PREP U CH.23
An older adult client comes to the health center reporting difficulty sleeping. Which statement by the client would the nurse need to address?
- "I find myself napping on and off throughout the day." Explanation: The client's statement about napping throughout the day will need to be addressed by the nurse because this can interfere with the client's ability to sleep at night. Avoiding activity after dinner, having a routine bedtime, and avoiding caffeine and alcohol are healthy sleep habits.
A nurse is conducting an education session about appropriate measures to promote sleep with an older adult who is experiencing frequent awakenings at night and then awakening early in the morning. The nurse determines that the education was successful when the client states:
- "I need to try and go to bed and get up at the same time each night." Explanation: Sleep measures include maintaining a routine, going to bed and getting up at the same time each night, avoiding exercise 3 to 4 hours before bed, using prescribed sleep medications only for the short-term (7 to 14 days), and avoiding alcohol, nicotine, and caffeine (which tea contains).
A nurse is teaching an older adult client's family about the causes of mental impairment. The nurse sees that the teaching has been effective when the family says which of the following?
- "Sundowning is a common problem of dementia." Explanation: A common problem in clients with dementia is sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated after dark. Dementia is chronic and usually develops gradually. AD is the most common degenerative illness and is irreversible. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment.
A nursing student is studying depression in older adults. Faculty members knows the student has mastered the information when she states which of the following?
- "Treatment of depression includes counseling." Explanation: Treatment of depression usually involves psychotherapy or counseling along with antidepressant medication. In an older adult, hopelessness rather than sadness is more often associated with suicidal intent. Depression usually does not resolve without treatment and is frequently underdiagnosed. There is usually a distinct change of behavior accompanied by other specific signs and symptoms of depression.
The daughter of an older adult client asks the nurse whether it is safe for her father to continue driving. Which of the following statements by the nurse is most accurate?
- "When it is obvious that your father should no longer drive, family members should address their concerns in an honest, forthright manner." Explanation: When it is obvious for safety reasons that an older driver should stop driving altogether, it is best if family members address their concerns with their older adult in an honest, forthright manner. The loss of the privilege of driving has serious repercussions for older adults. Certain adjustments can prolong an older person's ability to drive safely: driving only during daylight to avoid headlight glare, and traveling at less stressful times such as avoiding morning and evening rush hours. Loss of driving privileges may also result in fewer opportunities for activities or interactions with friends and family.
A female client asks the nurse why she urinates more frequently as she is getting older. Which of the following is the nurse's best response?
- "Your bladder capacity decreases with age." Explanation: Bladder capacity decreases by 50% in the older adult and voiding becomes more frequent. Blood flow to the kidneys actually decreases due to decreased cardiac output. The number of functioning nephron units decreases by 50%, and waste products are filtered and excreted more slowly. Although the vaginal area experiences decreased secretions and thinning, this has no compensatory relationship to more frequent urination.
The nurse is caring for an older adult client who is confused and agitated. When the client's family comes to visit the nurse asks how long the client has been confused. The family states that the client has been confused for a long time and the confusion is getting worse. The client is subsequently diagnosed with dementia. What is the most common cause of dementia in an older adult client?
- Alzheimer's disease Explanation: Alzheimer's disease is the most common cause of dementia in older adults. Approximately 10% of people over age 65 have Alzheimer's disease; about 50% of people over age 85 have the disease. Delirium, or acute confusion, is caused by an underlying disease and is not itself a cause of dementia. Depression is common in older adults but, in many cases, manifests itself in apathy, self-deprecation, or inertia — not dementia. Excessive drug use, commonly stemming from the client seeing multiple health care providers who are unaware of drugs that other health care providers have prescribed, can cause dementia. Although it is a problem among older adults, it is not as common as Alzheimer's disease.
Traumatic life events have had a damaging effect on a 55-year-old woman's psychosocial development in recent years. According to Erikson, a failure to achieve the tasks associated with middle adulthood may result in which of the following?
