Princ. EAQ #4

Which behaviors are associated with delirium? Select all that apply.

The patient gives up without trying any task. **The patient is distracted from the task assigned. The patient does not care to answer the questions asked. The patient frequently asks for feedback on performance. **The patient makes numerous errors while performing any activity. Delirium is a serious disturbance in a person's mental ability that results in confusion. A patient with delirium gets distracted from the work assigned because of mental confusion. Disturbed mental ability results in numerous errors while performing any activity. A patient with depression is preoccupied with personal thoughts and gives up without trying any task because of self-neglect. A patient with depression is preoccupied with personal thoughts and does not care to answer questions that are asked. A patient with dementia frequently asks for feedback on performance because of poor judgment ability.

The registered nurse is teaching about normal gastrointestinal system and abdomen changes in older adults. Which statement by the nurse needs correction?

The size of the abdomen decreases in older adults. In older adults, the amount of fat tissue increases in the trunk leading to increased abdominal size. Peristalsis decreases in older adults due to smooth muscle changes leading to constipation. The pH of the stomach increases in older adults. Salivary secretion also decreases in older patients.

While assessing an older patient, a nurse infers cognitive impairment. Which statements made by the patient's partner help to confirm the inferred condition? Select all that apply.

"He gets confused between activities." **"He is having a problem judging things." "He is unable to remember daily activities." **"He is unable to converse properly with family." **"He is unable to help my grandchild in calculations."

While assessing an older patient, a nurse infers cognitive impairment. Which statements made by the patient's partner help to confirm the inferred condition? Select all that apply.

"He gets confused between activities." ***"He is having a problem judging things." "He is unable to remember daily activities." ***"He is unable to converse properly with family." ***"He is unable to help my grandchild in calculations." Poor judgment, loss of language skills, and loss of the ability to calculate are associated with cognitive impairment. This may develop due a change in neurotransmitters in the brain and the symptoms may not be related to the normal aging process. Getting confused and experiencing forgetfulness may be associated with normal aging changes.

A registered nurse is evaluating the statements of the student nurse regarding reproductive changes that occur in both sexes due to aging. Which statement made by the student nurse indicates a need for further teaching?

"Production of sperm in men decreases during the third decade of life." Production of sperm declines during the fourth decade of a man's life; that is, it declines at 40 years of age, not at 30 years of age. With increasing age, sexual desire also decreases. A characteristic feature of reproductive change in women is decreased production of estrogen and progesterone. Decreased estrogen and progesterone may cause decreased lubrication of the vaginal mucosa, leading to irritation. Vaginal irritation, which occurs due to lack of lubrication, may result in pain during sexual activity.

After assessing an older patient, the nurse suspects the patient is depressed. Which further statement by the patient helps the nurse understand the reason for this condition in the patient? Select all that apply.

**"I was hospitalized recently." **"I lost my partner last month." "I employed a caregiver for myself." "I have renovated my house recently." **"I have had arthritis symptoms for a year now." Admission to a nursing center may cause depression in older adults. The loss of a partner may also be a cause of depression in an older adult. Impairment due to some health problems such as arthritis may cause depression in older adults. Employing a caregiver may help an older adult share his or her feelings and reduce depression. Renovation of a home does not disturb an older adult and therefore, would not induce depression.

A patient reports decreased ability to do activities of daily living due to fatigue to the nurse. Which problems could be present in the patient? Select all that apply.

**Anemia **Depression Fecal incontinence Cramping sensation **Thyroid dysfunction Decreased ability to do usual activities can be a sign of anemia, depression, or thyroid dysfunction. These may occur due to a decline in neural drive or nerve-based motor command to working muscles that results in a decline in the force output. This can result in peripheral muscle fatigue and decreased ability to do usual activities. Fecal incontinence and cramping sensations are signs of gastrointestinal problems and do not cause fatigue or muscle weakness.

The caregiver of an older adult patient complains of fragmented sleep cycle and worsened recent memory in the patient. The nurse performs an assessment of the patient and suspects dementia. Which other characteristics observed in the patient supports the nurse suspicion? Select all that apply.

