Hinkle Ch 8: Management of the Older Adult Patient

A nurse is educating teenagers on ageism. Which statement by the nurse is appropriate? - "Ageism is the bias against older people based solely on chronological age." - "Ageism is the fear of being in the same room as older adults." - "Ageism is the fear of memory loss." - "Ageism is the fear of growing old."

- "Ageism is the bias against older people based solely on chronological age." Explanation: Individuals demonstrating ageism base their beliefs and attitudes about older people on chronological age without consideration of functional capacity. Fear of aging and the inability of many to confront their own aging process may trigger ageist beliefs. Ageism is not the fear of being in the same room as older adults, fear of memory loss, or the fear of growing old.

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? - "Dementia is a terrible disease of the elderly." - "The most common cause of dementia in the elderly is Alzheimer's disease." - "Drug interactions are the most common cause of dementia in the elderly." - "Depression may manifest as dementia in elderly clients."

- "The most common cause of dementia in the elderly is Alzheimer's disease." Explanation: The nurse should inform the family member that Alzheimer's disease is the most common cause of dementia in elderly clients. Dementia is a clinical manifestation, not a disease process. Although drug interactions and overmedication are causes of dementia, these causes aren't as common as Alzheimer's disease. Depression is common in elderly clients, but it doesn't cause dementia.

An older adult reports fatigue and a rapid heart rate with activity. Which response(s) will the nurse give to explain the physiological reasons for the client's symptoms? Select all that apply. - "Aging reduces the heart's recovery rate after activity." - "Blood pressure increases as a normal age-related change." - "These are typical age-related symptoms of heart block." - "With aging, the heart rate does not increase with maximum demand." - "Aging can contribute to a diminished ability to respond to stress."

- "Aging reduces the heart's recovery rate after activity." - "Blood pressure increases as a normal age-related change." - "With aging, the heart rate does not increase with maximum demand." - "Aging can contribute to a diminished ability to respond to stress." Explanation: The cardiovascular system undergoes changes with aging. These changes include a reduction in the heart's recovery rate after activity. The blood pressure will increase as age-related changes occur to the cardiovascular system. Because of normal aging, the heart rate does not increase with maximum demand, causing a reduction in cardiac output and decreased ability to respond to stress. Although heart block is associated with fatigue, it results in decreased, rather than increased, heart rate.

A family of a patient with Alzheimer's disease asks the nurse what causes this condition? Which response by the nurse would be most appropriate? - "This condition is most likely due to a stroke that the patient didn't realize he had." - "A specific gene is involved in the development of this disorder." - "Evidence shows that there are changes in nerve cells and brain chemicals." - "The numerous drugs that he was taking contributed to his current confusion."

- "Evidence shows that there are changes in nerve cells and brain chemicals." Explanation: Specific neuropathologic and biochemical changes are found in patients with Alzheimer's disease. These include neurofibrillary tangles and neuritic plaques as well as altered neurotransmitter function, specifically acetylcholine. Vascular dementia is associated with a subclinical stroke. Although genetics is being studied as an underlying mechanism for Alzheimer's disease, no specific gene or genetic marker has been identified. Delirium is often the result of the interaction or use of multiple drugs.

The nurse notes that an older adult adds salt to all foods before eating a meal. Which question would the nurse ask this client? - "Have you tried adding herbs, garlic, or lemon to foods for added flavor?" - "Don't you know that adding salt to your food is bad for you?" - "Are you unable to taste the flavor of salt anymore?" - "Does the extra salt help with the dry mouth that older adults experience?"

- "Have you tried adding herbs, garlic, or lemon to foods for added flavor?" Explanation: The sense of taste is reduced in older adults. Blunted taste may contribute to the preference for salty foods, but herbs, garlic, onions, and lemon to foods can added as healthier substitutes for added flavor. Saying, "Don't you know that adding salt to your food is bad for you?" is not therapuetic nor helpful for this client; knowledge may not be the issue and this question will erode the therapuetic relationship. The older adult would not be unable to taste the flavor of salt anymore, but decreased sense of taste would be an expected finding and does not offer a solution. Not all older adults experience dry mouth, nor would the nurse expect added salt to help with dry mouth.

An older adult female has been widowed for several years. Which statements indicate to the nurse that the client may need to consider a change in living arrangements? Select all that apply. - "I don't like to cook for myself anymore." - "My granddaughter helps me with my laundry." - "I have coffee with my neighbor every morning." - "There is no one to talk to most days of the week." - "I attend religious services twice a week at my church."

- "I don't like to cook for myself anymore." - "There is no one to talk to most days of the week." Explanation: Many older adults have more than adequate financial resources and good health even until very late in life; therefore, they have many housing options. Many older adults relocate in response to changes in their lives such as retirement or widowhood, a significant deterioration in health, or disability. Older adults may move to retirement facilities or assisted living communities that provide some support, such as meals. These types of facilities will also provide opportunities for socialization. The client would not necessarily want to change current living arrangements if grandchildren are available to assist, or if there is a strong support system with neighbors or faith community.

