Craven Ch 16: Caring for the Older Adult

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. - "Can you tell me what your sleep patterns are?" - "Have you had any changes in weight recently such as a gain or loss?" - "Have you been seeing things that no one else seems to see?" - "What foods do you like to eat?" - "Have you lost interest in things you previously found pleasurable?"

- "Can you tell me what your sleep patterns are?" - "Have you had any changes in weight recently such as a gain or loss?" - "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.

An older adult client comes to the clinic for a follow-up evaluation. During the visit, the client tells the nurse about "having trouble sleeping lately." Which question should the nurse ask to obtain more detailed assessment information to develop a plan of care? - "Do you use nicotine, alcohol or caffeine?" - "Do you vary your bedtime to sensitize your body to going to bed at any time?" - "Do you exercise right before bedtime to tire yourself for a better night's rest?" - "Have you tried watching television in bed to promote sleep?"

- "Do you use nicotine, alcohol or caffeine?" Explanation: The nurse asking an open-ended question about the use of nicotine, alcohol and caffeine will allow the client to answer in a more conversational way, as well as give the nurse information pertinent to the sleep assessment. The use of nicotine, alcohol or caffeine can interfere with sleep. Going to bed at the same time each night, avoiding exercising for 3 to 4 hours before bedtime, and using the bed for only sleep and intimacy promote sleep.

The nurse is caring for a client who is experiencing ongoing pain following a shoulder injury. Which client statement about the current pain management regimen should the nurse address with further teaching? - "I am worried that I am getting addicted because I keep needing higher doses of my pain medication." - "I have started doing relaxation, exercises but I have kept taking the same dose of my pain medications." - "I have my adult child helping me with organizing my pain medications to make sure I do not miss a dose." - "If I do not get adequate pain control I am going to make another appointment with my care provider right away."

- "I am worried that I am getting addicted because I keep needing higher doses of my pain medication." Explanation: Some clients require reassurance and teaching that tolerance is not an indicator of pending addiction. Following up with the care provider if relief is not obtained is a sound practice. Similarly, having a trusted family member assist with organizing medications is advisable. Nonpharmacologic interventions should be encouraged, and clients should be encouraged to adhere to their pharmacologic regimen at the same time, as this client is doing.

An older adult client comes to the health center reporting difficulty sleeping. Which statement by the client would the nurse need to address? - "I try not to be too active once I've eaten dinner." - "I find myself napping on and off throughout the day." - "I go to bed around 10:30 pm every night." - "I don't drink coffee or alcohol."

- "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 should do some mild exercises about 2 hours before bedtime." - "I need to try and go to bed and get up at the same time each night." - "I should continue to take my sleep medication for as long as I need to." - "I should avoid coffee, but tea is okay to drink before bed."

- "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).

An older adult client has described recent struggles with insomnia and has acknowledged using over-the-counter sleep aids for the past several days. What teaching should the nurse provide? - "It is important to take these medications for as brief a time as possible." - "Over-the-counter sleep aids have actually been shown to be ineffective in causing sleep." - "You will likely find that prescription medications are more effective and do not have the side effects of over-the-counter medications." - "I encourage you to stop using over-the-counter sleep aids and to cut out naps from your routine instead."

- "It is important to take these medications for as brief a time as possible." Explanation: Over-the-counter sleep aids, while effective in the short term, must be used with great caution, for as little time as possible. Prescription medications are valid options but these have adverse effects as well. Recommending cessation of the medications and replacement with one specific aspect of sleep hygiene (avoiding naps) is simplistic and unlikely to resolve the client's underlying issue.

A nursing student is completing a clinical rotation on a hospital unit for older adults. A classmate tells the student, "Most of our clients are likely to have dementia, because it is a normal part of aging." What is the student's best response to the classmate? - "It is actually a myth that older adults get dementia more often than younger adults." - "Older clients are certainly more likely to have dementia than younger clients, but it is not a normal part of aging." - "Even though dementia is a normal part of aging, we still need to assess for it and choose appropriate interventions." - "Research has shown that the association between age and dementia is based on a stereotype."

- "Older clients are certainly more likely to have dementia than younger clients, but it is not a normal part of aging." Explanation: Although not a normal part of aging, the incidence of dementia (irreversible loss of intellectual function), such as Alzheimer disease, is rising in line with the aging population. This association is demonstrable and is therefore not simply a stereotype or myth.

The nurse in a long-term care facility is caring for an older adult who has dementia. The adult had a long career as a small business owner, and tells the nurse, "I need to leave right away to close up the shop for the day." What is the nurse's most therapeutic response? - "Tell me more about the store that you operated during your career?" - "Why is it important that you go and do this right now?" - "I am certain that someone will be taking care of that task for you." - "Remember that you are not responsible for doing that anymore."

- "Tell me more about the store that you operated during your career?" Explanation: Eliciting information about the client's store acknowledges the client's statement while redirecting the conversation to a matter of less urgency. The client is likely to respond to attempts at reorientation with frustration and agitation. Similarly, asking why this has to be done now is likely to cause frustration, because the client likely believes the need for this task is obvious to any reasonable person.

