Care of Older Adult

The patient is receiving donepezil (Aricept), lorazepam (Ativan), risperidone (Risperdal), and sertraline (Zoloft) for the management of AD. What benzodiazepine medication is being used to help manage this patient's behavior? a. Sertraline (Zoloft) b. Donepezil (Aricept) c. Lorazepam (Ativan) d. Risperidone (Risperdal)

10. c. Lorazepam (Ativan) is a benzodiazepine used to manage behavior with AD. Sertraline (Zoloft) is a selective serotonin reuptake inhibitor used to treat depression. Donepzil (Aricept) is a cholinesterase inhibitor used for decreased memory and cognition. Risperidone (Risperdal) is an antipsychotic used for behavior management.

The most common affective or mood disorder of old age is 1. dementia. 2. depression. 3. delirium. 4. Alzheimer's.

2. depression.

You are caring for an 80-year-old man who recently lost his wife. He shares with you 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. This patient is at risk for: 1 Dementia. 2 Liver failure. 3 Dehydration. 4 Suicide.

4 Suicide.

Which nursing actions will the nurse take to assess for possible malnutrition in an older adult patient (select all that apply)? a. Observe for depression. b. Review laboratory results. c. Assess teeth and oral mucosa. d. Ask about transportation needs. e. Determine food likes and dislikes.

ANS: A, B, C, D The laboratory results, especially albumin and cholesterol levels, may indicate chronic poor protein intake or high-fat/cholesterol intake. Transportation impacts patients' ability to shop for groceries. Depression may lead to decreased appetite. Oral sores or teeth in poor condition may decrease the ability to chew and swallow. Food likes and dislikes are not necessarily associated with malnutrition.

Of the following, which describes dementia? A. Quick onset, irreversible B. Slow onset, chronic C. Acute onset, reversible D. Progressive, terminal

B. Slow onset, chronic

When a fall results in injury and hospitalization, a cycle of disuse may occur over time. When establishing a care plan for the patient and family to prevent this, it is important to remember disuse is most likely a result of: A. Decreasing muscle strength. B. Decreased joint mobility. C. Fear of repeated falls. D. Changes in sensory perception.

C. Fear of repeated falls.

The nurse is planning client education for an older adult being prepared for discharge home after hospitalization for a cardiac problem. Which nursing action addresses the most commonly determined need for this age-group? A. Suggest that he purchase an emergency in-home alert system. B. Arrange for the client to receive meals delivered to his home daily. C. Encourage the client to use a compartmentalized pill storage container for his daily medications. D. Provide only written document describing the medications the client is currently prescribed.

Encourage the client to use a compartmentalized pill storage container for his daily medications.

Myths and stereotypes about aging lead to misconceptions that can result in errors in assessment. What is the term for this negative attitude? A. Bias B. Ageism C. Discrimination D. Prejudice

B Ageism is a negative attitude about age. Reference: 66

The risk for abuse of an older adult family member is greatest when the A. Caregiver lives alone with the older adult B. Caregiver is close in age to the older adult C. Older adult has decreased functional abilities D. Older adult has more than one chronic illness

D Many factors put vulnerable, older, community-dwelling adults at risk for domestic violence and mistreatment. They include physical or cognitive dysfunction that leads to an inability to perform ADLs (producing dependence on others for care), any psychiatric diagnoses (especially dementia and depression), alcohol abuse, and decreased social support. Reference: 69

Which medication prevents the breakdown of a brain chemical important for memory and thinking and may slow the progress of Alzheimer's disease. 1. memantine (Namenda) 2. ozazepam (Serax) 3. donepezil (Aricept) 4. citalopram (Celexa)

3. donepezil (Aricept)

j, l

A 67-year-old woman who has a long-standing diagnosis of incontinence is in the habit of arriving 20 minutes early for church in order to ensure that she gets a seat near the end of a row and close to the exit so that she has ready access to the restroom. Which of the following tasks of the chronically ill is the woman enacting (select all that apply)? j) Controlling symptoms k) Preventing social isolation l) Preventing and managing a crisis m) Denying the reality of the problem n) Adjusting to changes in the course of the disease

Which patient is most likely to need long-term nursing care management? a. 72-year-old who had a hip replacement after a fall at home b. 64-year-old who developed sepsis after a ruptured peptic ulcer c. 76-year-old who had a cholecystectomy and bile duct drainage d. 63-year-old with bilateral knee osteoarthritis who weighs 350 lb (159 kg)

ANS: D Osteoarthritis and obesity are chronic problems that will require planning for long-term interventions such as physical therapy and nutrition counseling. The other patients have acute problems that are not likely to require long-term management.

When caring for an older adult patient, the nurse uses the following interventions to accommodate visual changes with age: A. Eye glasses in the bedside table. B. Adequate lighting and uncluttered walkways. C. Draw drapes in room to prevent glare. D. Keep bedside rails down.

B. Adequate lighting and uncluttered walkways.

A nurse teaches the importance of folic acid intake to a group of pregnant women. This is considered which level of preventive care? A) Illness behavior B) Primary prevention C) Tertiary prevention D) Secondary prevention

B. Primary prevention is considered true prevention. It aims at maintaining physical and emotional health in an already healthy individual.

A patient comes to the ER during the morning and is experiencing rapid onset of impaired memory, reduced attention span, aggitation and disorientation, this patient will be experiencing a. sundowners b. Acute Delirium c. Alzhiemers d. Dementia

B. acute delirium s/s of delirium include rapid onset of symptoms that are reversible, sundowners" is a manifestation of symptoms that occur at night, intermittent with periods of clarity with periods of disoriention, imparied memory and impared atention span.

The three common conditions affecting cognition in the older adults are: A. Stroke, MI, Cancer B. Cancer, Alzheimer's disease, Stroke C. Delirium, Depression, Dementia D. Blindness, Hearing loss, Stroke

C. Delirium, Depression, Dementia

Of the following options, which is the greatest barrier to providing quality health care to the older-adult client? A. Poor client compliance resulting from generalized diminished capacity B. Inadequate health insurance coverage for the group as a whole C. Insufficient research to provide a basis for effective geriatric health care D. Preconceived assumptions regarding the lifestyles and attitudes of this group

D. Preconceived assumptions regarding the lifestyles and attitudes of this group

When administering a mental status examination to a patient, the nurse suspects depression when the patient responds with a. "I don't know." b. "Is that the right answer?" c. "Wait, let me think about that." d. "Who are those people over there?

a. "I don't know." Answers such as "I don't know" are more typical of depression. The response "Who are those people over there?" is more typical of the distraction seen in a patient with delirium. The remaining two answers are more typical of a patient with dementia.

Example of normal changes in aging include. Select all that apply a. Decreased chest wall compliance, and cough function b. Increased systolic pressure c. Less orthostatic hypotension d. Altered drug excretion e. More erections

a, b, d Normal changes in aging include decreased chest wall compliance, muscle strength, alveoli function, cough and macrophage function. Increased systolic pressure, more orthostatic hypotension, and arrhythmias. Many older men experience erectile dysfuntion and alteration in drug metabolism.

What manifestations of cognitive impairment are primarily characteristic of delirium (select all that apply)? a. Reduced awareness b. Impaired judgments c. Words difficult to find d. Sleep/wake cycle reversed e. Distorted thinking and perception f. Insidious onset with prolonged duration

a, d, e. Manifestations of delirium include cognitive impairment with reduced awareness, reversed sleep/wake cycle, and distorted thinking and perception. The other options are characteristic of dementia.

Which of the following psychiatric disorders is found most frequently among older adults? a. depression b. dementia c. anxiety d. social phobia

a. depression

A major goal of treatment for the patient with AD is to a. maintain patient safety. b. maintain or increase body weight. c. return to a higher level of self-care. d. enhance functional ability over time.

a. maintain patient safety. Rationale: The overall management goals are that the patient with AD will (1) maintain functional ability for as long as possible, (2) be maintained in a safe environment with a minimum of injuries, (3) have personal care needs met, and (4) have dignity maintained. The nurse should place emphasis on patient safety while planning and providing nursing care.

A 62-year-old patient is brought to the clinic by a family member who is concerned about the patient's inability to solve common problems. To obtain information about the patient's current mental status, which question should the nurse ask the patient? a. "Where were you were born?" b. "Do you have any feelings of sadness?" c. "What did you have for breakfast?" d. "How positive is your self-image?"

c. "What did you have for breakfast?" This question tests the patient's recent memory, which is decreased early in Alzheimer's disease (AD) or dementia. Asking the patient about birthplace tests for remote memory, which is intact in the early stages. Questions about the patient's emotions and self-image are helpful in assessing emotional status, but they are not as helpful in assessing mental state.

Nursing interventions directed at health promotion in the older adult are primarily focused on a. disease management b. controlling symptoms of illness c. teaching positive health behaviors d. teaching regarding nutrition to enhance longevity

c. teaching positive health behaviors A high value should be placed on health promotion and positive health behaviors.

Which of the following responses by an older-adult client is most reflective of a need for further education by the nurse regarding the physiological changes associated with the older adult? A. "I call a cab if I want to go out after dark." B. "I can't help worrying about becoming forgetful." C. "I have my eyes checked regularly. Can't afford to fall." D. "I really enjoy eating good vanilla ice cream, but I have cut way down." 0%

B. "I can't help worrying about becoming forgetful."

b

Examples of primary prevention strategies include: a. colonoscopy at age 50 b. avoidance of tobacco products c. intake of a diet low in saturated fat in a pt with high cholesterol d. teaching the importance of exercise to a pt with hypertension

Which of these assessments of an older adult, who has a urinary tract infection, requires an immediate nursing intervention? a. Presbycusis b. Confusion c. Death of a spouse 3 months ago d. Temperature of 97.6° F

b. Confusion

The leading cause of injury and preventable source of mortality and morbidity in older adults is 1. presbycusis. 2. car accidents. 3. pneumonia. 4. falls.

4. falls.

For which patient should the nurse prioritize an assessment for depression? A) A patient in the early stages of Alzheimer's disease B) A patient who is in the final stages of Alzheimer's disease C) A patient experiencing delirium secondary to dehydration D) A patient who has become delirious following an atypical drug response

A) A patient in the early stages of Alzheimer's disease Rationale: Patients in the early stages of Alzheimer's disease are particularly susceptible to depression, since the patient is acutely aware of his or her cognitive changes and the expected disease trajectory. Delirium is typically a shorter-term health problem that does not typically pose a heightened risk of depression.

Which of the following client statements regarding self-medication administration by an older-adult client requires follow-up teaching by the nurse? A. "I take all the pills ordered once a day at bedtime, so I'm less likely to forget them." B. "I have one pill that needs cut in half. I am going to ask the pharmacist to do that for me." C. "The pharmacist said to keep my pills away from the sunlight, so I put them inside the kitchen cabinet." D. "My daughter comes over each morning and puts my pills into a container that sorts them by the time they are due."

A. "I take all the pills ordered once a day at bedtime, so I'm less likely to forget them."

When completing an admission assessment on an older adult, the nurse gives the patient a high fall risk score. Which action should the nurse take first? a. Use a bed alarm system on the patient's bed. b. Administer the prescribed PRN sedative medication. c. Ask the health care provider to order a vest restraint. d. Place the patient in a "geri-chair" near the nurse's station.

ANS: A The use of the least restrictive restraint alternative is required. Physical or chemical restraints may be necessary, but the nurse's first action should be an alternative such as a bed alarm.

The nurse is caring for an older adult with hypertension. Based on the nurse's understanding of inappropriate medications for use in the older adult, the nurse would question an order for which drug as initial treatment for hypertension? Select all that apply. a) Clonidine b) Furosemide c) Methyldopa d) Quinapril e) Prazosin

Answer: A, C, E Rationale: Medications such as prazosin, clonidine, and methyldopa are not recommended for treatment of hypertension in the older adult due to the high risk for orthostatic hypotension; their use should be avoided. Furosemide and quinapril are appropriate for use in the older adult

Which of the following health promotion measures should occur most frequently in older adult women? a) Tetanus booster b) Fecal occult blood test c) Colonoscopy d) Pelvic and Papanicolaou (Pap) exam

Answer: Fecal occult blood test Rationale: Fecal occult blood tests are recommended annually for older adults. Pap exams and pelvic exams are recommended at least every 3 years. Colonoscopy or sigmoidoscopy should be performed every 3 to 5 years, and a tetanus booster is only necessary every 10 years.

A long-term care facility sponsors a discussion group on the administration of medications. The participants have a number of questions concerning their medications. The nurse responds most appropriately by saying: A. "Don't worry about the medication's name if you can identify it by its color and shape." B. "Unless you have severe side affects, don't worry about the minor changes in the way you feel." C. "Feel free to ask your physician why you are receiving the medications that are prescribed for you." D. "Remember that the hepatic system is primarily responsible for the pharmacotherapeutics of your medications."

C. "Feel free to ask your physician why you are receiving the medications that are prescribed for you." Rationale: The nurse should encourage the older adult to question the physician and/or pharmacist about all prescribed drugs and over-the-counter drugs. The older adult should be taught the names of all drugs being taken, when and how to take them, and the desirable and undesirable effects of the drugs.

A nurse caring for older adults in an assistive living facility recognizes that a clients quality of life needs are best determined by: A. Excellent physical, social, and emotional nursing assessments B. A working knowledge of this age-group's developmental needs C. A therapeutic nurse-client relationship that facilitates communication D. The client's need for complete physical, emotional, and cognitive care

C. A therapeutic nurse-client relationship that facilitates communication

Older adults who become ill are more likely than younger adults to a. complain about the symptoms of their problems b. refuse to carry out lifestyle changes to promote recovery c. seek medical attention because of limitations on their lifestyle d. alter their daily living activities to accommodate new symptoms.

d. alter their daily living activities to accommodate new symptoms. Older adults may underreport symptoms and treat symptoms by altering their functional status.

The primary purpose of hospice is to a. allow patients to die at home b. provide better quality of care than the family can c. coordinate care for dying patients and their families d. provide comfort and support for dying patients and their families

d. provide comfort and support for dying patients and their families Hosipice provides support and care at the end of life to help patients live as fully and as comfortable as possible. The emphasis is on symptom management, advance care planning, spiritual care, and family support, including bereavement.

The nurse is aware that the best predictor of an elderly person falling is: 1. A history of pervious falls 2. Use of multiple medications 3. Sensory deficits 4. Alterations in balance

Answer: 1. A history of pervious falls Rationale: Falls are the most common safety problems in older adults. Any fall is the best predictor of future falls. Two thirds of those who have experienced one fall will fall again within 6 months. Page reference: 168

What is one focus of collaborative care of patients with AD? a. Replacement of deficient acetylcholine in the brain b. Drug therapy for cognitive problems and undesirable behaviors c. The use of memory-enhancing techniques to delay disease progression d. Prevention of other chronic diseases that hasten the progression of AD

9. b. Because there is no cure for AD, collaborative management is aimed at controlling the decline in cognition, controlling the undesirable manifestations that the patient may exhibit, and providing support for the family caregiver. Anticholinesterase agents help to increase acetylcholine (ACh) in the brain but a variety of other drugs are also used to control behavior. Memoryenhancing techniques have little or no effect in patients with AD, especially as the disease progresses. Patients with AD have limited ability to communicate health symptoms and problems, leading to a lack of professional attention for acute and other chronic illnesses.

A nurse is caring for an older adult client preparing for discharge to a nursing center after having hip surgery. Which of the following nursing responses is most therapeutic with a client's concern that she, will never go back home? A. "What makes you think that this transfer to the nursing center will be permanent?" B. "The reason for this transfer is only to support you while you continue to recuperate." C. "The decision to stay in the nursing center is yours to make. When you want to leave no one will stop you." D. "The nursing center is a lovely place with a wonderful staff of caring people. Just give it a chance. You may like it."

A. "What makes you think that this transfer to the nursing center will be permanent?"

The nurse delegates to an unlicensed assistant the task of removing the restraints from the client's wrists every ________ hours and reporting any abnormalities. A) 2 B) 4 C) 6 D) 8

A. Removal of restraints and inspection of the contact area every 2 hours is a requirement of The Joint Commission. The time periods in the other options are too long. The client could experience a serious complication if restraints are not removed and the area under the restraints inspected frequently.

While bathing an elderly client who has limited abilities for self-care, the nurse notices several patches of dry skin on the clients heels, elbows, and coccyx. The nurse cleans and dries all the areas well and applies a moisturizing lotion. The most appropriate immediate follow-up by the nurse to ensure appropriate nursing care for this clients skin is to: A. Revise the client's care plan to show the need for the application of moisturizing lotion B. Assume personal responsibility to apply the moisturizing lotion daily to the client's skin C. Encourage the client to tell whomever bathes her to apply the moisturizing lotion to her areas of dry skin D. Inform the staff that the client's skin is showing signs of breakdown and moisturizing lotion needs to be applied daily

A. Revise the client's care plan to show the need for the application of moisturizing lotion

There is an 86-year-old female on the medical inpatient unit. She explains that the hospital is quite noisy and that she is having difficulty sleeping. Which is not true regarding sleep in the older adult? a) Deep sleep declines in the older adult. b) Chronic cardiovascular or respiratory illness can interfere with sleep. c) Stage 1 sleep increases in the older adult. d) Sleep medications are usually the first choice in treating sleep disturbance.