- An unhealthy fixation on her own needs and health Explanation: According to Erikson's theory of development, adults who do not achieve the tasks of middle adulthood tend to focus on themselves, becoming overly concerned with their own physical and emotional health needs. Emotional detachment, loss of trust, and a focus on new romantic relationships and sexuality are not specified within Erikson's characterization of development in middle adulthood.
A 79-year-old female is admitted to a long-term care facility. She is incontinent of urine and feces and has impaired cognition. What is the best nursing intervention to prevent skin breakdown for this resident?
- Assist her to the toilet every 2 hours and after meals Explanation: Implementing a toileting schedule will help prevent skin breakdown. Turning will not address the incontinence issue. Since the resident has poor cognition, asking her to notify the nurse for elimination needs is unrealistic. An indwelling catheter may increase her risk for infection and will not address the fecal incontinence.
The nurse is evaluating a 42-year-old client who says that he is feeling stressed. Which of the following does the nurse know that could be a cause of stress for this age group?
- Being caught in the sandwich generation Explanation: Middle-aged adults may be caught in a "generation sandwich," which includes involvement with children as well as aging parents and other family members. Retirement, the loss of driving privileges, and social isolation are often stressors for the older adult.
Most older adults gradually modify activities or lifestyle to accommodate for declines in strength and health. The nurse recognizes the need for older adults to maintain activity and exercise in order to preserve all physiologic functions. When encouraging activity, it is important to consider which of the following? Select all that apply. - Pain is a normal consequence of aging. - Chronic illness often accompanies aging. - There is an increased risk of sleep disorders. - Assistive devices help to maintain mobility and safety.
- Chronic illness often accompanies aging. - There is an increased risk of sleep disorders. - Assistive devices help to maintain mobility and safety. Explanation: The physical strength and health of the older adult declines and requires lifestyle modifications. Older adults have more chronic illness and have the potential for sleep disruptions and the increased risk of falls, thus the need for a cane/walker for assistance. Pain should not be assumed to be a normal consequence of aging.
An older adult client enjoys good overall health, but has just been diagnosed with pneumonia and has begun receiving an intravenous (IV) antibiotic. Shortly after being administered the first dose, the client pulled out his IV line and is now attempting to scale his bed rails. Which of the following phenomena most likely underlies this change in the client's cognition?
- Delirium Explanation: Delirium is a temporary state of confusion that is often precipitated by drug interactions or the effects of new drugs. Dementia is rooted in organic brain changes and rarely has a sudden onset. The client is not showing signs or symptoms of depression. Disorientation is a manifestation of a problem rather than a cause.
What term is used to describe various disorders that progressively affect cognitive function?
- Dementia Explanation: Dementia describes various disorders that progressively affect cognitive function. Delirium is a temporary state of confusion that can last from hours to weeks and resolves with treatment. Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in a few members of their group. Reminiscence is the phenomenon of an older adult telling stories of the past.
A 78-year-old woman is status post right hip fracture after a fall. She has stopped going to her church over the past few months. She has also asked her neighbor to help her and do her gardening, an activity she previously loved. The client tells the nurse "I just don't enjoy gardening like I used to. I am always worried about falling." What would most concern the nurse regarding the client?
- Depression Explanation: The nurse should assess the client and determine if depression is occurring first. Depression can be treated and the client's condition improved. If depression is not the issue, then the nurse could further assess and determine if there is another issue which should be addressed
A nurse encourages residents of a long-term care facility to continue a similar pattern of behavior and activity that existed in their middle adulthood years to ensure healthy aging. This intervention is based on which aging theory?
- Identity-continuity theory Explanation: The identity-continuity theory assumes that healthy aging is related to the older adult's ability to continue similar patterns of behavior from young and middle adulthood. Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified worldwide. Disengagement theory maintains that older adults often withdraw from usual roles and become more introspective and self-focused. This withdrawal was theorized as intrinsic and inevitable, necessary for successful aging, and beneficial for both the person and for society.