After teaching an older adult about measures to relieve constipation, which statement by the client indicates a need for additional teaching? - "I should use a laxative every other day." - "I'll make sure that I drink plenty of fluids each day." - "I'm going to start walking every day for exercise." - "I need to avoid foods that are high in fat."

- "I should use a laxative every other day." Explanation: Factors that may cause constipation include prolonged use of laxatives. Therefore, the patient should avoid the regular use of laxatives. To promote gastrointestinal motility, the patient should ensure adequate fluid intake, engage in regular exercise, avoid foods high in fat.

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? - "In order to prevent further bone loss, eat a diet high in calcium and low in phosphorus." - "In order to prevent further bone loss, eat a diet high in magnesium and high in phosphorus." - "You can reverse the shape of your spine with surgical intervention." - "Supplement your diet with a multivitamin."

- "In order to prevent further bone loss, eat a diet high in calcium and low in phosphorus." Explanation: 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.

The nurse works on a unit with elderly clients. Which of the following clients would the nurse visit first? The client who reports - "I have a headache. I think my blood pressure is up." - "My bladder feels full after going to the bathroom." - "It itches down there" (points to her genital area). - "It feels like I have food stuck in my throat."

- "It feels like I have food stuck in my throat." Explanation: The nurse has to prioritize among clients. The client who reports food being stuck in her throat may have food stuck in her throat. This client could aspirate saliva or anything else she ingests. Remember the ABCs. Airway takes priority, then breathing, then circulation. The nurse would then address the client with the possibly elevated blood pressure and finally the other two clients.

The nurse is concerned that an older adult is experiencing ageism. Which client statement did the nurse use to make this clinical determination? - "My neighbor's son cuts my grass every week." - "The newspaper boy places the paper on my porch every day." - "There is a really nice young lady who puts my groceries in my car for me." - "My grandchildren think I should work for my Social Security payments."

- "My grandchildren think I should work for my Social Security payments." Explanation: Ageism, or prejudice or discrimination against older adults, predominates in society, and there are many myths about aging. This belief is based on stereotypes that reinforce society's negative image of older adults. Retirement and perceived nonproductivity are partly responsible for negative feelings because a younger working person may falsely see older people as not contributing to society and draining economic resources. The grandchildren believing that the client should work for Social Security payments demonstrates ageism. A neighbor cutting grass, placement of the daily newspaper, and help with groceries are not examples of ageism.

The nurse caring for residents of a long-term care facility is explaining the occurrence of elder abuse in such facilities. Which statement from the nurse indicates the need for more education? - "Older adults in long-term care facilities are at low risk for elder abuse." - "Older adults with disabilities are at increased risk for elder abuse." - "Most states requires nurses to report elder abuse." - "Limitations to activities of daily living contribute to risk of elder abuse."

- "Older adults in long-term care facilities are at low risk for elder abuse." Explanation: Residence in a long-term care facility does not result in a lower risk for elder abuse. Older adults with disabilities of all types are at increased risk for elder abuse from family members, paid caregivers, and staff, whether they live in the community or a long-term care facility. Most states require caregivers, including nurses, to report elder abuse. Another factor that places older adults at higher risk of abuse is limitations to activities of daily living.

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? - "What concerns you most about Alzheimer disease?" - "Alzheimer disease can be a great burden on the family. What community resources do you know about?" - "Once the underlying cause of the confusion is found and treated, your loved one will be better than ever." - "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion."

- "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." Explanation: 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. Once the underlying cause(s) is found and treated, the confusion should subside; however, some clients may not recover from the underlying cause, so telling the family the client will be better than ever is not appropriate. Asking the family about their concerns about Alzheimer disease and what they know about community support related to it is not appropriate because the client is exhibiting symptoms related to delirium.

An older adult asks, "What can I do to prevent getting a chest cold during the winter?" Which suggestion(s) will the nurse make to this client? Select all that apply. - "Stop smoking." - "Get the annual flu shot." - "Engage in regular exercise." - "Suppress the urge to cough." - "Make sure you drink enough fluid every day."

- "Stop smoking." - "Get the annual flu shot." - "Engage in regular exercise." - "Make sure you drink enough fluid every day." Explanation: The respiratory system compensates well for the functional changes of aging. In general there is very little decline in respiratory functioning in a healthy nonsmoking older adult. Suggestions that the nurse should recommend to the client to maximize respiratory functioning and prevent the development of a respiratory illness include not smoking and getting the annual influenza vaccination. The client should also be encouraged to engage in regular exercise and ensure adequate fluid intake every day. Older adults should be encouraged to cough more frequently to maintain lung capacity and cough efficiency.

During a home visit, the nurse notes that an older adult's health status has not improved with prescribed medications. Which statement indicates to the nurse that the client may not be adhering to the prescribed medication regimen? - "That one little white pill that I take in the morning makes me feel sleepy all day." - "I put my morning medications next to my bed to take first thing in the morning." - "My neighbor brought me a pill box with compartments to organize my medications." - "My pharmacy delivers, and I can pay the bill once a month when my check arrives."