Answer: Sleep medications are usually the first choice in treating sleep disturbance. Rationale: Medications are typically the last choice for treating sleep disturbance because they can interact with other medications or have paradoxical effects on the older adult.

When providing nursing care to the elderly, it is most important to provide comfort due to which of the following changes? a) Dementia b) Isolation c) Thermoregulation d) Sexuality

Answer: Thermoregulation Rationale: The body can adapt to environmental temperatures within broad limits, but age and health status greatly affect this capacity. Thus, in the provision of nursing care that focuses on comfort, the nurse must be aware of changes in thermoregulation

A 90-year-old woman is admitted to a nurse's unit status post CVA. The client is alert and oriented to person, place, and time but has limited mobility and hemiparesis of the left side of her body. She is experiencing urinary incontinence. What is the most appropriate nursing action? a) Insert a Foley catheter to prevent incontinence. b) Assist the client once per shift to use the commode. c) Use disposable padding (Chux) to keep the bedding dry. d) Use the Braden scale to assess for pressure ulcers.

Answer: Use the Braden scale to assess for pressure ulcers. Rationale: The Braden scale is an evidence-based tool used to assess for pressure ulcers. Pressure ulcers can result from urinary incontinence, particularly if the skin is moist and skin integrity is impaired. The client would likely require assistance every time she uses the toilet. A Foley catheter is an extreme solution to this problem.

Which of the following statements made by a family member of a client recently diagnosed with early stages of Alzheimer's disease is most reflective of an understanding of this disease process? A. "Dad has always been a fighter; he'll fight this too. He won't give up." B. "We have an appointment with his care provider to see about medication therapy." C. "Good thing we found out about this early so we can prevent this from getting worse." D. "We have a made arrangements to discuss nursing home placement for dad."

B. "We have an appointment with his care provider to see about medication therapy."

In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging? A. Increased perspiration B. Increased airway resistance C. Increased salivary secretions D. Increased pitch discrimination

B. Increased airway resistance Rational: Normal physiological changes of aging include increased airway resistance in the older adult. The older adult would be expected to have decreased perspiration and drier skin as they experience glandular atrophy (oil, moisture, sweat glands) in the integumentary system. The older adult would be expected to have a decrease in saliva. A normal physiological change of the older adult related to hearing is a loss of acuity for high-frequency tones (presbycusis).

A client has been recently diagnosed with Alzheimer's disease. When teaching the family about the prognosis, the nurse must explain that: A. Diet and exercise can slow the process considerably B. It usually progresses gradually with a deterioration of function C. Many individuals can be cured if the diagnosis is made early D. Few clients live more than 3 years after the diagnosis

B. It usually progresses gradually with a deterioration of function

It is 1 day after the client underwent a mastectomy for the treatment of her breast cancer. The client is crying when the nurse enters the room. Which of the following is the nurse's best response? A) "Let me get you something for pain." B) "You seem upset. Would you like to tell me about what is bothering you?" C) "Cheer up. The worst is behind you now, and you'll start feeling better soon." D) "You shouldn't be crying now. Just wait until you go home and you're all alone without us to help you."

B. The nurse should use therapeutic communication skills to clarify the feelings of the client. The nurse should use open-ended questions, attentive listening, and presence to allow the clients to freely share her thoughts and concerns.

What do you expect in regard to the mental functioning of older adults? A. Decreases in vocabulary and verbal reasoning B. Improvement in the ability to synthesize new information C. Improvement in fluid intelligence D. Decline in long-term memory

C Although many aspects of mental functioning decline, there is an improvement in fluid intelligence and in vocabulary and verbal reasoning, with long-term memory remaining constant. Reference: 67

When performing a comprehensive geriatric assessment of an older adult, focus of the nursing assessment is on the patient's: A. Physical signs of aging. B. Immunological function. C. Functional abilities. D. Chronic illness.

C. Functional abilities.

When helping a person through grief work, the nurse knows that: A) Most clients want to be left alone. B) A person's perception of a loss has little to do with the grieving process. C) The stages of grief may occur in the standard order, they may be skipped, or they may reoccur. D) Coping mechanisms that were effective in the past are often disregarded in response to the pain of a loss.

C. Grief is manifested in a variety of ways that are unique to the individual and based on personal experiences, cultural expectations, and spiritual beliefs. The coping mechanisms that were effective in the past are repeated as a first response to the pain of a loss. When older coping strategies are unsuccessful, new coping mechanisms are attempted. The type of loss and the perception of the loss influence the depth and duration of grief a person experiences. The nurse must not assume that clients want to be left alone. If a client chooses not to share feelings or concerns, the nurse should convey a willingness to be available when needed. Sometimes clients need to begin resolving their grief before they can discuss their loss.

In reviewing changes in the older adult, the nurse recognizes that which of the following statements related to cognitive functioning in the older client is true? A. Delirium is usually easily distinguished from irreversible dementia. B. Therapeutic drug intoxication is a common cause of senile dementia. C. Reversible systemic disorders are often implicated as a cause of delirium. D. Cognitive deterioration is an inevitable outcome of the human aging process.

C. Reversible systemic disorders are often implicated as a cause of delirium. Rationale: Delirium is a potentially reversible cognitive impairment that is often due to a physiological cause such as an electrolyte imbalance, cerebral anoxia, hypoglycemia, medications, tumors, cerebrovascular infection, or hemorrhage.

The primary reason an older adult client is more likely to develop a pressure ulcer on the elbow as compared to a middle-age adult is: A. A reduced skin elasticity is common in the older adult B. The attachment between the epidermis and dermis is weaker C. The older client has less subcutaneous padding on the elbows D. Older adults have a poor diet that increases risk for pressure ulcers

C. The older client has less subcutaneous padding on the elbows

Based on the transtheoretical model of change, what is the most appropriate response to the following client statement: "Me, exercise? I haven't done that since Junior High gym class and I hated it then!" A) "That's fine. Exercise is bad for you anyway." B) "OK. I want you to walk 3 miles four times a week and I'll see you in 1 month." C) "I understand. Can you think of one reason why being more active would be helpful for you?" D) "I'd like you to ride your bike three times this week and eat at least four fruits and vegetables every day."

C. The transtheoretical model of change describes a series of changes that clients move through, starting with precontemplation and ending with maintenance. The first stage for this client would be to validate the client's opinion and move to the first part of precontemplation. The other options are later steps in the model.

There are factors that influence the musculoskeletal system associated with aging. The nurse recognizes that with age: A. Men have the greatest incidence of osteoporosis B. Muscle fibers increase in size and become tighter C. Weight-bearing exercise reduces the loss of bone mass D. Muscle strength does not diminish as much as muscle mass

C. Weight-bearing exercise reduces the loss of bone mass

An overall, general assessment of an older adult patient is best performed in which setting? A. During a meal. B. During assessment of vital signs. C. While assisting a patient with a bath. D. When assisting a patient during a walk.

C. While assisting a patient with a bath.

The fastest growing age group is those who are A. 65 years or younger. B. 65 to 70 years old. C. 70 to 80 years old. D. 85 years or older.

D The fastest growing age group is composed of those 85 years old or older. Reference: 65

The home care nurse is visiting patients in the community. Which patient is exhibiting an early warning sign of Alzheimer's disease? A) A 65-year-old male does not recognize his family members and close friends. B) A 59-year-old female misplaces her purse and jokes about having memory loss. C) A 79-year-old male is incontinent and not able to perform hygiene independently. D) A 72-year-old female is unable to locate the address where she has lived for 10 years.

D) A 72-year-old female is unable to locate the address where she has lived for 10 years. Rationale: An early warning sign of Alzheimer's disease is disorientation to time and place such as geographic disorientation. Occasionally misplacing items and joking about memory loss are examples of normal forgetfulness. Impaired ability to recognize family and close friends is a clinical manifestation of middle or moderate dementia (or Alzheimer's disease). Incontinence and inability to perform self-care activities are clinical manifestations of severe or late dementia (or Alzheimer's disease).

Which patient may face the greatest risk of developing delirium? A) A patient with fibromyalgia whose chronic pain has recently worsened B) A patient with a fracture who has spent the night in the emergency department C) An older patient whose recent computed tomography (CT) shows brain atrophy D) An older patient who takes multiple medications to treat various health problems

D) An older patient who takes multiple medications to treat various health problems Rationale: Polypharmacy is implicated in many cases of delirium, and this phenomenon is especially common among older adults. Brain atrophy, if associated with cognitive changes, is indicative of dementia. Alterations in sleep and environment, as well as pain, may cause delirium, but this is less of a risk than in an older adult who takes multiple medications.

A patient is taking delayed-release omeprazole (Prilosec) capsules for the treatment of gastroesophageal reflux disease (GERD). Which statement will the nurse include in the teaching plan about this medication? A. "Take this medication once a day after breakfast." B. "You will only have to be on this medication for 2 weeks for a life long treatment of the reflux disease." C. "The medication may be dissolved in a liquid for better absorption." D. "The entire capsule should be taken whole, not crushed, chewed, or opened."

D. "The entire capsule should be taken whole, not crushed, chewed, or opened."

A 70-year-old client asks the nurse to explain to her about hypertension. An appropriate response by the nurse as to why older clients often have hypertension is due to: A. Myocardial muscle damage B. Reduction in physical activity C. Ingestion of foods high in sodium D. Accumulation of plaque on arterial walls

D. Accumulation of plaque on arterial walls

The nurse is aware that the majority of older adults: A. Live alone B. Live in institutional settings C. Are unable to care for themselves D. Are actively involved in their community

D. Are actively involved in their community

The nurse, preparing to discharge an 81-year-old client from the hospital, recognizes that the majority of older adults: A. Require institutional care B. Have no social or family support C. Are unable to afford any medical treatment D. Are capable of taking charge of their own lives

D. Are capable of taking charge of their own lives

What is the best resource (of those listed below) for identifying information regarding an older adult's current functional ability? A. Psychological tests and related exams B. Diagnostic x-rays and lab tests C. Family members who visit occasionally and call weekly D. Neighbor who visits daily and helps the person to the store weekly.

D. Neighbor who visits daily and helps the person to the store weekly.

All of the following are examples of active strategies of health promotion except: A) Exercise training B) Weight reduction C) Smoking cessation D) Fluoridation of drinking water

D. Passive strategies of health promotion benefit individuals without any action by the individuals themselves. The fluoridation of municipal drinking water and the fortification of homogenized milk with vitamin D are examples of passive health promotion strategies. Weight reduction is considered an active strategy of health promotion. With active strategies of health promotion, individuals are motivated to adopt specific health programs. Smoking cessation requires clients to be actively involved in measures to improve their present and future levels of wellness while decreasing the risk of disease. Exercise training meets the criteria for active strategies of health promotion because it actively involves the client in his or her own health.

Lisa, a nurse assistant, is working with the nurse during the nurse's shift. One of the nurse's clients has upper limb restraints. In delegating care of this client to Lisa, the nurse would tell her to: A) Secure the restraints to the side rails. B) Check to see if the client can have a medication for sleep. C) Call the physician if the client becomes more agitated with the restraint. D) Report any signs of redness, excoriation, or constriction of circulation under the restraint.

D. The restraint sites much be checked regularly for signs of redness, excoriation, or constriction, and this task may be delegated. Calling the physician and performing medication assessments are nursing responsibilities. Restraints should never be secured to the side rails.

Vulnerable populations of clients are those who are more likely to develop health problems as a result of: A) Chronic diseases, homelessness, and poverty B) Poverty and limits in access to health care services C) Lack of transportation, dependence on others for care, and homelessness D) Excess risks, limits in access to health care services, and dependence on others for care

D. Vulnerable population are defined as clients who are more likely to develop health problems as a result of excess risks, who have limits in access to health care services, or who are dependent on others for care.

The acronym SPICES is used when assessing patients for ADL abilities, social-enviroment patterns and mental status. The acronym statnds for:

Sleep disorder Problems with eating or feeding Incontinence Confusion Evidence of Falls Skin Breakdown

An 80 yo female patient is receiving palliative care for heart failure. Primary purpose(s) of her receiving palliative care is (are) select all that apply: a. improve her quality of life. b. assess her coping ability with disease c. have time to teach patient and family about disease. d. docus on reducing the severity of disease symptoms. e. provide care that the family is unwilling or unable to give.

a and d The focus of palliatvie care is reduction of the severity of disease symptoms. the goals of palliative care are to (1) prevent and relieve suffering and (2) to improve quality of life for patients with serious, life limiting illnesses.

During assessment of an older adult's skin integrity, expected findings include which of the following? a. Decreased elasticity b. Oily skin c. Increased facial hair in men d. Faster nail growth

a. Decreased elasticity

The nurse correctly describes psychosocial theories on aging as theories that a. Describe role changes in behaviors in older adults. b. Emphasize that all adults age in similar ways. c. Stress the need for the aging to discontinue activities as they age. d. Describe behavior patterns for all aging adults as unpredictable.

a. Describe role changes in behaviors in older adults.

Several theories on aging have been put forth, and the nurse should use these theories to a. Guide nursing care. b. Explain the stochastic view of genetically programmed physiological changes. c. Select one theory to guide nursing care for all geriatric patients. d. Understand the nonstochastic views of aging as the result of cellular damage.

a. Guide nursing care.

A patient with gradual, progressive cognitive impairment (dementia) is admitted to the nursing unit after hip replacement surgery. Which of the following is a nursing care principle for care of cognitively impaired older adults? a. Maintain physical health. b. Evaluate the patient's manifestations of standard symptoms. c. Assist patient with all ADLs. d. Isolate patients to protect others.

a. Maintain physical health.

One of the greatest challenges for the nurse caring for older adults is ensuring safe medication use. One way to reduce the risks associated with medication usage is to a. Periodically review the patient's list of medications. b. Inform the patient that polypharmacy is to be avoided at all cost. c. Be aware that medication is absorbed the same way regardless of patient age. d. Focus only on prescribed medications.

a. Periodically review the patient's list of medications.

An older adult patient has developed acute confusion. The patient has been on tranquilizers for the past week. The patient's vital signs are normal. What should the nurse do? a. Take into account age-related changes in body systems that affect pharmacokinetic activity. b. Increase the dose of tranquilizer if the cause of the confusion is an infection. c. Note when the confusion occurs and medicate before that time. d. Restrict telephone usage to prevent further confusion.

a. Take into account age-related changes in body systems that affect pharmacokinetic activity.

An appropriate care choice for an older adult who lives with an employed daughter but requires help with activites of daily living is a. adult day care b. long-term care c. a retirement center. d. an assisted living facility

a. adult day care Adult day care (ADC) programs provide daily surpervision, social activites, and assistance with activities of daily living (ADL's) for persons who are cognitively impaired and persons who have problems with (ADL's). ADC centers provide physical and emotional relief for the caergiver and allow the caregive to pursue continued employment.

The family caregiver for a patient with AD expresses an inability to make decisions, concentrate, or sleep. The nurse determines what about the caregiver? a. The caregiver is also developing signs of AD. b. The caregiver is manifesting symptoms of caregiver role strain. c. The caregiver needs a period of respite from care of the patient. d. The caregiver should ask other family members to participate in the patient's care.

b. Family caregiver role strain is characterized by such symptoms of stress as the inability to sleep, make decisions, or concentrate. It is frequently seen in family members who are responsible for the care of the patient with AD. Assessment of the caregiver may reveal a need for assistance to increase coping skills, effectively use community resources, or maintain social relationships. Eventually the demands on a caregiver exceed the resources and the person with AD may be placed in an institutional setting.

Which symptom is an expected cognitive change in the older adult patient? a. Disorientation b. Slower reaction time c. Poor judgment d. Loss of language skills

b. Slower reaction time

Which statement regarding the use of restraints is true? a. Restraint free care appreciably diminishes the overall safety of any older adult patient compared with the use of physical or chemical restraints. b. The nurse is responsible for patient safety during the time the patient is restrained c. Chemical restraint presents less potential for patient harm that physical restraint d. Restraint may be used to prevent extubation if a nursing protocol exists.

b. The nurse is responsible for patient safety during the time the patient is restrained

A 68 yo man who recently retired states he is not his usual self, has poor appetite and low energy. Physical findings were within normal limits. The priority nursing intervention is to a. encourage the patient to seek diversional activities b. assess the patient for depression c. ask the patient if he has access to firearms d. refer the patient to a dietitin for counseling

b. assess the patient for depression

A male older adult patient expresses his concern and anxiety about decreased penile firmness during erection. What is the nurse's best response? a. Explain that over time, his libido will decrease, as will the frequency of sexual activity. b. Tell the patient to double his antidepressant medication to increase his libido. c. Tell the patient that this change is expected in aging adults. d. Tell the patient that touching should be avoided unless intercourse is planned.

c. Tell the patient that this change is expected in aging adults.

