nurse to suspect elder abuse? (Select all that apply.) A. Falls asleep in the examination room B. Repeatedly states, "Don't hurt me." C. Chafing around wrists and ankles. D. Bruises in various stages of healing.

B. Repeatedly states, "Don't hurt me." C. Chafing around wrists and ankles. D. Bruises in various stages of healing.

A woman who is being discharged from the hospital is oriented to person, place, and time, and her memory is intact. She has occasional forgetfulness without a consistent pattern of memory loss. Which of the following housing options would be most appropriate for this woman? A. Independent living. B. Retirement community. C. Assisted Living D. Nursing facility.

B. Retirement Community. • Retirement community living is suited for a person who is oriented to person, place, and time and has a memory that is intact, but has occasional forgetfulness without a consistent pattern of memory loss. Independent living may be appropriate for the person if she had a consistent pattern of memory loss. Assisted living or nursing facility living may be appropriate if the woman has difficulty with orientation to person, place, or time or has difficulty with confusion that results in anxiety, social withdrawal, or depression.

Which of the following nursing diagnoses is a priority related to the problem of urinary incontinence? a. Risk for social isolation. b. Risk for impaired skin integrity. c. Risk for inadequate fluid intake. d. Risk for impaired coping.

B. Risk for impaired skin integrity. • Although social isolation and decreased fluid intake may occur because of urinary incontinence, impaired skin integrity is a major concern because of its impact on physical and psychological health.

The clinic nurse has seen the following four people today. Which of the following people is demonstrating a healthy coping patter? A. Discuss very little except the loss of her husband 3 years ago. B. Talks about the good times she and her husband had before his illness and death 1 year ago. C. States that life is not worth living without her husband, who died 2 years ago. D. Blames herself for her husband's death because she did not make him go to the doctor.

B. Talks about the good times she and her husband had before his illness and death 1 year ago. • Research has demonstrated that rumination, self-blame, and catastrophizing have negative effects on coping, whereas positive reappraisal has a positive effect.

Which information obtained by the home health nurse when making a visit to an 88-year-old with mild forgetfulness is of the most concern? A. The patient's son uses a marked pillbox to set up the patient's medications weekly. B. The patient has lost 10 pounds (4.5 kg) during the last month. C. The patient is cared for by a daughter during the day and stays with a son at night. D. The patient tells the nurse that a close friend recently died.

B. The patient has lost 10 pounds (4.5 kg) during the last month. • A 10-pound weight loss may be an indication of elder neglect or depression and requires further assessment by the nurse.

Which of the following statements is the best definition of polypharmacy? A. The use of more than five medications by different physicians. B. The use of multiple medications for same or different health problems. C. The use of multiple pharmacies and self-management of medications. D. The use of multiple medications and supplements simultaneously.

B. The use of multiple medications for same or different health problems. • Polypharmacy is the use of multiple medications for the same or different health problems. It is a major concern for elderly people, with the rate of polypharmacy in this population being between 9% and 39%.

When caring for the older adult, it is important to: A. Repeat oneself often because older adults are forgetful. B. Treat the client as an individual with a unique history of his or her own. C. Be aware that older adults are no longer interested in sex. D. Disregard the older adult's experience because older people are too old-fashioned to be of value today.

B. Treat the client as an individual with a unique history of his or her own.

A nurse is providing teaching for older an older adult client who has lost 4.5 kg (9.9 lb) since his last admission 6 months ago. Which of the following instructions should the nurse include in teaching? (Select all that apply.) A. "Eat three large meals a day." B. "Eat your meals in front of the television." C. "Eat foods that are easy to eat, such as finger foods." D. "Invite family members to eat meals with you." E. "Exercise every day to increase appetite."

C. "Eat foods that are easy to eat, such as finger foods." D. "Invite family members to eat meals with you." E. "Exercise every day to increase appetite." • The nurse should encourage the client to eat finger foods because finger foods are easier for the adult client to eat. • The nurse should encourage the client to involve family members with meals. Socialization during meals promotes nutritional intake. • The nurse should encourage the client to exercise daily to increase appetite.

A long-term care facility sponsors a discussion group on the administration of medications. The participants have a number of questions concerning their medications. The nurse responds most appropriately by saying: A. "Don't worry about the medication's name if you can identify it by its color and shape." B. "Unless you have severe side effects, don't worry about the minor changes in the way you feel." C. "Feel free to ask your physician why you are receiving the medications that are prescribed for you." D. "Remember that the hepatic system is primarily responsible for the pharmacotherapeutics of your medication."

