Gerontology Chapters 11 - 36

Which attempt by the family to prevent an older, frail adult from falling causes the home health nurse concern? a. Keeping several low wattage night-lights on in the evening b. Installing wooden railings on the stairway to the bathroom c. Keeping the side rails up on the client's bed at night d. Encouraging the client to use a cane when ambulating

ANS: C Keeping side rails up have proven to be a risk factor for falls rather than a positive intervention. The remaining interventions are appropriate and generally effective.

An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include: (Select all that apply.) a. tumors of the middle ear. b. cerumen impaction. c. infections of the external and middle ear. d. age-related hearing impairment. e. excessive and loud noise.

ANS: D, E A, B, and C are all associated with conductive hearing loss. Age-related hearing impairment, or presbycusis, is a form of sensorineural hearing loss. Excessive and loud noise can cause noise-induced hearing loss, which is also a common type of sensorineural hearing loss.

An 89-year-old hospitalized female patient tells a nurse, "I go to the bathroom really often, but I manage this by not drinking too much before I go to bed so I can sleep for the night." The patient has no pain or discomfort with voiding. The nurse considers this finding to be a: a. manifestation of urge incontinence. b. manifestation of a urinary tract infection. c. normal age-related change in an 89-year-old woman. d. manifestation of diabetes.

ANS: C A decreased bladder capacity is a normal age-related change. Urinating frequently with no other symptoms is not a manifestation of infection or diabetes. Urge incontinence is not a correct response as the patient is not experiencing incontinence.

Which of the following are age-related changes that affect hydration status? (Select all that apply.) a. Decrease in thirst sensation b. Decrease in total body water c. Decrease in ability of kidneys to maximally concentrate urine d. Decrease in bone marrow mass e. Decrease in bladder capacity

ANS: A, B, C As one ages, thirst sensation decreases and is not proportional to metabolic needs in response to dehydrating conditions. There is a decrease in total body water. The kidneys are less able to maximally concentrate urine resulting in a loss of water. While there is a decrease in bone marrow mass, this does not impact hydration status. Also, as one ages, bladder capacity decreases; however, this does not directly impact hydration status.

A nurse administers hypodermoclysis (HDC) to an older nursing home resident. The purpose of hypodermoclysis is: a. to rehydrate an individual with severe dehydration. b. to quickly administer 4-5 L of fluid within a 24-hour period. c. to rehydrate an individual with mild to moderate dehydration. d. as a supplement to IV hydration to expedite rehydration.

ANS: C HDC is an infusion of isotonic fluids into the subcutaneous space. It is an alternative to IV administration for individuals with mild to moderate dehydration. It cannot be used in individuals with severe dehydration or for any situation requiring more than 3 L over 24 hours.

A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (Select all that apply.) a. Difficulty placing hearing aid properly in the ear b. Stigma associated with wearing a hearing aid c. Difficulty changing the batteries in the hearing aid d. Ineffectiveness of hearing aids for individuals with age-related hearing loss e. Hearing annoying loud noises

ANS: A, B, C, E Options A, B, C, and E are all factors associated with low use after purchase. Option D is incorrect; most individuals with age-related hearing loss do experience some hearing enhancement with hearing aid use.

When an older adult client is diagnosed with restless leg syndrome (RLS), the nurse is confident that client education on the condition's contributing factors has been effective when the client states: a. "A warm bath at night instead of in the morning is my new routine." b. "Eating a banana at breakfast assures me the potassium I need." c. "I've cut way back on my caffeinated coffee, teas, and sodas." d. "I elevate my legs on a pillow so as to improve circulation."

ANS: C Increased caffeine use can be a contributing factor to RLS. There is no research to confirm that a warm bath prior to sleep or elevating the legs will minimize/prevent RLS. A potassium deficiency has not been identified as a contributing factor to RLS.

An otherwise healthy older adult reports having begun to experience problems "holding my water." The nurse shows an understanding of interventions that may help minimize the problem of urinary incontinency when: (Select all that apply.) a. asking whether the client smokes tobacco. b. assessing the average amount of caffeine the client drinks daily. c. asking if the client has been evaluated for diabetes recently. d. suggesting the client keep a record of the amount of fluids ingested daily. e. reviewing the client's current medication list.

ANS: A, B, C, E Risk factors for urinary incontinence include tobacco use, caffeine consumption, and increased urine resulting from diabetes and certain medications. Keeping record of fluid intake will have little or no impact on urine incontinence.

A nurse is assessing an older adult's risk for falls. One of the questions that she asks is whether the older adult has fallen in the past year. She asks this because individuals who have fallen: a. have a higher risk of falling again than persons who did not fall in the past year. b. are more likely to sustain injuries if they fall again than persons who did not fall in the past year. c. have most likely developed a fear of falling as compared to persons who did not fall in the past year. d. are most likely to have a balance disorder as compared to persons who did not fall in the past year.

ANS: A A history of falls is an important risk factor and individuals who have fallen have three times the risk of falling again than persons who did not fall in the past year. There is no evidence to support the other three options.

An older adult client shares with the nurse that, "I don't know what it is but it seems that I need more light for reading or even watching television as I get older." The nurse explains that aging may cause this change due to the: a. slower ability of the pupil to adjust to changes in lighting. b. impact arcus senilis has on visual acuity c. flattening and thinning of the cornea. d. retinal changes that begin to occur with aging.

ANS: A A slowed ability of the pupil to accommodate to changes in light accounts for the need of this patient to have more light in order to read. Arcus senilis does not affect vision. It is true that the cornea becomes flatter and thinner with aging, which results in astigmatism. Astigmatism does not account for the need for increased light that this patient is reporting. The changes in the retina do not account for the need for increased light that this patient is reporting.

A homecare nurse in an area of the country that is prone to tornadoes routinely discusses disaster preparedness with older adult clients. What is the primary rationale for this intervention? a. Older adults are less likely to seek formal and informal help when affected by natural disasters. b. The older adult is more likely to live in a communal environment that provides assistance in times of natural disasters. c. Most older adults have insurance to help them recover from material losses due to a natural disaster. d. Federal and private assistance agencies generally provide older adults with priority attention in time of natural disasters.

ANS: A Older adults are less likely to seek assistance than younger adults in times of disaster. The remaining options are not generally proven to be true for the majority of older adults.

An older patient asks a nurse, "I really have trouble sleeping and my doctor does not want to prescribe a sleeping pill for me. He says they are not good for older people. I really don't understand his response. Can you help me?" The best response by the nurse is: a. "Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep." b. "Prescription sleeping medications have many adverse effects in older people. Why don't you try using an over-the-counter medication?" c. "Sleeping medications do not provide any improvement in sleep for older people." d. "Sleep problems are common in older people. There really is nothing that you can do to help with that."

ANS: A Adverse effects of sleep medications, including over-the-counter medications, include problems with daily function, changes in mental status, motor vehicle accidents, daytime drowsiness, and increased risk of falls with only minimum improvement in sleep. Sleep problems are common in older adults; however, there are many nonpharmacologic interventions that can be utilized to improve sleep.

A nurse in a long-term care facility notes that an older resident with Alzheimer's disease awakens frequently at night and is restless and agitated. Which of the following interventions will be most effective to help manage this resident's sleep problems? a. Taking the resident outside in the garden for 45 minutes daily b. Limiting fluid intake for the resident c. Educating the resident on the association between Alzheimer's Disease and insomnia d. Administering a mild sedative hypnotic at bedtime

ANS: A Behavioral strategies for persons with dementia include daily walks and exposure to light to enhance sleep. Limiting fluid intake may or may not be effective depending on whether or not the resident has nocturia. Educating the resident about the association between AD and insomnia may be feasible depending on the resident's mental status but will not necessarily ameliorate the problem. Sedative hypnotics are not the first-line treatment for older adults with AD and sleep disturbances.

An 88-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She has a history of hypertension and congestive heart failure and is on a total of five different medications for these chronic conditions. The nurse caring for the woman develops a care plan that includes the diagnosis Risk for Falls. A priority nursing intervention for this client is to: a. perform a fall assessment. b. keep all of the side rails up on the client's bed at nighttime. c. place the client on bed rest so that she does not fall. d. assess the client's dietary intake for calcium adequacy.

