Gero Exam 3

1. An older person is concerned after learning of having left ventricular hypertrophy. What should the nurse respond to this concern? A. "This is considered an expected change with aging." B. "It happened because of ingesting a poor diet through the years." C. "You will need a complete cardiovascular evaluation." D. "Most people who exercise a great deal have this change."

A. "This is considered and expected change with aging" Rationale: Specific changes in the cardiovascular system with aging include myocardial hypertrophy, an increase in the size of muscle cells of the myocardium. This will change the function of the left ventricular wall and the ventricular septum. The left ventricular wall is 25% thicker for the average 80-year-old person as compared to the average 30-year-old person. A cardiovascular evaluation is required if the person is experiencing symptoms. Left ventricular hypertrophy is not associated with excessive exercise or ingesting a poor diet.

8. The nurse visits the home of an older person recovering from community-acquired pneumonia. Which action should the nurse recommend to help the person remove pulmonary secretions? A. Increase oral intake of fluids B. Remain on bedrest for two weeks C. Take antibiotics until symptoms subside D. Schedule a repeat chest x-ray in a week

A. Increase oral intake of fluids Rationale: Rehydration is essential when caring for the older person with pneumonia. The extra fluid helps thin respiratory secretions and eases expectoration. Bedrest is not required and may encourage the development of a deep vein thrombosis. After resolution of the pneumonia, the chest X-ray will not appear normal for about 6 weeks. The full course of antibiotics should be completed and not stopped if symptoms subside.

7. During a home visit, the nurse notes that an older person experiences urinary incontinence. Which environmental issue should the nurse consider as contributing to this person's urinary problem? A. Wearing pants with a zipper and button B. Bathroom located within the bedroom C. Three steps between the living room and the bedroom D. Kitchen on the other side of the dining room

A. Wearing pants with a zipper and button Rationale: The clothing that an older adult wears is a part of the environment and should be evaluated to see if it is impairing continence. The location of the bathroom might be an issue however the most obvious environmental cause for the incontinence is wearing clothing that might make it difficult to void. The location of the kitchen and the number of steps are not environmental issues contributing to this person's urinary incontinence.

20) The nurse is teaching an older adult client how to perform Kegel exercises. Which information will the nurse include in the teaching? 1. "Tighten your perineal muscles." 2. "Tighten your buttocks, perineum, and thighs." 3. "Tighten the muscles of your perineum and buttocks." 4. "Tighten the muscles of your abdomen, buttocks, and perineum."

Answer: 1 Explanation: 1. A Kegel is performed correctly when the perineal muscles are tightened and the abdominal, buttocks, and thigh muscles remain relaxed. 2. A Kegel is performed correctly when the perineal muscles are tightened and the abdominal, buttocks, and thigh muscles remain relaxed. 3. A Kegel is performed correctly when the perineal muscles are tightened and the abdominal, buttocks, and thigh muscles remain relaxed. 4. A Kegel is performed correctly when the perineal muscles are tightened and the abdominal, buttocks, and thigh muscles remain relaxed.

16) The nurse is obtaining a sexual history from an older male client. Which statement made by the client is most concerning to the nurse? 1. "I just don't want to have sex anymore." 2. "Sex is over much too quickly these days." 3. "My erections are not as firm anymore." 4. "I would like to be able to have sex more often."

Answer: 1 Explanation: 1. A report of a complete loss in sexual interest should be viewed with concern. 2. Difficulty anticipating or delaying ejaculation is a normal finding in an older male client. 3. Older men achieve erections that are less firm, but they are still capable of penetration. 4. The refractory period after orgasm is lengthened to several hours and is 24 hours in some

24) The nurse is planning care for an older patient with heart failure who is experiencing shortness of breath. Upon assessment, the patient stated the inability to purchase medication because of financial limits. Which nursing diagnoses will be of the greatest initial importance when planning care? 1. Fluid volume excess 2. Activity intolerance related to shortness of breath 3. Powerlessness related to lack of financial resources 4. Ineffective management of therapeutic regimen related to the inability to purchase medications

Answer: 1 Explanation: 1. Although all diagnoses listed are appropriate for this situation, fluid volume excess is the priority diagnosis for this patient. 2. Although all diagnoses listed are appropriate for this situation, fluid volume excess is the priority diagnosis for this patient. The patient's tolerance for activity will improve once the excess fluid is removed from the body. 3. Although all diagnoses listed are appropriate for this situation, fluid volume excess is the priority diagnosis for this patient. Physical diagnoses take priority over psychosocial. 4. Although all diagnoses listed are appropriate for this situation, fluid volume excess is the priority diagnosis for this patient. The nurse can work with social services to help the patient with finances so medications can be purchased in the future.

22) The nurse is reviewing new medication orders for an older client with asthma. Which medication should the nurse question before providing it to the client? 1. Aspirin 2. Levofloxacin 3. Coumadin 4. Amlodipine

Answer: 1 Explanation: 1. Certain medications should be avoided, if possible, when treating clients with asthma because adverse reactions can exacerbate asthmatic problems. Sudden, potentially life-threatening bronchospasm has been associated with aspirin and NSAID use in older clients. 2. Antibiotics can be safely provided to an older client with asthma. 3. Most anticoagulants can be safely provided to an older client with asthma. 4. Calcium channel blockers can be safely provided to an older client with asthma. Beta-blockers can trigger asthma symptoms, but if needed, are used with caution.

24) The nurse has identified the diagnosis of ineffective airway clearance for an older client with pneumonia. Which intervention is most important to include when planning care for this client? 1. Chest percussion on a schedule 2. Administer a cough suppressant 3. Teach smoking cessation 4. Administer the pneumococcal vaccine

Answer: 1 Explanation: 1. Chest percussion can help clear secretions. 2. The client will get a cough suppressant, usually at night, to facilitate rest. It is important not to keep the cough suppressed regularly, though, as this will worsen the pneumonia. 3. Smoking cessation will not help with the immediate need of ineffective airway clearance. 4. Administering the pneumococcal vaccine will not help with the immediate need of ineffective airway clearance.

18) The nurse has completed teaching about the methods for alleviating stress incontinence for an older client. Which statement made by the client indicates that further teaching is needed? 1. "I will make sure to include citrus juice with my breakfast." 2. "My family is going to help me to remember to go to the bathroom." 3. "I am going to practice Kegel exercises at least 3 days a week." 4. "I will keep a chart to help me track the scheduled times I should void."

Answer: 1 Explanation: 1. Citrus juices are considered bladder irritants and can aggravate stress incontinence. 2. Prompted voiding is another type of timed voiding that helps the client remember to use the bathroom and can prevent stress incontinence. 3. Kegel exercises strengthen the perineal muscles and are useful in preventing stress incontinence. 4. Timed voiding has been demonstrated to be effective for older women with stress incontinence.

1) Which respiratory system assessment finding of an older client does the nurse determine is most concerning? 1. Coughing during the night while sleeping 2. Purposefully sitting up straighter to get a deep breath 3. Shortness of breath when crossing a large parking lot 4. Three episodes of diagnosed bronchitis in twelve months

Answer: 1 Explanation: 1. Coughing during sleep can be a sign of asthma, heart failure, or other condition, but it is not normal and must be investigated. 2. Decreased muscle tone, increased abdominal girth, thoracic rigidity, and other issues can lead to incomplete chest expansion. The client who is aware of this may purposefully sit up straighter to take a deeper breath. 3. There is an increase in stiffness of the chest wall, decreased vital capacity, and increased residual volume occur with aging. Walking a significant distance can result in shortness of breath. If the client becomes short of breath when walking in the house, that is cause for concern. 4. Immune changes can cause increased frequency of respiratory infections. If infections occur more closely together or the client just never seems to get well, this is cause for increased concern.

2) The nurse plans teaching for the older adult client about prevention of respiratory illnesses. What is the most important strategy for the client to use? 1. Obtain vaccinations as scheduled 2. Reduce use of inhaled tobacco 3. Wear a mask when mowing the lawn 4. Use hand sanitizer after shopping

Answer: 1 Explanation: 1. Getting a flu vaccination annually and pneumonia vaccination beginning at the age of 65 are key to keeping the immune system healthy against diseases. Flu and pneumonia can result in death in the older adult client. 2. Elimination of smoking is recommended. This includes all smoking including tobacco, electronic cigarettes, and other inhaled, recreational substances. 3. If the client is allergic to substances found in the lawn, then this is advisable. The client should avoid allergens. airborne toxins, and air pollution. This is not a necessary precaution for many adults. 4. Washing hands frequently and avoiding others who are sick is ideal. While shopping, the client may have come into contact with many infectious sources. While using hand sanitizer after the trip is good, depending on the time of year, this may not be a strict enough strategy to prevent infection.

14) What should the nurse keep in mind when teaching an older client about smoking cessation? 1. Most people quit smoking several times before they are successful. 2. Bupropion (Zyban) is effective when used alone to decrease cravings. 3. A piece of nicotine gum should be chewed for 5 minutes of every waking hour. 4. Use of a nicotine patch is considered safe for anyone who has smoked regularly.

Answer: 1 Explanation: 1. Nurses should be persistent in educating and urging older clients to quit. The smoking addiction is difficult to beat. Many older people try to quit several times before they are ultimately successful. 2. Bupropion is contraindicated in people with seizure disorder. It is best used in combination with nicotine replacement therapy. 3. For clients choosing Nicorette gum, it is recommended that 9 to 12 pieces be used daily. The nurse should instruct clients to chew one piece at a time when they get the urge to smoke. After chewing the gum a few times to soften it, it should be held in the buccal cavity for at least one-half hour to release all the medication. 4. Nicotine replacement is contraindicated for those with certain cardiovascular conditions. While it has benefit over smoking, it is still not considered safe for certain populations of clients.

