Chapter 8: Management of the Older Adult Patient

35. A gerontologic nurse is overseeing the care in a large, long-term care facility. The nurse is educating staff about the significant threat posed by influenza in older, frail adults. What action should the nurse prioritize to reduce the incidence and prevalence of influenza in the facility? A. Teach staff how to administer prophylactic antiviral medications effectively. B. Ensure that residents receive a high-calorie, high-protein diet during the winter. C. Make arrangements for residents to limit social interaction during winter months. D. Ensure that residents receive influenza vaccinations in the fall of each year.

ANS: D Rationale: The influenza and the pneumococcal vaccinations lower the risks of hospitalization and death in older adults. The influenza vaccine, which is prepared yearly to adjust for the specific immunologic characteristics of the influenza viruses at that time, should be given annually in autumn. Prophylactic antiviral medications are not used. Limiting social interaction is not required in most instances. Nutrition enhances immune response, but this is not specific to influenza prevention. PTS: 1 REF: p. 188 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

4. An 80-year-old client is being admitted for dehydration and syncope. The client is found to be hypotensive, and intravenous fluids are ordered. What are some teaching strategies that the nurse should review with this client? A. Before ambulation the client should rise slowly and take mini breaks between lying, sitting, and standing. B. Increase consumption of meals to three times a day, with the largest meal being at breakfast. C. The client must use a rolling walker and call for assistance with any change in position. D. The temperature in the room should stay very hot, and bathing in hot water is appropriate.

ANS: A Rationale: A client experiencing hypotension should rise slowly. The client should consider having five or six small meals a day to minimize hypotension that can occur after a large meal. Extremes in temperature, especially hot showers, should be avoided. Hot temperatures can cause an increase in blood flow and cause dizziness. Every client does not need a rolling walker. Changes in position, especially in bed, should be done independently and often to prevent pressure ulcers. PTS: 1 REF: p. 171 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

28. For several years, a community health nurse has been working with a 78-year-old man who requires a wheelchair for mobility. The nurse is aware that the interactions between disabilities and aging are not yet clearly understood. This interaction varies depending on what variable? A. Socioeconomics B. Ethnicity C. Education D. Pharmacotherapy

ANS: A Rationale: Large gaps exist in our understanding of the interaction between disabilities and aging, including how this interaction varies depending on the type and degree of disability, and other factors such as socioeconomics and gender. Ethnicity, education, and pharmacotherapy are not identified as salient influences on this interaction. PTS: 1 REF: p. 190 NAT: Client Needs: Safe, Effective Care Environment: Management of Care | Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

5. A 76-year-old client is in the emergency department with reports of nausea, dyspnea, and shoulder pain. The spouse stated the client woke up confused, slightly unsteady, and pale. Which problem or condition is most likely occurring? A. Myocardial ischemia B. Urinary tract infection (UTI) C. Lung cancer D. Chronic obstructive pulmonary disease (COPD)

ANS: A Rationale: Older adults may have atypical pain or burning that may be in the upper body rather than substernal. Clients may report vague symptoms such as nausea, vomiting, syncope, mental status changes, and dyspnea. A UTI may present with mental status changes, but additional signs and symptoms include frequent, urgent, and/or painful urination. Lung cancer and COPD both usually present with more specific respiratory changes, such as wheezing and persistent coughing. PTS: 1 REF: p. 171 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

2. Which age-related physiologic change contributes to heart disease being the leading cause of death in older adults? A. Heart muscle and arteries lose their elasticity. B. Systolic blood pressure decreases. C. Resting heart rate decreases with age. D. Atrial-septal defects develop with age.

