Older Adult Health Exam 3

A nurse is assessing an older adult's risk for falls. One of the questions that she asks is whether the older adult has fallen in the past year. She asks this because individuals who have fallen: a. have a higher risk of falling again than persons who did not fall in the past year. b. are more likely to sustain injuries if they fall again than persons who did not fall in the past year. c. have most likely developed a fear of falling as compared to persons who did not fall in the past year. d. are most likely to have a balance disorder as compared to persons who did not fall in the past year.

ANS: A A history of falls is an important risk factor and individuals who have fallen have three times the risk of falling again than persons who did not fall in the past year. There is no evidence to support the other three options.

An older patient asks a nurse, "I really have trouble sleeping and my doctor does not want to prescribe a sleeping pill for me. He says they are not good for older people. I really don't understand his response. Can you help me?" The best response by the nurse is: a. "Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep." b. "Prescription sleeping medications have many adverse effects in older people. Why don't you try using an over-the-counter medication?" c. "Sleeping medications do not provide any improvement in sleep for older people." d. "Sleep problems are common in older people. There really is nothing that you can do to help with that."

ANS: A Adverse effects of sleep medications, including over-the-counter medications, include problems with daily function, changes in mental status, motor vehicle accidents, daytime drowsiness, and increased risk of falls with only minimum improvement in sleep. Sleep problems are common in older adults; however, there are many nonpharmacologic interventions that can be utilized to improve sleep.

A nurse in a long-term care facility notes that an older resident with Alzheimer's disease awakens frequently at night and is restless and agitated. Which of the following interventions will be most effective to help manage this resident's sleep problems? a. Taking the resident outside in the garden for 45 minutes daily b. Limiting fluid intake for the resident c. Educating the resident on the association between Alzheimer's Disease and insomnia d. Administering a mild sedative hypnotic at bedtime

ANS: A Behavioral strategies for persons with dementia include daily walks and exposure to light to enhance sleep. Limiting fluid intake may or may not be effective depending on whether or not the resident has nocturia. Educating the resident about the association between AD and insomnia may be feasible depending on the resident's mental status but will not necessarily ameliorate the problem. Sedative hypnotics are not the first-line treatment for older adults with AD and sleep disturbances.

An 88-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She has a history of hypertension and congestive heart failure and is on a total of five different medications for these chronic conditions. The nurse caring for the woman develops a care plan that includes the diagnosis Risk for Falls. A priority nursing intervention for this client is to: a. perform a fall assessment. b. keep all of the side rails up on the client's bed at nighttime. c. place the client on bed rest so that she does not fall. d. assess the client's dietary intake for calcium adequacy.

ANS: A Completing a fall assessment will enable the nurse to identify and correct the risk factors for this patient. Side rails have not been found to be effective in keeping a client in bed and may actually lead to injury. Maintaining a patient on bed rest can lead to deconditioning and actually contribute to falls. Assessing the client's dietary intake of calcium is a good intervention for this age group, but it is not a priority and will not prevent falls.

A major difference in the diagnosis of chronic disease between younger adults and older adults is that: a. chronic disease is often diagnosed earlier in younger adults and measures can be implemented to prevent later problems. b. chronic disease is often diagnosed earlier in older adults since they are more likely to seek medical care. c. chronic disease is usually not identified in older adults because of the many age-related changes. d. chronic illness is uncommon in younger adults.

ANS: A In a younger adult, the early signs of a pending chronic disease may be identified early enough to prevent later problems (e.g., a finding of an elevated cholesterol level). In older adults, a chronic disease may not be diagnosed until some amount of "end organ damage" has already occurred. For example, diabetic retinopathy may be found during an annual eye examination indicating that the diabetes has been present for some time. Although there are many age-related changes in the older adult, it is still possible to identify chronic illness. Chronic illness is common in younger adults, although it is more common in older adult

A nurse at a senior center promotes activity by leading exercise programs. Which of the following is a benefit of such exercise? a. Improvement of mood b. Cardiovascular stress c. Painful and stiff joints d. Depression

ANS: A Physical activity has many benefits including improvement of mood. Physical activity improves cardiovascular health, decreases depression, and helps decrease pain and increase flexibility in the joints.