) The nurse reviewing the laboratory results for an older client notes the specific gravity is below normal. The nurse's assessment findings include a temperature of 98.9℉, heart rate 102 bpm, B/P 110/64, and respirations 20/min. Which condition does the nurse suspect the client is experiencing? 1. Dehydration 2. Hypernatremia 3. Glomerulonephritis 4. Hypokalemia

Answer: 1 Explanation: 1. Older adults are less able to concentrate their urine, making them susceptible to dehydration. In addition, there is a deficit of the thirst response. The clinical assessment findings indicate the client is experiencing dehydration. 2. The aging kidney is less responsive to circulating ADH, producing urine that is poorly concentrated and rich in sodium. 3. A decrease of blood to the kidney occurs in conjunction with a decreased glomerular filtration rate as part of the aging process. Glomerulonephritis is an acute inflammation of the kidney. 4. The changes in the renal system predispose the older adult to hyperkalemia.

12) The nurse is caring for an older client with acute renal failure. Which statement made by the client is reflective of the disease? 1. "I feel so dizzy when I get up out of bed." 2. "I have been getting frequent headaches lately." 3. "I do not feel like eating, I have not had an appetite." 4. "I could not get my slippers on my feet this morning."

Answer: 1 Explanation: 1. Postural hypotension is associated with acute renal failure. 2. Elevated blood pressure is a manifestation of chronic renal failure. 3. A loss of appetite is associated with chronic renal failure. 4. Generalized edema is a manifestation of chronic renal failure.

13) An older patient who is a widower explains that routine sexual encounters remain an important part of his life. What teaching should the nurse provide to this patient? 1. Actions to ensure safe sex 2. Importance of an adequate fluid intake 3. Reasons to abstain from sexual activity 4. Interventions to prevent erectile dysfunction

Answer: 1 Explanation: 1. Sexually active older adults are at risk for the same sexually transmitted infections that affect younger adults. They should be offered the same education about safer sex, including the use of condoms. 2. An adequate fluid intake is important but this has nothing to do with the patient's routine sexual encounters. 3. The nurse should not expect an older patient to abstain from sexual activity if this is desired. 4. There are no specific interventions to prevent erectile dysfunction. This topic has nothing to do with the patient's routine sexual encounters.

6) The nurse preceptor is providing information for a novice nurse on the normal changes in the renal system of an older female adult. Which statement will the preceptor include in the teaching? 1. "Hyperglycemia is common in the older adult." 2. "The older adult experiences overflow incontinence." 3. "The older adult experiences chronic urinary tract infections." 4. "Incontinence occurs in the older adult due to the loss of bladder capacity."

Answer: 1 Explanation: 1. The older adult has an increased renal threshold for glucose resulting in higher blood levels of glucose before renal excretion occurs. 2. Overflow incontinence occurs in older clients with diabetes mellitus, B12 deficiency, alcoholism, bladder outlet obstruction, and in men with an enlarged prostate. 3. The older adult is at risk for urinary tract infections due to the inability to completely empty their bladder, but should not have a chronic urinary tract infection. 4. Increased incontinence occurs due to detrusor muscles becoming less contractile and somewhat unstable.

7) An older patient who is prescribed doxazosin mesylate (Cardura) has a lying blood pressure of 124/76 mm Hg and a sitting blood pressure of 100/64 mm Hg. What additional observation is needed for this patient? 1. Fall risk 2. Nausea and vomiting 3. Decreased urine output 4. Change in mental status

Answer: 1 Explanation: 1. The patient's blood pressure values indicate postural hypotension. In addition, the patient is taking a medication that is an alpha blocker, which increases the risk for postural hypotension. Both factors would place the patient at a risk for falls. 2. Nausea and vomiting are unrelated to the blood pressure changes. 3. Urine output is unrelated to the blood pressure changes. 4. Mental status changes are unrelated to the blood pressure changes.

25) The nurse is planning to assess an older patient's risk for cardiovascular disease. Which assessment question is priority? 1. "Are you short of breath at rest?" 2. "Do you sleep through the night?" 3. "Are your bowel movements regular?" 4. "Do you exercise several times a week?"

Answer: 1 Explanation: 1. The question would assess the patient's risk for cardiovascular problems. 2. The question would assess the patient's sleep pattern. 3. The question would assess elimination function. 4. The question would evaluate whether a patient engages in maintaining health.

7) The nurse is obtaining a history from an older male client with benign prostatic hypertrophy (BPH) experiencing urinary retention. Which question is the most important to include in the assessment? 1. "Do you take any medications?" 2. "Have you experienced pain with urination?" 3. "Are you experiencing erectile dysfunction?" 4. "Are you urinating more than 8 times in 24 hours?"

Answer: 1 Explanation: 1. Urinary retention in men with BPH can be precipitated by several classes of medications, including those with anticholinergic properties and over-the-counter medications for the common cold. 2. Pain with urination is a symptom associated with BPH. 3. Erectile dysfunction is a symptom associated with BPH. 4. Urinating more than 8 times a day is a symptom associated with BPH.

15) The nurse cares for a group of clients at risk for lower respiratory infection. The nurse is most concerned about which clients? Select all that apply. 1. The client who reports feeling cold and having chills. 2. The client with a respiratory rate of 30 breaths/min. 3. The client with a heart rate of 120 beats/min. 4. The client with new onset confusion and incontinence. 5. The client with nighttime cough and nasal discharge.

Answer: 1, 2, 3, 4 Explanation: 1. Fever may be absent in the older client because many older people have a lower basal temperature and will not exhibit a fever response in the face of infection. Abrupt onset of chills can be a presentation of pneumonia in the older adult client. 2. Many things can cause tachypnea or dyspnea, but the nurse is concerned that this client may have pneumonia. 3. New-onset of tachycardia is an important clue to an illness with both viral and bacterial pneumonia. 4. Subtle changes in behavior can indicate pneumonia in an older client. Older clients can present with atypical symptoms such as mental changes, falls, new-onset incontinence, or recent functional decline. 5. The client with nighttime cough and nasal discharge is more likely to indicate an upper respiratory ailment like rhinitis or sinusitis.

11) An older patient asks the nurse what holistic actions can be used to help lower elevated cholesterol and triglyceride levels. What information should the nurse provide to the patient? Select all that apply. 1. Increase dietary fiber. 2. Eat fatty fish twice a week. 3. Use margarine with phytosterols. 4. Increase the intake of soy products 5. Limit red meat consumption to 3 days a week.

Answer: 1, 2, 3, 4 Explanation: 1. The fiber found in oat bran, apples, citrus, and whole-grain products is particularly effective in reducing cholesterol. 2. Consumption of fish oil and ingestion of omega-3 fatty acids also have been shown to reduce cholesterol levels prompting the recommendation by the American Heart Association that fatty fish be eaten at least two times a week. 3. Phytosterols (plant sterols) are found in whole grains and many fruits and vegetables, and have the ability to interfere with the intestinal absorption of cholesterol. These products have been added to certain margarines and salad dressings, and the FDA has approved statements that consumption of these products may reduce the risk of coronary heart disease. 4. Soybeans have been shown to lower LDL blood levels and triglycerides and thus lower the risk of developing coronary heart disease. Soy products can be incorporated into the diet by drinking soy milk, eating tofu, or eating any product made with soybeans. The FDA has allowed the statement that inclusion of soy products in a diet low in saturated fat and cholesterol promotes heart health. 5. There is no specific recommendation for limiting the ingestion of red meat to control cholesterol and triglyceride levels

18) An older client asks the nurse what can be done to prevent a respiratory infection during the winter months. How should the nurse respond to this client? Select all that apply. 1. Stay active with daily exercise. 2. Don't smoke and avoid secondhand smoke. 3. Wash the hands often and get a flu vaccination. 4. Eat a healthy diet and maintain a normal weight. 5. Ask a family member to perform shopping duties.

Answer: 1, 2, 3, 4 Explanation: 1. Tips to keep a healthy respiratory system include staying active with daily exercise. Maintaining muscle tone and bone strength is essential to the ability to completely expand the chest while breathing. 2. Tips to keep a healthy respiratory system include not smoking and avoiding secondhand smoke. Second-hand smoke is an allergen and a respiratory irritant. 3. Tips to keep a healthy respiratory system include frequent hand washing and getting a flu vaccination. Hand washing is the single best prevention measure for any person to prevent infection. Flu prevention is essential as it often leads to pneumonia in the older adult client. 4. Tips to keep a healthy respiratory system include eating a healthy diet and maintaining a normal weight. Proper nutrients are required to prevent illness and obesity and frail thinness can both lead to decreased activity. 5. For most people, it is not reasonable or necessary to ask a family member to do all the shopping. This would significantly decrease the client's exposure to illness, but it is important for the client to continue to socialize, ambulate, and perform self-care duties.

6) The nurse is planning a presentation to a group of senior citizens on lifestyle modifications to manage high blood pressure. What major points will the nurse include in this presentation? Select all that apply. 1. Keep sodium intake to 2.4 grams per day. 2. Achieve and maintain a normal body mass index. 3. Perform aerobic activity for 30 minutes most days of the week. 4. Consumption of fruits and whole grains has little impact on blood pressure. 5. Limit daily alcohol intake to two drinks for males and one drink for females.

Answer: 1, 2, 3, 5 Explanation: 1. One lifestyle modification is to keep sodium intake below 2.4 grams per day. 2. One lifestyle modification is to achieve and maintain a normal body mass index. 3. One lifestyle modification is to perform aerobic activity for 30 minutes most days of the week. 4. Increasing the consumption of fruits, vegetables, and whole grains will lower blood pressure. 5. One lifestyle modification is to limit daily alcohol intake to two drinks for males and one drink for females.

11) What steps will the nurse follow when administering a two-step purified protein derivative (PPD) tuberculin skin test to an older client? Select all that apply. 1. Repeat the PPD test in 1 to 2 weeks. 2. Ask the client about exposure risks. 3. Measure the area of injection in 72 hours. 4. Administer 5 units of the BCG vaccination serum. 5. Give an injection of 0.1 mL of 5 TU intradermally.

