Chapter 25 & 26 (Vision and Hearing and Endocrine Function)

A nurse is providing care to an older adult client who is suspected of having type 2 diabetes. The nurse understands that early diagnosis of diabetes in this age group is often difficult because the classic symptoms of diabetes may not be evident. Which finding would the nurse expect to be used as the most reliable indicator of diabetes in an older adult? A. High blood glucose level in GTT B. Kidney Failure C. Glaucoma D. High urinary glucose level

A. High blood glucose level in GTT

A 76-year-old resident diagnosed with chronic glaucoma. What info should the nurse expect to share with the client about their diagnosis? A. You will most likely be prescribed eye drops that you will need to instill regularly B. It's imperative that this be resolved with 24 hours either by surgery or medication C. Your health care provider will probably talk to you about the need for lens replacement surgery D. In the past, this meant you would need surgery, but laser therapy is most commonly used these days.

A. You will most likely be prescribed eye drops that you will need to instill regularly

A nurse is providing care to an older adult diagnosed with type 2 diabetes. When developing the client's plan of care, which information would the nurse need to integrate into the plan? A. Older adults' kidneys tolerate higher glucose levels, so hyperglycemia does not necessarily result in glycosuria. B. Because older adults often display atypical signs and symptoms of diabetes, glycosuria coupled with hyperglycemia is considered the most accurate source of a definitive diagnosis. C. Decreased renal filtration capacity in older individuals causes their urine to normally contain more glucose than younger adults'. D. Glycosuria is considered a pathological finding in younger adults but a normal finding in older adults.

A. Older adults' kidneys tolerate higher glucose levels, so hyperglycemia does not necessarily result in glycosuria.

A nurse is conducting an educational program for a client newly diagnosed with type 2 diabetes. The nurse determines that the teaching has been successful based on which outcomes? A. Verbalization of understanding of diabetes and its management B. Evidence of a loss of 5 lb/week for the next 52 weeks C. Demonstration of the correct method of blood glucose testing D. Demonstration of the proper technique for medication administration E. Maintenance of a heart rate within normal limits.

A. Verbalization of understanding of diabetes and its management C. Demonstration of the correct method of blood glucose testing D. Demonstration of the proper technique for medication administration

A nurse is providing care to several clients. Which client would the nurse identify as facing the most immediate threat to vision? A. An 80-year old woman with newly diagnosed cataracts B. A 67-year-old man who has been diagnosed with narrow-angle glaucoma C. An 80-year-old man with open-angle glaucoma D. A 78-year-old man with corneal inflammation and ulceration

B. A 67-year-old man who has been diagnosed with narrow-angle glaucoma

The nurse plans care for a client who has had gradual vision loss. Which of the following should the nurse include in the care plan? A. Radio playing music in the client's room around the clock B. A clock that chimes the hour in the client's living room C. Brightly colored throw rugs to lighten up the client's room D. Fluorescent overhead lights on at night

B. A clock that chimes the hour in the client's living room

The nurse assesses a group of older adults at a senior center for conditions related to changes on the endocrine system related to aging. Which assessment findings should the nurse prioritize and address first? A. New onset of constipation in a 72-year-old adult B. Blood glucose of 300 in an 88-year old adult C. Evidence of a Dupuytren contracture in a 78-year-old adult D. Metabolic syndrome in a 67-year-old adult

B. Blood glucose of 300 in an 88-year old adult

The nurse at the ophthalmology office teaches the client who was newly diagnosed with cataracts. Which of the following should the nurse counsel the client to avoid now? A. Contact lenses B. Bright sunlight C. Reading D. Strenuous exercise

B. Bright sunlight

The nurse is assessing an older client's hearing. Which finding would lead the nurse to suspect that the client is experiencing a problem? Select all that apply. A. Client bumps into exam table on entering the room B. Client consistently asking, "What did you say?" C. Client asks to have words repeated D. Client looks directly at speaker's lips during interview E. Client leans head to one side

