PrepU Aging
A nurse is working with the family of a patient with Alzheimer's disease to develop an appropriate plan of care. Which of the following would the nurse suggest to foster socialization? a. Promoting frequent lengthy visits from friends. b. Encouraging participation in multiple-stepped activities. c. Limiting visitors to one or two at a time. d. Promoting hobbies involving fine motor skills.
c; When promoting socialization, visits, letters, and phone calls are encouraged. Visits should be brief and nonstressful, limiting visitors to one or two at a time to reduce overstimulation. The patient also is encouraged to participate in simple activities. Activities with multiple steps and hobbies requiring fine motor activity increase the risk of frustration, leading to the patient becoming overwhelmed.
A nurse is preparing a presentation for a local senior center about the health status of older adults. What trends in health promotion and disease prevention activities would the nurse explain as contributing to declining death rates in the older adult population? (Select all that apply). a. decreased smoking b. improved nutrition c. screening for hypertension d. early detection of elevated cholesterol levels e. decreased exercise f. decreased community-based services
a, b, c, d; Most deaths in the United States occur in people 65 years or older, with one-half of these cäused by heart disease and cancer. Decreased smoking, improved nutrition, screening for hypertension, and early detection of elevated cholesterol levels are contributing factors to a decreased death rate in older adults. Older adults are encouraged to increase exercise and increase community-based services.
An older adult asks, "What can I do to prevent getting a chest cold during the winter?" Which suggestion(s) will the nurse make to this client? (Select all that apply) a. "Stop smoking." b. "Get the annual flu shot." c. "Engage in regular exercise." d. "Suppress the urge to cough." e. "Make sure you drink enough fluid every day."
a, b, c, e; The respiratory system compensates well for the functional changes of aging. In general there is very little decline in respiratory functioning in a healthy nonsmoking older adult. Suggestions that the nurse should recommend to the client to maximize respiratory functioning and prevent the development of a respiratory illness include not smoking and getting the annual influenza vaccination. The client should also be encouraged to engage in regular exercise and ensure adequate fluid intake every day. Older adults should be encouraged to cough more frequently to maintain lung capacity and cough efficiency.
The nurse is teaching about preventing pneumonia and influenza to a group of clients in a senior citizens wellness class. The nurse includes which of the following topics in the class? (Select all options that apply). a. Avoiding environmental smoke b. Participating in regular exercise c. Ensuring appropriate fluid intake d. Avoiding all sun exposure e. Following a high-calcium diet
a, b, c; Activities that help elderly clients maintain good respiratory function include avoiding environmental smoke, regularly exercising, and ensuring appropriate fluid intake. Sun exposure and a high-calcium diet are health-promotion strategies for the integumentary and musculoskeletal systems respectively.
An older adult is observed sitting in a health care provider's waiting room wearing a heavy sweater on a warm summer day. Which physiological reason(s) will the nurse consider for this client's choice of clothing? (Select all that apply). a. Reduced vasodilation b. Less subcutaneous fat c. Slower metabolic rate d. Decreased physical activity e. Higher susceptibility to infection
a, b, c; The functions of the skin include protection, temperature regulation, sensation, and excretion. Aging can interrupt all functions of the skin and affect appearance. Subcutaneous fat diminishes, particularly in the extremities, and less vasodilation renders the body less able to produce or conserve body heat. This would explain why the older adult is wearing a sweater in the summer. A slower metabolic rate and decreased physical activity are physiologic changes in older adults that contribute to altered nutritional requirements, but are not reasons the client would be wearing a sweater in the summer. A higher susceptibility to infection is an age-related change; however, it does not explain why the client is wearing a heavy sweater on a warm day.
A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? (Select all that apply). a. Place grab bars in the shower and tub b. Have routine vision and hearing screenings c. Frequently change the furniture layout in the home d. Wear nonslip shoes or socks when walking e. Review medications routinely for side effects f. Use scatter rugs on hard wood surfaces.
a, b, d, e; Grab bars in the shower and tub may decrease the chance of a fall on a slippery surface. Visual and hearing issues may contribute to falls. Medication interaction and side effects may increase the risk for falls, so medications should be reviewed. The older adult should wear proper nonskid footwear or socks when walking to help prevent falls. Changing the layout of the furniture in the home may increase the risk for falls because of items being in unfamiliar locations. Scatter rugs should not be used because they increase the risk for falls.
The nurse recognizes which as the leading causes of death among older adults? (Select all that apply). a. Cancer b. Heart disease c. Osteoporosis d. Pneumonia e. Sepsis
a, b; Heart disease and cancer are the leading causes of death among the elderly, although in the past 60 years, there has been a significant decline in overall deaths from these two causes specifically. Osteoporosis, sepsis, and pneumonia are not leading causes of death among the elderly.
The nurse is caring for an older adult recovering from an acute illness. Which statements will the nurse make to reduce the emotional impact of the illness? (Select all that apply). a. "Tell me when you would like to get bathed in the morning." b. "Getting as much rest as possible will help improve your health." c. "After lunch we can take a walk up and down the hall for a few times." d. "Just put on your call light when you've completed filling out the menu." e. "I'm sure you will be busy once you get home, so extra sleep now would be a good idea."
a, c, d; Older adults who are hospitalized have anxiety and fears that include finances and becoming a burden to family members. Nurses must recognize the implications of these fears of dependency and encourage autonomy, early ambulation, and independent decision making. The statements about when to bathe in the morning, taking a walk after lunch, and completing the menu help address these fears. The statements about getting extra rest and sleep now before going home do not help reduce the fears associated with dependency.