Answer: 1, 2, 3, 5 Explanation: 1. When administering the two-step PPD tuberculin skin test to an older client the nurse should administer an injection of 0.1 mL of 5 TU intradermally, measure the area of injection in 72 hours, and repeat the test in 1 to 2 weeks. 2. Part of administering the test is obtaining answers to basic questions about exposures. This includes working in a healthcare environment and travel to areas such as eastern Europe or Latin America. 3. When administering the two-step PPD tuberculin skin test to an older client the nurse should administer an injection of 0.1 mL of 5 TU intradermally, measure the area of injection in 48-72 hours, and repeat the test in 1 to 2 weeks. 4. When administering the two-step PPD tuberculin skin test to an older client the nurse should administer an injection of 0.1 mL of 5 TU intradermally, measure the area of injection in 72 hours, and repeat the test in 1 to 2 weeks. The BCG vaccination is an anti tuberculosis vaccination that is often not used in the United States. It is not injected to test for tuberculosis. 5. When administering the two-step PPD tuberculin skin test to an older client the nurse should administer an injection of 0.1 mL of 5 TU intradermally, measure the area of injection in 72 hours, and repeat the test in 1 to 2 weeks.

5) An older client is prescribed an inhaled corticosteroid as part of treatment for asthma. What will the nurse instruct the client about the use of this medication? Select all that apply. 1. It can cause oral thrush or candidiasis. 2. Use a spacer when taking this medication. 3. It has no effect on any other health problems. 4. Rinse the mouth and spit after using this medication. 5. It is the most effective anti-inflammatory treatment for asthma

Answer: 1, 3, 4, 5 Explanation: 1. Inhaled corticosteroids can cause oral thrush (candidiasis). 2. clients should be urged to use spacers with their metered-dose inhalers. 3. Adverse effects of inhaled corticosteroids include electrolyte and fluid imbalances in older clients with cardiac or renal disease, the possibility of hypokalemia when the client is taking a thiazide diuretic, worsening of hypertension, and elevated blood sugar and blood urea nitrogen readings in clients with diabetes. 4. Clients should be urged to rinse and spit after use of inhaled corticosteroids. 5. Inhaled corticosteroid therapy is the most effective anti-inflammatory treatment for asthma.

16) An older patient is prescribed a beta blocker to treat hypertension. What effects will the nurse instruct the patient to report to the healthcare professional? Select all that apply. 1. Fatigue 2. Dry cough 3. Dry mouth 4. Cold extremities 5. Exercise intolerance

Answer: 1, 4, 5 Explanation: 1. Fatigue is a side effect of a beta blocker. 2. Dry cough is a side effect of an ACE inhibitor and not a beta blocker. 3. Dry mouth is a side effect of a centrally acting alpha2-agonist and not a beta blocker. 4. Reduced peripheral circulation which can manifest as cold extremities is a side effect of a beta blocker. 5. Exercise intolerance is a side effect of a beta blocker.

12) The nurse cares for a client admitted to rule out active tuberculosis. What manifestations best indicate that the client has active tuberculosis? Select all that apply. 1. Chronic, drenching night sweats 2. Frequent respiratory infections 3. Hypoxia and hypotension 4. Hemoptysis and chest pain 5. Loss of appetite and weight loss

Answer: 1, 4, 5 Explanation: 1. Weight loss and night sweats are non-specific symptoms of tuberculosis. However, drenching nightly sweating only occurs with a very few diseases, such as TB, non-Hodgkin's lymphoma, and AI. 2. Frequent lung infections or infections that appear chronic or treatment resistant often indicate lung cancer or other condition. This isn't related to TB. 3. Hypoxia and hypotension are associated with shock or pulmonary embolism for example. Only very advanced TB might result in these findings. 4. Bloody sputum with chest pain is clear and specific for tuberculosis. A few other conditions would cause these symptoms to occur together. 5. Loss of appetite and weight loss are non-specific symptoms of tuberculosis. Anorexia occurs in conditions ranging from depression to cancer.

10) An older patient with a history of atrial fibrillation has a fall at home and is diagnosed with a hemorrhagic stroke. What will the nurse assess first to help determine the cause of this patient's bleeding? Select all that apply. 1. Current INR 2. Platelet level 3. Liver function studies 4. Hemoglobin and hematocrit 5. Dose of warfarin sodium (Coumadin) taken at home

Answer: 1, 5 Explanation: 1. The INR is a laboratory test that measures the therapeutic level of anticoagulant medications and could indicate the cause of the patient's bleeding. 2. The platelet level will not help determine the cause of the patient's bleeding. 3. Liver function studies are not directly related to this patient's problem. 4. The hemoglobin and hematocrit levels are not directly related to this patient's problem. 5. Patients with atrial fibrillation are at risk for development of blood clots. A primary treatment is the use of anticoagulant drugs, such as warfarin sodium (Coumadin). Anticoagulant drugs place the patient at risk for hemorrhage, especially after a fall.

17) The nurse cares for a client with urinary incontinence. Which client statement most concerns the nurse? 1. "Every time I cough or sneeze, I urinate on myself a little." 2. "I have never had urinary incontinence before this week." 3. "I experience a strong urge to urinate but cannot make it to the bathroom." 4. "I have had several accidents because I just couldn't get up fast enough."

Answer: 2 Explanation: 1. A client who urinates on themselves when they cough or sneeze is experiencing stress incontinence. 2. New-onset urinary incontinence is always a nursing priority. DIAPPERS can be used to recall conditions for acute incontinence: delirium, infection, atrophic vaginitis, pharmacological therapy, psychological problems, restricted mobility, stool impaction. 3. Urge incontinence occurs when a client all of a sudden has a strong urge to void and cannot make it to the toilet in time. 4. Functional incontinence occurs when the client cannot make it to the toilet in time to void.

14) A 60-year-old male patient is planning to marry a woman in her 30s and is concerned about the need for contraception. How should the nurse respond to this patient? 1. "After age 50, you are considered virtually infertile." 2. "It is still possible at this time of life to father a child." 3. "You should have a vasectomy to avoid fathering a child." 4. "You will only need to be concerned about fertility for another few years."

Answer: 2 Explanation: 1. Approximately half of all men continue to produce viable sperm up to the age of 90 years. Older men can father children. 2. Approximately half of all men continue to produce viable sperm up to the age of 90 years. Older men can father children. 3. Discussion about a vasectomy is premature at this stage. A vasectomy may not be the best option for this patient. 4. Approximately half of all men continue to produce viable sperm up to the age of 90 years. Older men can father children.

11) The nurse has administered a beta blocker to an older adult client. Which finding alerts the nurse that the client may be experiencing toxicity? 1. Hypokalemia 2. Hypoglycemia 3. Hyponatremia 4. Hypocalcemia

Answer: 2 Explanation: 1. Hypokalemia is not a symptom of beta blocker toxicity. 2. Due to the changes in renal excretion related to aging, the older client is prone to drug toxicity. Signs of beta blocker toxicity include hypoglycemia. 3. Hyponatremia is not associated with beta blocker toxicity. 4. Hypocalcemia is not a symptom of beta blocker toxicity.

14) The nurse is teaching an older patient with hypertension about foods on a low sodium diet. Which food choices best reflects a low sodium meal? 1. Hamburger with milkshake 2. Green salad with grilled chicken 3. Chicken noodle soup with crackers 4. Pastrami sandwich with carrot sticks

Answer: 2 Explanation: 1. Milkshakes are high in sodium. 2. Grilled chicken and salad have a low sodium content. 3. Soups are high in sodium along with crackers. 4. Processed meats such as pastrami are high in sodium.

13) The nurse is assessing an older patient diagnosed with heart failure several years ago. Which would indicate the patient is in the late stage of heart failure? 1. Fatigue 2. Confusion 3. Lung congestion 4. Shortness of breath

Answer: 2 Explanation: 1. Most early heart failure symptoms include fatigue and tiredness. 2. When the patient becomes mentally confused, that presents during later stages of heart failure. 3. Most early heart failure symptoms include congestion in the lungs. 4. Most early heart failure symptoms include breathlessness or dyspnea.

25) The nurse has instructed an older client on ways to prevent the recurrence of pneumonia. Which client statement best indicates teaching was successful? 1. "I will get the influenza vaccine every year before February." 2. "Antivirals work best within one to two days of getting the flu virus." 3. "My allergy to eggs means I have to be monitored after I get any vaccination." 4. "I will get the pneumococcal vaccine before I am discharged from the hospital."

Answer: 2 Explanation: 1. The influenza vaccine should also be received yearly in people who are at risk for pneumonia. Though the vaccine can be given at any time, it is most effective when given in early fall, around September. 2. If the client suspects the flu, antiviral medications can shorten the illness course if they are given with the first signs of infection and within 48 hours of symptom onset. 3. In those with severe egg allergies, flu vaccination in a medical setting with supervision is recommended. For those with mild egg allergies, monitoring is not required after the flu vaccine. Egg allergies are not relevant to all vaccinations. 4. The client should receive the pneumococcal vaccination when they are well, usually after one week of anti-infective therapy. If the risk for compliance is low, health care providers may offer the pneumococcal vaccine as the client is being discharged, even though they are likely continuing an oral anti-infective course of treatment at home.

3) The nurse is having difficulty inserting a urinary catheter in an older female client. Which position should the nurse place the client in to facilitate the insertion of the catheter? 1. Lithotomy with head of bed at 20 degrees 2. Side-lying, lifting up the buttock 3. Side-lying with both knees flexed 4. Supine with legs flexed and knees apart

Answer: 2 Explanation: 1. The older female client may have difficulty assuming a lithotomy position. The side-lying position results in greater comfort to the client. 2. Because of estrogen-mediated changes in the perineal area of postmenopausal women, the urinary meatus may be very difficult to visualize. Placing the client in a side-lying position and lifting up the buttock is an alternative that provides better visualization of the urinary meatus. 3. Placing the client side-lying with both knees flexed will not allow for visualization of the urinary meatus. 4. The supine position, regardless of the leg position or height of the bed, does not increase the visualization of the urinary meatus because it is more distal due to the changes in the perineal area.

21) During a home visit an older patient with heart disease tells the nurse of plans to shovel the snow as soon as the visit concludes. How should the nurse instruct the patient at this time? 1. Shovel the steps only. 2. Avoid shoveling at this time. 3. Shovel for 30 minutes at a time. 4. Shovel for 10 minutes and then stop.