The staff at a long-term care facility have made minimal effort to secure a shared room for a couple in their late 80s, who have been married for several decades. The manager states, "I'm sure that bedroom activity is the last thing on their mind these days." How should the nurse best respond to the manager's characterization of sexuality in older adults? - "They might not be as active as in years past, but sexuality is still important for older people." - "It's actually a myth that older adults have sex less often than younger adults." - "There's no reason that we should assume they're less interested than when they first got married." - "Their sexual activity has probably stopped by now, but they still need companionship."

- "They might not be as active as in years past, but sexuality is still important for older people." Explanation: Although sexual activity may be less frequent, the ability to perform and enjoy sexual activity lasts well into the 90s in healthy older adults. However, it is unlikely that interest remains at the same level as when the couple was first married.

A home care nurse is caring for a client who lost the spouse to cancer 3 years ago. What question would the nurse ask to facilitate a life review? - "What would you like to do today?" - "Do you have any hobbies or extracurricular activities you enjoy?" - "Would you tell me about your life when you first met your spouse?" - "What would you do differently if you had the chance?"

- "Would you tell me about your life when you first met your spouse?" Explanation: Older adults search for emotional integration and acceptance of the past and present. They often like to tell stories of past events in life to reminisce and restructure life experiences to facilitate achieving ego integrity. 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. Nurses can also use reminiscence as a therapy to facilitate adaptation to present circumstances. Older clients can reminiscence which may include past emotions about life events and regret about undone tasks but this is not the goal of the reminiscing; therefore; asking if the client would do things differently would not be a good question to facilitate a life review. Asking the client what they would like to do today or about hobbies is a great way to get the client active but not to facilitate a life review.

A nurse is assessing an older adult for depression using the Yesavage Geriatric Depression Scale. Which score would the nurse identify as indicating possible depression? - 0 - 2 - 4 - 6

- 6 Explanation: A score of 5 points or more with the Yesavage Geriatric Depression Scale indicates probable depression.

A nurse is reviewing the medical records of several older adults admitted to the long-term care facility. Each of the clients has been assessed for depression using the Yesavage Geriatric Depression Scale. Which clients would the nurse identify as requiring interventions related to possible depression? Select all that apply. - 75-year-old male with a score of 3 - 80-year-old female with a score of 7 - 69-year-old female with a score of 4 - 71-year-old male with a score of 10 - 85-year-old male with a score of 1

- 80-year-old female with a score of 7 - 71-year-old male with a score of 10 Explanation: A score of 5 or more on the Yesavage Geriatric Depression Scale indicates probable depression. Therefore, the 80-year-old female and 71-year-old male may have depression and would need interventions to address it.

An older adult client tells the nurse, "I have never had trouble sleeping, but lately I find I take hours to fall asleep at night and do not wake up refreshed." The client denies any significant psychosocial stressors. What is the nurse's best assessment? - Assess for any recent changes in the client's medication regimen. - Assess the client's nutritional status. - Assess the client's coping strategies and level of social support. - Assess for recent changes in mobility.

- Assess for any recent changes in the client's medication regimen. Explanation: Many medications can have a profound effect on the quality and quantity of sleep. As such, the nurse should identify any changes that may account for the client's change in sleep. Although nutritional status affects all areas of functioning, it is less likely to account for a new and serious disturbance to sleep. Coping strategies would be an important focus in most situations, because stress directly impacts sleep; however, the client explicitly denies stressors. Mobility can have an indirect effect on sleep, but medications are a more common influencer.

A nurse is working as part of community group focusing on addressing health disparities and poverty. The community has a wide range of racial and ethnic minorities. The community group would focus its attention on which groups, when members lived alone, as having the highest poverty rates? Select all that apply. - Black women - Hispanic women - American Indian/First Nations men - Asian men - White non-Hispanic women

- Black women - Hispanic women Explanation: Of older Whites (non-Hispanic), 6.8% were poor in 2012 compared to 18.2% of Blacks, 12.3% of Asians, and 20.6% of Hispanics. The highest poverty rates were experienced among Hispanic women (41.6%) who lived alone and also by older Black women (33%) who lived alone.

A client aged 88 years who lives alone experiences dizziness caused by blood pressure medication. What intervention would the nurse prioritize in teaching this client? - Increase water intake. - Stop taking the medication. - Change positions slowly. - Increase sodium intake.

- Change positions slowly. Explanation: The client should change positions slowly to minimize the possibility of dizziness. The client should not stop taking the medication. Increasing water and sodium intake could increase blood pressure. The effects of chronic illness and medications may also make the older adult more prone to accidents.

The nurse is providing care to an older adult client. Which assessment finding would necessitate the inclusion of interventions in the nursing plan of care to decrease the risk for disability? - Client is prescribed calcium and vitamin D to prevent the development of osteoporosis. - Client's current body mass index (BMI) is 40. - Client is prescribed nitroglycerin to treat angina. - Client's current pain rating is a 3 on a 1-10 scale.

- Client's current body mass index (BMI) is 40. Explanation: A client who is obese which increases the risk for disability due to low levels of physical activity. A client taking supplements to decreasing their risk of the development of osteoporosis and a client using nitroglycerin to treat angina are decreasing their risk of disability. A client in pain does not increase the risk of disability.