The nurse is visiting the home of an adult client. Which action will the nurse take to reduce the client's risk for falling at home? (Select all that apply). a. Suggest small area lamps in the rooms. b. Remind client to wear loose clothing around the house. c. Place a small scatter rug in front of the kitchen sink. d. Recommend contrast colors to mark edges of steps. e. Discuss the advantages of grab bars in the bathroom.
a, d, e; Nurses can encourage older adults to make lifestyle and environmental changes to prevent falls. Adequate lighting with minimal glare and shadow can be achieved through the use of small area lamps. Contrasting colors can be used to mark the edges of steps. Grab bars by the bathtub, shower, and toilet are useful. Loose clothing can increase the risk of falling. Scatter rugs should be removed as these can slip and cause a fall in the home.
A nurse notes that an older female client has lost 2 inches in height since her appointment last year. The client reports lumbar back pain as unchanged. Which of the following would the nurse instructs the client? (Select all answers that apply). a. Increase intake of foods that are high in calcium. b. Allow for additional phosphorus intake in her daily diet. c. Decrease the frequency of any exercise. d. Take calcium and vitamin D supplements daily. e. Obtain the prescribed bone density screening.
a, d, e; Older clients may experience decreased bone density and, thus, back pain as a result of aging. Strategies to assist them are to instruct clients to increase calcium in the diet and take calcium and vitamin D supplements. A bone density test made be done to determine the degree of bone loss. The client needs to limit phosphorus intake because a high-phosphorus blood level decreases calcium blood levels. The client needs to continue with a regular exercise program.
An older adult female has been widowed for several years. Which statements indicate to the nurse that the client may need to consider a change in living arrangements? (Select all that apply). a. "I don't like to cook for myself anymore." b. "My granddaughter helps me with my laundry." c. "I have coffee with my neighbor every morning." d. "There is no one to talk to most days of the week." e. "I attend religious services twice a week at my church.
a, d; Many older adults have more than adequate financial resources and good health even until very late in life; therefore, they have many housing options. Many older adults relocate in response to changes in their lives such as retirement or widowhood, a significant deterioration in health, or disability. Older adults may move to retirement facilities or assisted living communities that provide some support, such as meals. These types of facilities will also provide opportunities for socialization. The client would not necessarily want to change current living arrangements if grandchildren are available to assist, or if there is a strong support system with neighbors or faith community.
An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to? a. Ingest five or six small meals each day. b. Minimize the use of stool softeners. c. Use whirlpool baths for relaxation. d. Take daily hot showers.
a; A client who experiences orthostatic hypotension should eat five or six small meals to minimize hypotension that can occur after large meals. The client should avoid straining when having a bowel movement. A stool softener would be useful. Hot showers and whirlpools should be avoided.
A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds: a."What precipitates the outbursts?" b. "You need to remain calm during the outbursts." c. "Play quiet music that your grandmother may like." d. "Start rubbing her shoulders and her back."
a; A client with Alzheimer's disease may respond to exciting or confusing events with a catastrophic reaction, such as screaming, crying, or becoming abusive. The nurse needs to assess the situation and what precipitates the catastrophic reactions to best address how to prevent these events. Other nursing interventions include telling the client's granddaughter to remain calm and to distract the grandmother with quiet music, stroking, or both.
A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? a. Decreased acetylcholine level b. Increased acetylcholine level c. Increased norepinephrine level d. Decreased norepinephrine level
a; A decreased acetylcholine level has been implicated as a cause of cognitive changes in healthy elderly clients and in the severity of dementia. Choline acetyltransferase, an enzyme necessary for acetylcholine synthesis, has been found to be deficient in clients with dementia. Norepinephrine is associated with aggression, sleep-wake patterns, and the regulation of physical responses to emotional stimuli, such as the increased heart and respiratory rates caused by panic.
A client reports to the nurse that her mother had macular degeneration and is concerned that she, too, may be at risk. What should the nurse tell the client? a. Wear sunglasses with ultraviolet (UV) protection when outside. b. Reduce the amount of cigarettes smoked daily from 20 to 10. c. Vision loss is not hereditary. It is related to diet. d. This condition is now curable.
a; A risk factor for macular degeneration is sunlight exposure. Wearing sunglasses provides some protection. Cigarette smoking is another risk factor, and the client must stop smoking to reduce risk. Still another risk factor is heredity, and the client's mother had macular degeneration. Macular degeneration may be treated, but there is no cure.