**Apraxia **Poor judgment Dysphoric mood Impaired attention Selective disorientation Fragmented sleep cycle and worsened recent memory are some clinical features of patients with dementia. Psychomotor behavior is generally normal in patients with dementia but some may have apraxia. Patients with dementia have poor judgment due to lack of proper insight. Dysphoric mood is a characteristic feature associated with depression but not dementia. Patients with dementia generally have normal attention while impaired attention is commonly seen in patients with delirium. Selective disorientation is seen in patients with depression but not dementia.

Which conditions are related to presbyopia? Select all that apply.

**Decreased accommodation Macular degeneration of retina **Reduced ability to see in darkness Loss in the transparency of the lens **More ambient light is necessary for reading

Older adults in an acute care setting are at risk for falls. Which intrinsic factors increase the risk of falls among older adults? Select all that apply.

**Impaired vision Inappropriate footwear **Conditions affecting mobility **Adverse medication reactions **Conditions affecting balance and gait Intrinsic factors that increase the risk for falling in older adults include impaired vision, conditions affecting mobility, adverse medication reactions, and conditions affecting balance and gait. Due to impairment of vision, older adults are unable to see clearly. Due to mobility-related problems, older adults have difficulty in moving around. A quick effort to move may increase the risk of falling. Adverse medication reactions increase the chance of falling by causing drowsiness or dizziness. Conditions affecting balance and gait also may lead to an increased risk of falling. Inappropriate footwear is an extrinsic factor that may increase the risk of falling.

The nurse is caring for older adults. Which appropriate measures should the nurse adopt when suggesting a nursing home for the patients? Select all that apply.

**Select a nursing home that allows family involvement in providing care. **Choose a nursing home that does not feel like a hospital. **Ensure that the nursing home provides quality care to the patients. Ensure that the nursing home has a huge facility with many patients. **Select a nursing home having active communication with the patient's family. A nursing home should involve the family members in providing care if the family members wish to. A nursing home should be a place where patients can live like at home and not as in a hospital. The nursing home should provide quality care, personal care, food, and assistance with daily living. The nursing home should have active communication with the patient's family to keep them informed. The nursing home does not need to be huge and crowded, but it should be hygienic and homelike with no pervasive odors.

Sexuality is maintained throughout our lives. Which answer below best explains sexuality in an older adult?

All older adults, whether healthy or frail, need to express sexual feelings

Which clinical feature is related to depression in older adults?

Agitation Psychomotor disorientation or agitation is commonly seen in patients with depression. Apraxia is a clinical feature associated with dementia but not depression. Patients with delirium have increased alertness (hypervigilance). However, the alertness in patients with depression is usually normal. Impaired orientation is associated with delirium and patients with depression may have selective disorientation.

Which statement is true regarding dementia?

Attention is not affected. Patients with dementia experience no effect on their attention. Delirium, not dementia, is a state of reduced mental ability, severe enough to interfere with daily activities. Dementia starts slowly and is often unrecognized. Dementia does not worsen either in the daytime or at night. It lasts for months to years.

An elderly patient reports that he is unable to see bright lights, far objects appear blurred, and he is unable to read the newspaper as before. After examining the eyes, the nurse finds the patient's lens to be opaque. What does the nurse suspect in the patient?

Cataract Sensitivity towards bright lights is called glare. Opacity of the lens indicates loss of transparency of the lens. Loss of transparency of the lens, blurred vision, increased sensitivity to glare, and gradual loss of vision are the clinical manifestations of cataract. Presbyopia is a condition, wherein the eye is unable to focus on near objects; though presbyopia is manifested by discoloration of the lens, it is not associated with blurred vision. Diabetic retinopathy has no early signs and symptoms. Macular degeneration is manifested by accumulation of extracellular material on the retina.

Which physiological change occurs with aging?

Decreased Bladder capacity

Which endocrine change is associated with aging?

Decreased ability to respond to stress Aging decreases the ability to respond to stress, because the functional ability of the body declines with age and hormone production is altered. Aging decreases insulin sensitivity because of reduced body weight. The thyroid gland becomes nodular with age, which results in decreased thyroid secretions. Anti-inflammatory hormones are increased in older adults because of degenerative changes and oxidative stress.

An older patient reports vomiting and diarrhea. What risk will the nurse suspect in the patient?

