Old People Class Chapter 6-16

Which nursing statement shows a true appreciation for an older client's willingness to tell their personal stories about "the war?"

"I learn so much about a client when they share their life story with me."

Which statement by the nurse is the strongest example of ageism by professional nurses?

"It is so difficult to find nurses who are truly effective geriatric nurses."

When providing information regarding age-related visual problems, the nurse recognizes that the target population is: Select all that apply.

- African-American - More likely male - 65 years of age and older

A nurse manager is providing a novice geriatric nurse with guidelines when encouraging an older client to reminisce about their life and past experiences. Which suggestions will be included? Select all that apply

- Don't correct the client even when you suspect the memory is incorrect - When the focus remains on sad topics, assess the client for possible depression - Expect and respect a degree of repetition

Which intervention is therapeutic when facilitating communication with a cognitively impaired older client? Select all that apply.

- Explain a task using simple, concise phrasing and one step at a time - Allow for additional time for the client to respond to questions or directions - Use non-verbal as well as verbal cues to help get your message across to the client

A NANDA nursing diagnosis that could be appropriate for an older adult with a marked hearing impairment is: Select all that apply

- Fear - Social Interaction Impaired - Risk for Injury - Self Esteem Disturbance

Your patient is 82 & has been diagnosed with new onset Alzheimers. Her daughter is giving her ginkgo biloba with her prescribed xarelto, tylenol, & enbrel. You teach the pt & daughter ...

1) Ginkgo biloba does not have any scientific evidence demonstrating benefit to cognitive function 2) Ginkgo biloba causes bleeding. Pt is on xarelto

The nurse is assessing the patient's knowledge of their medications. The nurse will assess 3 factors regarding each medication. What are these 3 factors?

1) is the pt taking the med as intended 2) are there any side effects of the med 3) is the med doing what it is intended to do

A client's oral intake decreased from 2,500 mL per day to 2,000 mL per day. What is the percentage decrease?

20 % decrease 2,500 mL - 2,000 mL = 500 mL 500 mL : 2,500 mL = 0.2 = 20%

Which of the following is the most common malignant skin cancer? A. Melanoma B. Squamous cell carcinoma C. Basal cell carcinoma D. Actinic keratosis

A. Melanoma

Which one of the following is a myth about PEG tubes? A. PEGs do not improve quality of life B. PEGs do not prolong survival in dementia C. PEGs do not reduce the risk of aspiration D. PEGs improve albumin levels and nutritional status

A. PEGs do not improve quality of life

What is the #1 treatment of PU? A. Prevention B. Early identification C. Thorough patient history D. Risk assessment

A. Prevention

Communication strategies for elders with hearing impairment include: A. speaking slowly. B. using a picture board. C. giving one-step directions. D. speaking at the elder's level.

A. speaking slowly. C. giving one-step directions.

What does the Katz index assess & is the Katz index sensitive to changes in the older adults status?

ADL's & the Katz index is not sensitive to change in the older adults ADL status

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.

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.

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.

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.

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.

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.

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 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 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.

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.

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.

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 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.

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.

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 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 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.

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 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.

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.

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 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.

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.

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 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.

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.

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.

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.

The nurse is providing care for an older client who is experiencing mild cognitive impairment. Which communication technique is most likely to bring about a negative outcome?

Asking the family to answer interview questions

When caring for an ill adult client, the nurse is particularly concerned that the client communicates well since:

Assessment, planning of care and even the therapeutic relationship is based on effective communication

What is the estimated number of institutionalized older adults who are unable to eat independently? A. 40% B. 50% C. 60% D. 70%

B. 50%

The FAST tool is an assessment tool to gauge: A. ADLs. B. Alzheimer's. C. depression. D. mood.

B. Alzheimer's

Which of the following is most likely to mimic symptoms of Parkinson's disease? A. Antidepressants B. Antipsychotics C. Antianxiety agents D. Mood stabilizers

B. Antipsychotics

What persons have the highest risk for fecal incontinence? A. Persons living in the community B. Persons residing in nursing homes C. Persons in the hospital D. Persons that are younger in age

B. Persons residing in nursing homes

Signs and symptoms of dehydration in an older adult include all of the following except: A. dry mucous membranes in mouth and nose. B. decreased skin turgor. C. dry axilla. D. speech incoherence.