An older adult has a score of 12 on the Geriatric Depression Scale (GDS). What action should the nurse complete first? a. Assess for the potential for self-harm. b. Notify the physician. c. Encourage the client to participate in exercise activities. d. Encourage the client to discuss feelings.
a; A score of 12 on the GDS indicates that the client may be mildly depressed, and even mildly depressed clients can have thoughts of suicide. The nurse must first assess the potential for self-harm; safety is the top concern. The other actions by the nurse would be appropriate only after the potential for self-harm is addressed
The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse? a. Assess the need for pneumococcal and influenza vaccinations. b. Administer intravenous morphine for report of postoperative pain. c. Instruct the client to receive at least 1 hour of sun exposure each day. d. Encourage physical activity of 30 minutes following breakfast daily.
a; Activities that help elderly people maintain respiratory function include pneumococcal and yearly influenza immunizations. The nurse is to ensure the safety of the client. It is unsafe to administer an intravenous pain medication and then immediately discharge the client. Elderly clients should limit sun exposure to 10 to 15 minutes daily, and avoid heavy activity after eating to prevent indigestion.
Which is an age-related change associated with the cardiovascular system? a. Decreased cardiac output. b. Decreased blood pressure. c. Increased compliance of heart muscle. d. Thinner heart valves.
a; Age-related changes associated with the cardiovascular system include decreased cardiac output, increased blood pressure, decreased compliance of the heart muscle, and thickening of the heart valves.
The client asks the nurse why she seems to have bone changes since she has gotten older. What is the best response by the nurse? a. "Bone changes from aging result from a loss of calcium." b. "Bone changes from aging result from a loss of magnesium." c. "Bone changes from aging result from most medication therapies." d. "Bone changes from aging result from a loss of vitamin absorption."
a; Age-related changes that affect mobility include alterations in bone remodeling and loss of bone calcium, leading to decreased bone density, loss of muscle mass, deterioration of muscle fibers and cell membranes, and degeneration in the function and efficiency of joints. Bone changes do not occur from loss of magnesium, most medications, and loss of vitamin absorption.
An older adult asks what can be done to prevent the deterioration of the bones and muscles that often occurs with aging. Which response will the nurse make? a. "Add more leafy greens to your diet." b. "Eat small, frequent, high-protein meals." c. "Limit the intake of alcoholic beverages. d. "Limit weight-bearing exercises to once a week."
a; Age-related changes to the musculoskeletal system include loss of bone density, loss of muscle strength and size, and degenerated joint cartilage. Actions to prevent these changes include eating foods that are rich in calcium, such as leafy greens. Small, frequent, high-protein meals would not help prevent the age-related changes to the musculoskeletal system. Alcohol intake is not identified as affecting the musculoskeletal system. Weight-bearing exercises should be done 3 times a week to prevent changes to the musculoskeletal system with aging.
An elderly client recovering from a hip repair becomes disoriented and tries to get out of bed frequently. The client states, "I forget I am in the hospital." The best nursing intervention is to? a. Post a sign stating "You are in the hospital" at the client's eye level. b. Raise the upper and lower side rails of the bed. c. Place the client in a Posey chest restraint with ties attached to the bed frame. d. Administer an oral dose of prescribed alprazolam (Xanax).
a; Client confusion increases the risk of falls. Environmental cues include a sign stating, "You are in the hospital." Measures that are not restraining are used first. Raising the lower side rails is considered a restraint. This increases a confused client's risk for falling. Placing a client in a Posey chest restraint is a last resort. Administering an anti-anxiety medication can increase confusion in a client who is already confused.
An older adult voids a small amount of urine in the toilet but experiences a large volume of incontinence while walking back to the bed. Which nursing intervention would be appropriate for this client? a. Implement a prompted, timed voiding schedule. b. Show disapproval to help prevent reoccurence. c. Remind the client to verbalize toileting needs. d. Provide education about medications to treat this problem.
a; Detrusor hyperactivity with impaired contractility is a type of urge incontinence that is seen predominantly in the older adult population. In this variation of urge incontinence, clients have no warning that they are about to urinate. They often void only a small volume of urine or none at all and then experience a large volume of incontinence after leaving the bathroom. Nurses should be familiar with this form of incontinence and plan for routine toileting times with these clients, including the implementation of a prompted, timed voiding schedule. Intermittent catheterization may also be necessary because of postvoid residual urine volumes. Showing disapproval or reminding the client to verbalize toileting needs would be inappropriate actions for this type of incontinence, as the client has no warning they are about to urinate. Medications do exist to treat some forms of incontinence; however, the adverse affects associated with these medications usually make them inappropriate choices for older adults
A nurse is assessing a client brought to the emergency room by his daughter. Which statement by the daughter would most likely lead the nurse to suspect that the client may have an infection? a. "All of a sudden my dad seemed to become confused." b. "My dad said he felt dizzy when he stood up from his chair." c. "My dad's temperature was 97.6 degrees F this afternoon." d. "My dad told me that he felt a little more tired today."
a; Due to age-related changes in the nervous system, a sudden onset of confusion may be the first symptom of an infection. Feeling dizzy on arising suggests orthostatic hypotension. A temperature of 97.6 degrees F may or may not suggest an infection. Typically older adults do not experience a traditional fever. Complaints of being tired could indicate numerous conditions.
An elderly client reports fatigue without shortness of breath with walking 30 minutes five times each week. The nurse assesses the resting heart rate as 72 beats per minute; 10 minutes after walking, the client's heart rate is 92 beats per minute. What should the nurse instruct the client to do next? a. Continue to walk at his current level. b. Refrain from any form of exercise. c. Increase walking at a faster pace. d. Decrease walking frequency to three times each week.
a; Elderly clients may report fatigue with increased activity as a result of a slower heart rate recovery, which may be a physiological response to aging. An appropriate nursing intervention is to educate the client to exercise regularly but also to pace activities. The nurse does not want to tell the client not to exercise, to walk faster, or to decrease frequency.
