Health Care of the Older Adult
A hospitalized older adult complains of increased coughing and shortness of breath. The nurse assesses the vital signs as temperature 100.2°F oral, respirations 18, pulse 88, and BP 128/80. What action should the nurse do next? (a) Assess lung sounds and sputum. (b) Notify the physician. (c) Administer cough medicine as needed (PRN). (d) Instruct patient to use incentive spirometer.
a--The older adult's immune system is not as effective, so the older adult may not show typical signs and symptoms of infection. The nurse should assess the lung sounds and sputum for signs and symptoms of infection.
Which neurotransmitter is implicated in depression? (a) Atropine (b) Serotonin (c) Acetylcholine (d) Epinephrine
b
The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The client continuously yells, "It's 1999 and you are going to hurt me!" What action should the nurse do first? (a) Reorient the patient. (b) Take the vital signs. (c) Notify the physician. (d) Assess for infection.
a--after reorientation, you would take VS
Which is a factor that contributes to urinary incontinence in older female adults? (a) Decreased urinary residual (b) Increased bladder capacity (c) Relaxed perineal muscle (d) Detrusor stability
c
A client with Alzheimer's disease is being admitted to the hospital for malnutrition and dehydration. What is the rationale for the nurse to place the client closer to the nurses' station? (a) encouragement of eating (b) change of positions (c) monitor for acquiescent behavior (d) limit wandering
d
The reason that governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement? (a) Clients are unable to make any health care decision. (b) Clients lack capacity because of cognitive impairment. (c) Clients lack different perspectives. (d) Older adult clients are vulnerable.
d
A nurse is caring for an elderly adult client admitted to the hospital from a nursing home because of a change in behavior. The client has a diagnosis of Alzheimer's disease and has started to experience episodes of incontinence. The hospital staff is having difficulty with toileting because the client wanders around the unit all day. To assist with elimination, a nurse should: (a) incorporate the client's toileting schedule into the pattern of his wandering. (b) ask the physician to order sedation to allow the client to rest. (c) ask the physician to order restraints to prevent wandering. (d) have the client wear two briefs at a time to ensure absorption of incontinent urine.
a
The nurse is working in a long-term care facility. When assessing her patients, what body system dysfunction should the nurse look for as the leading cause of morbidity and mortality in the older adult population? (a) Cardiovascular (b) Genitourinary (c) Gastrointestinal (d) Respiratory
a
Which characteristic distinguishes normal aging from pathological changes associated with aging? (a) Universality (b) Confidentiality (c) Morality (d)Spirituality
a
When assessing an older adult's gastrointestinal system, the nurse would identify an increase in which of the following as normal? (a) Feeling of fullness (b) Gastric motility (c) Stomach emptying (d) Calcium absorption
a--In an older adult, gastric motility slows modestly, which results in delayed stomach emptying, which in turn leads to early satiety (feeling of fullness). Calcium absorption is also decreased.
Which is an age-related change associated with the nervous system? (a) Cerebral hypertrophy (b) Postural hypotension (c) Increased cerebral function (d) Increased nerve impulse conduction
b--Postural hypotension, cerebral atrophy, decreased cerebral function, and decreased nerve impulse conduction are age-related changes associated with the nervous system.
A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching? (a) A decline in sexual activity is a normal occurrence as you age. (b) Most older adults reside in a long-term care facility. (c) As an older adult, you will not be able to learn new skills or knowledge. (d) How old you feel will be determined by your physical and cognitive abilities.
d
An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to (a) Ingest five or six small meals each day. (b) Minimize the use of stool softeners. (c) Use whirlpool baths for relaxation. (d) Take daily hot showers.
a--A client who experiences orthostatic hypotension should eat five or six small meals to minimize hypotension that can occur after large meals. The client should avoid straining when having a bowel movement. A stool softener would be useful. Hot showers and whirlpools should be avoided.
Which factor alters urinary elimination patterns in older adults? (a) Decreased residual volume (b) Increased bladder capacity (c) Decreased muscle tone (d) Active lifestyle
c--Older adults typically have decreased muscle tone related to urinary elimination. Increased residual volume, decreased bladder capacity, and sedentary lifestyle are other factors that alter urinary elimination patterns in the older adult.