B. decreased skin turgor.

The National Health and Nutrition Examination Survey indicates that the highest use of herbals and supplements were among: A. African Americans. B. Asians. C. White Caucasian. D. Hispanic.

C. White Caucasian.

What is the earliest symptom of an adverse reaction?

CONFUSION Nursing Role = start low and go slow

An older African-American client shares that they, "Don't hear as well as they used to." Responding based on evidence-based data, the nurse will:

Check the client's ears for a cerumen impaction

Name benefits of reminiscing & storytelling in individuals with cognitive impairment

Cognitive stimulation, increased quantity & quality of communication, increased socialization, increased connectedness with others, reduction in behavioral problems

Dressing, bathing, tolieting, and feeding are examples of what? A. Functional markers B. IADLs C. Cognitive markers D. ADLs

D. ADLs

Which of the following are risk factors for UI? A.High caffeine intake B. Smoking C. Estrogen deficiency D. All of the above

D. All of the above

Which of the following is NOT an age-related change that affects hydration? A. Thirst sensation diminishes B. Creatinine clearance declines C. Total body water decreases D. Loss of fat cells and increase in muscle mass

D. Loss of fat cells and increase in muscle mass

Which of the following is chemically equivalent to the statins? A. Saw palmetto B. Hawthorn C. Echinacea D. Red yeast rice

D. Red yeast rice

Drugs and their metabolites are excreted primarily through: A. sweat. B. saliva. C. liver. D. kidneys.

D. kidneys

The life story is constructed through all of the following except: A. reminiscing. B. journaling. C. life review. D. reading.

D. reading.

Herbs that are well known are regulated by the Food & Drug Administration. True or False

False Herbal manufacturers label herbs as food

The nurse is recording all of the patient's medications during admission. The patient states he takes "a supplement to help my arthritic knees feel better, I can't remember the name." You ask if it is...

Glucosamine & Chondroitin Sulfate

Name what IADL stands for & give examples of IADL's

Instrumental Activities of Daily Living. Examples of IADL's: ability to use phone, ability to travel, shopping, food prep, taking care of finances, medication self administration, housekeeping, laundry

Most drugs are metabolized by what organ

Liver

Missing Chapter 10

Missing Chapter 10

NO CHAPTER 8

NO CHAPTER 8

A 70 y/o pt has been taking atenolol and norvasc for hypertension for the past few years. He decided to take hawthorn to supplement his regimen. What may occur with this combination?

Significant hypotension

Which technique is most effective when communicating with a client who is positioned in bed?

Sitting in a chair at the bedside facing the client

When conducting an admissions interview with an older client, the nurse observes that the client pauses for a period of time before responding to the questions. The nurse responds to this client based on the assumption that the client is:

Sorting through their vast life experiences in order to answer appropriately

Your 68 y/o pt in the mental health clinic where you work is dx w/ major depressive disorder. He tells you he will continue to take his St. John's Wort, not the zoloft the Psychiatric NP has prescribed. What is your response?

St. John's Wort is ineffective for major depression, & should also not be taken with SSRI's

An older adult client is being admitted to an assisted living residence facility. Which nursing intervention best initially assesses the client's hearing?

The nurse asks, "Do you think you have a hearing problem?"

An older adult patient arrives in the Emergency Room with new onset left sided chest pain radiating to the jaw. What is the gold standard lab test to diagnose the problem?

Troponin (I & T)

A 77-year-old Hispanic Catholic nun (retired) who immigrated to the United States 15 years ago lives alone but in an apartment complex where her biological sister lives as well. She is being discharged home after a hospitalization for congestive heart failure with prescriptions for eight different medications. She is considered at risk for noncompliance due to contributing factors that include: (Select all that apply.) a.) language barrier. b.) living alone. c.) large number of medications. d.) ethnic background. e.) religious background.

a, b, c a.) language barrier. b.) living alone. c.) large number of medications. Language barriers, living alone, and a large number of medications are all factors that have been shown to contribute to noncompliance in older adults. There is no evidence that ethnic or religious background contributes to noncompliance.