- "That one little white pill that I take in the morning makes me feel sleepy all day." Explanation: Nonadherence with medication regimens can lead to significant morbidity and mortality among older adults. The many contributing factors include the number of medications prescribed, the complexity of the regimen, difficulty opening containers, inadequate patient education, financial cost, and the disease or medication interfering with the patient's life. The statement that the one medication makes the client feel sleepy could be the reason for nonadherence. Placing the medications in a location where the client will remember to take them would enhance adherence. Coordinating the medications in a pill box will enhance adherence. Having a service where the medications can be delivered with an easy payment method would also enhance adherence.

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? - "This drug will help to stop the disease from getting worse." - "Once it becomes effective, you can stop the drug." - "The drug helps to control the symptoms of the disease." - "The client need to take this drug for the rest of his or her life."

- "The drug helps to control the symptoms of the disease." Explanation: Donepezil hydrochloride is a cholinesterase inhibitor used to control symptoms of Alzheimer's disease. It does not cure or slow progression. Typically cognitive ability improves within 6 to 12 months of therapy, but if stopped, cognitive progression occurs. It is recommended that treatment continue at least through the moderate stage of the illness. However, it usually is not prescribed as life-long therapy.

An older female client is concerned because of experiencing vaginal bleeding after having intercourse. Which response will the nurse make to this client? - "The vaginal tissues are dryer with aging." - "Intercourse should be avoided at your age." - "Bleeding after intercourse results from a thickening of the vaginal walls." - "Testing for a sexually transmitted infection is needed."

- "The vaginal tissues are dryer with aging." Explanation: With aging, changes that occur in the female reproductive system include thinning of the vaginal wall along with a shortening of the vagina and a loss of elasticity; decreased vaginal secretions, resulting in vaginal dryness, itching, and decreased acidity; involution of the uterus and ovaries; and decreased pubococcygeal muscle tone, resulting in a relaxed vagina and perineum. Without the use of water-soluble lubricants, these changes may contribute to vaginal bleeding and painful intercourse. Older adults report that a fairly stable and active sex life is an important quality of life issue. Although the vaginal walls become thinner as women age, this is not associated with bleeding after intercourse.

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: - "What precipitates the outbursts?" - "You need to remain calm during the outbursts." - "Play quiet music that your grandmother may like." - "Start rubbing her shoulders and her back."

- "What precipitates the outbursts?" Explanation: 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.

Which is a true statement regarding pharmacologic aspects of aging? - Elderly have a decreased percentage of body fat. - Potential for drug-drug reactions decreases with the number of drugs prescribed. - Absorption may be affected by changes in gastric pH. - Aged population tends to be compliant with their medication regimen.

- Absorption may be affected by changes in gastric pH. Explanation: During the aging process, absorption may be affected by changes in gastric pH. The elderly have an increased percentage of body fat. The potential for drug-drug interaction increases with the number of drugs prescribed. The aged population tends to be less compliant with their medication regimen.

An older adult with mild dementia is diagnosed with a terminal illness. Which action will the nurse take to support this client's right to self-determination? - Tell the client what treatment is needed. - Provide care based upon the specific condition. - Petition the court to appoint a guardian to make decisions for the client. - Ask the client if there is someone who can help make decisions for treatment.

- Ask the client if there is someone who can help make decisions for treatment. Explanation: People with mild dementia tend to be viewed as incapable of self-determination. However, people with mild dementia may have sufficient cognitive capability to make some, but perhaps not all, decisions. A client may be able to identify a proxy decision maker and yet be unable to select specific treatment options. People with mild dementia may be competent to understand the nature and significance of different options for care and should not be told what treatment is needed as this does not support the client's self-determination. Providing care based upon the specific condition does not support the client's right to self-determination. There is no reason to petition the court to appoint a guardian at this time.

An older adult seeks medical attention for a new onset of epigastric distress and bilateral arm pain. Which action will the nurse complete? - Encourage the client to ambulate. - Assess cardiovascular function. - Recommend taking an over-the-counter antacid. - Review the contents of the client's most recent meal.

- Assess cardiovascular function. Explanation: Careful assessment of older adults is necessary because they often present with different symptoms than those seen in younger clients. Rather than the typical substernal chest pain associated with myocardial ischemia, older adults may report burning or sharp pain or discomfort in an area of the upper body. When a client reports symptoms related to digestion and breathing and upper extremity pain, cardiac disease must be considered. Because the absence of chest pain in an older client is not a reliable indicator of the absence of heart disease, the client should not be encouraged to ambulate or recommended to take an over-the-counter antacid. Time should not be wasted reviewing the contents of the client's most recent meal.

