Chapter 8: Care of the Older Adult

A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds: -"What precipitates the outbursts?" -"You need to remain calm during the outbursts." -"Play quiet music that your grandmother may like." -"Start rubbing her shoulders and her back."

"What precipitates the outbursts?" Explanation: A client with Alzheimer's disease may respond to exciting or confusing events with a catastrophic reaction, such as screaming, crying, or becoming abusive. The nurse needs to assess the situation and what precipitates the catastrophic reactions to best address how to prevent these events. Other nursing interventions include telling the client's granddaughter to remain calm and to distract the grandmother with quiet music, stroking, or both.

A nurse is teaching nursing assistants in an extended-care facility measures to protect the skin of elderly clients. Which of the following measures is the nurse likely to recommend? -Taking the clients outside for sun exposure daily -Assisting clients to soak in the bathtub several times each week -Encouraging clients to avoid cigarette smoking -Instructing clients to use perfumed skin creams

-Encouraging clients to avoid cigarette smoking Explanation: Measures to promote healthy skin function in elderly clients include not smoking. Other measures include avoiding exposure to the sun, using emollient skin cream containing petrolatum or mineral oil, and avoiding hot soaks in the bathtub.

Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to which condition after a rib fracture? -Confusion -Asthma attacks -Bronchospasm -Pneumonia

-Pneumonia Explanation: Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to pneumonia after a rib fracture. Confusion, asthma attacks, and bronchospasm are not conditions that occur after a rib fracture.

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

-Presbyopia Explanation: Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. Presbycusis refers to age-related hearing loss. Cataract is the development of opacity of the eye lens. Glaucoma is a disease characterized by increased intraocular pressure.

Which action is included in a nurse's role when providing home care for a client with Alzheimer disease? -Support patient with household errands -Provide emotional and physical support -Provide assistance with administering IV fluids -Provide assistance with administering oxygen

-Provide emotional and physical support Explanation: Home health care nurses provide emotional support and intervene if family caregivers become overburdened. The nurse also instructs the family about physical care, the disease process, and treatment. Administering IV and oxygen or supporting patients with household errands is not a relevant role for a home nurse.

A client reports to the nurse that her mother had macular degeneration and is concerned that she, too, may be at risk. What should the nurse tell the client? -Wear sunglasses with ultraviolet (UV) protection when outside. -Reduce the amount of cigarettes smoked daily from 20 to 10. -Vision loss is not hereditary. It is related to diet. -This condition is now curable.

-Wear sunglasses with ultraviolet (UV) protection when outside. Explanation: A risk factor for macular degeneration is sunlight exposure. Wearing sunglasses provides some protection. Cigarette smoking is another risk factor, and the client must stop smoking to reduce risk. Still another risk factor is heredity, and the client's mother had macular degeneration. Macular degeneration may be treated, but there is no cure.

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

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

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

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

The nurse notes that an older adult is experiencing adverse effects and mild depression from multiple medications. Which question will the nurse ask the client to help determine the reason for these assessment findings? -"How many meals do you eat each day?" -"How would you describe your alcohol consumption?" -"Have you been taking more than the prescribed doses?" -"How many times have you forgotten to take your medications?"

"How would you describe your alcohol consumption?" Explanation: Substance use disorders caused by misuse of alcohol and drugs may be related to depression. Even though moderate alcohol consumption has shown to have positive health benefits, such as lowering the risks for cardiovascular disease, alcohol use disorder is especially dangerous in older adults because of age-related changes in renal and liver function as well as the high risk of interactions with prescription medications and the resultant adverse effects. Alcohol and drug misuse in older adults often remains hidden because many older adults deny their habit when questioned. Asking an open-ended question in which the older adult describes their alcohol consumption may be helpful. Food intake will not likely cause adverse effects and mild depression. It is unlikely that the client is taking more than the prescribed doses of the medications. Although it could cause depression, forgetting to take medications would not cause adverse effects, as these are related to the medication.

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

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

An older adult asks what can be done to prevent the deterioration of the bones and muscles that often occurs with aging. Which response will the nurse make? -"Add more leafy greens to your diet." -"Eat small, frequent, high-protein meals." -"Limit the intake of alcoholic beverages." -"Limit weight-bearing exercises to once a week."

-"Add more leafy greens to your diet." Explanation: Age-related changes to the musculoskeletal system include loss of bone density, loss of muscle strength and size, and degenerated joint cartilage. Actions to prevent these changes include eating foods that are rich in calcium, such as leafy greens. Small, frequent, high-protein meals would not help prevent the age-related changes to the musculoskeletal system. Alcohol intake is not identified as affecting the musculoskeletal system. Weight-bearing exercises should be done 3 times a week to prevent changes to the musculoskeletal system with aging.

