Ch 11 Medsurg

A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds:

"What precipitates the outbursts?"

Which older adult is at highest risk for medication-related toxicity?

A 65-year-old with renal insufficiency

An older adult has a score of 12 on the Geriatric Depression Scale (GDS). What action should the nurse complete first?

Assess for the potential for self-harm.

Family members report to the nurse that their elderly grandmother has had a sudden onset of confusion and that they are having difficulty providing care for her. What is the nurse's best response?

Assess the grandmother for adventitious lung sounds

An elderly client with heart failure reports constipation that has progressively worsened over the last several months. The client's vital signs are pulse 86 beats per minute, blood pressure 94/56, and respirations 18 breaths per minute. It would be best for the nurse to instruct the client to

Avoid straining when having a bowel movement.

A nurse is obtaining the health history of a 72-year-old woman who has come to the ambulatory care center for an evaluation. When obtaining information about the woman's sleep patterns, which of the following would the nurse expect to assess?

Complaints about frequently waking up during the night

An 84-year-old client has returned from the post-anesthetic care unit (PACU) following hip arthroplasty. The client is oriented to name only. The client's family is very upset because, before having surgery, the client had no cognitive deficits. The client is subsequently diagnosed with postoperative delirium. What should the nurse explain to the client's family?

Delirium of this type is treatable and her cognition will return to previous levels.

Which are leading causes of death among the elderly? Select all that apply.

Heart disease

A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching?

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

A nurse is working with the family of a patient with Alzheimer's disease to develop an appropriate plan of care. Which of the following would the nurse suggest to foster socialization?

Limiting visitors to one or two at a time

An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of

Loss of bone density

Why are IV solutions usually given at a slower rate to older adults?

Older adults may have cardiac or renal disorders.

The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The client continuously yells, "It's 1999 and you are going to hurt me!" What action should the nurse do first?

Reorient the patient

Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse?

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

_______ is the development of opacity of the eye lens

cataract

Which is an age-related change associated with the cardiovascular system?

decreased cardiac output

Which is an age-related change in the respiratory system?

decreased gas exchange

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should:

stay with the client and encourage him to eat.

An older adult client has returned to the community following knee replacement surgery. The community health nurse recognizes that the client has prescriptions for nine different medications for the treatment of varied health problems. In addition, she has experienced occasional episodes of dizziness and lightheadedness since her discharge. The nurse should identify which of the following nursing diagnoses?

Risk for falls related to polypharmacy and impaired balance

Which neurotransmitter is implicated in depression?

Serotonin

is implicated in the development of depression.

Serotonin

An elderly client experienced a cerebrovascular accident (CVA) and was unable to ambulate following his CVA. The client was transferred from a hospital and is now at a subacute care facility. For continuation of Medicare coverage, the nurse evaluates that the client must demonstrate

Improvement in ambulation

Bone changes associated with aging frequently result from a loss of

calcium

The leading cause of death in older adults in the United States is

cardiovascular disease

The most common affective or mood disorder of old age is

depression

A universal health promotion strategy that strengthens the musculoskeletal system and improves all body systems is

exercise

What is a disease characterized by increased intra-ocular pressure?

glaucoma

Name 3 nursing interventions that can be used to help older adults with learning and memory

good sleep hygiene, cognitive remediation and memory enhancement treatment of depression and treatment of anxiety MMSE used to assess

A nurse is caring for an elderly adult client admitted to the hospital from a nursing home because of a change in behavior. The client has a diagnosis of Alzheimer's disease and has started to experience episodes of incontinence. The hospital staff is having difficulty with toileting because the client wanders around the unit all day. To assist with elimination, a nurse should:

incorporate the client's toileting schedule into the pattern of his wandering.

Which is an age-related change associated with the nervous system?

postural hypotension

Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away?

presbyopia

in which continuous nursing assistance is provided.

skilled nursing services

The admissions department at a local hospital is registering a male older adult for an outpatient diagnostic test. The admissions nurse asks the man if he has an advanced directive. The man responds that he does not want to complete an advance directive because he does not want anyone controlling his finances. What would be appropriate information for the nurse to share with this client?

"Advance directives are limited only to health care instructions and directives."

A nurse is assessing a client brought to the emergency room by his daughter. Which statement by the daughter would most likely lead the nurse to suspect that the client may have an infection?

"All of a sudden my dad seemed to become confused."