Which patient is most at risk for developing delirium? a. A 50-year-old woman with cholecystitis b. A 19-year-old man with a fractured femur c. A 42-year-old woman having an elective hysterectomy d. A 78-year-old man admitted to the medical unit with complications related to heart failure

d. A 78-year-old man admitted to the medical unit with complications related to heart failure Rationale: Risk factors that can precipitate delirium include age of 65 years or older, male gender, and severe acute illness (e.g., heart failure). The 78-year-old man has the most risk factors for delirium

What is the best suggestion a nurse could make to a family requesting help in selecting a local nursing center? a. Suggest choosing a nursing center that is as sanitary as possible. The closer the center is to hospital standards, the better. b. Have family members evaluate nursing home staff according to their ability to get tasks done efficiently. c. Make sure that nursing home staff members get patients out of bed every day for the entire day. d. Explain that it is probably best for the family to visit the center and inspect it personally.

d. Explain that it is probably best for the family to visit the center and inspect it personally.

An older adult patient in no acute distress reports being less able to taste and smell. What is the nurse's best response to this information? a. Notify the physician immediately to rule out cranial nerve damage. b. Perform testing on the vestibulocochlear nerve and a hearing test. c. Schedule the patient for an appointment at a smell and taste disorders clinic. d. Explain to the patient that diminished senses are normal findings.

d. Explain to the patient that diminished senses are normal findings.

An 80-year-old male is brought to the emergency department with an exacerbation of chronic obstructive pulmonary disease (COPD). He states that he quit smoking 30 years ago, so it can't be COPD. He argues, "It's just these colds I've been getting. They're just getting worse and worse." The nurse understands that a. These symptoms are more associated with normal aging than with disease. b. Older adults do not have to alter physical activity because of physical changes. c. The patient's age will require adjustment of lifestyle to one of inactivity. d. Older adults usually are aware and accepting of the aging process.

d. Older adults usually are aware and accepting of the aging process.

For the past 5 years Tom has repeatedly asked his mother to donate his deceasd father's belongings to charity, but his mother has refused. She sits in the bedroom closet, crying and talking to her long-dead husband. What type of grief is Tom's mother experiencing? a. Adaptive grief b. Disruptive grief c. Anticipatory grief d. Prolonged grief disorder

d. Prolonged grief disorder Prolonged grief disorder is prolonge, intense mourning and includes symptoms such as recurrent distressing emotions and intrusive thoughts related to the loss of a loved one, severe pangs of emotion, self-neglect, and denial of the loss for longer than 6 months.

An older patient has fallen and broken his hip. As a consequence, the patient's family is concerned about his ability to care for himself, especially during his convalescence. What should the nurse do? a. Stress that older patients usually ask for help when needed. b. Inform the family that placement in a nursing center is a permanent solution. c. Tell the family to enroll the patient in a ceramics class to maintain his quality of life. d. Provide information and answer questions as family members make choices among care options.

d. Provide information and answer questions as family members make choices among care options.

When administering a mental status examination to a patient with delirium, the nurse should a. medicate the patient first to reduce any anxiety. b. give the examination when the patient is well-rested. c. reorient the patient as needed during the examination. d. choose a place without distracting environmental stimuli.

d. choose a place without distracting environmental stimuli. Because overstimulation by environmental factors can distract the patient from the task of answering the nurse's questions, these stimuli should be avoided. The nurse will not wait to give the examination because action to correct the delirium should occur as soon as possible. Reorienting the patient is not appropriate during the examination. Antianxiety medications may increase the patient's delirium.

An ethnic older adult may feel a loss of self-worth when the nurse a. informs the patient about ethnic support services b. allows a patient to rely on ethnic health beliefs and practices c. has to use an interpreter to provide explanations and teachings. d. emphasizes that a therapeutic diet does not allow for ethnic foods.

d. emphasizes that a therapeutic diet does not allow for ethnic foods. An older adult with strong ethnic and cultural beliefs may experience loss of self if nurses ignore ethnic and cultural practices and behaviors.

A 63-year-old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are your major concerns for this patient? (Select all that apply.) 1 The loss of his work role 2 The risk of social isolation 3 A determination if the wife will need to start working 4 How the wife expects household tasks to be divided in the home in retirement 5 The age the patient chose to retire

1 The loss of his work role 4 How the wife expects household tasks to be divided in the home in retirement

What N-methyl-d-aspartate (NMDA) receptor antagonist is frequently used for a patient with AD who is experiencing decreased memory and cognition? a. Trazodone (Desyrel) b. Olanzapine (Zyprexa) c. Rivastigmine (Exelon) d. Memantine (Namenda)

11. d. Memantine (Namenda) is the N-methyl-d-aspartate (NMDA) receptor antagonist frequently used for AD patients with decreased memory and cognition. Trazodone (Desyrel) is an atypical antidepressant that may help with sleep problems. Olanzapine (Zyprexa) is an antipsychotic medication used for behavior management. Rivastigmine (Exelon) is a cholinesterase inhibitor used for decreased memory and cognition.

A patient with AD in a long-term care facility is wandering the halls very agitated, asking for her "mommy" and crying. What is the best response by the nurse? a. Ask the patient, "Why are you behaving this way?" b. Tell the patient, "Let's go get a snack in the kitchen." c. Ask the patient, "Wouldn't you like to lie down now?" d. Tell the patient, "Just take some deep breaths and calm down."

12. b. Patients with moderate to severe AD frequently become agitated but because their short-term memory loss is so pronounced, distraction is a very good way to calm them. "Why" questions are upsetting to them because they don't know the answer and they cannot respond to normal relaxation techniques.

The sister of a patient with AD asks the nurse whether prevention of the disease is possible. In responding, the nurse explains that there is no known way to prevent AD but there are ways to keep the brain healthy. What is included in the ways to keep the brain healthy (select all that apply)? a. Avoid trauma to the brain. b. Recognize and treat depression early. c. Avoid social gatherings to avoid infections. d. Do not overtax the brain by trying to learn new skills. e. Daily wine intake will increase circulation to the brain. f. Exercise regularly to decrease the risk for cognitive decline

13. a, b, f. Avoiding trauma to the brain, treating depression early, and exercising regularly can maintain cognitive function. Staying socially active, avoiding intake of harmful substances, and challenging the brain to keep its connections active and create new ones also help to keep the brain healthy.

The son of a patient with early-onset AD asks if he will get AD. What should the nurse tell this man about the genetics of AD? a. The risk of early-onset AD for the children of parents with it is about 50%. b. Women get AD more often than men do, so his chances of getting AD are slim. c. The blood test for the ApoE gene to identify this type of AD can predict who will develop it. d. This type of AD is not as complex as regular AD, so he does not need to worry about getting AD.

14. a. The risk of early-onset AD for the children of parents with it is 50%. Women do get AD more often than men but that is more likely related to women living longer than men than to the type of AD. ApoE gene testing is used for research with late-onset AD but does not predict who will develop the disease. Late-onset AD is more genetically complex than early-onset AD and is more common in those over age 60 but because his parent has early-onset AD he is at a 50% risk of getting it.

A patient with moderate AD has a nursing diagnosis of impaired memory related to effects of dementia. What is an appropriate nursing intervention for this patient? a. Post clocks and calendars in the patient's environment. b. Establish and consistently follow a daily schedule with the patient. c. Monitor the patient's activities to maintain a safe patient environment. d. Stimulate thought processes by asking the patient questions about recent activities

15. b. Adhering to a regular, consistent daily schedule helps the patient to avoid confusion and anxiety and is important both during hospitalization and at home. Clocks and calendars may be useful in early AD but they have little meaning to a patient as the disease progresses. Questioning the patient about activities and events they cannot remember is threatening and may cause severe anxiety. Maintaining a safe environment for the patient is important but does not change the disturbed thought processes.

The wife of a man with moderate AD has a nursing diagnosis of social isolation related to diminishing social relationships and behavioral problems of the patient with AD. What is a nursing intervention that would be appropriate to provide respite care and allow the wife to have satisfactory contact with significant others? a. Help the wife to arrange for adult day care for the patient. b. Encourage permanent placement of the patient in the Alzheimer's unit of a long-term care facility. c. Refer the wife to a home health agency to arrange daily home nursing visits to assist with the patient's care. d. Arrange for hospitalization of the patient for 3 or 4 days so that the wife can visit out-of-town friends and relatives.

17. a. Adult day care is an option to provide respite for caregivers and a protective environment for the patient during the early and middle stages of AD. There are also in-home respite care providers. The respite from the demands of care allows the caregiver to maintain social contacts, perform normal tasks of living, and be more responsive to the patient's needs. Visits by home health nurses involve the caregiver and cannot provide adequate respite. Institutional placement is not always an acceptable option at earlier stages of AD, nor is hospitalization available for respite care.

The health care provider is trying to differentiate the diagnosis of the patient between dementia and dementia with Lewy bodies (DLB). What observations by the nurse support a diagnosis of DLB (select all that apply)? a. Tremors b. Fluctuating cognitive ability c. Disturbed behavior, sleep, and personality d. Symptoms of pneumonia, including congested lung sounds e. Bradykinesia, rigidity, and postural instability without tremor

18. b, e. Dementia with Lewy bodies (DLB) is diagnosed with dementia plus two of the following symptoms: (1) extrapyramidal signs such as bradykinesia, rigidity, and postural instability but not always a tremor, (2) fluctuating cognitive ability, and (3) hallucinations. The extrapyramidal signs plus tremors would more likely indicate Parkinson's disease. Disturbed behavior, sleep, personality, and eventually memory are characteristics of frontotemporal lobe degeneration (FTLD).

Delegation Decision: The RN in charge at a long-term care facility could delegate which activities to unlicensed assistive personnel (UAP) (select all that apply)? a. Assist the patient with eating. b. Provide personal hygiene and skin care. c. Check the environment for safety hazards. d. Assist the patient to the bathroom at regular intervals. e. Monitor for skin breakdown and swallowing difficulties.

19. a, b, d. All caregivers are responsible for the patient's safety. Basic care activities, such as those associated with personal hygiene and activities of daily living (ADLs) can be delegated to unlicensed assistive personnel (UAP). The RN will perform ongoing assessments and develop and revise the plan of care as needed. The RN will assess the patient's safety risk factors, provide education, and make referrals. The licensed practical nurse (LPN) could check the patient's environment for potential safety hazards.

A nurse has conducted an assessment of a new patient who has come to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the nursing history. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing: 1 Dementia. 2 Depression. 3 Delirium. 4 Disengagement.

2 Depression.

A 71-year-old patient enters the emergency department after falling down stairs in the home. The nurse is conducting a fall history with the patient and his wife. They live in a one-level ranch home. He has had diabetes for over 15 years and experiences some numbness in his feet. He wears bifocal glasses. His blood pressure is stable around 130/70. The patient does not exercise regularly and complains of weakness in his legs when climbing stairs. He is alert, oriented, and able to answer questions clearly. What are the fall risk factors for this patient? (Select all that apply.) 1 Presence of a chronic disease 2 Impaired vision 3 Residence design 4 Blood pressure 5 Leg weakness 6 Exercise history

2 Impaired vision 5 Leg weakness 6 Exercise history

A nurse is caring for a patient preparing for discharge from the hospital the next day. The patient does not read and has a hearing loss. His family caregiver will be visiting before discharge. What can you do to facilitate the patient's understanding of his discharge instructions? (Select all that apply.) 1 Speak loudly so the patient can hear you. 2 Sit facing the patient so he is able to watch your lip movements and facial expressions. 3 Present one idea or concept at a time. 4 Send a written copy of the instructions home with him and tell him to have the family review them. 5 Include the family caregiver in the teaching session.

2 Sit facing the patient so he is able to watch your lip movements and facial expressions. 3 Present one idea or concept at a time. 5 Include the family caregiver in the teaching session.

During a home health visit a nurse talks with a patient and his family caregiver about the patient's medications. The patient has hypertension and renal disease. Which of the following findings places him at risk for an adverse drug event? (Select all that apply.) 1 Taking two medications for hypertension 2 Taking a total of eight different medications during the day. 3 Having one physician who reviews all medications 4 Patient's health history 5 Involvement of the caregiver in assisting with medication administration

2 Taking a total of eight different medications during the day. 4 Patient's health history

A patient's family member is considering having her mother placed in a nursing center. You have talked with the family before and know that this is a difficult decision. Which of the following criteria would you recommend in choosing a nursing center? (Select all that apply.) 1 The center should be clean, and rooms should look like a hospital room. 2 There should be adequate staffing on all shifts. 3 Social activities should be available for all residents. 4 Three meals should be served daily with a set menu and serving schedule. 5 Family involvement in care planning and assisting with physical care is necessary.

2 There should be adequate staffing on all shifts. 3 Social activities should be available for all residents. 5 Family involvement in care planning and assisting with physical care is necessary.

You are caring for a 78 year-old female cardiac patient. In preconference, your clinical instructor asks you what is an age-related change in the cardiac system of the older adult? Your best response would be Student Response Value Correct Answer Feedback 1. Decreased blood pressure 2. Decreased cardiac output 3. Increase ability to respond to stress 4. Increased heart recovery rate

2. Decreased cardiac output

Your patient assigned to you has pneumonia. You are reviewing the age-related changed involved with the older adult. Select all age-related changes of the respiratory system that apply. 1. Decreased in residual lung volume 2. Decreased gas exchange 3. Decreased cough efficiency 4. Increased gas exchange

2. Decreased gas exchange 3. Decreased cough efficiency

One reason for medication problems in the elderly is that 1. Regular use of laxatives increases absorption of medications 2. Decreased renal function slows excretion of drugs 3. Enhanced sense of taste of medications 4. Increased perception of pain from injections

2. Decreased renal function slows excretion of drugs

Which statement accurately describes dementia? a. Overproduction of β-amyloid protein causes all dementias. b. Dementia resulting from neurodegenerative causes can be prevented. c. Dementia caused by hepatic or renal encephalopathy cannot be reversed. d. Vascular dementia can be diagnosed by brain lesions identified with neuroimaging.

2. d. The diagnosis of vascular dementia can be aided by neuroimaging studies showing vascular brain lesions along with exclusion of other causes of dementia. Overproduction of β-amyloid protein contributes to Alzheimer's disease (AD). Vascular dementia can be prevented or slowed by treating underlying diseases (e.g., diabetes mellitus, cardiovascular disease). Dementia caused by hepatic or renal encephalopathy potentially can be reversed.

A 68-year-old man is admitted to the emergency department with multiple blunt trauma following a one-vehicle car accident. He is restless; disoriented to person, place, and time; and agitated. He resists attempts at examination and calls out the name "Janice." Why should the nurse suspect delirium rather than dementia in this patient? a. The fact that he wouldn't have been allowed to drive if he had dementia b. His hyperactive behavior, which differentiates his condition from the hypoactive behavior of dementia c. The report of emergency personnel that he was noncommunicative when they arrived at the accident scene d. The report of his family that although he has heart disease and is "very hard of hearing," this behavior is unlike him

21. d. Delirium is an acute problem that usually has a rapid onset in response to a precipitating event, especially when the patient has underlying health problems, such as heart disease and sensory limitations. In the absence of prior cognitive impairment, a sudden onset of confusion, disorientation, and agitation is usually delirium. Delirium may manifest with both hypoactive and hyperactive symptoms.

What should be included in the management of a patient with delirium? a. The use of restraints to protect the patient from injury b. The use of short-acting benzodiazepines to sedate the patient c. Identification and treatment of underlying causes when possible d. Administration of high doses of an antipsychotic drug such as haloperidol (Haldol)

22. c. Care of the patient with delirium is focused on identifying and eliminating precipitating factors if possible. Treatment of underlying medical conditions, changing environmental conditions, and discontinuing medications that induce delirium are important. Drug therapy is reserved for those patients with severe agitation because the drugs themselves may worsen delirium.

When caring for a patient in the severe stage of AD, what diversion or distraction activities would be appropriate? a. Watching TV b. Playing games c. Books to read d. Mobiles or dangling ribbons

23. d. In the severe stage of AD, the patient is at a developmental level of 15 months or less; therefore appropriate distractions would be infant toys. Watching TV and playing games are more appropriate in the mild stage. Books to read would need to be at developmentally appropriate levels to be used as a diversion.

Sexuality is maintained throughout our lives. Which answer below best explains sexuality in an older adult? 1 When the sexual partner passes away, the survivor no longer feels sexual. 2 A decrease in an older adult's libido occurs. 3 Any outward expression of sexuality suggests that the older adult is having a developmental problem. 4 All older adults, whether healthy or frail, need to express sexual feelings.

4 All older adults, whether healthy or frail, need to express sexual feelings.

Kyphosis, a change in the musculoskeletal system, leads to: 1 Decreased bone density in the vertebrae and hips. 2 Increased risk for pathological stress fractures in the hips. 3 Changes in the configuration of the spine that affect the lungs and thorax. 4 Calcification of the bony tissues of the long bones such as in the legs and arm.

3 Changes in the configuration of the spine that affect the lungs and thorax.

A major life event such as the death of a loved one, a move to a nursing home, or a cancer diagnosis could precipitate: 1 Dementia. 2 Delirium. 3 Depression. 4 Stroke.

3 Depression.

A patient with Alzheimer's disease (AD) dementia has manifestations of depression. The nurse knows that treatment of the patient with antidepressants will most likely do what? a. Improve cognitive function b. Not alter the course of either condition c. Cause interactions with the drugs used to treat the dementia d. Be contraindicated because of the central nervous system (CNS)-depressant effect of antidepressants

3. a. Depression is often associated with AD, especially early in the disease when the patient has awareness of the diagnosis and the progression of the disease. When dementia and depression occur together, intellectual deterioration may be more extreme. Depression is treatable and use of antidepressants often improves cognitive function.