A nurse is assessing a client brought to the emergency room by his daughter. Which statement by the daughter would most likely lead the nurse to suspect that the client may have an infection? -"All of a sudden my dad seemed to become confused." -"My dad said he felt dizzy when he stood up from his chair." -"My dad's temperature was 97.6 degrees F this afternoon." -"My dad told me that he felt a little more tired today."

-"All of a sudden my dad seemed to become confused." Explanation: Due to age-related changes in the nervous system, a sudden onset of confusion may be the first symptom of an infection. Feeling dizzy on arising suggests orthostatic hypotension. A temperature of 97.6 degrees F may or may not suggest an infection. Typically older adults do not experience a traditional fever. Complaints of being tired could indicate numerous conditions.

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

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

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

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

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

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

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

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

A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate? -"Dementia is a terrible disease of the elderly." -"The most common cause of dementia in the elderly is Alzheimer's disease." -"Drug interactions are the most common cause of dementia in the elderly." -"Depression may manifest as dementia in elderly clients."

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

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

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

Several staff members are taking a break in the unit's conference room when one of them states, "I dread getting old and having to retire. I don't want to just sit on the porch in my rocking chair." The statement reflects which of the following? -Ageism -Gerontology -Geriatrics -Chronological aging

-Ageism. Explanation: The staff member's statement reflects ageism, attitudes based on stereotypes that reinforce negative images of older people. Gerontology is the scientific study of the aging process. Geriatrics is the practice that focuses on the physiology, pathology, diagnosis, and management of disorders and diseases of older adults. Chronological aging refers to the passage of time as one gets older.

A client reports to the nurse that over the past few months the elderly mother has become increasingly angry, responds inappropriately to conversations, and does not respond to calls if her back is turned away. What is the nurse's best response? -Ask if the mother could come in for a hearing evaluation. -Tell the client it appears the mother has a hearing loss. -Inform the client to ignore the behavior and the mother will stop. -Teach the client techniques for coping with the mother's anger.

-Ask if the mother could come in for a hearing evaluation. Explanation: The client's mother may be experiencing a hearing loss, and the mother should be evaluated for the symptoms the client has described. The other options do not facilitate assessment and, thus, treatment.

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

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

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

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

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

-Assess the need for pneumococcal and influenza vaccinations. Explanation: Activities that help elderly people maintain respiratory function include pneumococcal and yearly influenza immunizations. The nurse is to ensure the safety of the client. It is unsafe to administer an intravenous pain medication and then immediately discharge the client. Elderly clients should limit sun exposure to 10 to 15 minutes daily, and avoid heavy activity after eating to prevent indigestion.

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

-Decreased acetylcholine level Explanation: A decreased acetylcholine level has been implicated as a cause of cognitive changes in healthy elderly clients and in the severity of dementia. Choline acetyltransferase, an enzyme necessary for acetylcholine synthesis, has been found to be deficient in clients with dementia. Norepinephrine is associated with aggression, sleep-wake patterns, and the regulation of physical responses to emotional stimuli, such as the increased heart and respiratory rates caused by panic.

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

-Directing all health decisions to the older adult's child Explanation: The nurse should provide high-quality care to all clients, no matter what the age of the client. Allowing the client adequate time to complete tasks is appropriate and individualized. The older adult should be encouraged to develop routines not associated with work to decrease the potential for feeling nonproductive.

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

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

An elderly client reports to the nurse that food does not taste right. During a dietary assessment, the nurse learns that the client uses a lot of sugar and salt. The client states, "It makes the food taste better." The nurse intervenes by -Encouraging the client to use lemon, spices, and herbs in the diet -Increasing the amount of hot foods served to the client -Instructing the client to eat small, frequent meals -Bringing 8 ounces of the client's favorite drink to the client

-Encouraging the client to use lemon, spices, and herbs in the diet Explanation: Elderly clients may have a decreased ability to taste and compensate with excessive use of sugar and salt. The nurse should instruct the client to use lemon, spices, and herbs in meals. These substances may make food taste better. Increasing the amount of hot foods, ingesting small, frequent meals, and drinking favorite fluids will not make food taste better.

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

-Feeling of fullness Explanation: In an older adult, gastric motility slows modestly, which results in delayed stomach emptying, which in turn leads to early satiety (feeling of fullness). Calcium absorption is also decreased.

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

-Ingest five or six small meals each day. Explanation: A client who experiences orthostatic hypotension should eat five or six small meals to minimize hypotension that can occur after large meals. The client should avoid straining when having a bowel movement. A stool softener would be useful. Hot showers and whirlpools should be avoided.

An elderly client reports that he feels like he voids frequently during the day and at night but cannot empty his bladder. The nurse instructs the client to -Decrease fluid intake. -Hold his urine as long as possible before voiding. -Limit ingestion of caffeinated beverages. -Drink no more than his current 2 to 3 ounces of alcohol each day.