Family members report to the nurse that their elderly grandmother has had a sudden onset of confusion and that they are having difficulty providing care for her. What is the nurse's best response? - Assess the grandmother for adventitious lung sounds - Inform the family that this is a result of aging - Administer donepezil every day - Recommends placement of the grandmother in a nursing home

- Assess the grandmother for adventitious lung sounds Explanation: Sudden onset of confusion may be the first symptom of an infection, such as pneumonia or urinary tract infection. The nurse needs to fully assess the situation before acting (such as telling the family this is a result of aging). Donepezil is used for Alzheimer's disease, which does not have acute onset. A recommendation for placement in a nursing home is premature without a full assessment at this time.

The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse? - Assess the need for pneumococcal and influenza vaccinations. - Administer intravenous morphine for report of postoperative pain. - Instruct the client to receive at least 1 hour of sun exposure each day. - Encourage physical activity of 30 minutes following breakfast daily.

- Assess the need for pneumococcal and influenza vaccinations. Explanation: 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 with heart failure reports constipation that has progressively worsened over the last several months. The client's vital signs are pulse 86 beats per minute, blood pressure 94/56, and respirations 18 breaths per minute. It would be best for the nurse to instruct the client to - Ingest meals with a slightly higher fat content. - Take a laxative, such as milk of magnesia, every day. - Avoid straining when having a bowel movement. - Increase fluid intake to 3000 mL per day.

- Avoid straining when having a bowel movement. Explanation: An elderly client may experience hypotension and needs to avoid straining when having a bowel movement. The client should ingest meals with a higher fiber intake, not fat content. Clients are not to take laxatives every day because they can increase their risk for dependence on laxatives to have a bowel movement. It may be good for clients to increase fluids; however, this client has heart failure and may not be able to increase fluid intake.

The nurse is teaching about preventing pneumonia and influenza to a group of clients in a senior citizens' wellness class. The nurse includes which of the following topics in the class? Select all options that apply. - Avoiding environmental smoke - Participating in regular exercise - Ensuring appropriate fluid intake - Avoiding all sun exposure - Following a high-calcium diet

- Avoiding environmental smoke - Participating in regular exercise - Ensuring appropriate fluid intake Explanation: Activities that help elderly clients maintain good respiratory function include avoiding environmental smoke, regularly exercising, and ensuring appropriate fluid intake. Sun exposure and a high-calcium diet are health-promotion strategies for the integumentary and musculoskeletal systems respectively.

An elderly client reports fatigue without shortness of breath with walking 30 minutes five times each week. The nurse assesses the resting heart rate as 72 beats per minute; 10 minutes after walking, the client's heart rate is 92 beats per minute. What should the nurse instruct the client to do next? - Continue to walk at his current level. - Refrain from any form of exercise. - Increase walking at a faster pace. - Decrease walking frequency to three times each week.

- Continue to walk at his current level. Explanation: Elderly clients may report fatigue with increased activity as a result of a slower heart rate recovery, which may be a physiological response to aging. An appropriate nursing intervention is to educate the client to exercise regularly but also to pace activities. The nurse does not want to tell the client not to exercise, to walk faster, or to decrease frequency.

A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? - Decreased acetylcholine level - Increased acetylcholine level - Increased norepinephrine level - Decreased norepinephrine level

- Decreased acetylcholine level Explanation: 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. Norepinephrine is associated with aggression, sleep-wake patterns, and the regulation of physical responses to emotional stimuli, such as the increased heart and respiratory rates caused by panic.

Nursing students are reviewing different types of mental health problems in the older adult population. The students demonstrate an understanding of this information when they identify which condition as the most common affective disorder? - Anxiety - Depression - Schizophrenia - Phobias

- Depression Explanation: Depression is the most common affective or mood disorder of old age. Although anxiety may be common, anxiety disorders including phobias are not as common as depression. Schizophrenia is a thought disorder and is less common than depression.

An older adult has lost 10% of body weight because of diet changes and exercise. The nurse would provide anticipatory guidance regarding dosage changes in which of the client's daily medications based on this weight loss? - Aspirin - Diazepam - Acetaminophen - Vitamin B and C supplements

- Diazepam Explanation: Some medications are affected by the percentage of body fat. Even though the client has lost 10% of total body weight, the proportion of body fat increases with age, resulting in an increased ability to store fat-soluble medications, increased accumulation of the drug in the body, and delayed excretion. Medications affected include diazepam. Aspirin and acetaminophen are not among the fat-soluble medications affected by percentage of body fat. Vitamin B and C supplements are water-soluble vitamins and would not be affected by the percentage of body fat.

The nurse is assessing a 78-year-old woman and suspects that the patient may have age-related macular degeneration. Which assessment finding would most likely support this suspicion? - Decreased peripheral vision - Diminished color perception - Decreased ability to see all objects - Loss of gross detail discrimination

- Diminished color perception Explanation: Age-related macular degeneration affects central vision, not peripheral vision. It also affects color perception and fine detail discrimination, affecting common visual skills such as reading, driving, and seeing faces.