Dehydration Vomiting and diarrhea decrease water content, which causes the patient to be at risk for dehydration. Decrease in a patient's appetite may indicate that the patient is at risk for pneumonia because appetite can decrease due to breathing problems. Decrease in a patient's appetite may indicate that the patient is at risk for heart failure because fluid is built up near the liver; this causes the appetite to decrease. Decrease in a patient's appetite indicates that the patient is at risk for a urinary tract infection (UTI) because bacterial infection may cause a decrease in appetite.

The nurse finds that an older adult patient has reduced consciousness and fatigue, and imagines something that does not exist. Which condition does the nurse suspect in the patient?

Delirium Delirium is an acute confusion state in which the patient has reduced or disturbed consciousness, is lethargic, and has distorted perceptions accompanied by delusions, hallucinations, and misperceptions. Dementia is a generalized impairment of intellectual functioning that interferes with social and occupational functioning. Older adults sometimes experience late-life depression; this is the most common undetected and untreated impairment. Alzheimer's disease is a progressive cerebral deterioration that can occur in middle or older age.

Which clinical manifestation may present in a patient with dementia?

Difficulty with abstraction A patient with dementia may face difficulty with abstraction. Incoherent speech may be associated with a patient with delirium. Attention may be altered in a patient with delirium; however, patients with dementia generally have normal attention. Misperceptions are usually absent in dementia. However, in delirium, the patient may find it difficult to distinguish between reality and misperceptions.

Which statement is true regarding delirium?

Disturbed sleep/wake cycle is disturbed. The sleep/wake cycle is disturbed in delirium. The onset of delirium is sudden or abrupt but not insidious. Alertness in delirium fluctuates and is lethargic or hypervigilant, but not normal. Progression of delirium is abrupt, not gradual over months and years.

Which body system is involved in presbycusis?

Ears Presbycusis is characterized by the presence of a loss of acuity for high-frequency tones and conversational speeches due to aging. It is a physiological sensory change that may occur in the ears with aging. Sensory changes in the eyes include yellowing of the lens and altered color perception. A sensory change in taste is often characterized by fewer taste buds. A sensory change in the touch might be caused by decreased skin receptors.

The nurse is assessing an older patient who attempted suicide twice due to death of his life partner. He has undergone psychotherapy for depression, but the symptoms have not subsided. Which therapy would be beneficial for the patient?

Electroconvulsant therapy Older adults may experience late-life depression due to the loss of a life partner, but this is not a normal part of aging. If the patient does not respond to psychotherapy, it indicates the patient has resistant depression. In this case, electroconvulsant therapy is used. Reminiscence is the recollection of the past, which is used to understand and resolve present conflicts. Validation therapy is an alternative approach used to treat older adults who are confused about the present. Medication therapy is used to treat clinical depression.

Which system is affected in periodontal disease, which occurs as a result of common physiological change with aging?

Gastrointestinal system Periodontal disease may occur as a physiological change in the gastrointestinal system with aging. The respiratory system is characterized by increased cough reflex, decreased cilia, and fewer alveoli. Physiological changes in the neurological system include degeneration of nerve cells and degeneration of neurons. Physiological changes in the genitourinary system include decreased nephrons and decreased bladder capacity.

While caring for an elderly patient, the nurse suspects that the patient has developed depression. Which action of the patient supports the nurse's suspicion?

Getting up early in the morning with frequent arousals at the night An elderly patient with depression may have disturbed sleep at nights and may wake up early in the morning due to preoccupied personal thoughts and poor appetite. A patient with delirium finds it difficult to cope with daily activities such as dressing and tying shoelaces. This is due to exaggeration of personality type associated with acute physical illness. The patient with delirium usually feels distracted from tasks and makes mistakes while performing daily basic activities. A patient with dementia gets tired easily after performing a small activity.

Aging affects bodily secretions. What is the effect of reduced salivary secretion and taste bud atrophy in the elderly patient?

Inability to differentiate various tastes Inability to differentiate various tastes Reduced salivary secretion and taste bud atrophy occur due to aging, leading to the inability to differentiate among salty, sweet, sour, and bitter tastes. Reduced salivary secretion and taste bud atrophy do not cause gum diseases, mouth ulceration, or a decrease in appetite.