Older adults experience a change in sexual activity. Which best explains this change? 1 The need to touch and be touched is decreased. 2 The sexual preferences of older adults are not as diverse. 3 Physical changes usually do not affect sexual functioning. 4 Frequency and opportunities for sexual activity may decline.

4 Frequency and opportunities for sexual activity may decline.

A student nurse is caring for a 78-year-old patient with multiple sclerosis. The patient has had an indwelling Foley catheter in for 3 days. Eight hours ago the patient's temperature was 37.1° C (98.8° F). The student reports her recent assessment to the registered nurse (RN): the patient's temperature is 37.2° C (99° F); the Foley catheter is still in place, draining dark urine; and the patient is uncertain what time of day it is. From what the RN knows about presentation of symptoms in older adults, what should he recommend first? 1 Tell the student that temporary confusion is normal and simply requires reorientation 2 Tell the student to increase the patient's fluid intake since the urine is concentrated 3 Tell the student that her assessment findings are normal for an older adult 4 Tell the student that he will notify the physician of the findings

4 Tell the student that he will notify the physician of the findings

For what purpose would the nurse use the Mini-Mental State Examination to evaluate a patient with cognitive impairment? a. It is a good tool to determine the etiology of dementia. b. It is a good tool to evaluate mood and thought processes. c. It can help to document the degree of cognitive impairment in delirium and dementia. d. It is useful for initial evaluation of mental status but additional tools are needed to evaluate changes in cognition over time.

4. c. The Mini-Mental State Examination is a tool to document the degree of cognitive impairment and it can be used to determine a baseline from which changes over time can be evaluated. It does not evaluate mood or thought processes but can detect dementia and delirium and differentiate these from psychiatric mental illness. It cannot help to determine etiology.

During assessment of a patient with dementia, the nurse determines that the condition is potentially reversible when finding out what about the patient? a. Has long-standing abuse of alcohol b. Has a history of Parkinson's disease c. Recently developed symptoms of hypothyroidism d. Was infected with human immunodeficiency virus (HIV) 10 years ago

5. c. Hypothyroidism can cause dementia but it is a treatable condition if it has not been long standing. The other conditions are causes of irreversible dementia.

The husband of a patient is complaining that his wife's memory has been decreasing lately. When asked for examples of her memory loss, the husband says that she is forgetting the neighbors' names and forgot their granddaughter's birthday. What kind of loss does the nurse recognize this to be? a. Delirium b. Memory loss in AD c. Normal forgetfulness d. Memory loss in mild cognitive impairment

6. d. In mild cognitive impairment people frequently forget people's names and begin to forget important events. Delirium changes usually occur abruptly. In Alzheimer's disease the patient may not remember knowing a person and loses the sense of time and which day it is. Normal forgetfulness includes momentarily forgetting names and occasionally forgetting to run an errand.

The wife of a patient who is manifesting deterioration in memory asks the nurse whether her husband has AD. The nurse explains that a diagnosis of AD is usually made when what happens? a. A urine test indicates elevated levels of isoprostanes b. All other possible causes of dementia have been eliminated c. Blood analysis reveals increased amounts of β-amyloid protein d. A computed tomography (CT) scan of the brain indicates brain atrophy

7. b. The only definitive diagnosis of AD can be made on examination of brain tissue during an autopsy but a clinical diagnosis is made when all other possible causes of dementia have been eliminated. Patients with AD may have β-amyloid proteins in the blood, brain atrophy, or isoprostanes in the urine but these findings are not exclusive to those with AD.

Which criterion must a 65-year-old person meet in order to qualify for Medicare funding? a. being entitled to Social Security benefits b. a documented absence of family caregivers c. a validated need for long-term residential care d. a history of failed responses to standard medical treatments

A - In order to qualify for Medicare, an individual must be entitled to receive Social Security benefits. Absence of caregivers and inadequate responses to treatment are not qualification criteria for Medicare, and the program does not cover residential care services.

A 67-year-old woman who has a long-standing diagnosis of incontinence is in the habit of arriving 20 minutes early for church in order to ensure that she gets a seat near the end of a row and close to the exit so that she has ready access to the restroom. Which tasks of the chronically ill is the woman demonstrating (select all that apply)? a. controlling symptoms b. preventing social isolation c. preventing and managing a crisis d. denying the reality of the problem e. adjusting to changes in the course of the disease

A and C - The woman's efforts to ensure that she can continue in her lifestyle of church attendance while accommodating the frequent elimination caused by her health problem are an example of controlling her symptoms and preventing a personal crisis.

c, d

A characteristic of chronic illness is that it (select all): a. has reversible pathologic changes b. has a consistent, predictable clinical course c. results in permanent deviation from the normal d. is associated with many stable and unstable phases e. always starts with an acute illness and then progresses slowly

e

A nurse who is providing care for an 81-year-old female patient recognizes the need to maximize the patient's mobility during her recovery from surgery. Which of the following statements provides the best rationale for the nurse's actions? e) Continued activity prevents deconditioning. f) Pharmacokinetics are improved by patient mobility. g) Lack of stimulation contributes to the development of cognitive deficits in older adults. h) Regularly scheduled physical rehabilitation provides an important sense of purpose for older patients.

Although he has been told that ginkgo biloba will probably have no effect, a 58-year-old man with early stage Alzheimer's disease insists on taking the herb because he believes it will slow the disease progression. Which statement, if made by the patient to the nurse, indicates understanding about the side effects of ginkgo? A) "Ginkgo may increase the risk of bruising." B) "Ginkgo may cause leg pain while walking." C) "It is not safe to suddenly stop taking ginkgo." D) "Ringing in the ears is a side effect of ginkgo."

A) "Ginkgo may increase the risk of bruising." Rationale: Ginkgo biloba may increase the risk for bruising and bleeding. There are no indications that sudden withdrawal of ginkgo biloba is unsafe. Ginkgo biloba is possibly effective for treating intermittent claudication (leg pain while walking). There is insufficient evidence to indicate that ginkgo biloba is effective in treatment of tinnitus (ringing in the ears).

Which statement by the wife of a patient with Alzheimer's disease (AD) demonstrates an accurate understanding of her husband's medication regimen? A) "I'm really hoping his medications will slow down his mental losses." B) "We're both holding out hope that this medication will cure his disease." C) "I know that this won't cure him, but we learned that it might prevent a bodily decline while he declines mentally." D) "I learned that if we are vigilant about his medication schedule, he may not experience the physical effects of his disease."

A) "I'm really hoping his medications will slow down his mental losses." Rationale: There is presently no cure for Alzheimer's disease, and drug therapy aims at improving or controlling decline in cognition. Medications do not directly address the physical manifestations of AD.

The nurse who has administered a dose of risperidone (Risperdal) to a patient with delirium should assess for what intended effect of the medication? A) Lying quietly in bed B) Alleviation of depression C) Reduction in blood pressure D) Disappearance of confusion

A) Lying quietly in bed Rationale: Risperidone is an antipsychotic drug that reduces agitation and produces a restful state in patients with delirium. However, it should be used with caution. Antidepressant medications treat depression, and antihypertensive medications treat hypertension. However, there are no medications that will cause confusion to disappear in a patient with delirium.

A 78-year-old woman is in the intensive care unit after emergency abdominal surgery. The nurse notes that the patient is disoriented and confused, has incoherent speech, and is restless and agitated. Which action by the nurse is most appropriate? A) Reorient the patient. B) Notify the physician. C) Document the findings. D) Administer lorazepam (Ativan).

A) Reorient the patient. Rationale: The patient is exhibiting clinical manifestations of delirium. Care of the patient with delirium is focused on eliminating precipitating factors and protecting the patient from harm. Give priority to creating a calm and safe environment. The nurse should stay at the bedside and provide reassurance and reorienting information as to place, time, and procedures. The nurse should reduce environmental stimuli, including noise and light levels. Avoid the use of chemical and physical restraints if possible.

The patient is having some increased memory and language problems. What diagnostic tests will be done before this patient is diagnosed with Alzheimer's disease (select all that apply)? A) Urinalysis B) MRI of the head C) Liver function tests D) Neuropsychologic testing E) Blood urea nitrogen and serum creatinine

A) Urinalysis B) MRI of the head C) Liver function tests D) Neuropsychologic testing E) Blood urea nitrogen and serum creatinine Rationale: Because there is no definitive diagnostic test for Alzheimer's disease, and many conditions can cause manifestations of dementia, testing must be done to eliminate any other causes of cognitive impairment. These include urinalysis to eliminate a urinary tract infection, an MRI to eliminate brain tumors, liver function tests to eliminate encephalopathy, BUN and serum creatinine to rule out renal dysfunction, and neuropsychologic testing to assess cognitive function.

A recently widowed 80-year-old male is dehydrated and is admitted to the hospital for intravenous fluid replacement. During the evening shift, the patient becomes acutely confused. The nurse's best action is to assess the patient for which of the following reversible causes? (Select all that apply.) a. Electrolyte imbalance b. Hypoglycemia c. Drug effects d. Dementia e. Cerebral anoxia

A, B, C, E

Which assessment findings would alert the nurse to possible elder mistreatment (select all that apply)? a. agitation b. depression c. weight gain d. weight loss e. hypernatremia

A, B, D and E - Agitation and depression may be manifestations of psychologic abuse or neglect. Hypernatremia may signify dehydration caused by physical neglect. A loss of body weight, rather than weight gain, is another clinical manifestation of physical neglect.

A male patient has a history of hypertension and type 1 diabetes mellitus. Because of these chronic illnesses, the patient exercises and eats the healthy diet that his wife prepares for him. Which factors will most likely have a positive impact on his biologic aging (select all that apply)? a. exercise b. diabetes c. social support d. good nutrition e. coping resources

A, C, D and E - Biologic aging is the progressive loss of function. Obesity, diabetes, hypertension, and cancer are all associated with the effects of aging. Exercise, good nutrition, social support, stress management, and coping resources are all positive factors related to the aging process.

Which conditions would you expect to see in the older adult population (select all that apply)? A. Hypertension B. Cancer C. Diabetes D. Psychosis E. Thrombosis

A,B,C Most persons 65 years of age and older have at least one chronic condition and many have multiple conditions. The most common chronic conditions present in the older adult are hypertension, arthritis, heart disease, cancer, and diabetes. Other common chronic conditions include vision loss, deafness and hearing impairment, Alzheimer's disease, osteoporosis, hip fractures, urinary incontinence, stroke, Parkinson's disease, and depression. Reference: 66

A family member of a recently deceased client talks casually with the nurse at the time of the client's death and expresses relief that she will not have to visit at the hospital anymore. Which of the following may apply to this family member in terms of her grief? A) Denial B) Anticipatory grief C) Dysfunctional grief D) Yearning and searching

A. In the denial stage, a person acts as though nothing has happened and refuses to accept the fact of a loss. This is a normal stage and is a self-protective mechanism. In dysfunctional grief, the grieving person has a prolonged or significantly difficult time moving forward after a loss. Emotional outbursts of tearful sobbing and acute distress characterize Bowlby's second stage of grief, termed yearning and searching. A person experiences anticipatory grief, the unconscious process of disengaging or letting go, before the actual loss or death occurs, especially in situations of prolonged or predicted loss.

A client in the end stage of terminal cancer is hospitalized. His family members are sitting at his bedside. What can the nurse do to best aid the family at this time? A) Find simple and appropriate care activities for the family to perform. B) Limit the time visitors may stay so they do not become overwhelmed by the situation. C) Avoid telling family members about the client's actual condition so they will not lose hope. D) Discourage spiritual practices because this will have little meaning for the client at this time.

A. It is helpful for the nurse to find simple care activities for the family to perform, such as feeding the client, washing the client's face, combing the hair, and filling out the client's menu card. This helps the family demonstrate their caring for the client and enables the client to feel their closeness and concern. Older adults often become particularly lonely at night and may feel more secure if a family member stays at the bedside during the night. The nurse should allow visitors to remain with dying clients at any time if the client wants them there. It is up to the family members to determine if they are feeling overwhelmed, not the nurse. The nurse should keep the family informed so the family can anticipate the type of symptoms the client will likely experience and the implications for care. Facilitating connections to a spiritual practice or community and supporting the expression of culturally held beliefs can provide comfort for many clients, especially at this time.

The local health department received information from the Centers for Disease Control and Prevention that the flu was expected to be very contagious this season. The nurse is asked to set up flu vaccine clinics in local churches and senior citizen centers. This activity is an example of which level of prevention? A) Primary intervention B) Tertiary intervention C) Nursing intervention D) Secondary intervention

A. Secondary intervention includes disease prevention after a health issue has been identified. Primary intervention is prevention of a health problem that has not yet occurred in the community. Tertiary intervention occurs after a problem has occurred and aims at preventing long-term negative impacts or recurrences in a population.

A 72-year-old man diagnosed with chronic obstructive pulmonary disease 5 years ago has been participating for the last 2 years in a pulmonary rehabilitation exercise class offered by the local hospital at a fitness facility. This is what level of prevention? A) Tertiary prevention B) Primary prevention C) Secondary prevention D) Quaternary prevention

A. Tertiary prevention occurs when a defect or disability is permanent and irreversible, and the aim is to reduce negative impacts and complications. Primary prevention is true prevention that precedes disease and involves clients considered physically and emotionally healthy. Secondary prevention is aimed at individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Quaternary prevention is not a recognized term.

The day shift nurse at the long-term care facility learns that a patient with dementia experienced sundowning late in the afternoon on the previous two days. Which action should the nurse take? a. Keep blinds open during the daytime hours. b. Provide hourly orientation to time and place. c. Have the patient take a brief mid-morning nap. d. Move the patient to a quieter room late in the afternoon.

ANS: A A likely cause of sundowning is a disruption in circadian rhythms and keeping the patient active and in daylight will help reestablish a more normal circadian pattern. Moving the patient to a different room might increase confusion. Taking a nap will interfere with nighttime sleep. Hourly orientation will not be helpful in a patient with dementia

The nurse cares for an alert, homeless older adult patient who was admitted to the hospital with a chronic foot infection. Which intervention is the most appropriate for the nurse to include in the discharge plan for this patient? a. Refer the patient to social services for further assessment. b. Teach the patient how to assess and care for the foot infection. c. Schedule the patient to return to outpatient services for foot care. d. Give the patient written information about shelters and meal sites.

ANS: A An interdisciplinary approach, including social services, is needed when caring for homeless older adults. Even with appropriate teaching, a homeless individual may not be able to maintain adequate foot care because of a lack of supplies or a suitable place to accomplish care. Older homeless individuals are less likely to use shelters or meal sites. A homeless person may fail to keep appointments for outpatient services because of factors such as fear of institutionalization or lack of transportation.

The home health nurse cares for an older adult patient who lives alone and takes several different prescribed medications for chronic health problems. Which intervention, if implemented by the nurse, would best encourage medication compliance? a. Use a marked pillbox to set up the patient's medications. b. Discuss the option of moving to an assisted living facility. c. Remind the patient about the importance of taking medications. d. Visit the patient daily to administer the prescribed medications.

ANS: A Because forgetting to take medications is a common cause of medication errors in older adults, the use of medication reminder devices is helpful when older adults have multiple medications to take. There is no indication that the patient needs to move to assisted living or that the patient does not understand the importance of medication compliance. Home health care is not designed for the patient who needs ongoing assistance with activities of daily living (ADLs) or instrumental ADLs (IADLs).

An older patient complains of having "no energy" and feeling increasingly weak. The patient has had a 12-pound weight loss over the last year. Which action should the nurse take initially? a. Ask the patient about daily dietary intake. b. Schedule regular range-of-motion exercise. c. Discuss long-term care placement with the patient. d. Describe normal changes associated with aging to the patient.

ANS: A In a frail older patient, nutrition is frequently compromised, and the nurse's initial action should be to assess the patient's nutritional status. Active range of motion may be helpful in improving the patient's strength and endurance, but nutritional assessment is the priority because the patient has had a significant weight loss. The patient may be a candidate for long-term care placement, but more assessment is needed before this can be determined. The patient's assessment data are not consistent with normal changes associated with aging.

The nurse plans to complete a thorough assessment of an older patient. Which method should the nurse use to gather the most complete information? a. Use a geriatric assessment instrument to evaluate the patient. b. Ask the patient to write down medical problems and medications. c. Interview both the patient and the primary caregiver for the patient. d. Review the patient's medical record for a history of medical problems.

ANS: A The most complete information about the patient will be obtained through the use of an assessment instrument specific to the geriatric population, which includes information about both medical diagnoses and treatments and about functional health patterns and abilities. A review of the medical record, interviews with the patient and caregiver, and written information by the patient are all included in a comprehensive geriatric assessment.

An older patient who takes multiple medications for chronic cardiac and pulmonary diseases is alert and lives with a daughter who works during the day. During a clinic visit, the patient verbalizes to the nurse that she has a strained relationship with her daughter and does not enjoy being alone all day. Which nursing diagnosis should the nurse assign as the priority for this patient? a. Risk for injury related to drug interactions b. Social isolation related to weakness and fatigue c. Compromised family coping related to the patient's many care needs d. Caregiver role strain related to need to adjust family employment schedule

ANS: A The patient's age and multiple medications indicate a risk for injury caused by interactions between the multiple drugs being taken and a decreased drug metabolism rate. Problems with social isolation, caregiver role strain, or compromised family coping are not physiologic priorities. Drug-drug interactions could cause the most harm to the patient and is therefore the priority.