An older client prescribed a transdermal morphine patch for severe chronic pain is being educated on the appropriate administration of the medication. The nurse shows an understanding of essential information regarding this route of drug administration when stating: (Select all that apply.) a.) "This is an effective route for delivering small doses of medication over long periods of time." b.) "Since you have problems with digestion, this is a good way to take your medication." c.) "Please show me how you would apply your patch." d.) "Be careful to put the patch only on your chest but change locations with each application." e.) "Be sure to avoid placing the patch on injured skin."

a, b, c, e a.) "This is an effective route for delivering small doses of medication over long periods of time." b.) "Since you have problems with digestion, this is a good way to take your medication." c.) "Please show me how you would apply your patch." d.) "Be careful to put the patch only on your chest but change locations with each application." e.) "Be sure to avoid placing the patch on injured skin." Aging does increase the risk of developing an allergic reaction due to its effect on the immune system and decreased gastric motility. Transdermal medications bypass the gastrointestinal tract and so do not cause digestion problems, and their effectiveness is not affected by digestive problems. Demonstrating the application process is an excellent way to evaluate the client's understanding and technique. Transdermal patches can be applied to areas other than the chest, such as the arms, backs, legs, and abdomen, but damaged skin should be avoided.

Which pharmacokinetic/pharmacodynamic parameter does the aging process least affect? a.) Absorption b.) Distribution c.) Metabolism d.) Excretion

a.) Absorption There is no conclusive evidence that the absorptive process is changed appreciably in older adults. Distribution, metabolism, and excretion are all affected significantly by aging.

A nurse is assessing a patient's activities of daily living. The nurse will assess which of the following? (Select all that apply.) a.) Eating b.) Continence c.) Toileting d.) Self-medication administration e.) Bathing

a.) Eating b.) Continence c.) Toileting e.) Bathing The basic activities of daily living include eating, transfer, toileting, bathing, continence, and dressing. Self-medication administration is an independent activity of daily living (IADL).

What factor is an important contribution to polypharmacy in older adults? a.) Inadequate communication among medical care providers b.) Implementation of Medicare Part D prescription drug benefit c.) Use of generic medications d.) Increasing popularity of dietary and herbal supplements

a.) Inadequate communication among medical care providers Polypharmacy is often the result of inadequate communication among specialists or between specialists and primary care providers. Medicare Part D prescription drug benefits influence the financing of medication but are not directly related to polypharmacy. Generic medications are a way to keep medication costs down. The use of herbal supplements is an important factor when examining drug interactions or adverse reactions but is not a direct factor related to polypharmacy.

A nurse identifies a need to assess a patient's cognitive status. The nurse chooses to use the MMSE. The nurse knows that the patient must have which of the following abilities? (Select all that apply.) a.) Number fluency b.) Familiarity with analog clocks c.) Ability to hear and see d.) Ability to sit up for 10 minutes e.) Ability to speak English

a.) Number fluency b.) Familiarity with analog clocks c.) Ability to hear and see The MMSE requires number fluency, ability to see and hear and hold a pencil, and experience with analog clocks. The instrument is available in languages other than English. It is a cognitive status exam and does not require that the patient be able to sit up.

The FANCAPES assessment tool focuses on the older adult's: a.) ability to meet personal needs to identify the amount of assistance needed. b.) ability to perform instrumental activities of daily living (IADLs). c.) cognitive abilities. d.) level of dementia present.

a.) ability to meet personal needs to identify the amount of assistance needed. The FANCAPES assessment tool focuses on physical functioning and evaluates the individual's ability to meet his/her needs and how much assistance is needed to meet the needs. FANCAPES evaluates physical functioning. IADLs involve more than just physical functioning. FANCAPES does not assess cognitive function, nor does it assess dementia.

