Chapter 40 The Older Adult Patient

Which medications are considered an alternative to angiotensin-converting enzyme (ACE) inhibitors in older adult hypertension patients with diabetes mellitus and heart failure (HF)? a. Angiotensin-receptor blockers b. Beta-blockers c. Calcium antagonists d. Direct renin inhibitors

a. Angiotensin-receptor blockers

Which sign or symptom can be a normal assessment finding for an older patient? a. Asymptomatic dysrhythmias b. Decreased urine output c. Increased respiratory effort d. Difficulty problem solving

a. Asymptomatic dysrhythmias

The nurse recognizes that there are numerous interventions that can decrease the negative physical, functional, and cognitive long-term outcomes associated with critical illness. Identify a few of these interventions. (Select all that apply.) a. Avoid pharmacologic sleep agents. b. Focus on planning for home. c. Use restraints. d. Use indwelling catheters. e. Reduce noise at night.

a. Avoid pharmacologic sleep agents. b. Focus on planning for home. e. Reduce noise at night.

Which parameter remains unchanged in an older person when he or she exercises? a. Cardiac output b. Heart rate c. Blood pressure d. Heart rhythm

a. Cardiac output

Which factors contribute to diminished wound healing in the older adult? (Select all that apply.) a. Decreased cytokine production b. Increased production of growth factor c. Decreased inflammatory response d. Decreased glucocorticoid secretion e. Decreased cell proliferation

a. Decreased cytokine production c. Decreased inflammatory response e. Decreased cell proliferation

Hospitalized critically ill older adults undergo a number of function changes each day they are in the hospital. What changes might the nurse expect to see by day 3? (Select all that apply.) a. Decreased stroke volume b. Orthostatic hypotension c. Decreased heart rate d. Decreased total lung capacity e. Visible muscle weakness

a. Decreased stroke volume b. Orthostatic hypotension

An older patient is admitted to the hospital with a hip fracture. Which nursing intervention would be a priority? a. Encourage frequent deep breathing. b. Administer stool softeners. c. Perform neurologic checks. d. Frequently offer liquids to drink.

a. Encourage frequent deep breathing.

An older patient is started on spironolactone to control hypertension. The nurse knows to monitor for what side effect? a. Hyperkalemia b. Irregular heart rate c. Confusion d. Pulmonary edema

a. Hyperkalemia

Which sign or symptom would be a normal assessment finding for an older patient? a. Inability to remember what was eaten yesterday b. An increase in resting heart rate c. Hypoactive bowel sounds d. Brisk papillary response to light

a. Inability to remember what was eaten yesterday

Which age-related changes contribute to a higher risk for myocardial ischemia in an older patient? (Select all that apply.) a. Increased diastolic filling pressures b. Decreased intracellular free calcium c. Thinning of the left ventricular wall d. Increased myocardial collagen content e. Increased myocardial oxygen consumption

a. Increased diastolic filling pressures d. Increased myocardial collagen content e. Increased myocardial oxygen consumption

Which sound may be difficult for an older person to hear? a. Telephone ringing b. Clothes dryer running c. Car horn honking d. Child crying

b. Clothes dryer running

An older patient is starting a new medication that is metabolized in the liver and excreted by the kidneys. Which is the best assessment to monitor the patient's ability to tolerate the medication? a. Liver function tests b. Drug side effects experienced by the patient c. Kidney function tests d. Therapeutic drug levels

b. Drug side effects experienced by the patient

A 78-year-old patient has been admitted after an inferior myocardial infarction (MI). The nurse knows that age-related changes in the cardiovascular system coupled with the MI place the patient at risk for what problem? a. Hypertension b. Heart failure c. Ventricular fibrillation d. Bradycardia

b. Heart failure

An older patient is admitted to the hospital with an acute onset of mental changes and recent falls. What is the one of the most common causes of mental changes in older patients? a. Dementia b. Infection c. Stroke d. Depression

b. Infection

What is the chemical change in a drug called that renders it active or inactive? a. Absorption b. Metabolism c. Excretion d. Distribution

b. Metabolism

An 82-year-old patient was admitted for pneumonia. The nurse knows that there are a number of age-related pulmonary changes that may affect this patient. What change would the nurse expect to find? a. Increased tidal volumes b. Weakening of intercostal muscles and the diaphragm c. Improved cough reflex d. Decreased sensation of the glottis

b. Weakening of intercostal muscles and the diaphragm

An older patient is receiving a nephrotoxic medication. Which parameter would be a priority for the nurse to monitor? a. Electrocardiogram b. Lung sounds c. Blood pressure d. Level of consciousness

c. Blood pressure

What age-related change can affect the absorption of medications? a. Decreased renal blood flow b. Decreased red blood cells c. Decreased splanchnic blood flow d. Decreased gastric acid pH

c. Decreased splanchnic blood flow

A 78-year-old patient was admitted after an inferior myocardial infarction. The patient awakens during the night confused and disoriented. The nurse suspects the patient may be developing what condition? a. Stroke b. Neurocognitive decline c. Delirium d. Dementia

c. Delirium

An older adult is placed on a continuous infusion of high-dose loop diuretic for diuresis. What finding would alert the nurse to the presence of a possible adverse effect? a. Tremors b. Bradycardia c. Electrolyte imbalance d. Hypoglycemia

c. Electrolyte imbalance

An 82-year-old patient was admitted after an inferior myocardial infarction. Why would the nurse need to provide increased attention to the patient's skin integrity? a. There is thickening of the epidermal skin layer. b. There is a loss of sebaceous glands. c. There is loss of subcutaneous tissue. d. There is decreased melanocyte production.

c. There is loss of subcutaneous tissue.

A nurse is teaching an older patient about the signs and symptoms of a myocardial infarction. Which statement by the patient would indicate that the teaching was effective? a. "The pain in my chest may last a long time." b. "I will feel like I have an elephant sitting on the center of my chest." c. "The chest pain will be sharp and over the center of my chest." d. "The pain may not be severe and may not be in my chest."

d. "The pain may not be severe and may not be in my chest."

A 68-year-old patient was admitted after an inferior myocardial infarction (MI). Dopamine 3 mcg/kg/min has been ordered for this patient. What nursing implications should be considered when administering this medication to an older patient? a. No changes are noted in older patients with this drug. b. Drug effect is enhanced by increased receptor site action. c. Increased breakdown by liver hepatocytes occurs, increasing dosage requirements. d. Drug metabolism and detoxification are slowed, increasing the risks of drug toxicity.

d. Drug metabolism and detoxification are slowed, increasing the risks of drug toxicity.

Which nonsteroidal antiinflammatory drug (NSAID) has the side effect of renal failure, hypertension (HTN), heart failure, and gastrointestinal (GI) bleed in the elderly population? a. Indomethacin b. Ketorolac c. Aspirin greater than 325 mg d. Naproxen

d. Naproxen

The focus on the relief of a patient's suffering, in all of its dimensions, is referred to as what type of care? a. Aggressive b. Comfort c. Hospice d. Palliative

d. Palliative