ANS: A Rationale: The leading cause of death for clients over the age of 65 years is cardiovascular disease. With age, heart muscle and arteries lose their elasticity, resulting in a reduced stroke volume. As a person ages, systolic blood pressure does not decrease, resting heart rate does not decrease, and atrial-septal defects are not more likely to develop with age. PTS: 1 REF: p. 169 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

9. A nurse is caring for an 81-year-old client who has become increasingly frail and unsteady when standing. During the assessment, the client reports having fallen three times in the month, though the client did not suffer any injury. The nurse should take action in the knowledge that this client is at a high risk for which type of injury? A. A hip fracture B. A femoral fracture C. Pelvic dysplasia D. Tearing of a meniscus or bursa

ANS: A Rationale: The most common fracture resulting from a fall is a fractured hip resulting from osteoporosis and the condition or situation that produced the fall. The other listed injuries are possible, but less likely than a hip fracture. PTS: 1 REF: p. 187 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

8. The nurse is providing education to a client with early-stage Alzheimer disease (AD) and the family members. The client has been prescribed donepezil hydrochloride. What should the nurse explain to the client and family about this drug? A. It slows the progression of AD. B. It cures AD in a small minority of clients. C. It removes the client's insight that they have AD. D. It eliminates the physical effects of AD and other dementias.

ANS: A Rationale: There is no cure for AD, but several medications have been introduced to slow the progression of the disease, including donepezil and hydrochloride These medications do not eliminate the client's AD but can alleviate some of the symptoms. PTS: 1 REF: p. 184 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice

11. A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be administering intramuscular (IM) doses of the vaccine. Which age-related change should the nurse be aware of when planning the appropriate administration of this drug? An older adult client has: A. less subcutaneous tissue and less muscle mass than a younger client. B. more subcutaneous tissue and less durable skin than a younger client. C. more superficial and tortuous nerve distribution than a younger client. D. a higher risk of bleeding after an IM injection than a younger client.

ANS: A Rationale: When administering IM injections, the nurse should remember that in an older client, subcutaneous fat diminishes, particularly in the extremities. Muscle mass also decreases. There are no significant differences in nerve distribution or bleeding risk. PTS: 1 REF: p. 170 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

21. A 76-year-old client with Parkinson disease has been admitted with aspiration pneumonia and constipation. Which nursing intervention would help both diagnoses? A. Sitting upright for meals B. Good oral hygiene C. Prolonged laxative usage D. Increase dietary fat

ANS: A Sitting upright for meals is beneficial to both problems. It decreases risk from further aspiration and increases motility. Good oral hygiene promotes gastrointestinal health. Prolonged laxative use and increased dietary fat are not recommended for either condition. PTS: 1 REF: p. 173 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice

36. When implementing a comprehensive plan to reduce the incidence of falls on a gerontologic unit, what risk factors should the nurse identify? Select all that apply. A. Medication effects B. Overdependence on assistive devices C. Poor lighting D. Sensory impairment E. Ineffective use of coping strategies

ANS: A, C, D Rationale: Causes of falls are multifactorial. Both extrinsic factors (e.g., changes in the environment or poor lighting) and intrinsic factors (e.g., physical illness, neurologic changes, or sensory impairment) play a role. Mobility difficulties, medication effects, foot problems or unsafe footwear, postural hypotension, visual problems, and tripping hazards are common, treatable causes. Overdependence on assistive devices and ineffective use of coping strategies have not been shown to be factors in the rate of falls in the older adult population. PTS: 1 REF: p. 187 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Response

3. An occupational health nurse overhears an employee talking to a manager about a 65-year-old coworker. Which phenomenon should the nurse identify when hearing the employee state to the coworker, "You should just retire and make way for some new blood"? A. Intolerance B. Ageism C. Dependence D. Nonspecific prejudice

ANS: B Rationale: Ageism refers to prejudice against the aged. Intolerance is implied by the employee's statement, but the intolerance is aimed at the coworker's age. The employee's statement does not raise concern about dependence. The prejudice exhibited in the statement is very specific. PTS: 1 REF: p. 176 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Caring BLM: Cognitive Level: Analyze NOT: Multiple Choice

12. The admissions department at a local hospital is registering a 78-year-old client for an outpatient diagnostic test. The admissions nurse asks if the client has an advance directive. The client reports not wanting to complete an advance directive because they do not want anyone controlling their finances. What would be appropriate information for the nurse to share with this client? A. "Advance directives are not legal documents, so you have nothing to worry about." B. "Advance directives are limited only to health care instructions and directives." C. "Your finances cannot be managed without an advance directive." D. "Advance directives are implemented when you become incapacitated, when you will use a living will to allow the state to manage your money."