B. Client consistently asking, "What did you say?" C. Client asks to have words repeated D. Client looks directly at speaker's lips during interview E. Client leans head to one side

An otologist has recommended the use of a hearing aid for a 74-year-old client who has experienced a progressive loss of hearing acuity in recent years. When teaching the client about this, which information would the nurse most likely include? A. With the right hearing aid, you can expect your hearing to be back to normal B. Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise C. You can save money by purchasing hearing aids online or by mail order after you get the prescription D. Many people find that hearing aids always help with certain types of hearing loss that are caused by previous noise exposure.

B. Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise

A gerontological nurse at a wellness center is conducting an exercise program for older adult clients with diabetes. The nurse cautions the clients to exercise with caution for which reason? A. The absorption of insulin is lowered. B. Hypoglycemia may occur. C. The resting heart rate is lowered D. The heart rate is temporarily increased

B. Hypoglycemia may occur.

The nurse interviews the client at a yearly office visit. The client states "I don't really eat that much, I'm not that hungry, but I keep gaining weight. Just look at my fat face!" Which of the following conditions should the nurse suspect? A. Hyperlipidemia B. Hypothyroidism C. Diabetes D. Peripheral vascular disease

B. Hypothyroidism

The nurse practitioner is assessing an 84-year-old client who has come to the health center for an evaluation. The client reports feeling tired and chilly, and having dry skin and coarse hair. The nurse practitioner interprets these findings as suggestive of which condition? A. Peripheral Vascular Disease B. Hypothyroidism C. Hyperlipidemia D. Diabetes

B. Hypothyroidism

An older adult client with diabetes comes to the clinic for a follow-up visit. The client is receiving insulin as part of his treatment plan for diabetes. During the visit, the nurse reviews the client dietary intake over the past several weeks. Which client statement would the nurse identify as indicating the need for intervention? Select all that apply. A. My neighbor has been coming over several times a week bringing me dinners so that I don't have to cook all the time B. I visited my children the last few weekends and ate more when I was there than I do when I'm home alone C. I haven't been cooking as much lately because I've been feeling tired from not sleeping well at night. D. I've been a little short on money over the past few weeks, so I've cut back a little on my meals and snack. E. I've been going to the grocery store regularly and making sure that I have enough of food at home to eat.

B. I visited my children the last few weekends and ate more when I was there than I do when I'm home alone C. I haven't been cooking as much lately because I've been feeling tired from not sleeping well at night. D. I've been a little short on money over the past few weeks, so I've cut back a little on my meals and snack.

A gerontological nurse is reviewing health statistics about older adults in the community. The nurse notes that this population has a high incidence of hyperglycemia. The nurse identifies which situation as increasing older adults vulnerability for this condition? A. Hereditary nature of the condition B. Increased amount of fat tissue C. Glucose intolerance D. Improved activity levels

B. Increased amount of fat tissue

A nurse is reading a journal article about corneal ulcers and their development. Which factor would the nurse expect to find as common in older adults? A. Diabetes mellitus and peripheral vascular disease B. Infections and cerebrovascular accidents C. Decreased percentage of water versus body weight and decreased renal function D. Constipation and straining during defecation

B. Infections and cerebrovascular accidents

A client newly diagnosed with diabetes tells the nurse, "I'm fearful and nervous about having to cope with this disease." Which response by the nurse would be most appropriate? A. You have nothing to worry about. Diabetes is easy to control and most people don't develop any problems. B. It's true that you will have to make some changes but these changes will help control your diabetes. C. If you avoid all kinds of sugar, you won't need to worry about injecting yourself with insulin. D. It might mean that your grocery bill will increase but that increase will be well worth it.