-Limit ingestion of caffeinated beverages. Explanation: Symptoms that the client describes may be indicative of benign prostatic hypertrophy. The client should limit caffeinated beverages. He does not want to decrease fluid intake; doing so may increase his susceptibility to urinary tract infections. He needs to void frequently and not wait long periods between voiding. The client also should limit his alcohol intake, preferably decreasing it.

Students are reviewing information about visual changes and conditions associated with aging. The group demonstrates understanding of the information when they identify which condition as the major cause of vision loss in the elderly? -Cataracts -Presbyopia -Macular degeneration -Glaucoma

-Macular degeneration Explanation: Age-related macular degeneration is the primary cause of vision loss in the elderly. More than 25% of people older than 75 years have some signs of this disease, and 6% to 8% have advanced disease associated with severe vision loss. Presbyopia refers to the condition in which the lens becomes less flexible and the near point of focus get farther away. It results in the need for reading glasses to magnify objects, but vision is not lost. Cataracts and glaucoma affect older adults, but these conditions are not the major cause of vision loss.

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

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

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

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

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

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

The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The client continuously yells, "It's 1999 and you are going to hurt me!" What action should the nurse do first? -Reorient the patient. -Take the vital signs. -Notify the physician. -Assess for infection.

-Reorient the patient. Explanation: The client is likely experiencing delirium after surgery. The first action that should be taken by the nurse is to reorient the patient. Hospitalized older adults are at risk for disorientation and confusion. Although the nurse will still need to take the vital signs and assess for infection, reorienting the client remains the first action. If the client can be reoriented, then the nurse may be able to complete the other actions without difficulty or potentially harming the client. The nurse may need to notify the physician if the client is unable to be oriented or if the assessment is abnormal.

A client with Alzheimer's disease is admitted for hip surgery after falling and fracturing the right hip. The client's spouse tells the nurse about feeling guilty for letting the accident happen and reports not sleeping well lately because the spouse has been getting up at night and doing odd things. Which nursing diagnosis is most appropriate for the client's spouse? -Relocation stress syndrome related to hospitalization -Defensive coping related to diagnosis of Alzheimer's disease -Risk for caregiver role strain related to increased client care needs -Decisional conflict related to lack of relevant treatment information

-Risk for caregiver role strain related to increased client care needs Explanation: The client's spouse is at risk for caregiver role strain because the client has started to exhibit care needs beyond the spouse's capacity to provide. A diagnosis of Relocation stress syndrome may be appropriate for a client with inadequate preparation for hospital admission, transfer, or discharge; however, this client is confused and may be unable to grasp the meaning of such preparation. The spouse, on the other hand, is more likely to be relieved, at least physically, and able to rest because of the client's admission. Defensive coping and Decisional conflict aren't pertinent nursing diagnoses in this situation because the client's spouse is aware of and has accepted the client's disease.

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

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

Which older adult is at highest risk for medication-related toxicity? -A 65-year-old with renal insufficiency -An 82-year-old with chronic diarrhea -A 72-year-old with a body mass index (BMI) of 22.6 -An 86-year-old who has had type 2 diabetes mellitus for 2 years

A 65-year-old with renal insufficiency Explanation: Many medications are excreted through the kidneys; therefore, the patient with the highest risk for drug toxicity is the patient with renal insufficiency. An older adult with chronic diarrhea has increased gastric motility, which may decrease the absorption of the medication and not increase the risk of toxicity. A BMI of 22.6 is within the normal range; therefore, the client is not at as high risk as someone who is underweight or overweight. Vascular changes do happen with diabetes mellitus, which may increase the risk for drug toxicity. Because the client has been diagnosed with diabetes for only 2 years, vascular changes are usually not significant enough to put the client at a higher risk than someone with known renal insufficiency.

A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to -Encourage the mother to take responsibility for cooking and cleaning the house. -Ensure that the mother does not have access to car keys or drive an automobile. -Allow the mother to smoke cigarettes outside on the porch without supervision. -Turn off lights at night so that the mother differentiates night and day.

Ensure that the mother does not have access to car keys or drive an automobile. Explanation: A person with Alzheimer's disease needs to be provided with a safe environment. Driving is prohibited. Cooking and cleaning may be too much stimulation and place the client in danger. Daily activities must be simplified, short, and achievable. Smoking is allowed only with supervision. The person needs adequate lighting, and nightlights are helpful, particularly if the person has increased confusion at night.

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

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

An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of -Degeneration in the efficiency of bone joints -The client's failure to exercise -Loss of bone density -Decreased muscle mass and joint cartilage

Loss of bone density Explanation: Elderly clients experience decreased bone density; they also may experience a loss of bone density from insufficient exercise. For this client, however, additional information indicates that she is taking prednisone, which may induce osteoporosis (loss of bone density). No information indicates that the client is not exercising or has experienced degeneration of bone joints. Degeneration in the efficiency of the bone joints and decreased muscle mass and joint cartilage would have more of an effect on increased pain than on decreased height.