C. "Feel free to ask your physician why you are receiving the medications that are prescribed for you." • The nurse should encourage the older adult to question the physician and/or pharmacist about all prescribed drugs and over-the-counter drugs. The older adult should be taught the names of all drugs being taken, when and how to take them, and the desirable and undesirable effects of the drugs."

An assisted living facility has provided its clients with an educational program on safe administration of prescribed medications. Which statement made by an older-adult client reflects the best understanding of safe self-administration of medications? A. "I don't seem to have problems with side effects, but I'll let my doctor know if something happens." B. "I'm lucky since my daughter is really good about keeping up with my medications." C. "I'll be sure to read the inserts and ask the pharmacist if I don't understand something." D. "It shouldn't be too hard to keep it straight since I don't have any really serious health issues."

C. "I'll be sure to read the inserts and ask the pharmacist if I don't understand something."

A nurse is counseling an older adult who describes having difficulty dealing with several issues. Which of the following problems verbalized by the client should the nurse identify as the priority for further assessment and intervention? A. "I spent my whole life dreaming about retirement, and now I wish I had my job back." B. "It's been so stressful for me to have to depend on my son to help around the house." C. "I just heard my friend Al died. That's the third one in 3 months." D. "I'm struggling with helping out in my community."

C. "I'm struggling with helping out in my community." When using the urgent vs. nonurgent approach to client care, the nurse determines that the counseling priority is the problem that reflects a lack of completion of the previous stage and progression to the current stage of development. According to Erikson, it is a task of middle adulthood to develop generativity (such as by reaching and helping in the community) vs. self‑absorption and stagnation. This older adult is still struggling with this task and needs assistance in working through that dilemma.

According to the National Resource Center on Nutrition, Physical Activity and Aging, it is estimated that between _____ of older residents living in long-term care facilities are malnourished. A. 10% and 15% B. 20% and 25% C. 35% and 50% D. 55% and 70%

C. 35% and 50% • The National Resource Center on Nutrition, Physical Activity and Aging (2012) stages that between 35% and 50% of older residents living in long-term care facilities are malnourished and approximately 65% of older adults in hospitals may be malnourished. His data underscores the problems of maintaining good nutrition.

According to Erikson's Theory of development, which of the following older adults has successfully navigated the stage of ego integrity versus despair? A. A 70-year-old man who is reluctant to retire because work is everything to him. B. 78-year-old woman who has scheduled her third face lift. C. 80-year-old man who has informed his children that he has made his funeral arrangements. D. 67-year-old woman who is depressed because she has not been promoted at work for the past 10 years.

C. 80-year-old man who has informed his children that he has made his funeral arrangements. • Successfully navigating the stage of ego integrity versus despair requires that the individual accept normal bodily changes associated with aging, find meaning in life apart from work, accepts the inevitability of death, and is at peace with his or her life.

A nurse caring for older adults in an assistive living facility recognizes that a clients quality of life needs are best determined by: A. Excellent physical, social, and emotional nursing assessments. B. A working knowledge of this age-group's developmental needs. C. A therapeutic nurse-client relationship that facilitates communication. D. The client's need for complete physical, emotional, and cognitive care.

C. A therapeutic nurse-client relationship that facilitates communication.

A 70-year-old client asks the nurse to explain to her about hypertension. An appropriate response by the nurse as to why older clients often have hypertension is due to: A. Myocardial muscle damage B. Reduction in physical activity. C. Ingestion of foods high in sodium. D. Accumulation of plaque on arterial walls.

C. Accumulation of plaque on arterial walls.

A nurse is conducting a community education program about cognition in older adults. Which of the following information should be included? A. Some form of mild dementia is a normal part of aging. B. All forms of dementia have the same symptoms, but progress at different rates. C. Assessment for dementia should be part of routine physical exams. D. Elders who score below 27 points on the Mini-Mental State Exam (MMSE) are not likely to have a cognition problem.

C. Assessment for dementia should be part of routine physical exams. • Cognitive alterations are key symptoms that indicate changes in physiological function among older persons. Thus, assessment of cognition is an important part of routine assessments. Dementia is not a normal part of aging. Dementia symptoms vary according to the specific type of dementia. A score of 23 or lower on the MMSE indicates a problem with cognition.