A 75-year-old female asks a nurse "I know I should be moving, but how much is the right amount of exercise for me?" The best response of the nurse is: a. "You need to engage in 30 minutes of moderate intensity exercise on at least 5 days a week." b. "You need to engage in at least 30 minutes of moderate intensity exercise every day of the week." c. "Since you are 75, the recommendations are 30 minutes of moderate exercise three times a week." d. "There are no specific recommendations for someone of your age; just keep moving."

ANS: A Recommendations for all adults are participation in 30 minutes of moderate intensity physical activity for 5 or more days per week.

An older man who is a smoker is hospitalized for orthopedic surgery. A nurse takes the opportunity to provide smoking cessation education. The patient asks the nurse: "I have been smoking for most of my life, and I am an old man. Why are you wasting your time telling me to stop smoking? Isn't it too late?" The nurse bases the response on the knowledge that: a. smoking cessation as late as age 75 can reduce premature death by up to 50%. b. smoking cessation as late as age 75 can completely eliminate premature death. c. smoking cessation at a late age will not impact the smoker but can reduce exposure of family members to second-hand smoke. d. smoking cessation education is only effective in individuals under age 75.

ANS: A Smoking cessation as late as age 75 can reduce premature death by up to 50%. The remaining options are not true.

A nurse is caring for an older adult who is in the pre-trajectory phase of the Chronic Illness Trajectory. The nurse knows that this phase is characterized by which of the following: a. The absence of signs or symptoms of the illness b. Diagnostic testing being conducted c. A progressive decline in physical and or mental status d. A period of temporary remission from the crisis

ANS: A The pre-trajectory phase is characterized by the absence of signs or symptoms of the illness. The trajectory onset includes the diagnostic period. The downward phase is characterized by a progressive decline in physical/mental status, characterized by increasing disability/symptoms. The comeback phase is characterized as a period of temporary remission from the crisis.

An older adult who has a balance disorder and has sustained repeated falls is recommended to start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual? (Select all that apply.) a. Yoga b. Tai Chi c. Swimming d. Pilates e. Weight lifting

ANS: A, B Yoga and Tai Chi are exercises that improve balance, as they use movements that improve the ability to maintain control of the body over the base of support to avoid falling. Swimming, Pilates, and weight lifting do not do this.

A nurse cares for an older adult who is described as being "frail." The nurse understands that in order to be characterized as frail an individual must possess which of the following characteristics? (Select all that apply.) a. Slow walking speed b. Low activity level c. Self-reported exhaustion d. Taking at least five prescribed medications e. A diagnosis of at least two chronic conditions

ANS: A, B, C Frailty is defined as evidence of three of the following: unexplained weight loss, self-reported exhaustion, weak grip strength, slow walking speed, and low activity. Neither the number of medications that an individual is prescribed nor the number of chronic conditions is part of the diagnosis of frailty

Which assessment finding is a contributor to an older client's risk for falls? (Select all that apply.) a. Client is awaiting cataract surgery on right eye. b. Client's type 2 diabetes is poorly controlled with diet and exercise alone. c. Client reports a fall in the last year. d. Client has a history of contact dermatitis and psoriasis. e. Client attends Tai Chi classes at the senior center.

ANS: A, B, C The correct options are those that affect the client's vision, presence of factors affecting sensations in the legs and feet, and a history of falls. There is no research to connect the risk of falls with either of the skin conditions mentioned. Tai Chi improves balance, which decreases risk of falls.

A nurse is caring for a frail older adult in a long-term care facility and is concerned about preventing hypothermia. Which of the following interventions should the nurse implement? (Select all that apply.) a. Make sure that the temperature in the resident's room is at least 65 degrees Fahrenheit. b. Cover residents well when in bed and while bathing. c. Provide a head covering for the resident. d. Maintain resident in bed covered with heavy blankets at all times. e. Provide hot, high-protein meals and bedtime snacks.