ANS: B Rationale: An advance directive is a formal, legally endorsed document that provides instructions for care (living will) or names a proxy decision maker (durable power of attorney for health care) and covers only issues related specifically to health care. They do not address financial issues. Advance directives are implemented when a client becomes incapacitated, but financial issues are addressed with a durable power of attorney for finances or a living will. PTS: 1 REF: p. 190 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

26. A 55-year-old client is preparing to retire in the next five years. The client has made both financial and social plans to make a successful transition. What are some examples of social change that the client could plan? A. Additional reliance on the spouse and family to fill in leisure time B. Developing routines and friends not associated with work C. Planning several vacations to expand the client's social circle D. Starting an online social network to keep the client connected with co-workers

ANS: B Rationale: Developing routines and friends not associated with work are some health promotion strategies. Other ways to promote successful aging include having an adequate income, and relying on other groups and people, besides the spouse, to spend free time with. PTS: 1 REF: p. 176 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice

7. An 80-year-old client has been admitted to the hospital for hypertension and now requires oxygen. The client asks the nurse why oxygen is needed because they have never smoked and feel fine. The client requires oxygen in the hospital because of which respiratory changes or requirements? A. As a therapeutic measure to encourage coughing and deep breathing B. Diminished respiratory efficiency and declining aerobic capacity C. To increase inspiratory and expiratory force of lungs D. Lung mass increases and residual volume decreases

ANS: B Rationale: Diminished respiratory efficiency and declining aerobic capacity are related to age. Older, healthy adults are usually able to compensate for these changes, but stress from illness may increase the demand for oxygen. Oxygen is a drug and not used to encourage cough and deep breathing. Reduced maximal inspiratory and expiratory force may occur in the lungs due to calcification and weakening of the muscles of the chest wall. Lung mass decreases and residual volume increases as the client ages. PTS: 1 REF: p. 171 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

22. A gerontologic nurse is making an effort to address some of the misconceptions about older adults that exist among health care providers. The nurse has made the point that most people aged 75 years and over remain functionally independent. The nurse should attribute this trend to what factor? A. Early detection of disease and increased advocacy by older adults B. Application of health-promotion and disease-prevention activities C. Changes in the medical treatment of hypertension and hyperlipidemia D. Genetic changes that have resulted in increased resiliency to acute infection

ANS: B Rationale: Even among people 75 years of age and over, most remain functionally independent, and the proportion of older adults with limitations in activities is declining. These declines in limitations reflect recent trends in health-promotion and disease-prevention activities, such as improved nutrition, decreased smoking, increased exercise, and early detection and treatment of risk factors such as hypertension and elevated serum cholesterol levels. This phenomenon is not attributed to genetics, medical treatment, or increased advocacy. PTS: 1 REF: p. 168 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

19. A 59-year-old client has come to the health care provider's office for an annual physical and is being assessed by the office nurse. The nurse who is performing routine health screening for this client should be aware that one of the first physical signs of aging is what? A. Having more frequent aches and pains B. Failing eyesight, especially close vision C. Increasing loss of muscle tone D. Accepting limitations while developing assets

ANS: B Rationale: Failing eyesight, especially close vision, is one of the first signs of aging in middle life. More frequent aches and pains begin in the "early" late years (between ages 65 and 79). Increase in loss of muscle tone occurs in later years (ages 80 and older). Accepting limitations while developing assets is socialization development, which occurs in adulthood. PTS: 1 REF: p. 175 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

29. Gerontologic nursing is a specialty area of nursing that provides care for older adults in our population. Which goal of care should a gerontologic nurse prioritize when working with this population? Helping older adults: A. determine how to reduce their use of external resources. B. use their strengths to optimize independence. C. promote social integration. D. identify the weaknesses that most limit them.