The nurse is reviewing the medication orders for an older client and notes an order for a benzodiazepine. The nurse contacts the physician based on the understanding that the use of this drug places the client at risk for which condition? Select all that apply. - Cognitive impairment - Delirium - Falls - Hyperkalemia - Stroke

- Cognitive impairment - Delirium - Falls Explanation: Older adults have an increased sensitivity to benzodiazepines and slower metabolism of the longer-acting agents. In general, all benzodiazepines increase the risk of cognitive impairment, delirium, falls, fractures and motor vehicle accidents in older adults. Hyperkalemia is a possible effect with spironolactone, a potassium-sparring diuretic. Stroke is a risk when first and second generation antipsychotics are used.

A home care nurse has been working with an older adult client with a chronic leg ulcer for several months and has noticed a gradual decline in the client's ability to provide self-care and activities of daily living (ADLs). What action will the nurse take? - Collaborate with the client's family to explore options and organize care. - Facilitate a referral for physical therapy and assessment. - Advocate for increased pain medication with the primary care provider. - Assess the client for Parkinson disease or multiple sclerosis.

- Collaborate with the client's family to explore options and organize care. Explanation: The family plays a pivotal role in helping older adults adjust to and compensate for decreased self-care and functional ability. Occupational therapists can be beneficial, but physical therapy is not always relevant, depending on the cause of the client's decline. There is no indication that pain underlies the client's decline. Assessing for specific medical diagnoses is beyond the nurse's scope of practice.

A nurse is making a home visit to an older adult with multiple chronic health problems. The client is alert and oriented and cognition is intact. While talking with the client, the client reveals a belief that the adult child is stealing the client's social security checks to buy beer and eat out all the time. What action should the nurse first do regarding the possible elder abuse to keep the client safe? - Immediately report the abuse to the state authorities. - Educate the adult child on how to recognize and prevent elder abuse. - Complete an elder abuse assessment by using an elder abuse screening tool. - Educate the client on how to recognize and prevent elder abuse.

- Complete an elder abuse assessment by using an elder abuse screening tool. Explanation: The client could be a victim of exploitation which involves illegally taking or misusing the funds, property, or assets of a vulnerable older adult. There are many elder abuse assessment tools available for healthcare providers. Many states require the nurse to report suspected elder abuse; however, the nurse should first assess the client using an elder abuse screening tool. More information should be gathered before reporting the abuse to authorities in order accurately report the facts of the case. Educating the adult child more than likely would not prevent the abuse from happening. Educating the client on elder abuse may help the client to understand that they may be the victim of abuse, but it won't keep them safe.

A older adult client reports that he was taking an over-the-counter antihistamine. He shows the nurse the package which lists chlorpheniramine as an ingredient. The nurse would assess the client for which adverse effect? Select all that apply. - Confusion - Dry mouth - Constipation - Incontinence - Decreased appetite

- Confusion - Dry mouth - Constipation Explanation: Chlorpheniramine is a first generation antihistamine that is highly anticholinergic. As a result, the client is at risk for confusion, dry mouth and constipation. Urinary retention, not incontinence, might be noted. Decreased appetite is not associated with the use of this drug.

A nurse is caring for an older adult client who fell and sustained a hip fracture. Which intervention needs to be included in the nursing care plan? Select all that apply. - Cough and deep breathe every 2 hours. - Avoid massaging over bony prominences. - Turn the client every 4 hours. - Auscultate breath sounds every 1-2 hours. - Monitor daily weights.

- Cough and deep breathe every 2 hours. - Avoid massaging over bony prominences. - Auscultate breath sounds every 1-2 hours. Explanation: An older adult is more likely to develop complications after illness occurs. An older adult with a hip fracture is at high risk for pneumonia and skin breakdown because of immobility, a decreased ability to expel pulmonary secretions, and thinner, more fragile skin. Coughing, deep breathing, and auscultating breath sounds are interventions used in preventing and detecting impaired gas exchange (pneumonia). Maintaining skin integrity can be achieved by the avoidance of massage over bony prominences. Repositioning the client every 4 hours is not frequent enough; it should be done every 2 hours. Monitoring daily weights is not an intervention useful in pneumonia or skin breakdown.

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 - Dementia - Disorientation - Depression

- 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.

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 - Generalized anxiety disorder - Realistic caution - Bipolar disorder

- 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 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? - Observing client behavior to determine if coincides with report of pain - Taking the clients vital signs to determine if indicative of pain - Determining if the client is able to communicate pain verbally or nonverbally - Obtaining family feedback about client's pain level

- 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.

During a home visit, an older adult client acknowledges that they are is not receiving adequate nutrition. The client states, "I just do not have enough money for groceries, because my adult child spends all my money as soon as I get any." What is the nurse's priority action? - Take prompt action to protect the client from the adult child. - Document and report the client's statement to the appropriate authorities. - Arrange for the client to receive legal advice. - Facilitate a referral to social work.

