Gerontology Final

The home health nurse is caring for a patient who has cancer and is using a fentanyl transdermal patch for pain control. Which of the following action should the nurse take when caring for this patient?

Avoid using a heating pad on the area with the patch. Applying heat over the site of the transdermal patch will increase the rate of absorption of the opioid medication and might cause respiratory depression.

The nurse is reviewing the medical record of an older adult patient. Which of the following medications should the nurse to conduct a hearing assessment of the patient?

Furosemide Furosemide can cause ototoxicity, especially in the older adult client, because there is a decrease in medication metabolism in the kidneys. The nurse should monitor clients taking ototoxic medications, such as furosemide, and teach the client the signs and symptoms of ototoxicity, such as tinnitus and difficulty hearing.

A nurse is conducting an in-service for a group of assistive personnel about the basic needs of older adult patients. Following statements should the nurse include in the teaching?

"Deep sleep is decreased." The sleep architecture, or time spent in various stages of sleep, changes with aging. The older adult spends less time in stages III and IV, which are the stages of deep sleep. This decrease in time spent in deep sleep can delay healing.

I nurse is performing an assessment on an older adult patient who has chronic pain. Which of the following affects of unrelieved pain should the nurse identify as a priority finding to report?

Impaired mobility The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one positing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. The nurse should identify that limited mobility will have an effect on the client's skin integrity, respiratory function, and elimination. Complications of the immobility resulting from unrelieved pain include pressure ulcers, pneumonia, and constipation.

And nurses caring for an older adult patient who is having a stroke. After assessing airway, breathing, and circulation, which of the following assessments is the nurses priority?

Level of consciousness The nurse should apply the urgent versus nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs to be the priority need because they pose more of a threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The nurse should assess the client's level of consciousness to evaluate for increases in intracranial pressure that might have occurred. The nurse should use the NIH stroke scale or the Glasgow coma scale to evaluate level of consciousness.

what finding should the nurse identify as a benign, age-related skin change commonly seen in older adult patients?

Liver spots Liver spots, also known as age spots or lentigines, are flat, brownish-black macules that usually occur in sun-exposed areas of the body. Aging and exposure to sunlight, or other forms of ultraviolet light, can result in increased pigmentation. Liver spots are extremely common after 40 years of age; they occur most often on the forearms, shoulders, face, forehead, and backs of the hands, which are also the areas of highest sun exposure. They are harmless and painless, but they can affect the client's cosmetic appearance.

The nurse is transferring an older adult patient who has right-sided weakness from the bed to wheelchair. Which of the following actions should the nurse take to provide a safe transfer?

Maintain a straight back and bend at the knees. The nurse should maintain a straight back and bend at the hips and knees when transferring a client in order to allow the larger muscles of the thighs to do the lifting. Good body mechanics are essential in preventing injury to the nurse.

A nurse working in a community health center is completing an assessment of an older adult female patient. Which of the following findings should the nurse identify as a priority?

Rales heard in the bases of the lungs The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning - having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life, and is therefore, the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority-setting framework because adequate ventilator effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority-setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable to efficiently carrying oxygen to them. Air moving into collapsed airways results in rales and can occur in clients who have bronchitis, pneumonia, or chronic pulmonary disease. This finding is the priority and requires further assessment.

And yours is assessing an older adult patient has right-sided heart failure. Which of the following findings is the nurses priority?

Weight has increased 0.91 kg (2 lb) in 24 hr. The nurse should apply the urgent versus nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs to be the priority need because they pose more of a threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The nurse should evaluate daily weight of client's experiencing heart failure. A weight gain of 0.45 to 0.91 kg (1 to 2 lb) overnight or 1.36 kg (3 lb) within one week is an indication of worsening heart failure.

A nurse teaching an older adult patient about osteoporosis. Which of the following statements to the nurse include in the teaching?

"Brisk walking will help prevent bone loss." The nurse should encourage weight-bearing exercises to help minimize bone loss in the older adult client. A sedentary lifestyle, on the other hand, leads to a loss of minerals in the bones, especially calcium and phosphorus.