An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of (a) Degeneration in the efficiency of bone joints (b) The client's failure to exercise (c) Loss of bone density (d) Decreased muscle mass and joint cartilage
c--Elderly clients experience decreased bone density; they also may experience a loss of bone density from insufficient exercise. For this client, however, additional information indicates that she is taking prednisone, which may induce osteoporosis (loss of bone density)
Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to which condition after a rib fracture? (a) Confusion (b) Asthma attacks (c) Bronchospasm (d) Pneumonia
d
A nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply. (a) Providing a calm, quiet environment (b) Supervising nutritional intake (c) Using familiar cues about the environment (d) Administering psychoactive drugs (e) Keeping the patient awake as much as possible
a,b,c--Appropriate interventions when caring for a patient with delirium include maintaining a calm, quiet environment, supervising and monitoring nutritional and fluid intake, and using familiar environmental cues. Psychoactive drugs should be minimized to reduce the possibility of delirium. Keeping the patient awake as much as possible would lead to sleep deprivation, which would increase the patient's risk for delirium.
A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds: (a) "What precipitates the outbursts?" (b) "You need to remain calm during the outbursts." (c) "Play quiet music that your grandmother may like." (d) "Start rubbing her shoulders and her back."
a--A client with Alzheimer's disease may respond to exciting or confusing events with a catastrophic reaction, such as screaming, crying, or becoming abusive. The nurse needs to assess the situation and what precipitates the catastrophic reactions to best address how to prevent these events. Other nursing interventions include telling the client's granddaughter to remain calm and to distract the grandmother with quiet music, stroking, or both.
A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? (a) Decreased acetylcholine level (b) Increased acetylcholine level (c) Increased norepinephrine level (d) Decreased norepinephrine level
a--A decreased acetylcholine level has been implicated as a cause of cognitive changes in healthy elderly clients and in the severity of dementia. Choline acetyltransferase, an enzyme necessary for acetylcholine synthesis, has been found to be deficient in clients with dementia.
The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse? (a) Assess the need for pneumococcal and influenza vaccinations. (b) Administer intravenous morphine for report of postoperative pain. (c) Instruct the client to receive at least 1 hour of sun exposure each day. (d) Encourage physical activity of 30 minutes following breakfast daily.
a--Activities that help elderly people maintain respiratory function include pneumococcal and yearly influenza immunizations. The nurse is to ensure the safety of the client. It is unsafe to administer an intravenous pain medication and then immediately discharge the client. Elderly clients should limit sun exposure to 10 to 15 minutes daily, and avoid heavy activity after eating to prevent indigestion.
An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to (a) Instruct the family to remove the toddler from the room for the protection of the client. (b) Ask the family to leave the client's room. (c) Inform the family to either wash their hands or use the hand sanitizer. (d) Allow the toddler to remain in the room if a family member wipes the toddler's nose.
a--Elderly clients, particularly those who may be immunocompromised, need to avoid exposure to those who may have upper respiratory tract infections. The toddler needs to be removed from the client's room, not the whole family. It is appropriate for the family to wash their hands or use the hand sanitizer. However, it does not address the runny nose of the toddler, and it is not the most important action of the nurse.
Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? (a) Presbyopia (b) Presbycusis (c) Cataract (d) Glaucoma
a--Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. Presbycusis refers to age-related hearing loss. Cataract is the development of opacity of the eye lens. Glaucoma is a disease characterized by increased intraocular pressure.
A client at an extended-care facilty who has Alzheimer's disease is awake throughout the night. The nurse intervenes with activities that will promote sleep at night, which include (a) Walking the client in the facility yard during the day (b) Allowing the client to take a 2-hour nap in the afternoon (c) Providing a glass of warm milk for breakfast (d) Having the client sit at the nurse's station during night-time hours
a--Regular exercise during the day will enhance sleep at night for clients with Alzheimer's disease. Another activity that helps for interrupted sleep, inability to fall asleep, or both is drinking warm milk at night. The nurse should discourage excessive sleep during the day. Sitting at the nurse's station may be too stimulating at night-time hours.