ANS: A, B, C, E Interventions to prevent hypothermia in frail elders include maintaining an ambient temperature of no lower than 65 degrees Fahrenheit, providing a head covering whenever possible—in bed, out of bed, and particularly out-of-doors, covering patients well when in bed and when bathing, and providing hot, high-protein meals and bedtime snacks to add heat and sustain heat production throughout the day and as far into the night as possible. In addition, it is important to get the patient out of bed and provide as much exercise as possible to generate heat from muscle activity.

The daughter of an older patient says to a nurse, "I am so concerned that my dad is still driving. He is dangerous! He has had a couple of accidents and I am worried that he is going to kill himself or, worse, somebody else. What can I do?" The nurse recommends which of the following involved type action strategies for driving cessation? (Select all that apply.) a. Report the person to the division of motor vehicles for license suspension. b. Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem. c. Arrange for alternate transportation for the person. d. Confiscate the keys to the car. e. Ask the patient's physician to write a prescription for the person to stop driving.

ANS: B, C Options B and C are examples of the involved type of action strategies for driving cessation. Options A, D, and E are all examples of the imposed type of action strategies for driving cessation.

An older patient is diagnosed with RLS. Which of the following nonpharmacologic interventions should the nurse include in the plan of care? (Select all that apply.) a. Engage in regular mild to moderate physical activity including stretching activities for the lower extremities. b. Avoid caffeine, alcohol, and tobacco. c. Avoid hot baths. d. Relaxation techniques may be helpful. e. A mild sleeping medication such as diphenhydramine (Benadryl) might be helpful.

ANS: A, B, D Nonpharmacologic therapy includes stretching the lower extremities, mild to moderate physical activity, hot baths, massage, acupressure, relaxation techniques, and avoidance of caffeine, alcohol, and tobacco. The use of diphenhydramine (Benadryl) as a sleeping medication for older adults is not appropriate. There is also no evidence that it will decrease RLS.

An older patient asks a nurse, "It seems like all of my friends and I have difficulty sleeping. Is it common among older people?" The nurse formulates a response based on the knowledge that normal age-related changes in sleep include: (Select all that apply.) a. total sleep time and sleep efficiency are reduced. b. rapid eye movement (REM) sleep is shorter, less intense, and more evenly distributed. c. sleep requirements for older adults are less than that of younger adults. d. daytime napping is common. e. sleep tends to be deeper in older adults than in younger adults.

ANS: A, B, D Normal age-related changes in older adults include a reduced total sleep time and sleep efficiency and shorter, less intense, and more evenly distributed REM sleep. Older adults tend to nap during the daytime. Sleep requirements do not decrease as one ages. Sleep tends to be objectively and subjectively lighter in older adults.

An older adult tells a nurse that he is experiencing difficulty falling asleep, he routinely gets into bed at 8:30 PM and watches his favorite television shows until 11:00 PM, and often lies awake for hours after. Which of the following suggestions are appropriate for the nurse to give to this patient? (Select all that apply.) a. Go to bed only when sleepy. b. If unable to sleep within a reasonable time (15-20 minutes), get out of bed and pursue relaxing activities. c. Engage in moderate exercise to induce fatigue. d. Do not watch television or work in bed. e. If unable to sleep, engage in enjoyable activities on the computer.

ANS: A, B, D Some interventions to improve sleep include going to bed only when sleepy, matching the number of hours in bed to the actual hours of sleep, and reserving the bed for sleep and sex only. Engaging in exercise immediately before sleep will not assist the person in falling asleep, and use of the computer is also discouraged as it can disturb sleep.

The benefits of telehealth include that it: (Select all that apply.) a. promotes self-management of illness in rural and underserved areas. b. facilitates remote physical assessment and monitoring of chronic conditions. c. decreases costs by replacing the role of the nurse with technology. d. decreases costs by reducing hospital readmissions. e. is reimbursed by all health care insurances.

ANS: A, B, D Telehealth promotes self-management of illness and facilitates remote assessment and monitoring in rural and underserved areas. Evidence has demonstrated that it reduces costs by decreasing hospital readmission. Telehealth does not replace the role of the nurse; the technology augments the ability of the nurse to reach clients in remote areas. Unfortunately, not all health care insurers reimburse for telehealth services.

