Brunner & Suddarth's Textbook of Medical-Surgical Nursing

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? "Bone changes from aging result from a loss of magnesium." "Bone changes from aging result from most medication therapies." "Bone changes from aging result from a loss of calcium." "Bone changes from aging result from a loss of vitamin absorption."

"Bone changes from aging result from a loss of calcium."

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. "I attend religious services twice a week at my church." "I don't like to cook for myself anymore." "My granddaughter helps me with my laundry." "I have coffee with my neighbor every morning." "There is no one to talk to most days of the week."

"I don't like to cook for myself anymore." "There is no one to talk to most days of the week."

After teaching an older adult about measures to relieve constipation, which statement by the client indicates a need for additional teaching? "I'm going to start walking every day for exercise." "I'll make sure that I drink plenty of fluids each day." "I should use a laxative every other day." "I need to avoid foods that are high in fat."

"I should use a laxative every other day."

The nurse caring for residents of a long-term care facility is explaining the occurrence of elder abuse in such facilities. Which statement from the nurse indicates the need for more education? "Older adults with disabilities are at increased risk for elder abuse." "Most states requires nurses to report elder abuse." "Limitations to activities of daily living contribute to risk of elder abuse." "Older adults in long-term care facilities are at low risk for elder abuse."

"Older adults in long-term care facilities are at low risk for elder abuse."

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? "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." "Alzheimer disease can be a great burden on the family. What community resources do you know about?" "Once the underlying cause of the confusion is found and treated, your loved one will be better than ever." "What concerns you most about Alzheimer disease?"

"Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion."

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? "I put my morning medications next to my bed to take first thing in the morning." "My neighbor brought me a pill box with compartments to organize my medications." "That one little white pill that I take in the morning makes me feel sleepy all day." "My pharmacy delivers, and I can pay the bill once a month when my check arrives."

"That one little white pill that I take in the morning makes me feel sleepy all day."

A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include? "The client need to take this drug for the rest of his or her life." "Once it becomes effective, you can stop the drug." "The drug helps to control the symptoms of the disease." "This drug will help to stop the disease from getting worse."

"The drug helps to control the symptoms of the disease."

Which is a true statement regarding pharmacologic aspects of aging? Aged population tends to be compliant with their medication regimen. Potential for drug-drug reactions decreases with the number of drugs prescribed. Elderly have a decreased percentage of body fat. Absorption may be affected by changes in gastric pH.

Absorption may be affected by changes in gastric pH.

Which condition is characterized by a decline in intellectual functioning? Delirium Depression Dementia Delusion

Dementia

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? Vitamin B and C supplements Acetaminophen Aspirin Diazepam

Diazepam

The nurse is caring for an older adult who is prescribed bed rest. Which action will the nurse take to prevent the development of impaired mobility? Assist the client to sit on the side of the bed and dangle the legs. Keep the head of the bed elevated 60 degrees. Encourage the client to perform active range-of-motion exercises. Transfer the client to a chair to change the bed linen.

Encourage the client to perform active range-of-motion exercises.

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? Assisting clients to soak in the bathtub several times each week Taking the clients outside for sun exposure daily Encouraging clients to avoid cigarette smoking Instructing clients to use perfumed skin creams

Encouraging clients to avoid cigarette smoking

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? Assess the grandmother for adventitious lung sounds Inform the family that this is a result of aging Recommends placement of the grandmother in a nursing home Administer donepezil every day

Assess the grandmother for adventitious lung sounds Explanation: 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.

An older adult was found unable to get up after sustaining a hip fracture after falling at home. Which outcome will the nurse identify for this client's care? Attain maximum level of functioning. Maintain current level of functioning. Learn to adjust to limited functioning. Return to full pre-injury functioning.

Attain maximum level of functioning.

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. Avoiding environmental smoke Avoiding all sun exposure Ensuring appropriate fluid intake Participating in regular exercise Following a high-calcium diet

Avoiding environmental smoke Participating in regular exercise Ensuring appropriate fluid intake

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? Digitalis glycosides Barbiturates Diuretics Anticoagulants

Barbiturates

The nurse is working in a long-term care facility. When assessing her patients, what body system dysfunction should the nurse look for as the leading cause of morbidity and mortality in the older adult population? Cardiovascular Gastrointestinal Respiratory Genitourinary

Cardiovascular

The nurse plans care for a client who is newly diagnosed with Alzheimer disease (AD). For each nursing action specify if the intervention is appropriate to address cognitive function, physical safety, or independence in self-care. - Limit environmental stimuli. - Provide clear and simple explanations. - Prominently display a clock. - Ensure adequate lighting. - Remove clutter from the environment. - Use a bed alarm. - Initiate a referral with occupational therapy (OT). - Allow the client to make simple choices with activities of daily living (ADLs). - Provide adaptive equipment.