Answer: 2 Explanation: 1. The older heart cannot respond to stressful stimuli as well as the younger heart. The patient should be cautioned not to engage in stressful activities like vigorous shoveling of snow without engaging in a gradual exercise program to build fitness. Shoveling the steps could be harmful to the patient. 2. The older heart cannot respond to stressful stimuli as well as the younger heart. The patient should be cautioned not to engage in stressful activities like vigorous shoveling of snow without engaging in a gradual exercise program to build fitness. 3. The older heart cannot respond to stressful stimuli as well as the younger heart. The patient should be cautioned not to engage in stressful activities like vigorous shoveling of snow without engaging in a gradual exercise program to build fitness. Shoveling for 30 minutes could be harmful to the patient. 4. The older heart cannot respond to stressful stimuli as well as the younger heart. The patient should be cautioned not to engage in stressful activities like vigorous shoveling of snow without engaging in a gradual exercise program to build fitness. Shoveling for 10 minutes could be harmful to the patient.

20) An older patient is diagnosed with arterial peripheral vascular disease. What will the nurse assess in this patient? Select all that apply. 1. Leg ulcers 2. Pain with walking 3. 40-year history of smoking 4. Pain relieved when legs dangle 5. History of working as a computer operator

Answer: 2, 3, 4 Explanation: 1. Leg ulcers are associated with venous peripheral vascular disease. 2. Pain with walking is a symptom associated with arterial occlusion. 3. Smoking is a risk factor for the development of arterial peripheral vascular disease. 4. Pain relieved when dangling the legs is an indication of arterial peripheral vascular disease. 5. A history of sitting for long periods of time is a risk factor for venous peripheral vascular disease.

21) What will the nurse instruct an older client with asthma to do to control exposure to household allergens? Select all that apply. 1. Eliminate surfaces that collect dust. 2. Remove carpets from the bedroom. 3. Reduce indoor humidity to less than 50 percent. 4. Stay out of a room that is being vacuumed. 5. Do not sleep or lie on upholstered furniture.

Answer: 2, 3, 4, 5 Explanation: 1. It is difficult to remove surfaces that collect dust because this includes dressers, stands, vases, and most household furniture. 2. Removing carpets from the bedroom is an action to control house dust. 3. Reducing indoor humidity is an action to control house dust. 4. Staying out of a room that is being vacuumed is an action to control asthma symptoms caused by house dust. 5. Avoiding upholstered furniture is an action to control house dust.

16) The nurse is caring for a frail older client with chronic obstructive pulmonary disease (COPD) who is having difficulty clearing secretions from the respiratory tract. Which actions can the nurse take to help this client? Select all that apply. 1. Offer only hot beverages. 2. Use postural drainage. 3. Perform chest percussion. 4. Teach controlled coughing. 5. Perform tracheal suctioning.

Answer: 2, 3, 4, 5 Explanation: 1. Oral fluids help to thin respiratory secretions and should not be limited in the client with COPD. Hot drinks like broth, tea, and coffee should be offered, but the goal is to get fluids into the client by meeting their preferences, whether that is hot or cold drinks. 2. Postural drainage uses gravity to force secretion upward and stimulates a cough reflex. If the client can tolerate this, it is a great intervention. 3. Chest percussion loosens secretions. 4. Controlled coughing contracts the diaphragm to maximize the cough response. 5. Tracheal suctioning is used to remove secretions in those who are too frail or near end of life.

6) The nurse instructs an older client with asthma about use of a peak flow meter. The nurse instructs the client to use the meter at which times? Select all that apply. 1. After eating dinner in the evening 2. If feeling like cold symptoms are occurring 3. If wheezing or tightness in the chest occurs 4. In the morning after awakening and in the early afternoon 5. Every day for the first two weeks after medication changes

Answer: 2, 3, 4, 5 Explanation: 1. This time of day is not ideal for peak flow meter use for any reason. 2. The nurse should instruct an older client with asthma to use a peak flow meter with cold symptoms. 3. The nurse should instruct an older client with asthma to use a peak flow meter with chest tightness or wheezing. 4. The nurse should instruct an older client with asthma to use a peak flow meter in the morning after awakening and between noon and 2 p.m. 5. The nurse should instruct an older client with asthma to use a peak flow meter every day for the first two weeks when medication or treatments are changed.

8) The nurse is providing discharge instructions for an older patient who is prescribed atorvastatin (Lipitor) for elevated cholesterol. What effects should the nurse advise the patient to report to the healthcare provider? Select all that apply. 1. Headaches 2. Stomachache 3. Shortness of breath 4. Muscle pain and weakness 5. Bruising and excessive bleeding

Answer: 2, 4 Explanation: 1. Headaches are not documented side effects of statin medications. 2. Gastrointestinal distress is a side effect of statin medication and should be reported to the healthcare provider. 3. Shortness of breath is not a documented side effect of statin medications. 4. Muscle pain and weakness is a side effect of statin medication and should be reported to the healthcare provider. 5. Bruising and excessive bleeding are not documented side effects of statin medications.

18) The nurse anticipates that an older patient with right-sided heart failure would exhibit which symptoms? Select all that apply. 1. Pallor 2. Edema 3. Wheezing 4. Exertional dyspnea 5. Neck vein distention

Answer: 2, 4, 5 Explanation: 1. Pallor is not a specific symptom of right-sided heart failure. 2. Physical signs of right-sided heart failure include edema in the extremities. 3. Wheezing is not a specific symptom of right-sided heart failure. 4. Exertional dyspnea is a specific symptom of right-sided heart failure. 5. Physical signs of right-sided heart failure include dilated neck veins.

17) Grant funding has been decreased for community disease-prevention programs. Which programs are the nurse's priority to implement, without modification, for the community of older-adult clients? Select all that apply. 1. Smoking cessation program for lung cancer prevention for an assisted living group. 2. Seasonal influenza vaccine clinic for the groups at the senior citizen's center. 3. Biannual pneumonia vaccine clinic at the local grocery store on senior discount day. 4. Antituberculosis vaccine and tuberculosis prevention education at the refugee center. 5. Weekly gathering of an older adult group for walking at the park together.

Answer: 2, 5 Explanation: 1. Smoking cessation is always good. However, lung cancer risks only decline after about 10-15 years of smoking abstinence. This program is not essential. 2. Flu vaccines in the early fall season for the elderly are extremely important, particularly when the clients are still active in the community, increasing exposures. 3. The pneumonia vaccine is only needed every few years after the age of 65. Offering the pneumonia vaccine in the same location every 6 months is unlikely to have the desired impact on the community. 4. The BCG (Bacillus Calmette-Guerin) is an anti tuberculosis vaccine that is not used in the United States. This group has a high potential for already being exposed to tuberculosis. It would be much more important to ensure testing was done and education regarding the prevention of its spread was complete. 5. This is a low cost intervention. Exercise and encouraging activity helps the client stay healthy and increases deep breathing, reducing the risk of lower airway conditions.

10) The nurse is providing teaching for reproductive cancer screenings for an older female client. Which information will the nurse include in the teaching? 1. "A pelvic ultrasound should be done annually." 2. "Obtain an CA-125 on your next annual exam." 3. "Pap smears can be eliminated if the previous one was normal." 4. "Either a mammogram or clinical breast exam should be done annually."

Answer: 3 Explanation: 1. A pelvic ultrasound is used to evaluate symptoms and is only useful in detecting an advanced disease. 2. The CA-125 is not recommended as an ovarian cancer screening tool because there is little conclusive evidence that it would decrease the mortality from ovarian cancer. 3. Current recommendations are that women who are over age 65, who have had a regular history of normal Pap smears, and who are not at high risk because of other factors should not receive routine Pap smears. 4. Mammography is recommended yearly for women over the age of 40.

23) An older patient with valvular disease is scheduled for an echocardiogram. What should the nurse teach the patient about this diagnostic test? 1. Determines the risk for metabolic syndrome 2. Analyzes the reasons for high blood pressure 3. Visualizes the heart valves as they open and close 4. Measures the amount of blood flowing through arteries

Answer: 3 Explanation: 1. An echocardiogram evaluates all heart valve function. This test allows the visualization of the valves as they open and close. Using this test, one can determine valve area, cardiac output, and any regurgitation. It is not used to determine the risk for metabolic syndrome. 2. An echocardiogram evaluates all heart valve function. This test allows the visualization of the valves as they open and close. Using this test, one can determine valve area, cardiac output, and any regurgitation. It is not used to analyze the reasons for high blood pressure. 3. An echocardiogram evaluates all heart valve function. This test allows the visualization of the valves as they open and close. Using this test, one can determine valve area, cardiac output, and any regurgitation. 4. An echocardiogram evaluates all heart valve function. This test allows the visualization of the valves as they open and close. Using this test, one can determine valve area, cardiac output, and any regurgitation. It is not used to measure the amount of blood flowing through arteries.

1) An older female patient experiences fatigue and nausea, is not sleeping well, and makes a vague complaint of intermittent chest discomfort. How should the nurse interpret these symptoms? 1. Signs of anemia 2. Pancreatic disease 3. Myocardial infarction 4. Normal changes of aging

Answer: 3 Explanation: 1. Anemia would present with fatigue but not with nausea or chest discomfort. 2. Pancreatic disease would present with pain in the abdominal region. 3. Many older women will complain of vague symptoms when having a myocardial infarction, including fatigue, sleep disturbances, and epigastric pain. 4. These symptoms are not considered normal changes of aging.

8) Which finding in the older client with chronic obstructive pulmonary disease (COPD) most concerns the nurse? 1. Controlled atrial fibrillation on the heart monitor 2. Cyanotic nail beds and clubbed fingers 3. Chronic cigarette smoking while at home reported 4. Cough in the morning producing clear sputum

Answer: 3 Explanation: 1. Enlargement and thickening of the right ventricle of the heart often results in dysrhythmias. This occurs later in the disease. Controlled atrial fibrillation, meaning the rate is acceptable, is not concerning. 2. With the progression of COPD, the body compensates by producing extra red blood cells. These extra blood cells clog the small blood vessels of the fingers leading to the development of cyanotic nail beds and clubbing of the fingertips. 3. It worsens the disease process to continue smoking. Additionally, the client with COPD is typically on home oxygen either continually or as needed. Even when the oxygen tank is turned off, the environment is considered oxygen rich, leading more easily to fire ignition. 4. The earliest presenting symptom of COPD is morning cough with clear sputum. If the client develops an infection, the sputum would become yellow or green in color.