After reviewing health records of four older patients, the nurse suspects normal age-related physiological changes in one patient. Which patient's lab findings may the nurse observe?

Patient 2 has increased fat tissue, decreased thymus size, and increased anti-inflammatory hormones. In older patients, the amount of fat tissue increases, the thymus gland decreases in size and volume, and anti-inflammatory response increases. Therefore, patient 2 has normal age-related changes. In older patients, the size of the prostate increases, sensitivity to glare increases, and firm erections are fewer. The blood vessels narrow, the vessel lumen thickens, and there is decreased calcification of heart, decreased thyroid secretions, decreased T-cell function, and increased systolic blood pressure in older patients. Therefore, the findings in Patient 1, Patient 3, and Patient 4 are not age-related changes.

While assessing the health of four patients, the nurse discovers one of the patient's findings to be age-related. Which patient supports the nurse's conclusion?

Patient B has yellowing of the lens. With aging, the crystalline fibers present in the lens stop regenerating and undergo many post-translational changes. These changes make the lens appear opaque and yellowish. Therefore, patient B's finding supports the nurse's conclusion. White sclera is a normal finding, not an age-related change. In older adults, there will be increased sensitivity to glare as an effect of aging. Therefore, the finding of patient C is not a physiological change related to aging. Pupils dilate upon exposure to light. Therefore, patient D's finding is normal.

Which patient's finding will the nurse document as a normal aging process?

Patient C has a loss of skin elasticity Loss of skin elasticity is a normal aging process because of loss of elastic tissue under the skin. Therefore, the nurse will document patient C's finding as a normal aging process. Loss of language skill is not a normal process of aging and signifies some other cause behind it. Pain in the muscles is due to diseases and is not a normal process of aging. The inability to calculate in an older adult is due to a mental disorder and is not a normal process of aging.

The nurse is reviewing the diagnostic report of four patients. Which patient will the nurse suspect to have difficulty hearing?

Patient C has presbycusis Presbycusis refers to age-related hearing impairment in older adults. The nurse suspects that patient C will have difficulty hearing if he or she has been diagnosed with presbycusis. Patient A has cataract; therefore, the nurse will suspect loss of transparency in the eye lens. Patient B has presbyopia; therefore, the nurse will suspect retinal damage. Patient D has macular degeneration; therefore, the nurse will suspect change in the macula of the patient's eye.

After interacting with an older adult patient, the nurse suspects that the patient has presbyopia. Which action of the patient supports the nurse's suspicion?

Picking a blue shirt assuming it as black Presbyopia is a visual acuity that leads to progressive decline of the eyes to accommodate vision. Therefore, an older adult patient with presbyopia may not able to differentiate dark colors such as black and blue. A patient with mental impairment finds it hard to remember things and keeps repeating essential words. Salivary secretion reduces in older adults. Therefore, the patient sips water occasionally to reduce thirst. Older adults may have age-related hearing impairment, known as presbycusis. These older adults may ask others to speak loudly.

Which condition does the nurse suspect in an older adult patient who has complained of daily hearing decline?

Presbycusis

The caregiver of an older adult patient reports, "My father, in spite of turning up the volume on the radio and television, complains that he is unable to hear." Which condition should the nurse suspect in the patient?

Presbycusis Auditory changes are often subtle in older adults, and are often unidentified and untreated. A 68-year-old patient with presbycusis may have impacted cerumen, which is a common cause of diminished hearing acuity. Kyphosis occurs in the older adults due to osteoporosis, which leads to curvature of the thoracic spine. Keratoses are irregular, round or oval, brown, and watery lesions usually found on an older adult's skin due to aging. Presbyopia is a visual acuity defect in older adults that occurs due to retinal damage, reduced pupil size, development of opacities in the lens, or loss of lens elasticity.

Which condition may result in difficulty initiating voiding and maintaining a urinary stream in older adult males?

Prostatic hypertrophy Difficulty initiating voiding and inconsistent urinary stream may occur due to an enlarged prostate, or prostate hypertrophy. Stress incontinence is usually seen in women, and the urine is released involuntarily during sneezing, coughing, and laughing due to stress on the urinary bladder. Urinary tract infections may not lead to an inconsistent urine stream. Weakened bladder muscles lead to urinary incontinence.