When discussing pharmacological considerations, a 68-year-old client asks, "Why do medications seem to act differently than they did when I was younger?" The nurse bases the response on the concept that: a.) age-related changes affect the way drugs are metabolized by older adults. b.) Over-the-counter (OTC) drugs have standardized dosages that are appropriate for all ages. c.) older adults may need larger doses of medication to bring about the desired effects. d.) adverse drug reactions occur with similar frequency in older adults as the general population.

a.) age-related changes affect the way drugs are metabolized by older adults. Age-related pharmacokinetic and pharmacodynamic changes explain why older adults react differently to medications. OTC drugs can result in altered drug outcomes since that relates to the individual's response to the medication. Age-related changes may require smaller doses of medication in older patients than in younger patients. The rule is to "start low and go slow." The older a person is, the more likely he or she is to have an adverse drug reaction.

A nurse utilizes the SPICES tool (Sleep disorders, Problems with eating, Incontinence, Confusion, Evidence of falls, and Skin breakdown) to assess an older female patient in the hospital. The nurse notes that the patient has new onset urinary incontinence. The first action by the nurse is to: a.) conduct a more in-depth focused assessment of the urinary incontinence. b.) call the provider and obtain an order for an antibiotic for a suspected urinary tract infection. c.) send a urine specimen for culture and sensitivity. d.) develop a plan of care with the patient to control episodes of incontinence.

a.) conduct a more in-depth focused assessment of the urinary incontinence. SPICES is an assessment tool. Anything that indicates a problem in any of the categories warns the nurse that a more in-depth assessment is needed. The nurse needs to further assess the urinary incontinence prior to implementing any interventions.

The area in which nurses have the greatest effect on the safe, effective medication therapy of an older client is: a.) educating the client to all aspects of the medication. b.) assessing for adverse reactions to the medication. c.) monitoring overall health of the client as it is affected by the medication. d.) evaluating the outcomes resulting from the medication.

a.) educating the client to all aspects of the medication. Nurses have the greatest opportunity to impact medication use and improve treatment outcomes through patient education. Assessing for reactions, monitoring effects, and evaluation of outcomes all depend on the client's understanding and compliance with the medication therapy (i.e., are affected by client education).

Factors that affect the pharmacokinetics of lipophilic medications in older adults include: a.) greater adipose tissue ratio to body mass. b.) decreased total body water. c.) increased glomerular filtration rate. d.) increased creatinine clearance.

a.) greater adipose tissue ratio to body mass. Older adults have a higher ratio of adipose (fat) tissue where lipophilic (fat-soluble) medications can be stored thus resulting in a potential for an accumulation of the medication and potentially fatal overdoses. Older adults have a decrease in lean body mass and an increase in fat. An increased body mass would not affect lipophilic medication absorption. Older adults have a decreased glomerular filtration rate, which begins to decline as early as age 25. Older adults have a decrease in overall kidney function.

A nurse completes a functional status assessment of an older person using the Lawton IADL instrument, a self-reported instrument. The nurse knows that limitations of self-reported measures include that: (Select all that apply.) a.) individuals tend to overestimate their functional ability. b.) self-reports often differ from that of proxy reports. c.) self-reports are not indicative of small changes in function. d.) self-reports do not provide a valid measurement of function. e.) older adults are not able to complete self-reported measurements.

a.) individuals tend to overestimate their functional ability. b.) self-reports often differ from that of proxy reports. Individuals tend to overestimate their functional ability and often self-reported measures differ from proxy reports. Self-reported measures are a valid measurement of function, and older adults are able to complete them. The choice of tool and the type of scoring of the tool is the factor that determines if the small changes in function can be detected.