The nurse is planning an educational event for the nurses on a subacute medical unit on the topic of normal, age-related physiologic changes. What phenomenon should the nurse address?

A decrease in muscle mass and bone density

A gerontologic nurse is aware of the demographic changes that affect the provision of health care. Which of the following phenomena is currently undergoing the most rapid and profound change?

A growing number of people live to a very old age.

A nurse is caring for an older adult client who has become increasingly frail and unsteady on her feet. During the assessment, the client indicates that she has fallen three times in the month, though she has not yet suffered an injury. The nurse should take action in the knowledge that this client is at a high risk for what health problem?

A hip fracture

The primary cause of age-related vision loss in the elderly is

macular degeneration

A health care team is involved in caring for a client with advanced Alzheimer's disease. During a team conference, a newly hired nurse indicates that she has never cared for a client with advanced Alzheimer's disease. Which key point about the disease should the charge nurse include when teaching this nurse?

Clients with Alzheimer's disease are at high risk for injury because of their impaired memory and poor judgment.

Which actions by the nurse will assist in promoting an older adult's adherence to medication therapy? Select all that apply.

Encourage the client to keep a list of medications and review it frequently for updates. Use easy-to-open lids. Provide a written medication schedule.

A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate?

Distract the client with a familiar object or music.

An elderly client is reporting changes in bowel movements from every day to every 3 to 4 days. The client also states that the stools are hard. Nursing interventions include instructing the client to

Increase fluid intake.

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to

Ingest five or six small meals each day.

An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to

Instruct the family to remove the toddler from the room for the protection of the client.

Which is a factor that contributes to urinary incontinence in older female adults?

Relaxed perineal muscle

Based on a client's vague explanations for recurring injuries, the nurse suspects that a community-dwelling older adult may be the victim of abuse. What is the nurse's primary responsibility?

Report the findings to adult protective services.

When assessing an older adult, the nurse anticipates an increase in which component of respiratory status?

Residual lung volume

A client with Alzheimer's disease is admitted for hip surgery after falling and fracturing the right hip. The client's spouse tells the nurse about feeling guilty for letting the accident happen and reports not sleeping well lately because the spouse has been getting up at night and doing odd things. Which nursing diagnosis is most appropriate for the client's spouse?

Risk for caregiver role strain related to increased client care needs

When administering medications to an older adult patient, which medication does the nurse understand may remain in the body longer due to increased body fat?

Barbiturates

Nursing students are reviewing different types of mental health problems in the older adult population. The students demonstrate an understanding of this information when they identify which condition as the most common affective disorder?

Depression

A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to

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

_____ is when people require limited assistance with their daily living needs.

assisted living

The leading cause of injury in the elderly population:

falls

can contribute to urinary incontinence, especially when laughing, coughing, and sneezing.

the relaxed muscle

Chronic conditions, many of which are preventable or treatable, are the major causes of _______ and pain among older adults.

disability

When performing a respiratory assessment on an older adult patient, what changes associated with aging does the nurse expect to find? Select all that apply. A) Increased residual volume B) Decreased residual volume C) Loss of elastic tissue surrounding the alveoli D) Reduced vital capacity E) Decrease pulmonary resistance

ACD

usually begins in the fifth decade of life, when reading glasses are required to magnify objects

presbyopia

Name at least 3 differences between delirium and dementia with regard to clinical manifestations

dementia occurs between ages 50 to 70/ delirium can occur at any age dementia is a slow gradual onset/ delirium is a rapid onset dementia the sleep wake cycle is often impaired with increased wandering and agitation at night/ delirium takes brief naps throughout the day and night

in which people manage their own needs every day

independent dwelling

A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be administering intramuscular (IM) doses of the vaccine. Of what age-related change should the nurse be aware when planning the appropriate administration of this drug?

An older client has less subcutaneous tissue and less muscle mass than a younger client.

Define the term geriatric syndromes. Provide examples.

Multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render. Pressure ulcers / incontinence / Falls / delirium.

Age-related changes reduce the efficiency of the cardiovascular system. These changes include which result in a decreased stroke volume

Myocardial hypotrophy__, ____decreased pacemaker cells___, and _ valvular stenosis

After a sudden decline in cognition, a 77-year-old man who has been diagnosed with vascular dementia is receiving care in his home. To reduce this man's risk of future infarcts, what action should the nurse most strongly encourage?

Rigorous control of the client's blood pressure and serum lipid levels