The home health nurse visits an older patient with mild forgetfulness. The nurse is most concerned if which information is obtained? a. The patient tells the nurse that a close friend recently died. b. The patient has lost 10 pounds (4.5 kg) during the last month. c. The patient is cared for by a daughter during the day and stays with a son at night. d. The patient's son uses a marked pillbox to set up the patient's medications weekly.

ANS: B A 10-pound weight loss may be an indication of elder neglect or depression and requires further assessment by the nurse. The use of a marked pillbox and planning by the family for 24-hour care are appropriate for this patient. It is not unusual that an 86-year-old would have friends who have died.

The nurse manages the care of older adults in an adult health day care center. Which action can the nurse delegate to unlicensed assistive personnel (UAP)? a. Obtain information about food and medication allergies from patients. b. Take blood pressures daily and document in individual patient records. c. Choose social activities based on the individual patient needs and desires. d. Teach family members how to cope with patients who are cognitively impaired.

ANS: B Measurement and documentation of vital signs are included in UAP education and scope of practice. Obtaining patient health history, planning activities based on the patient assessment, and patient education are all actions that require critical thinking and will be done by the registered nurse.

The family of an older patient with chronic health problems and increasing weakness is considering placement in a long-term care (LTC) facility. Which action by the nurse will be most helpful in assisting the patient to make this transition? a. Have the family select a LTC facility that is relatively new. b. Obtain the patient's input about the choice of a LTC facility. c. Ask that the patient be placed in a private room at the facility. d. Explain the reasons for the need to live in LTC to the patient.

ANS: B The stress of relocation is likely to be less when the patient has input into the choice of the facility. The age of the long-term care facility does not indicate a better fit for the patient or better quality of care. Although some patients may prefer a private room, others may adjust better when given a well-suited roommate. The patient should understand the reasons for the move but will make the best adjustment when involved with the choice to move and the choice of the facility.

A patient who has severe Alzheimer's disease (AD) is being admitted to the hospital for surgery. Which intervention will the nurse include in the plan of care? a. Encourage the patient to discuss events from the past. b. Maintain a consistent daily routine for the patient's care. c. Reorient the patient to the date and time every 2 to 3 hours. d. Provide the patient with current newspapers and magazines.

ANS: B Providing a consistent routine will decrease anxiety and confusion for the patient.

Which nursing actions could the nurse delegate to a licensed practical/vocational nurse (LPN/LVN) who is part of the team caring for a patient with Alzheimer's disease (select all that apply)? a. Develop a plan to minimize difficult behavior. b. Administer the prescribed memantine (Namenda). c. Remove potential safety hazards from the patient's environment. d. Refer the patient and caregivers to appropriate community resources. e. Help the patient and caregivers choose memory enhancement methods. f. Evaluate the effectiveness of the prescribed enteral feedings on patient nutrition.

ANS: B, C LPN/LVN education and scope of practice includes medication administration and monitoring for environmental safety in stable patients. Planning of interventions such as ways to manage behavior or improve memory, referrals, and evaluation of the effectiveness of interventions require registered nurse (RN)-level education and scope of practice.

The spouse of a 67-year-old male patient with early stage Alzheimer's disease (AD) tells the nurse, "I am exhausted from worrying all the time. I don't know what to do." Which actions are best for the nurse to take next (select all that apply)? a. Suggest that a long-term care facility be considered. b. Offer ideas for ways to distract or redirect the patient. c. Teach the spouse about adult day care as a possible respite. d. Suggest that the spouse consult with the physician for antianxiety drugs. e. Ask the spouse what she knows and has considered about dementia care options.

ANS: B, C, E The stress of being a caregiver can be managed with a multicomponent approach. This includes respite care, learning ways to manage challenging behaviors, and further assessment of what the spouse may already have considered for care options. The patient is in the early stages and does not need long-term placement. Antianxiety medications may be appropriate, but other measures should be tried first.

Which nursing action will be most effective in ensuring daily medication compliance for a patient with mild dementia? a. Setting the medications up monthly in a medication box b. Having the patient's family member administer the medication c. Posting reminders to take the medications in the patient's house d. Calling the patient weekly with a reminder to take the medication

ANS: B-Having the patient's family member administer the medication Because the patient with mild dementia will have difficulty with learning new skills and forgetfulness, the most appropriate nursing action is to have someone else administer the drug.

Which intervention will the nurse include in the plan of care for a patient with moderate dementia who had an appendectomy 2 days ago? a. Provide complete personal hygiene care for the patient. b. Remind the patient frequently about being in the hospital. c. Reposition the patient frequently to avoid skin breakdown. d. Place suction at the bedside to decrease the risk for aspiration.

ANS: B-Remind the patient frequently about being in the hospital. The patient with moderate dementia will have problems with short- and long-term memory and will need reminding about the hospitalization. The other interventions would be used for a patient with severe dementia, who would have difficulty with swallowing, self-care, and immobility.

When administering the Mini-Cog exam to a patient with possible Alzheimer's disease, which action will the nurse take? a. Check the patient's orientation to time and date. b. Obtain a list of the patient's prescribed medications. c. Ask the person to use a clock drawing to indicate a specific time. d. Determine the patient's ability to recognize a common object such as a pen.

ANS: C In the Mini-Cog, patients illustrate a specific time stated by the examiner by drawing the time on a clock face. The other actions may be included in assessment for Alzheimer's disease, but are not part of the Mini-Cog exam.

Which statement, if made by an older adult patient, would be of most concern to the nurse? a. "I prefer to manage my life without much help from other people." b. "I take three different medications for my heart and joint problems." c. "I don't go on daily walks anymore since I had pneumonia 3 months ago." d. "I set up my medications in a marked pillbox so I don't forget to take them."

ANS: C Inactivity and immobility lead rapidly to loss of function in older adults. The nurse should develop a plan to prevent further deconditioning and restore function for the patient. Self-management is appropriate for independently living older adults. On average, an older adult takes seven different medications so the use of three medications is not unusual for this patient. The use of memory devices to assist with safe medication administration is recommended for older adults.

The nurse's initial action for a patient with moderate dementia who develops increased restlessness and agitation should be to a. reorient the patient to time, place, and person. b. administer a PRN dose of lorazepam (Ativan). c. assess for factors that might be causing discomfort. d. assign unlicensed assistive personnel (UAP) to stay in the patient's room.

ANS: C Increased motor activity in a patient with dementia is frequently the patient's only way of responding to factors like pain, so the nurse's initial action should be to assess the patient for any precipitating factors. Administration of sedative drugs may be indicated, but this should not be done until assessment for precipitating factors has been completed and any of these factors have been addressed. Reorientation is unlikely to be helpful for the patient with moderate dementia. Assigning UAP to stay with the patient may also be necessary, but any physical changes that may be causing the agitation should be addressed first.

An older adult patient presents with a broken arm and visible scattered bruises healing at different stages. Which action should the nurse take first? a. Notify an elder protective services agency about the possible abuse. b. Make a referral for a home assessment visit by the home health nurse. c. Have the family member stay in the waiting area while the patient is assessed. d. Ask the patient how the injury occurred and observe the family member's reaction.

ANS: C The initial action should be assessment and interviewing of the patient. The patient should be interviewed alone because the patient will be unlikely to give accurate information if the abuser is present. If abuse is occurring, the patient should not be discharged home for a later assessment by a home health nurse. The nurse needs to collect and document data before notifying the elder protective services agency.

Which hospitalized patient will the nurse assign to the room closest to the nurses' station? a. Patient with Alzheimer's disease who has long-term memory deficit b. Patient with vascular dementia who takes medications for depression c. Patient with new-onset confusion, restlessness, and irritability after surgery d. Patient with dementia who has an abnormal Mini-Mental State Examination

ANS: C This patient's history and clinical manifestations are consistent with delirium. The patient is at risk for safety problems and should be placed near the nurses' station for ongoing observation. The other patients have chronic symptoms that are consistent with their diagnoses but are not at immediate risk for safety issues.

The nurse cares for an older adult patient who lives in a rural area. Which intervention should the nurse plan to implement to best meet this patient's needs? a. Suggest that the patient move to an urban area. b. Assess the patient for chronic diseases that are unique to rural areas. c. Ensure transportation to appointments with the health care provider. d. Obtain adequate medications for the patient to last for 4 to 6 months.

ANS: C Transportation can be a barrier to accessing health services in rural areas. The patient living in a rural area may lose the benefits of a familiar situation and social support by moving to an urban area. There are no chronic diseases unique to rural areas. Because medications may change, the nurse should help the patient plan for obtaining medications through alternate means such as the mail or delivery services, not by purchasing large quantities of the medications.

The nurse admits an acutely ill, older patient to the hospital. Which action should the nurse take first? a. Speak slowly and loudly while facing the patient. b. Obtain a detailed medical history from the patient. c. Perform the physical assessment before interviewing the patient. d. Ask a family member to go home and retrieve the patient's cane.

ANS: C When a patient is acutely ill, the physical assessment should be accomplished first to detect any physiologic changes that require immediate action. Not all older patients have hearing deficits, and it is insensitive of the nurse to speak loudly and slowly to all older patients. To avoid tiring the patient, much of the medical history can be obtained from medical records. After the initial physical assessment to determine the patient's current condition, then the nurse could ask someone to obtain any assistive devices for the patient if applicable.

After change-of-shift report on the Alzheimer's disease/dementia unit, which patient will the nurse assess first? a. Patient who has not had a bowel movement for 5 days b. Patient who has a stage II pressure ulcer on the coccyx c. Patient who is refusing to take the prescribed medications d. Patient who developed a new cough after eating breakfast

ANS: D A new cough after a meal in a patient with dementia suggests possible aspiration and the patient should be assessed immediately. The other patients also require assessment and intervention, but not as urgently as a patient with possible aspiration or pneumonia.

The nurse assesses an older patient who takes diuretics and has a possible urinary tract infection (UTI). Which action should the nurse take first? a. Palpate over the suprapubic area. b. Inspect for abdominal distention. c. Question the patient about hematuria. d. Invite the patient to use the bathroom.

ANS: D Before beginning the assessment of an older patient with a UTI and on diuretics, the nurse should have the patient empty the bladder because bladder fullness or discomfort will distract from the patient's ability to provide accurate information. The patient may seem disoriented if distracted by pain or urgency. The physical assessment data are obtained after the patient is as comfortable as possible.

A patient who has just moved to a long-term care facility has a nursing diagnosis of relocation stress syndrome. Which action should the nurse include in the plan of care? a. Remind the patient that making changes is usually stressful. b. Discuss the reason for the move to the facility with the patient. c. Restrict family visits until the patient is accustomed to the facility. d. Have staff members write notes welcoming the patient to the facility.

ANS: D Having staff members write notes will make the patient feel more welcome and comfortable at the long-term care facility. Discussing the reason for the move and reminding the patient that change is usually stressful will not decrease the patient's stress about the move. Family member visits will decrease the patient's sense of stress about the relocation.

Which nursing action will be most helpful in decreasing the risk for drug-drug interactions in an older adult? a. Teach the patient to have all prescriptions filled at the same pharmacy. b. Instruct the patient to avoid taking over-the-counter (OTC) medications. c. Make a schedule for the patient as a reminder of when to take each medication. d. Have the patient bring all medications, supplements, and herbs to each appointment.

ANS: D The most information about drug use and possible interactions is obtained when the patient brings all prescribed medications, OTC medications, and supplements to every health care appointment. The patient should discuss the use of any OTC medications with the health care provider and obtain all prescribed medications from the same pharmacy, but use of supplements and herbal medications also need to be considered in order to prevent drug-drug interactions. Use of a medication schedule will help the patient take medications as scheduled but will not prevent drug-drug interactions.

The nurse performs a comprehensive geriatric assessment of a patient who is being assessed for admission to an assisted living facility. Which question is the most important for the nurse to ask? a. "Have you had any recent infections?" b. "How frequently do you see a doctor?" c. "Do you have a history of heart disease?" d. "Are you able to prepare your own meals?"

ANS: D The patient's functional abilities, rather than the presence of an acute or chronic illness, are more useful in determining how well the patient might adapt to an assisted living situation. The other questions will also provide helpful information but are not as useful in providing a basis for determining patient needs or for developing interventions for the older patient.

An older patient is hospitalized with pneumonia. Which intervention should the nurse implement to provide optimal care for this patient? a. Use a standardized geriatric nursing care plan. b. Minimize activity level during hospitalization. c. Plan for transfer to a long-term care facility upon discharge. d. Consider the preadmission functional abilities when setting patient goals.

ANS: D The plan of care for older adults should be individualized and based on the patient's current functional abilities. A standardized geriatric nursing care plan will not address individual patient needs and strengths. A patient's need for discharge to a long-term care facility is variable. Activity level should be designed to allow the patient to retain functional abilities while hospitalized and also to allow any additional rest needed for recovery from the acute process.

The nurse is concerned about a postoperative patient's risk for injury during an episode of delirium. The most appropriate action by the nurse is to a. secure the patient in bed using a soft chest restraint. b. ask the health care provider to order an antipsychotic drug. c. instruct family members to remain with the patient and prevent injury. d. assign unlicensed assistive personnel (UAP) to stay with the patient and offer reorientation.

ANS: D-assign unlicensed assistive personnel (UAP) to stay with the patient and offer reorientation.

A factor that contributes to the development of hypothermia in older adults is decreased: 1. Activity level 2. Sensory perception of cold 3. Percentage of body fat 4. Nutritional and fluid intake

Answer: 2. Sensory perception of cold Rationale: Older adults are highly susceptible to hypothermia for several reasons. Normal changes that occur with aging affect the body's ability to regulate temperature. Changes in the skin reduce the older person's ability to perceive dangerously hot or cold environments. Decreased muscle tissue, diminished peripheral circulation, reduced subcutaneous fat, and decreased metabolic rate affect the amount of heat produced and retained by the body. Page reference: 173

A nurse is conducting an education session about appropriate measures to promote sleep with an older adult who is experiencing frequent awakenings at night and then awakening early in the morning. The nurse determines that the education was successful when the client states: a) "I need to try and go to bed and get up at the same time each night." b) "I should continue to take my sleep medication for as long as I need to." c) "I should avoid coffee, but tea is okay to drink before bed." d) "I should do some mild exercises about 2 hours before bedtime."

Answer: " I need to try to go to bed and get up at the same time each night." Rationale: Sleep measures include maintaining a routine, going to bed and getting up at the same time each night, avoiding exercise 3 to 4 hours before bed, using prescribed sleep medications only for the short-term (7 to 14 days), and avoiding alcohol, nicotine, and caffeine (which tea contains).

A nurse is teaching an elderly client's family about the causes of mental impairment. The nurse sees that the teaching has been effective when the family says which of the following? a) "Alzheimer's disease (AD) is a reversible neurologic illness." b) "Delirium progressively affects cognitive function and is a chronic process." c) "Sundowning is a common problem of dementia." d) "Dementia is an acute process and develops suddenly."

Answer: "Sundowning is a common problem dementia." Rationale: A common problem in patients with dementia is sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated after dark. Dementia is chronic and usually develops gradually. AD is the most common degenerative illness and is irreversible. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment.

The nurse is assigned to care for a client age 87 years admitted to the medical unit for congestive heart failure. It is the fourth hospital day, and the response to treatment has been good. The client is no longer short of breath and the lung sounds are clearing. There is still a diet restriction of decreased sodium and fluids are limited to no more than 1000 mL per day. The nurse is preparing the client and family for discharge. The nurse's discharge education, in order to promote the older client's health, will include which instructions? Select all that apply. a) Do not use the salt shaker at meals. b) Gradually increase activities as tolerated. c) Increased stress may interfere with recovery. d) Take several naps during the day.

Answer: A, B, C Rationale: Promoting health for older adults includes ensuring adequate nutrition (e.g., low-fat diet, other diet modifications); balancing calories and activities; planning exercise as a daily activity; and educating the client that illness is a physical and emotional stress and increases the risk for complications. Taking naps will interfere with sleep at night

A nurse is reading a journal article about mood disorders in the older adult population. Which information about these conditions would the nurse expect to find? Select all that apply. a) Symptoms often mimic those of other chronic comorbidities of the older adult. b) Suicide is the most serious consequence of depression. c) The stigma associated with depression is less for older adults. d) Depression is often misdiagnosed. e) Depression is considered a normal part of aging.

Answer: A, B, D Rationale: Mood disorders (especially depression) are often unrecognized or misdiagnosed in older adults partly due to the false belief that depression is a natural reaction to illness, advanced age, or life changes that occur with age. Therefore, depression is not viewed as something that needs to be treated in the older adult. Furthermore, symptoms of depression may include poor cognitive performance, sleep problems, and lack of initiative ? symptoms commonly seen in people with multiple chronic comorbidities (such as diabetes or heart failure) or in clients with dementia or delirium, causing it to be unrecognized. Although depression is not a normal part of aging, older adults are at an increased risk of experiencing depression due to chronic illness and other age-related changes. The older adult population is also less likely to report symptoms due to the stigma attached. Suicide is the most serious consequence of depression.