I nurse is providing teaching to a patient who is to start taking alendronate sodium which of the following recommendations should the nurse include in the teaching?

"Discontinue the medication if you develop heartburn." The nurse should instruct the client to stop taking the medication if she develops heartburn or if it worsens and to contact her provider. This is an indication that esophageal irritation has occurred. Ways to avoid this are to take alendronate with 240 mL (8 oz) of water and to avoid lying down for 30 to 60 min after taking the medication.

A nurse is caring for an older adult patient who reports that he has just retired and express his feelings of loneliness due to loss of daily interactions with coworkers. Which of the following responses should the nurse make?

"Do you know about the local senior citizen group?" The nurse should assist the client in the resocialization process by using the therapeutic communication technique of giving information. Becoming involved in an organization might assist the client in resocialization, which is beneficial to clients who have depended upon their employment for social interaction.

A nurse is teaching an older adult patient about methods to improve sleep. Which of the following statements should the nurse include in the teaching?

"Go to bed at the same time every night." The nurse should recommend that the client keep consistent sleep and wake times, even on the weekends. Having a regular sleep schedule will help minimize the alterations to the circadian rhythm that occurs in the older adult client.

A nurse at a long-term care facility is teaching an older adult patient about ambulating with a quad-cane. Which of the following statements should the nurse include in the teaching?

"Hold the cane in the hand on the stronger side of your body." The client should hold the cane with the hand on the stronger side of her body so that she can move the cane to support the weaker leg. This action allows for a more normal gait, with the ipsilateral arm and weaker leg moving at the same time.

a nurse is teaching a patient who has chronic obstructive pulmonary disease and has been losing weight about ways to improve his nutritional intake. what statement by the patient indicates an understanding of the teaching?

"I should add grated cheese to sauces and vegetables." The nurse should reinforce that adding cheese to side dishes will increase the protein and calcium intake as well as increase calories. This will assist the client in regaining weight and stamina.

a nurse is providing teaching to a patient who is to start taking finasteride. what statement by the patient indicates an understanding of the teaching?

"I should see a decrease in my PSA levels." The nurse should emphasize that the decrease in PSA levels with this medication will be measured 6 months after starting treatment. The expected decline is 30% to 50% in the PSA level.

The nurse is teaching an older adult patient who is healthy and has chronic constipation about establishing a bowel retraining program. Which of the following statements to the nurse include in the teaching?

"Increase the fiber content of your diet." The purpose of a bowel training program is to manipulate factors within the client's control to produce the elimination of a soft-formed stool at regular intervals. The increase of fiber in the client's diet will help to increase the effectiveness of a bowel training program.

A nurse is admitting an older adult patient who has urinary incontinence and smells strongly of urine. The patient's partner, Who has been caring for her at home, states that he is sorry and embarrassed about the unpleasant smell. Which is the following responses should the nurse make?

"It must be difficult to care for someone who has incontinence." The nurse should use therapeutic responses such as acknowledgement and empathy when addressing the client's partner. This response is nonjudgmental and acknowledges the effort the client's partner has made. The use of therapeutic communication also encourages further discussion and provides the nurse with an opportunity to teach and to evaluate the need for assistance in the home.

what dietary recommendation should the nurse include in the teaching to a group of older adults patients?

"You should consume 1,200 milligrams of calcium daily." The nurse should encourage the older adult client to increase dietary calcium intake to 1,200 mg daily in divided doses. Good sources of dietary calcium include dairy products, green leafy vegetables, beans, and tofu.

A nurse in an assisted living facility is assisting in the care of an older adult client who moved in 3 months ago following the death of his partner. The client reports awakening in the morning and admits to feeling very sad. The nurse should identify then the client is experiencing which of the following types of grief.

Acute Grief The client experiencing acute grief will have both somatic and psychological manifestations of distress, such as the inability to sleep well or profound sadness. The nurse should identify that this client is experiencing acute grief and further assess his support system, concurrent stressors in his life, and his ability to manage stress.