Factors that complicate assessment of older adults include: (Select all that apply.) a.) presence of multiple comorbid conditions. b.) atypical presentation of illness. c.) difficulty in differentiating symptoms of disease from normal age-related changes. d.) increase in iatrogenic illness. e.) lack of assessment instruments specific for the older adult population.

a.) presence of multiple comorbid conditions. b.) atypical presentation of illness. c.) difficulty in differentiating symptoms of disease from normal age-related changes. d.) increase in iatrogenic illness. Factors that complicate assessment of older adults include difficulty differentiating disease symptoms from normal age-related changes, the presence of multiple comorbidities, atypical presentations of illness, and the presence of iatrogenic illness. There are many assessment tools that are designed specifically for use in the older adult population.

An older adult patient in the community has new onset confusion & incontinence over the past 2 days. The patient saw her PCP who ordered labs. The CBC results were WNL. What may be going on & why?

an infection i.e. UTI, & older adults have delayed responses in immune function.

An antihypertensive medication has been prescribed for an older patient with hypertension. The patient tells a clinic nurse that he would like to take an herbal substance to help lower his blood pressure instead of the prescription medication. Which of the following should the nurse do? (Select all that apply.) a.) Tell the patient that herbal substances are less effective than prescription medications b.) Encourage the patient to discuss the use of an herbal substance with his primary care provider c.) Explore with the patient which herbal substance he is planning on taking d.) Educate the patient on possible interactions of the herbal substance with his other medications e.) Instruct the patient not to take the herbal substance, as it is dangerous

b, c, d b.) Encourage the patient to discuss the use of an herbal substance with his primary care provider c.) Explore with the patient which herbal substance he is planning on taking d.) Educate the patient on possible interactions of the herbal substance with his other medications The popularity of medicinal herbs and supplements continues to rise. A major concern with the use of herbs and supplements is the potential interactions with prescribed medications. It is important that the patient share his or her use of herbs and substances with all providers and that the provider review the herbs and the prescribed medications to ensure compatibility.

The nurse's first response when told by a client during an assessment interview that he "can't take furosemide (Lasix)" is to ask: a.) "Is your health care provider aware that you are allergic to Lasix?" b.) "Can you describe what happened when you took Lasix?" c.) "When was the last time you took Lasix?" d.) "Have you any questions regarding your reaction to Lasix?"

b.) "Can you describe what happened when you took Lasix?" It is important to document the type of allergic reaction, when the patient had it, how long it lasted, and how it was treated. Determining whether the health care provider is aware of the allergic reaction or when the medication was last taken does not have precedence over assessing the client's reaction to the medication since neither has a direct bearing on the management of a similar reaction. Evaluating the client's understanding of the reaction is appropriate but not as an initial response.

An 81-year-old patient is being discharged from the hospital to home. She is on seven different medications, which are to be taken at four different times during the day. What would be most useful in helping this patient manage her medications? a.) The package inserts from all of the medications for the client to read b.) A pillbox with compartments for each day and each of the doses c.) A written list of all the client's medications and administration routine d.) A suggestion that the client's daughter administer the medications

b.) A pillbox with compartments for each day and each of the doses Providing a pillbox is an effective method to reinforce exactly which medications are to be given at what times. It also serves as an effective method to remind patients when they have missed a dose. Package inserts are often written in language that is not easy for patients to understand. Another consideration is that the size of the print in package inserts may be too small for aging eyes. Although providing a written list of the medications is appropriate, it does not make as much of an impact on the overall management of this patient's medications as other options. There is no indication that this patient cannot self-administer the medications.

A resident of a long-term care facility is assessed by a nurse upon admission to the facility. The assessment includes a comprehensive health, social, and functional profile. The tool that the nurse utilizes is: a.) Outcomes and Assessment Information Set (OASIS). b.) Resident Assessment Instrument (RAI). c.) Older Americans Resources and Services (OARS). d.) Comprehensive Geriatric Assessment (CGS). e.) Mini Mental Status Examination (MMSE).

b.) Resident Assessment Instrument (RAI). The OASIS is used in the homecare setting. The RAI is used in the long-term care setting. OARS is a functional status instrument. Comprehensive geriatric assessment is not a specific tool but rather an approach to assessment. The MMSE is a mental status assessment tool.