Cognitive function - Limit environmental stimuli. - Provide clear and simple explanations. - Prominently display a clock. Physical safety - Ensure adequate lighting. - Remove clutter from the environment. - Use a bed alarm. Independence in self-care - Initiate a referral with occupational therapy (OT). - Allow the client to make simple choices with activities of daily living (ADLs). - Provide adaptive equipment.

A nurse is obtaining the health history of a 72-year-old woman who has come to the ambulatory care center for an evaluation. When obtaining information about the woman's sleep patterns, which of the following would the nurse expect to assess? Statements that she rarely takes naps during the day Reports that she has trouble waking up from sleeping Reports that she falls asleep more quickly Complaints about frequently waking up during the night

Complaints about frequently waking up during the night

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? Continue to walk at his current level. Increase walking at a faster pace. Refrain from any form of exercise. Decrease walking frequency to three times each week.

Continue to walk at his current level.

A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? Increased norepinephrine level Decreased acetylcholine level Increased acetylcholine level Decreased norepinephrine level

Decreased acetylcholine level

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? Contact a home health care agency. Hire a home health aide. Ask a neighbor to watch the client during the day. Enroll in an adult day care facility.

Enroll in an adult day care facility.

Which action by the nurse demonstrates ageism? Encouraging the older adult to develop routines not associated with work Allowing adequate time for the older adult to complete tasks Providing the same high quality of care to all clients Directing all health decisions to the older adult's child

Directing all health decisions to the older adult's child

A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate? Place the client in a secluded room until calm. Document the inability to assess vital signs due to client's agitation. Continue taking the vital signs. Distract the client with a familiar object or music.

Distract the client with a familiar object or music.

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 Ensure that the mother does not have access to car keys or drive an automobile. Encourage the mother to take responsibility for cooking and cleaning the house. Allow the mother to smoke cigarettes outside on the porch without supervision. Turn off lights at night so that the mother differentiates night and day.

Ensure that the mother does not have access to car keys or drive an automobile.

The nurse notes that an older adult is experiencing symptoms of depression. Which nonpharmacologic recommendations will the nurse suggest to this client? Select all that apply. Reminiscing Cognitive therapy Bright light Interactions with others Exercise

Exercise Bright light Reminiscing Cognitive therapy Interactions with others

A nurse is preparing to assess an older adult patient. Which approach would the nurse most likely use? Body region assessment Functional assessment Head-to-toe assessment Body system assessment

Functional assessment

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? Mix the vaccines in a syringe before administering as one injection in order to minimize client discomfort. Give the client the influenza vaccine first and then administer the pneumococcal vaccine in another site. Give the pneumococcal vaccine first and schedule the client to return the next day for the influenza vaccine. Give the influenza vaccine and schedule the client to return in a week for the pneumococcal vaccine.

Give the client the influenza vaccine first and then administer the pneumococcal vaccine in another site.

An elderly female client tells the nurse she has trouble holding her "water." A nursing intervention is informing the client to Take prophylactic antibiotics. Realize this is normal for her age. Have adequate fluid intake. Decrease fluid intake.

Have adequate fluid intake.

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? Genitourinary system Hearing Respiratory system Digestion

Hearing

A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching? Most older adults reside in a long-term care facility. A decline in sexual activity is a normal occurrence as you age. How old you feel will be determined by your physical and cognitive abilities. As an older adult, you will not be able to learn new skills or knowledge.

How old you feel will be determined by your physical and cognitive abilities.

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? Implement a prompted, timed voiding schedule. Show disapproval to help prevent reoccurrence. Provide education about medications to treat this problem. Remind the client to verbalize toileting needs.

Implement a prompted, timed voiding schedule.

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. Increase intake of foods that are high in calcium. Decrease the frequency of any exercise. Allow for additional phosphorus intake in her daily diet. Obtain the prescribed bone density screening. Take calcium and vitamin D supplements daily.

Increase intake of foods that are high in calcium. Take calcium and vitamin D supplements daily. Obtain the prescribed bone density screening.

The nurse identifies which of the following as an age-related change in the respiratory system? Increased residual lung volume Increased vital capacity Increased diffusion capacity Increased cough efficiency

Increased residual lung volume

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to Take daily hot showers. Minimize the use of stool softeners. Use whirlpool baths for relaxation. Ingest five or six small meals each day.

Ingest five or six small meals each day. Explanation: 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.