Which action by the nurse demonstrates ageism? - Providing the same high quality of care to all clients - Encouraging the older adult to develop routines not associated with work - Directing all health decisions to the older adult's child - Allowing adequate time for the older adult to complete tasks

- Directing all health decisions to the older adult's child Explanation: When the nurse directs all health care-related decisions to the older adult's child, the nurse is not respecting the individual choice of the older adult. The nurse is also assuming that the older adult cannot understand the decisions to be made, which is a myth about the elderly. The nurse should provide high-quality care to all clients, no matter what the age of the client. Allowing the client adequate time to complete tasks is appropriate and individualized. The older adult should be encouraged to develop routines not associated with work to decrease the potential for feeling nonproductive.

A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate? - Continue taking the vital signs. - Place the client in a secluded room until calm. - Distract the client with a familiar object or music. - Document the inability to assess vital signs due to client's agitation.

- Distract the client with a familiar object or music. Explanation: The nurse should try to calm the patient by using distraction with a familiar object or music. Continuing to take the vital signs will cause further agitation and possible harm to the client or nurse. Placing the client in a secluded room may increase agitation and should not be used in this situation. The nurse should document the inability to assess vital signs and the reason why this should be done after the client's basic needs have been met.

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? - Taking the clients outside for sun exposure daily - Assisting clients to soak in the bathtub several times each week - Encouraging clients to avoid cigarette smoking - Instructing clients to use perfumed skin creams

- Encouraging clients to avoid cigarette smoking Explanation: 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 older adult patient is experiencing presbycusis. When interviewing the patient, the nurse would be alert for problems associated with which consonants? Select all that apply. - F - D - S - P - L - W

- F - S - P Explanation: With presbycusis, the patient loses the ability to hear high-frequency tones and often cannot follow conversations because tones of high-frequency consonants, such as f, s, th, ch, sh, b, t, and p, all sound alike.

When assessing an older adult's gastrointestinal system, the nurse would identify an increase in which of the following as normal? - Feeling of fullness - Gastric motility - Stomach emptying - Calcium absorption

- Feeling of fullness Explanation: 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.

An older adult who is scheduled for the annual influenza vaccination has yet to receive the pneumococcal vaccination. Which action will the nurse take when the client is prescribed to receive both vaccinations? - Mix the vaccines in a syringe before administering as one injection in order to minimize client discomfort. - Give the client the influenza vaccine first and then administer the pneumococcal vaccine in another site. - Give the influenza vaccine and schedule the client to return in a week for the pneumococcal vaccine. - Give the pneumococcal vaccine first and schedule the client to return the next day for the influenza vaccine.

- Give the client the influenza vaccine first and then administer the pneumococcal vaccine in another site. Explanation: Influenza and 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. The pneumococcal vaccine should be administered as recommended. Both of these injections can be received at the same time in separate injection sites. The vaccines are not mixed to be given as one injection. There is no reason for the client to return later to receive either the pneumococcal or influenza vaccinations.

An elderly female client tells the nurse she has trouble holding her "water." A nursing intervention is informing the client to - Take prophylactic antibiotics. - Decrease fluid intake. - Realize this is normal for her age. - Have adequate fluid intake.

- Have adequate fluid intake. Explanation: Ensuring adequate fluid intake in an elderly client helps to decrease urinary incontinence. Antibiotics would be prescribed for actual bladder infections, not to prevent them. There are not sufficient data to support the existence of a bladder infection. Decreasing fluid intake may lead to bladder infections, problems with fluid and electrolyte imbalance, and urinary incontinence. Incontinence is not a normal consequence of aging.

The family of an older adult seeks medical attention for the client because of an increase in inappropriate responses and avoidance of social interactions. On which body area will the nurse focus when assessing the client? - Hearing - Digestion - Genitourinary system - Respiratory system

- Hearing Explanation: Presbycusis is a gradual sensorineural loss that progresses from loss of the ability to hear high-frequency tones to a generalized loss of hearing. Hearing loss may cause older adults to respond inappropriately, misunderstand conversations, and avoid social interaction. This behavior may be erroneously interpreted as confusion. The nurse should focus on assessing the client's hearing. Inappropriate responses and avoidance of social interaction are not assessment findings associated with changes in the digestive, genitourinary, or respiratory systems.

A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching? - A decline in sexual activity is a normal occurrence as you age. - Most older adults reside in a long-term care facility. - As an older adult, you will not be able to learn new skills or knowledge. - How old you feel will be determined by your physical and cognitive abilities.

- How old you feel will be determined by your physical and cognitive abilities. Explanation: The physical health and cognitive abilities of older adults are directly related to quality of life and how "old" one really feels. Older adults can maintain healthy sexual activity and are able to learn new skills and knowledge. Of older adults, 90% live in the community, not in long-term care facilities.

An older adult voids a small amount of urine in the toilet but experiences a large volume of incontinence while walking back to the bed. Which nursing intervention would be appropriate for this client? - Implement a prompted, timed voiding schedule. - Show disapproval to help prevent reoccurence. - Remind the client to verbalize toileting needs. - Provide education about medications to treat this problem.