ANS: B Rationale: Gerontologic nursing is provided in acute care, skilled and assisted living, community, and home settings. The goals of care include promoting and maintaining functional status and helping older adults identify and use their strengths to achieve optimal independence. Goals of gerontologic nursing do not include helping older adults "promote social integration" or identify their weaknesses. Optimal independence does not necessarily involve reducing the use of available resources. PTS: 1 REF: p. 168 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

14. The nurse is planning an educational event for the nurses on a subacute medical unit on the topic of normal, age-related physiologic changes. What phenomenon should the nurse address? A. A decrease in cognition, judgment, and memory B. A decrease in muscle mass and bone density C. The disappearance of sexual desire for both men and women D. An increase in sebaceous and sweat gland function in both men and women

ANS: B Rationale: Normal signs of aging include a decrease in the sense of smell, a decrease in muscle mass, a decline but not disappearance of sexual desire, and decreased sebaceous and sweat glands for both men and women. Cognitive changes are usually attributable to pathologic processes, not healthy aging. PTS: 1 REF: p. 174 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

33. The nurse is caring for a 78-year-old client with cardiovascular disease. The client comes to the clinic with a suspected respiratory infection and is diagnosed with pneumonia. What should the nurse recognize about the altered responses of older adults? A. Treatments for older adults need to be more holistic than treatments used in the younger population. B. Increased and closer monitoring of older adults' body systems must occur to identify possible systemic complications. C. The aging process of older adults must define all nursing interventions with the client. D. Older adults become hypersensitive to antibiotic treatments for infectious disease states.

ANS: B Rationale: Older adults may be unable to respond effectively to an acute illness, or, if a chronic health condition is present, they may be unable to sustain appropriate responses over a long period. Furthermore, their ability to respond to definitive treatment is impaired. The altered responses of older adults reinforce the need for nurses to monitor all body system functions closely and be alert to signs of impending systemic complication. Holism should be integrated into all clients' care. Altered responses in the older adult do not define the interactions between the nurse and the client. Older adults do not become hypersensitive to antibiotic treatments for infectious diseases. PTS: 1 REF: p. 188 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

37. When the nurse observes physical indicators of illness in the older population, that nurse should be aware of which of the following principles? A. Potential life-threatening problems in the older adult population are not as serious as they are in a middle-aged population. B. Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults. C. The same physiologic processes that indicate serious health care problems in a younger population indicate mild disease states in older adults. D. Middle-aged people do not react to disease states the same way a younger population does.

ANS: B Rationale: Physical indicators of illness that are useful and reliable in young and middle-aged people cannot be relied on for the diagnosis of potential life-threatening problems in older adults. A potentially life-threatening problem in an older person is more serious than it would be in a middle-aged person because the older adult does not have the physical resources of the middle-aged person. Physical indicators of serious health care problems in a young or middle-aged population do not indicate disease states that are considered "mild" in the older adult population. It is true that middle-aged people do not react to disease states the same as a younger population, but this option does not answer the question. PTS: 1 REF: p. 188 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

25. A 72-year-old client has returned to the community following knee replacement surgery. The client takes nine different medications and has experienced dizziness since discharge. The nurse should identify which nursing diagnosis? A. Risk for infection related to polypharmacy and hypotension B. Risk for falls related to polypharmacy and impaired balance C. Adult failure to thrive related to chronic disease and circulatory disturbance D. Disturbed thought processes related to adverse drug effects and hypotension

ANS: B Rationale: Polypharmacy and loss of balance are major contributors to falls in older adults. This client does not exhibit failure to thrive or disturbed thought processes. There is no evidence of a heightened risk of infection. PTS: 1 REF: p. 179 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

1. The nurse is providing care for an 82-year-old client whose signs and symptoms of Parkinson disease have worsened over the past several months. The client reports no longer being able to do as many things as in the past. Based on this statement, what issue is of most concern to the client? A. Neurologic deficits B. Loss of independence C. Age-related changes D. Tremors and decreased mobility

ANS: B Rationale: This client's statement places a priority on a loss of independence, not specific symptoms. This is undoubtedly a result of the neurologic changes associated with the disease, but this is not the focus of the statement. This is a disease process, not an age-related physiologic change. PTS: 1 REF: p. 168 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