ANS: A Completing a fall assessment will enable the nurse to identify and correct the risk factors for this patient. Side rails have not been found to be effective in keeping a client in bed and may actually lead to injury. Maintaining a patient on bed rest can lead to deconditioning and actually contribute to falls. Assessing the client's dietary intake of calcium is a good intervention for this age group, but it is not a priority and will not prevent falls.

Which of the following nursing actions would help minimize the psychosocial impact of bladder and/or bowel incontinence for individuals experiencing incontinence prior to going to a group dining room? a. Assess for soiled clothing and change, if necessary. b. Toilet the client and then promptly transport to the dining room. c. Provide peri-care and fresh underclothing. d. Ask the client if toileting is needed and assist as necessary.

ANS: A Deviations from normal bowel and bladder toileting can lead to chastisement, ostracism, and social withdrawal. By addressing incontinency issues prior to social interactions, such negative responses can be minimized. While toileting is appropriate, it does not directly address the social impact that may result from soiled and/or odorous clothing. Providing peri-care and clean underclothing is necessary only if incontinency has occurred. Asking to toilet the client is not necessarily an effective intervention when the client is consistently incontinent.

A nurse implements a nursing care plan for a patient with constipation. Which of the following should the nurse include in the plan? a. Increasing fiber in the diet b. Administering aluminum hydroxide antacids c. Bed rest d. Restricting fluids

ANS: A Fluid intake of at least 1.5 L/day, unless contraindicated, is the cornerstone of constipation therapy, with fluids coming mainly from water. A gradual increase in fiber, either as supplements or incorporated into the diet, is generally recommended. Fiber helps stools become bulkier and softer and move through the body more quickly. Physical activity is important as an intervention to stimulate colon motility and bowel evacuation. Daily walking for 20-30 minutes, if tolerated, is helpful, especially after a meal. Aluminum hydroxide antacids are known to be constipating.

A nurse identifies that an older adult needs more education on nutritional needs when the older adult states the following: a. "Since I am an older person, I need more calories because my metabolic rate is slower" b. "Since I am an older person, I need fewer calories since my metabolic rate is slower" c. "Even though I am an older person, I still need the same amount of nutrients in order to be healthy" d. "Even though I am an older person, I still need to pay attention to my diet and activity levels"

ANS: A Generally, older adults need fewer calories because they may not be as active and metabolic rates slow down. Older adults generally require the same amount of nutrients for optimal health outcomes. Older adults need to pay attention to meeting nutritional requirements and obtaining adequate physical activity for optimal health.

A nurse is assessing an older patient and notes a cluster of fluid-filled vesicles on the right thoracic area. The nurse suspects HZ. The patient asks the nurse, "I really don't understand how I got shingles. I don't even know anyone who has this infection." The nurse includes which of the following in formulating a response to the patient? a. HZ is caused by a reactivation of dormant varicella zoster virus within the sensory neuron of the dorsal root ganglion b. HZ is caused by the same virus as chickenpox and requires exposure to an individual with active chickenpox c. HZ is caused by the same virus as chickenpox and requires direct contact with an individual with HZ d. HZ is caused by the varicella zoster virus and occurs only in individuals who were never previously exposed to the virus

ANS: A HZ is a viral infection caused by a reactivation of the latent varicella zoster virus (the same virus that causes chickenpox) within the sensory neurons of the dorsal root ganglion, decades after the initial varicella zoster infection is established. HZ is infectious until the lesions are completely crusted over. Individuals do not have to have direct contact with someone who has either chickenpox or HZ in order to have a reactivation; other factors such as illness and stress can cause the reactivation. Individuals who have HZ infection were previously exposed to the varicella zoster virus.

A hospitalized older adult who recently had surgery and a wound infection postoperatively is noted to be losing weight despite consuming his meal trays and snacks. One reason that this might be occurring is: a. an injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization. b. an injury may cause malabsorption of nutrients. c. most hospitalized older patients do not consume adequate amounts of micro- and macronutrients. d. most hospitalized patients do not have accurate weights recorded upon admission.

ANS: A One trajectory for malnutrition is inflammation-related malnutrition; in this situation, malnutrition develops as a consequence of injury, surgery, or disease that triggers inflammatory mediators that contribute to an increased metabolic rate and impaired nutrient utilization. An injury does not necessarily cause malabsorption of nutrients. There is no evidence that most hospitalized patients do not consume adequate diets, and there is also no evidence that accurate weights are not recorded for most hospitalized patients.

A nurse at a senior center promotes activity by leading exercise programs. Which of the following is a benefit of such exercise? a. Improvement of mood b. Cardiovascular stress c. Painful and stiff joints d. Depression

ANS: A Physical activity has many benefits including improvement of mood. Physical activity improves cardiovascular health, decreases depression, and helps decrease pain and increase flexibility in the joints.

An older client reports to a nurse, "My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well." Based on the client's description, the nurse suspects which of the following? a. Presbycusis b. Otosclerosis c. Tinnitus d. A perforated eardrum

ANS: A Presbycusis is a type of sensorineural hearing loss. It is slow and progressive and often ignored by older adults and considered normal aging. Symptoms include difficulty filtering background noise and understanding women and children's voices. Individuals often accuse people of mumbling. Often, it is recognized by others first, before the affected person notices it. Otosclerosis is a cause of conductive hearing loss, as is a perforated eardrum. Tinnitus is a perception of sound in one or both ears where no external sound is present.

An older man tells a nurse, "The doctor says I have something wrong with my eyes, something called presbyopia. Can you explain why I have this? I was always fortunate to have good eyesight." The nurse formulates a response based on the knowledge that: a. the lens of the eye loses elasticity causing a loss of focus for near objects. b. the cornea of the eye becomes thicker and less curved causing an increase in astigmatism. c. the lens of the eye increases in opacity causing a decrease in light refraction. d. the cornea of the eye forms a gray ring at the edges.

ANS: A Presbyopia is the loss of focus for near objects, caused by a loss of elasticity and hence a loss of accommodation of the lens of the eye. All of the other options are normal age-related changes; however, they are not related to presbyopia.

A 75-year-old female asks a nurse "I know I should be moving, but how much is the right amount of exercise for me?" The best response of the nurse is: a. "You need to engage in 30 minutes of moderate intensity exercise on at least 5 days a week." b. "You need to engage in at least 30 minutes of moderate intensity exercise every day of the week." c. "Since you are 75, the recommendations are 30 minutes of moderate exercise three times a week." d. "There are no specific recommendations for someone of your age; just keep moving."

ANS: A Recommendations for all adults are participation in 30 minutes of moderate intensity physical activity for 5 or more days per week.

Which of the following statements describing oral care for the older population is correct? a. Regular dental examinations can prevent tooth loss and improve the ability to chew healthful foods. b. Losing one's teeth is considered a normal part of the aging process. c. Oral malignancies seldom occur in older adults so oral examinations are of low priority. d. Preventative dental care is covered under Medicare.

ANS: A Regular dental care is essential and can prevent tooth loss. Losing one's teeth is not a normal part of aging; about one-quarter of adults over age 65 are edentulous. Oral cancers occur more often in older individuals. The median age at diagnosis is 61. Oral examinations can assist in early identification and treatment. Medicare does not provide any coverage for oral care services.

An older person is admitted to the hospital with an exacerbation of congestive heart failure. The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse, "How did I get something like this?" The best response by the nurse is: a. "Scabies is highly contagious and spreads easily through physical contact." b. "Scabies is commonly seen in older adults due to normal age-related changes in the skin." c. "Scabies is only seen in older adults who have multiple chronic illnesses." d. "Certain medications can make you more susceptible to contracting scabies."

ANS: A Scabies is caused by a tiny burrowing mite and is highly contagious and easily passed by an infected person to family members and others in close contact by direct physical content. It is not limited to older adults, and age-related changes in the skin do not cause it or make a person more susceptible. Individuals with multiple chronic conditions are not more likely to develop scabies than other individuals. There is no evidence that medications can make an individual more susceptible.

A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma. The nurse's response is: a. the exact etiology of glaucoma is variable and often unknown. b. spasms of the orbicular muscle. c. changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves. d. bits of broken coalesced vitreous from the peripheral or central part of the retina.

ANS: A The etiology of glaucoma is variable and often unknown. However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. Spasms of the orbicular muscle can cause the lower lid to turn inward. If it stays this way, it is called entropion. The changes described contribute to decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters.

