TEST 5: Chapter 14 Mastering (Fundamentals of Nursing)

Which body system is involved in presbycusis?

*A. Ears B. Eyes C. Taste D. Touch RATIONALE: Presbycusis is characterized by the presence of a loss of acuity for high-frequency tones and conversational speeches due to aging. It is a physiological sensory change that may occur in the ears with aging. Sensory changes in the eyes include yellowing of the lens and altered color perception. A sensory change in taste is often characterized by fewer taste buds. A sensory change in the touch might be caused by decreased skin receptors.

The nurse visits a patient at home. Which activities should the nurse assess to determine the patient's ability to perform activities of daily living (ADL),? Select all that apply.

*A. Bathing *B. Toileting *C. Dressing D. Shopping E. Cooking RATIONALE: Bathing, toileting, and dressing are activities of daily living (ADL). These are basic activities and indicate the functional status of a person. Shopping and cooking are instrumental activities of daily living (IADL). ADL and IADL are sensitive indicators of health and illness. TEST-TAKING TIP: Be sure you can distinguish between activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

An elderly patient reports that he is unable to see bright lights, far objects appear blurred, and he is unable to read the newspaper as before. After examining the eyes, the nurse finds the patient's lens to be opaque. What does the nurse suspect in the patient?

*A. Cataract B. Presbyopia C. Diabetic retinopathy D. Macular degeneration RATIONALE: Sensitivity towards bright lights is called glare. Opacity of the lens indicates loss of transparency of the lens. Loss of transparency of the lens, blurred vision, increased sensitivity to glare, and gradual loss of vision are the clinical manifestations of cataract. Presbyopia is a condition, wherein the eye is unable to focus on near objects; though presbyopia is manifested by discoloration of the lens, it is not associated with blurred vision. Diabetic retinopathy has no early signs and symptoms. Macular degeneration is manifested by accumulation of extracellular material on the retina.

Gastrointestinal function changes due to aging. Which effects are related to alterations in the lower gastrointestinal tract? Select all that apply.

*A. Diarrhea B. Vomiting *C. Flatulence D. Gastric ulcer *E. Constipation RATIONALE: Alterations in the lower gastrointestinal tract lead to diarrhea, flatulence, and constipation. Due to aging, peristalsis movement becomes slow, and alterations in secretions occur. Alterations in the lower gastrointestinal tract do not cause vomiting or gastric ulcers.

An older patient presents to the nurse with impaired vision, nocturia, and agitation. Which risk is most likely to occur in this patient?

*A. Falls B. Stroke C. Heart disease D.Chronic lung disease RATIONALE: Impaired vision, nocturia, and agitation may increase the risk of falls in the patient. Diabetes mellitus, hypertension, and hyperlipidemia are the risk factors for stroke. Obesity, stress, and stroke are risk factors for heart disease. Smoking tobacco is a risk factor for chronic lung disease. TEST-TAKING TIP: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses.

An older adult wishes to start an exercise regimen. Which safety advice should the nurse provide this patient? Select all that apply.

*A. Go slow. *B. Wear supportive shoes. C. Do not drink water before exercise. *D. Exercise with a partner. *E. Avoid exercising outdoors in extreme weather. RATIONALE: Exercise is important for the overall health of older adults. Exercises should be started and progressed slowly to avoid exhaustion and injury. Wearing good support shoes prevents injury to the joints and muscles. Exercising with a partner increases the motivation to exercise. Exercising outdoors in extreme weather can predispose the older adult to temperature-related injuries such as heat stroke or hypothermia. Drinking water before and after exercise prevents dehydration.

An older patient is diagnosed with dorsal kyphosis. What is a contributing factor for developing this disorder?

*A. Osteoporosis B. Impacted cerumen C. Subdural hematomas D. Calcification of coastal cartilage RATIONALE: Osteoporosis is a condition that results in loss of bone mass by crushing bones and leaving the bones brittle and prone to fractures. This causes curvature of thoracic spine, which is known as dorsal kyphosis. Impacted cerumen causes diminished hearing acuity in older adults. Subdural hematomas cause delirium in older adults. Calcification of coastal cartilage causes decreased mobility of the ribs in older adults. TEST-TAKING TIP: Dorsal kyphosis is curvature of thoracic spine in older adults. Use this information to answer the question.

While assessing an elderly patient, the nurse notices that the patient refuses to eat, drink, or receive medication and is unwilling to follow safety precautions. Which elder mistreatment does the nurse infer from this behavior?