When developing the plan of care for an older adult who is hospitalized for an acute illness, the nurse should: A. Use a standardized geriatric nursing care plan. B. Plan for likely long-term-care transfer to allow additional time for recovery. C. Consider the preadmission functional abilities when setting patient goals. D. Minimize activity level during hospitalization.

C. Consider the preadmission functional abilities when setting patient goals. • The plan of care for older adults should be individualized based on the patient's current functional abilities. A standardized geriatric nursing care plan is unlikely to address the individual patient needs and strengths. A patent's need for discharge to a long-term-care-facility is variable. Activity level should be designed to allow the patient to retain functional abilities while hospitalized and also to allow any additional rest needed for recovery from the acute process.

A nurse is assigned to provide care for a 96-year-old bedridden man who experiences severe pain from a chronic neurological disease. The man asks the nurse to please help him leave this world so that his suffering ends. Which of the following actions would be most appropriate for the nurse to take? A. Assist the doctor with the mans request B. Refuse to care for the man C. Contact the pain care specialist D. Provide the man with names of doctors who participate in assisted suicide

C. Contact the pain care specialist • Nurses caring for chronically ill older adults have the added responsibility of determining who is at risk for wanting physician-assisted suicide and helping them to be as comfortable as possible and free of pain through the use of pharmacological and nonpharmacological interventions. Refusing to care for the man could be construed as abandonment and is not necessary. Consulting a pain care specialist is the correct action.

Three common conditions affecting cognition in the older adults are: A. Stroke, MI, Cancer B. Cancer, Alzheimer's disease, Stroke C. Delirium, Depression, Dementia D. Blindness, Hearing loss, Stroke

C. Delirium, Depression, Dementia

Which medication prevents the breakdown of a brain chemical important for memory and thinking and may slow the progress of Alzheimer's disease? A. Memantine (Namenda) B. Ozazepam (Serax) C. Donepezil (Apicept) D. Citalopram (Celexa)

C. Donepezil (Apricept)

The nurse is planning client education for an older adult being prepared for discharge home after hospitalization for a cardiac problem. Which nursing action addresses the most commonly determined need for this age-group? A. Suggest that he purchase an emergency in-home alert system. B. Arrange for the client to receive meals delivered to his home daily. C. Encourage the client to use a compartmentalized pill storage container for his daily medications. D. Provide only written document describing the medications the client is currently prescribed.

C. Encourage the client to use a compartmentalized pill storage container for his daily medications.

When a fall results in injury and hospitalization, a cycle of disuse may occur over time. When establishing a care plan for the patient and family to prevent this, it is important to remember disuse is most likely a result of: A. Decreasing muscle strength B. Decreased joint mobility. C. Fear of repeated falls. D. Changes in sensory perception.

C. Fear of repeated falls.

When performing a comprehensive geriatric assessment of an older adult, focus of the nursing assessment is on the patient's A. Physical signs of aging B. Immunological function C. Functional abilities D. Chronic illness

C. Functional abilities

Which of the following statements concerning urinary incontinence is correct? A. Urge incontinence occurs when one has the urge to void but us unable. B. Stress incontinence is associated with emotional turmoil. C. Functional incontinence occurrence is associated with environmental barriers. D. Incontinence with high post-void residual occurs when someone laughs or sneezes.

C. Functional incontinence occurrence is associated with environmental barriers. • Functional incontinence is associated with environmental barriers, physical limitations, or cognitive impairment in which the client is unable to reach the toilet. Stress incontinence occurs when someone coughs or sneezes. Urge incontinence occurs when someone cannot wait to void once the urge to void is felt. Urge, mixed, or stress incontinence with high-post void residual is caused by physiological changes that affect voiding, such as an enlarged prostate gland.

When assessing an older adult. The nurse may expect an increase in: A. Nail growth B. Skin turgor C. Urine residual D. Nerve conduction

C. Urine residual

The son of a 70-year-old man dying of cancer asks the nurse to tell him about the hospice program, so he can help his father decide if the program would be of benefit to him. Which of the following responses should be given by the nurse? A. At hospice, your father will be heavily medicated, so he will not have pain. B. All of your father's care will be provided by nurses at hospice. C. Hospice care can take place either at home or in a hospice facility. D. Visiting hours are about the same as they are here in the hospital.