An older adult is concerned that if her spouse, who recently suffered a stroke, is placed in a nursing home, "they will take everything in order to pay for his care." What response will the nurse make? a. "A spouse is allowed to keep a percentage of the family income and cash as well as the family home, car, and personal property" b. "You should consider transferring the assets to your son so that your husband will qualify for Medicaid" c. "Have you considered caring for your husband at home since Medicare will cover custodial care at home?" d. "Are you aware that your children have a legal obligation to provide financial support toward the care of disabled parents?"

ANS: A The spouse is permitted to keep a portion of the assets, home, car, and personal property. There is a "look back" period of 36 months to determine whether funds that were transferred would normally have been available to the individual. Medicare does not cover the cost of custodial care; it covers skilled care only. There is no legal obligation of a child to support a parent.

A nursing student asks the instructor, "Our textbook discussed the obesity paradox in older adults. I am not sure I understand; isn't obesity bad for everyone?" The best response by the instructor is: a. "While there is evidence that obesity in younger people lessens life expectancy, it remains unclear whether overweight and obesity are predictors of mortality in older adults." b. "Obesity is usually not a concern in older adults, as most older people tend to weigh less than they did when they were younger." c. "Obesity is a concern in all age groups; however, over the past decade obesity in older adults has decreased." d. "Obesity in older adults is less of a concern than we once thought; individuals over age 65 with a higher BMI have a lower mortality rate."

ANS: A There is evidence that obesity in younger people contributes to a decreased life expectancy. However, in older adults, it is not clear whether obesity is a predictor of mortality. Recent evidence demonstrated that for people who have survived to 70 years of age, mortality risk is lowest in those with a BMI classified as overweight. Persons who increased or decreased BMI have a greater mortality risk than those who have a stable BMI, particularly in those aged 70-79. Obesity is prevalent in older adults. The proportion of older adults who are obese has doubled in the past 30 years. More than one-third of individuals 65 years and older are obese with a higher prevalence in those 65-74 years than in those 75 years and older.

An older resident in a long-term care facility reports to the nurse that she has been noticing changes in her vision, including the appearance of halos around objects and a yellow tint to most objects. The nurse knows that these complaints are most often associated with: a. cataracts. b. glaucoma. c. diabetic retinopathy. d. age-related macular degeneration.

ANS: A Signs of cataracts include the appearance of halos around objects as light is diffused, blurring, decreased perception of light and color giving a yellow tint to most objects, and a sensitivity to glare.

A nurse is caring for an older adult who has a gastrostomy tube. The nurse is developing a care plan related to oral care. Which of the following should the nurse consider for this patient? (Select all that apply.) a. Oral care should be provided every four hours. b. Teeth should be brushed with a toothbrush after each tube-feeding. c. Lemon glycerin swabs should be used in between feedings to keep the mouth moist. d. Foam swabs should be used in place of a toothbrush to clean the teeth after each tube-feeding. e. Oral care should be provided only twice daily if the older adult is edentulous.

ANS: A, B Tube-feeding is associated with significant pathologic contamination of the mouth, greater than in individuals who receive oral feeding. Oral care should be provided every 4 hours for patients with gastrostomy tubes and teeth should be brushed with a toothbrush after each feeding to decrease the risk of aspiration pneumonia. Lemon glycerin swabs should never be used for oral care, as they dry and inhibit saliva production. Foam swabs do not remove plaque as well as toothbrushes. Oral care is required even if the individual is edentulous.

An older adult who has a balance disorder and has sustained repeated falls is recommended to start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual? (Select all that apply.) a. Yoga b. Tai Chi c. Swimming d. Pilates e. Weight lifting

ANS: A, B Yoga and Tai Chi are exercises that improve balance, as they use movements that improve the ability to maintain control of the body over the base of support to avoid falling. Swimming, Pilates, and weight lifting do not do this.

An older patient is diagnosed with diabetic retinopathy. The patient asks a nurse: "Is there anything that I can do to prevent progression of this disease and blindness?" The nurse includes which of the following into the response? (Select all that apply.) a. Strict control of blood glucose levels is important in slowing disease progression b. Laser photocoagulation treatments can stop progression of the disease c. Control of blood pressure and cholesterol levels are important steps slowing disease progression d. Wearing sunglasses to protect the eyes from ultraviolet light can stop disease progression e. Eating a diet high in beta-carotene can stop disease progression

ANS: A, B, C Constant strict control of blood pressure, blood glucose, and cholesterol and laser photocoagulation treatments can halt progression of the disease. Laser treatment can reduce vision loss in 50% of patients. Neither protecting the eyes from ultraviolet light nor eating a diet high in beta-carotene has been proven to be effective in stopping disease progression.

A nurse is performing preoperative teaching for an older adult who is scheduled to have a cataract extraction and lens implant. The nurse includes which of the following in the teaching plan? (Select all that apply.) a. Avoid lifting heavy objects after the surgery b. Avoid bending from the waist after the surgery c. Take stool softeners as needed d. Maintain strict control of your blood sugar and blood pressure e. Maintain a dry sterile dressing over the eye for 10 days

ANS: A, B, C Postcataract surgery the individual needs to avoid heavy lifting, straining, and bending from the waist. Fall prevention is also very important as is complying with eye drop administration. Maintaining strict blood sugar and blood pressure control is most important for diabetic retinopathy, not cataract extraction. There usually is not a dressing over the operative site, and not for 10 days.

An older patient complains of pruritus. The nurse suggests which of the following interventions to alleviate the patient's complaint? (Select all that apply.) a. Use only nonperfumed laundry detergent and fabric softeners b. Avoid sudden temperature changes c. Wear loose-fitting clothing d. Apply heat to affected areas e. Exercise vigorously for at least 30 minutes daily

ANS: A, B, C Pruritus is aggravated by heat, sudden temperature changes, sweating, restrictive clothing, fatigue, exercise and anxiety, perfumed detergents, and fabric softeners.

Symptoms of gastroesophageal reflux disease (GERD) in older adults include: (Select all that apply.) a. heartburn. b. regurgitation. c. abdominal pain within one hour of eating. d. vomiting. e. fever and elevated white blood cell count.

ANS: A, B, C Symptoms of GERD include heartburn, regurgitation, persistent cough, exacerbation of asthma, laryngitis, and intermittent chest pain. In addition, abdominal pain within one hour of eating and worsening of symptoms upon lying down are common. Vomiting is not associated with GERD and neither is fever and elevated white blood cell count.

Which assessment finding is a contributor to an older client's risk for falls? (Select all that apply.) a. Client is awaiting cataract surgery on right eye. b. Client's type 2 diabetes is poorly controlled with diet and exercise alone. c. Client reports a fall in the last year. d. Client has a history of contact dermatitis and psoriasis. e. Client attends Tai Chi classes at the senior center.

ANS: A, B, C The correct options are those that affect the client's vision, presence of factors affecting sensations in the legs and feet, and a history of falls. There is no research to connect the risk of falls with either of the skin conditions mentioned. Tai Chi improves balance, which decreases risk of falls.

Which of the following are subscales on the Braden Scale for predicting pressure ulcers? (Select all that apply.) a. Nutrition b. Moisture c. Mobility d. Age e. BMI

ANS: A, B, C The six subscales of the Braden Scale are sensory perception, activity, mobility, moisture, friction and shear, and nutrition.

A nurse is providing glaucoma education for a group of older adults in a senior center. The nurse knows that the following groups are most likely to develop glaucoma. (Select all that apply.) a. African Americans b. Mexican Americans c. Individuals with a family history of glaucoma d. Individuals with diabetes e. Asian Americans

ANS: A, B, C, D African Americans are at risk of developing glaucoma at an earlier age than other racial and ethnic groups. Mexican Americans, individuals with a family history of glaucoma, and individuals with diabetes are among the other high-risk groups. Asian Americans are more likely to lose eyesight from age-related macular degeneration than other groups.

A nurse is caring for a frail older adult in a long-term care facility and is concerned about preventing hypothermia. Which of the following interventions should the nurse implement? (Select all that apply.) a. Make sure that the temperature in the resident's room is at least 65 degrees Fahrenheit. b. Cover residents well when in bed and while bathing. c. Provide a head covering for the resident. d. Maintain resident in bed covered with heavy blankets at all times. e. Provide hot, high-protein meals and bedtime snacks.