*A. Self-neglect B. Physical abuse C. Abandonment D. Financial exploitation RATIONALE: Self-neglect involves an older patient who threatens his or her own well-being or safety, or disregards personal health by refusing food, water, and medication causing needs to go unmet. Physical abuse involves inflicting physical pain or injury on a vulnerable elderly patient. Abandonment is desertion of a vulnerable elderly person by a caregiver. Financial exploitation is illegal taking, misuse, or concealment of funds and may involve forging a signature or stealing money, property, or assets of a vulnerable elder.

Which statement is true regarding dementia?

A. Onset is sudden. B. The condition worsens during the daytime. C. The effects of dementia are self-limited. *D. Attention is not affected. RATIOANLE: Patients with dementia experience no effect on their attention. Delirium, not dementia, is a state of reduced mental ability, severe enough to interfere with daily activities. Dementia starts slowly and is often unrecognized. Dementia does not worsen either in the daytime or at night. It lasts for months to years.

A registered nurse is evaluating the statements of the student nurse regarding reproductive changes that occur in both sexes due to aging. Which statement made by the student nurse indicates a need for further teaching?

A. "The desire to have sex decreases with aging." B. "Vaginal irritation causes pain during sexual activity." C. "Lack of lubrication of vaginal mucosa causes irritation." *D. "Production of sperm in men decreases during the third decade of life." RATIONALE: Production of sperm declines during the fourth decade of a man's life; that is, it declines at 40 years of age, not at 30 years of age. With increasing age, sexual desire also decreases. A characteristic feature of reproductive change in women is decreased production of estrogen and progesterone. Decreased estrogen and progesterone may cause decreased lubrication of the vaginal mucosa, leading to irritation. Vaginal irritation, which occurs due to lack of lubrication, may result in pain during sexual activity. TEST-TAKING TIP: The production of sex hormones decreases with increasing age. Relate the effects of sex hormones on reproductive system in geriatrics. This may help you in answering the question.

What may be the reason for decreased mobility of the ribs?

A. Curvature of the thoracic spine *B. Calcification of the costal cartilage C. Decrease in the respiratory muscle strength D. Increase in the anteroposterior diameter of thorax RATIONALE: Decreased mobility of the ribs is due to calcification of the costal cartilage. This occurs with aging. The curvature of the thoracic spine is known as dorsal kyphosis and is due to vertebral change. Decrease in the respiratory muscle strength and increase in the anteroposterior diameter of the thorax are age-related problems due to configurational changes in the thorax.

Which physiological change occurs with aging?

A. Decreased stomach pH *B. Decreased bladder capacity C. Decreased airway resistance D. Increased peripheral circulation RATIONALE: Aging is the process of becoming older. Aging decreases bladder capacity, because the bladder elasticity decreases. The stomach pH increases with aging, because the body produces less hydrochloric acid with advancing age. Aging decreases upper airway size and results in increased airway resistance. Peripheral circulation decreases with aging because of a narrowing of the arteries. TEST-TAKING TIP: Identify option components as correct or incorrect. This may help you identify a wrong answer.

Which condition does the nurse suspect in an older adult patient who has complained of daily hearing decline?

A. Delirium B. Dementia C. Presbyopia D. Presbycusis RATIONALE: Presbycusis refers to progressive loss of hearing that occurs with age. Delirium is a cognitive impairment resulting in a confused state in the patient. Dementia is an impairment of intellectual functioning that interferes with social and occupational functioning. Presbyopia is a progressive decline of the vision. TEST-TAKING TIP: Identify option components as correct or incorrect. This may help you identify a wrong answer.

The nurse has conducted an assessment of a new patient who has come to the medical clinic. The 82-year-old patient has had osteoarthritis for 10 years and diabetes mellitus for 20 years. The patient is alert but becomes easily distracted during the nursing history. The patient recently moved to a new apartment, and the patient's pet beagle died just 2 months ago. Which is this patient most likely experiencing?

A. Dementia *B. Depression C. Delirium D. Disengagement RATIONALE: Factors that often lead to depression include presence of a chronic disease or a recent change or life event (such as loss). Patients are alert but easily distracted in conversation. The symptoms presented by this patient do not indicate dementia, delirium, or disengagement.

When an older adult suffers a major life event such as the death of a loved one, a move to a nursing home, or a cancer diagnosis, for what should the nurse be alert?

A. Dementia B. Delirium *C. Depression D. Stroke RATIONALE: The onset of depression could be abrupt or gradual, but the usual cause is a major life-altering event in the life of the person experiencing the depression. Delirium is rapid onset and usually has a physiological cause; dementia's onset is slow; and a stroke presents with neurological changes.

The nurse is caring for an 80-year-old man who recently lost his wife. He states that he has been drinking more than he ever did in the past and feels hopeless without his wife. He reports that he rarely sees his children and feels isolated and alone. Which is the greatest risk for this patient?