- Implement a prompted, timed voiding schedule. Explanation: Detrusor hyperactivity with impaired contractility is a type of urge incontinence that is seen predominantly in the older adult population. In this variation of urge incontinence, clients have no warning that they are about to urinate. They often void only a small volume of urine or none at all and then experience a large volume of incontinence after leaving the bathroom. Nurses should be familiar with this form of incontinence and plan for routine toileting times with these clients, including the implementation of a prompted, timed voiding schedule. Intermittent catheterization may also be necessary because of postvoid residual urine volumes. Showing disapproval or reminding the client to verbalize toileting needs would be inappropriate actions for this type of incontinence, as the client has no warning they are about to urinate. Medications do exist to treat some forms of incontinence; however, the adverse affects associated with these medications usually make them inappropriate choices for older adults.

A nurse notes that an older female client has lost 2 inches in height since her appointment last year. The client reports lumbar back pain as unchanged. Which of the following would the nurse instructs the client? Select all answers that apply. - Increase intake of foods that are high in calcium. - Allow for additional phosphorus intake in her daily diet. - Decrease the frequency of any exercise. - Take calcium and vitamin D supplements daily. - Obtain the prescribed bone density screening.

- Increase intake of foods that are high in calcium. - Take calcium and vitamin D supplements daily. - Obtain the prescribed bone density screening. Explanation: Older clients may experience decreased bone density and, thus, back pain as a result of aging. Strategies to assist them are to instruct clients to increase calcium in the diet and take calcium and vitamin D supplements. A bone density test made be done to determine the degree of bone loss. The client needs to limit phosphorus intake because a high-phosphorus blood level decreases calcium blood levels. The client needs to continue with a regular exercise program.

The nurse identifies which of the following as an age-related change in the respiratory system? - Increased residual lung volume - Increased vital capacity - Increased diffusion capacity - Increased cough efficiency

- Increased residual lung volume Explanation: The older adult experiences an increase in residual lung volume, decreased vital capacity, decreased diffusing capacity, and decreased cough efficiency.

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to - Ingest five or six small meals each day. - Minimize the use of stool softeners. - Use whirlpool baths for relaxation. - Take daily hot showers.

- Ingest five or six small meals each day. Explanation: 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.

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 - Instruct the family to remove the toddler from the room for the protection of the client. - Ask the family to leave the client's room. - Inform the family to either wash their hands or use the hand sanitizer. - Allow the toddler to remain in the room if a family member wipes the toddler's nose.

- Instruct the family to remove the toddler from the room for the protection of the client. Explanation: 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.

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 - Decrease fluid intake. - Hold his urine as long as possible before voiding. - Limit ingestion of caffeinated beverages. - Drink no more than his current 2 to 3 ounces of alcohol each day.

- Limit ingestion of caffeinated beverages. Explanation: 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 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 - Degeneration in the efficiency of bone joints - The client's failure to exercise - Loss of bone density - Decreased muscle mass and joint cartilage

- Loss of bone density Explanation: 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). No information indicates that the client is not exercising or has experienced degeneration of bone joints. Degeneration in the efficiency of the bone joints and decreased muscle mass and joint cartilage would have more of an effect on increased pain than on decreased height.

An elderly client, while being seen in an urgent care facility for a possible respiratory infection, asks the nurse if Medicare is going to cover the cost of the visit. What information can the nurse give the client? - Medicare has a copayment for many of the services it covers. This requires the client to pay a part of the bill. - Medicare pays for 100% of the cost for acute-care services, so the cost of the visit will be covered. - Medicare will only pay the cost for acute-care services if the client has a very low income. - Medicare will not pay for the cost of acute-care services so the client will be billed for the services provided.

- Medicare has a copayment for many of the services it covers. This requires the client to pay a part of the bill. Explanation: The two major programs that finance health in the United States are Medicare and Medicaid, both of which are overseen by the Centers for Medicaid and Medicare Services (CMS). Both programs cover acute-care needs such as inpatient hospitalization, physician care, outpatient care, home health services, and skilled nursing care in a nursing. Medicare is a plan specifically for the elderly population, and Medicaid is a program that provides services based on income.

An elderly client recovering from a hip repair becomes disoriented and tries to get out of bed frequently. The client states, "I forget I am in the hospital." The best nursing intervention is to - Post a sign stating "You are in the hospital" at the client's eye level. - Raise the upper and lower side rails of the bed. - Place the client in a Posey chest restraint with ties attached to the bed frame. - Administer an oral dose of prescribed alprazolam (Xanax).

- Post a sign stating "You are in the hospital" at the client's eye level. Explanation: Client confusion increases the risk of falls. Environmental cues include a sign stating, "You are in the hospital." Measures that are not restraining are used first. Raising the lower side rails is considered a restraint. This increases a confused client's risk for falling. Placing a client in a Posey chest restraint is a last resort. Administering an anti-anxiety medication can increase confusion in a client who is already confused.