ANS: A, B, C, E Interventions to prevent hypothermia in frail elders include maintaining an ambient temperature of no lower than 65 degrees Fahrenheit, providing a head covering whenever possible—in bed, out of bed, and particularly out-of-doors, covering patients well when in bed and when bathing, and providing hot, high-protein meals and bedtime snacks to add heat and sustain heat production throughout the day and as far into the night as possible. In addition, it is important to get the patient out of bed and provide as much exercise as possible to generate heat from muscle activity.

A nurse is conducting an assessment of an older patient's eyes. The nurse expects to see which of the following normal age-related changes of the external eye? (Select all that apply.) a. The eyelids are less elastic and droopy b. The eyes are very dry c. The eyelids may not close completely d. There is a loss of eyelashes e. The lower lid may be turned outward

ANS: A, B, C, E Normal age-related changes in the external eye include a loss of elasticity causing drooping. Eyes become drier, and the eyelids may not close completely. Decreases in orbital muscle strength may result in entropion, the outward turning of the lower lid. Loss of eyelashes is not a normal age-related change.

An older patient is diagnosed with RLS. Which of the following nonpharmacologic interventions should the nurse include in the plan of care? (Select all that apply.) a. Engage in regular mild to moderate physical activity including stretching activities for the lower extremities. b. Avoid caffeine, alcohol, and tobacco. c. Avoid hot baths. d. Relaxation techniques may be helpful. e. A mild sleeping medication such as diphenhydramine (Benadryl) might be helpful.

ANS: A, B, D Nonpharmacologic therapy includes stretching the lower extremities, mild to moderate physical activity, hot baths, massage, acupressure, relaxation techniques, and avoidance of caffeine, alcohol, and tobacco. The use of diphenhydramine (Benadryl) as a sleeping medication for older adults is not appropriate. There is also no evidence that it will decrease RLS.

An older patient asks a nurse, "It seems like all of my friends and I have difficulty sleeping. Is it common among older people?" The nurse formulates a response based on the knowledge that normal age-related changes in sleep include: (Select all that apply.) a. total sleep time and sleep efficiency are reduced. b. rapid eye movement (REM) sleep is shorter, less intense, and more evenly distributed. c. sleep requirements for older adults are less than that of younger adults. d. daytime napping is common. e. sleep tends to be deeper in older adults than in younger adults.

ANS: A, B, D Normal age-related changes in older adults include a reduced total sleep time and sleep efficiency and shorter, less intense, and more evenly distributed REM sleep. Older adults tend to nap during the daytime. Sleep requirements do not decrease as one ages. Sleep tends to be objectively and subjectively lighter in older adults.

An older patient tells a nurse. "The nurse practitioner told me that these ugly purple bruises on my arms are called purpura and are due to fragile blood vessels. I still don't understand why this happens to me." The nurse responds based on the knowledge that: (Select all that apply.) a. purpura is due to normal age-related changes. b. the incidence of purpura increases with age. c. purpura is a precancerous skin condition. d. individuals who take blood thinners are especially prone to purpura. e. individuals prone to purpura should make sure that affected areas are open to the air.

ANS: A, B, D Purpura is due to normal age-related changes and hence the incidence increases with age. Individuals who take blood thinners are especially prone to purpura. Purpura is not a precancerous condition. Individuals who are prone to purpura are encouraged to wear protective garments such as long sleeves and long pants.

An older adult tells a nurse that he is experiencing difficulty falling asleep, he routinely gets into bed at 8:30 PM and watches his favorite television shows until 11:00 PM, and often lies awake for hours after. Which of the following suggestions are appropriate for the nurse to give to this patient? (Select all that apply.) a. Go to bed only when sleepy. b. If unable to sleep within a reasonable time (15-20 minutes), get out of bed and pursue relaxing activities. c. Engage in moderate exercise to induce fatigue. d. Do not watch television or work in bed. e. If unable to sleep, engage in enjoyable activities on the computer.

ANS: A, B, D Some interventions to improve sleep include going to bed only when sleepy, matching the number of hours in bed to the actual hours of sleep, and reserving the bed for sleep and sex only. Engaging in exercise immediately before sleep will not assist the person in falling asleep, and use of the computer is also discouraged as it can disturb sleep.

The benefits of telehealth include that it: (Select all that apply.) a. promotes self-management of illness in rural and underserved areas. b. facilitates remote physical assessment and monitoring of chronic conditions. c. decreases costs by replacing the role of the nurse with technology. d. decreases costs by reducing hospital readmissions. e. is reimbursed by all health care insurances.

ANS: A, B, D Telehealth promotes self-management of illness and facilitates remote assessment and monitoring in rural and underserved areas. Evidence has demonstrated that it reduces costs by decreasing hospital readmission. Telehealth does not replace the role of the nurse; the technology augments the ability of the nurse to reach clients in remote areas. Unfortunately, not all health care insurers reimburse for telehealth services.

Which precaution would be beneficial in minimizing an older adult's risk of being a victim of fraud? (Select all that apply.) a. Do not allow uninvited salespersons into your home. b. Never provide personal information to telephone sales solicitors. c. Rely on the advice of people who only friends have recommended. d. Contact the local Medicare or Medicaid service office for information when needed. e. Keep your bank account and credit card numbers with you at all times.

ANS: A, B, D The correct options provide sound advice, but relying on friends alone for advice may not be prudent while personal information should be kept in a safe place, not necessarily on your person.

A nurse caring for an older hospitalized woman is concerned about promoting functional status. Which of the following interventions should the nurse include in this patient's plan of care? (Select all that apply.) a. Conduct a baseline functional status assessment of the patient b. Request a physical therapy referral c. Make sure that the patient has all activities of daily living performed for her d. Progressive mobility interventions e. Encouraging the patient to feed herself

ANS: A, B, D, E A baseline assessment of functional ability is important and can assist in setting appropriate goals for the hospitalized individual. Physical therapy is important in developing an individualized plan of exercises and functional mobility program. Progressive mobility interventions range from passive range of motion to safe transfers and ambulation and are important in maintaining function. Encouraging self-care activities rather than "doing for" is also important.

An older adult complains of xerostomia. Which of the following interventions should the nurse implement for this patient? (Select all that apply.) a. Encourage the patient to brush and floss teeth regularly. b. Encourage the patient to have regular dental screenings. c. Provide antiseptic mouthwash (e.g., Listerine) for the patient. d. Encourage adequate intake of water. e. Provide saliva substitutes.

ANS: A, B, D, E Individuals with xerostomia should have regular dental screenings and be encouraged to practice good oral hygiene. Adequate intake of water is important, as is avoidance of alcohol and caffeine. Saliva substitutes may be helpful. Antiseptic mouthwashes usually contain alcohol, which can further dry the mouth.

A group of older women in an assisted living facility are talking about one of the residents who fell and fractured her hip. The women ask a nurse the following: "It seems like so many of us fall and break our hips, and then it is downhill from there. Is this really true?" In formulating a response, the nurse considers which of the following? (Select all that apply.) a. Hip fractures are a leading cause of hospitalization for older people. b. The major cause of hip fractures is falls. c. Women have significantly higher mortality rates from hip fractures than do men. d. Nearly all older patients who sustain a hip fracture will regain prefracture mobility status within 1 year. e. Hip fractures are associated with very high morbidity and mortality.

ANS: A, B, E Hip fracture is the second leading cause of hospitalization for older people. More than 95% of hip fractures among older adults are caused by falls. Older adults who fracture a hip have a five to eight times increased risk of mortality during the first 3 months after hip fracture. This excess mortality persists for 10 years after the fracture and is higher in men. Only 50-60% of patients with hip fractures will recover their prefracture ambulation abilities in the first year postfracture. Most research on hip fractures has been conducted with older women.

Which of the following nursing interventions should be implemented to prevent dehydration in hospitalized older adults? (Select all that apply.) a. Implementing intake and output recording for any patients with fever, diarrhea, vomiting, or an infection b. Limiting duration of NPO requirements for diagnostic tests and procedures c. Administering IV fluids to all hospitalized older adults d. Limiting the use of diuretic medications in hospitalized older adults e. Making sure that hospitalized patients have easy access to fluids

ANS: A, B, E In order to prevent dehydration, it is essential to closely monitor hospitalized older adults. Any individual who develops fever, diarrhea, vomiting, or an infection should be monitoring closely by implementing intake and output records and providing additional fluids. NPO requirements for diagnostic tests and procedures should be as short as possible. It is not appropriate to administer IV fluids to all hospitalized older adults. IV fluids are administered when there is a clinical indication. It is not appropriate to limit the use of diuretics. Diuretics are an important treatment for many older patients. Hydration management involves acute and ongoing management of oral intake. Oral hydration is the first line of treatment for dehydration prevention.