10. The case manager is working with an 84-year-old client newly admitted to a rehabilitation facility. When developing a care plan for this client, which factors should the nurse identify as positive attributes that enhance coping in this age group? Select all that apply. A. Decreased risk taking B. Effective adaptation skills C. Avoiding participation in untested roles D. Increased life experience E. Resilience during change

ANS: B, D, E Rationale: Because changes in life patterns are inevitable over a lifetime, older clients need resilience and coping skills when confronting stresses and change. It is beneficial for older clients to continue to participate in risk taking and new, untested roles, not to avoid them, to help build confidence and develop new skills. PTS: 1 REF: p. 176 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Response

38. The nurse is caring for a 91-year-old client who reports urge incontinence and sometimes falling when trying to get to the bathroom at home. The nurse identifies the nursing diagnosis of Risk for Falls related to impaired mobility and urinary incontinence. This client's risk for falls is considered to be which of the following? A. The result of impaired cognitive functioning B. The accumulation of environmental hazards C. A geriatric syndrome D. An age-related health deficit

ANS: C Rationale: A number of problems commonly experienced by older adults are becoming recognized as geriatric syndromes. These conditions do not fit into discrete disease categories. Examples include frailty, delirium, falls, urinary incontinence, and pressure ulcers. Impaired cognitive functioning, environmental hazards in the home, and an age-related health deficit may all play a part in the episodes in this client's life that led to falls, but they are not diagnoses and are, therefore, incorrect. PTS: 1 REF: p. 187 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

34. The nurse is caring for clients in the urology clinic. A new, 73-year-old client presents with reports of urinary incontinence and is prescribed an anticholinergic. Why might this type of medication be an inappropriate choice in the older adult population? A. Gastrointestinal hypermotility can be an adverse effect of this medication. B. Detrusor instability can be an adverse effect of this medication. C. Confusion can be an adverse effect of this medication. D. Increased symptoms of urge incontinence can be an adverse effect of this medication.

ANS: C Rationale: Although medications such as anticholinergics may decrease some of the symptoms of urge incontinence (detrusor instability), the adverse effects of these medications (dry mouth, slowed gastrointestinal motility, and confusion) may make them inappropriate choices for older adults. PTS: 1 REF: p. 181 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

20. A gerontologic nurse is aware of the demographic changes that affect the provision of health care. Which demographic change has the biggest impact? A. More families are having to provide care for their aging members. B. Adult children find themselves participating in chronic disease management. C. A growing number of people live to a very old age. D. Older adults are having more accidents, increasing the costs of health care.

ANS: C Rationale: As the older population increases, the number of people who live to a very old age is dramatically increasing. The other options are all correct, but none is a factor that is most dramatically increasing in this age group. PTS: 1 REF: p. 167 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

23. After a sudden decline in cognition, a 77-year-old client who has been diagnosed with vascular dementia is receiving care at home. To reduce this client's risk of future infarcts, which action should the nurse most strongly encourage? A. Activity limitation and falls reduction efforts B. Adequate nutrition and fluid intake C. Rigorous control of the client's blood pressure and serum lipid levels D. Use of mobility aids to promote independence

ANS: C Rationale: Because vascular dementia is associated with hypertension and cardiovascular disease, risk factors (e.g., hypercholesterolemia, history of smoking, diabetes) are similar. Prevention and management are also similar. Therefore, measures to decrease blood pressure and lower cholesterol levels may prevent future infarcts. Activity limitation is unnecessary, and infarcts are not prevented by nutrition or the use of mobility aids. PTS: 1 REF: p. 186 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

15. A home health nurse makes a home visit to a 90-year-old client who has cardiovascular disease. During the visit the nurse observes that the client has begun exhibiting subtle and unprecedented signs of confusion and agitation. What should the home health nurse do? A. Increase the frequency of the client's home care. B. Have a family member check in on the client in the evening. C. Arrange for the client to see their primary care provider. D. Refer the client to an adult day program.