9) An older patient who is postmenopausal is experiencing uterine bleeding. Which action would be appropriate for the nurse to take at this time? 1. Provide hygienic care. 2. Collect a urine specimen. 3. Direct the patient for evaluation for endometrial cancer. 4. Instruct the patient on normal changes of the reproductive system in the elderly.

Answer: 3 Explanation: 1. Hygienic care is important but it is not a priority at this time. 2. Collecting a urine specimen may be part of the further assessment but is not a priority. 3. Any older woman who reports postmenopausal uterine bleeding should be assumed to have endometrial cancer until proved otherwise. The patient should be directed to seek healthcare to evaluate for the presence of endometrial cancer. 4. Uterine bleeding is not a normal change in the older female patient.

4) What is the most important teaching point from the nurse to the older client diagnosed with asthma? 1. It is essential to rinse out the mouth after use of inhaled medications, especially steroids. 2. Asthma is treated with the same types of medications in older clients as in younger clients. 3. Place several rescue inhalers around the house and label them with brightly colored tape. 4. If a metered-dose inhaler is too difficult to use, a nebulizer can be used for treatments.

Answer: 3 Explanation: 1. It is important to prevent infection such as oral candidiasis. This is done by rinsing out the mouth with warm water after the use of an inhaler. This also helps prevent tooth decay and gum disease. 2. The same types of medications are used to treat asthma in older adults as in younger adults. While this is true, it is not the most important thing for the client to know. 3. The client needs to be able to find rescue medication quickly and easily if it is needed. This protects airway and breathing. Placing a brightly colored tape on them ensures that they do not blend into their surroundings. Having multiple canisters ensures that they are available wherever an asthma attack occurs. 4. Sometimes the older adult becomes unable to effectively manage the hand strength and coordination required to use a metered-dose inhaler. If this is the case, the client can request to be switched to nebulizer treatments.

15) The nurse teaches the client about a new prescription for hormone replacement therapy. Which information in the client history most concerns the nurse? 1. Mother had breast cancer 2. History of oral contraceptives for fifteen years 3. Anticoagulant therapy for the past six months 4. Treatment for hypercholesterolemia

Answer: 3 Explanation: 1. Most breast cancers are not hereditary. The client's personal risk for breast cancer does increase with HRT, though. A personal history of breast cancer is a contraindication to HRT. 2. Prolonged exposure to oral contraceptives can increase the risk of breast cancer, particularly in estrogen-progesterone therapies. This risk is not the most concerning. 3. Thromboembolic disease is a direct contraindication to HRT. The client who is on anticoagulants has either had a clot or is at high risk for clots due to something like atrial fibrillation. The nurse must ensure the client does not have direct contraindication to therapy. 4. Hormone replacement therapy is contraindicated in coronary heart disease. Though heart disease and hypercholesterolemia are closely related, they are not the same. This client can proceed with HRT with caution.

15) An older patient being treated for hypertension experiences lightheadedness when getting up in the middle of the night to void and when making sudden movements. How should the nurse instruct this patient? 1. Encourage a sleeping pill to prevent nighttime waking. 2. Ensure that the side rails are upright on the bed to prevent the patient from ambulating. 3. Move slowly from a lying to a sitting position and then slowly from sitting to standing. 4. Decrease fluid intake in the evening to prevent the need to get up in the middle of the night.

Answer: 3 Explanation: 1. Other alternatives would be indicated before encouraging a patient to take a medication for sleep. 2. The patient is being treated for hypertension and should not be discouraged from walking to the bathroom if proper precautions are made. This may be considered a restraint. 3. Patients taking antihypertensive medications should be instructed to change positions slowly. Rising too quickly from lying to standing position can result in pooling of blood in the extremities and reduced blood flow to the head. This can cause orthostatic hypotension, which is experienced as lightheadedness or syncope. 4. The nurse should not encourage the patient to restrict fluids since this could potentiate other health problems.

5) The nurse is planning care for an older patient with hypertension who recently fell in the home. Which assessment would the nurse plan for this patient? 1. Check serum sodium levels. 2. Check serum creatinine levels. 3. Check postural blood pressures. 4. Check blood pressure every 2 hours

Answer: 3 Explanation: 1. Serum sodium levels would be used to assess renal function. 2. Serum creatinine levels would be used to assess renal function. 3. Since baroreceptors are less efficient with aging, postural hypotension is more likely to occur. Also, patients treated for hypertension could have an increase in sensitivity to the medications. Postural blood pressure assessment allows the nurse to prevent postural hypotension and falls. 4. Every 2 hours is too frequent for assessments of a noncritical patient.

8) The nurse is reviewing the chart of an older adult client with acute renal failure. Which assessment finding is most likely? 1. Excoriated areas on the skin 2. Muscle weakness and cramping 3. +3 edema in the lower extremities 4. Weight loss of 13 pounds in a month

Answer: 3 Explanation: 1. Skin excoriation may be attributed to pruritis that is associated with chronic renal failure. 2. Muscle weakness and cramping are symptoms associated with hypocalcemia. Hypocalcemia occurs in older clients with chronic renal failure. 3. Dependent edema occurs in the older client with acute renal failure. 4. Weight loss of 1 pound per day is expected in an older adult with acute renal failure.

5) The nurse is providing teaching about lifestyle changes for an older client with BPH. Which statement made by the client indicates further teaching is required? 1. "I will avoid drinking alcohol." 2. "I will increase the fiber in my diet." 3. "I will decrease my intake of fluids." 4. "I will no longer take any antihistamines."

Answer: 3 Explanation: 1. Standard treatments for BPH include recommendations for lifestyle changes which include reducing the intake of of liquids (especially before sleep), avoiding caffeine and alcohol, avoiding medications with anticholinergic side effects (decongestants, antihistamines, antidepressants, and diuretics), bladder training, and preventing constipation. 2. Standard treatments for BPH include recommendations for lifestyle changes which include reducing the intake of of liquids (especially before sleep), avoiding caffeine and alcohol, avoiding medications with anticholinergic side effects (decongestants, antihistamines, antidepressants, and diuretics), bladder training, and preventing constipation. 3. A significant reduction in fluid intake may result in hypotension increasing the client's risk for falls. Teaching should be directed at decreasing the fluid intake before sleep. 4. Standard treatments for BPH include recommendations for lifestyle changes which include reducing the intake of of liquids (especially before sleep), avoiding caffeine and alcohol, avoiding medications with anticholinergic side effects (decongestants, antihistamines, antidepressants, and diuretics), bladder training, and preventing constipation.

4) During a home visit, the nurse learns that an older patient with hypertension takes prescribed medications only when feeling tense. What instruction should the nurse provide to the patient? 1. Contact the physician for a change in blood pressure medication. 2. Continue to administer the blood pressure medication as needed. 3. Teach to take the blood pressure medication as prescribed regardless of feeling tense. 4. Instruct to take a double dose of the medication for one day then resume the normal schedule.

Answer: 3 Explanation: 1. The dosage prescribed may be appropriate if taken daily; therefore, it would not need to be changed. 2. The patient's current practice is incorrect. The patient needs to be instructed to take the medication as prescribed and not only when feeling tense. 3. Patients sometimes mistakenly take blood pressure medication only on an as-needed basis. This is incorrect and the patient should take the medication as prescribed on a daily basis. 4. To advise the patient to increase the medication without a physician consultation would be out of the scope of nursing practice.

23) An older client is prescribed isoniazid (INH) for 6 months. What should the nurse instruct the client about this medication? 1. Avoid vitamin supplements. 2. Use alcohol only in small amounts. 3. Report yellow eyes or skin immediately. 4. Expect the finger and toe tingling to occur.

Answer: 3 Explanation: 1. There is no reason to avoid vitamin supplements while taking this medication. 2. Clients taking isoniazid are urged not to drink alcoholic beverages, including wine, beer, and liquor. 3. Serious side effects of isoniazid include jaundice. The client should report yellow eyes or skin immediately. 4. Serious side effects of isoniazid include tingling in the fingers and toes and should be reported immediately.

4) An older female patient asks the home care nurse what can be done to help with painful intercourse. What recommendations should the nurse make to the patient? Select all that apply. 1. Avoid intercourse. 2. Decrease the frequency of intercourse. 3. Use vaginal lubricants during intercourse. 4. Use the hand to guide the penis into the vagina. 5. Tolerate the problem because it is a normal part of aging.

Answer: 3, 4 Explanation: 1. Avoiding intercourse does not resolve the problem for the patient. 2. Decreasing the frequency of intercourse does not resolve the problem for the patient. 3. It is not uncommon for an elderly female to report painful intercourse, which is related to a decrease in vaginal lubrication as well as the lack of elevation of the labia during sexual arousal. Vaginal lubricants can be very effective in reducing the pain experienced during intercourse. 4. The older female might be advised to use her hand to guide her partner's penis into the vagina. 5. Although this is a normal change of aging, patients do not have to tolerate the discomfort.

19) The nurse is concerned that an older patient is at risk for developing metabolic syndrome. What manifestations would be present? Select all that apply. 1. Heart rate 88 and regular 2. Blood pressure 156/90 mm Hg 3. Respiratory rate 18 and regular 4. Waist circumference 42 inches 5. Fasting capillary blood glucose 144 mg/dL

Answer: 3, 4, 5 Explanation: 1. Heart rate is not used as a component to diagnose metabolic syndrome. 2. Blood pressure equal to or greater than 130/85 mm Hg is a component to diagnose metabolic syndrome. 3. Respiratory rate is not used as a component to diagnose metabolic syndrome. 4. Women's waist circumference that is equal to or greater than 35 inches is a component to diagnose metabolic syndrome. 5. Blood glucose equal to or greater than 100 mg/dL is a component to diagnose metabolic syndrome.