What information should be included in an informational program to be presented on burn prevention to a senior citizens group? (Select all that apply.) a. Do not smoke in bed or when sleepy b. Wear well-fitted clothing when cooking or when grilling outdoors c. Establish a meeting place for all family members outside of the home in case of a fire d. Establish a plan for exiting each room of your home in the case of a fire e. Have a fire extinguisher readily available in the kitchen

ANS: A, B, E Measures to prevent burns include not smoking in bed or when sleepy, not wearing loose-fitting clothing (e.g., bathrobes, nightgowns, pajamas) when cooking or around an open heat source, and installing a portable hand fire extinguisher in the kitchen. The remaining options are related to safely evacuating a home in case of a fire.

A nurse is educating a group of nursing assistants in long-term care on the prevention of skin tears. Which of the following interventions should the nurse include in the education? (Select all that apply.) a. Lubricate the resident's skin with moisturizers twice daily b. Ensure that the resident has adequate nutrition and hydration c. Bathe the resident in hot soapy water d. Avoid the use of lifting shifts when transferring the resident e. Dress the resident in long sleeves and long pants to protect the extremities

ANS: A, B, E Soapless bathing, tepid water, and moisturizers twice daily are recommended to prevent skin tears. Heavy soaps and hot water dry out the skin increasing the risk of skin tears. Lifting sheets are recommended as are the use of long sleeves and long pants to protect the extremities.

An older person reports hearing whistling in both ears when no external sounds are present and is diagnosed with tinnitus. Which of the following are causes of tinnitus? (Select all that apply.) a. Exposure to loud noises b. Use of a hearing aid c. Cerumen buildup d. Side effects of medications e. Age-related changes in the middle and inner ear

ANS: A, C, D Hearing aids are not known as a cause or a trigger to worsen tinnitus and are at times used to amplify environmental noise to mask tinnitus. Tinnitus is not an age-related change, although it occurs in about 11% of individuals who have presbycusis. Exposure to loud noise and cerumen buildup are known to exacerbate or cause tinnitus. Over 200 prescription and nonprescription medications have tinnitus as a side effect. There are also many ototoxic medications.

A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. Which of the following are hazards in the home? (Select all that apply.) a. The absence of railings on the stairway b. Night-lights in all rooms c. Clutter throughout the home d. A small throw rug outside of the shower stall e. Grab bars in bathroom beside toilet

ANS: A, C, D The absence of railings on stairway, clutter, and throw rugs can all contribute to falls in the home. Night-lights are recommended to prevent falls as are grab bars positioned beside the toilet in the bathroom.

A nurse is caring for an older adult with xerosis. Which of the following interventions should the nurse include in the patient's plan of care? (Select all that apply.) a. Encourage adequate fluid intake b. Encourage daily baths of at least 20 minutes c. Maintain a humid environment d. Apply water-laden emulsions to skin immediately after bathing e. Use only deodorant soaps when bathing

ANS: A, C, D Xerosis is extremely dry, itchy skin. Adequate intake of water is essential in rehydrating the skin. Long duration baths or showers should be avoided, and daily bathing may not be needed. An environment of 60% humidity is recommended. Water-laden emulsions should be applied immediately after bathing. Deodorant soaps should be avoided except in the axilla and groin.

Many older adults have a vitamin B12 deficiency. Reasons for this include which of the following? (Select all that apply.) a. Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B12 absorption less efficient b. The major source of vitamin B12 is sunlight, and older adults are less likely to be outdoors and absorb vitamin B12 in this manner c. Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B12 from food d. Most older adults do not consume five servings of fruits and vegetables daily, which is the main dietary source of vitamin B12 e. Certain antibiotics and anticonvulsant medication increase the risk of vitamin B12 deficiency

ANS: A, C, E A normal age-related change in the stomach is the production of less gastric acid, which makes vitamin B12 absorption less efficient. For most older adults, intake of vitamin B12 is usually adequate. Use of proton pump inhibitors and H2 receptor blockers for more than a year can lead to lower serum vitamin B12 levels by impairing absorption of the vitamin from food. Certain antibiotics and anticonvulsants can also increase the risk of vitamin B12 deficiency. While it is true that older adults may be outdoors less, the major source of vitamin B12 is not sunlight. While it is also true that older adults may not consume five servings of fruits and vegetables daily, fruit and vegetables are the major sources of vitamins A, C, and E and potassium.

The nurse interviewing an older adult for a nursing history recognizes that the client is experiencing symptomology inconsistent with normal aging of the urinary tract when the client reports: (Select all that apply.) a. finding it more difficult in the last few months to start voiding. b. having two bladder infections in the last 4 years. c. getting up once or twice each night to urinate. d. occasionally experiencing pain when urinating. e. needing to urinate at least every 2 hours during the day.

ANS: A, D Difficulty and pain are not characteristics of urination normally attributed to aging. In about 10-20% of well older adults, aging of the urinary tract is associated with an increased frequency of involuntary bladder contractions. These changes may lead to frequency, nocturia, urgency, and vulnerability to infection.

A 74-year-old woman who is in the hospital for rehabilitation following hip replacement has been experiencing incontinence since admission. Which of the following interventions are likely to facilitate the restoration of the patient's bladder function? (Select all that apply.) a. Assess the patient's recent voiding pattern. b. Request an order for an indwelling catheter from the patient's physician. c. Teach the patient how to meet hydration needs while still limiting fluid intake. d. Assist the patient to use the bathroom. e. Request an order for medication to decrease bladder spasms.

ANS: A, D When a patient experiences new onset incontinence, the first step is assessment. Assisting the patient to the bathroom has many beneficial aspects to it and it provides a private setting where the patient is in the most normal physiological position to urinate. Placing an indwelling catheter is not a solution to urinary incontinence. Limiting fluids is not indicated in this patient. There is no indication that this patient is having bladder spasms.

A nurse is preparing to hand feed an older adult with a history of a right cerebrovascular accident (CVA) with facial weakness and dysphagia. Which techniques should the nurse utilize when feeding this patient? (Select all that apply.) a. Sit the patient upright in a chair at 90 degrees. b. Allow the patient to sit upright for 15 minutes after the meal is completed. c. Feed the patient only liquids to make swallowing easier. d. Place the solid food in the left side of the mouth. e. Have the patient swallow twice for every mouthful of food given.

ANS: A, E When feeding a patient with dysphagia, it is important to have the patient sit upright at 90 degrees and to remain upright for an hour following the meal. Other important techniques include having the patient swallow twice for every mouthful of food given. This patient has a history of a right CVA, which would mean that the patient has left-sided weakness. The food needs to be placed in the nonimpaired side of the mouth, which in this case would be the right side. Since the patient has a CVA, the intake of "thin liquids" can increase risk for aspiration.

An older adult who is within a normal weight range asks a nurse, "I have heard that it is important to limit the amount of fats in my diet, but I don't know how much I should be taking in daily. Can you help me?" The best response by the nurse is: a. "Someone of your age needs to limit fats." b. "Since you are at your ideal weight, you should limit your daily fat grams to half your weight." c. "Fat intake will depend on the presence of any cardiac issues." d. "Read food labels well and focus your diet on low-fat foods."

ANS: B A simple technique to determine how much fat a person should consume is to divide the ideal weight in half and allowing that number of grams of fat. The remaining options don't address the issue of how much fat should be eaten daily.

The nurse is most concerned by observing when assisting with an older client's bath: a. A firm, irregularly-shaped, pink-colored nodule b. A slightly raised multicolor lesion with an asymmetrical, irregular border c. A pearly papule with prominent blood vessels d. Rough, scaly, sandpaper-like patches that are slightly tender

ANS: B A slightly raised multicolor lesion with an asymmetrical irregular border is characteristic of melanoma that accounts for less than 5% of skin cancer cases, but it causes most skin cancer deaths. A firm, irregularly-shaped, pink-colored nodule or persistent red lesion is characteristic of squamous cell carcinoma. A pearly papule with prominent blood vessels is a characteristic of a basal cell carcinoma. A tender, rough, scaly, sandpaper-like patch is a characteristic of actinic keratoses (a precancerous lesion).