A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by (a) Placing one food at a time in front of the client during meals (b) Cutting the client's food into small pieces (c) Serving hot foods at a warm temperature (d) Converting liquid foods to a gelatin texture
a--Tasks should be simplified for the client with Alzheimer's disease. All options are steps the nurse can take to promote eating for the client with Alzheimer's disease. Offering one food at a time, however, helps to prevent the client from playing with food.
The nurse identifies which of the following as an age-related change in the respiratory system? (a) Increased residual lung volume (b) Increased vital capacity (c) Increased diffusion capacity (d) Increased cough efficiency
a--The older adult experiences an increase in residual lung volume, decreased vital capacity, decreased diffusing capacity, and decreased cough efficiency.
An older adult female client tells the nurse, "I have lost an inch [2.5 cm] of height and have a hump on my back. What can I do about this?" What is the best response by the nurse? (a) "In order to prevent further bone loss, eat a diet high in calcium and low in phosphorus." (b) "In order to prevent further bone loss, eat a diet high in magnesium and high in phosphorus." (c) "You can reverse the shape of your spine with surgical intervention." (d) "Supplement your diet with a multivitamin."
a--To promote musculoskeletal health, the nurse should tell the client to do the following: exercise regularly; eat a high-calcium diet; limit phosphorus intake; and take calcium and vitamin D supplements as prescribed.
Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse? (a) BMI 24; "My family never gives me my favorite foods." (b) Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore." (c) Diabetic with fasting blood sugar 92; "It is difficult to afford food with all of these medication costs." (d) Obvious deformity to right arm; "I tripped on the rug and fell on my arm."
b
Which actions by the nurse will assist in promoting an older adult's adherence to medication therapy? Select all that apply. (a) Educate the client to keep all medications and bottles for future reference. (b) Encourage the client to keep a list of medications and review it frequently for updates. (c) Use easy-to-open lids. (d) Instruct the client not to take herbal supplements. (e) Provide a written medication schedule. (f) Encourage the patient to use multiple pharmacies to obtain cheapest prices.
b,c,e
A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to (a) Encourage the mother to take responsibility for cooking and cleaning the house. (b) Ensure that the mother does not have access to car keys or drive an automobile. (c) Allow the mother to smoke cigarettes outside on the porch without supervision. (d) Turn off lights at night so that the mother differentiates night and day.
b--A person with Alzheimer's disease needs to be provided with a safe environment. Driving is prohibited. Cooking and cleaning may be too much stimulation and place the client in danger. Daily activities must be simplified, short, and achievable. Smoking is allowed only with supervision. The person needs adequate lighting, and nightlights are helpful, particularly if the person has increased confusion at night.
Which is an age-related change in the respiratory system? (a) Increased blood pressure (b) Decreased gas exchange (c) Loss of muscle strength and size (d) Difficulty swallowing
b--Age-related changes associated with the respiratory system include decreased gas exchange and diffusing capacity; decreased muscle strength, endurance, and vital capacity; and decreased cough efficiency. Age-related changes associated with the cardiovascular system include increased blood pressure. Changes that occur in the musculoskeletal system include loss of muscle strength and size. Difficulty swallowing occurs as an age-related change associated with the gastrointestinal system.
A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate? (a) "Dementia is a terrible disease of the elderly." (b) "The most common cause of dementia in the elderly is Alzheimer's disease." (c) "Drug interactions are the most common cause of dementia in the elderly." (d) "Depression may manifest as dementia in elderly clients."
b--Although drug interactions and overmedication are causes of dementia, these causes aren't as common as Alzheimer's disease
A nurse is obtaining the health history of a 72-year-old woman who has come to the ambulatory care center for an evaluation. When obtaining information about the woman's sleep patterns, which of the following would the nurse expect to assess? (a) Reports that she falls asleep more quickly (b) Complaints about frequently waking up during the night (c) Reports that she has trouble waking up from sleeping (d) Statements that she rarely takes naps during the day
b--Older adults tend to take longer to fall asleep, awaken more frequently and easily, and spend less time in deep sleep. They may experience variations in their normal sleep-wake cycles. Coupled with the lack fo quality of sleep at night, napping during the day is a common complaint.