7) An older client with asthma is prescribed a rescue inhaler of albuterol. What should the nurse instruct the client about using this medication? Select all that apply. 1. Refrigerate unused canisters until needed. 2. Metered dose inhalers must be used with a spacer. 3. Label each canister with bright red tape. 4. Obtain a prescription for extra canisters. 5. Keep inhalers in multiple areas in the home.

Answer: 3, 4, 5 Explanation: 1. Unused canisters should not be refrigerated unless directed to do so by the pharmacy. 2. Spacers are useful for those using a metered dose inhaler; however, it is not necessary to attach a spacer to the canister for use. 3. Clients who require the use of rescue inhalers should label them with bright red tape so they can be easily seen if needed quickly. 4. Clients who require the use of rescue inhalers should obtain prescriptions for extra canisters. 5. Clients who require the use of rescue inhalers should keep several inhalers in strategic places in the home.

22) An older patient diagnosed with pneumonia does not understand why the health problem occurred since respiratory problems have never been experienced. How should the nurse respond to this patient? Select all that apply. 1. Back joints are stiffer. 2. Less oxygen is used with aging. 3. Ciliary function decreases with age. 4. Retention of carbon dioxide occurs with aging. 5. Decreased immune function occurs with aging.

Answer: 3, 5 Explanation: 1. Back joints are stiffer with aging; however, this does not explain the onset of pneumonia in the patient. 2. Less oxygen is not used with aging. 3. Ciliary function is decreased with aging, which makes the older person more susceptible to pneumonia. 4. Retention of carbon dioxide is an indication of pathology and not a normal sign of aging. 5. Decreased immune function occurs with aging and makes the older person more susceptible to pneumonia.

3) An older client is scheduled for diagnostic testing. What is the best indication for the client to undergo pulmonary function tests? 1. Chest x-ray demonstrating bilateral infiltrates 2. Abnormal arterial blood gas analysis results 3. The presence of hemoptysis and fatigue 4. Chronic wheezing with an undiagnosed cause

Answer: 4 Explanation: 1. A chest x-ray will give information related to the pulmonary condition. Infiltrates often indicate pneumonia or similar process. If this information is not specific enough, a CT scan is the next diagnostic test the nurse anticipates. 2. An abnormal ABG is treated with medications or ventilation assistance. Further testing is not warranted until the imbalance is corrected. 3. Hemoptysis and fatigue are indications for a battery of respiratory tests, including CT or PET scan or bronchoscopy. A pulmonary function test may be included, but it is not the best indication for this test. 4. Pulmonary function tests are the most reliable way to diagnose asthma and differentiate it from other illness such as COPD. Measurement of air during expiration is used in the differential diagnosis.

9) The nurse is caring for an older client with asthma that has a respiratory rate of 28 breaths per minute and audible wheezes on inspiration. Which nursing diagnosis is most important for this client? 1. Activity intolerance 2. Altered peripheral tissue perfusion 3. Ineffective airway clearance 4. Ineffective breathing pattern

Answer: 4 Explanation: 1. Activity intolerance or diminished activity is appropriate if the client experiences fatigue or shortness of breath. Inability to perform activities is not a priority, though. 2. Altered tissue perfusion, whether peripheral or specific to a central organ, is important, but circulation is a concern after issues of airway and breathing. 3. Ineffective airway clearance would be appropriate if the client has a cough or if the client appears to have excessive or thick mucus. This is always a risk for the client with COPD or asthma. If mucus is not a current concern, the nurse does promote secretion thinning and continual clearance by encouraging fluid intake and deep breathing. 4. Ineffective breathing pattern is appropriate since this diagnosis is used if the client is experiencing wheezing and tachypnea. A high respiratory rate is not a sustainable breathing pattern and can lead to respiratory fatigue and failure.

9) An older patient has an increase in pitting edema of both ankles and is experiencing breathlessness. The patient is not experiencing any pain. What action should the nurse take to help the patient at this time? 1. Allow the patient to rest. 2. Measure intake and output. 3. Measure the patient's weight. 4. Contact the physician for further evaluation and treatment.

Answer: 4 Explanation: 1. Although allowing the patient to rest may reduce the breathlessness, this alone does not provide the appropriate intervention to address the patient's underlying problem. 2. Measuring intake and output is helpful assessment data but will not help the patient's current symptoms. 3. Measuring the patient's weight is helpful assessment data but will not help the patient's current symptoms. 4. The absence of chest pain in the older person does not indicate an absence of ischemic heart disease. Older adults can present with fatigue, weakness, shortness of breath, and gastrointestinal complaints. The nurse needs to contact the physician for further evaluation and treatment.

2) During a blood pressure screening at a pharmacy, an older person experiences a fluttering in the chest. What should the nurse interpret this finding as being? 1. Hypothyroidism 2. Exercise intolerance 3. Nonspecific cardiac changes with aging 4. Underlying illness that requires a medical evaluation

Answer: 4 Explanation: 1. Chest fluttering can be a sign of hyperthyroidism, not hypothyroidism. 2. Exercise intolerance would include symptoms of shortness of breath, which the older person does not report. 3. This symptom does not indicate normal cardiac changes. 4. New onset atrial fibrillation and other arrhythmias may signal the onset of a serious underlying illness that requires further medical evaluation.

20) When admitting an older client with chronic obstructive lung disease (COPD), which finding most concerns the nurse? 1. Chronic cough with thick sputum 2. Calluses on both of the client's elbows 3. Lives with child and grandchildren 4. Use of fire place for winter heat

Answer: 4 Explanation: 1. Chronic cough with tenacious or thick clear sputum is typical in the client with COPD. Mucolytics and increased fluid intake helps to thin secretions. 2. Older clients with COPD often have calluses on their elbows as a result of leaning over tables to stretch out their torsos so that more air can enter and exit during respiration. It is often referred to as the "tripod" position. 3. As long as everyone in the house observes infection control measures such as hand washing, covering their face for coughs and sneezes, and obtaining vaccinations, living with the family is usually a positive finding. 4. The client with COPD is likely on oxygen and should not be near an open flame. Wood stoves and smoky fires create indoor pollutants that are dangerous for the client with COPD.

10) An older client with chronic obstructive pulmonary disease (COPD) is admitted for nebulizer treatment, intravenous steroids, and antibiotics. The client develops a tachydysrhythmia. Which nursing diagnosis is the priority for this client? 1. Diminished activity 2. Inability to achieve airway clearance 3. Impaired gas exchange 4. Risk for decreased cardiac output

Answer: 4 Explanation: 1. Diminished activity is relevant for this client, but it is not a priority in the presence of heart complications. 2. The client does likely need continued intervention to ensure airway clearance. This is not the most relevant nursing diagnosis, though. 3. Impaired gas exchange is typically related to untreated infection, bronchoconstriction, or overexertion. This is highly relevant for this admitted client, but is not the priority. 4. Though "risk for" diagnoses are often lower priority, in this instance, it is the priority. The respiratory issues are being managed already. The arrhythmia is a new finding with the potential to result in decreased peripheral and central perfusion. Tachydysrhythmia results in decreased cardiac output which can lead to respiratory failure. This can occur as the result of complications from COPD such as cor pulmonale or from a comorbidity such as a pulmonary embolism.

13) What should the nurse teach an older client with chronic obstructive pulmonary disease who is newly diagnosed with tuberculosis? 1. In the early stage, tuberculosis causes shortness of breath. 2. An infection related to human immunodeficiency virus (HIV) causes tuberculosis. 3. Tuberculosis spreads from persons who have few to no symptoms. 4. Immunosuppressants, like steroids, must be used cautiously with tuberculosis.

Answer: 4 Explanation: 1. Early symptoms include weight loss, night sweats, and loss of appetite. 2. Tuberculosis is caused by mycobacterium tuberculosis, which is an acid-fast, aerobic bacterium. Clients with HIV are at greater risk for tuberculosis because of altered immune status. 3. Tuberculosis is spread by droplet infection by persons with active disease. Persons with positive skin tests have been exposed to the infection and have sustained an immune response to the exposure. They usually are given an antibiotic prophylactically. 4. A risk factor for developing tuberculosis is the use of medications that suppress the immune system, such as corticosteroids or anticancer medications. Steroids are often used to treat COPD and may have placed the client at risk initially and may complicate treatment of the infection.

12) The nurse is providing instruction to an older patient regarding a new diuretic medication. Which should be included in the teaching? 1. Patient should eat a high iron diet. 2. Patient should eat a low calcium diet. 3. Patient should eat a high sodium diet. 4. Patient should eat a high potassium diet.

Answer: 4 Explanation: 1. Lasix does not affect iron levels. 2. Lasix does not affect calcium levels. 3. Lasix does not affect sodium levels. 4. Lasix is a loop diuretic that depletes the potassium level. Patients who take potassium-depleting diuretics like Lasix should eat foods that replace the electrolyte.

1) The nurse is caring for a client who states, "I feel fine other than I have been frequently getting up at night to go to the bathroom." Which clinical manifestation is this client experiencing? 1. Fluid overload 2. Increased glycosuria 3. Hormonal imbalance 4. Age-related changes

Answer: 4 Explanation: 1. Older adults have a decreased response to fluid overload by not increasing urine output. 2. Older adults excrete less glucose in the urine. 3. Hormonal imbalances affect the urethra in women causing a thinner sphincter muscle and the prostate in men causing a constriction of the urethra. 4. The kidneys of older adults excrete more fluid and electrolytes at night than in the daytime. More urine is formed at night, frequently interrupting sleep patterns.

19) The nurse is providing teaching for an older female client about decreasing the risk of a urinary tract infection. Which information will the nurse include in the teaching? 1. Use powder to keep dry 2. Douche after intercourse 3. Drink cranberry juice daily 4. Take showers instead of baths

Answer: 4 Explanation: 1. The client should avoid the use of powder in the genital area. 2. Douching contributes to urinary tract infections by flushing out the normal flora that help prevent urinary tract infections. 3. Cranberry juice may benefit some clients with recurrent urinary tract infections, but large amounts over time may increase the risk for urinary stones. 4. The client should be encouraged to take showers instead of baths. Sitting in bath water allows bacteria to enter the urethra, potentially resulting in a urinary tract infection.

