Gerontology Tabloski Chapter 22
Which assessment finding places an older patient at the greatest risk factor for the development of Alzheimer's disease? 1. Age 2. Genetic predisposition 3. Environmental exposure 4. History of previous head injury
Answer: 1 Explanation: 1. Advanced age is the single greatest factor for the development of Alzheimer's disease. 2. Genetic causes are responsible for fewer than 5% of the cases of Alzheimer's disease. 3. Environmental exposure is not identified as a risk factor for the development of Alzheimer's disease. 4. History of a previous head injury is considered a medical risk for the development of Alzheimer's disease but advanced age is the single greatest risk factor for the development of the disorder.
An older client is being evaluated for delirium. Of the following, which is not a manifestation typically used to make a diagnosis of this disorder? 1. Unable to physically swallow when asked to 2. Unable to remember who visited earlier in the day 3. Unable to sleep at night, but able to sleep through the day 4. Unable to maintain attention
Answer: 1 Explanation: 1. Delirium is a disturbance in mental abilities. The physical ability of swallowing is not affected by delirium. 2. Short-term memory impairment such as being unable to remember who visited earlier in the day is a symptom of delirium. 3. Sleep-wake cycle disturbance, such as being able to sleep through the day but not at night, is a symptom of delirium. 4. Not being able to maintain attention is an impairment that is a symptom of delirium.
An older patient is diagnosed with early-mild Alzheimer's disease. Which should be done at the time of diagnosis? 1. Discuss treatment options and wishes with the patient. 2. Identify a long-term care facility for immediate transfer. 3. Explain that this stage of the disorder can last up to 10 years. 4. Instruct family members to slowly improve the home environment for safety.
Answer: 1 Explanation: 1. Early diagnosis provides the family and the older person with the opportunity to discuss treatment options and wishes while the older person still has decision-making capacity. 2. It is not necessary to identify a long-term care facility for the older patient at this stage of the disorder. 3. There is no specific time interval for early-mild Alzheimer's disease. 4. The family should prepare the home to avoid safety issues as soon as possible.
An older client is diagnosed with dementia caused by Lewy bodies. What will the nurse most likely assess in this client? Select all that apply. 1. Tremor 2. Rigidity 3. Postural instability 4. Sleep apnea 5. Visual hallucinations
Answer: 1, 2, 3, 5 Explanation: 1. Clinical symptoms of dementia caused by Lewy bodies include a tremor. 2. Clinical symptoms of dementia caused by Lewy bodies include rigidity. 3. Clinical symptoms of dementia caused by Lewy bodies include postural instability. 4. Sleep apnea is not a clinical symptom of dementia caused by Lewy bodies. 5. Clinical symptoms of dementia caused by Lewy bodies include visual hallucinations.
The nurse suspects that an older client is experiencing Parkinson's disease. What did the nurse observe in this patient? Select all that apply. 1. Chorea 2. Tremor 3. Epileptic seizures 4. Restless leg syndrome 5. Dystonia
Answer: 1, 2, 4, 5 Explanation: 1. Chorea is involuntary twitching of the limbs or facial muscles which is an extrapyramidal manifestation of Parkinson's disease. 2. A tremor is an extrapyramidal manifestation of Parkinson's disease. 3. Although tremors associated with Parkinson's disease can be similar to epileptic seizures, they are unrelated conditions. 4. Restless leg syndrome is a twitching or discomfort of the legs. It is also associated with the need to constantly move the legs, and is a manifestation of Parkinson's disease. 5. Dystonia is involuntary muscle contractions forcing unusual or painful positions and is an extrapyramidal manifestation of Parkinson's disease.