Which precaution would be beneficial in minimizing an older adult's risk of being a victim of fraud? (Select all that apply.) a. Do not allow uninvited salespersons into your home. b. Never provide personal information to telephone sales solicitors. c. Rely on the advice of people who only friends have recommended. d. Contact the local Medicare or Medicaid service office for information when needed. e. Keep your bank account and credit card numbers with you at all times.

ANS: A, B, D The correct options provide sound advice, but relying on friends alone for advice may not be prudent while personal information should be kept in a safe place, not necessarily on your person.

A nurse is planning health education on chronic illnesses for a group of seniors in the community. When deciding upon which illnesses to focus upon, the nurse knows that which of the following are the most common diseases in the United States? (Select all that apply.) a. Heart disease b. Hypertension c. Asthma d. Osteoarthritis e. Diabetes

ANS: A, B, D The most common chronic diseases in the United States are heart disease, hypertension, and osteoarthritis.

A nurse caring for an older hospitalized woman is concerned about promoting functional status. Which of the following interventions should the nurse include in this patient's plan of care? (Select all that apply.) a. Conduct a baseline functional status assessment of the patient b. Request a physical therapy referral c. Make sure that the patient has all activities of daily living performed for her d. Progressive mobility interventions e. Encouraging the patient to feed herself

ANS: A, B, D, E A baseline assessment of functional ability is important and can assist in setting appropriate goals for the hospitalized individual. Physical therapy is important in developing an individualized plan of exercises and functional mobility program. Progressive mobility interventions range from passive range of motion to safe transfers and ambulation and are important in maintaining function. Encouraging self-care activities rather than "doing for" is also important.

A group of older women in an assisted living facility are talking about one of the residents who fell and fractured her hip. The women ask a nurse the following: "It seems like so many of us fall and break our hips, and then it is downhill from there. Is this really true?" In formulating a response, the nurse considers which of the following? (Select all that apply.) a. Hip fractures are a leading cause of hospitalization for older people. b. The major cause of hip fractures is falls. c. Women have significantly higher mortality rates from hip fractures than do men. d. Nearly all older patients who sustain a hip fracture will regain prefracture mobility status within 1 year. e. Hip fractures are associated with very high morbidity and mortality.

ANS: A, B, E Hip fracture is the second leading cause of hospitalization for older people. More than 95% of hip fractures among older adults are caused by falls. Older adults who fracture a hip have a five to eight times increased risk of mortality during the first 3 months after hip fracture. This excess mortality persists for 10 years after the fracture and is higher in men. Only 50-60% of patients with hip fractures will recover their prefracture ambulation abilities in the first year postfracture. Most research on hip fractures has been conducted with older women.

What information should be included in an informational program to be presented on burn prevention to a senior citizens group? (Select all that apply.) a. Do not smoke in bed or when sleepy b. Wear well-fitted clothing when cooking or when grilling outdoors c. Establish a meeting place for all family members outside of the home in case of a fire d. Establish a plan for exiting each room of your home in the case of a fire e. Have a fire extinguisher readily available in the kitchen

ANS: A, B, E Measures to prevent burns include not smoking in bed or when sleepy, not wearing loose-fitting clothing (e.g., bathrobes, nightgowns, pajamas) when cooking or around an open heat source, and installing a portable hand fire extinguisher in the kitchen. The remaining options are related to safely evacuating a home in case of a fire.

A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. Which of the following are hazards in the home? (Select all that apply.) a. The absence of railings on the stairway b. Night-lights in all rooms c. Clutter throughout the home d. A small throw rug outside of the shower stall e. Grab bars in bathroom beside toilet

ANS: A, C, D The absence of railings on stairway, clutter, and throw rugs can all contribute to falls in the home. Night-lights are recommended to prevent falls as are grab bars positioned beside the toilet in the bathroom.