ANS: C Rationale: In more than half of the cases, sudden confusion and hallucinations are evident in multi-infarct dementia. This condition is also associated with cardiovascular disease. Having the client's home care increased does not address the problem, neither does having a family member check on the client in the evening. Referring the client to an adult day program may be beneficial to the client, but it does not address the acute problem the client is having. The nurse should arrange for the client to see their primary care provider. PTS: 1 REF: p. 181 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

17. A 54-year-old female client visiting her gynecologist is postmenopausal and reports painful intercourse. What is a physical change that is occurring to the client's reproductive system to account for this problem? A. Thickening of the vaginal wall B. Increased vaginal secretions C. Shortening of the vagina D. Increased pubococcygeal muscle tone

ANS: C Rationale: Ovarian production of estrogen and progesterone decreases with menopause. Changes include thinning of the vaginal wall, decreased vaginal secretions, and decreased pubococcygeal/pelvic floor muscle tone. These changes may cause vaginal bleeding and painful intercourse. PTS: 1 REF: p. 172 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

30. The presence of a gerontologic advanced practice nurse in a long-term care facility has benefited both the clients and the larger community in which they live. Nurses in this advanced practice role have been shown to cause which outcome? A. Greater interaction between younger adults and older adults occurs. B. Older adults recover more quickly from acute illnesses. C. Less deterioration takes place in the overall health of clients. D. Older adults are happier in long-term care facilities than at home.

ANS: C Rationale: The use of advanced practice nurses who have been educated in geriatric nursing concepts has proved to be very effective when dealing with the complex care needs of an older client. When best practices are used and current scientific knowledge applied to clinical problems, significantly less deterioration occurs in the overall health of aging clients. This does not necessarily mean that clients are happier in long-term care than at home, that they recover more quickly from acute illnesses, or greater interaction occurs between younger and older adults. PTS: 1 REF: p. 168 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

32. A 69-year-old client is readmitted with heart failure. The client reports taking all medications as prescribed. The client's grandchild usually helps to set up a weekly organizer pill container but is away at college. What should the nurse first do with this information? A. Call the client's home to solicit another family member to help with the medications on discharge. B. Explain the current inpatient orders and make a note on the chart for discharge C. Contact the client's health care provider (HCP) for assistance and direction on how to proceed. D. Complete a comprehensive assessment reviewing the client's medication history, including over-the-counter medications

ANS: D Rationale: A comprehensive assessment begins with a thorough medication history. This is a nursing intervention and part of the admission process. While a note is appropriate, interventions should start before discharge to ensure medication compliance and safety and to decrease readmission. The client's inpatient orders may change once the medication history is reviewed. Until a medication history is obtained, calling the family isn't appropriate. The nurse may need to contact the HCP regarding the client's medication practices, but this should be done after completing a comprehensive assessment of the client's medication history. PTS: 1 REF: p. 168 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Caring BLM: Cognitive Level: Analyze NOT: Multiple Choice

6. A 65-year-old client has come to the clinic for a yearly physical. The client reports enjoying good health, but also reports having occasional episodes of constipation over the past 6 months. What intervention should the nurse first suggest? A. Reduce the amount of stress the client currently experiences. B. Increase carbohydrate intake and reduce protein intake. C. Take herbal laxatives, such as senna, each night at bedtime. D. Increase daily intake of water.

ANS: D Rationale: Constipation is a common problem in older adults, and increasing fluid intake is an appropriate early intervention. This should likely be attempted prior to recommending senna or other laxatives. Stress reduction is unlikely to wholly resolve the problem, and there is no need to increase carbohydrate intake and reduce protein intake. PTS: 1 REF: p. 173 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

27. The nurse is caring for a 77-year-old client who was recently admitted to the geriatric medical unit. Since admission, the client has spoken frequently of becoming a burden to their children and the challenge of "staying afloat" financially. When planning this client's care, the nurse should recognize a heightened risk of what nursing diagnosis? A. Disturbed thought processes B. Impaired social interaction C. Decisional conflict D. Anxiety

ANS: D Rationale: Economic concerns and fear of becoming a burden to families often lead to high anxiety in older adults. There is no clear indication that the client has disturbed thought processes, impaired social interaction, or decisional conflict. PTS: 1 REF: p. 185 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

16. The home health nurse is making an initial home visit to a 71-year-old client who is widowed. The client reports having begun taking some herbal remedies. Which should the nurse be sure to include in the client's education? A. Herbal remedies are consistent with holistic health care. B. Herbal remedies are often cheaper than prescribed medication. C. It is safest to avoid the use of herbal remedies. D. There is a need to inform the primary care provider and pharmacist about the herbal remedies.