An older adult seeks medical attention for a new onset of rectal bleeding. For which reason will the nurse perform a complete physical assessment with the client? - The symptom of rectal bleeding is vague - More than one body system may be affected - The bleeding may be coming from another body orifice - Older adult clients may be poor historians of symptoms

- More than one body system may be affected Explanation: In an older person, illness has far-reaching repercussions. The decline in organ function that occurs in every system of the aging body eventually depletes the body's ability to respond at full capacity. Illness places new demands on body systems that have little or no reserve to meet the crisis. Homeostasis is jeopardized. 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. The altered responses of older adults reinforce the need for nurses to monitor all body system functions closely, being alert to signs of impending systemic complication. There is no evidence that the client's report of rectal bleeding is vague or that it is coming from another body orifice. Age of the client does not determine the reliability of the client being able to provide an accurate, detailed history and would not be a reason for a complete physical assessment to be performed.

An older adult was diagnosed with Alzheimer disease 2 years ago and the disease has progressed at an increasing pace in recent months. The client has lost 7.5 kg (16 pounds) over the past 3 months, leading to a nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements. What intervention should the nurse include in this client's plan of care? - Offer the client rewards for finishing all the food on her tray. - Offer the client bland, low-salt foods to limit offensiveness. - Offer the client only one food item at a time to promote focused eating. - Arrange for insertion of a gastrostomy tube and initiate enteral feeding.

- Offer the client only one food item at a time to promote focused eating. Explanation: To avoid any "playing" with food, one dish should be offered at a time. Foods should be familiar and appealing, not bland. Tube feeding is not likely necessary at this time and a reward system is unlikely to be beneficial.

The reason that governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement? - Clients are unable to make any health care decision. - Clients lack capacity because of cognitive impairment. - Clients lack different perspectives. - Older adult clients are vulnerable.

- Older adult clients are vulnerable. Explanation: Because of the vulnerability of older adults, governments have carefully regulated the treatment given in licensed health care facilities. Cognitive impairment does not automatically constitute incapacity. Older people with fluctuating cognitive status may retain sufficient ability to make some, if not all, their health care decisions. Individuals with different perspectives are required in ethics committees to resolve ethical dilemmas.

Why are IV solutions usually given at a slower rate to older adults? - Older adults may have poor skin turgor. - Veins of older adults tend to be rigid. - Older adults often find infusions painful. - Older adults may have cardiac or renal disorders.

- Older adults may have cardiac or renal disorders. Explanation: IV solutions usually are given at a slower rate to older adults because these clients usually have cardiac or renal disorders. Veins of older adults tend to be rigid and they have poor skin turgor, making venipuncture difficult; however, this factor does not affect infusion. Older adults do not find infusion more painful than other clients.

A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? Select all that apply. - Place grab bars in the shower and tub - Have routine vision and hearing screenings - Frequently change the furniture layout in the home - Wear nonslip shoes or socks when walking - Review medications routinely for side effects - Use scatter rugs on hard wood surfaces.

- Place grab bars in the shower and tub - Have routine vision and hearing screenings - Wear nonslip shoes or socks when walking - Review medications routinely for side effects Explanation: Grab bars in the shower and tub may decrease the chance of a fall on a slippery surface. Visual and hearing issues may contribute to falls. Medication interaction and side effects may increase the risk for falls, so medications should be reviewed. The older adult should wear proper nonskid footwear or socks when walking to help prevent falls. Changing the layout of the furniture in the home may increase the risk for falls because of items being in unfamiliar locations. Scatter rugs should not be used because they increase the risk for falls.

A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by - Placing one food at a time in front of the client during meals - Cutting the client's food into small pieces - Serving hot foods at a warm temperature - Converting liquid foods to a gelatin texture

- Placing one food at a time in front of the client during meals Explanation: 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.

A department of nursing within a health care organization is adopting the Functional Consequences Theory when caring for older adults. Which action would the nurse take to faciliate using this theory when caring for a client? - Identify reasons for changes in musculoskeletal function. - Recognize that immune system changes cannot be altered. - Plan interventions to address consequences of age-related changes. - Establish improvement of cognitive function as the overall goal of care.

- Plan interventions to address consequences of age-related changes. Explanation: The Functional Consequences Theory encourages nurses to consider the effects of normal age-related changes and the damage caused by disease or environment and behavioral risk factors when planning care. This theory suggests that nurses can alter the outcome for clients through nursing interventions that address the consequences of these changes. The Functional Consequences Theory does not focus specifically on musculoskeletal function, immunity, or cognitive functioning.

Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? - Presbyopia - Presbycusis - Cataract - Glaucoma

- Presbyopia Explanation: 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 nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply. - Providing a calm, quiet environment - Supervising nutritional intake - Using familiar cues about the environment - Administering psychoactive drugs - Keeping the patient awake as much as possible

- Providing a calm, quiet environment - Supervising nutritional intake - Using familiar cues about the environment Explanation: 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.

