Chapter 23: Middle-Age Adult

2. A 45-year-old client who has experienced a ten pound weight gain during the past year asks the nurse if she thinks iron supplements would help increase her energy. Which of the following would be the most appropriate action for the nurse to take? a. Ask the client to describe her daily activity and diet b. Leave a note requesting an iron supplement on the clients chart for the doctor c. Provide the client with information related to aerobic exercise classes d. Ask the client if she is still menstruating

ANS: A A lack of routine exercise and activity plus a diet high in calories contributes to weight gain and a lack of energy. The priority action by the nurse is assessment, which will reveal the reason for a lack of energy.

19. The occupational health nurse is asked to develop a plan to reduce work-related injuries. Which of the following recommendations would the nurse stress as the most effective way to reduce work-related injuries? a. Make the work environment smoke-free. b. Reduce environmental noise levels. c. Conduct regular walk-through assessments at the worksite. d. Increase paid personal days from one to three.

ANS: A Accidents are twice as high among smokers than nonsmokers. Possible explanations include the loss of attention, the use of one hand for smoking, and irritation of the eyes. Because smoking has such an impact on accident rates, this would have the largest effect on reduction of work-related injuries.

17. Which of the following middle-age adults has successfully transitioned to Eriksons generativity-versus-stagnation stage of development? a. A 60-year-old woman who retired last year and volunteers at a homeless shelter 2 days a week b. A 63-year-old man who regrets his career choice and feels he cannot change careers c. A 45-year-old woman who resents having to care for her aging mother-in-law d. A 50-year-old man who has not saved for retirement but spends his discretionary income on vacations he takes by himself

ANS: A Generativity according to Eriksons theory involves a sense of productivity, creativity, and the desire to help others, whereas stagnation involves a sense of isolation and focus on oneself.

7. A nurse has received a grant to provide a community-based education series for middle-age adults. Which of the following topics would allow the nurse to have the greatest impact on the health of members of this age group?a. Diet and exercise b. Seat belt use c. Depression screening d. Cancer prevention

ANS: A Obesity is a major risk factor for heart disease, metabolic syndrome, and Type 2 diabetes mellitus. An educational series devoted to discussing diet and exercise will have the greatest impact on health.

24. Which of the following medications is generally recommended to help preserve cardiovascular health in middle-age women? a. Aspirin b. Folic acid c. Estrogen d. Estrogen receptor modulator

ANS: A Only aspirin is recommended to help maintain cardiovascular health by lowering the risk of clot formation.

11. Which of the following statements about alcohol intake is correct? a. Women have a higher death rate related to alcoholism than men. b. A woman who drinks two glasses of wine per day with her evening meal is considered a moderate drinker. c. More women than men are considered problem drinkers. d. Women who experience fewer cognitive effects from drinking are less likely to drink heavily than do women who get a buzz from drinking.

ANS: A The death rate for female alcoholics is 50% to 100% higher than for male alcoholics. More men than women are considered problem drinkers. Moderate drinking for women is defined as one alcohol-containing drink a day. Women who are able to hold their liquor are more likely to drink excessively than those who cannot hold their liquor.

1. Which of the following individuals is at risk for developing osteoporosis? (select all that apply) a. A 55-year-old man who is on a low dose of oral prednisone every day because of rheumatoid arthritis b. A 40-year-old woman who works as a secretary c. A 60-year-old woman who walks three miles a day d. A 50-year-old man who works as a mason

ANS: A, B Osteoporosis occurs most frequently in postmenopausal women who have fair complexions and are small, sedentary individuals, and people on long-term steroid use. It increases with age.

2. Blacks are more likely than non-Hispanic White Americans to be diagnosed with cancer at a later stage and have a less optimal outcome after the diagnosis is made. Which of the following reasons help explain this difference? (select all that apply) a. Lack of access to, or utilization of, cancer screening b. Lack of health insurance c. Genetic variations d. Lack of resiliency against disease

ANS: A, B, C Although poverty and lack of access may account for lack of screening and early diagnosis, genetic variations in tumor growth and response to medication along with other major health problems also affect outcomes.