After a neurologic assessment, the nurse determines that an older patient is exhibiting normal signs of aging. What did the nurse assess in this patient? Select all that apply. 1. Slow movements 2. Intermittent hand tremor 3. Ataxia with position changes 4. Decreased sensation in the feet 5. Slight impairment of coordination
Answer: 1, 2, 4, 5 Explanation: 1. Slower movements are a normal neurologic sign of aging. 2. Intermittent hand tremor is a normal neurologic sign of aging. 3. Ataxia with position changes is not a normal neurologic sign of aging. 4. Decreased sensation in the feet is a normal neurologic sign of aging. 5. Slight impairment of coordination is a normal neurologic sign of aging.
What should the nurse teach the family of an older patient with Alzheimer's disease to help with spatial disorientation? Select all that apply. 1. Use color to contrast objects and items. 2. Keep furniture in the same familiar place. 3. Fill the patient's room with memorabilia. 4. Remove cues for exiting the home away from the doors. 5. Place family photos or recognizable familiar items in a prominent spot.
Answer: 1, 2, 5 Explanation: 1. The use of color to contrast objects and items is a form of a pop-up cue and helps with spatial disorientation. 2. Keeping furniture in the same familiar place provides landmarks and helps with spatial disorientation. 3. Filling the patient's room with memorabilia could contribute to clutter and does not help with spatial disorientation. 4. Removing cues for exiting the home reduces the risk of elopement and does not help with spatial disorientation. 5. Placing family photos or familiar items in a prominent spot provides landmarks and helps with spatial disorientation.
The nurse is preparing an educational session on stroke prevention for a group of senior citizens. What information would be important for the nurse to provide to these participants? Select all that apply. 1. Stop smoking. 2. Stop drinking alcohol. 3. Maintain a healthy body weight. 4. Follow a low-sodium diet as prescribed. 5. Take blood pressure medication as prescribed.
Answer: 1, 3, 4, 5 Explanation: 1. Healthy aging tips for stroke prevention include smoking cessation. 2. Healthy aging tips for stroke prevention include limiting the amount of alcohol consumed. Having one drink per day may actually reduce the risk of stroke, while having more than two drinks per day can drastically increase the risk of stroke. 3. Healthy aging tips for stroke prevention include losing weight if overweight. 4. Healthy aging tips for stroke prevention include ingesting below 2 to 3 grams of sodium each day. 5. Healthy aging tips for stroke prevention include reducing blood pressure to at least 140/90 mm Hg.
The nurse is preparing an educational session on vascular dementia for a group of senior citizens. He wants to include information on factors that can potentially reduce the risk of this type of dementia. What information would be important for the nurse to provide to these participants? Select all that apply. 1. Control blood pressure 2. Discontinue alcohol consumption 3. Control weight 4. Take a daily, low-dose aspirin 5. Control blood sugar level
Answer: 1, 3, 5 Explanation: 1. Controlling blood pressure helps improve vascular health, which lessens the risk of vascular dementia. 2. There is no evidence to support discontinuing alcohol consumption helps lessen the risk of vascular dementia. 3. Controlling weight helps improve vascular health, which lessens the risk of vascular dementia. 4. There is no evidence to support taking a daily, low-dose aspirin helps lessen the risk of vascular dementia. 5. Controlling blood sugar level helps improve vascular health, which lessens the risk of vascular dementia.
An older client is prescribed gabapentin (Neurontin) for a seizure disorder. When instructing the client on this medication, which common side effects should the nurse include? Select all that apply. 1. Headache 2. Increased thirst 3. Irritability 4. Black, tarry stools 5. Weight gain
Answer: 1, 5 Explanation: 1. Headache is a common side effect of gabapentin (Neurontin). 2. Increased thirst is a possible side effect of gabapentin (Neurontin), but very rare. 3. Irritability is a possible side effect of gabapentin (Neurontin), but very rare. 4. Black, tarry stools are a possible side effect of gabapentin (Neurontin), but rare. 5. Weight gain is a common side effect of gabapentin (Neurontin).