An older patient reports the following symptoms to a nurse during a routine visit to the geriatric clinic: blurry vision, the need for more light when reading, and blind spots in the middle of his visual field. He also states, "Strangely enough my peripheral vision continues to be pretty good." The nurse suspects that the patient has which of the following? a. Glaucoma b. Age related macular degeneration c. Diabetic retinopathy d. Cataracts

ANS: B Blurry vision, needing more light, and blind spots in the middle of the visual field (scotomas) are all characteristics of age related macular degeneration. The other three eye diseases do not present with these symptoms.

A nurse is using the function-focused care approach to care for a hospitalized older adult. The nurse is assisting the patient to transfer from the bed to a chair. Which of the following statements by the nurse is most congruent with this approach to care? a. "Place your hands across your chest and let us move you to the edge of the bed." b. "Place both of your hands on the overbed trapeze and pull yourself up to a sitting position." c. "How do you get yourself out of bed when you are at home? Why can't you do the same thing here?" d. "It is taking you a long time to get yourself into a sitting position. Let me help you sit up."

ANS: B FFC is based on a philosophy of care where the nurse acknowledges the older adult's physical and cognitive abilities and encourages the individual to function at the highest level possible. Option B is correct because the nurse is giving step-by-step directions and allowing the patient to move independently. Option A is incorrect because the nurse is moving the patient instead of allowing the patient to move himself/herself. Option C is incorrect because although it does solicit important information from the patient, it is making the assumption that the hospital setting is the same as the home setting. The response also has a negative tone to it. Option D is incorrect because it is not allowing the patient to use as much time as needed in order to be independent.

The nurse is preparing educational material concerning fire safety in the home. What research data will be included in the material? a. Most fires occur during the daytime hours. b. Fire mortality is highest in adults older than 80 years of age. c. Most people who die in fires are killed by the flames. d. Most fires occur outside the home.

ANS: B Fire-related mortality is three times higher in individuals over age 80. Most deaths in fires are caused by smoke injuries. Most fires occur within the home, and most fires occur at night.

A 70-year-old diabetic patient has just received instruction from a nurse on glucose self-monitoring. He tells the nurse: "I hear that those test strips cost a lot. I am not sure that I can afford anything else. The only health insurance I have is Medicare Parts A and B." The best response by the nurse is: a. "I am sorry, but Medicaid is the only insurance that covers the cost of diabetic testing supplies." b. "Medicare Part A will cover the cost of the supplies to manage your diabetes." c. "Medicare Part B will cover the cost of the supplies to manage your diabetes." d. "I am sorry, but Medigap insurance is the only insurance that covers the cost of diabetic testing supplies."

ANS: B Medicare Part B covers the cost of diabetic testing supplies.

A homecare nurse visits an older patient who lives in a Naturally Occurring Retirement Community (NORC). The nurse understands that NORCs are: a. purpose-built senior housing communities. b. neighborhoods or buildings where a large segment of the residents are older adults. c. communities where volunteers coordinate access to services for older adults. d. intentional collaborative housing where residents participate in the design and operation of the neighborhood.

ANS: B NORCs are neighborhoods or buildings where a large number of the residents are older adults. They were not purposely built as senior housing. The residents in a NORC aged in place. The village model is where volunteers coordinate access to affordable care for seniors. Cohousing is an intentional collaborative model where residents participate in the design and operation of the neighborhood.

A 79-year-old client resides independently in the community. The visiting home health nurse finds that despite it being 90 degrees Fahrenheit outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to: a. cognitive changes that diminish the individual's awareness of temperature changes. b. age-related neurosensory changes that diminish awareness of temperature changes. c. a delirium-related acute illness that is affecting body heat production. d. age-related motor deficiencies that result in self-neglect.

ANS: B Neurosensory changes related to aging tend to delay or diminish the individual's awareness of temperature changes and may impair behavior or thermoregulatory responses to dangerously high or low temperatures. There is no evidence in this scenario that the client has cognitive changes, an acute illness, or is incapable of self-care, and such assumptions should not be routinely made based on age alone.

A nurse assesses a nursing home resident's pressure ulcer to be a "healing stage III." The primary reason reverse staging is never used is because: a. even though all tissue layers are replaced as a wound heals, the healed skin is not as strong as it originally was. b. not all tissue layers are replaced as a wound heals, and the healed skin is not as strong as it originally was. c. reimbursement in nursing homes does not allow for reverse staging to be utilized. d. the collagen layer is not replaced during wound healing.

ANS: B Not all tissue layers are replaced as a wound heals. The wound fills with granulation tissue composed of endothelial cells, fibroblasts, collagen, and extracellular matrix. Muscle, subcutaneous fat, and dermis are not replaced. The healed skin is not as strong as it originally was. Reimbursement in long-term care is not the primary reason for not using reverse staging.

An older woman asks a nurse, "You always seem to be telling me that I need to drink more water. How much water do I really need to drink?" The nurse bases her response on the knowledge that older adults should consume at least: a. 1000 mL of fluid per day. b. 1500 mL of fluid per day. c. 2000 mL of fluid per day. d. 2500 mL of fluid per day.

ANS: B Older adults, with the exception of those who require a fluid restriction, should consume at least 1500 mL of fluid per day.

The nurse is recommending that a client diagnosed with moderate stage Alzheimer's disease attend a support group when he becomes defensive about not driving his automobile and the effects it will have on "being stuck at home." Which is the priority outcome expected for this client when attending the group sessions? a. Facilitates socialization thus minimizing the effects of social isolation b. Helps with minimizing the loss as a factor in causing depression c. Provides caregivers with respite while assuring the client is well attended to d. Allows for the opportunity for a mental health professional to assess the client

ANS: B Participants attending the driving cessation support groups had an improvement in depression scores, were less angry, and were happier. Support groups designed specifically to deal with loss of driving privileges among individuals with dementia may be important in alleviating depressive symptoms and other negative outcomes associated with cessation of driving. The remaining options represent possible outcomes but they do not have the priority that minimizing depression has for this client.

A nurse in a long-term care facility notes that there has been an increase in falls on one unit and that many of the falls are occurring immediately following mealtime. The nurse recommends that the nursing home conduct a trial of six smaller meals instead of the three traditional meals. The nurse makes this recommendation on the understanding that: a. postural changes in blood pressure are common in older adults and frequently occur around mealtimes. b. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. c. residents of long term care facilities are often on many different medications, which are given at mealtimes. d. it is common practice to take long term care residents to the bathroom immediately following meals.

ANS: B Postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. Modifications such as increased water intake before eating or substituting six smaller meals daily for three larger meals may be effective. Orthostatic hypotension is a cause of falls in older adults, but does not just occur around meal times. While it is true that residents of long term care facilities are on multiple medications and are usually toileted following meals, neither of these options addresses postprandial hypotension.

An older adult asks a nurse, "I hear a lot about limiting the amount of fat in my diet and eating a balanced diet. It is confusing. Can you help me understand what a balanced diet for me would be?" The nurse bases a response on which of the following? a. 10-15% of total calories should be from fat, 30-40% from carbohydrates, and 35-75% from protein b. 20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein c. 45-65% of total calories should be from fat, 20-35% from carbohydrates, and 10-35% from protein d. 20-35% of total calories should be from fat, 10-25% from carbohydrates, and 50-75% from protein

ANS: B Recommendations for older adults are that 20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein.

An older adult's nutritional status is screened by a nurse using the Mini Nutritional Assessment (MNA). The older adult scores a score of "10" on the screening portion of the tool. The best action by the nurse is to: a. refer the patient to a dietician. b. complete the assessment portion of the tool. c. conduct a 72-hour calorie count. d. initiate nutritional supplements between meals.

ANS: B The MNA is both a screening tool and a detailed assessment. It is validated for use in individuals over age 65 and intended for use by professionals. If an individual scores less than a 12 on the screening portion of the tool, then the assessment portion must be completed. The assessment portion needs to be completed before any interventions or referrals are taken, as the information that is obtained in the assessment will guide the choice of interventions.

A nurse is discussing the importance of exercise with a 78-year-old female who states: "I know I should be exercising, but I have arthritis in my knees and it is painful. Can you recommend a type of exercise that would be beneficial and cause me less pain?" Which of the following exercises should the nurse recommend? a. Tennis b. Swimming c. Dancing d. Use of a treadmill and elliptical machine in the gym

ANS: B The high prevalence of joint diseases, such as osteoarthritis, may hamper successful performance of aerobic exercises that cause joint impact. Tennis, dancing, and use of a treadmill and elliptical machine in the gym may all cause joint impact. Swimming is a low-risk activity that provides aerobic benefit, and water-based exercises are particularly beneficial for individuals with arthritis or other mobility limitations.