An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to? a. Instruct the family to remove the toddler from the room for the protection of the client. b. Ask the family to leave the client's room. c. Inform the family to either wash their hands or use the hand sanitizer. d. Allow the toddler to remain in the room if a family member wipes the toddler's nose.
a; Elderly clients, particularly those who may be immunocompromised, need to avoid exposure to those who may have upper respiratory tract infections. The toddler needs to be removed from the client's room, not the whole family. It is appropriate for the family to wash their hands or use the hand sanitizer. However, it does not address the runny nose of the toddler, and it is not the most important action of the nurse.
During a home visit, the nurse notes that an older adult's health status has not improved with prescribed medications. Which statement indicates to the nurse that the client may not be adhering to the prescribed medication regimen? a. "That one little white pill that I take in the morning makes me feel sleepy all day." b. "I put my morning medications next to my bed to take first thing in the morning." c. "My neighbor brought me a pill box with compartments to organize my medications." d. "My pharmacy delivers, and I can pay the bill once a month when my check arrives."
a; Nonadherence with medication regimens can lead to significant morbidity and mortality among older adults. The many contributing factors include the number of medications prescribed, the complexity of the regimen, difficulty opening containers, inadequate patient education, financial cost, and the disease or medication interfering with the patient's life. The statement that the one medication makes the client feel sleepy could be the reason for nonadherence. Placing the medications in a location where the client will remember to take them would enhance adherence. Coordinating the medications in a pill box will enhance adherence. Having a service where the medications can be delivered with an easy payment method would also enhance adherence.
The nurse is preparing a teaching tool that focuses on elder abuse. Which type of abuse will the nurse highlight as being the most common? a. neglect b. physical c. financial d. emotional
a; Older adults are at risk for elder abuse and neglect, both in the community setting and in nursing homes. Neglect is the most common type of elder abuse. Other forms of elder abuse include physical, financial, and emotional. However, neglect is associated with poor health.
The family of an older adult seeks medical attention for the client because of an increase in inappropriate responses and avoidance of social interactions. On which body area will the nurse focus when assessing the client? a. Hearing b. Digestion c. Genitourinary system d. Respiratory system
a; Presbycusis is a gradual sensorineural loss that progresses from loss of the ability to hear high-frequency tones to a generalized loss of hearing. Hearing loss may cause older adults to respond inappropriately, misunderstand conversations, and avoid social interaction. This behavior may be erroneously interpreted as confusion. The nurse should focus on assessing the client's hearing. Inappropriate responses and avoidance of social interaction are not assessment findings associated with changes in the digestive, genitourinary, or respiratory systems.
Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? a. Presbyopia b. Presbycusis c. Cataract d. Glaucoma
a; Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. Presbycusis refers to age-related hearing loss. Cataract is the development of opacity of the eye lens. Glaucoma is a disease characterized by increased intraocular pressure.
To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should: a. stay with the client and encourage him to eat. b. help the client fill out his menu. c. give the client privacy during meals. d. fill out the menu for the client.
a; Staying with the client and encouraging him to feed himself will ensure adequate food intake. A client with Alzheimer's disease can forget how to eat. Allowing privacy during meals, filling out the menu, or helping the client to complete the menu doesn't ensure adequate nutritional intake.
Family members report to the nurse that their elderly grandmother has had a sudden onset of confusion and that they are having difficulty providing care for her. What is the nurse's best response? a. Assess the grandmother for adventitious lung sounds b. Inform the family that this is a result of aging c. Administer donepezil every day d. Recommends placement of the grandmother in a nursing home
a; Sudden onset of confusion may be the first symptom of an infection, such as pneumonia or urinary tract infection. The nurse needs to fully assess the situation before acting (such as telling the family this is a result of aging). Donepezil is used for Alzheimer's disease, which does not have acute onset. A recommendation for placement in a nursing home is premature without a full assessment at this time.
A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by? a. Placing one food at a time in front of the client during meals b. Cutting the client's food into small pieces c. Serving hot foods at a warm temperature d. Converting liquid foods to a gelatin texture
a; Tasks should be simplified for the client with Alzheimer's disease. All options are steps the nurse can take to promote eating for the client with Alzheimer's disease. Offering one food at a time, however, helps to prevent the client from playing with food.
The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The client continuously yells, "It's 1999 and you are going to hurt me!" What action should the nurse do first? a. Reorient the patient. b. Take the vital signs. c. Notify the physician. d. Assess for infection.
a; The client is likely experiencing delirium after surgery. The first action that should be taken by the nurse is to reorient the patient. Hospitalized older adults are at risk for disorientation and confusion. Although the nurse will still need to take the vital signs and assess for infection, reorienting the client remains the first action. If the client can be reoriented, then the nurse may be able to complete the other actions without difficulty or potentially harming the client. The nurse may need to notify the physician if the client is unable to be oriented or if the assessment is abnormal.
The nurse identifies which of the following as an age-related change in the respiratory system? a. Increased residual lung volume b. Increased vital capacity c. Increased diffusion capacity d. Increased cough efficiency
a; The older adult experiences an increase in residual lung volume, decreased vital capacity, decreased diffusing capacity, and decreased cough efficiency.