When comparing the Older American's Resources and Services (OARS) with the Katz Index of ADLs, what is true? a.) The Katz Index and the OARS both measure only ADL performance b.) The OARS is a comprehensive assessment tool that measures ability in five areas; the Katz Index measures only ADL performance c.) The OARS is used only for older adults in the long-term care setting; the Katz Index is used in all settings d.) The OARS is not valid for use in older adults who are cognitively impaired, whereas the Katz Index is

b.) The OARS is a comprehensive assessment tool that measures ability in five areas; the Katz Index measures only ADL performance The OARS evaluates ability, disability, and capacity at which the person is able to function. Five dimensions are assessed: social resources, economic resources, physical health, mental health, and ADLs. The Katz Index only evaluates ADL ability. Both instruments are used in a variety of care settings and are valid for use with cognitively impaired older adults.

A limitation of the Katz Index of activities of daily living (ADLs) is that: a.) completion of the tool requires the joint efforts of the interdisciplinary team. b.) all ADLs are weighted equally. c.) it puts a heavier weight on the cognitive abilities necessary to perform ADLs. d.) it provides a range of performance for each task.

b.) all ADLs are weighted equally. The Katz Index assigns an equal weight to all of the ADLs, and because of that, it cannot be used to identify the particular area of need or change in any one task. Any health care professional can complete the Katz Index, although input from the interdisciplinary team is valuable. The Katz Index does not address the cognitive abilities necessary to perform ADLs. The ADLs are considered in dichotomous terms only, the ability to compete the task independently or the complete inability to do so.

The Beers Criteria is an effective tool for health care professionals prescribing and/or managing the medication therapy of older adults since it identifies medications that for this population: a.) are not typically covered by drug benefit plans. b.) have a higher than usual risk for injury. c.) are likely to be abused. d.) generally cause allergic reactions.

b.) have a higher than usual risk for injury. Drugs on the Beers' list are those that have been identified to have a higher than usual risk when used in older adults. The Beers Criteria have no relation to medication financing. There is no evidence that the drugs are likely to be abused by older adults. There is no greater likelihood of these drugs causing allergic reactions.

A 78-year-old man is being evaluated in the geriatric clinic. His daughter reports that he has been very forgetful lately, and she is concerned that he might be "senile." The advanced practice nurse administers the clock-drawing test and the patient draws a distorted circular shape and places the numbers all on one side of the shape. Based on his performance, the nurse concludes that the patient: a.) probably has Alzheimer's disease. b.) needs further evaluation. c.) probably has delirium. d.) needs a functional status assessment.

b.) needs further evaluation. Cognitively intact persons rarely produce errors on the clock-drawing test, such as grossly distorted contour. A low score on the clock-drawing test requires further evaluation. Alzheimer's disease is not a diagnosis using a mental status assessment tool. It is definitively diagnosed with a brain biopsy. The clock-drawing test does not assess for delirium. A low score on the clock-drawing test does not necessarily warrant a functional status assessment.

The nurse suspects that a client is experiencing tardive dyskinesia when observing that: a.) the client can't seem to stop moving. b.) the client's facial muscles are twisting involuntarily. c.) the client not able to get up out of a chair. d.) the client's hand tremors so much that drinking from a cup is difficult.

b.) the client's facial muscles are twisting involuntarily. Facial movements and involuntary twisting of the limbs, trunk, neck, and face is the definition of tardive dyskinesia. A compulsion to be in motion is the definition of akathisia. An inability to move is the definition of akinesia. A bilateral tremor and rigidity reflects Parkinsonian symptoms.

The patient verbalizes wanting to go back to her home. The nurse states "You should feel grateful for being in this facility, many other people do!" What communication skill should the nurse have thought of before she answered the patient?

being non-judgmental

An older patient is prescribed warfarin for stroke prevention. A nurse is providing patient education. Which of the following foods should the patient be taught to avoid? (Select all that apply.) a.) Milk b.) Whole grains c.) Kale d.) Spinach e.) Red meats

c.) Kale d.) Spinach It is important to avoid "leafy green vegetables" when taking Coumadin.