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 Loss of bone density The client's failure to exercise Decreased muscle mass and joint cartilage Degeneration in the efficiency of bone joints

Loss of bone density

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? Medicare will not pay for the cost of acute-care services so the client will be billed for the services provided. Medicare will only pay the cost for acute-care services if the client has a very low income. Medicare pays for 100% of the cost for acute-care services, so the cost of the visit will be covered. Medicare has a copayment for many of the services it covers. This requires the client to pay a part of the bill.

Medicare has a copayment for many of the services it covers. This requires the client to pay a part of the bill.

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? More than one body system may be affected The symptom of rectal bleeding is vague The bleeding may be coming from another body orifice Older adult clients may be poor historians of symptoms

More than one body system may be affected

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? Offer the client rewards for finishing all the food on her tray. Offer the client only one food item at a time to promote focused eating. Arrange for insertion of a gastrostomy tube and initiate enteral feeding. Offer the client bland, low-salt foods to limit offensiveness.

Offer the client only one food item at a time to promote focused eating.

The reason that governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement? Clients lack different perspectives. Clients are unable to make any health care decision. Clients lack capacity because of cognitive impairment. Older adult clients are vulnerable.

Older adult clients are vulnerable.

Why are IV solutions usually given at a slower rate to older adults? Veins of older adults tend to be rigid. Older adults may have poor skin turgor. Older adults often find infusions painful. Older adults may have cardiac or renal disorders.

Older adults may have cardiac or renal disorders.

A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? Select all that apply. Place grab bars in the shower and tub Frequently change the furniture layout in the home Have routine vision and hearing screenings Use scatter rugs on hard wood surfaces. Review medications routinely for side effects Wear nonslip shoes or socks when walking

Place grab bars in the shower and tub Have routine vision and hearing screenings Wear nonslip shoes or socks when walking Review medications routinely for side effects

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 facilitate using this theory when caring for a client? Recognize that immune system changes cannot be altered. Identify reasons for changes in musculoskeletal function. Plan interventions to address consequences of age-related changes. Establish improvement of cognitive function as the overall goal of care.

Plan interventions to address consequences of age-related changes.

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? Pneumonia Asthma attacks Confusion Bronchospasm

Pneumonia

A nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply. Providing a calm, quiet environment Supervising nutritional intake Administering psychoactive drugs Keeping the patient awake as much as possible Using familiar cues about the environment

Providing a calm, quiet environment Supervising nutritional intake Using familiar cues about the environment

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? Instruct the client to go to a local government agency building to arrange help. Recommend the client contact their local area agencies for older adults for assistance. Call the neighborhood meal delivery team and arrange deliveries on the client's behalf. Inform the client that they will need to call their insurance and arrange for home assistance.

Recommend the client contact their local area agencies for older adults for assistance.

Which is a factor that contributes to urinary incontinence in older female adults? Detrusor stability Increased bladder capacity Relaxed perineal muscle Decreased urinary residual

Relaxed perineal muscle

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? Assess for infection. Reorient the patient. Notify the physician. Take the vital signs.

Reorient the patient.

Which neurotransmitter is implicated in depression? Acetylcholine Epinephrine Atropine Serotonin

Serotonin

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? Response to sexual stimulation may be less intense. It might take longer to complete sexual intercourse. Sexual desire typically becomes progressively less. Sexual arousal may take longer to occur.

Sexual desire typically becomes progressively less.

Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse? Diabetic with fasting blood sugar 92; "It is difficult to afford food with all of these medication costs." Obvious deformity to right arm; "I tripped on the rug and fell on my arm." BMI 24; "My family never gives me my favorite foods." Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore."

Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore."

Which characteristic distinguishes normal aging from pathological changes associated with aging? Confidentiality Morality Universality Spirituality

Universality

The following information is documented on the assessment form for an older adult: Kyphosis Dry mucous membranes Decreased respiratory excursion Urinary incontinence The nurse is reviewing the information and reports which finding to the physician?

Urinary incontinence

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? This condition is now curable. Vision loss is not hereditary. It is related to diet. Wear sunglasses with ultraviolet (UV) protection when outside. Reduce the amount of cigarettes smoked daily from 20 to 10.

Wear sunglasses with ultraviolet (UV) protection when outside.

An age-related change associated with the cardiovascular system is? thinner heart valves. increased compliance of heart muscle. decreased cardiac output. decreased blood pressure.

decreased cardiac output.

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. decreased smoking decreased community-based services early detection of elevated cholesterol levels improved nutrition screening for hypertension decreased exercise

decreased smoking improved nutrition screening for hypertension early detection of elevated cholesterol levels

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? emotional physical financial neglect

neglect

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should: help the client fill out his menu. give the client privacy during meals. stay with the client and encourage him to eat. fill out the menu for the client.

stay with the client and encourage him to eat.