A nurse is reading a journal article about mood disorders in the older adult population. Which information about these conditions would the nurse expect to find? Select all that apply. - Depression is often misdiagnosed. - Symptoms often mimic those of other chronic comorbidities of the older adult. - Depression is considered a normal part of aging. - The stigma associated with depression is less for older adults. - Suicide is the most serious consequence of depression.
- Depression is often misdiagnosed. - Symptoms often mimic those of other chronic comorbidities of the older adult. - Suicide is the most serious consequence of depression. Explanation: Mood disorders (especially depression) are often unrecognized or misdiagnosed in older adults partly due to the false belief that depression is a natural reaction to illness, advanced age, or life changes that occur with age. Therefore, depression is not viewed as something that needs to be treated in the older adult. Furthermore, symptoms of depression may include poor cognitive performance, sleep problems, and lack of initiative ? symptoms commonly seen in people with multiple chronic comorbidities (such as diabetes or heart failure) or in clients with dementia or delirium, causing it to be unrecognized. Although depression is not a normal part of aging, older adults are at an increased risk of experiencing depression due to chronic illness and other age-related changes. The older adult population is also less likely to report symptoms due to the stigma attached. Suicide is the most serious consequence of depression.
A nurse is preparing to medicate an older adult client with an opioid analgesic. Which information will the nurse obtain first to decide about administering the medication?
- Determining if the client is able to communicate pain verbally or nonverbally Explanation: The nurse should ascertain the level and intensity of the client's pain. The family is not able to give adequate information about the client's pain. Taking the client's vital signs can be of value as a baseline. A client may share indication of pain other than verbally, such as a grimace or moaning. Each client may exhibit different behaviors when in pain. This is not a reliable indicator as to a client's pain level.
Gould viewed the middle years as a time when adults increase their feelings of self-satisfaction, value their spouse as a companion, and become more concerned with health. Which nursing action best facilitates this process?
- Encouraging a client to have regular checkups Explanation: Gould viewed the middle years as a time when adults look inward (ages 35 to 43); accept their lifespan as having definite boundaries, and have a special interest in spouse, friends, and community (ages 43 to 50); and increase their feelings of self-satisfaction, value spouse as a companion, and become more concerned with health (ages 50 to 60). The nursing action that best facilitates this process would be encouraging a client to have regular checkups.
Erikson identified ego integrity vs. despair and disgust as the last stage of human development, which begins at about 60 years of age. Which intervention would best foster older clients' ego integrity?
- Encouraging life review Explanation: The intervention that would best foster older clients' ego integrity would be encouraging life review. Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified worldwide. In a sense, this is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Integrity vs. despair and disgust would not be fostered by distracting the client, praising the client, or promoting independent living.
An older adult client is becoming progressively confused due to Alzheimer's disease. The family can no longer manage the client at home due to wandering. Which of the following living arrangements could the nurse recommend?
- Extended-care facility Explanation: If the older adult is cognitively impaired, family caregivers face the need for daily care giving, such as that which is provided in an extended-care facility. Respite care is temporary housing NORCs (Naturally Ocurring Retirement Community) enable the client to remain at home. Accessory apartments are separate apartments constructed, in part, out of an existing house and do not have any health care services.
The middle adult is sometimes called the "sandwich generation". According to Erikson, the developmental task of the middle adult is what?
- Generativity versus stagnation Explanation: The developmental task of the middle adult is "generativity versus stagnation." They are in a stage of guiding the next generation, accepting their own changes and adjusting to need of aging parents, as well as evaluating their own goals and accomplishments. "Initiative versus guilt" is the developmental task for toddlers. "Ego integrity versus despair" is the developmental task for older adults. "Goal attainment versus crisis" is not a developmental task.
An older adult client comes to the senior center for a check-up. During the visit, the client tells the nurse that he knows he should be more active than he is. The nurse reinforces the client's statement, explaining that physical activity helps to lower the risk of which condition? Select all that apply. Heart disease Stroke Diabetes Anxiety Arthritis
- Heart disease - Stroke - Diabetes Explanation: Physical activity is good for all people including the older adult. Being physically active (1) lowers the risk of heart disease, stroke, and diabetes, (2) reduces depression symptoms 3) improves thinking (Health People 2020). Staying active will increase or maintain strength and balance, allowing for continued independence and the prevention of injuries. Activity may be used to address symptoms of anxiety but it will not help lower the risk for anxiety. Arthritis can interfere with the older adult's ability to engage in physical activity.