The nurse notes that an older adult adds salt to all foods before eating a meal. Which question would the nurse ask this client? a. "Have you tried adding herbs, garlic, or lemon to foods for added flavor?" b. "Don't you know that adding salt to your food is bad for you?" c. "Are you unable to taste the flavor of salt anymore?" d. "Does the extra salt help with the dry mouth that older adults experience?"
a; The sense of taste is reduced in older adults. Blunted taste may contribute to the preference for salty foods, but herbs, garlic, onions, and lemon to foods can added as healthier substitutes for added flavor. Saying, "Don't you know that adding salt to your food is bad for you?" is not therapuetic nor helpful for this client; knowledge may not be the issue and this question will erode the therapuetic relationship. The older adult would not be unable to taste the flavor of salt anymore, but decreased sense of taste would be an expected finding and does not offer a solution. Not all older adults experience dry mouth, nor would the nurse expect added salt to help with dry mouth.
An elderly client, while being seen in an urgent care facility for a possible respiratory infection, asks the nurse if Medicare is going to cover the cost of the visit. What information can the nurse give the client? a. Medicare has a copayment for many of the services it covers. This requires the client to pay a part of the bill be covered. b. Medicare pays for 100% of the cost for acute-care services, so the cost of the visit will be free. c. Medicare will only pay the cost for acute-care services if the client has a very low income. d. Medicare will not pay for the cost of acute-care services so the client will be billed for the services provided.
a; The two major programs that finance health in the United States are Medicare and Medicaid, both of which are overseen by the Centers for Medicaid and Medicare Services (CMS). Both programs cover acute-care needs such as inpatient hospitalization, physician care, outpatient care, home health services, and skilled nursing care in a nursing. Medicare is a plan specifically for the elderly population, and Medicaid is a program that provides services based on income.
An older adult has experienced several acute illnesses over the past few months. Which assessment finding will the nurse use to identify the reason for the client's frequent illness? a. Recent weight loss b. Ongoing home renovations c. Family members visiting for a holiday d. Participation in weekly card club events
a; Undernutrition, which can lead to malnutrition, may be a problem for older adults. A recent weight loss may have serious consequences and may affect the older adult's ability to maintain health and fight illness. It is unlikely that the client's home environment, family visits, or recreational activities are causing the client to experience frequent infections.
Which characteristic distinguishes normal aging from pathological changes associated with aging? a. Universality b. Confidentiality c. Morality d. Spirituality
a; Universality is the major criterion used to distinguish normal aging from pathologic changes associated with illness. Confidentiality, morality, and spirituality do not distinguish normal aging form pathological changes associated with aging.
The nurse brings the older adult patient a dinner tray and observes the patient placing excess amounts of salt on the food. What suggestions for flavoring can the nurse provide to decrease the amount of salt the patient is placing on her food? (Select all that apply). a. Drink water before the meal. b. Use low-sodium herbs and spices. c. Use an alcohol-based mouthwash prior to eating d. Use pepper instead of salt. e. Use lemon instead of salt to flavor food.
b, d, e; To add flavor to food without adding salt, the nurse should encourage the use of lemon, spices, and herbs. Drinking water or using an alcohol-based mouthwash prior to eating would not improve the taste of the food.
A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to? a. Encourage the mother to take responsibility for cooking and cleaning the house. b. Ensure that the mother does not have access to car keys or drive an automobile. c. Allow the mother to smoke cigarettes outside on the porch without supervision. d. Turn off lights at night so that the mother differentiates night and day.
b; A person with Alzheimer's disease needs to be provided with a safe environment. Driving is prohibited. Cooking and cleaning may be too much stimulation and place the client in danger. Daily activities must be simplified, short, and achievable. Smoking is allowed only with supervision. The person needs adequate lighting, and nightlights are helpful, particularly if the person has increased confusion at night.
The nurse is assessing a 78-year-old woman and suspects that the atient may have age-related macular degeneration. Which ssessment finding would most likely support this suspicion? a. Decreased peripheral vision b. Diminished color perception c. Decreased ability to see all objects d. Loss of gross detail discrimination
b; Age-related macular degeneration affects central vision, not peripheral vision. It also affects color perception and fine detail discrimination, affecting common visual skills such as reading, driving, and seeing faces.
An older unmarried adult with no children loses consciousness as a symptom of a chronic condition. Which action will the nurse take to help guide the type of care the client desires to receive? a. Ask the health care provider. b. Review the client's advance directive. c. Provide routine care until otherwise notified. d. Analyze the care needed based on the condition.
b; An advance directive is a formal, legally endorsed document that provides instructions for care. It is to be implemented if the signer becomes incapacitated. The advance directive is not meant to be used only when certain (or all) types of medical treatment are withheld; rather, it allows for a description of health care preferences, including requesting full use of all available medical interventions. The client's advance directive should be used to guide the care. The health care provider may not have reviewed the client's advance directive. Aspects of routine care might not be a part of the client's advance directive. The care based on the condition might not be a part of the client's advance directive.