- Document and report the client's statement to the appropriate authorities. Explanation: The nurse has a responsibility to report any instances of elder abuse to the appropriate authorities. Because the adult child does not pose an immediate threat of direct physical harm, protecting the client is not an immediate priority. Social work referrals and legal advice may be necessary, but the nurse's immediate responsibility is to report this plausible case of elder abuse.

Fall prevention is a major part of nursing and risk management. In order to reduce the risk of falling, the nurse should do which of the following? Select all that apply. - Ensure that the client wears their prescription glasses when up. - Post signs to alert staff to the client at high risk for falls. - Always assist every client with ambulation. - Assess the client's fatigue level. - Monitor gait and balance.

- Ensure that the client wears their prescription glasses when up. - Post signs to alert staff to the client at high risk for falls. - Assess the client's fatigue level. - Monitor gait and balance. Explanation: Fall prevention need only apply to clients at risk. To prevent the risk for falls, the nurse should ensure that the client wears their prescription glasses when up and to assess the client's fatigue level, gait and balance. If necessary the nursing staff should be alerted if the client is at risk. It is not realistic to expect that every client would always need assistance to ambulate.

The community health nurse has been providing care for an older adult client or several weeks. During the past three visits, the client has been responding to questions with an uncharacteristically hostile tone and has suggested that the nurse has dishonest motives for visiting the home. In addition to ensuring the nurse's own safety, how should the nurse best follow-up these assessment findings? - Facilitate screening for dementia or other cognitive deficits. - Decrease the frequency of visits to diffuse the client's suspicions and aggression. - Advocate for admission to inpatient care. - Administer a screening tool for depression.

- Facilitate screening for dementia or other cognitive deficits. Explanation: Dementia can manifest as uncharacteristic aggression or suspicion. The nurse should ensure the client is assessed accordingly. Decreasing the frequency of visits enhances safety but does not facilitate the care the client may need. There is no obvious indication for inpatient care. Depression can cause changes in behavior, but these rarely involve aggression and/or suspicion.

A group of nursing students is reviewing information about the older adult and mobility. The students demonstrate a need for additional study when they identify which statement as accurate? - Falls are the leading cause of death due to injury in individuals who are over the age of 75 years. - An older adult experiences numerous factors that increase the risk for falls. - Older adults are faced with challenges related to the fear of falling and striving for independence. - Medications in the older adult play a major contributing role to the risk for falling.

- Falls are the leading cause of death due to injury in individuals who are over the age of 75 years. Explanation: For people over the age of 65 years, falls are the leading cause of injury leading to death, with hip fractures resulting in significant morbidity and mortality. Numerous factors place the older adult at risk for falls, including a history of falls, fear of falling, cognitive and mood impairments, dizziness, functional impairments, and environmental hazards. Older adults are faced with dealing with the fear of falling and striving for independence. Medications often play a major role in contributing to falls and other complications in the older adult.

A nurse is assessing a 55-year-old female client. What is a normal physical change in the middle adult? Select all that apply. - Skin moisture increases. - Hormone production increases. - Hearing acuity diminishes. - Cognitive ability diminishes. - Cardiac output begins to decrease. - There is a loss of calcium from bones.

- Hearing acuity diminishes. - Cardiac output begins to decrease. - There is a loss of calcium from bones. Explanation: Normal physical changes that occur in the female middle adult include: hearing acuity diminishes, cardiac output begins to decrease, and there is a loss of calcium from bones. Skin becomes more dry, hormone production decreases, and cognitive ability does not diminish.

A 78-year-old woman is on a nurse's rehabilitation unit status post a cerebrovascular accident (CVA). As the nurse assess her gait, the nurse notices that the client's left foot is dragging and she is not bending her left knee nor swinging her left arm. How would the nurse best describe the client's gait? - Spastic - Festinating - Hemiparesis - Ataxic

- Hemiparesis Explanation: Hemiparesis is weakness on one side of the body.

A nurse is working with an older adult population at a local community senior center. Based on information from the Association of Aging, the nurse would anticipate needing to address which condition as most common? - Cancer - Diabetes - Hypertension - Arthritis

- Hypertension Explanation: The most frequent occurring conditions for older adults from 2010-2012 were hypertension, arthritis, heart disease, cancer, and diabetes (72%, 50%, 30%, 24%, 20%, respectfully).

A nursing student is providing care in a long-term care facility where several residents have dementia and other cognitive impairments that result in confusion. What communication strategy(ies) should the student employ when interacting with chronically confused residents? Select all that apply. - Avoid mentioning the time of day or the date to prevent further confusion. - Identify themselves during each encounter with the client. - Speak louder than usual but avoid using simplistic language. - Use simple, short sentences when giving directions. - Ask only one question at a time.

- Identify themselves during each encounter with the client. - Use simple, short sentences when giving directions. - Ask only one question at a time. Explanation: Communication strategies for working with confused clients include simple, short directions and questions and always identifying oneself. Speaking loudly does not normally improve comprehension. Many clients benefit from reorientation to the time or place, but this should not be universally avoided.

A nurse is working on a unit where the majority of the clients are older adults. When reviewing the plans of care for these clients, the nurse notes that chronic pain management due to osteoarthritis is a priority. Which measures should the nurse implement? - Individualized regular exercise to maintain joint mobility. - An intensive exercise regimen to increase joint strength. - Limit rest to keep the clients active. - Bedrest to relieve joint pain.