Mrs. Jimenez, age 79, became a widow earlier this year and now resides alone in the house that she and her husband shared for 30 years. Her children have encouraged her to move, but she expresses a desire to remain in her home, despite some slight mobility challenges. The nurse who provides occasional home healthcare for Mrs. Jimenez should first propose which of the following?
- Home modification Explanation: Older adults typically express a desire to maintain their existing living relationships and this should be facilitated as long as it is safe. Consequently, the nurse should prioritize Mrs. Jimenez's wishes. Home modification may allow her to maximize her independence and maintain her current living situation in spite of some mobility challenges.
The nurse is reminiscing with a 72-year-old client with early onset dementia while providing care in a long-term care facility. How does the nurse implement this form of therapy to maximize the therapeutic value?
- Listen to the client's stories and ask questions to facilitate ego integrity and provide companionship. Explanation: Reminiscence is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Listening and asking questions also provides a sense of companionship to clients as they often experience loneliness during dementia even though they may have family members that visit. , nor does it support the client's acceptance of declining health status.
A nurse is assessing middle-age adults living in a retirement community. What behavior would the nurse typically see in the middle-age adult?
- Looks inward, accepts life span as having definite boundaries, and has special interest in spouse, friends, and community Explanation: Middle-age adults would be looking inward, accepting the life span as having definite boundaries, and having special interest in spouse, friends, and community. The other options are behaviors of the older adult. Reference:
The nurse practitioner is examining a 55-year-old female client. Which of the following findings would be uncommon for this age group?
- Lower extremity pulses are weak Explanation: Normal physiologic changes of the middle-aged adult do not include peripheral pulses becoming weak and not always palpable. The other options can be seen in a middle-aged adult.
A nurse is preparing an in-service presentation for a group of nurses who work with older adults. The nurse would include which finding associated with this population? Select all that apply
- Older adults living with a spouse decreases with age. - Most older adults are satisfied with their life - There are three times as many widows as widowers. Explanation: Older men were much more likely to be married than older women - 71% of men and 45% of women. Widows accounted for 36% of all older women in 2013. There were over three times as many widows (8.7 million) as widowers (2.3 million). The proportion living with their spouse decreased with age, especially for women. Most older adults find that they are satisfied with their lives and enjoying retirement and old age more than they had anticipated. The median income of older adults in 2012 had increased from 2008 by $27,612 for males and $16,040 for females.
A healthy 52-year-old client asks the nurse what she can do to maintain her health. Which of the following does the nurse recommend?
- Perform self-examination of the skin every month Explanation: Guidelines for health-related screenings, examinations and immunizations for the adult include self-examination of the skin every month; beginning at age 50 colonoscopy every 3-5 years physical examination every year from age 40 the zoster vaccine is recommended for adults 60 years and older.
An client 81 years of age is in a long-term-care facility. His family could no longer cope with his progressing senile dementia, including wandering away and unpredictable behavior. Late one night the nurse finds the client wandering in the hall. He says he is looking for his wife. What should the nursing approach should be?
- Remind him of where he is and assess why he is having difficulty sleeping. Explanation: Reminding the client where he is will help orient him to his surroundings. Assessment is needed to determine any need that may be disturbing the client, such as the need to use the bathroom, feeling cold/warm, etc. The other responses do not include orienting the disoriented/confused client.
The home care nurse is visiting an older adult client in the home to assess a leg wound and change the dressings. The nurse is aware that the client receives money monthly but there is no food in the house, no adequate heat, and the client states, "My sister takes my check and cashes it every month." What is the correct action by the nurse?