An older adult seeks medical attention for a new onset of epigastric distress and bilateral arm pain. Which action will the nurse complete? a. Encourage the client to ambulate. b. Assess cardiovascular function. c. Recommend taking an over-the-counter antacid. d. Review the contents of the client's most recent meal.
b; Careful assessment of older adults is necessary because they often present with different symptoms than those seen in younger clients. Rather than the typical substernal chest pain associated with myocardial ischemia, older adults may report burning or sharp pain or discomfort in an area of the upper body. When a client reports symptoms related to digestion and breathing and upper extremity pain, cardiac disease must be considered. Because the absence of chest pain in an older client is not a reliable indicator of the absence of heart disease, the client should not be encouraged to ambulate or recommended to take an over-the-counter antacid. Time should not be wasted reviewing the contents of the client's most recent meal.
Which action is included in a nurse's role when providing home care for a client with Alzheimer disease? a. Support patient with household errands b. Provide emotional and physical support c. Provide assistance with administering IV fluids d. Provide assistance with administering oxygen
b; Home health care nurses provide emotional support and intervene if family caregivers become overburdened. The nurse also instructs the family about physical care, the disease process, and treatment. Administering IV and oxygen or supporting patients with household errands is not a relevant role for a home nurse.
An older adult seeks medical attention for a new onset of rectal bleeding. For which reason will the nurse perform a complete physical assessment with the client? a. The symptom of rectal bleeding is vague b. More than one body system may be affected c. The bleeding may be coming from another body orifice b. Older adult clients may be poor historians of symptoms
b; In an older person, illness has far-reaching repercussions. The decline in organ function that occurs in every system of the aging body eventually depletes the body's ability to respond at full capacity. Illness places new demands on body systems that have little or no reserve to meet the crisis. Homeostasis is jeopardized. Older adults may be unable to respond effectively to an acute illness or, if a chronic health condition is present, they may be unable to sustain appropriate responses over a long period. The altered responses of older adults reinforce the need for nurses to monitor all body system functions closely, being alert to signs of impending systemic complication. There is no evidence that the client's report of rectal bleeding is vague or that it is coming from another body orifice. Age of the client does not determine the reliability of the client being able to provide an accurate, detailed history and would not be a reason for a complete phsyical assessment to be performed.
An older adult who is scheduled for the annual influenza vaccination has yet to receive the pneumococcal vaccination. Which action will the nurse take when the client is prescribed to receive both vaccinations? a. Mix the vaccines in a syringe before administering as one injection in order to minimize client discomfort. b. Give the client the influenza vaccine first and then administer the pneumococcal vaccine in another site. c. Give the influenza vaccine and schedule the client to return in a week for the pneumococcal vaccine. d. Give the pneumococcal vaccine first and schedule the client to return the next day for the influenza vaccine.
b; Influenza and pneumococcal vaccinations lower the risks of hospitalization and death in older adults. The influenza vaccine, which is prepared yearly to adjust for the specific immunologic characteristics of the influenza viruses at that time, should be given annually in autumn. The pneumococcal vaccine should be administered as recommended. Both of these injections can be received at the same time in separate injection sites. The vaccines are not mixed to be given as one injection. There is no reason for the client to return later to receive either the pneumococcal or influenza vaccinations.
Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse? a. BMI 24; "My family never gives me my favorite foods." b. Stage Il decubitus ulcer on coccyx; "No one is able to turn or lift me anymore." c. Diabetic with fasting blood sugar 92; "It is difficult to afford food with all of these medication costs." d. Obvious deformity to right arm; "I tripped on the rug and fell on my arm."
b; Neglect is the most common form of elder abuse. The inability of an older adult to obtain basic care is considered neglect. If a client is not being turned or repositioned to prevent skin breakdown, then neglect is happening. A BMI of 24 is within the normal range, and the inability of the client to have his or her favorite foods would not be abuse. The client with diabetes has blood sugar within normal ranges, and the client is only expressing concern over the cost of medications; social services may need to be notified to provide help through community resources. The story provided by the older adult with the deformed arm is consistent with the injury.
When administering medications to an older adult patient, which medication does the nurse understand may remain in the body longer due to increased body fat? a. Anticoagulants b. Barbiturates c. Digitalis glycosides d. Diuretics
b; Proportion of body fat increases with age, resulting in increased ability to store fat-soluble medications, including barbiturates; this causes drug accumulation, prolonged storage, and delayed excretion. The other medications listed are not fat-soluble.
An older adult has lost 10% of body weight because of diet changes and exercise. The nurse would provide anticipatory guidance regarding dosage changes in which of the client's daily medications based on this weight loss? a. Aspirin b. Diazepam c. Acetaminophen d. Vitamin B and C supplements
b; Some medications are affected by the percentage of body fat. Even though the client has lost 10% of total body weight, the proportion of body fat increases with age, resulting in an increased ability to store fat-soluble medications, increased accumulation of the drug in the body, and delayed excretion. Medications affected include diazepam. Aspirin and acetaminophen are not among the fat-soluble medications affected by percentage of body fat. Vitamin B and C supplements are water-soluble vitamins and would not be affected by the percentage of body fat.