- Individualized regular exercise to maintain joint mobility. Explanation: Osteoarthritis is a major cause of chronic pain in older adults. Regular individualized exercise will help to improve and/or maintain joint mobility. Bedrest or an intensive exercise routine may not be appropriate for an older adult. Intermittent rest periods can allow the client to gain strength and continue activity.

Which statement is true for nursing care of older adults? - Most older adults are unable to care for themselves independently. - Most older adults are functional, benefiting from health-oriented interventions. - Fewer older adults will require nursing care during the 21st century. - Interventions for older adults are no different from those for young adults.

- Most older adults are functional, benefiting from health-oriented interventions. Explanation: As the number of older adults increases, nurses will spend more time providing care for this population. Most older adults are not impaired but remain functional in the community, thereby benefiting from health-oriented nursing interventions. Interventions for older adults are focused on safety and independence, which are different for this group than the younger aged.

A nurse is providing care at an ambulatory care center to a wide range of older adults from diverse racial and ethnic groups. Based on recent statistics, which group would the nurse most likely identify as projected to be the largest? - Blacks - Non-Hispanic Whites - Hispanics - Asians

- Non-Hispanic Whites Explanation: In 2012, 21% of people 65 and over were members of racial or ethnic minority populations. Racial and ethnic minority groups have increased from 6.1 million in 2002 (17% of the older population) to 8.9 million in 2012 (21% of the older population) and are projected to increase to 20.2 million in 2030 (28%% of the older population). Between 2012 and 2030, the white non-Hispanic population 65 years or older is projected to increase by 54%, compared with 123.5% for older racial and ethnic minorities, including Hispanics (155%); Blacks (104%); American Indian and Native Alaskans (116%); and Asians (119%).

An older adult client is prescribed antipsychotic therapy. The nurse understands that this therapy has been initiated based on which reason? Select all that apply. - The client needs less-intensive treatment. - Other strategies have failed. - There is a risk of harm to self or others. - The client is exhibiting signs of depression. - The client is displaying psychotic behavior.

- Other strategies have failed. - There is a risk of harm to self or others. - The client is displaying psychotic behavior. Explanation: Antipsychotics should be reserved for situations in which behavioral strategies and environmental strategies have failed, or the client poses a threat to self or others. Antipsychotic medications are typically prescribed only when the client displays psychotic behavior, and these medications are meant only for short-term use. They are not used to treat depression, or used when the client needs less-intensive therapy.

A nursing instructor is educating a class about older adults. Which measure would the instructor identify as one of the most valuable to maximize the quality of life for this population? - Sleep hygiene - Pain palliation - Nutritional support - Mobility aids

- Pain palliation Explanation: Although sleep hygiene, nutritional support, and mobility aids promote older adult functioning, providing pain palliation is one of the most valuable ways a nurse can maximize the quality of life for older adults.

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? - Use a matter-of-fact attitude and gently help him back to his room. - Remind him that he must not get up unassisted and should stay in his room at night. - Remind him of where he is and assess why he is having difficulty sleeping. - Allow him to sleep in the recliner in the day-room, so he will not disturb other clients.

- 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.

There is an 86-year-old female on the medical inpatient unit. She explains that the hospital is quite noisy and that she is having difficulty sleeping. Which is not true regarding sleep in the older adult? - Sleep medications are usually the first choice in treating sleep disturbance. - Stage 1 sleep increases in the older adult. - Deep sleep declines in the older adult. - Chronic cardiovascular or respiratory illness can interfere with sleep.

- Sleep medications are usually the first choice in treating sleep disturbance. Explanation: Medications are typically the last choice for treating sleep disturbance because they can interact with other medications or have paradoxical effects on the older adult.

An older adult who is newly widowed is not adjusting to this change in their role. They are unable to form new relationships. What is the client at risk for developing? - Social isolation - Low self-esteem - Cognitive deficits - Negativism of aging

- Social isolation Explanation: If an older adult cannot adjust to changes in social roles and form new relationships, social isolation can become a problem. Social isolation is a sense of being alone and lonely as a result of having fewer meaningful relationships. There is no resultant risk of cognitive deficits. Low self-esteem may or may not result from this situation.

A nurse at a long-term care facility is working to develop a program to promote regular medical check-ups for the residents in order to minimize the risk of infection. When proposing this program to the facility's governing board, which statement would the nurse emphasize as the underlying rationale for this type of program? - Older adults experience an increase in T-cell function, placing them at high risk. - Most older adults develop breaks in skin integrity, providing an entrance for microorganisms. - The antibody response in older adults is lower, placing them at increased risk. - Sleep disturbances leads to multiple injury and subsequent increased risk.

- The antibody response in older adults is lower, placing them at increased risk. Explanation: Older adult clients are prone to infections due to a lower antibody response toward microorganisms. Inadequate nutrition and the presence of chronic illnesses adversely affect the immune system and the ability to ward off infection. Older adults are predisposed to infection due to a decrease in T-cell function. Sleep disturbances do not directly affect the immunity of the older adult client.