Aging primarily affects the _________of drugs. a. excretion b. absorption c. metabolism d. distribution

C - Because the liver mass shrinks and hepatic blood flow and enzyme activity decrease in older adults, metabolism of drugs drops 1/2 to 2/3 of the rate of young adults. This increases the chance of drug toxicity and adverse drug events.

A nurse is preparing a presentation for a group of older adults about promoting safety while maintaining their mobility. Based on the nurse's understanding of factors placing the older adult at risk for falls, which area would the nurse most likely address? Select all that apply. a) environmental hazards b) hearing loss c) medication use d) changes in bowel function e) diminished strength

Answer: A, C, E Rationale: Multiple factors place the older adult at risk for falls, including the use of medications affecting balance, thinking, memory, and elimination; impaired vision; environmental hazards (e.g., slippery floors, throw rugs, poor lighting); decreased strength; loss of bone mass; and neurological and musculoskeletal problems. Hearing loss and changes in bowel function are not associated with an increased risk for falling.

A nurse is screening for Alzheimer's disease (AD) in patients in a long-term care facility. Which facts regarding AD are accurate? (Select all that apply.) a) Nearly half of 85-year-old adults have A b) AD accounts for about one-third of the cases of dementia in the United States. c) AD affects brain cells and is characterized by patchy areas of the brain that degenerate. d) AD primarily affects young to middle adults. e) AD is a progressively serious but not a life- threatening disease. f) Scientists estimate that more than 5 million people have AD.

Answer: A, C, F Rationale: The following facts about Alzheimer's disease (AD) are correct. Scientists estimate that more than 5 million people have AD. Nearly half of 85-year-old adults have AD. AD affects the brain cells and is characterized by patchy areas of the brain that degenerate. The first indications of AD usually occur after 60 years of age. AD is a progressively serious and ultimately fatal disorder.

The nurse is caring for an older adult client who is confused and agitated. When the client's family comes to visit the nurse asks how long the client has been confused. The family states that the client has been confused for a long time and the confusion is getting worse. The client is subsequently diagnosed with dementia. What is the most common cause of dementia in an older adult client? a) Depression b) Alzheimer's disease c) Delirium d) Excessive drug use

Answer: Alzheimer's disease Rationale: Alzheimer's disease is the most common cause of dementia in older adults. Approximately 10% of people over age 65 have Alzheimer's disease; about 50% of people over age 85 have the disease. Delirium, or acute confusion, is caused by an underlying disease and is not itself a cause of dementia. Depression is common in older adults but, in many cases, manifests itself in apathy, self-deprecation, or inertia — not dementia. Excessive drug use, commonly stemming from the client seeing multiple physicians who are unaware of drugs that other physicians have prescribed, can cause dementia. Although it is a problem among older adults, it is not as common as Alzheimer's disease.

After obtaining the health history from an older adult client, the nurse develops a plan of care and identifies a nursing diagnosis of Risk for Impaired Physical Mobility. A history of which condition would support this nursing diagnosis? Select all that apply a) Glaucoma b) Hip fracture c) Diverticulitis d) Arthritis e) Stroke

Answer: B, D, E Rationale: Some chronic conditions such as walking, driving, shopping, and exercise can negatively affect aspects of mobility. Arthritis, gait and balance disorders (caused by musculoskeletal or neurologic conditions), and cataracts are among the many health conditions that cause mobility problems.

An older adult client enjoys good overall health, but has just been diagnosed with pneumonia and has begun receiving an intravenous (IV) antibiotic. Shortly after being administered the first dose, the client pulled out his IV line and is now attempting to scale his bed rails. Which of the following phenomena most likely underlies this change in the client's cognition? a) Disorientation b) Dementia c) Delirium d) Depression

Answer: Delirium Rationale: Delirium is a temporary state of confusion that is often precipitated by drug interactions or the effects of new drugs. Dementia is rooted in organic brain changes and rarely has a sudden onset. The client is not showing signs or symptoms of depression. Disorientation is a manifestation of a problem rather than a cause.

A 78-year-old woman is status post right hip fracture after a fall. She has stopped going to her church over the past few months. She has also asked her neighbor to help her and do her gardening, an activity she previously loved. The client tells the nurse "I just don't enjoy gardening like I used to. I am always worried about falling." What would most concern the nurse regarding the client? a) Realistic caution b) Depression c) Generalized anxiety disorder d) Bipolar disorder

Answer: Depression Rationale: One sign of depression is a lack of interest in previously enjoyable activities. Further investigation is necessary to make a formal diagnosis

The nurse understands that when caring for the older adult it is important to assist in maintaining independence and self-esteem. Assisting the client to adjust to a walker or wheelchair is an example of supporting which of Erikson's developmental tasks of the older adult? a) Ego integrity and coping with reality of limitations b) Adaptation to age and preservation of self c) Functional adaptation and self-awareness d) Prevention of injury and safety in navigation

Answer: Ego integrity and coping with reality of limitations Rationale: Age does affect the older adult due to many different physiological changes, as evidenced by a decrease of cardiac output, peripheral circulation, oxygenation of blood, decreased ability to control temperature, and a slower heart rate. Ego integrity is the task of the older adult, according to Erikson, including "wholeness," emotional integration, and acceptance of physical decline. The others are not developmental tasks described by Erikson.

Erikson identified ego integrity versus despair and disgust as the last stage of human development, which begins at about 60 years of age. Which intervention would best foster older patients' ego integrity? a) Encouraging life review b) Promoting independent living c) Distracting the patient d) Praising the patient

Answer: Encourage life review Rationale: The intervention that would best foster older clients' ego integrity would be encouraging life review. Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified world-wide. In a sense, this is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Integrity versus despair and disgust would not be fostered by distracting the client, praising the client, or promoting independent living.

A nurse is making a home visit to an older adult with multiple chronic health problems. The client is alert and oriented and his cognition is intact. While talking with the client, he reveals that he thinks his son is stealing his social security checks to buy his beer and eat out all the time. The nurse interprets this statement as possibly suggesting which type of elder abuse? a) Abandonment b) Exploitation c) Emotional d) Physical

Answer: Exploitation Rationale: Exploitation involves illegally taking or misusing the funds, property, or assets of a vulnerable older adult. Physical abuse involves the infliction of pain/injury on a vulnerable older adult, the threat of inflicting such pain or injury, or depriving them of basic needs. Emotional/psychological abuse involves verbal or nonverbal actions causing mental pain, anguish, or distress on the older adult. Abandonment involves desertion of a vulnerable adult by anyone who has assumed responsibility for his care.

When caring for older adults, nurses must be aware of common conditions found in this population. Which statements accurately describe these conditions? (Select all that apply.) a) Polypharmacy is a term that is used to describe the habit of older adults to use many pharmacies to obtain their prescription drugs. b) Delirium is a permanent state of confusion occurring in older adulthood. c) Depression is a prolonged or extreme state of sadness occurring in many older adults. d) A significant percentage of older adults limit their activities because of fear of falling that might result in serious health consequences. e) As many as 50% of adults 65 years and older experience an episode of delirium during a hospitalization. f) Sundowning syndrome is a condition in which an older adult habitually becomes confused, restless, and agitated after dark.

Answer: F, C, D Rationale: Several of the statements listed are true statements. Sundowning syndrome is a condition in which an older adult habitually becomes confused, restless, and agitated after dark. Depression is a prolonged or extreme state of sadness occurring in many older adults. A significant percentage of older adults limit their activities because of fear of falling that might result in serious health consequences. There were three statements that were not true. First, delirium is not a permanent state of confusion occurring in older adulthood. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment. Polypharmacy does not look at the number of pharmacies used to obtain prescriptions but the amount of drugs prescribed by health care providers for a variety of medical conditions. Polypharmacy, the use of many medications at the same time, can pose many hazards for older adults. Complicated regimens need careful review to minimize risks and complications and maximize benefits.

An older adult client is prescribed a sleep medication. When explaining the medication to the client, the nurse would emphasize which aspect of therapy? a) rare occurrences of confusion b) need for follow-up laboratory tests c) greatest effectiveness with short term use d) minimal risk of adverse effects

Answer: Greatest effectiveness with short term use Rationale: Sleep medications may be used, but these drugs are most effective when limited to short-term use (7 to 14 days); otherwise, the medications may actually interfere with sleep and cause other adverse outcomes such as falls, confusion, and constipation. The risks for adverse effects depend on the drug prescribed. There is no need for follow up laboratory tests.

A nurse encourages residents of a long-term care facility to continue a similar pattern of behavior and activity that existed in their middle adulthood years to ensure healthy aging. This intervention is based on which aging theory? a) Disengagement theory b) Identity-continuity theory c) Life review theory d) Activity theory

Answer: Identity-continuity theory Rationale: The identity-continuity theory assumes that healthy aging is related to the older adult's ability to continue similar patterns of behavior from young and middle adulthood. Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified world- wide. Disengagement theory, maintained that older adults often withdraw from usual roles and become more introspective and self-focused. This withdrawal was theorized as intrinsic and inevitable, necessary for successful aging, and beneficial for both the person and for society.

The nurse practitioner is examining a 55-year-old female client. Which of the following findings would be uncommon for this age group? a) Presbyopia occurs b) Lower extremity pulses are weak c) Agility gradually decreases d) Menopause occurs

Answer: Lower extremity pulses are weak. Rationale: Normal physiologic changes of the middle-aged adult do not include peripheral pulses becoming weak and not always palpable. The other options can be seen in a middle-aged adult.

A nurse is preparing a presentation for families who are caring for older adults at home. Which information would the nurse most likely include about an older adult's cognition? a) Delirium is more common in middle-age adults. b) Many older adults retain full cognitive function into advanced age. c) Aging normally leads to impairments in judgment and insight. d) Dementia is considered a normal part of aging.

Answer: Many older adults retain full cognitive function into advanced age. Rationale: Many older adults retain full cognitive (thinking) function into advanced age. Dementia is not a normal part of aging. Older adults experience higher rates of delirium as compared to younger adults. Although some older adults may experience impairments in judgment and insight, this is not a normal change.

A male client reports chronic insomnia. Which medication would the nurse not want to administer to the client? a) Nasal decongestant for an upper respiratory infection b) Beta blocker for blood pressure control c) Diuretic in the morning for hypertension d) Acetaminophen for postoperative pain

Answer: Nasal decongestant for an upper respiratory infection Rationale: Decongestants can worsen insomnia in the older adult.

An 80-year-old client tells the nurse that he has been dizzy since starting to take an herbal remedy for arthritis in addition to prescribed medications. The nurse recognizes that the client may be experiencing the effects of which of the following? a) Fluid volume overload b) Polypharmacy c) Cascade iatrogenesis d) Sleep disorder

Answer: Polypharmacy Rationale: Polypharmacy, the use of many medications at the same time, can pose many hazards for older adults. Alternative therapies, such as herbal remedies, have the potential to interact with prescribed drugs. Fluid volume overload and sleep disorders are not the cause of dizziness. Cascade iatrogenesis is a sequence of adverse events in a frail, older adult.

An 85-year-old client's daughter calls the nurse and states her father is recently having periods of confusion, is unable to dress himself, and is having periods of incontinence. Which of the following should the nurse do first? a) Make arrangements for the client to move to an extended-care facility b) Perform a SPICES assessment c) Teach the daughter how to use reminiscence as a therapy d) Schedule an appointment for a physical examination

Answer: Schedule an appointment for a physical examination Rationale: Drug interactions, circulatory or metabolic problems, nutritional deficiencies, or a worsening illness are likely causes for confusion and changes in function, thus a physical examination is indicated. Moving to an extended-care facility is premature until physical causes have been examined. Reminiscence therapy, a way for older adults to facilitate adaptation by reliving past experiences, is used for psychosocial development. A SPICES (sleep problems, problems with eating and feeding, incontinence, confusion, evidence of falls, and skin breakdown) assessment is used to identify problems that can lead to negative outcomes in the elderly client. Although it may be useful in this client, the priority is finding the cause for the physical changes

In a report, the night nurse tells the incoming nurse that one client with dementia has sundowning syndrome. Which of the following nursing diagnoses would be most appropriate for this client? a) Sleep deprivation b) Grieving c) Social isolation d) Noncompliance

Answer: Sleep deprivation Rationale: A common problem in clients with dementia is sundowning syndrome in which an older adult habitually becomes confused, restless, and agitated after dark and does not sleep. Implementing the nursing diagnosis of sleep deprivation will help the client obtain adequate sleep at night and awaken refreshed. Social isolation, grieving, and noncompliance are diagnoses that could be related to dementia but not sundowning.

In a report, the night nurse tells the incoming nurse that one client with dementia has sundowning syndrome. Which of the following nursing diagnoses would be most appropriate for this client? a) Sleep deprivation b) Noncompliance c) Grieving d) Social isolation

Answer: Sleep deprivation Rationale: A common problem in clients with dementia is sundowning syndrome in which an older adult habitually becomes confused, restless, and agitated after dark and does not sleep. Implementing the nursing diagnosis of sleep deprivation will help the client obtain adequate sleep at night and awaken refreshed. Social isolation, grieving, and noncompliance are diagnoses that could be related to dementia but not sundowning.

A nurse arrives at the home of an older adult client. The agency was called because a neighbor noticed that the client was home alone. The nurse finds the client alone in the living room. When asked about the client's daughter who lives there and has been caring for her, the client says, "She went on vacation for about a month. She'll be back soon." Further assessment reveals that there are no other family members or services currently involved. The nurse would identify this situation as: a) emotional abuse. b) neglect. c) abandonment. d) exploitation.

Answer: abandonment Rationale: The client is alone and without any support or caregivers. Therefore, abandonment, which is the desertion or a vulnerable older adult by anyone who has assumed responsibility for that adult's care, would apply. Exploitation involves illegally taking or misusing funds, property, or assets of a vulnerable older adult. Neglect involves refusal or failure by those responsible to provide food, shelter, protection, or health care for a vulnerable older adult. Emotional abuse involves verbally or nonverbally causing mental pain, anguish or distress on the older adult.

A 76-year-old man is recovering from a myocardial infarction. In regards to his recovery, it is important for the nurse to: a) have a male counterpart address sexuality. b) instruct him to eliminate sex for 1 month. c) address any questions about sexuality. d) refer the client to a therapist.

Answer: address any questions about sexuality Rationale: With regard to sexuality, the nurse should spend time with the older adult; use clear, easy-to-understand language; help the client feel more comfortable talking about sex; be open minded and talk openly; listen, and encourage discussion; give advice or suggestions as needed; and understand that sex is not just for the young.

A nurse is providing care to an older adult who is experiencing delirium. Which risk factors would the nurse identify as being most common? Select all that apply. a) poor nutrition b) trauma c) sleep deprivation d) advanced age e) pre-existing cognitive impairment

Answer: advanced age; pre-existing cognitive impairment Rationale: Although trauma, poor nutrition, and sleep deprivation are risk factors for delirium, advanced age and preexisting cognitive impairment are the most common.

A nurse is preparing a presentation for a group of families who are providing care to their older adult parents. One of the family members asks the nurse, "How common is Alzheimer's disease?" The nurse responds by telling the group that after age 65, the prevalence of Alzheimer's disease: a) decreases by 10 for every year. b) triples every year. c) doubles every 5 years. d) declines but the rate is unknown.

Answer: doubles every year Answer: According to the Alzheimer's Association, the prevalence of Alzheimer's disease doubles every 5 years beyond age 65.

An elderly patient has come in to the clinic for her yearly physical. The patient tells the nurse that she is having difficulty with bowel movements. What intervention could the nurse suggest? a) Increasing caloric intake b) Adequate privacy c) Stress reduction d) Increasing intake of water

Answer: increasing intake of water Rationale: Age-related changes, as well as additional risk factors such as disease and the effects of medications, can result in a negative impact on function. Constipation is a common problem in aged people. The nurse should assess the patient for frequent laxative and antacid use, which is associated with constipation. The patient should eat high-fiber foods, drink eight to 10 glasses of water daily, and establish regular bowel habits. Interventions the nurse would not suggest are stress reduction, eating more, or insuring adequate privacy.

While working with populations of older adult women, you advocate for equity for older women in the health care system and federal research funding. Older adult women are considered a special population primarily because they A. frequently live alone in rural areas with limited access to health care. B. have fewer financial resources than men. C. have a lower life expectancy than men. D. more often experience age-related cognitive impairment.

B Many factors have a significant negative impact on the health of the older woman. Many are directly related to reduced financial resources and the greater longevity experienced by women. Older women often experience disparities, including unequal access to quality health care. Reference: 66

What should be included when planning care for an older adult? a. patient priorities should be the only focus of care. b. additional time related to declining energy reserves c. reduction of disease and problems should be the focus. d. tobacco cessation will help the patient cope with other illnesses.

B - Additional time is required with older patients with declining energy reserves. Patient priorities are considered to best meet the patient needs but will not be the only focus of care. Focusing on strengths and abilities as well as physical and mental status will facilitate goal setting to reduce disease or problems. As with all patients, safety is a primary concern, and decreasing tobacco use will improve all of the patient's body functioning.