A nursing instructor is preparing a class about age-related changes in the cardiovascular system that occur in the older adult. Which of the following would the instructor most likely include? (a) Thinning of the heart valves (b) Increased blood pressure (c) Atophy of the heart muscle (d) Decreased arterial resistance
b--age-related changes in the cardiovascular system include thickening of the heart valves, increased blood pressure, hypertrophy of the heart muscle, and increased arterial resistance.
A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate? (a) Continue taking the vital signs. (b) Place the client in a secluded room until calm. (c) Distract the client with a familiar object or music. (d) Document the inability to assess vital signs due to client's agitation.
c
A client with Alzheimer's disease is admitted for hip surgery after falling and fracturing the right hip. The client's spouse tells the nurse about feeling guilty for letting the accident happen and reports not sleeping well lately because the spouse has been getting up at night and doing odd things. Which nursing diagnosis is most appropriate for the client's spouse? (a) Relocation stress syndrome related to hospitalization (b) Defensive coping related to diagnosis of Alzheimer's disease (c) Risk for caregiver role strain related to increased client care needs (d) Decisional conflict related to lack of relevant treatment information
c
A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include? (a) "This drug will help to stop the disease from getting worse." (b) "Once it becomes effective, you can stop the drug." (c) "The drug helps to control the symptoms of the disease." (d) "The client need to take this drug for the rest of his or her life."
c
Which is a true statement regarding pharmacologic aspects of aging? (a) Elderly have a decreased percentage of body fat. (b) Potential for drug-drug reactions decreases with the number of drugs prescribed. (c) Absorption may be affected by changes in gastric pH. (d) Aged population tends to be compliant with their medication regimen.
c
A nurse is teaching nursing assistants in an extended-care facility measures to protect the skin of elderly clients. Which of the following measures is the nurse likely to recommend? (a) Taking the clients outside for sun exposure daily (b) Assisting clients to soak in the bathtub several times each week (c) Encouraging clients to avoid cigarette smoking (d) Instructing clients to use perfumed skin creams
c--Measures to promote healthy skin function in elderly clients include not smoking. Other measures include avoiding exposure to the sun, using emollient skin cream containing petrolatum or mineral oil, and avoiding hot soaks in the bathtub.
An elderly client reports that he feels like he voids frequently during the day and at night but cannot empty his bladder. The nurse instructs the client to (a) Decrease fluid intake. (b) Hold his urine as long as possible before voiding. (c) Limit ingestion of caffeinated beverages. (d) Drink no more than his current 2 to 3 ounces of alcohol each day.
c--Symptoms that the client describes may be indicative of benign prostatic hypertrophy. The client should limit caffeinated beverages. He does not want to decrease fluid intake; doing so may increase his susceptibility to urinary tract infections. He needs to void frequently and not wait long periods between voiding. The client also should limit his alcohol intake, preferably decreasing it.
An older adult develops sudden onset of confusion and is hospitalized. The family expresses concern that their loved one is developing Alzheimer disease. What response by the nurse is most appropriate? (a) "What concerns you most about Alzheimer disease?" (b) "Alzheimer disease can be a great burden on the family. What community resources do you know about?" (c) "Once the underlying cause of the confusion is found and treated, your loved one will be better than ever." (d) "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion."
d--Delirium is associated with a sudden onset of confusion, not Alzheimer disease. The family needs to be told the correct information, which is that several underlying conditions could be causing the confusion.
The plan of care for a patient with advanced Alzheimer's disease includes the nursing diagnosis of risk for injury. The nurse has identified this nursing diagnosis most likely as related to which of the following? (a) Communication difficulties (b) Separation from others (c) Personality changes (d) Impaired memory
d--Patients with Alzheimer's disease are at high risk for injury because they have impaired memory and poor judgment. They also exhibit impulsivity, which increases their risk. Maintaining a safe environment takes top priority. Communication difficulties could be the basis for several nursing diagnoses such as impaired verbal communication, powerlessness, and impaired social interaction.