The student nurse is caring for an elderly patient with dementia. Which action of the student nurse indicates a need for correction? Select all that apply.

Providing support with mealtime choices Asking the caregiver questions about the patient Provide assistance in bathing, dressing, and eating **Asking the patient to administer the medications as per the prescription **Encouraging the caregiver to send the patient to a nursing home immediately

Which factor indicates the normal process of aging?

Reduced number of brain cells

What are the clinical features of an older patient with dementia?

Remote memory that becomes progressively impaired, fragmented sleep Dementia is a generalized impairment of intellectual functioning. A patient with dementia may have progressive impairment of memory that interferes with social and occupational functioning. Dementia also minimizes quality of life, such as fragmented and poor quality of sleep, mood, and cognition. A patient with delirium may have symptoms such as reduced consciousness, impaired orientation, acute physical illness, and disoriented perception. A patient with depression may have selective disorientation associated with intact perception.

Taste buds atrophy and lose sensitivity, and appetite may decrease. As a result, which is the older adult less able to discern?

Salty, sour, and bitter tastes As people, age, salivary secretion is reduced, and taste buds atrophy and lose sensitivity. The older adult is less able to differentiate among salty, sweet, sour, and bitter tastes. Often an adult uses heavy spices because of the inability to taste food. Older adults maintain their ability to differentiate between hot and cold temperatures, and moist and dry food.

The nurse is teaching a group of older adults. Which principles are helpful in promoting learning in older adults? Select all that apply.

Sit to the side rather than directly facing the patient. *Ask for feedback from the patient. *Present one idea or concept at a time. Speak fast and in a loud voice. *Use audio and visual cues while teaching. In old age, some sensory changes occur in the body, so the teaching should be adjusted accordingly. By using appropriate teaching techniques, the nurse should be able to help the patient compensate for sensory changes and perform activities independently. The nurse should ask for feedback from the patient to ensure that the patient understands the information. Presenting one idea or concept at a time helps to avoid confusion. Audio and visual cues should be used while teaching, because they help the patient to remember and retain information. These principles help to promote learning in the older adult. The nurse should sit facing the patient so that the patient is able to watch lip movements and facial expressions, because this helps the patient to understand the subject. The nurse should speak slowly and in a normal tone of voice for the patient to understand properly.

Which condition can be inferred in a patient who complains of involuntary release of urine while laughing, sneezing, and coughing?

Stress incontinence Involuntary release of urine while laughing, sneezing, coughing, and lifting things is a sign of stress incontinence. In diabetes mellitus, a patient may show symptoms such as increased frequency of urinating. Prostate hypertrophy can lead to difficulty in initiation of voiding and maintenance of the urinary stream. Patients may have pain while urinating when experiencing a urinary tract infection.

The nurse has conducted an assessment of a new patient who has come to the medical clinic. The 82-year-old patient has had osteoarthritis for 10 years and diabetes mellitus for 20 years. The patient is alert but becomes easily distracted during the nursing history. The patient recently moved to a new apartment, and the patient's pet beagle died just 2 months ago. Which is this patient most likely experiencing?

depression Factors that often lead to depression include presence of a chronic disease or a recent change or life event (such as loss). Patients are alert but easily distracted in conversation. The symptoms presented by this patient do not indicate dementia, delirium, or disengagement.

Upon interacting with an older adult patient with preoccupied thoughts and poor hygiene and self-care, the nurse finds the patient feels lost after losing a family member in an accident. Which condition would the nurse suspect in the patient?

depression Older adults may experience late-life depression, but it is not a normal part of aging. Depression may occur with major life changes such as losing family in an accident; this is assessed easily by preoccupied thoughts, and poor hygiene and self-care. Delirium may be manifested by variable affective changes and exaggeration of personality type. It is also associated with acute physical illness. Lewy body disease and Alzheimer's disease are the generalized impairment of intellectual functioning that interferes with social and occupational functioning as aging progresses.

Which body system is affected in presbyopia?

eyes Sensory change in the eyes is characterized by the presence of decreased accommodation to near or far vision and is called presbyopia. Sensory changes in the ears include thickening of the tympanic membrane and sclerosis of the ear. Sensory changes of smell include diminished sense of smell. A sensory change in the taste is often characterized by fewer taste buds.