EAQ Geriatrics

Which response would be given by a nurse providing discharge teaching to an older adult who was admitted to the hospital to be treated for dehydration when the client asks what to do about itchy, dry skin?

"Use a moisturizer on the skin daily to help reduce itching" RATIONALE: Lubricating the skin with a moisturizer effectively relieves dryness and, thus the pruritus (itching). Warm or cool, not hot, tub baths will reduce itching. Exposing the skin to the air causes further drying and will not relieve pruritus.

Which intervention would the nurse include when developing a plan of care for an older client with dementia?

Provide consistency in carrying out nursing activities for the client. RATIONALE: The nurse would include providing consistency in carrying out nursing activities for the client. Familiarity with situations and continuity add to the client's sense of security and foster trust in the relationship. Detailed explanations will be forgotten; instructions should be simple and to the point and given when needed for clients with dementia. Although demonstrating interest in the client's likes and dislikes helps individualize care, in a client with dementia likes and dislikes may be hard to remember. Being firm when dealing with the client's attitudes and behaviors may increase anxiety in the client with dementia; some degree of flexibility by the nurse helps decrease outbursts from clients with dementia.

How much solution will the nurse administer after the health care provider prescribes haloperidol 0.5 mg intramuscularly (IM) given that haloperidol is available in a vial that contains 2mg/mL?

0.25 mL RATIONALE: The prescribed dose is 0.5 mg. The available concentration is 2 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliter the nurse would administer.

Which action would the nurse take when caring for an older adult with a history of recent memory loss?

Employ electronic devices that provide alerts. RATIONALE: Providing electronic devices that give alerts can help an older adult who has developed recent memory loss. Instructing the client to move slowly when changing positions can prevent dizziness and falls caused by orthostatic blood pressure changes or altered balance/coordination. Reminding the client to check where the feet are placed can help older adults with decreased sensory perception of touch. Adjusting the daily schedule can aid older adults who have changes in their sleep pattern.

Which nursing intervention would the nurse take for an older adult with delirium who begins acting out while in the dayroom?

Giving the client one simple direction at a time in a firm, low pitched voice. RATIONALE: Clients with delirium typically respond to simple directions stated one a time in a firm, low-pitched voice. "Be quiet" is a nontherapeutic order; furthermore, it is demeaning to the client. Allowing the client to act out until fatigue sets in will not help the client gain control and might be frightening to other clients in the dayroom. Guiding the client from the room by gently holding the client's arm is done only after giving simple directions and attempting to calm the client has failed. Touch should also be used cautiously in clients who have delirium because the client may misinterpret the gesture as aggressive.

Which gerontologic assessment finding of the auditory system is related to the inner ear?

Hair cell degeneration Reduced blood supply to the cochlea Less effective vestibular apparatus in the semicircular canals RATIONALE: Hair cell degeneration, reduced blood supply to the cochlea, and less effective vestibular apparatus in the semicircular canals are assessment findings related to the inner ear. Atrophic changes of the tympanic membrane is an assessment finding associated with the middle ear. A decline in ability to filter out unwanted sounds is an assessment finding related to the brain.

Which age-related effects on the immune system occur in the older client?

Increased autoantibodies RATIONALE: The effects of aging on the immune system include increased autoantibodies. Expression of IL-2 receptors, delayed hypersensitivity reaction, and primary and secondary antibody responses decrease in older adults because of the effects of aging on the immune system.

Which area of the client's body would the nurse consider a high risk for developing a pressure injury when caring for an older adult with Alzheimer type dementia who consistently sleeps in a semi-Fowler position in bed?

Sacrum RATIONALE: The sacrum is the center of the greatest body mass; an elevated torso exerts pressure toward this area. Although the scapulae are at risk, they do not bear the greatest body weight as when the client is in Semi-Fowler position. The ischial spine bears the greatest pressure when the client is in an upright sitting position. Greater trochanter is at risk when the client is in a side-lying position.

Which characteristic of a therapeutic milieu would the nurse consider important for a confused older adult with socially aggressive behavior?

Sets limits RATIONALE: The therapeutic milieu characteristic would be to set limits. Because clients with socially aggressive behavior have poor control, these individuals require a therapeutic environment in which appropriate limits for behavior are set for them. Variety will increase anxiety. The daily routine should be structured and repetitive. A group-oriented environment is too stimulating for a person with socially aggressive behavior. Freedom of expression may result in injury to the client or others, because the client may be unable to control impulses.

Which activity would the nurse ask an older adult client to do when testing short-term memory?

State three random words mentioned earlier in the examination RATIONALE: Stating three random words mentioned earlier in the examination is a test of the client's ability to recall short-term memory. Subtracting serial sevens from 100 is a test of the ability to calculate and pay attention. Copying one simple geometric figure is a test of visual comprehension. Naming two common objects when the nurse points to them is a test of verbal skill, not short-term memory.