19) The nurse is preparing a care plan for an older client with asthma. The client is receiving oxygen and has a respiratory rate of 28 breaths per minute, heart rate of 86 beats per minute, and blood pressure of 108/52 mmHg. Which nursing diagnosis would be the priority for this client? 1. Risk for Injury 2. Risk for Infection 3. Activity Intolerance 4. Ineffective Tissue Perfusion

Answer: 4 Explanation: 1. There is no evidence that the client is at risk for injury. 2. The client may or may not be at risk for infection. 3. The client may or may not have activity intolerance. 4. Ineffective Tissue Perfusion is the appropriate diagnosis for the client with tachypnea, requiring oxygen and asthma care.

17) An older patient complains of prolonged and severe chest pain that occurs at the same time each day during rest with no precipitating factors. How should the nurse describe this type of pain? 1. Pericarditis 2. Unstable angina 3. Coronary artery disease 4. Atypical angina (Prinzmetal's angina)

Answer: 4 Explanation: 1. This patient is experiencing anginal pain. Pericarditis is an inflammation of the lining surrounding the heart. The cause of pericarditis is unknown but is often due to viral infection. 2. Unstable angina is not relieved by rest or nitroglycerin and is less predictable. 3. Coronary artery disease is a circulatory problem that causes blockages in the arteries. 4. Atypical or Prinzmetal's angina often occurs at the same time each day and typically at rest.

3) An older patient has a blood pressure reading of 150/88. The patient reports no other symptoms or medical history of illness. What should the nurse instruct the patient to do? 1. Have the blood pressure rechecked in a month. 2. Do nothing since this is a normal variant of aging. 3. Go to the emergency department for further evaluation and treatment. 4. Contact the primary care provider for further evaluation and treatment.

Answer: 4 Explanation: 1. Waiting for 1 month to recheck the blood pressure is too long of a period of time for evaluation and treatment. 2. Blood pressure elevation frequently occurs with aging, although it is not considered a normal variant. 3. It is not a symptom of emergent nature because the diastolic is not elevated above 110 mm Hg. 4. If left uncontrolled, high systolic pressure can lead to stroke, myocardial infarction, heart failure, kidney damage, blindness, or other conditions. Although it cannot be cured once it has developed, isolated systolic hypertension (ISH) can be controlled.

5. An older person with an ejection fraction of 38% tolerates routine activities of daily living without fatigue or shortness of breath. Which treatment should the nurse anticipate being prescribed for this person? A. Diuretic B. ACE Inhibitor C. Hydralazine D. Digitalis

B. ACE Inhibitor Rationale: With an ejection fraction of 38%, this person is classified as a Category I of the New York Heart Association Functional Classification. Treatment includes an ACE inhibitor. A diuretic, digitalis, and hydralazine are indicated for persons classified as Category II.

6. The nurse is caring for an older adult with chronic obstructive pulmonary disease (COPD). Which action should the nurse take before placing the person into a position for postural drainage? A. Coach to perform controlled coughing B. Administer prescribed bronchodilator C. Increase oxygen-flow rate D. Lightly clap the chest and back helps to loosen secretions

B. Administer prescribed bronchodilator Rationale: Postural drainage is more effective following inhalation of a bronchodilator. The oxygen flow rate is not adjusted for postural drainage. Controlled coughing and chest physiotherapy are two additional techniques to remove respiratory secretions are not identified to be done before postural drainage.

1. The nurse notes that an older person who has never smoked cigarettes has a barrel chest. What should the nurse consider as the reason for this person's anatomical change? A. Insufficient caloric (nutritional) and vitamin intake B. Altered alveolar shape resulting in increased alveolar diameter C. Excessive use of antibiotics for non-bacterial lung infections D. Repeated infections caused by influenza and pneumonia

B. Altered alveolar shape resulting in increased alveolar Diameter Rationale: Altered alveolar shape resulting in increased alveolar diameter decreases elastic recoil of the lung that produces increased residual volume. The chronic increase in residual volume changes the shape, specifically, the anterior-posterior diameter of the chest to become rotund or barrel shaped. This finding is not caused by diet, infections, or the use of antibiotics.

2. The nurse notes that an older person uses the bathroom to void every hour. Which age-related change should the nurse suspect this person is experiencing? A. Adverse reaction to potassium-sparing medications B. Change in the contractility of the detrusor muscle C. Increase in the number of nephrons in the kidney D. Thinning of the external sphincter muscle of the urethra

B. Change in the contractility of the detrusor muscle Rationale: The detrusor muscles, three layers of muscle that cover the bladder, become less contractile and also somewhat unstable. This may mean the older adult is subject to an inability to completely empty the bladder. The number of nephrons do not increase with aging. The need to void hourly is not caused by an adverse medication reaction. Thinning of the external sphincter muscle of the urethra increases the risk for incontinence in women.

8. The nurse is assessing an older person's functional health patterns. Which question should the nurse use to assess the person's health perception/health management status? A. Are you able to shop for food that is healthy? B. Do you have any difficulty getting or taking medications? C. Do you have one or two good friends you can count on? D. How far can you walk before you get short of breath?

B. Do you have any difficulty getting or taking medications Rationale: Asking about medications is used to assess health perception/health management status. The question about food shopping focuses on nutrition/metabolic status. Asking about walking and shortness of breath focuses on activity/exercise status. Asking about friends focuses on role/relationship status.

9. The spouse of an older person is upset because of a change in the frequency of sexual intercourse since the person had surgery for bladder cancer. What should the nurse consider as causing this couple's distress with sexuality? A. Adverse effect from the anesthesia B. Presence of a urinary-collection device C. Current side effects from postoperative medication D. Residual fatigue and depression after the surgery

B. Presence of a urinary- collection device Rationale: If the bladder is removed, a stoma on the abdomen is created and an external collection device is worn over the stoma to collect urine. This type of surgery presents a challenge to the older person's body image which would adversely affect comfort with sexual intercourse. It is unlikely that the person is experiencing an adverse effect from the anesthesia. Depending upon when the surgery occurred, fatigue and depression might be occurring however this is not identified within the scenario. There is no information to support the person is receiving post-operative medication.

5. An older person is concerned about a new onset of wheezing and chest tightness. Which diagnostic test should the nurse prepare teaching for this person? A. CT scan of the thorax B. Pulmonary function tests C. Sputum samples D. Chest x-ray

B. Pulmonary Function tests Rationale: Pulmonary function tests are the most reliable way to diagnose asthma and differentiate it from other illnesses such as COPD. A chest x-ray is used commonly used for respiratory disorders but is not identified as a test to diagnose asthma. Sputum samples are used to diagnose tuberculosis. A CT scan of the thorax is used to help diagnose lung cancer.

7. An older person has a positive tuberculin skin test but has a negative chest x-ray for the disease. What should the nurse include when teaching the person about the treatment for this infection? A. Expect to take the medication for at least 18 months B. Schedule monthly liver-function tests C. Stop taking the medication if side effects occur D. Limit alcohol intake to one drink per day

B. Schedule monthly liver-function tests Rationale: Once infected with M. tuberculosis, the person is treated with isoniazid to prevent active disease. This drug can cause hepatitis in a small percent-age of persons and presents a particular risk for those over age 35. Liver function tests should be routinely monitored in the older person to prevent liver complications. Persons taking isoniazid are urged not to drink alcoholic beverages, including wine, beer, and liquor. When the antibiotic treatment is interrupted because of unpleasant side effects, the TB bacteria may become resistant and be more difficult to eradicate when treatment is started again. Isoniazid is taken for 6 to 9 months.

4. The nurse notes that a resident in an assisted-living facility leaves the dining room several times during the evening meal to void. What should the nurse suspect is occurring with this resident? A. Acute renal failure B. Urinary-tract infection C. Chronic renal failure D. Urinary incontinence

B. Urinary-tract infection Rationale: If an older adult presents with new symptoms of urinary urgency, a shortened period of time between the urge to void and actual urination, urinary frequency, or more than seven voids per 24-hour period, an investigation for a urinary tract infection is necessary. The increased need to void is not a symptom of acute or chronic renal failure. The resident would be incontinent of urine if urinary continence is occurring.

9. An older person with COPD arrives for a routine wellness visit. Which approach should the nurse use when assessing this person's lung sounds? A. Listen for tracheal sounds with the person in the supine position B. Begin at the apices and compare from side to side C. Start with the side with reduces respiratory excursion D. Identify the 8th rib and begin auscultation on the anterior chest

B. begin at the apices and compare from side to side Rationale: The lungs should be auscultated beginning at the apices of one lung and comparing that sound to the same area of the other lung. Usually auscultation proceeds from posterior to anterior and from the apex downward to the eighth rib, noting the presence of crackles, wheezes, rhonchi, or pleural rub. Respiratory excursion is a separate assessment. The person should be in a comfortable position for auscultation which not usually supine.

4. During an assessment, the nurse asks an older person about any recent trips to major cities. Which finding caused the nurse to ask this question? A. Weight gain of 2 lbs. B. Cough and pulmonary congestion C. Elevated blood pressure D. Hyperactive bowel sounds

B. cough and pulmonary congestion Rationale: One way to prevent respiratory system problems with aging is to avoid urban air pollution. Visiting a major city increases exposure to air pollution which could be the reason for the person's cough and pulmonary congestion. Change in weight, blood pressure, and bowel sounds are not directly linked to recent travel to a major city.

7. An older person seeks medical attention for a new onset of cardiovascular symptoms. Which part of the assessment should the nurse identify as being the most important? A. Review of systems B. Health history C. Chief complaint D. List of medications

B. health history Rationale: The history is the most important part of the assessment. Even though the nurse will assess the chief complaint, review of systems, and list of medications, the health history provides a comprehensive picture of the person's overall health. This information is necessary to plan effective care.