A nurse is using the function-focused care approach to care for a hospitalized older adult. The nurse is assisting the patient to transfer from the bed to a chair. Which of the following statements by the nurse is most congruent with this approach to care? a. "Place your hands across your chest and let us move you to the edge of the bed." b. "Place both of your hands on the overbed trapeze and pull yourself up to a sitting position." c. "How do you get yourself out of bed when you are at home? Why can't you do the same thing here?" d. "It is taking you a long time to get yourself into a sitting position. Let me help you sit up."

ANS: B FFC is based on a philosophy of care where the nurse acknowledges the older adult's physical and cognitive abilities and encourages the individual to function at the highest level possible. Option B is correct because the nurse is giving step-by-step directions and allowing the patient to move independently. Option A is incorrect because the nurse is moving the patient instead of allowing the patient to move himself/herself. Option C is incorrect because although it does solicit important information from the patient, it is making the assumption that the hospital setting is the same as the home setting. The response also has a negative tone to it. Option D is incorrect because it is not allowing the patient to use as much time as needed in order to be independent.

The nurse is preparing educational material concerning fire safety in the home. What research data will be included in the material? a. Most fires occur during the daytime hours. b. Fire mortality is highest in adults older than 80 years of age. c. Most people who die in fires are killed by the flames. d. Most fires occur outside the home.

ANS: B Fire-related mortality is three times higher in individuals over age 80. Most deaths in fires are caused by smoke injuries. Most fires occur within the home, and most fires occur at night.

A homecare nurse visits an older patient who lives in a Naturally Occurring Retirement Community (NORC). The nurse understands that NORCs are: a. purpose-built senior housing communities. b. neighborhoods or buildings where a large segment of the residents are older adults. c. communities where volunteers coordinate access to services for older adults. d. intentional collaborative housing where residents participate in the design and operation of the neighborhood.

ANS: B NORCs are neighborhoods or buildings where a large number of the residents are older adults. They were not purposely built as senior housing. The residents in a NORC aged in place. The village model is where volunteers coordinate access to affordable care for seniors. Cohousing is an intentional collaborative model where residents participate in the design and operation of the neighborhood.

A 79-year-old client resides independently in the community. The visiting home health nurse finds that despite it being 90 degrees Fahrenheit outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to: a. cognitive changes that diminish the individual's awareness of temperature changes. b. age-related neurosensory changes that diminish awareness of temperature changes. c. a delirium-related acute illness that is affecting body heat production. d. age-related motor deficiencies that result in self-neglect.

ANS: B Neurosensory changes related to aging tend to delay or diminish the individual's awareness of temperature changes and may impair behavior or thermoregulatory responses to dangerously high or low temperatures. There is no evidence in this scenario that the client has cognitive changes, an acute illness, or is incapable of self-care, and such assumptions should not be routinely made based on age alone.

The nurse is recommending that a client diagnosed with moderate stage Alzheimer's disease attend a support group when he becomes defensive about not driving his automobile and the effects it will have on "being stuck at home." Which is the priority outcome expected for this client when attending the group sessions? a. Facilitates socialization thus minimizing the effects of social isolation b. Helps with minimizing the loss as a factor in causing depression c. Provides caregivers with respite while assuring the client is well attended to d. Allows for the opportunity for a mental health professional to assess the client

ANS: B Participants attending the driving cessation support groups had an improvement in depression scores, were less angry, and were happier. Support groups designed specifically to deal with loss of driving privileges among individuals with dementia may be important in alleviating depressive symptoms and other negative outcomes associated with cessation of driving. The remaining options represent possible outcomes but they do not have the priority that minimizing depression has for this client.

A nurse in a long-term care facility notes that there has been an increase in falls on one unit and that many of the falls are occurring immediately following mealtime. The nurse recommends that the nursing home conduct a trial of six smaller meals instead of the three traditional meals. The nurse makes this recommendation on the understanding that: a. postural changes in blood pressure are common in older adults and frequently occur around mealtimes. b. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. c. residents of long term care facilities are often on many different medications, which are given at mealtimes. d. it is common practice to take long term care residents to the bathroom immediately following meals.