Staff at a long-term care facility suspect that a resident, who has previously been cognitively healthy, may be showing early signs of dementia. What behavior(s) or symptom(s) may have led to this conclusion? Select all that apply. - The client has made sexually-suggestive comments that are out of character. - The client has begun waking up around 6:00 a.m. each day, 90 minutes earlier than usual. - The client is displaying signficant "highs" and "lows" in mood. - The client's interest in food is gradually declining. - The client has expressed suspicion about the motives of various caregivers.

- The client has made sexually-suggestive comments that are out of character. - The client is displaying signficant "highs" and "lows" in mood. - The client has expressed suspicion about the motives of various caregivers. Explanation: Uncharacteristic sexual comments, suspicion and emotional lability are associated with dementia. Changes in appetite and sleep patterns may be attributed to a large number of potential causes that are unrelated to dementia.

After obtaining the health history from an older adult client, the nurse develops a plan of care and identifies the client has impaired physical mobility. What information would support this impairment? Select all that apply. - The client states the hip and knee joints hurt and are stiff when ambulating. - The client states that he or she must use a walker for stability. - The client reports weakness on one side of the body following a stroke. - The client reports inflammation of a diverticula, which is causing mild pain. - The client reports improvement in vision following recent cataract surgery.

- The client states the hip and knee joints hurt and are stiff when ambulating. - The client states that he or she must use a walker for stability. - The client reports weakness on one side of the body following a stroke. Explanation: Data that would support the client's impaired physical mobility are pain and stiffness in hip and knee joints, using a walker for stability, and weakness on one side. Mild abdominal pain and improvement in vision following cataract surgery would not impair mobility.

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? - Life expectancy has increased for men but not for women. - The group experiencing the largest growth is those 85 years of age and older. - The number of older adults has begun to plateau since the year 2000. - The older adult population appears to be younger than in the past.

- 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.

Which statement is true of the demographics of older adults in the United States? - The proportion of older adults in the population peaked in the 2010s and is expected to gradually decline. - The number of older adults in the population has increased steadily in recent decades and is expected to continue doing so. - In 2017, older adults from racial or ethnic minority groups represented over 50% of the older adult population for the first time. - Most older adults will live in an institutional setting at some point before they die.

- The number of older adults in the population has increased steadily in recent decades and is expected to continue doing so. Explanation: The number of older adults in the U.S. population has increased steadily in recent decades and is expected to continue doing so for decades to come. Similarly, the proportion of older adults relative to the overall population will grow. Although the proportion of older adults in institutional settings increases with age, the overall proportion remains a minority. In 2017, 23% of Americans 65 and older were part of a racial or ethnic minority population.

A home care nurse visits an older adult client with dementia due to Alzheimer's disease. As a result of the client's confused thinking, the client is experiencing significant difficulty in communicating with family members. Which intervention would be most appropriate for this client? - Orient the client to reality. - Validate the client's current needs. - Provide appropriate sensory appliances. - Maintain levels of sensory stimulation.

- Validate the client's current needs. Explanation: The nurse should use validation therapy by validating the client's current needs in order to facilitate communication and to minimize the adverse consequences of confused thinking. Validation therapy is a type of interpersonal interaction in which the health professional attempts to understand and validate the client's current needs. Reality orientation is recommended for orienting people with reversible states of confusion. Providing appropriate sensory appliances like glasses and hearing aids, and maintaining levels of sensory stimulation, are not helpful in dementia or irreversible confusion.

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. - exploitation. - neglect. - emotional abuse.

- 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.

The nurse is caring for a client diagnosed with dementia. Which behaviors would the nurse most likely assess? Select all that apply. - asking questions repeatedly - stable mood - socially inappropriate behavior - wandering - irritability

- asking questions repeatedly - socially inappropriate behavior - wandering - irritability Explanation: Behavioral findings associated with dementia include: asking questions repeatedly, emotional lability, socially inappropriate behavior, wandering and irritability.

The gerontological nurse is admitting a client who has been deemed unsafe because of the severe, cyclical fluctuations in mood, from severe depression to periods of mania. What is the client's most likely diagnosis? - major depression - bipolar disorder - delusional disorder - schizophrenia

- bipolar disorder Explanation: Cycling between depression and mania is the hallmark of bipolar disorder. Major depression is not accompanied by manic episodes. Schizophrenia is marked by delusional thinking, among other symptoms. Delusional clients who do not have other symptoms may be diagnosed with delusional disorder.

When completing an assessment, especially of the older adult, the nurse knows the importance of including spiritual development. Older adults have completed moral development and many experience self-transcendence, which may be defined as what? - a state of consciousness with lower levels of tension, anxiety, and increased tolerance of frustration - the ability to traverse life's difficulties with ease - capability to reach beyond prior limits with more awareness of other people's values and beliefs - an ability to leave the past behind but still face the future without fear of the unknown

- capability to reach beyond prior limits with more awareness of other people's values and beliefs Explanation: Self-transcendence in the older adult may be described as the characteristic that helps one expand beyond personal limits, and to reach out to others with greater awareness of other people's beliefs and values. Past and future are more integrated into the present without regret or fear. Transcendence is a source of strength for the older adult faced with inevitable change and loss. The state of consciousness described is transcendental meditation.