An older client is demonstrating signs of a brain attack. What will the nurse do to assess the degree of cerebral infarct? 1. Assess the client's ability to cry 2. Assess the client's motor strength 3. Assess the client's ability to sleep 4. Assess the client's ability to digest food
Answer: 2 Explanation: 1. Although some clients experience sudden mood changes, such as suddenly going from crying to laughing, assessing the ability to cry is not common when determining the degree of cerebral infarction. 2. Usually, the National Institutes of Health (NIH) Stroke Scale is used to gauge the degree of cerebral infarction by determining motor strength, among other elements, such as gaze and facial palsy. 3. Although sleep problems are common after a stroke, assessing the ability to sleep is not common when determining the degree of cerebral infarction. 4. The ability to swallow food should be assessed in determining the degree of cerebral infarction in a client, but the ability to digest food would not.
An older client is being evaluated for frontotemporal dementia. Of the following, which manifestation would be present to make this diagnosis? 1. Abrupt onset of dementia 2. Loss of personal awareness 3. Lewy bodies in the midbrain 4. Cerebrovascular low-density areas
Answer: 2 Explanation: 1. An abrupt onset of dementia is characteristic of Vascular Dementia. 2. Loss of social and/or personal awareness are characteristic of Frontotemporal Dementia. 3. Lewy bodies in the midbrain is characteristic of Lewy Body Dementia. 4. Cerebrovascular low-density areas are characteristic of Vascular Dementia.
An older client with moderate stage dementia frequently cannot remember which room he is assigned in a long-term care facility. Which nursing intervention would help this client? 1. Reorient the client when it happens again. 2. Establish landmarks. 3. Investigate placing the client in a private room. 4. Accompany the client on walks.
Answer: 2 Explanation: 1. Reorienting the client does little to assist the client in remaining independent. 2. Landmarks such as pictures and familiar belongings will promote the client's recognition of the correct room. 3. Placing the patient in a private room will serve to promote isolation and will be counterproductive. 4. Accompanying the client on walks does little to assist the client in remaining independent.
An older patient with Alzheimer's disease has a feeding tube. The family wants to know if the patient will ever be able to eat solid food again. What information should the nurse include when responding to this family's question? 1. The dietitian will decide if this can be done. 2. It depends upon the patient's functional eating abilities. 3. This can be done but the feeding tube has to be removed first. 4. In the patient with dementia, the restoration of natural feeding is highly unlikely.
Answer: 2 Explanation: 1. The dietitian helps determine a feeding plan but does not determine if the patient will be able to eat solid food again. This is based upon the patient's functional eating abilities. 2. Even older people with advanced Alzheimer's disease can revert to natural feeding after tube feeding. An individualized care plan, based on the older person's target body weight and functional eating abilities, should be developed by an interdisciplinary team that includes a nurse, dietitian, and physician. 3. Natural feeding can begin with the tube in place until the older person's eating is reestablished. 4. Even older people with advanced Alzheimer's disease can revert to natural feeding after tube feeding.
The nurse instructs an older client with Parkinson's disease about carbidopa-levodopa (Sinemet). Which of the following shows an accurate understanding of the medication? 1. The client takes medication with meals. 2. The client sits on the side of the bed before standing. 3. The client believes the medication will cure Parkinson's disease. 4. The client believes this medication will not affect her blood pressure medications.
Answer: 2 Explanation: 1. To maximize absorption and facilitate crossing the blood-brain barrier, carbidopa-levodopa should be taken on an empty stomach. 2. The older client may experience postural hypotension. The nurse needs to teach strategies to prevent falling, such as sitting on the side of the bed before standing. 3. There is no medication known to cure Parkinson's disease. 4. The older client may experience postural hypotension, which could affect the patient's blood pressure medication dosage.
An older client with Alzheimer's disease has wandered away from the home several times. What can the nurse suggest that the spouse do to reduce the client's risk for wandering? Select all that apply. 1. Use hospital-approved belt restraints. 2. Install motion detectors on the door of the client's room. 3. Disguise the door so it looks like a mirror. 4. Alert neighbors. 5. Place emergency telephone numbers on the refrigerator door.