ANS: B Postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. Modifications such as increased water intake before eating or substituting six smaller meals daily for three larger meals may be effective. Orthostatic hypotension is a cause of falls in older adults, but does not just occur around meal times. While it is true that residents of long term care facilities are on multiple medications and are usually toileted following meals, neither of these options addresses postprandial hypotension.

A nurse is discussing the importance of exercise with a 78-year-old female who states: "I know I should be exercising, but I have arthritis in my knees and it is painful. Can you recommend a type of exercise that would be beneficial and cause me less pain?" Which of the following exercises should the nurse recommend? a. Tennis b. Swimming c. Dancing d. Use of a treadmill and elliptical machine in the gym

ANS: B The high prevalence of joint diseases, such as osteoarthritis, may hamper successful performance of aerobic exercises that cause joint impact. Tennis, dancing, and use of a treadmill and elliptical machine in the gym may all cause joint impact. Swimming is a low-risk activity that provides aerobic benefit, and water-based exercises are particularly beneficial for individuals with arthritis or other mobility limitations.

A nurse is admitting and orienting an older adult to the hospital unit. She discusses fall prevention and demonstrates the use of the call bell to the patient. The patient's daughter asks: "Why don't you just put up all the side rails to prevent my mother from getting out of bed by herself and falling. That should work, right?" The best response by the nurse is: a. "Side rails have only proven to be effective in decreasing falls in patients who have already fallen." b. "There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury." c. "Side rails are only effective when used with patients who have dementia." d. "Side rails do not decrease falls, but they do decrease fall-related injuries."

ANS: B There is no evidence to date that side rail use decreases the risk or rate of fall occurrence. There are numerous reports and studies documenting the negative effects of side rail use, including entrapment deaths and injuries that occur when the person slips through the side rail bars or between split side rails, the side rail and the mattress, or between the head or footboard, side rail, the mattress, or between the head or footboard, side rail, and mattress

An older adult's diagnosis of sleep apnea is supported by nursing assessment and history data that include: (Select all that apply.) a. followed a vegetarian diet for last 28 years. b. male gender. c. a smoking history of 1 pack a day for 45 years. d. 30 pounds over ideal weight. e. history of Crohn's disease.

ANS: B, C, D Rest factors for sleep apnea include being male, a smoking habit, and excess weight. There is no current research to support a connection between a vegetarian diet (possible low protein) or Crohn's disease to the development of sleep apnea.

A long term care facility has selected sleep promotion as its quality improvement project. Which of the following interventions would be appropriate to implement on this unit? (Select all that apply.) a. Ensuring that all residents receive evening care and are in bed by 8:00 PM b. Taking as many residents as possible outside for 30 minutes daily c. Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9:00 PM and 6:00 AM d. Avoiding waking residents for routine care during the night e. Limiting caffeine and fluids before bedtime

ANS: B, C, D, E Strategies to promote sleep for individuals in long term care and hospitals include allowing the resident to stay out of the bed and the room for as long as possible before bed, and not placing him/her in bed too early. Exposing individuals to sunlight for 30 minutes daily in a comfortable outdoor location is also helpful in promoting sleep. Limiting fluids and caffeine before bedtime is also helpful. Changing institutional routines to avoid waking residents for routine care and providing care when residents wake up are also successful strategies to promote sleep.

A homecare nurse visits a client in the home to conduct a fall risk assessment. The nurse assesses the client and the home for extrinsic risk factors for falls. Which of the following are extrinsic risk factors? (Select all that apply.) a. The client has an unsteady gait. b. The client uses a cane, but the cane is not the appropriate size for the client. c. The client's home is cluttered. d. The client is on two different medications that cause orthostatic hypotension. e. There are no grab bars in the client's bathroom.

ANS: B, C, E Extrinsic risk factors are external to the patient and related to the physical environment and include inadequate support devices. Options B, C, and E are extrinsic risk factors. Intrinsic risk factors are unique to each patient. Options A and D are intrinsic risk factors.