A. Dementia B. Liver failure C. Dehydration *D. Suicide RATIONALE: The patient is sharing that he is depressed. Key concepts include recent loss of his wife, excessive drinking, hopelessness, and isolation, making him at risk for suicide. Dementia presents with memory problems; liver failure would occur after significant liver damage; dehydration would occur from poor fluid intake.

Which is a barrier for health care providers to health promotion and disease control for older adults?

A. Health literacy B. Personal motivation *C. Lack of consistent guidelines D. Previous health care experiences RATIONALE: Lack of consistent guidelines is a barrier that health care providers must overcome for health promotion and disease control in older adults. Health literacy, personal motivation, and previous health care experiences are the barriers that older adults themselves must overcome.

In which health care setting would the nurse be most likely to find an older adult with chronic dehydration exacerbated by acute illness?

A. Home care B. Nursing home care *C. Hospital care D. Ambulatory care RATIONALE: In a hospital care setting, an older adult may experience chronic dehydration exacerbated by acute illness; this could occur due to medications and diagnostic procedures that limit the intake of fluids. In a home care setting, older adults with late-stage heart disease should be monitored for loss of appetite. In a nursing home setting, patients should be observed for a decline in functional ability, which may indicate the onset of illness. An older patient who seeks ambulatory care with a complaint of fatigue and limited ability to perform normal activities may have thyroid problems, anemia, or cardiac problems.

Which endocrine change is associated with aging?

A. Increased insulin sensitivity B. Increased thyroid secretions *C. Decreased ability to respond to stress D. Decreased anti-inflammatory hormone secretions RATIONALE: Aging decreases the ability to respond to stress, because the functional ability of the body declines with age and hormone production is altered. Aging decreases insulin sensitivity because of reduced body weight. The thyroid gland becomes nodular with age, which results in decreased thyroid secretions. Anti-inflammatory hormones are increased in older adults because of degenerative changes and oxidative stress.

While assessing the health of four patients, the nurse discovers one of the patient's findings to be age-related. Which patient supports the nurse's conclusion?

A. Patient A has white sclera. *B. Patient B has yellowing of the lens. C. Patient C has a decreased sensitivity to glare. D. Patient D has dilation of pupil in the presence of light. RATIONALE: With aging, the crystalline fibers present in the lens stop regenerating and undergo many post-translational changes. These changes make the lens appear opaque and yellowish. Therefore, patient B's finding supports the nurse's conclusion. White sclera is a normal finding, not an age-related change. In older adults, there will be increased sensitivity to glare as an effect of aging. Therefore, the finding of patient C is not a physiological change related to aging. Pupils dilate upon exposure to light. Therefore, patient D's finding is normal.

Which type of elder mistreatment involves desertion of a vulnerable elder at a hospital?

A. Physical abuse *B. Abandonment C. Caregiver neglect D. Psychosocial abuse RATIONALE: Abandonment may involve desertion by a caregiver of older adults who are unable to protect themselves at a hospital or other public location. Physical abuse refers to the infliction of physical pain such as hitting, beating or slapping. Caregiver neglect refers to failure of providing caregiving activities such as refusal to provide food, water, or clothing. Psychosocial abuse refers to an act that inflicts mental pain or distress such as humiliation and social isolation.

While reviewing the x-ray reports of an older patient, the nurse observes curvature of the thoracic spine. What does the nurse document in the patient's health record?

A. Presbyopia B. Presbycusis *C. Dorsal kyphosis D. Macular degeneration RATIONALE: Dorsal kyophosis is curvature of the thoracic spine in which the top of the back appears more rounded than normal. Presbyopia is a progressive decline in the ability of the eyes in older patients. Presbycusis is age-related hearing loss in older patients. Macular degeneration is a disorder of the eyes that results in loss of vision in older patients.

Which statement is true regarding delirium?

A. The onset of delirium is insidious. *B. Disturbed sleep/wake cycle is disturbed. C. The patient with delirium may have normal alertness. D. Progression of the delirium is slow over months and years RATIONALE: The sleep/wake cycle is disturbed in delirium. The onset of delirium is sudden or abrupt but not insidious. Alertness in delirium fluctuates and is lethargic or hypervigilant, but not normal. Progression of delirium is abrupt, not gradual over months and years.

Aging may cause impairment of urinary function. Which is an effect of weakening of the perineal and bladder muscles on the urinary system?

A. Urinary tract infection B. Burning sensation with urination C. Pain on one side of the back *D. Involuntary release of urine RATIONALE: Weakening of the perineal and bladder muscles leads to involuntary release of urine. Urinary tract infection, burning with urination, and pain on one side of the back do not occur because of the weakening of the perineal and bladder muscles.