C. Hospice care can take place either at home or in a hospice facility. • Once the person is placed in hospice care, treatment to relieve pain and other symptoms is continued by the physician after they have decided to end all curative treatment. Hospice care can occur in the home, a hospice inpatient facility, nursing home, and acute care hospital. The focus of hospice care is to help the person remain alert but free of pain. Families are encouraged to participate in care giving. There are no restrictions to visiting hours.

A nurse is conducting a staff development program about human sexuality for nurses who work in a long-term care facility. Which of the following statements would most likely be made by the nurse. A. The desire for sexual intimacy declines rapidly with age. B. Older adults are very well-informed about sexuality. C. Older adults need to practice safe sex. D. The danger of contracting STDs during sexual intimacy is extremely low In older adults.

C. Older adults need to practice safe sex. • The desire for sexual intimacy remains a primary force throughout life. Older adults need teaching related to safe sexual practices, STD transmission, and so on. HIV infection is a concern in all age groups.

A community health nurse is working with a diverse population of older adults within the community. Based on the data from the National Health Interview Survey, which of the following assumptions should be made by the nurse when working with this diverse population? A. White Non-Hispanic older adults tend to require more assistance with their activities of daily living. B. Hispanic older adults tend to rate their health as poorer than other ethnic groups. C. Older adults who tend to rate their health as fair or poor are also financially poor. D. Older adults tend to require more assistance with activities of daily living than with meeting their routine needs.

C. Older adults who tend to rate their health as fair or poor are also financially poor. • The National Health Interview Survey conducted by the Centers for Disease Control and Prevention in 2010 provides interesting information about the perceptions of a variety of ethnic groups regarding their health status, their perceived need for assistance with routine needs, and the need for assistance with activities of daily living. In all groups, those who described their health as fair or poor were also more likely to be financially poor.

The nurse is caring for an agitated older client with Alzheimer's disease. Which nursing intervention most likely would calm the client? A. Playing a radio B. Turning the lights out. C. Putting an arm around the client's waist D. Encouraging group participation.

C. Putting an arm around the client's waist. • Nursing interventions for the client with Alzheimer's disease who is angry frustrated, or hostile include decreasing environmental stimuli, approaching the client calmly and with assurance, not demanding anything from the client. For the nurse to reach out, tough, hold a hand, put an arm around the waist, or in some way maintain physical contact is important. Playing a radio may increase stimuli and turning the lights out may produce more agitation. The client with Alzheimer's disease would not be a candidate for this group work if the client is agitated.

In reviewing changes in the older adult, the nurse recognizes that which of the following statements related to cognitive functioning in the older client is true? A. Delirium is usually easily distinguished from irreversible dementia. B. Therapeutic drug intoxication is a common cause of senile dementia. C. Reversible systemic disorders are often implicated as a cause of delirium. D. Cognitive deterioration is an inevitable outcome of the human aging process.

C. Reversible systemic disorders are often implicated as a cause of delirium. • Delirium is a potentially reversible cognitive impairment that is often due to a physiological cause such as an electrolyte imbalance, cerebral anoxia, hypoglycemia, medications, tumors, cerebrovascular infection, or hemorrhage.

The primary reason an older adult client is more likely to develop a pressure ulcer on the elbow as compared to a middle-aged adult is: A. A reduced skin elasticity is common in the older adult. B. The attachment between the epidermis and dermis is weaker. C. The older client has less subcutaneous padding on the elbows. D. Older adults have a poor diet that increases risk for pressure ulcers.

C. The older client has less subcutaneous padding on the elbows.

These are factors that influence the musculoskeletal system associated with aging. The nurse recognizes that with age: A. Men have the greatest incidence of osteoporosis. B. Muscle fibers increase in size and become tighter C. Weight-bearing exercise reduces the loss of bone mass. D. Muscle strength does not diminish as much as muscle mass.

C. Weight-bearing exercise reduces the loss of bone mass.

An overall, general assessment of an older adult patient is best performed in which setting? A. During a meal. B. During assessment of vital signs C. While assisting a patient with a bath. D. When assisting a patient during a walk.

C. While assisting a patient with a bath.

Which of the following statements made by an older-adult client poses the greatest concern for the nurse conducting an assessment regarding the client's adjustment to the aging process? A. "I used to enjoy dancing and jogging so much, but now I have arthritis in my knees so that it's hard to even walk." B. "I've given my grandchildren money for college, so they can live a better life than I had." C. "Growing old certainly presents all sorts of challenges. I wish I knew then what I know now." D. "As I age, I've found its harder to do the things I love doing, but I guess it will be all over soon enough."