ANS: D Rationale: Herbal remedies combined with prescribed medications can lead to interactions that may be toxic. Clients should notify the health care provider and pharmacist of any herbal remedies they are using. Even though herbal remedies are considered holistic, this is not something that is necessary to include in the client's teaching. Herbal remedies may be cheaper than prescribed medicine, but this is still not something that is necessary to include in the client's teaching. For most people, it is not necessary to wholly avoid herbal remedies. PTS: 1 REF: p. 180 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

24. Nurses and members of other health disciplines at a state's public health division are planning programs for the next 5 years. The group has made the decision to focus on diseases that are experiencing the sharpest increases in their contributions to the overall death rate in the state. This team should plan health promotion and disease prevention activities to address what health problem? A. Stroke B. Cancer C. Respiratory infections D. Alzheimer disease

ANS: D Rationale: In the past 60 years, overall deaths, and specifically, deaths from heart disease, have declined. Recently, deaths from cancer and cerebrovascular disease have declined. However, deaths from Alzheimer disease among those 65 years and older have risen, and are projected to be approximately 1.6 million annually by 2050. PTS: 1 REF: p. 182 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

31. A gerontologic nurse is basing the therapeutic programs at a long-term care facility on Miller's Functional Consequences Theory. To put this theory into practice, the nurse should prioritize which task? A. Attempting to control age-related physiologic changes B. Lowering expectations for recovery from acute and chronic illnesses C. Helping older adults accept the inevitability of death D. Differentiating between age-related changes and modifiable risk factors

ANS: D Rationale: The Functional Consequences Theory requires the nurse to differentiate between normal, irreversible age-related changes and modifiable risk factors. This theory does not emphasize lowering expectations, controlling age-related changes, or helping adults accept the inevitability of death. PTS: 1 REF: p. 168 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

13. A nurse is planning discharge education for an 81-year-old client with mild short-term memory loss. The discharge education will include how to perform basic wound care for the venous ulcer on the client's lower leg. When planning the necessary health education for this client, the nurse should take which action? A. Set long-term goals with the client. B. Provide a list of useful websites to supplement learning. C. Keep visual cues to a minimum to enhance the client's focus. D. Keep teaching periods short.

ANS: D Rationale: To assist the older adult client with short-term memory loss, the nurse should keep teaching periods short, provide glare-free lighting, link new information with familiar information, use visual and auditory cues, and set short-term goals with the client. The client may or may not be open to the use of online resources. PTS: 1 REF: p. 179 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

18. A 62-year-old woman started experiencing urinary incontinence six months ago and now wears disposable incontinent panties. The client does not drink any fluids after 5 pm and considers this problem part of aging. What priority modifications and advice should be given to this client? A. "While urinary incontinence is part of the aging process, you should still see your health care provider (HCP) about this condition." B. "You probably have a urinary tract infection and should start drinking cranberry juice." C. "You could purchase pads to place into washable panties. This would decrease costs and feel less like a diaper." D. "Urinary incontinence is not part of the aging process. You should see your HCP and increase your water intake."

ANS: D Rationale: Urinary incontinence affects more women than men under the age of 80. It is not a normal condition due to aging. While embarrassing, the focus should not be on living with it by wearing disposable panties but getting evaluated by a HCP. Adequate consumption of fluids decreases the likelihood of bladder infection. PTS: 1 REF: p. 172 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 8: Care of the Older Adult KEY: Integrated Process: Caring BLM: Cognitive Level: Analyze NOT: Multiple Choice