Answer: 2, 3, 4 Explanation: 1. Although belt restraints may sometimes be appropriate in healthcare settings, they should not be used in a home setting to discourage a wandering client. 2. Installing motion detectors on the door of the client's room would alert family members that the client is mobile and could potentially wander from the home. 3. Disguising the door so it looks like a mirror could help reduce the client's risk of wandering away from home. 4. Alerting neighbors of the client's risk of wandering away from home could help reduce the risk.. 5. Placing emergency telephone numbers on the refrigerator door will have no impact on the client's tendency to wander.
An older patient is being evaluated for dementia. What manifestations need to be present to diagnose this disorder? Select all that apply. 1. Intermittent forgetfulness 2. Inability to manage finance 3. Misplacing personal belongings 4. Repetitive questions or conversations 5. Difficulty thinking of common words while speaking
Answer: 2, 3, 4, 5 Explanation: 1. The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Intermittent forgetfulness is not a cognitive symptom of any specific domain. 2. The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Inability to manage finances indicates impaired reasoning and handling of complex tasks. 3. The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Misplacing personal belongings indicates impaired ability to acquire and remember new information. 4. The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Repetitive questions or conversations indicate impaired ability to acquire and remember new information. 5. The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Difficulty thinking of common words while speaking indicates impaired language functions.
An older patient newly diagnosed with Alzheimer's disease is prescribed galantamine (Razadyne). How will the nurse instruct the patient about this medication? Select all that apply. 1. Take at bedtime. 2. Take the medication with food. 3. The dosage may be changed every 4 weeks. 4. Side effects of this medication are minimal. 5. Do not take the medication with an NSAID.
Answer: 2, 3, 5 Explanation: 1. This medication is not specifically to be given at bedtime. 2. This medication can cause gastrointestinal upset and should be taken with food. 3. This medication is titrated at 4-week intervals. The dosage may be changed every 4 weeks. 4. The side effects of this medication include gastrointestinal upset and bleeding, arrhythmias, urinary obstruction, somnolence, tremor, abdominal pain, and rhinitis. 5. This medication should be used with caution if also prescribed NSAIDs since this could increase the risk of gastrointestinal bleeding.
An older client with mild Alzheimer's disease abruptly stops taking the prescribed medication donepezil (Aricept). When assessing the patient for withdrawal symptoms of the the sudden discontinuation of the medication, on which area should the nurse focus? 1. The client's reflexes 2. The client's rest and sleep pattern 3. The client's cognitive function 4. The client's cardiovascular function
Answer: 3 Explanation: 1. Abrupt cessation of donepezil (Aricept) does not affect reflexes. 2. Abrupt cessation of donepezil (Aricept) does not affect rest and sleep. 3. Abrupt cessation of donepezil (Aricept) is associated with a reduction in cognitive abilities. 4. Abrupt cessation of donepezil (Aricept) does not affect cardiovascular function.
The family of an older patient with Alzheimer's disease does not want to discuss long-term care placement for at least "a few years." How should the nurse respond to the family? 1. "Long-term care placement is inevitable with this diagnosis." 2. "It often takes a year for an individual with Alzheimer's disease to be admitted." 3. "Talking about it now gives you time to think about locations and make a decision." 4. "By providing this information now, we will not need to address these concerns later."
Answer: 3 Explanation: 1. Placement in a long-term care facility may or may not occur with the patient. It is not a fate of all patients with this disease process. 2. There is no evidence to suggest that it takes a year for a patient with Alzheimer's disease to be admitted to a long-term care facility. 3. By discussing placement issues as early as possible in the placement process, hopefully crisis and emergency placement can be avoided, allowing adequate time to investigate all options. 4. Nurses will need to provide reinforced education and referrals throughout the disease process, not just during this initial hospitalization.
An older patient with Alzheimer's disease is demonstrating agnosia. Which intervention would be important to include in this patient's plan of care? 1. List choices for the patient to select. 2. Provide deadlines for self-care activities. 3. Refrain from providing verbal instructions. 4. Remove inedible items from the environment.