The original intent of Social Security was to: a. provide a hospital insurance plan. b. minimize the dependency of older members on younger members of society. c. provide the blind, older adult, or disabled with adequate financial support. d. penalize women financially for numerous zero wage years while raising children.

ANS: B The original intent of Social Security was to minimize the dependency of older members of society on younger members. Social Security is not a health insurance plan. It was designed to provide monetary support to persons at a certain age or when blind or disabled. It was not intended to meet all financial needs of the individual. Benefits are provided to individuals who worked or are married to someone who worked the number of years required.

The cost of nursing home care is significant. The primary payer for nursing home care is: a. Medicare. b. Medicaid and private pay. c. Long-term care insurance. d. Medigap insurance.

ANS: B The primary payers for nursing home care are Medicaid and private pay. Because of the potentially high co-payments associated with Medicare, persons who are able to do so often purchase supplemental insurance plans. These feature standard benefits and generally several different policies are available from which to select in each state. Plans referred to as Medigap cover only the deductibles and part of the coinsurance amounts based on Medicare-approved amounts contracted with providers. Long term care insurance does pay for nursing home, but the primary payers are Medicaid and private pay.

A nurse is admitting and orienting an older adult to the hospital unit. She discusses fall prevention and demonstrates the use of the call bell to the patient. The patient's daughter asks: "Why don't you just put up all the side rails to prevent my mother from getting out of bed by herself and falling. That should work, right?" The best response by the nurse is: a. "Side rails have only proven to be effective in decreasing falls in patients who have already fallen." b. "There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury." c. "Side rails are only effective when used with patients who have dementia." d. "Side rails do not decrease falls, but they do decrease fall-related injuries."

ANS: B There is no evidence to date that side rail use decreases the risk or rate of fall occurrence. There are numerous reports and studies documenting the negative effects of side rail use, including entrapment deaths and injuries that occur when the person slips through the side rail bars or between split side rails, the side rail and the mattress, or between the head or footboard, side rail, the mattress, or between the head or footboard, side rail, and mattress.

A nurse is observing a nurse aide perform denture care for a resident in the nursing home. The nurse recommends that the nurse aide receive additional education on denture care when the nurse observes which of the following? a. The nurse aide places a face cloth in the sink and fills the sink half full with water. b. The nurse aide uses toothpaste to clean the dentures. c. The nurse aide utilizes a specially designed denture brush to clean the dentures. d. The nurse aide stores the dentures in a denture cup filled with denture cleansing solution.

ANS: B Toothpaste is not used to clean dentures since it abrades denture surfaces. All of the other options are correct steps in the process to cleanse dentures.

A nurse is providing an educational session on vaccines to a group of older adults. The nurse is discussing the zoster vaccine (Zostavax). Which of the following information should the nurse include in the education? a. Zostavax should only be given to individuals who have never had an episode of herpes zoster (HZ) b. Zostavax is recommended for all individuals over age 60 that have no contraindications to the vaccine c. Zostavax should not be given to anyone with a chronic cardiac or respiratory condition d. Zostavax will always prevent an individual from developing Herpes Zoster

ANS: B Zostavax is recommended for all persons 60 and older who have no contraindications to the vaccine, including persons with a previous episode of Herpes Zoster (HZ) and those with chronic conditions. The vaccine does not guarantee that an individual will not get HZ; however, individuals who get the vaccine cut their risk in half and if they do get HZ, it is likely that they will get a milder case.

The daughter of an older patient says to a nurse, "I am so concerned that my dad is still driving. He is dangerous! He has had a couple of accidents and I am worried that he is going to kill himself or, worse, somebody else. What can I do?" The nurse recommends which of the following involved type action strategies for driving cessation? (Select all that apply.) a. Report the person to the division of motor vehicles for license suspension. b. Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem. c. Arrange for alternate transportation for the person. d. Confiscate the keys to the car. e. Ask the patient's physician to write a prescription for the person to stop driving.

ANS: B, C Options B and C are examples of the involved type of action strategies for driving cessation. Options A, D, and E are all examples of the imposed type of action strategies for driving cessation.

A nurse is educating a group of older adults on the benefits of an exercise program. The nurse includes education on when not to exercise. Which of the following should the nurse include in the education? (Select all that apply.) a. Do not exercise if your resting heart rate is over 80 b. Do not exercise if your blood pressure is greater than 200 systolic and 100 diastolic c. It is important to wait 30 minutes after a big meal before engaging in vigorous exercise d. Do not exercise if a joint that you are using to exercise is red, warm, and painful e. Do not exercise if you have a fever and muscle aches

ANS: B, D, E Older adults are advised to avoid exercise if their resting heart rate is over 120, not 80. It is important to wait 2 hours after a heavy meal before engaging in vigorous exercise, but leisurely exercise such as a walk is fine.

A nurse is caring for an older adult in a hospital who has an indwelling catheter. The nurse assesses the patient based on the knowledge that which of the following are correct indications for an indwelling catheter? (Select all that apply.) a. To assist with incontinence management b. To manage acute urinary retention c. To assist in healing of open sacral or perineal wounds in incontinent patients d. To accurately measure urinary output in critically ill patients e. To prevent falls related to toileting in hospitalized older patients

ANS: B, C, D Indwelling urinary catheters are appropriate in the management of acute urinary retention, to assist in the healing of open sacral or perineal wounds in incontinent patients, and when accurate measurement of urinary output is essential in managing a critically ill patient. Urinary catheters are not an appropriate intervention for the management of incontinence and do not prevent falls related to toileting in hospitalized patients.

An older adult's diagnosis of sleep apnea is supported by nursing assessment and history data that include: (Select all that apply.) a. followed a vegetarian diet for last 28 years. b. male gender. c. a smoking history of 1 pack a day for 45 years. d. 30 pounds over ideal weight. e. history of Crohn's disease.

ANS: B, C, D Rest factors for sleep apnea include being male, a smoking habit, and excess weight. There is no current research to support a connection between a vegetarian diet (possible low protein) or Crohn's disease to the development of sleep apnea.

A nurse caring for a cognitively impaired older adult client shows an understanding of the unique clinical symptoms of constipation in this population when: (Select all that apply.) a. checking documentation to determine if the client has had a bowel movement in the last 24-36 hours. b. questioning staff as to whether the client has any unexplained falls in the last few days. c. asking the client to name all of his or her children and grandchildren. d. requesting that the client's temperature be taken now and again in 4 hours. e. reviewing the client's food intake over the last 24-36 hours.

ANS: B, C, D, E It is important to note that alterations in cognitive status, incontinence, increased temperature, poor appetite, or unexplained falls may be the only clinical symptoms of constipation in the cognitively impaired or frail older person. Frequency of defecation is not necessarily an indicator of constipation since it is such a personal characteristic.

A nurse is developing a care plan for an older adult in a long-term care facility that has a nutritional problem. Which of the following interventions are appropriate to ensure adequate nutrition? (Select all that apply.) a. Assign a nursing aide to feed the resident to ensure adequate consumption of meals b. Supervise the resident during meals c. Provide a pleasant eating environment d. Provide nutritional supplements for the resident e. Assess the resident for ability to feed himself/herself

ANS: B, C, D, E Nurses hold an important role in ensuring adequate nutrition. Interventions that support this goal include supervision of eating, modification of the environment to be pleasing for eating, and assessing the individual for issues related to performance at mealtimes. Feeding a resident is not indicated unless it is known that the resident cannot feed himself/herself. It is important to promote independence as much as possible.

A long term care facility has selected sleep promotion as its quality improvement project. Which of the following interventions would be appropriate to implement on this unit? (Select all that apply.) a. Ensuring that all residents receive evening care and are in bed by 8:00 PM b. Taking as many residents as possible outside for 30 minutes daily c. Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9:00 PM and 6:00 AM d. Avoiding waking residents for routine care during the night e. Limiting caffeine and fluids before bedtime

ANS: B, C, D, E Strategies to promote sleep for individuals in long term care and hospitals include allowing the resident to stay out of the bed and the room for as long as possible before bed, and not placing him/her in bed too early. Exposing individuals to sunlight for 30 minutes daily in a comfortable outdoor location is also helpful in promoting sleep. Limiting fluids and caffeine before bedtime is also helpful. Changing institutional routines to avoid waking residents for routine care and providing care when residents wake up are also successful strategies to promote sleep.