When performing the initial assessment on a new client in a geriatric outpatients practice, the most effective method the nurse can implement to elicit an accurate medication assessment is to ask that the client: a.) make a list of all her current medications. b.) work with a family member to make a list of her medications. c.) bring in all of the medications that she is currently taking. d.) allow her previous primary care provider to provide a list of medications.

c.) bring in all of the medications that she is currently taking. The gold standard is to use the "brown bag" approach. The patient is asked to bring all medications including prescription drugs, OTC drugs, and herbal and dietary supplements. The patient may not remember all of the medications that are being taken. As each medication is removed from the bag, necessary information is obtained. A complete medication assessment includes OTC drugs, as well as herbal and dietary supplements, not just prescription medications. Your primary source of information should be the patient if she is able to provide the information; the previous provider may not be able to provide information on supplements or OTC and herbal medications. The nurse needs to include more than just prescription medications. In addition, prescribed medications do not always reflect what is being taken.

When developing a teaching plan for an older, newly diagnosed diabetic client, the nurse best ensures an understanding of oral hypoglycemic medications when providing: a.) the package insert and assessing the client's reading skills. b.) the client with the website address for the American Diabetes Association. c.) oral explanations and sending the client home with a written copy. d.) the information in paragraph form as opposed to numbered line fashion.

c.) oral explanations and sending the client home with a written copy. Providing memory aids, such as written information including charts, is effective in reinforcing teaching. Package inserts are not always written in lay language that is understandable and appropriate to the reading level of the older adult. The font size of the print may be too small for aging eyes. Not all older adults are computer literate or comfortable with the use of the computer. This method may be more effective for younger clients. A more effective manner in which to provide written information to older adults is in the form of lists using a large-size font.

Name medications which cause predictable adverse drug reactions

coumadin-bleeding; steroids-immunosuppresssion; chemotherapeutic agents-immunosuppression

Your patient's CBC is as follows: WBC 6.2, Hgb 11.5, Hct 41.3, & platelets 300,000. The patient is not feeling well. What may be going on?

dehydration

The nurse is displaying what type of ageism when she says to the older adult patient, "Sweety we need to take our medicine now."

elderspeak

The nurse is having a conversation with an older adult who is reminiscing about a beloved pet. The older adult has repeated a story about the pet 4 times. The appropriate response by the nurse is?

have patience

Why does the older adult health assessment take more time than that of a younger adult? Name reasons

more medical problems, more functional issues, more social issues

The definition of ageism?

stereotyping & discriminating against people due to their age

Your 74 y/o postoperative patient becomes confused, gets OOB, & stumbles into another pt's room during your night shift. The hospitalist is on the unit & orders a dose of haldol for the patient. What else might you suggest to the MD?

suggest to the hospitalist that the patient may be dehydrated, have an electrolyte imbalance, an adverse drug reaction, or an infection. Bloodwork may be appropriate.

An older adult patient has not been paying his usual bills, and has been neglecting shaving although he has prided himself on his impeccably smooth face. What instrument might the nurse use to quickly assess cognitive status?

the Mini-Cog

Name the comprehensive geriatric assessment which measures functional capacity & takes 45 minutes to administer. AND name the areas the tool assesses

the OMFAQ-Older Americans Resources & Services Multidimensional Functional Assessment Questionnaire. AND social resources, economic resources, mental health, physical health, ADL's & IADL's

You are reviewing CBC, ESR, & a complete metabolic panel for an older adult. What should you keep in mind about the results of older adults compared to younger adults?

the lab value normals are the same for older & younger adults

A nurse is crushing the following tablets for 9AM meds to put through the patient's PEG tube: metoprolol XL 100mg, norvasc 5mg, oxycodone 5mg, ecotrin 325mg, & folic acid 1mg. What should you tell the nurse?

the metoprolol XL is a long acting drug & should not be crushed, & ecotrin is enteric coated & should not be crushed. The PCP needs to be notified for a different order for both meds

These 2 vitamins are part of a dementia work up or unexplained changes in neurological status

vitamin B12 & folate levels