Answer: 4 Explanation: 1. Listing choices for the patient to select will not help with agnosia, which is the inability to recognize objects. 2. Providing deadlines for self-care activities will not help with agnosia, which is the inability to recognize objects. 3. Verbal prompts decrease the chances of the older person becoming confused, however, it will not help with agnosia, which is the inability to recognize objects. 4. Agnosia is the inability to recognize objects and causes functional impairment and predisposes the patient to safety hazards such as eating inedible objects.
An older patient begins to experience status epilepticus. Which action will the nurse take to help this patient? 1. Measure vital signs. 2. Orient the patient between seizures. 3. Prevent chilling with warmed bed linens. 4. Ensure an intravenous access line is available.
Answer: 4 Explanation: 1. Status epilepticus is a medical emergency which necessitates the establishment of an adequate airway, administration of oxygen, and administration of fluids and emergency medications. An intravenous access line is imperative for this patient. Vital signs can be assessed once the seizures have ceased. 2. Status epilepticus is a medical emergency which necessitates the establishment of an adequate airway, administration of oxygen, and administration of fluids and emergency medications. An intravenous access line is imperative for this patient. The patient will most likely be unconscious. 3. Status epilepticus is a medical emergency which necessitates the establishment of an adequate airway, administration of oxygen, and administration of fluids and emergency medications. An intravenous access line is imperative for this patient. Patient chilling is not of a high priority at this time. 4. Status epilepticus is a medical emergency which necessitates the establishment of an adequate airway, administration of oxygen, and administration of fluids and emergency medications. An intravenous access line is imperative for this patient.
The nurse suspects an older client is having a grand mal seizure. What is the nurse's highest priority? 1. To use the head-tilt/chin-lift method 2. To prevent the seizure from lasting more than five minutes 3. To document the progression of symptoms 4. To prevent the client from being injured
Answer: 4 Explanation: 1. The head-tilt/chin-lift method should be used to obtain an airway, if necessary. 2. It is not possible to stop a seizure once it has started; however, if one seizure lasts longer than 10 minutes, or several seizures occur back-to-back, lasting longer than 30 minutes, this is an emergency. The client should be given oxygen. 3. Although it is crucial to document the progression of symptoms, this is not the nurse's highest priority. 4. Although preventing injury from seizures is important in clients of all ages, it is especially so for older clients, due to the likely severity of the injury.
An older client with advanced Alzheimer's disease is being treated for pneumonia. The daughter is not sure if resuscitation efforts should be a part of the plan of care. What information should the nurse provide to the daughter? 1. "Resuscitation is often effective for older adults." 2. "After resuscitation, the patient will return to the same level of functioning." 3. "As long as the resuscitation efforts are initiated quickly, the patient will survive." 4. "Resuscitation for cardiac or respiratory arrest can be effective for older adults."
Answer: 4 Explanation: 1. The patient with advanced Alzheimer's disease has a reduced chance of successful resuscitation. 2. After successful resuscitation, the patient with dementia will often demonstrate a reduced level of functioning. 3. Certainly resuscitation is more successful if initiated quickly, but the patient in question will likely not survive such interventions. 4. Statistically, resuscitation for cardiac or respiratory arrest in the older adult is low (approximately 40 percent), but it is still possible.
A care conference is being held with the family of an older patient in the late stages of Alzheimer's disease. The family wants to know if a feeding tube should be placed. How should this question be answered? 1. Tube feeding will aid the patient to gain weight. 2. Tube feeding is associated with a reduced risk of aspiration. 3. Tube feeding reduces the discomfort associated with dehydration. 4. The absence of tube feeding promotes dehydration which reduces pain sensitivity.
Answer: 4 Explanation: 1. Tube feeding does not promote weight gain. 2. Tube feeding does not prevent aspiration. 3. Tube feeding does not decrease comfort associated with dehydration. 4. Dehydration is beneficial during the dying process because it decreases the sensation of pain and prevents edema and excessive respiratory secretions.