B. It's true that you will have to make some changes but these changes will help control your diabetes.

The nurse is providing care to an older adult resident of a nursing home who has diabetes. Which finding would the nurse be alert for as an early indicator of hypoglycemia? A. Perspiration and anxiety B. Poor sleep patterns and slurred speech C. Tachycardia and restlessness D. Anxiety and restlessness

B. Poor sleep patterns and slurred speech

A gerontological nurse is developing programs for older adults who are experiencing hearing deficits, working to address serious threats to the their emotional health. Which area would the nurse ensure is addressed by these programs? A. Confusion brought on by having to depend on written communication B. Social isolation brought on by the difficulty in communication C. Anger and frustration brought on by ill-fitting hearing aids D. Suspicion of those around them due to the inability to lip-read conversations

B. Social isolation brought on by the difficulty in communication

A nurse is assessing a 94-year-old resident of a nursing home who has diabetes mellitus. Which finding would lead the nurse to check the client's blood glucose level? A. Numbness and weak pulses B. Somnolence and slurred speech C. Restlessness and postural hypotension D. Perspiration and incontinence

B. Somnolence and slurred speech

A nurse is assessing the eyes of a 77-year-old client. Which finding would lead the nurse to suspect that the client is developing cataracts? A. The client's most recent eye exam indicated increased intraocular pressure B. The client states, "My vision is becoming more and more blurry" C: The client has eye pain that is described as "a constant dull ache" D. The client states, "I often see double, especially early in the morning

B. The client states, "My vision is becoming more and more blurry"

With aging, the endocrine system experiences changes that can be diverse and interrelated. Which of the following statements accurately describes an effect of aging on the endocrine system and its hormones? A. The action of water-soluble hormones on body cells increases. B. The endocrine system's ability to regulate body activities decreases. C. The response of body cells to hormones increases. D. Hormones become more concentrated.

B. The endocrine system's ability to regulate body activities decreases.

A 79-year-old client with type 2 diabetes in very good health has a lipid screening during a visit to the nurse practitioner. Which triglyceride level would the nurse identify as desirable for this client? A. Tryiglycerides 19 mg/dL B. Triglycerides 149 mg/dL C. Triglycerides 299 mg/dL D> Triglycerides 199 mg/dL

B. Triglycerides 149 mg/dL

A gerontological nurse who is a certified diabetes educator is conducting an in-service program for nurses providing care to older adults admitted to the subacute unit of a hospital. One of the participants asks, "What do we need to know about diagnosing diabetes in this group?" Which response by the nurse would be most appropriate? A. "Older adults with a new onset of diabetes will be hungry and thirsty with copious urine output." B. "Because of an absence of signs and symptoms in older adults with diabetes, diagnosis can be very difficult." C. "Older persons can often display signs and symptoms of diabetes that are more subtle than those in younger adults." D. "Pancreatic biopsy is often required in order to determine a definitive diagnosis of diabetes in the elderly."

C. "Older persons can often display signs and symptoms of diabetes that are more subtle than those in younger adults."

A 77-year-old client is diagnosed with glaucoma and is receiving treatment. When teaching the client about self-care measures to prevent complications, which information would the nurse most likely include? A. Avoid watching television in low-light conditions or for long periods of time B. Use antihypertensive medications and diuretics with great caution C. Avoid stress, coughing, sneezing, or the valsalva maneuver D. Remain in a lying position as much as possible throughout the day

C. Avoid stress, coughing, sneezing, or the valsalva maneuver

During patient education of a 71-year-old who has a recent diagnosis of diabetes, the nurse has emphasized the importance of consistently maintaining blood glucose levels within the normal range rather than simply reacting to high or low levels. Which of the following tests is most likely to gauge the consistency of the patient's blood sugar control over time? A. Random blood glucose B. Triglyceride monitoring C. Hemoglobin A1c D Glucose tolerance test (GTT)

C. Hemoglobin A1c

A nurse is teaching an older client diagnosed with hypothyroidism about the treatment plan. Which client statement indicates to the nurse that additional teaching is needed? A. I will call the office if I have any chest palpitations B. I will start with a low dose but the dose may be gradually increased C. I will not need to refill this prescription once it's completed D. I will continue to take the stool softener until my constipation is better.