1. An older person is concerned about having to void large amounts of urine two times every night. Which response should the nurse make that explains this change in renal functioning? A. "This is an adverse effect of some medications you are taking." B. "This is an early indication of renal failure that needs to be investigated." C. "Due to normal changes in the kidney, more urine is produced at night." D. "This means that you are drinking too much fluid at the end of the day."

C. " Do to normal changes in the kidney, more urine is produced at night." Rationale: Blood flow to the kidney decreases as a result of atrophy in the supplying blood vessels, particularly in the renal cortex. In addition, the proximal tubules decrease in number and length. Because of this, the kidneys of older adults excrete more fluid and electrolytes at night than in the daytime. More urine is formed at night, frequently interrupting sleep patterns and causing repeated episodes of nocturia.

6. An older person feels like their bladder is not completely empty despite voiding several times a day. For which health problem should the nurse plan care for this person? A. Urinary-tract infection B. Functional incontinence C. Benign prostatic hyperplasia D. Chronic renal failure

C. Benign Prostatic Hyperplasia Rationale: The symptoms of BPH are sometimes referred to as "nuisances," and include urinary frequency (up to 8 or more times/day) and a feeling of incomplete bladder emptying. These symptoms are not associated with chronic renal failure, a urinary tract infection, or functional incontinence.

3. The nurse prepares an educational seminar on female reproductive changes that occur with aging for members of a women's group. Which information should the nurse include? A. Increased estrogen levels B. Increased lubrication of vaginal tissues C. Decreased glandular tissue in breasts D. Decreased autonomic innervation

C. Decreased glandular tissue in breasts Rationale: An age-related change in the female reproductive system is a decrease in glandular tissue in the breasts. Estrogen levels decrease with aging. Autonomic innervation does increase however this is a change in bladder and urethra functioning. Lubrication of vaginal tissues decreases with aging.

6. After an assessment, the nurse plans interventions to address an older person's venous vascular disease. Which assessment finding caused the nurse to make this clinical decision? A. Calf pain with exercise B. Ankle-brachial index 0.3 C. Evidence of hemosiderin D. Dangling the leg relieves the pain

C. Evidence of hemosiderin Rationale: When the valves of the veins are incompetent, higher than normal pressures develop in the veins. This pressure is transmitted to the capillaries of the lower extremities. Over time, a thickening of the tissues around the ankles develops along with a brownish discoloration due to red blood cells that are pressed outside the capillaries. As the cells break down, hemosiderin (a breakdown product of hemoglobin) deposits collect. Calf pain with exercise, an ankle-brachial index less than 1m, and dangling to relieve the pain are findings associated with arterial vascular disease.

9. An older person with heart failure is concerned about having to void frequently during the night. What should the nurse explain about this symptom? A. It occurs because of ingesting too much fluid during the day B. Inadequate pumping of the heart causes fluid to be routed to the kidneys C. Fluid in the legs is moved back into circulation, increasing urine output D. It is caused by taking prescribed diuretics too late in the day

C. Fluid in the legs is moved back into circulation, increasing urine output. Rationale: At night, fluid that has collected in the legs is moved into the full circulation for removal by the kidneys. Nocturia or voiding during the night is not caused by taking prescribed diuretics too late in the day or because of ingesting too much fluid during the day. Inadequate pumping of the heart causes fluid to be routed to the lungs and peripheral tissues.

5. The nurse prepares teaching material for an older person experiencing stress incontinence. Which assessment finding did the nurse use to select this topic for education? A. Wakes up several times during the night to void B. Feels the urge to void every hour C. Leaks urine when sneezing D. Experiences difficulty voiding

C. Leaks urine when sneezing Rationale: A characteristic of stress incontinence is leaking a small amount of urine when intraabdominal pressure is increased such as when sneezing. Difficulty voiding can be a symptom of renal failure or benign prostatic hypertrophy. Feeling the urge to void every hour may indicate frequency associated with a urinary tract infection. Waking up several times during the night to void may be an age-related change in renal functioning.

2. An older person reports having more respiratory infections since retiring from a position as a mail carrier. What should the nurse explain as the potential reason for these infections? A. Immune system adjustments to the change in environment B. Increased exposure to pathogens in the home C. Loss of muscle tone caused by a change in lifestyle D. Respiratory system effort to rid the body of toxins

C. Loss of muscle tone caused by a change in lifestyle Rationale: Changes in other body systems can adversely affect respiratory functioning. A loss of muscle tone, exacerbated by deconditioning and sedentary lifestyle could be the reason why a former mail carrier is experiencing more respiratory infections after retirement. There is no evidence that the person is exposed to pathogens in the home. The infections are not caused by the body getting rid of toxins. The person has lived in the same home and should not have immune system adjustments because of a change in environment.

10. An older female person seeks medical attention for a new onset of pain with sexual intercourse. Which recommendation should the nurse make? A. Use the spoon position B. Consider changing the form of sexual expression C. Use a water-soluble lubricant D. Take a bath before engaging in sexual intercourse

C. Use a water-soluble lubricant Rationale: Dyspareunia, painful intercourse for the older woman, may be related to decreased vaginal lubrication which can be experienced by over one third of older women. The older couple might be advised to use a water-soluble vaginal lubricant as part of their sexual activity. The spoon position is helpful for couples with hip or joint discomfort. There is no need for the couple to change the form of sexual expression. Taking a bath before intercourse will not help reduce the vaginal discomfort.

The nurse determines that an older person with a blood pressure of 150/90 mm Hg has been implementing lifestyle changes to bring the blood pressure down to 130/76 mm Hg. Which assessment data did the nurse use to support this change in blood pressure? A. Alcohol intake 3 drinks per day B. Sodium intake 3 grams per day C. Weight loss of 22 lbs. D. Exercises 10 minutes per day

C. Weight loss of 22 lbs Rationale: Reducing weight by 10 kg can decrease systolic blood pressure 5- 20 mm Hg. Since the person's systolic blood pressure dropped 20 mm Hg, weight loss is the reason. Recommendations to further decrease blood pressure include exercising 30 minutes each day, limiting sodium intake to 2.4 grams, and restricting alcohol to 2 drinks per day for men and 1 drink per day for women.

10. A older adult with heart failure is having difficulty reducing the amount of sodium when preparing meals. Which approach should the nurse use first to help with the necessary dietary change? A. Explain the importance of restricting sodium to prevent fluid retention B. Provide a list of permitted foods C. Discuss actions to take if foods high in sodium are consumed D. Analyze preferred foods and suggest small changes

D. Analyze preferred foods and suggest small changes Rationale: Diet therapy will involve teaching and may also involve consultation with dietitians. It is best to start with the person's preferred diet and suggest small changes that are acceptable to the person. Providing a list of permitted foods may not include the ones the person prefers. The goal is to prevent consuming foods high in sodium. The need to restrict sodium to prevent fluid retention most likely has already been discussed since the person is experiencing issues with sodium when preparing meals.

3. An older person asks what can be done to prevent the development of respiratory infections during the winter months. Which recommendation should the nurse provide to this person? A. Increase the intake of vitamin supplements B. Restrict the intake of dairy products C. Limit cigarette smoking D. Increase daily exercise

D. Increase daily exercise Rationale: Actions to support healthy aging of the respiratory system include staying active with daily exercise. Cigarette smoking should be avoided. There is no need to restrict any food group to promote respiratory functioning. Vitamin supplements are not identified as an approach to support respiratory functioning when aging.

4. An older person with stable angina reports using sublingual nitroglycerin several times a day to treat the pain. What should the nurse anticipate being prescribed for this person? A. Progressive exercise regimen B. Cardiac-rehabilitation program C. Low-fat, low-sodium diet D. Long-term nitrate medication

D. Long-term nitrate medication Rationale: Older persons who need multiple doses of nitrates every day can be placed on long-term nitrate therapy. Treatment for angina does not include a change in diet, a progressive exercise program, or participation in a cardiac rehabilitation program.

8. A resident in an assisted-living facility is upset because a group of friends went to see a movie and didn't invite the resident to join them. Which finding should the nurse consider as a possible reason for the person's social isolation? A. Hearing deficit B. Timing of medications C. Use of a cane to ambulate D. Odor from incontinence pad

D. Odor from incontinence pad Rationale: Many older adults who experience urinary incontinence use disposable incontinence pads or protective under-garments. Although these may be helpful in managing the social consequences of UI, they are neither a cure nor without adverse effects. Used incontinence products can have an unpleasant odor. It is unlikely that the resident is being avoided because of a hearing deficit, medication schedule, or use of an assistive device to ambulate.

10. The nurse notes that an older person being treated for pneumonia at home continues to smoke and drink alcoholic beverages most evenings. Which issues should the nurse use to guide this person's care? A. Ongoing infection B. Resistance to prescribed treatment C. Poor oxygenation D. Poor health maintenance

D. Poor health maintenance Rationale: The person with pneumonia who uses tobacco or alcohol is at risk for health maintenance issues. There is insufficient evidence that the person has poor oxygenation, or the infection is not being healed. There is no evidence to support that the person is not taking medications as prescribed.

2. A nurse, new to the cardiovascular-intervention laboratory, notes a high number of older persons requiring pacemakers. What should the nurse manager explain as the reason for the nurse's observation? A. The number of people needing pacemakers varies with the seasons B. It depends upon the person's genetic makeup and lifestyle C. Older persons do not engage in adequate exercise to support cardiac functioning D. The number of functioning pacemaker cells in the right atrium decreases

D. The number of functioning pacemaker cells in the right atrium decreases. Rationale: Electrical activity of the heart is affected in aging with a decrease in the number of normal pacemaker cells in the sinus node. By age 75, only 10% of original pacemaker cells are still functional, but under normal circumstances this number can still support cardiac function. If the number of cells does not support cardiac functioning, a pacemaker will be required. The number of older people requiring pacemakers does not vary with the seasons. Genetic makeup and lifestyle affects overall cardiovascular functioning and not specifically heart rate or rhythm. The need for a pacemaker is not because of inadequate exercise.