D. "As I age, I've found its harder to do the things I love doing, but I guess it will all be over soon enough."

A nurse is counseling an older adult who describes having difficulty dealing with several issues. Which of the following problems verbalized by the client should the nurse identify as the priority? A. "I spent my whole life dreaming about retirement, and now I wish I had my job back." B. "It's been so stressful for me to have to depend on my son to help me around the house." C. "I just heard my friend Al died. That's the third one in 3 months." D. "I keep forgetting which medications I have taken during the day."

D. "I keep forgetting which medications I have taken during the day." • The greatest risk to the client is injury from overdosing or underdoing medication to loss of short-term memory. The priority issues for the nurse should assist the client to use a pill organizer to help him remember to take his medications and to keep a list of all current medications.

A patient is taking delayed-release omeprazole (Prilosec) capsules for the treatment of gastroesophageal reflux disease (GERD). Which statement will the nurse include in the teaching plan about this medication? A. "Take this medication once a day after breakfast." B. "You will only have to be on this medication for 2 weeks for a life long treatment of the reflux disease." C. "The medication may be dissolved in a liquid for better absorption." D. "The entire capsule should be taken whole, not crushed, chewed, or opened."

D. "The entire capsule should be taken whole, not crushed, chewed, or opened."

According to the U.S. Census Bureau, the fastest-growing group within the older population is: A. 65 to 70 B. 70 to 75 C. 75 to 80 D. 85 and older.

D. 85 and older. • The fastest-growing group within the older adult population is 85 years and older. According to the U.S. Census Bureau, an individual who was 65 years of age in 2009 could expect to live 19.2 more years, for a total of 84.2 years. Individuals aged 85 years in 2009 could expect to live an average of 6.3 more years, for a total of 91.3 years.

Which of the following statements accurately reflects data the nurse should use in planning care to meet the needs of the older adult? A. 50% of older adults have two chronic health problems. B. Cancer is the most common cause of death among older adults. C. Nutritional needs for both younger and older adults are essentially the same. D. Adults older than 65 years of age are the greatest users of prescription medications.

D. Adults older than 65 years of age are the greatest users of prescription medications. • Approximately two thirds of older adults use prescription and nonprescription drugs with one third of all prescriptions being written for older adults.

The nurse is aware that the majority of older adults: A. Live alone B. Live in institutional settings C. Are unable to care for themselves D. Are actively involved in their community

D. Are actively involved in their community.

The nurse, preparing to discharge an 81-year-old client from the hospital, recognizes that the majority of older adults: A. Require institutional care B. Have no social or family support C. Are unable to afford any medical treatment D. Are capable of taking charge of their own lives

D. Are capable of taking charge of their own lives.

When caring for an elderly client it is important to keep in mind the changes in color vision that may occur. What colors are apt to be most difficult for the elderly to distinguish? A. Red and blue. B. Blue and gold C. Red and green D. Blue and green

D. Blue and Green The elderly are better able to distinguish between red and blue because of the difference in wavelengths. The elderly are better able to distinguish between blue and gold because of the difference in wavelengths. The elderly are better able to distinguish between red and green because of the difference in wavelengths. Red and green color blindness in an inherited disorder that is unrelated to age. The elderly have poor blue-green discrimination. The effects of age are greatest on short wavelengths. These changes are related to the yellowing of the lens with age.

When administering a mental status examination to a patient with delirium, the nurses should: A. Give the examination when the patient is well-rested. B. Choose a place without distracting environmental stimuli. C. Reorient the patient as needed during the examination. D. Medicate the patient first to reduce anxiety.

D. Choose a place without distracting environmental stimuli.

The nurse is setting up an education session with an 85-year-old patient who will be going home on anticoagulant therapy. Which strategy would reflect consideration of aging changes that may exist with this patient? A. Show a colorful video about anticoagulation therapy. B. Present all the information in one session just before discharge. C. Develop large-print handouts that reflect the verbal information presented.

D. Develop large-print handouts that reflect verbal information presented. • Option D addresses altered perception in two ways. First, by using visual aids to reinforce verbal instructions, one addresses the possibility of decreased ability to hear high-frequency sounds. By developing the handouts In large print, one addresses the possibility of decreased visual acuity. Option A does not allow discussion of the information; furthermore, the text and print may be small and difficult to read and understand.