- Report the incident to social service informing them the client has no food or heat. Explanation: The client is apparently a victim of financial abuse and is being left without resources in order to live comfortably and to have basic needs cared for. The nurse should not confront the sister or have the client confront her due to the potential for violence. The incident must be reported to social service to have them involved with obtaining immediate resources for the client. Taking the client to the Emergency department would be against regulations for home health nurses and the client is not in need of immediate medical attention.
In a report, the night nurse tells the incoming nurse that one client with dementia has sundowning syndrome. Which of the following nursing diagnoses would be most appropriate for this client?
- Sleep deprivation Explanation: A common problem in clients with dementia is sundowning syndrome in which an older adult habitually becomes confused, restless, and agitated after dark and does not sleep. Implementing the nursing diagnosis of sleep deprivation will help the client obtain adequate sleep at night and awaken refreshed. Social isolation, grieving, and noncompliance are diagnoses that could be related to dementia but not sundowning.
A public health nurse is participating in a health fair that is being held at a local community center. The nurse should encourage adult participants to completely eliminate which of the following from their diet and lifestyle?
- Smoking Explanation: Alcohol, salt, and cholesterol all have the potential to cause harm when used in excess. However, moderate and conscientious intake of each is not unhealthy, and complete elimination of cholesterol or salt from the diet would in fact be harmful. Smoking, however, is never a benign activity and even "moderate" smoking should be discontinued.
A nurse has attended an inservice workshop that addressed the phenomenon of ageism in the health care system. Which of the following practices is indicative of ageism?
- Speaking to older adults with the presumption that they have mild cognitive deficits Explanation: Accommodation of normal, age-related changes such as decreased skin turgor and slightly decreased nutritional needs is not an indication of ageism. Similarly, safety measures are unlikely to be motivated by ageist beliefs. Assuming that all older adults have cognitively deficits, however, is an indication of ageism.
Which of the following assessment findings of a male client age 77 years should signal the nurse to a potentially pathologic finding, rather than a normal age-related change?
- The client is oriented to person and place but is unsure of the month. Explanation: Age-related physiologic changes include a weakening of bladder emptying, presbycusis (hearing loss), and a slow gait that may be accompanied by stooped posture. Disorientation to time, however, should always prompt the nurse to perform further assessment and should never be considered a normal accompaniment to the aging process.
A nurse is preparing a presentation for a group of older adults about health promotion. Which statistic would the nurse need to keep in mind about this group?
- The group experiencing the largest growth is those 85 years of age and older. Explanation: The older population itself is older than it has been in the past. In 2012, the 65-74 age range was more than 10 times larger than in 1900; however, in contrast, the 75-84 age group was 17 times larger, and those age 85 years or older was 48 times larger. Life expectancy has increased for both men and women. Worldwide, the number of older adults has grown exponentially. Since 1900, the percentage of individuals 65 years or older has tripled, and the number has increased over 13 times. The older adult population itself is older than it has been in the past.
A nurse arrives at the home of an older adult client. The agency was called because a neighbor noticed that the client was home alone. The nurse finds the client alone in the living room. When asked about the client's daughter who lives there and has been caring for her, the client says, "She went on vacation for about a month. She'll be back soon." Further assessment reveals that there are no other family members or services currently involved. The nurse would identify this situation as:
- abandonment. Explanation: The client is alone and without any support or caregivers. Therefore, abandonment, which is the desertion or a vulnerable older adult by anyone who has assumed responsibility for that adult's care, would apply. Exploitation involves illegally taking or misusing funds, property, or assets of a vulnerable older adult. Neglect involves refusal or failure by those responsible to provide food, shelter, protection, or health care for a vulnerable older adult. Emotional abuse involves verbally or nonverbally causing mental pain, anguish or distress on the older adult.
When creating a nursing care plan, what information should the nurse elicit from a client having difficulty sleeping?
- amount of caffeine consumed per day Explanation: In order to develop a plan of care, the nurse should ask about the amount of caffeine consumed per day, as this may influence the quality of sleep. Clients who are having difficulty sleeping should consider changes in sleep hygiene. Asking the client what activities the bed is used for (such as reading or watching television) is important, but specifically asking where sexual intercourse occurs may be seen as inappropriate. Asking when the client performs personal hygiene is not relevant to sleeping habits. Family medical history would not be necessary to develop a plan of care regarding sleep.