An older adult has experienced several acute illnesses over the past few months. Which assessment finding will the nurse use to identify the reason for the client's frequent illness? - Recent weight loss - Ongoing home renovations - Family members visiting for a holiday - Participation in weekly card club events

- Recent weight loss Explanation: Undernutrition, which can lead to malnutrition, may be a problem for older adults. A recent weight loss may have serious consequences and may affect the older adult's ability to maintain health and fight illness. It is unlikely that the client's home environment, family visits, or recreational activities are causing the client to experience frequent infections.

Which is a factor that contributes to urinary incontinence in older female adults? - Decreased urinary residual - Increased bladder capacity - Relaxed perineal muscle - Detrusor stability

- Relaxed perineal muscle Explanation: Female older adults typically have relaxed perineal muscle. The relaxed muscle can contribute to urinary incontinence, especially when laughing, coughing, and sneezing. Decreased urinary residual would not be a contributing factor. Most older adults have an increase in urinary residual. Most older adults have a decreased bladder capacity; this contributes to an increase in frequency in urination but not incontinence. Detrusor stability is a normal finding and helps prevent incontinence.

Which neurotransmitter is implicated in depression? - Atropine - Serotonin - Acetylcholine - Epinephrine

- Serotonin Explanation: Serotonin is implicated in the development of depression. Atropine, acetylcholine, and epinephrine are not implicated in the development of depression.

An elderly client is hospitalized. To maintain the client's mobility, the best nursing intervention is - Sit the client in a chair for meals. - Encourage the client to perform active range-of-motion exercises. - Assist the client with passive range-of-motion exercises. - Turn the client every 2 hours.

- Sit the client in a chair for meals. Explanation: For elderly clients, bedrest should be kept to a minimum. Having the client sit in a chair for meals will help to minimize deconditioning. Other activities, if the client must maintain bedrest, include active and passive range-of-motion exercises and frequent turning.

Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse? - BMI 24; "My family never gives me my favorite foods." - Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore." - Diabetic with fasting blood sugar 92; "It is difficult to afford food with all of these medication costs." - Obvious deformity to right arm; "I tripped on the rug and fell on my arm."

- Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore." Explanation: Neglect is the most common form of elder abuse. The inability of an older adult to obtain basic care is considered neglect. If a client is not being turned or repositioned to prevent skin breakdown, then neglect is happening. A BMI of 24 is within the normal range, and the inability of the client to have his or her favorite foods would not be abuse. The client with diabetes has blood sugar within normal ranges, and the client is only expressing concern over the cost of medications; social services may need to be notified to provide help through community resources. The story provided by the older adult with the deformed arm is consistent with the injury.

An older adult who is becoming increasingly debilitated refuses to move to an assisted living facility as suggested by an adult child who lives out of state. Which recommendation will the nurse consider to address this situation? - The adult child can move in with the parent - The older client can move in with the adult child - The adult child can hire caregivers for the older parent - The older client's grandchildren can move in with the client

- The adult child can hire caregivers for the older parent Explanation: Most older adults want to remain in their own homes; in fact, they function best in their own environment. The family home and familiar community may have strong emotional significance for them, and this should not be ignored. Additional family support or more formal support may be necessary to compensate for declining function and mobility. Many services and organizations can assist older adults to successfully "age in place" in their own homes or in assisted living facilities. Since the client refuses to move to a facility, hiring caregivers may be the best suggestion to recommend to the client and adult child. The adult child lives out of state and should not be expected to move in with the parent. The older client refuses to move so going to live with the adult child is not a viable option. Grandchildren should not be expected to care for aging family members.

A nurse is preparing a presentation for a local senior center about the health status of older adults. What trends in health promotion and disease prevention activities would the nurse explain as contributing to declining death rates in the older adult population? Select all that apply. - decreased smoking - improved nutrition - screening for hypertension - early detection of elevated cholesterol levels - decreased exercise - decreased community-based services

- decreased smoking - improved nutrition - screening for hypertension - early detection of elevated cholesterol levels Explanation: Most deaths in the United States occur in people 65 years or older, with one-half of these caused by heart disease and cancer. Decreased smoking, improved nutrition, screening for hypertension, and early detection of elevated cholesterol levels are contributing factors to a decreased death rate in older adults. Older adults are encouraged to increase exercise and increase community-based services.

The nurse is preparing a teaching tool that focuses on elder abuse. Which type of abuse will the nurse highlight as being the most common? - neglect - physical - financial - emotional

- neglect Explanation: Older adults are at risk for elder abuse and neglect, both in the community setting and in nursing homes. Neglect is the most common type of elder abuse. Other forms of elder abuse include physical, financial, and emotional. However, neglect is associated with poor health.

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should: - stay with the client and encourage him to eat. - help the client fill out his menu. - give the client privacy during meals. - fill out the menu for the client.

- stay with the client and encourage him to eat. Explanation: Staying with the client and encouraging him to feed himself will ensure adequate food intake. A client with Alzheimer's disease can forget how to eat. Allowing privacy during meals, filling out the menu, or helping the client to complete the menu doesn't ensure adequate nutritional intake.