The nurse defines ageism most accurately as: A. The undervaluing of individuals based on their age. B. Perceptions of a person's worth based on productivity. C. Biases directed towards individuals considered aged. D. Discrimination based on an individual's increasing age.

D. Discrimination based on an individual's increasing age.

Which of the following should be taken to help an older client to prevent osteoporosis? A. Decrease dietary calcium intake. B. Increase sedentary lifestyles. C. Increase dietary protein intake. D. Encourage regular exercise.

D. Encourage regular exercise. • Key word in question is prevent. Weight-bearing exercises helps to fight off degeneration of bone in osteoporosis.

The leading cause of injury and preventable source of mortality and morbidity in older adults is: A. Presbycusis B. Car accidents C. Pneumonia D. Falls

D. Falls

A person is preparing to return home following a 2-week hospital stay for congestive heart failure and pneumonia. Which of the following referrals would be most beneficial for the person? A. Transportation assistance. B. Home-delivered meals C. Adult day care D. Home health nursing

D. Home health nursing. • Home care nurses provide health care information and services to individuals and families. The resources available to community health nurses frequently are rich and enable the nurses to draw on a variety of sources to assist in promoting the health of community-dwelling older adults. Although all of the referrals listed may be of benefit to the person, the home health nurse will provide the most comprehensive services and be able to connect the person to necessary community resources.

Characteristic behaviors of older adults who have successfully met Erikson's ego integrity versus despair developmental task include: A. Fear of death. B. Feelings that life has been lived in vain. C. Identity is related to career and work only. D. Honest acceptance of the life that has passed.

D. Honest acceptance of the life that has passed. • Ego integrity versus despair is the developmental stage of older adults. The quality associated with successful passage of this stage is integrity, defined as an honest acceptance of the life that has passed and the stage of life that is currently being lived. Individuals who have reached this stage are said to be at peace with themselves. The inability to reach this stage leads to fear of death and despair that life has been lived in vain. Ego differentiation, which is a part of the developmental stage of ego integrity, involves achieving an identity apart from work.

A 75-year-old man tells the nurse that he has difficulty staying asleep during the night. Which of the following responses should be made by the nurse? A. Older adults need as much sleep as middle-aged and younger adults. Let's talk about your sleep patterns. B. I'll ask the nurse practitioner to prescribe a sleeping pill for you. C. Taking naps during the day can help relieve excessive fatigue and will help you sleep better. D. Let's talk about your sleep schedule and things that prevent you from getting a restful night's sleep.

D. Let's talk about your sleep schedule and things that prevent you from getting a restful night's sleep. • Nurses should assist older adults in achieving a good night's sleep through assessment that might reveal possible causes of sleep disturbances. Older adults need less sleep than younger adults. Daytime naps may prevent sleeping adequately at night. Medications to assist in sleeping are not the initial therapy choice because of side effects.

Which of the following statements concerning nutrition and older adults is true? A. Older adults who live in their own homes are more likely to be malnourished than older adults living in a nursing home. B. Older adults lose their desire for high-fat, salty foods. C. Meals served in long-term care institutions are usually more well-balanced than foods eaten by older adults living at home. D. Many older adults are not aware of food assistance programs.

D. Many older adults are not aware of food assistance programs. • Barriers that may interfere with the ability of independent seniors to obtain adequate nutritional food include limited transportation, income, and social support resources. Many older persons are unaware that they are eligible to participate in SNAP. The percent of older adults who life in their own homes and are malnourished is lower than that of older adults who live in a nursing home. Older adults do not lose their desire for high-fat, high-cholesterol, high-sodium foods. Fresh fruits and vegetables are not always available for older adults living in nursing homes.

The home care nurse is visiting an older female client whose husband died 6 months ago. Which behavior, by the client, indicated ineffective coping? A. Visiting her husband's grave once a month. B. Participating in a senior citizens program. C. Looking at old snapshots of her family. D. Neglecting her personal grooming.

D. Neglecting her personal grooming. • Coping mechanisms are behaviors used to decrease stress and anxiety. In response to a death, ineffective coping is manifested by an extreme behavior that in some instances may be harmful to the individual physically or psychologically. Option D is indicative of a coping behavior in the grieving process.

What is the best resource (of those listed below) for identifying information regarding an older adult's current functional ability? A. Psychological tests and related exams. B. Diagnostic x-rays and lab tests C. Family members who visit occasionally and call weekly D. Neighbor who visits daily and helps the person to the store weekly.