3. A community health nurse is caring for a variety of different people in the community. Which of the following individuals would the nurse recognize as being at risk to experience increased stress related to family dynamics? (select all that apply) a. A 54-year-old couple whose young adult daughter and grandson move back into their home b. A 44-year-old single mother raising three adolescent children without child support c. A 60-year-old couple whose children have established successful careers in another state d. A 36-year-old couple whose child plays competitive tennis

ANS: A, B, D Stressors of middle age include adult children moving back home, heading a single parent household, and parents whose child plays competitive sports with an emphasis on winning. The couple who has children living out of state who have established successful careers are at the least risk to have stress related to family dynamics.

4. The occupational health nurse working for a large corporation is a member of a task force to improve the work environment. Which of the following suggestions by the nurse would help to improve work conditions? (select all that apply) a. On-site walking paths b. On-site food vendors c. On-site counseling services d. On-site meetings of support groups such as Alcoholics Anonymous

ANS: A, C, D On-site facilities that improve health (walking paths) and psychological well-being (support groups, counseling) will help to create a positive work environment. Depending on the food vendor who is on-site, the healthy food options may not be beneficial to the employees.

15. A nurse conducted a 5-week education series about health maintenance. Which of the following statements by a participant indicates the analysis stage of cognition as defined by Blooms taxonomy? a. If I eat too much food and do not exercise, I will gain weight. b. Fat is more calorie-dense than is protein. If I eat calorie-dense foods and do not do moderate exercise at least 5 days a week, I will gain weight. c. I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight. d. I can eat more if I exercise more.

ANS: B During the analysis stage of cognition, all aspects of learning come together in thought and the individual is cognizant of the relationships and interactions of all the parts. If I eat too much food and do not exercise, I will gain weight indicates knowledge (recall of facts). I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight indicates application. I can eat more if I exercise more indicates comprehension.

6. A nurse has been asked to develop a visit plan for a mobile mammogram van. Which of the following considerations would be made by the nurse when deciding which neighborhoods to visit? a. Hispanic women have the highest rate of breast cancer of all minority groups in the United States. b. The death rate from breast cancer is higher in Hispanic women than for women in other ethnic groups. c. The death rate from breast cancer in Hispanic women has risen in the past 10 years. d. Breast cancer in Hispanic women is usually diagnosed at an early stage.

ANS: B Even though Hispanic women have a breast cancer rate approximately 40% lower than non-Hispanic White women, their death rate is higher and the cancer is diagnosed at a later stage.

16. A 62-year-old person states to the nurse, I have trouble with my peripheral vision. Sometimes, I do not notice objects unless they are in front of me. Which of the following disorders is the client likely experiencing? a. Presbyopia b. Glaucoma c. Cataracts d. Diabetic retinopathy

ANS: B Glaucoma occurs as a result of increased intraocular pressure, which can damage the optic nerve. Damage to the optic nerve is irreversible, but visual loss can be prevented if damage is identified early and treatment is initiated. Peripheral vision is affected in glaucoma. Presbyopia is farsightedness. Cataracts cause cloudy vision.

8. The nurse collects the following assessment data from a woman: Hispanic ethnicity, BMI 29 kg/m2, age 41. Which of the following actions should be taken by the nurse? a. Encourage the client to continue her dietary and exercise patterns. b. Discuss her current dietary and exercise lifestyle habits. c. Counsel the client that she will face chronic health problems because of her weight. d. Encourage the client to adopt a low-calorie diet to help control her weight.

ANS: B Obesity is defined as a BMI of 30 kg/m2. The client is at risk for obesity. Further data should be gathered related to her dietary and exercise patterns so as to plan appropriate interventions. Adoption of a low-calorie diet may not be an appropriate intervention depending on what additional data collection reveals. Also, dietary changes should be accompanied by regular aerobic exercise.