A homecare nurse visits a client in the home to conduct a fall risk assessment. The nurse assesses the client and the home for extrinsic risk factors for falls. Which of the following are extrinsic risk factors? (Select all that apply.) a. The client has an unsteady gait. b. The client uses a cane, but the cane is not the appropriate size for the client. c. The client's home is cluttered. d. The client is on two different medications that cause orthostatic hypotension. e. There are no grab bars in the client's bathroom.

ANS: B, C, E Extrinsic risk factors are external to the patient and related to the physical environment and include inadequate support devices. Options B, C, and E are extrinsic risk factors. Intrinsic risk factors are unique to each patient. Options A and D are intrinsic risk factors.

A nurse is performing an admission assessment on an older patient who presented with a high fever and cough, reduced oral intake for 3 days, and lower extremity weakness. The patient has sunken eyes, and the patient's skin turgor over the sternum is poor. The nurse suspects that the patient is dehydrated. Which of the following are indicators of dehydration in this patient? (Select all that apply.) a. Poor skin turgor over the sternum b. Lower extremity weakness c. High fever d. Sunken eyes e. Cough

ANS: B, D Older adults often present atypically when dehydrated. Skin turgor over the sternum is not a reliable marker in older adults due to the loss of subcutaneous tissue with aging. Lower extremity weakness and sunken eyes may indicate dehydration. High fever and cough can be associated with many other conditions and are not typically signs of dehydration.

When an older adult is considering long-term care insurance (LTCI), what is important for the nurse to encourage the client to consider? a. The older one is when applying, the lower the rates will be b. It is financially better to avoid purchasing LTCI through a group policy c. It is wise to scrutinize all exclusions before enrolling d. All policies cover care at home as well as in a long-term care facility

ANS: C LTCI policies vary, and many have exclusions for specific diseases, for example, Alzheimer's disease. It is prudent to examine the policy before purchasing. Costs increase as one ages. The best plans are those that are negotiated by a large group such as an employer, state organization, or association. Although policies are becoming more creative, they are traditionally limited to care in a long-term care facility and frequently do not cover care in the home.

A nurse is working with an older individual who has recently started an exercise program. The individual tells the nurse, "This exercise thing is really hard, and I absolutely hate walking on a treadmill going nowhere. I think I am going to call it quits." Which of the following responses by the nurse will be most effective in encouraging the individual to remain in the program? a. "If you stop exercising, you will reverse all the good effects that the exercise accomplished." b. "I will have to report that to your physician." c. "What types of exercise do you enjoy doing?" d. "Most older people hate exercising, but they do it anyways."

ANS: C Providing choices, as well as making exercise fun and entertaining, is a strategy to sustain participation in an exercise program. Options A, B, and D do not address the patient's issue of not liking a particular type of exercise.

A patient tells the nurse, "Every time I laugh or cough, I wet myself." Which type of urinary incontinence is this patient describing? a. Urge b. Functional c. Stress d. Mixed

ANS: C Stress incontinence is defined as the loss of a small amount urine with activities that increase intraabdominal pressure such as coughing, sneezing, exercise, lifting, or bending.

An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse? a. Refer the resident for an evaluation for a hearing aid b. Raise her voice when speaking to the resident c. Examine the resident's ears for cerumen impaction d. Teach the resident to read lips

ANS: C When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing losses. Raising one's voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.

In a long-term care facility, a nurse is having a discussion with the nurse aides about ways to deal with dementia clients who are uncooperative with mouth care. Appropriate methods to use include: a. speaking to the client sternly and instructing the client to open the mouth and cooperate immediately. b. having another nurse aide assist in holding the client's mouth open with a tongue depressor. c. involving the client in the process of oral hygiene, such as using the hand over hand technique to brush the client's teeth. d. quickly performing oral hygiene without explanation since the client is uncooperative.

ANS: C With uncooperative individuals, it is important for the caregiver to be at eye level and explain all actions with step-by-step instructions. Speaking to the client sternly, having another nurse aide hold the patient's mouth open, or performing oral hygiene without an explanation will only serve to agitate the patient. Involving the client and having the client participate to the extent possible is important. Using a hand over hand technique is effective.

A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. The nurse recommends that the patient eliminate which of the following? (Select all that apply.) a. Night-lights b. Railings on the stairway c. Loose carpeting on the floors d. The use of a cane e. Excess clutter

ANS: C, E Extrinsic risk factors are external to the patient and related to the physical environment and include lack of support equipment by bathtubs and toilets, height of beds, condition of floors, poor lighting, inappropriate footwear, and improper use of or inadequate assistive devices. Nightlights, railings on the stairway, and the use of a cane are all measures that can ameliorate some extrinsic risk factors.

An older patient asks a nurse, "My doctor referred me to a hearing specialist who thinks that surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?" The nurse formulates a response based on the knowledge that: a. a cochlear implant is permanent, surgically-implanted hearing aid. b. a cochlear implant speeds up the conduction of sound to the auditory nerve. c. a cochlear implant functions as an artificial auditory nerve. d. a cochlear implant directly stimulates the auditory nerve.

ANS: D A cochlear implant bypasses damaged portions of the ear and directly stimulates the auditory nerve.

A 78-year-old patient has a history of osteoarthritis and lives alone in a two-story home. The bathroom is on the first level and the bedroom is on the second level. The patient states, "I am so upset. I have been wetting the bed at night." What type of incontinence does the patient most likely have? a. Mixed incontinence b. Stress incontinence c. Urge incontinence d. Functional incontinence

ANS: D Functional incontinence is defined as incontinence that is due to the individual being unable to get to the toilet as a result of barriers, including environmental barriers.

A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which of the following should be included in the nurse's teaching plan? a. "Many people find that hearing aids only help with certain types of hearing loss that are caused by previous noise exposure." b. "With the right hearing aid, you can expect your hearing to be back to normal." c. "Hearing aids are covered by Medicare Part B." d. "Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise."

ANS: D Hearing aids do bring challenges, such as distorted speech and amplified background noise. Although hearing aids are not indicated for all individuals with hearing loss, they are not restricted to those with hearing loss due to excessive noise exposure. Hearing aids do not restore hearing to normal. Medicare does not cover the cost of hearing aids.

A Navy war veteran is seeking advice about getting treatment for a chronic respiratory problem at the local veterans' hospital. The nurse's initial response is to ask: a. "Why aren't you considering the local general hospital for the care that you need?" b. "Are you willing to travel to a veterans' hospital that offers respiratory diagnostic services?" c. "Have you ever been treated at a veterans' hospital before?" d. "Is the problem related to something that occurred while you were in the Navy?"

ANS: D Instead of coverage of any health problems, priorities were set for those problems that were in some way deemed "service connected"; in other words, the health care problem had to be linked to the time the person was on active duty. While the other questions are not inappropriate, they do not address the issue of whether the client is illegible for care at a veterans' hospital.

A client who reported "a problem sleeping" shows an understanding of good sleep hygiene by: a. doing 10 pushups before bed to encourage a "pleasant tiredness." b. seldom eating a bedtime snack. c. engaging in computer games as a pre-bed activity. d. limiting the afternoon nap to just 30 minutes.

ANS: D Limiting daytime napping to 30 minutes or less is a good sleep hygiene practice. Exercise should be completed at least 4 hours before retiring while a bedtime snack is acceptable if the food is light and easily digested. Computer-focused activities are not generally encouraged as a part of a bedtime routine.

You have four rooms to choose from for your older client to be admitted this afternoon. Which room would you choose? A. A brightly lit, blue room with cozy throw rugs B. An orange-carpeted room with soft lighting and yellow walls C. A brightly lit, blue room with an EZ-Glide wax floor D. A fluorescent-lighted room with green walls and a glossy, tiled floor

Ans: B Light colors such as red, orange, and yellow are more easily seen by aging eyes. Softer lighting will help reduce some of the glare and is also easier seen by aging eyes. Fidelity of color is less accurate with the blues, greens, and violets of the spectrum, and the slowed ability of the pupils to adjust to light makes glare a problem. Glare can come from sunlight, but a brightly waxed floor and glossy tile can also cause glare.