A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate? a. "Dementia is a terrible disease of the elderly." b. "The most common cause of dementia in the elderly is Alzheimer's disease." c. "Drug interactions are the most common cause of dementia in the elderly." d. "Depression may manifest as dementia in elderly clients."
b; The nurse should inform the family member that Alzheimer's disease is the most common cause of dementia in elderly clients. Dementia is a clinical manifestation, not a disease process. Although drug interactions and overmedication are causes of dementia, these causes aren't as common as Alzheimer's disease. Depression is common in elderly clients, but it doesn't cause dementia.
An older adult with mild confusion lives with a family member who needs to attend work every day. Which suggestion will the nurse make to the family member to ensure the client's safety? a. Hire a home health aide. b. Enroll in an adult day care facility. c. Contact a home health care agency. d. Ask a neighbor to watch the client during the day.
b; There are community support services available to help older adults outside the home. Adult day care facilities offer daily supervision and social opportunities for older adults who cannot be left alone. These care centers may be expensive; however, they provide respite and enable family members to carry on daily activities while the older person is at the day care center. Hiring a home health aide or contacting a home health care agency may be cost prohibitive. The older adult may not qualify for home health agency services to be paid through health insurance. The older adult and family might not have a neighbor who is able to watch the client during the day.
An older adult seeks medical attention after having a minor vehicle crash. Which assessment findings will indicate to the nurse that the client is having complications from the crash that are bevond the normal aging process? (Select all that apply). a. Tactile sensation is reduced b. Slower reaction time c. Confusion d. Double vision e. Fatigue
c, d, e; Confusion is not a normal part of the aging process, and a sudden onset of confusion may be the first symptom of an infection or change in physical condition, or a complication from an auto accident. Although some visual changes such as difficulty focusing at near and far distances are normal parts of the aging process, double vision is not an expected finding in the older adult and may indicate a complication. Fatigue is not a normal part of the aging process, but is a common issue that may indicate cardiac problems, infection, or many other possible problems or complications. Tactile sensation being reduced and slower reaction times are both part of the normal aging process and would not indicate that the client is having complications from the accident.
Which is a true statement regarding pharmacologic aspects of aging? a. Elderly have a decreased percentage of body fat. b. Potential for drug-drug reactions decreases with the number of drugs prescribed. c. Absorption may be affected by changes in gastric pH. d. Aged population tends to be compliant with their medication regimen.
c; During the aging process, absorption may be affected by changes in gastric pH. The elderly have an increased percentage of body fat. The potential for drug-drug interaction increases with the number of drugs prescribed. The aged population tends to be less compliant with their medication regimen.
An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of? a. Degeneration in the efficiency of bone joints b. The client's failure to exercise c. Loss of bone density. d. Decreased muscle mass and joint cartilage
c; Elderly clients experience decreased bone density; they also may experience a loss of bone density from insufficient exercise. For this client, however, additional information indicates that she is taking prednisone, which may induce osteoporosis (loss of bone density). No information indicates that the client is not exercising or has experienced degeneration of bone joints. Degeneration in the efficiency of the bone joints and decreased muscle mass and joint cartilage would have more of an effect on increased pain than on decreased height.
Which is a factor that contributes to urinary incontinence in older female adults? a. Decreased urinary residual b. Increased bladder capacity c. Relaxed perineal muscle d. Detrusor stability
c; Female older adults typically have relaxed perineal muscle. The relaxed muscle can contribute to urinary incontinence, especially when laughing, coughing, and sneezing. Decreased urinary residual would not be a contributing factor. Most older adults have an increase in urinary residual. Most older adults have a decreased bladder capacity; this contributes to an increase in frequency in urination but not incontinence. Detrusor stability is a normal finding and helps prevent incontinence.
A nurse is preparing a health promotion class for a group of seniors at a local community center. As one part of the presentation, the nurse is planning to address sexuality and sexual function. Which statement would be least appropriate to include? a. Sexual arousal may take longer to occur. b. It might take longer to complete sexual intercourse. c. Sexual desire typically becomes progressively less. d. Response to sexual stimulation may be less intense.
c; In both older men and women, it may take longer to become sexually aroused, longer to complete intercourse, and longer before sexual arousal can occur again. Although a less intense response to sexual stimulation and a decline in sexual activity occurs with increasing age, sexual desire does not disappear.
A nurse is teaching nursing assistants in an extended-care facility measures to protect the skin of elderly clients. Which of the following measures is the nurse likely to recommend? a. Taking the clients outside for sun exposure daily b. Assisting clients to soak in the bathtub several times each week c. Encouraging clients to avoid cigarette smoking d. Instructing clients to use perfumed skin creams
c; Measures to promote healthy skin function in elderly clients include not smoking. Other measures include avoiding exposure to the sun, using emollient skin cream containing petrolatum or mineral oil, and avoiding hot soaks in the bathtub.
A department of nursing within a health care organization is adopting the Functional Consequences Theory when caring for older adults. Which action would the nurse take to faciliate using this theory when caring for a client? a. Identify reasons for changes in musculoskeletal function. b. Recognize that immune system changes cannot be altered. c. Plan interventions to address consequences of age-related changes. d. Establish improvement of cognitive function as the overall goal of care.
c; The Functional Consequences Theory encourages nurses to consider the effects of normal age-related changes and the damage caused by disease or environment and behavioral risk factors when planning care. This theory suggests that nurses can alter the outcome for clients through nursing interventions that address the consequences of these changes. The Functional Consequences Theory does not focus specifically on musculoskeletal function, immunity, or cognitive functioning.