4. A nurse is conducting a community education program. Which of the following should be stressed as the leading cause of death in middle-age adults? a. Automobile accidents b. Malignant disease c. Homicide d. Suicide

ANS: B The leading causes of death during middle adulthood are heart disease, cancer, and accidents. Accidents are the major cause of death for children and young adults. Homicide and suicide are major causes of death for young adults.

22. An occupational health nurse is planning injury-prevention educational sessions. Which of the following considerations should be made by the nurse? a. Education should be focused on workers with the least experience. b. All workers need continued education related to safety issues. c. OSHA rules apply to all companies with more than 25 employees. d. Middle-age workers have the lowest rate of injury of any age group.

ANS: B The role of the occupational health nurse is focused on keeping the worksite safe for employees. Experienced workers may not know how to prevent injury. OSHA applies to all companies. There are no data to support that middle-age workers have the lowest rate of injury. Physical and cognitive changes, which are part of middle age, may predispose workers to injury (i.e., decline in vision/hearing).

20. Which of the following effects of divorce on middle-age adults and children has been documented by research? a. Children adapt to divorce more rapidly than do adults. b. Emotional healing after a divorce takes approximately 24 months in adults. c. Children of divorced parents may have life-long difficulty forming relationships. d. Children of divorced parents undergo similar emotional turmoil as their parents.

ANS: C Although research is continuing, longitudinal studies by Wallerstein and her colleagues beginning in the early 1970s indicate that children bear the emotional scars of a divorce for a lifetime. The emotional response to divorce is different for children and parents, with most parents adjusting to the divorce within 3 years after the event.

3. Which of the following is a normal physiological change that occurs during middle age? a. Increase in gastric emptying resulting in acid reflux b. Reduction in height caused by kyphosis c. Reduction of glomerular filtration by 50% d. Increase in the amount of estrogen produced in both genders

ANS: C Gastric emptying is decreased, kyphosis is not an expected part of aging, and estrogen levels decrease in women and increase in men as male testosterone levels decrease.

5. A nurse formed a political action committee to advocate for health insurance for the uninsured. On which of the following populations would the nurse focus the groups efforts? a. Asian Americans b. Blacks c. Hispanic Americans d. Working-poor White Americans

ANS: C Hispanic Americans are the largest minority group in the United States and have the highest uninsured rate.

14. A 63-year-old woman complains to the nurse that she has insomnia and sleeps only 6 hours a night. Which of the following responses should be made by the nurse? a. Do you want a sleeping pill? b. Make sure that you do not nap during the day even if you are tired. c. Do you feel excessively tired during the day? d. The nurse practitioner may want to run some simple tests to find out why you are having trouble sleeping.

ANS: C It is important to assess the quality of sleep as well as the effects that the limited sleep has on this individuals daily activities. Medication should not be the first intervention used to help someone attain restful sleep. People should nap when tired, if they are able to do so, rather than forcing themselves to stay awake.

1. A 35-year-old person asks the nurse working in a dermatology clinic what causes skin to wrinkle. Which of the following statements would be most appropriate way for the nurse to reply? a. There is really nothing you can do to prevent a lot of wrinkles. It is part of aging. b. As we age, we lose fat beneath the skin so wrinkles appear. There is nothing we can do to prevent it. c. Wrinkles appear for a number of reasons, including loss of fat beneath your skin and too much sun exposure. d. Wrinkles are caused by genetic factors

ANS: C Loss of subcutaneous fat and collagen damage related to sun exposure cause wrinkles.

18. A 52-year-old woman going through menopause tells the nurse working in the womens health center that she is interested in slowing down the aging process and asks if she should take estrogen. Which of the following statements would be the best response by the nurse? a. The latest research has shown that estrogen is safe to take and will help keep you healthy. Ill tell the nurse practitioner that you are interested in estrogen therapy. b. Estrogen is safe to take for about 10 years. Ill get you some information on estrogen therapy that you can take home and read. c. The safety of long-term estrogen therapy is inconclusive. It is primarily used short-term to relieve hot flashes. d. You can get the same effects from natural products in a health food store, and each product is backed up by research showing that it is effective.