A 60-year-old female patient has had increased evidence of dementia and physical deterioration. What would be the best assistance to recommend to her caregiver husband who is exhausted? a. long-term care b. adult day care c. home health care d. homemaker services

B - Adult day care provides social, recreational, and health-related services in a safe, community-based environment that would keep this patient safe and decrease the stress on the husband. Long-term care is used when the patient has rapid deterioration, the caregiver is unable to continue to provide care, and there is an alteration in or loss of the family support system. Home health care is used when there is supportive caregiver involvement for patients with health needs. Homemaker services provide services, but do not care for the patient.

A 59-year-old female patient, who has frontotemporal lobar degeneration, has difficulty with verbal expression. One day she walks out of the house and goes to the gas station to get a soda but does not understand that she needs to pay for it. What is the best thing the nurse can suggest to this patient's husband to keep the patient safe during the day while the husband is at work? A) Assisted living B) Adult day care C) Advance directives D) Monitor for behavioral changes

B) Adult day care Rationale: To keep this patient safe during the day while the husband is at work, an adult day care facility would be the best choice. This patient would not need assisted living. Advance directives are important but are not related to her safety. Monitoring for behavioral changes will not keep her safe during the day.

When providing community health care teaching regarding the early warning signs of Alzheimer's disease, which signs should the nurse advise family members to report (select all that apply)? A) Misplacing car keys B) Losing sense of time C) Difficulty performing familiar tasks D) Problems with performing basic calculations E) Becoming lost in a usually familiar environment

B) Losing sense of time C) Difficulty performing familiar tasks D) Problems with performing basic calculations E) Becoming lost in a usually familiar environment Rationale: Difficulty performing familiar tasks, problems with performing basic calculations, losing sense of time, and becoming lost in a usually familiar environment are all part of the early warning signs of Alzheimer's disease. Misplacing car keys is a normal frustrating event for many people.

The nurse in the long-term care facility cares for a 70-year-old man with severe (late-stage) dementia who is undernourished and has problems chewing and swallowing. What should the nurse include in the plan of care for this patient? A) Turn on the television to provide a distraction during meals. B) Provide thickened fluids and moist foods in bite-size pieces. C) Limit fluid intake during scheduled meals to prevent aspiration. D) Allow the patient to select favorite foods from the menu choices.

B) Provide thickened fluids and moist foods in bite-size pieces. Rationale: If patients with dementia have problems chewing or swallowing, pureed foods, thickened liquids, and nutritional supplements should be provided. Foods that are easy to swallow are moist and should be in bite-size pieces. Distractions at mealtimes, including the television, should be avoided. Fluids should not be limited but offered frequently; fluids should be thickened. Patients with severe (late-stage) dementia have difficulty understanding words and would not have the cognitive ability to select menu choices.

The patient has been diagnosed with the mild cognitive impairment stage of Alzheimer's disease. What nursing interventions should the nurse expect to use with this patient? A) Treat disruptive behavior with antipsychotic drugs. B) Use a calendar and family pictures as memory aids. C) Use a writing board to communicate with the patient. D) Use a wander guard mechanism to keep the patient in the area.

B) Use a calendar and family pictures as memory aids. Rationale: The patient with mild cognitive impairment will have problems with memory, language, or another essential cognitive function that is severe enough to be noticeable to others but does not interfere with activities of daily living. A calendar and family pictures for memory aids will help this patient. This patient should not yet have disruptive behavior or get lost easily. Using a writing board will not help this patient with communication.

The nurse works with elderly clients in a wellness screening clinic on a weekly basis. Which of the following statements made by the nurse is the most therapeutic regarding their mobility? A. "Your shoulder pain is normal for your age." B. "Continue to exercise your joints regularly to your tolerance level." C. "Why don't you begin walking 3 to 4 miles a day, and we'll evaluate how you feel next week." D. "Don't worry about taking that combination of medications since your doctor has prescribed them."

B. "Continue to exercise your joints regularly to your tolerance level."

Which of the following statements, made by the daughter of an older adult client concerning bringing her mother home to live with her family, presents the greatest concern for the nurse? A. "If this doesn't work out, she can always go to live with my sister." B. "I don't think she will react very well to me making decisions for her." C. "I'm afraid that mom will be depressed and miss her home." D. "My children will just have to adjust to having their grandmother with us."

B. "I don't think she will react very well to me making decisions for her."

Which of the following statements made by a nurse reflects the best understanding of the health value of conducting a blood pressure (BP) screening at a senior citizens centers health fair? A. "This is a high risk group, so assessing BP allows us to identify clients at risk and send them for treatment." B. "Older adults enjoy health fairs, so it's a good place to screen substantial numbers of clients for hypertension." C. "Hypertension doesn't present symptoms early on, so screening elder adults is a wonderful preventive measure." D. "Blood pressure problems are common among this group, so it's a good way to monitor the effectiveness of their medications."

B. "Older adults enjoy health fairs, so it's a good place to screen substantial numbers of clients for hypertension."

A parish nurse for a Catholic church provides a free blood pressure screening the first Sunday of every month. This is what level of prevention? A) Tertiary prevention B) Primary prevention C) Secondary prevention D) Quaternary prevention

B. Primary prevention is true prevention that precedes disease and is aimed at clients considered physically and emotionally healthy. Secondary prevention involves individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Tertiary prevention occurs when a defect or disability is permanent and irreversible, and the aim is to reduce negative impacts and complications. Quaternary prevention is not a recognized term.

A 76-year-old adult female is brought to a neighborhood client after being found wandering around the local park. The client appears disheveled and reports being hungry. Which of the following assessment and interview findings would cause the nurse to suspect elder abuse? (Select all that apply.) A. Falls asleep in the examination room B. Repeatedly states, "Don't hurt me." C. Chafing around wrists and ankles D. Bruises in various stages of healing

B. Repeatedly states, "Don't hurt me." C. Chafing around wrists and ankles D. Bruises in various stages of healing

Which information obtained by the home health nurse when making a visit to an 88-year-old with mild forgetfulness is of the most concern? A. The patient's son uses a marked pillbox to set up the patient's medications weekly. B. The patient has lost 10 pounds (4.5 kg) during the last month. C. The patient is cared for by a daughter during the day and stays with a son at night. D. The patient tells the nurse that a close friend recently died.

B. The patient has lost 10 pounds (4.5 kg) during the last month. Rationale: A 10-pound weight loss may be an indication of elder neglect or depression and requires further assessment by the nurse.

The family of the nurse's confused, ambulatory client insists that all four side rails be up when the client is alone. The best way to handle this situation is to: A) Ask them to stay with the client at all times. B) Inform them of the risks associated with side rail use. C) Thank them for being conscientious and put the four rails up. D) Provide the client with a one-to-one sitter while the side rails are up.

B. The use of side rails when a client is disoriented will cause more confusion and further injury. A confused client who is determined to get out of bed may attempt to climb over the side rail or climb out at the foot of the bed, and may fall or experience other injury. After the nurse has this discussion with the family, then the nurse should perform a thorough nursing assessment and develop a plan to ensure the client's safety.

A patient's family member is considering having her mother placed in a nursing center. You have talked with the family before and know that this is a difficult decision. Which of the following criteria would you recommend in choosing a nursing center? (Select all that apply.) A. The center should be clean, and rooms should look like a hospital room. B. There should be adequate staffing on all shifts. C. Social activities should be available for all residents. D. Three meals should be served daily with a set menu and serving schedule. E. Family involvement in care planning and assisting with physical care is necessary.

B. There should be adequate staffing on all shifts. C. Social activities should be available for all residents. E. Family involvement in care planning and assisting with physical care is necessary. Adequate staffing, provision of social activities, and active family involvement are essential. Meals should be high quality with options for what to eat when it is served. A nursing center should be clean, but it should look like a person's home.

A client says, "I've noticed how many people are out walking in my neighborhood. Is walking good for you?" What is the best response to help the client through the stages of change toward regular exercise? A) "Walking is OK. I really think running is better." B) "Yes, walking is great exercise. Do you think you could go for a 5-minute walk this next week?" C) "Yes, I want you to begin walking. Walk for 30 minutes every day and start eating more fruits and vegetables, too." D) "They probably aren't walking fast enough or far enough. You need to spend at least 45 minutes walking if you are going to do any good."

B. This option supports the preparation stage in which the client is beginning to consider making small changes. The other options are not good ones for this client.

When caring for the older adult, it is important to: Student Response Value Correct Answer Feedback A. Repeat oneself often because older adults are forgetful. B. Treat the client as an individual with a unique history of his or her own. C. Be aware that older adults are no longer interested in sex. D. Disregard the older adult's experiences because older people are too old-fashioned to be of value today.

B. Treat the client as an individual with a unique history of his or her own.

Which option accurately reflects the number of U.S. residents expected to be 65 year or older by 2030? A. 1 in 3 B. 1 in 4 C. 1 in 5 D. 1 in 6

C About 36 million people, or 12.4% of the population, are 65 years old or older. Almost 1 in U.S. residents is expected to be 65 or older by the year 2030. Reference: 65

You are taking the blood pressure of an older man at the senior center when you notice large bruises on both of his upper arms. When you question him about the cause of the bruises, he responds, "I must have bumped myself." What action should you take? A. Ask the patient if anyone in his family has been mistreating him. B. Report the finding to the state agency responsible for elder abuse. C. Ask the patient to describe his living situation and usual activities. D. Reassure the patient that information that he tells you will be kept confidential.

C The nursing approach to older, community-dwelling adults includes a thorough history and physical examination that includes screening for mistreatment during each clinical encounter. You should follow the organization's protocols for elder mistreatment screening and intervention. Reference: 70

A characteristic of a chronic illness is that (select all that apply): a. has reversible pathologic changes b. has a consistent, predictable clinical course c. results in permanent deviation from normal d. is associated with many stable and unstable phases e. always starts with an acute illness and then progresses slowly

C and D - The following are characteristics of chronic illness: permanent impairments or deviations from normal, irreversible pathologic changes, residual disability, requirements for special rehabilitation, and need for long-term medical or nursing management (or both). Chronic illness may have stable and unstable periods.

Benzodiazepines are indicated in the treatment of cases of delirium that have which cause? A) Polypharmacy B) Cerebral hypoxia C) Alcohol withdrawal D) Electrolyte imbalances

C) Alcohol withdrawal Rationale: Benzodiazepines can be used to treat delirium associated with sedative and alcohol withdrawal. However, these drugs may worsen delirium caused by other factors and must be used cautiously. Polypharmacy, cerebral hypoxia, and electrolyte imbalances are not treated with benzodiazepines.

Which nursing intervention is most appropriate when caring for patients with dementia? Avoid direct eye contact. Lovingly call the patient "honey" or "sweetie." Give simple directions, focusing on one thing at a time. Treat the patient according to his or her age-related behavior.

C) Give simple directions, focusing on one thing at a time. Rationale: When dealing with patients with dementia, tasks should be simplified, giving directions using gestures or pictures and focusing on one thing at a time. It is best to treat these patients as adults, with respect and dignity, even when their behavior is childlike. The nurse should use gentle touch and direct eye contact. Calling the patient "honey" or "sweetie" can be condescending and does not demonstrate respect.

Unlicensed assistive personnel (UAP) working for a home care agency report a change in the alertness and language of an 82-year-old female patient. The home care nurse plans a visit to evaluate the patient's cognitive function. Which assessment would be most appropriate? A) Glasgow Coma Scale (GCS) B) Confusion Assessment Method (CAM) C) Mini-Mental State Examination (MMSE) D) National Institutes of Health Stroke Scale (NIHSS)

C) Mini-Mental State Examination (MMSE) Rationale: The MMSE is a commonly used tool to assess cognitive function. Cognitive testing is focused on evaluating memory, ability to calculate, language, visual-spatial skills, and degree of alertness. The CAM is used to assess for delirium. The GCS is used to assess the degree of impaired consciousness. The NIHSS is a neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.

An assisted living facility has provided its clients with an educational program on safe administration of prescribed medications. Which statement made by an older-adult client reflects the best understanding of safe self-administration of medications? A. "I don't seem to have problems with side effects, but I'll let my doctor know if something happens." B. "I'm lucky since my daughter is really good about keeping up with my medications." C. "I'll be sure to read the inserts and ask the pharmacist if I don't understand something." D. "It shouldn't be too hard to keep it straight since I don't have any really serious health issues."

C. "I'll be sure to read the inserts and ask the pharmacist if I don't understand something."

When developing the plan of care for an older adult who is hospitalized for an acute illness, the nurse should A. use a standardized geriatric nursing care plan. B. plan for likely long-term-care transfer to allow additional time for recovery. C. consider the preadmission functional abilities when setting patient goals. D. minimize activity level during hospitalization.

C. consider the preadmission functional abilities when setting patient goals. Rationale: The plan of care for older adults should be individualized and based on the patients current functional abilities. A standardized geriatric nursing care plan is unlikely to address individual patient needs and strengths. A patients need for discharge to a long-term-care facility is variable. Activity level should be designed to allow the patient to retain functional abilities while hospitalized and also to allow any additional rest needed for recovery from the acute process.

Which of the following statements made by an older-adult client poses the greatest concern for the nurse conducting an assessment regarding the clients adjustment to the aging process? A. "I use to enjoy dancing and jogging so much, but now I have arthritis in my knees so that it's hard to even walk." B. "I've given my grandchildren money for college so they can live a better life than I had." C. "Growing old certainly presents all sorts of challenges. I wish I knew then what I know now." D. "As I age I've found its harder to do the things I love doing, but I guess it will all be over soon enough."

D. "As I age I've found its harder to do the things I love doing, but I guess it will all be over soon enough."

Which of the following statements accurately reflects data that the nurse should use in planning care to meet the needs of the older adult? A. 50% of older adults have two chronic health problems. B. Cancer is the most common cause of death among older adults. C. Nutritional needs for both younger and older adults are essentially the same. D. Adults older than 65 years of age are the greatest users of prescription medications.

D. Adults older than 65 years of age are the greatest users of prescription medications. Rationale: Approximately two thirds of older adults use prescription and nonprescription drugs with one third of all prescriptions being written for older adults

The nurse is setting up an education session with an 85-year-old patient who will be going home on anticoagulant therapy. Which strategy would reflect consideration of aging changes that may exist with this patient? A. Show a colorful video about anticoagulation therapy. B. Present all the information in one session just before discharge. C. Give the patient pamphlets about the medications to read at home. D. Develop large-print handouts that reflect the verbal information presented.

D. Develop large-print handouts that reflect the verbal information presented. Rationale: Option D addresses altered perception in two ways. First, by using visual aids to reinforce verbal instructions, one addresses the possibility of decreased ability to hear high-frequency sounds. By developing the handouts in large print, one addresses the possibility of decreased visual acuity. Option A does not allow discussion of the information; furthermore, the text and print may be small and difficult to read and understand.

Which of the following interventions should be taken to help an older client to prevent osteoporosis? A. Decrease dietary calcium intake. B. Increase sedentary lifestyles C. Increase dietary protein intake. D. Encourage regular exercise.

D. Encourage regular exercise. Rationale: Key word in question is prevent Weight-bearing exercises helps to fight off degeneration of bone in osteoporosis

During the night shift a client is found wandering the hospital halls looking for a bathroom. The nurse's initial intervention would be to: A) Insert a urinary catheter. B) Ask the physician to order a restraint. C) Assign a staff member to stay with the client. D) Provide scheduled toileting during the night shift.

D. Providing scheduled toileting during the night makes it less likely that a client will wander while being confused and ensures staff presence to decrease confusion at the times when the client is away from bed. Inserting a urinary catheter is not necessary. Assigning a staff member to stay with the client might not be necessary if the scheduled toileting is successful. Restraints are unnecessary in this case..

During the nurse's assessment of a 56-year-old man, he reports increased alcohol consumption because of stress at work. One of the expected outcomes for this client will be to: A) Decrease stress in his life. B) Teach him ways to promote sleep. C) Decrease his alcohol intake during times of stress. D) Provide the client with information about stress management classes.

D. Resources for stress management and sleep promotion can help accomplish reduced alcohol intake during times of stress in the client's life. Management of stress is the expectation, but decreasing stress may not be possible.

The nurse in a diabetic clinic conducts monthly seminars for diabetic clients. During these seminars, the importance of taking insulin as directed to prevent diabetic complications is emphasized. This is considered which level of preventive care? A) Illness prevention B) Tertiary prevention C) Primary prevention D) Secondary prevention

D. Secondary prevention is prevention geared toward individuals who are already experiencing health problems or illness and who are at risk of experiencing complications or a worsening of their condition.

b, e, f

Which of the following are normal age related physiological changes? Select all that apply a. increased heart rate b. decline in visual acuity c. decreased respiratory rate d. decline in long term memory e. increased susceptibility to urinary tract infections f. increased incidence of awakening after sleep onset

e, f, h, i

Which of the following assessment findings would alert the nurse to possible elder mistreatment (select all that apply)? e) Agitation f) Depression g) Weight gain h) Weight loss i) Hypernatremia

a

The home care nurse is visiting an older female client whose husband died 6 months ago. Which behavior by the client indicates ineffective coping? a. neglecting her personal grooming b. looking at old snapshots of her family c. participating in a senior citizens' program d. visiting her husband's grave once a month

c

The home health nurse is visiting a client for the first time. While assessing the client's medication, it is noted that there are at least 19 prescriptions and several OTC medications that the client has been taking. Which intervention should the nurse take first? a. check for drug-drug interactions b. determine whether there are any adverse side effects c. determine whether there are medication duplications d. call the prescribing physician and report any polypharmacy

d

The visiting nurse observes that the older male client is confined by his daughter in law to his room. When the nurse suggests that he walk to the den and join the family, he says, I'm in everyone's way; my daughter in law needs me to stay here. The most important action for the nurse to take is to: a. say nothing, because it is best for the nurse to remain neutral and wait to be asked for help b. Suggest to the client and daughter in law that they consider a nursing home for the client c. say to the daughter in law, confining your father in law to his room is inhuman d. suggest appropriate resources to the client and daughter in law, such as respite care and a senior citizen's center.