A nurse is educating a group of older adults on the benefits of an exercise program. The nurse includes education on when not to exercise. Which of the following should the nurse include in the education? (Select all that apply.) a. Do not exercise if your resting heart rate is over 80 b. Do not exercise if your blood pressure is greater than 200 systolic and 100 diastolic c. It is important to wait 30 minutes after a big meal before engaging in vigorous exercise d. Do not exercise if a joint that you are using to exercise is red, warm, and painful e. Do not exercise if you have a fever and muscle aches

ANS: B, D, E Older adults are advised to avoid exercise if their resting heart rate is over 120, not 80. It is important to wait 2 hours after a heavy meal before engaging in vigorous exercise, but leisurely exercise such as a walk is fine.

When an older adult client is diagnosed with restless leg syndrome (RLS), the nurse is confident that client education on the condition's contributing factors has been effective when the client states: a. "A warm bath at night instead of in the morning is my new routine." b. "Eating a banana at breakfast assures me the potassium I need." c. "I've cut way back on my caffeinated coffee, teas, and sodas." d. "I elevate my legs on a pillow so as to improve circulation."

ANS: C Increased caffeine use can be a contributing factor to RLS. There is no research to confirm that a warm bath prior to sleep or elevating the legs will minimize/prevent RLS. A potassium deficiency has not been identified as a contributing factor to RLS

Which attempt by the family to prevent an older, frail adult from falling causes the home health nurse concern? a. Keeping several low wattage night-lights on in the evening b. Installing wooden railings on the stairway to the bathroom c. Keeping the side rails up on the client's bed at night d. Encouraging the client to use a cane when ambulating

ANS: C Keeping side rails up have proven to be a risk factor for falls rather than a positive intervention. The remaining interventions are appropriate and generally effective.

A nurse is working with an older individual who has recently started an exercise program. The individual tells the nurse, "This exercise thing is really hard, and I absolutely hate walking on a treadmill going nowhere. I think I am going to call it quits." Which of the following responses by the nurse will be most effective in encouraging the individual to remain in the program? a. "If you stop exercising, you will reverse all the good effects that the exercise accomplished." b. "I will have to report that to your physician." c. "What types of exercise do you enjoy doing?" d. "Most older people hate exercising, but they do it anyways."

ANS: C Providing choices, as well as making exercise fun and entertaining, is a strategy to sustain participation in an exercise program. Options A, B, and D do not address the patient's issue of not liking a particular type of exercise.

A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. The nurse recommends that the patient eliminate which of the following? (Select all that apply.) a. Night-lights b. Railings on the stairway c. Loose carpeting on the floors d. The use of a cane e. Excess clutter

ANS: C, E Extrinsic risk factors are external to the patient and related to the physical environment and include lack of support equipment by bathtubs and toilets, height of beds, condition of floors, poor lighting, inappropriate footwear, and improper use of or inadequate assistive devices. Nightlights, railings on the stairway, and the use of a cane are all measures that can ameliorate some extrinsic risk factors.

A client who reported "a problem sleeping" shows an understanding of good sleep hygiene by: a. doing 10 pushups before bed to encourage a "pleasant tiredness." b. seldom eating a bedtime snack. c. engaging in computer games as a pre-bed activity. d. limiting the afternoon nap to just 30 minutes.

ANS: D Limiting daytime napping to 30 minutes or less is a good sleep hygiene practice. Exercise should be completed at least 4 hours before retiring while a bedtime snack is acceptable if the food is light and easily digested. Computer-focused activities are not generally encouraged as a part of a bedtime routine.

A homecare nurse in an area of the country that is prone to tornadoes routinely discusses disaster preparedness with older adult clients. What is the primary rationale for this intervention? a. Older adults are less likely to seek formal and informal help when affected by natural disasters. b. The older adult is more likely to live in a communal environment that provides assistance in times of natural disasters. c. Most older adults have insurance to help them recover from material losses due to a natural disaster. d. Federal and private assistance agencies generally provide older adults with priority attention in time of natural disasters.

Older adults are less likely to seek assistance than younger adults in times of disaster. The remaining options are not generally proven to be true for the majority of older adults.