D. Neighbor who visits daily and helps the person to the store weekly.

Of the following options, which is the greatest barrier to providing quality health care to the older-adult client? A. Poor client compliance resulting from generalized diminished capacity. B. Inadequate health insurance coverage for the group as a whole. C. Insufficient research to provide a basis for effective geriatric health care. D. Preconceived assumptions regarding the lifestyles and attitudes of this group.

D. Preconceived assumptions regarding the lifestyles and attitudes of this group.

The community health nurse has obtained a grant to offer a Safe Driving series for older adults. Which of the following information should the nurse stress during the series? A. Traffic fatalities involving older adults occur mainly at dusk. B. The cause of two-vehicle accidents is frequently an older driver striking another car. C. The average blood alcohol level in older adults involved in accidents is higher than the blood alcohol level of younger drivers involved in accidents. D. Relearning the art of defensive driving can help reduce the likelihood that an older driver will be involved in a motor vehicle

D. Relearning the art of defensive driving can help reduce the likelihood that an older driver will be involved in a motor vehicle • Traffic fatalities involving older adults occur mainly during the daytime. The cause of two vehicle accidents is frequently a younger driver striking the car driven by an older adult. The average blood alcohol level in older adults involved in accidents is lower than the blood alcohol level of younger drivers involved in accidents.

A nurse is planning to write a grant for a health promotion project in the community. Which of considerations should the nurse make when determining the appropriate population for this project? A. The fastest growing population is children under the age of 12. B. The fastest growing population is young Black American adults. C. The fastest growing populations is White middle-aged adults. D. The fastest growing population is non-White older adults age 65 and older.

D. The fastest growing population is non-White older adults age 65 and older. • Adults age 85 and older are the fastest growing population in the United States, and the percentage of White Americans greater than age of 65 is decreasing compared with other ethnic groups.

A nurse is assisting with development of menu items at a long-term care facility. Which of the following menus would the nurse most likely recommend? A. One egg over easy, one slice of whole wheat toast with sugar-free jam, 4 oz orange juice. B. 5-oz cheeseburger cooked medium well with lettuce and tomato, 10 baked potato chips, and 1 cup of decaf coffee with low-fat milk and artificial sweetener. C. Chef salad with 2 ox each ham and turkey, lettuce, tomato, bean sprouts, onion, green pepper with low-fat dressing, and one small roll with low-fat spread. D. Turkey bacon, lettuce and tomato sandwich on whole wheat bread with two teaspoons of low-fat mayonnaise, 10 vegetable chips and iced tea with artificial sweetener.

D. Turkey bacon, lettuce and tomato sandwich on whole wheat bread with two teaspoons of low-fat mayonnaise, 10 vegetable chips and iced tea with artificial sweetener. • The United States Department of Agriculture recommends that infants and young children, pregnant women, older adults, and those who are immune compromised should not consume raw (unpasteurized) milk or any products from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or shellfish, unpasteurized juices, or raw sprouts.

The nurse who volunteers at a senior citizens center is planning activities for the members who attend the center. Which activity would best promote health and maintenance for these senior citizens? A. Gardening every day for an hour. B. Cycling 3 times a week for 20 minutes. C. Sculpting once a week for 40 minutes. D. Walking 3 to 5 times a week for 30 minutes.

D. Waling 3 to 5 times a week for 30 minutes.

An effective method for older adults to feel engaged in the community is through: A. Volunteering B. Downsizing C. Retirement D. Gardening

D. Walking • Walking, which can be done in both community settings and health care facilities, is broadly reported as the most widely accepted form of exercise among older adults: Other popular activities for older adults include swimming, weight-bearing, and aquatic exercises. Weight-bearing and muscle-building exercises help to maintain functional mobility promote independence and prevent falls. Weight-bearing exercises are shown to be highly effective in reducing bone wasting associated with osteoporosis.

The most widely accepted form of exercise among older adults is reported to be: A. Swimming B. Running C. Strength-training D. Walking

D. Walking • Walking, which can be done in both community settings and health care facilities, is broadly reported as the most widely accepted form of exercise among older adults: Other popular activities for older adults include swimming, weight-bearing, and aquatic exercises. Weight-bearing and muscle-building exercises help to maintain functional mobility promote independence and prevent falls. Weight-bearing exercises are shown to be highly effective in reducing bone wasting associated with osteoporosis.