For which older adult client(s) will the nurse use reality orientation? Select all that apply. client who has been confused since developing a urinary tract infection - client whose dementia is at at advanced stage - client who is delirious after taking prescribed opioid medications - client whose episodes of forgetfulness have just resulted in a diagnosis of early dementia - client with depression who has become disoriented in the past several days

- client whose dementia is at at advanced stage - client whose episodes of forgetfulness have just resulted in a diagnosis of early dementia - client with depression who has become disoriented in the past several days Explanation: Reality orientation can be effective and beneficial for older adults whose confusion is transient and reversible, as in the case of delirium caused by a urinary tract infection or opioids. It may also benefit clients whose dementia is in the early stages and who may appreciate being reminded of time and place. It is more likely to cause frustration or agitation in clients whose dementia is more advanced.

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 families who are providing care to their older adult parents. One of the family members asks the nurse, "How common is Alzheimer's disease?" The nurse responds by telling the group that after age 65, the prevalence of Alzheimer's disease: - doubles every 5 years. - triples every year. - decreases by 10 for every year. - declines but the rate is unknown.

- doubles every 5 years. Explanation: According to the Alzheimer's Association, the prevalence of Alzheimer's disease doubles every 5 years beyond age 65.

Family members of older adults with limitations from chronic illnesses may experience multiple stressors. Which is not considered one of these stressors? - feeling valued, useful, and productive - coping with the physical and economic needs of the older adult who is ill - changing lifestyle - providing care for a parent

- feeling valued, useful, and productive Explanation: Family members may experience stress from coping with the physical and economic needs of the older adult who is ill, the change in lifestyle, and the change in role (as they now provide care to a parent).

An older adult client is prescribed a sleep medication. When explaining the medication to the client, the nurse would emphasize which aspect of therapy? - greatest effectiveness with short term use - minimal risk of adverse effects - rare occurrences of confusion - need for follow-up laboratory tests

- greatest effectiveness with short term use Explanation: Sleep medications may be used, but these drugs are most effective when limited to short-term use (7 to 14 days); otherwise, the medications may actually interfere with sleep and cause other adverse outcomes such as falls, confusion, and constipation. The risks for adverse effects depend on the drug prescribed. There is no need for follow up laboratory tests.

A nurse is performing a home assessment for a 90-year-old widower who lives in a third story apartment. The assessment reveals there are smoke alarm and carbon monoxide alarm systems; slip-proof surfaces in the bathtub and shower; no throw-rugs present; handrails on the steps; unlocked cabinets with potential poisons; adequate lighting; large flat screen TV on wall; and the water set at a safe temperature. As the nurse considers the client's home environment, what modification can be made to enhance safety for the client? - locks on cabinets where potential poisons are located - handrails in bathroom - removal of large flat screen TV on wall - ensuring there is an automated external defibrillator (AED) in the home

- handrails in bathroom Explanation: As mobility impairment increases in persons over the age of 65, the risk of falls increases. Hip fractures are a particular risk factor for disability and death. Modification of the environment, such as slip-proof surfaces (bathtub, shower, floors); handrails in bathroom and stairway; lighting; removal of throw rugs; to prevent falls are key concerns for older adults. General concerns such as, but not limited to, smoke alarm and carbon monoxide alarm systems and water set at safe temperature range are also modifications to consider. It would be appropriate to ensure that large objects hanging on the wall are secured, but removal is not necessary. Ensuring there is an AED in the home is not necessary. If the client has dementia, concerns of poisoning and appliance use may be an issue; however, in this example there is no mention of confusion or dementia.

A nurse documents "dry, thin skin with several areas of ecchymoses" on an older adult client's chart. Which nursing concern will the nurse designate to help plan care for this client? - fall risk - altered body temperature risk - injury risk - sedentary lifestyle risk

- injury risk Explanation: The dry, thin skin of older adult clients is prone to injury because it is less flexible and resilient than the skin of younger adults. The blood vessels in the skin are more fragile, and bruising results. Thin, dry skin does not pose a significant threat to thermoregulation, falls, or sedentary lifestyle.

The nurse is assessing an older adult client that states, "I feel lonely." What factors might the nurse identify as contributing factors to the client's loneliness? Select all that apply. - loss of an important relationship - depression - cognitive changes - financial limitations

- loss of an important relationship - depression - cognitive changes Explanation: Loss of important relationships places an older person at risk for loneliness. Loneliness refers to a subjective emotional state of being alone, and there is a relationship between loneliness and health outcomes. Sensory losses may make it difficult for an older adult to communicate with others and can contribute to loneliness and depression. Depression may cause the person to become more socially isolated or physically separated from other people (Ivbijaro, 2013). Cognitive disorders (such as dementia) diminish the capacity to interact meaningfully or appropriately in social situations. Financial factors such as limited income do not contribute to loneliness but may limit the ability to travel outside of the immediate area.

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 Explanation: 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.