A patient with mild dementia has a new prescription for donepezil (Aricept). Which nursing action will be most effective in ensuring compliance with the medication? a. Having the patient's spouse administer the medication b. Setting the medications up weekly in a medication box c. Calling the patient daily with a reminder to take the medication d. Posting reminders to take the medications in the patient's house

a. Having the patient's spouse administer the medication Because the patient with mild dementia will have difficulty with learning new skills and forgetfulness, the most appropriate nursing action is to have someone else administer the drug. The other nursing actions will not be as effective in ensuring that the patient takes the medications.

When assessing a patient with Alzheimer's disease (AD) who is being admitted to a long-term care facility, the nurse learns that the patient has had several episodes of wandering away from home. Which nursing action will the nurse include in the plan of care? a. Place the patient in a room close to the nurses' station. b. Ask the patient why the wandering episodes have occurred. c. Have the family bring in familiar items from the patient's home. d. Reorient the patient to the new living situation several times daily.

a. Place the patient in a room close to the nurses' station. Patients at risk for problems with safety require close supervision. Placing the patient near the nurse's station will allow nursing staff to observe the patient more closely. The use of "why" questions is frustrating for patients with AD because they are unable to understand clearly or verbalize the reason for wandering behaviors. Because of the patient's short-term memory loss, reorientation will not help prevent wandering behavior. Because the patient had wandering behavior at home, familiar objects will not prevent wandering.

A patient who is hospitalized with pneumonia is disoriented and confused 2 days after admission. Which information obtained by the nurse about the patient indicates that the patient is experiencing delirium rather than dementia? a. The patient was oriented and alert when admitted. b. The patient's speech is fragmented and incoherent. c. The patient is disoriented to place and time but oriented to person. d. The patient has a history of increasing confusion over several years.

a. The patient was oriented and alert when admitted. The onset of delirium occurs acutely. The degree of disorientation does not differentiate between delirium and dementia. Increasing confusion for several years is consistent with dementia. Fragmented and incoherent speech may occur with either delirium or dementia.

An outcome for an older adult patient living alone is to be free from falls. Which of these statements by a patient indicates that teaching on safety concerns has been effective? a. "I'll leave my throw rugs in place so that my feet won't touch the cold tile." b. "I'll take my time getting up from the bed or chair." c. "I should wear my favorite smooth bottom socks to protect my feet when walking around." d. "I will have my son dim the lighting outside to decrease the glare in my eyes."

b. "I'll take my time getting up from the bed or chair."

The home health nurse visits a 40 yo patient with metastatic breast cancer who is receiving palliative care. The patient is experincing pain 7-10. In prioritizing activities for the visit, the nurse would do which first? a. Auscultate for breath sounds b. Administer PRN pain medication c. Check pressure points for skin breakdown d. Ask family about patient's food and fluid intake.

b. Administer PRN pain medication Meeting the patient's physiological safety needs is the priority. Physical care focuses on the needs for oxygen, nutrition, pain relief, mobilty, elimination, and skin care. The paatient is not experiencing oxygenation problem. the priority is to treat the severe pain with pain medication.

Which statement(s) accurately describe(s) mild cognitive impairment (select all that apply)? a. Always progresses to AD b. Caused by variety of factors and may progress to AD c. Should be aggressively treated with acetylcholinesterase drugs d. Caused by vascular infarcts that, if treated, will delay progression to AD e. Patient is usually not aware that there is a problem with his or her memory

b. Caused by variety of factors and may progress to AD Rationale: Although some individuals with mild cognitive impairment (MCI) revert to normal cognitive function or do not go on to develop Alzheimer's disease (AD), those with MCI are at high risk for AD. No drugs have been approved for the treatment of MCI. A person with MCI is often aware of a significant change in memory.

A 67 yo woman was recently diagnosed with inoperable pancreatic cancer. Before the diagnosis she was very active in her neighoborhood association. Her husband is concerned because his wife is staying home and missing her usual community activities. Which common EOL psychologic manifestation is she most likely demonstrating? a. Peacefullness b. Decreased socialization c. Decreased decision making d. Anxiety about unfinished business

b. Decreased socialization Decreased socialization is a common psychosocial manifestation of approaching death.

Which intervention will the nurse include in the plan of care for a patient who has late-stage Alzheimer's disease (AD)? a. Encourage the patient to discuss events from the past. b. Maintain a consistent daily routine for the patient's care. c. Reorient the patient to the date and time every 2 to 3 hours. d. Provide the patient with current newspapers and magazines.

b. Maintain a consistent daily routine for the patient's care. Providing a consistent routine will decrease anxiety and confusion for the patient. In late-stage AD, the patient will not remember events from the past. Reorientation to time and place will not be helpful to the patient with late-stage AD, and the patient will not be able to read.

The spouse of a male patient with early stage Alzheimer's disease (AD) tells the nurse, "I am just exhausted from the constant worry. I don't know what to do." Which action is best for the nurse to take next (select all that apply)? a. Suggest that a long-term care facility be considered. b. Offer ideas for ways to distract or redirect the patient. c. Suggest that the spouse consult with the physician for antianxiety drugs. d. Educate the spouse about the availability of adult day care as a respite. e. Ask the spouse what she knows and has considered about dementia care options.

b. Offer ideas for ways to distract or redirect the patient. d. Educate the spouse about the availability of adult day care as a respite. e. Ask the spouse what she knows and has considered about dementia care options. The stress of being a caregiver can be managed with a multicomponent approach. This includes respite care, learning ways to manage challenging behaviors, and further assessment of what the spouse may already have considered. The patient is in the early stages and does not need long-term placement. Antianxiety medications may be appropriate but other measures should be tried first.

When developing a plan of care for a hospitalized patient with moderate dementia, which intervention will the nurse include? a. Provide complete personal hygiene care for the patient. b. Remind the patient frequently about being in the hospital. c. Reposition the patient frequently to avoid skin breakdown. d. Place suction at the bedside to decrease the risk for aspiration.

b. Remind the patient frequently about being in the hospital. The patient with moderate dementia will have problems with short- and long-term memory and will need reminding about the hospitalization. The other interventions would be used for a patient with severe dementia, who would have difficulty with swallowing, self-care, and immobility.

Which action will the nurse in the outpatient clinic include in the plan of care for a patient with mild cognitive impairment (MCI)? a. Suggest a move into an assisted living facility. b. Schedule the patient for more frequent appointments. c. Ask family members to supervise the patient's daily activities. d. Discuss the preventive use of acetylcholinesterase medications.

b. Schedule the patient for more frequent appointments. Ongoing monitoring is recommended for patients with MCI. MCI does not interfere with activities of daily living, acetylcholinesterase drugs are not used for MCI, and an assisted living facility is not indicated for MCI.

An elderly patient asks the nurse what contributes most to healty aging. The best response would be. (select all that apply) a. regular exercise at least 90 min per day b. a nutritious diet with plenty of fruits and vegetables c. a strong support system d. involvement in community activites

b. a nutritious diet with plenty of fruits and vegetables c. a strong support system d. involvement in community activites

Examples of primary prevention stragegies include a. colonoscopy at age 50 b. avoidance of tobacco products. c. intake of a diet low in saturated fat in a person with high cholesterol. d. teaching the important of exercise to a patient with hypertension.

b. avoidence of tobacco produts. Primary prevention refers to measures such as poper diet, suitable exercise and timely immunizations that prevent the occurence of a specific disease.

The early stage of AD is characterized by a. no noticeable change in behavior. b. memory problems and mild confusion. c. increased time spent sleeping or in bed. d. incontinence, agitation, and wandering behavior.

b. memory problems and mild confusion. Rationale: An initial sign of AD is a subtle deterioration in memory.

A 70-year-old patient who suffers from worsening dementia is no longer able to live alone. When discussing health care services and possible long-term living arrangements with the patient's only son, what should the nurse suggest? a. An apartment setting with neighbors close by b. Having the patient utilize weekly home health visits c. A nursing center because home care is no longer safe d. That placement is irrelevant because the patient is retreating to a place of inactivity

c. A nursing center because home care is no longer safe

When comparing developmental tasks of middle-aged persons versus older adults, what should the nurse infer? a. Learning to cope with loss is most common during the middle adult years. b. After age 65, most older adults age both biologically and psychologically the same way. c. All older adults will need nursing assistance to deal with loss. d. Older adults fear and resent retirement as a disruption of their lifestyle

c. All older adults will need nursing assistance to deal with loss.

Which teaching strategy is best to utilize with older adult patients? a. Provide several topics of discussion at once to promote independence and making choices. b. Avoid uncomfortable silences after questions by helping patients complete their statements. c. Ask patients to recall past experiences that correspond with their interests. d. Speak in a high pitch to help patients hear better.

c. Ask patients to recall past experiences that correspond with their interests.

The newly admitted patient has moderate AD. What does the nurse know this patient will need help with? a. Eating b. Walking c. Dressing d. Self-care activities

c. In the moderate stage of AD, the patient may need help with getting dressed. In the severe stage, patients will be unable to dress or feed themselves and are usually incontinent.

During the morning change-of-shift report at the long-term care facility, the nurse learns that the patient with dementia has had sundowning. Which nursing action should the nurse take while caring for the patient? a. Provide hourly orientation to time of day. b. Move the patient to a quieter room at night. c. Keep blinds open during the daytime hours. d. Have the patient take a brief mid-morning nap.

c. Keep blinds open during the daytime hours. The most likely cause of sundowning is a disruption in circadian rhythms and keeping the patient active and in daylight will help to reestablish a more normal circadian pattern. Moving the patient to a different room might increase confusion. Taking a nap will interfere with nighttime sleep. Hourly orientation will not be helpful in a patient with memory difficulties.

When teaching the children of a patient who is being evaluated for Alzheimer's disease (AD) about the disorder, the nurse explains that a. the most important risk factor for AD is a family history of the disorder. b. new drugs have been shown to reverse AD dramatically in some patients. c. a diagnosis of AD can be made only when other causes of dementia have been ruled out. d. the presence of brain atrophy detected by MRI confirms the diagnosis of AD in patients with dementia.

c. a diagnosis of AD can be made only when other causes of dementia have been ruled out. The diagnosis of AD is one of exclusion. Age is the most important risk factor for development of AD. Drugs can slow the deterioration but do not dramatically reverse the effects of AD. Brain atrophy is a common finding in AD, but it can occur in other diseases as well and does not confirm an AD diagnosis.

A long-term care patient with moderate dementia develops increased restlessness and agitation. The nurse's initial action should be to a. reorient the patient to time, place, and person. b. administer the PRN dose of lorazepam (Ativan). c. assess for factors that might be causing discomfort. d. have a nursing assistant stay with the patient to ensure safety.

c. assess for factors that might be causing discomfort. Increased motor activity in a patient with dementia is frequently the patient's only way of responding to factors like pain, so the nurse's initial action should be to assess the patient for any precipitating factors. Administration of sedative drugs may be indicated, but this should not be done until assessment for precipitating factors has been completed and any of these factors have been addressed. Reorientation is unlikely to be helpful for the patient with moderate dementia. Assigning a nursing assistant to stay with the patient also may be necessary, but any physical changes that may be causing the agitation should be addressed first.

Vascular dementia is associated with a. transient ischemic attacks. b. bacterial or viral infection of neuronal tissue. c. cognitive changes secondary to cerebral ischemia. d. abrupt changes in cognitive function that are irreversible.

c. cognitive changes secondary to cerebral ischemia. Rationale: Vascular dementia is the loss of cognitive function that results from ischemic, ischemic-hypoxic, or hemorrhagic brain lesions caused by cardiovascular disease. In this type of dementia, narrowing and blocking of arteries that supply the brain causes a decrease in blood supply.

Ageism is characterized by a. denial of negative stereotypes regarding aging b. positive attitudes toward the elderly based on age c. negative attitudes toward the elderly based on age d. negative attitudes toard the elderly based on physical disability.

c. negative attitudes toward the eldery based on age. Agesim is a negative attidude based on age

An important nursing action to help a chronically ill older adult is to a. avoid discussing future lifestyle changes. b. assure the patient that the condition is stable. c. tret the patient as a competent manager of the disease. d. encourage the patient to "fight" the disease as long as possible.

c. treat the patient as a competent manager of the disease. Chronically ill older adults should understand and manage their own health. Self management is the individual's ability to manage his or her symptoms, treatment, physical and psychological consequences, and lifestyle changes in response to living with long-term disorder.

Which of these patient statements is the most reliable indicator that an older adult has the correct understanding of health promotion activities? a. "I need to increase my fat intake and limit protein." b. "I should discontinue my fitness club membership for safety reasons." c. "I'm up to date on my immunizations, but at my age, I don't need the tetanus vaccine." d. "I still keep my dentist appointments even though I have partials now."

d. "I still keep my dentist appointments even though I have partials now."

To promote physical well-being and socialization in an older adult, what should the nurse realize? a. Social isolationism is always a chosen behavior. b. Body image plays no role in decision making by the older adult. c. No community resources are focused on the older adult. d. Older adults may have a functional purpose in social arenas.

d. Older adults may have a functional purpose in social arenas.

A 72-year-old woman was recently widowed. She worked as a teller at a bank for 40 years and has been retired for the past 5 years. She never learned how to drive. She lives in a rural area that does not have public transportation. Which of the following psychosocial changes does the nurse focus on as a priority? a. Sexuality b. Housing and environment c. Retirement d. Social isolation

d. Social isolation

To determine whether a new patient's confusion is caused by dementia or delirium, which action should the nurse take? a. Assess the patient using the Mini-Mental Status Exam. b. Obtain a list of the medications that the patient usually takes. c. Determine whether there is positive family history of dementia. d. Use the Confusion Assessment Method tool to assess the patient.

d. Use the Confusion Assessment Method tool to assess the patient. The Confusion Assessment Method tool has been extensively tested in assessing delirium. The other actions will be helpful in determining cognitive function or risk factors for dementia or delirium, but they will not be useful in differentiating between dementia and delirium.

To protect a patient from injury during an episode of delirium, the most appropriate action by the nurse is to a. secure the patient in bed using a soft chest restraint. b. ask the health care provider about ordering an antipsychotic drug. c. instruct family members to remain with the patient and prevent injury. d. assign a nursing assistant to stay with the patient and offer frequent reorientation.

d. assign a nursing assistant to stay with the patient and offer frequent reorientation. The priority goal is to protect the patient from harm, and a staff member will be most experienced in providing safe care. Visits by family members are helpful in reorienting the patient, but families should not be responsible for protecting patients from injury. Antipsychotic medications may be ordered, but only if other measures are not effective because these medications have multiple side effects. Restraints are sometimes used but tend to increase agitation and disorientation.

A 72-year-old patient is diagnosed with moderate dementia as a result of multiple strokes. During assessment of the patient, the nurse would expect to find a. excessive nighttime sleepiness. b. difficulty eating and swallowing. c. variable ability to perform simple tasks. d. loss of both recent and long-term memory.

d. loss of both recent and long-term memory. Loss of both recent and long-term memory is characteristic of moderate dementia. Patients with dementia have frequent nighttime awakening. Dementia is progressive, and the patient's ability to perform tasks would not have periods of improvement. Difficulty eating and swallowing is characteristic of severe dementia.

The clinical diagnosis of dementia is based on a. CT or MRS. b. brain biopsy. c. electroencephalogram. d. patient history and cognitive assessment.

d. patient history and cognitive assessment. Rationale: The diagnosis of dementia depends on determining the cause. A thorough physical examination is performed to rule out other potential medical conditions. Cognitive testing (e.g., Mini-Mental State Examination) is focused on evaluating memory, ability to calculate, language, visual-spatial skills, and degree of alertness. Diagnosis of dementia related to vascular causes is based on the presence of cognitive loss, the presence of vascular brain lesions demonstrated by neuroimaging techniques, and the exclusion of other causes of dementia. Structural neuroimaging with computed tomography (CT) or magnetic resonance imaging (MRI) is used in the evaluation of patients with dementia. A psychologic evaluation is also indicated to determine the presence of depression.

Dementia is defined as a a. syndrome that results only in memory loss. b. disease associated with abrupt changes in behavior. c. disease that is always due to reduced blood flow to the brain. d. syndrome characterized by cognitive dysfunction and loss of memory.

d. syndrome characterized by cognitive dysfunction and loss of memory. Rationale: Dementia is a syndrome characterized by dysfunction in or loss of memory, orientation, attention, language, judgment, and reasoning. Personality changes and behavioral problems such as agitation, delusions, and hallucinations may result.