ANS: C Research about the safety of estrogen therapy is mixed, therefore it is only recommended for short-term use (1 to 3 years) and only to relieve hot flashes. Natural products do not need research to back up their claims of safety or efficacy.

9. A nurse working in a rural location is interested in starting a weight management group for clients in the area. Which of the following interventions is most likely to ensure success? a. Using a pre-set list of topics for discussion b. Relying on printed material to relay information to the group c. Asking for a list of topics that interest the group d. Beginning each session with a 2-mile walk

ANS: C When participants plan the topics of discussion, interest is maintained. A pre-set list of topics may not meet the learning needs of this particular group. A 2-mile walk may not be realistic for participants.

21. A nurse is discussing sexuality with middle-age men and women. Which of the following information should be stressed by the nurse? a. Contraception usage should be decreased as a woman nears menopause. b. Difficulty with sexual performance among men happens near age 60. c. HIV infection after age 50 is rare. d. The majority of new HIV/AIDS cases occur among middle-age adults.

ANS: D Adults in middle age represent 71% of all new cases of HIV/AIDS. Unintended pregnancy occurs most often in middle-age women. Male sexual performance issues begin between the ages of 40 to 50. HIV infection is not rare among middle-age adults.

23. Taking into account all of the agents that affect middle-age adults, the nurse plans a health education workshop focused on developing an individualized lifestyle change program for each participant. Which of the following actions should the nurse stress that individuals take first? a. Limiting unprotected exposure to sun b. Starting a smoking cessation program c. Exercising at least three times a week d. Scheduling a complete physical and dental exam

ANS: D Although limited unprotected exposure to the sun, starting a smoking cessation program, and regular exercise are important to overall health, assessment data must first be collected to create an effective lifestyle change program. Health care needs and issues vary according to race and ethnicity, socioeconomic status, marital status, and so on. Approaches to health care/education must be individualized.

12. The occupational health nurse is planning a health fair for employees. Which of the following information about dental health should be included? a. Drinking bottled water helps prevent tooth decay. b. Gingivitis results in bone destruction and can be eliminated by flossing daily. c. Preventive dental care requires a visit to the dentist every 4 months. d. In addition to screening for tooth decay, dentists screen for mouth cancer.

ANS: D Dental health is essential to overall health. Dental professionals may be the first to detect a symptom or irregularity that points to a potentially dangerous condition, such as cancer of the mouth and esophageal cancer. Bottled water does not contain fluoride. Periodontitis is oral bone destruction. An annual dental check-up is recommended for the average person, not a check-up every 4 months.

13. Which of the following people has exceeded the recommended guidelines for activity? a. A 36-year-old man who engages in bike riding and has a pulse rate of 137 during activity b. A 45-year-old woman who swims and has a pulse rate of 145 during activity c. A 50-year-old man who jogs and has a pulse rate of 120 during activity d. A 60-year-old woman who walks briskly and has a pulse rate of 125 during activity

ANS: D During activity, the persons pulse rate should not exceed 220 minus the age times 0.75. Thus the woman who is 60 years old would subtract (220 60 = 180); then multiply 180 by 0.75 to give 120 for the optimal heart rate for this client. A pulse rate of 125 exceeds the recommended optimal rate of 120.

10. A 52-year-old postmenopausal woman tells the nurse that she is afraid she will develop osteoporosis like her mother did. Which of the following statements is the most appropriate response by the nurse? a. The American diet is much better now than when your mother was your age, so you have enough calcium in your diet to keep your bones strong. b. You have a strong genetic risk factor. There is not much we can do to stop the process. c. You need about 1000 mg of calcium a day to keep your bones strong. Lets talk about your diet. d. Tell me about your diet, how much walking you do each day, and what medications you take.

ANS: D The postmenopausal woman needs 1500 mg of calcium a day if she is not taking estrogen. Dietary calcium and vitamin D intake, and walking, can help prevent osteoporosis.