An older adult was diagnosed with Alzheimer disease 2 years ago and the disease has progressed at an increasing pace in recent months. The client has lost 7.5 kg (16 pounds) over the past 3 months, leading to a nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements. What intervention should the nurse include in this client's plan of care? a. Offer the client rewards for finishing all the food on her tray. b. Offer the client bland, low-salt foods to limit offensiveness. c. Offer the client only one food item at a time to promote focused eating. d. Arrange for insertion of a gastrostomy tube and initiate enteral feeding.
c; To avoid any "playing" with food, one dish should be offered at a time. Foods should be familiar and appealing, not bland. Tube feeding is not likely necessary at this time and a reward system is unlikely to be beneficial.
The nurse is caring for an older adult who has no family but will be returning home after discharge. Which action by the nurse is appropriate to help ensure client needs will be met in the home environment? a. Inform the client that they will need to call their insurance and arrange for home assistance. b. Instruct the client to go to a local government agency building to arrange help. c. Call the neighborhood meal delivery team and arrange deliveries on the client's behalf. d. Recommend the client contact their local area agencies for older adults for assistance.
d; Area agencies for older adults can provide many community services for older adults. Among the services provided by these agencies are assessment of need, information and referral, case management, transportation, outreach, homemaker services, day care, nutritional education and congregate meals, legal services, respite care, senior centers, and part-time community work. Similar services such as homemaker, home health aide, and chore services can be obtained at an hourly rate through these agencies or through local community nursing services if the older adult does not meet the low-income criteria. Calling the insurance agency would not be helpful in arranging assistance in the home. A government buliding would not be able to help arrange the assistance and support that the client needs. Meal delivery services would provide a meal a day to the older adult but would not support other needs the client may have around the home.
The reason that governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement? a. Clients are unable to make any health care decision b. Clients lack capacity because of cognitive impairment. c. Clients lack different perspectives. d. Older adult clients are vulnerable.
d; Because of the vulnerability of older adults, governments have carefully regulated the treatment given in licensed health care facilities. Cognitive impairment does not automatically constitute incapacity. Older people with fluctuating cognitive status may retain sufficient ability to make some, if not all, their health care decisions. Individuals with different perspectives are required in ethics committees to resolve ethical dilemmas.
An older adult develops sudden onset of confusion and is hospitalized. The family expresses concern that their loved one is developing Alzheimer disease. What response by the nurse is most appropriate? a. "What concerns you most about Alzheimer disease?" b. "Alzheimer disease can be a great burden on the family. What community resources do you know about?" c. "Once the underlying cause of the confusion is found and treated, your loved one will be better than ever." d. "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion."
d; Delirium is associated with a sudden onset of confusion, not Alzheimer disease. The family needs to be told the correct information, which is that several underlying conditions could be causing the confusion. Once the underlying cause(s) is found and treated, the confusion should subside; however, some clients may not recover from the underlying cause, so telling the family the client will be better than ever is not appropriate. Asking the family about their concerns about Alzheimer disease and what they know about community support related to it is not appropriate because the client is exhibiting symptoms related to delirium.
Why are IV solutions usually given at a slower rate to older adults? a. Older adults may have poor skin turgor. b. veins of older adults tend to be rigid. c. Older adults often find infusions painful. d. Older adults may have cardiac or renal disorders.
d; IV solutions usually are given at a slower rate to older adults because these clients usually have cardiac or renal disorders. Veins of older adults tend to be rigid and they have poor skin turgor, making venipuncture difficult; however, this factor does not affect infusion. Older adults do not find infusion more painful than other clients.
Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to which condition after a rib fracture? a. Confusion b. Asthma attacks c. Bronchospasm d. Pneumonia
d; Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to pneumonia after a rib fracture. Confusion, asthma attacks, and bronchospasm are not conditions that occur after a rib fracture.
The nurse is describing hospice services to the family of a patient with end-stage heart failure. Which of the following would the nurse be least likely to include as a major focus of care? a. Symptom management b. Pain control c. Emotional support d. Invasive therapy
d; The goal of hospice is to improve the patient's quality of life by focusing on symptom management, pain control, and emotional support.
The nurse works on a unit with elderly clients. Which of the following clients would the nurse visit first? The client who reports a. "I have a headache. I think my blood pressure is up." b. "My bladder feels full after going to the bathroom." c. "It itches down there" (points to her genital area. d. "It feels like I have food stuck in my throat."
d; The nurse has to prioritize among clients. The client who reports food being stuck in her throat may have food stuck in her throat. This client could aspirate saliva or anything else she ingests. Remember the ABCs. Airway takes priority, then breathing, then circulation. The nurse would then address the client with the possibly elevated blood pressure and finally the other two clients.
A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching? a. A decline in sexual activity is a normal occurrence as you age. b. Most older adults reside in a long-term care facility. c. As an older adult, you will not be able to learn new skills or knowledge. d. How old you feel will be determined by your physical and cognitive abilities.
d; The physical health and cognitive abilities of older adults are directly related to quality of life and how "old" one really feels. Older adults can maintain healthy sexual activity and are able to learn new skills and knowledge. Of older adults, 90% live in the community, not in long-term care facilities.