A nurse is preparing for a discussion with a group of older adults about the need for adequate nutrition. Which factor would the nurse address as placing an older adult at risk for decreased food intake? Select all that apply. - reduced thirst sensation - limited changes in smell - early satiety - reduced level of physical activity - decreased number of taste buds

- reduced thirst sensation - early satiety - reduced level of physical activity - decreased number of taste buds Explanation: Researchers generally agree that food intake declines with aging. Various physiologic age-related processes appear to explain this, including decreased thirst and smell, alterations in taste, early satiation (feeling full), and anorexia. Decreased dietary intake is also associated with a decline in physical activity that further limits the intake of essential micronutrients.

An older adult client being cared for at home has developed a decubitus injury. The nurse would instruct the family caregiver to institute measures to: - relieve sustained pressure. - control incontinence. - promote bowel elimination. - improve nutrition.

- relieve sustained pressure. Explanation: Although incontinence and malnutrition can place a client at risk for skin breakdown, the priority would be to relieve sustained pressure, which is the underlying cause of a pressure injury, also known as a decubitus ulcer. Promoting bowel elimination would have no effect on skin integrity. However, the caregiver should implement measures to prevent fecal incontinence, which could place the client at risk for skin breakdown.

The nurse is caring for an older adult client post surgery in the critical care unit. The nurse finds that the client is acutely confused and trying to get out of bed. Which is the priority nursing intervention? - administer a benzodiazepine - review with the client that he or she is in the hospital - insert an indwelling urinary catheter - maintain the client on bed rest

- review with the client that he or she is in the hospital Explanation: Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment. The nurse can use reality orientation, which involves interventions to redirect the client's attention to what is real in the environment. Benzodiazepines are usually avoided because they may increase confusion and cause oversedation. Insertion of an indwelling urinary catheter can trigger a series of downward events that are referred to as cascade iatrogenesis. Delirium may be managed by incorporating a bundle of strategies in routine care, one of which is early progressive mobility, not bed rest.

A nurse is caring for a client who experiences the involuntary release of urine when straining physically, coughing or sneezing. The nurse recognizes the characteristics of what health concern? - stress incontinence - urge incontinence - functional incontinence - overflow incontinence

- stress incontinence Explanation: Stress incontinence arises from weak pelvic floor muscles that may be overcome by the strain of movement, coughing or sneezing. Urge incontinence involves a sudden and unavoidable desire to void. Overflow incontinence occurs when the bladder muscle distends and urine is forced out. Functional incontinence occurs when a physical or psychological impairment impedes continence despite a competent urinary system.

An older adult is admitted to the health care facility with a diagnosis of depression. The nurse would be especially alert for: - poor cognitive performance. - sleep problems. - lack of initiative. - suicidal thoughts.

- suicidal thoughts. Explanation: Although poor cognitive performance, sleep problems, and lack of initiative are manifestations of depression, the nurse should be alert for indications of suicidal thoughts or behaviors. Suicide is the most serious consequence of depression.

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? - talk rapidly but be confused - withdraw from strangers - interrupt with frequent questions - take longer to respond and react

- 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.

The nurse is assigned to a 52-year-old client. The client is talkative and usually friendly when the nurse enters the room. Today, however, the client is standing at the mirror and says: "I lost my job because the company downsized; there isn't anything I can do." The nurse recognizes this expression of concern is related to: - the client assuming the termination is their fault. - dissatisfaction with changes in appearance and energy levels. - the client's compromised career goals and retirement plans. - the client being in an androgenic crisis.

- the client's compromised career goals and retirement plans. Explanation: The loss of employment is a major change that disrupts life-long goals. The middle adult is becoming aware of physical changes and limited time to live. This situation is not a hormonal crisis, and although the client may feel the job loss is their fault, that is not what was expressed.

The nurse is developing a plan of care for an older adult with late stage Alzheimer's disease. Which intervention would be most appropriate for the nurse to include in the plan of care? - reality orientation - handheld amplifier - validation therapy - hearing aid

- validation therapy Explanation: In the latter stages of irreversible dementia, reality orientation is less successful and often causes agitated or angry responses. At this latter point, validation therapy is most appropriate. Appropriate sensory appliances (glasses and hearing aids) assist older adults in interacting appropriately with their environments. An inexpensive handheld amplifier serves as an excellent alternative for communicating with clients who are hard of hearing and do not have an available hearing aid. Reality orientation can be useful for orienting people with reversible confusional states (e.g., delirium).

A nurse is counseling the caregivers of an older adult male. The caregivers feel that they want to do everything to prevent hospitalization of their loved one. Which of the following can the nurse recommend? Select all that apply. - avoiding pain medications whenever possible - vitamin D supplementation - daily exercise - throw rugs with nonslip backing - wearing socks at home

- vitamin D supplementation - daily exercise - throw rugs with nonslip backing Explanation: Falls are the most common cause of injuries and hospital admission in older adults. Recommendations for prevention of falls in older adults include an exercise component, vitamin D supplementation, and ensuring that all throw rugs have nonslip backing. The older adult should wear shoes inside and outside the home. Older adults need to have their pain managed adequately. Delirium, sleep disturbances, cognitive changes, and diminished functional abilities may result when pain is not managed, which can lead to falls.