Based on an understanding of the cognitive changes that normally occur with aging, what might the nurse expect a newly hospitalized older adult to do?
- take longer to respond and react Explanation: The nurse would expect a newly hospitalized older adult to take longer to respond and react. It is normal for an older adult to take longer to respond and react, particularly in new or unfamiliar surroundings. Knowing this, the nurse should slow the pace of care and allow older clients extra time to ask questions or complete activities.
One of the greatest causes of death in the United States and Canada is colon cancer. The nurse instructs the community on which of the following factors?
-Annual screening after the age of 50 Explanation: Colorectal screening annually after the age of 50.
An adult child accompanies an older adult client to the clinic and states, "I am not sure what is going on with my parent but I think it is depression." What questions should the nurse ask the client to determine if he or she is depressed? Select all that apply. 1. "Can you tell me what your sleep patterns are?" 2. "Have you had any changes in weight recently such as a gain or loss?" 3. "Have you been seeing things that no one else seems to see?" 4. "What foods do you like to eat?" 5. "Have you lost interest in things you previously found pleasurable?"
1. "Can you tell me what your sleep patterns are?" 2. "Have you had any changes in weight recently such as a gain or loss?" 5. "Have you lost interest in things you previously found pleasurable?" Explanation: Extreme or prolonged sadness in an older adult may be a warning sign of depression. Depression is not a normal part of aging. Death of a spouse or friends and changes in living environment and financial resources can precipitate feelings of grieving that, if unresolved, may result in depression. There is usually a distinct change of behavior accompanied by other specific signs and symptoms of depression, such as sleep disturbances, weight loss (sometimes gain), difficulty with concentration, irritability or anger, loss of interest in once pleasurable activities, vague pains, crying, fatigue, and suicidal thoughts or preoccupation with death. Visual hallucinations are not part of the symptoms of depression and may be indicative of another form of mental illness or have an organic cause. Finding out what foods the client eats does not ask a question that relates to finding out if the client is depressed.
A nurse caring for older adults in a long-term care facility is teaching a novice nurse characteristic behaviors of older adults. Which statement is not considered ageism?
Personality is not changed by chronologic aging. Explanation: Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in only a few members of their group. Fundamental to ageism is the view that older people are different and will remain different; therefore, they do not experience the same desires, needs, and concerns as other adults. The statement not considered ageism would be that personality is not changed by chronological aging. Most older adults are not ill and institutionalized. Intelligence does not decline with age Old age does not begin at age 65.
When describing the older adult's risk for infection, which aspect would the nurse most likely address? Select all that apply. - enhanced immune function - decline in humoral immunity - lowered antibody responses - inadequate nutrition - maintenance of T-cell function
decline in humoral immunity lowered antibody responses inadequate nutrition Explanation: As people age, their immune systems become less efficient. Humoral immunity declines because of changes in T-cell function, and older adults have lower antibody response to microorganisms that cause influenza and pneumonia (Frasca, et al, 2010). Inadequate nutrition and chronic illnesses adversely affect the immune system and the ability to ward off infection. Without proper nutrients, basic body functions lack the necessary vitamins, minerals, and food substances (proteins, carbohydrates, and fats) to maintain optimal functioning.
A nurse is preparing a presentation for a group of older adults about promoting safety while maintaining their mobility. Based on the nurse's understanding of factors placing the older adult at risk for falls, which area would the nurse most likely address? Select all that apply. - hearing loss - medication use - diminished strength - environmental hazards - changes in bowel function
medication use diminished strength environmental hazards Multiple factors place the older adult at risk for falls, including the use of medications affecting balance, thinking, memory, and elimination; impaired vision; environmental hazards (e.g., slippery floors, throw rugs, poor lighting); decreased strength; loss of bone mass; and neurological and musculoskeletal problems. Hearing loss and changes in bowel function are not associated with an increased risk for falling.