C. I will not need to refill this prescription once it's completed

A nurse is developing a teaching program for a 66-year-old adult who was just diagnosed with type 2 diabetes. When providing this teaching, which educational material would be most appropriate for the nurse to use? A. Online interactive presentation B. An audio recording of instructions C. Printed handouts on white paper with font size 16 D. A commercial pamphlet with pictures and font size 12

C. Printed handouts on white paper with font size 16

The nurse is making a home visit to an older adult with severe hearing loss. The client also does not use a hearing aid. Several family members are present and voice difficulty in caring for the client. Which suggestion would be most appropriate for the nurse to make? A. Speak as loudly as possible and face the person B. Use simple, one-syllable words, talking directly into the affected ear C. Speak in a low-frequency voice, and use sign language D. Buy the person the best hearing aid available immediately.

C. Speak in a low-frequency voice, and use sign language

The nurse presents at a seminar on "Aging of the Endocrine Glands" at a senior center. Which of the following should the nurse include in the presentation? A. Blood tests are necessary for initial assessment of endocrine system decline. B. Endocrine function decline can be prevented with exercise and vitamins. C. Glands that secrete hormones decline at a predetermined prescribed rate. D. The thyroid, pancreas, and adrenal glands are at risk for dysfunction in the older adult.

D) The thyroid, pancreas, and adrenal glands are at risk for dysfunction in the older adult.

The home care nurse regularly performs visits to a client's apartment. This client asks about ways that exercise might be able to control his type 2 diabetes. How should the nurse respond to the client's query? A. "Exercise is very beneficial for diabetes control, but if it's too vigorous it can lead to rebound hyperglycemia that is dangerous." B. "Confirm with your doctor, but it's likely best to maintain a low activity levels to keep your glucose levels within normal range." C. "Exercise can be an excellent substitute for oral antihyperglycemic medications." D. "It's important to have an exercise plan that is appropriate specifically for you, because you don't want to bring on hypoglycemia by exercising too hard."

D. "It's important to have an exercise plan that is appropriate specifically for you, because you don't want to bring on hypoglycemia by exercising too hard."

A gerontological nurse is participating at a community health fair and is providing information to older adults about ways to promote healthy sensory function. Which suggestion would the nurse most likely make? A. Although they may not appear connected, regular physical activity is key to preventing loss of vision B. To help your hearing, you should remove your ear wax gently but regularly using a cotton-tipped applicator C. High cholesterol levels and diabetes can have a negative effect on hearing, so it's important to keep these health problems well-managed D. Even if you have good vision, its important to get an eye examination every year

D. Even if you have good vision, its important to get an eye examination every year

A home care nurse is making a visit to an older adult client. During the visit, the nurse notes that the client has cerumen accumulated in the left ear. The nurse assists the client in removing it. Which action would be appropriate? A. Applying a forceful stream of a water and peroxide solution B. Pushing the cerumen out with cotton-tipped applicators C. Using a hairclip to clean out the ear D. Gently irrigating the external auditory canal with warm water.

D. Gently irrigating the external auditory canal with warm water.

A nurse is reviewing the medical record of an older adult client. Which finding would the nurse attribute to an underlying pathological process? A. An increased sensitivity to glare B. Difficulty transitioning between areas of bright light and low light C. A gradual loss in the number of photoreceptor cells in the retina D. Increased pressure within the eye that inhibits visual acuity

D. Increased pressure within the eye that inhibits visual acuity

A nurse is conducting a presentation to a group of older adults at the local senior center about visual changes. After teaching the group about these changes, the nurse determines that the teaching was successful when the group identifies which condition as the most common cause of blindness in people over age 65 years? A. Detached Retina B. Glaucoma C. Accidental Injury D. Macular Degeneration

D. Macular Degeneration