A public health nurse is planning an immunization clinic for older adults. I would to the following times should an older adult patient receiving influenza vaccine?

Annually in the fall The nurse should recommend that older adult clients receive the influenza vaccine annually. Influenza outbreaks occur annually, and the influenza virus changes constantly. Consequently, an influenza vaccine from a previous year will not protect a client exposed to this year's influenza strain. Influenza in older adults can result in the development of primary viral influenza pneumonia, which causes several deaths a year. An influenza vaccine given in the fall, prior to the onset of flu season, will be most effective in preventing influenza in this target population.

A nurse is collecting data afrom an older adult client who reports feeling anxious about financial concerns and having difficulty sleeping for several months. Which of the following actions should the nurse take?

Anxiety can cause disturbed sleep patterns. The sleep patterns of older adults are different from those of young adults. However, anxiety and emotional stress can result in sleep disturbances in people of all ages. The nurse should further assess the client's sleep problems and anxiety.

A nurse is completing medication reconciliation for an older adult patient who is receiving multiple medications. Which of the following actions should the nurse take first?

Ask the client about over-the-counter medications she is taking. The nurse should apply the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, she must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision. When performing medication reconciliation, it is important that the nurse collect a list of all the medications the client takes in order to compare the full list of medications against any new medications the client will take. The list should include prescriptions, over-the-counter medications, and herbal and nutritional supplements.

A nurse is at a long term care facility and is planning care for a patient with Alzheimers and wanders at night. Which of the following interventions should the nurse include in the plan?

Assign the client to a room closer to the nurse's station. The nurse should place the client who wanders in a room that allows for close observation. The nurse should provide clients who wander a safe place to walk and supervision when the client is ambulating.

what Kubler-Ross stages of grief should the nurse identify the patient is experiencing when a patient with a terminal illness states, "I just want to live one more month so I can see my grandchild get married."

Bargaining Bargaining is the third stage of grief, according to Kübler-Ross. Bargaining represents a last effort at overcoming death by earning longer life. Trying to put off death for one last major celebration in the client's life, like the marriage of a grandchild, is a form of bargaining.

A nurse is reinforcing teaching with a group of healthy, older adult clients about age related changes and sexual response. Which of the following changes should the nurse include as an age related change?

Decreased vaginal lubrication The nurse should inform the clients that a decrease in vaginal secretions is an expected age-related change in older adult female clients. Vaginal dryness might result in painful intercourse, which clients can manage with the use of water-soluble lubricants during intercourse.

A nurse is collecting data from an older adult client who lives alone. Although the client is able to answer all questions appropriately, the nurse notes that the client has a decreased attentions span, expresses feelings of overwhelming sadness, and has low energy level. The nurse should identify that the client is exhibiting manifestations of which of the following disorders?

Depression The client who has an inability to sleep or complete ADLs is exhibiting manifestations of depression. Depression involves a cluster of manifestations that include changes in sleep habits, appetite, and relationships with others. Clients who have depression might have a decreased ability to make decisions or concentrate and, in some cases, complete ADLs. Anhedonia, the inability to feel happy, is another manifestation of depression.

A nurse is assessing an 85-year-old patient. Which of the following findings should the nurse report to the provider?

Differences in pulse strength between lower extremities A difference in pulse strength can indicate a vascular complication. Assessment of the peripheral vascular system should also include temperature, color, sensation, edema, and skin integrity of both the upper and lower extremities. The nurse should identify any differences in symmetry of these findings and report them.

A community health nurse is visiting home of an older adult patient and her caregiver. The patient has excoriations to her wrists and ankles. Which of the following actions should the nurse take first?

Interview the client in private. The nurse should apply the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds upon the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, she must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision. The nurse should interview the client in private to gain information about possible abuse because the client might be reluctant to talk with the caregiver present.

A nurse is caring for a patient who is using a continuous passive motion device following a right total knee replacement. Which of the following action should the nurse take when applying the CPM device?

Line up the frame joints of the CPM device with the client's knee. MY ANSWER To avoid damage to the operative knee, the nurse should line up the joints of the CPM machine with the client's operative knee.

A nurse is caring for an older adult client who is expressing feelings of grief and longing for his earlier life. Which of the following actions should the nurse take?

Listen attentively and allow the client to talk about the past. The nurse should encourage the client to reminisce as a means of dealing with his feelings of grief and longing. This is the therapeutic technique of offering self. Listening to the client allows for venting of the client's feelings about the loss of a healthy, active life. According to Erikson's theory, reminiscence is a necessary activity for older adults, who are in the stage of integrity vs despair.

A nurse is reviewing the records of a group of older adults. Which of the following findings should the nurse identify as an unexpected manifestation of the aging process

Obesity The nurse should recognize that, although obesity is found among a large percentage of the older adult population, this is an unexpected finding and can lead to cardiovascular disease, diabetes, and stroke.

A nurse is caring for an older adult client who has a hip fracture and is rating her pain at 8 on a 0 to 10 scale. Which of the following medications should the nurse adminster?

Oxycodone/acetaminophen 7.5/325 tablet PO A client who rates his pain as 8 on a scale of 0 to 10 is experiencing severe pain, and the nurse should administer an opioid for this type of pain. Oxycodone/acetaminophen is a combination of an opioid and a nonopioid analgesic medication and is an appropriate medication to administer to the client. The nurse should monitor the client for adverse effects, such as respiratory depression, and proactively address constipation that occurs with opioid use.

a nurse is caring for a patient who ahs aphasia following a stroke. what action should the nurse take?

Present one idea in a sentence. The nurse should present one idea or thought in a sentence to avoid creating frustration for the client. Additionally, the nurse should allow time for the client to process and respond to the nurse.

A nurse is managing an adult daycare as developing treatment plans for older adult patients. Which of the following therapeutic strategies should the nurse use to help the patient achieved Ericksons developmental task of this age group?

Reminiscence therapy The nurse should incorporate reminiscence therapy as a therapeutic strategy for the purpose of encouraging clients to engage in life review. The process of sharing memories helps clients to achieve a sense of fulfillment and self-worth and allows a positive outcome to Erikson's developmental task of integrity vs despair.

a nurse is caring for an older adult patient who has moderate hearing loss which of the following actions should the nurse take to enhance communication?

Speak at a moderate rate. The nurse should slow the rate of speech for an older adult client who has hearing loss. However, the nurse should not speak with an exaggerated slowness because this can distort words and make it difficult for the client to understand.

A nurse is caring for an older adult patient who is on bed rest. Which of the following foods should the nurse plan to include on the patient breakfast tray to prevent constipation?

Stewed prunes The nurse should include foods that are high in dietary fiber, such as stewed prunes, to help prevent constipation for the client who is on bed rest.

a nurse is teaching an older adult patient about ambulation with a standard walker. what action by the patient indicates an understand of the teaching?

The client moves the walker ahead about 15.24 cm (6 in) and then steps into the walker. The correct technique for using a walker is to balance on both feet; lift the walker and place it in front; walk into the walker, using it for support when standing on the affected limb; and then balance on both feet before repeating the sequence. This provides maximum support for the client.

A nurse is caring for an older adult client who is unresponsive following a stroke. Which of the following actions should the nurse take while providing mouth care.

Turn the client on his side before starting oral care. The nurse should place the client in a lateral position to allow excess fluids to run out of his mouth into a basin, which reduces the risk of aspiration of fluids and secretions.

a nurse at a long-term care facility is planning care for an older adult patient who has dementia. which of the following interventions should the nurse include in the plan?

Use photographs as memory triggers. The nurse should place photographs on the unit that trigger the client's memories, such as a picture of a toilet at the entrance to the bathroom, or a picture of the client as a young adult at the entrance to her room.