Chapter 4 - The Older Adult

Based on the Beer Criteria for Potentially Inappropriate Medication Use in Older Adults, which drug(s) would the nurse question when prescribed for an older adult? Select all that apply. A. Promethazine B. Diazepam C. Amitriptyline D. Diphenhydramine E. Oxycodone F. Ticlopidine G. Chlorpropamide

A, B, C, D, E, F, G All of these drugs are examples of potentially inappropriate medication use for older adults. Digoxin (dose greater than 0.125 mg) and Ferrous Sulfate (dose greater than 325 mg daily) are also on the list.

Which home modification will the nurse recommend to the family of a client at risk for falls before discharge to home? Select all that apply. A. Placement of handrails B. Install grab bars in the bathroom C. Lower toilet seats D. Remove clutter from all rooms E. Assure adequate lighting in the home F. Remove scatter rugs G. Use nonslip bathmats

A, B, D, E, F, G

The nurse recognizes that which condition may result from undiagnosed depression in a 78-year-old patient which chronic pain? Select all that apply. A. Alcoholism B. Incontinence C. Increased Pain D. Suicidal Ideation E. Increased Appetite

A. Alcoholism C. Increased Pain D. Suicidal Ideation

Which actions will the nurse take for a client who requires physical restraints? Select all that apply. A. Check the patient every 30-60 minutes B. Encourage family members to go home at night C. Release the restraints every 1-2 hours for turning, repositioning, and toileting D. Provide soft, calming music E. Turn the television on if the client is agitated F. Cover tubes and lines with roller gauze if the client pulls on them G. Place the client in an area where he or she can be supervised

A. Check the patient every 30-60 minutes C. Release the restraints every 1-2 hours for turning, repositioning, and toileting D. Provide soft, calming music F. Cover tubes and lines with roller gauze if the client pulls on them G. Place the client in an area where he or she can be supervised Family members or friends should be asked or encouraged to stay with the patient at night. When the client is agitated, the television should be turned off to avoid excessive stimulation, not on. Before restraints are applied, alternatives should be tried and restraints only applied if the alternatives are ineffective.

Which question would the nurse ask to identify an immediate physiologic consequence when an older adult's teeth are in poor condition and the client says that he or she only eats soft foods? A. Do you have any problems with your bowel movements? B. Have you lost any weight recently? C. Do you take any OTC vitamin supplements? D. Would you like me to help you make an appointment with the dentist?

A. Do you have any problems with your bowel movements? Older adults with poor dentition often eat soft and high-calorie foods such as ice cream, mashed potatoes, and macaroni and cheese. These foods lack roughage and fiber which can lead to constipation. Additionally, unless the older adult chooses nutritious foods, they may develop vitamin deficiency. Although vitamin deficiency can develop, altered bowel elimination is more immediate

What are the best interventions for the nurse to use to help reduce relocation stress in an older adult client? Select all that apply. A. Explain all procedures to the client before they occur B. Reorient the client frequently to her location C. Initially, encourage family and friends to keep their visits to a minimum D. Provide opportunity and time for the client to participate in decision making E. Arrange for familiar keepsakes to be kept at the client's bedside F. Change room assignment several times and assess the client's preferred choice G. Early on establishing a trusting relationship with the client H. Teach the client to expect limited food selection and a set schedule for bathing.

A. Explain all procedures to the client before they occur B. Reorient the client frequently to her location D. Provide opportunity and time for the client to participate in decision making E. Arrange for familiar keepsakes to be kept at the client's bedside G. Early on establishing a trusting relationship with the client

The Fulmer 'SPICES' framework identifies which type of condition? A. Marker B. Genetic C. Neoplastic D. Mental health

A. Marker The Fulmer SPICES framework was developed as part of the Nurses Improving Care for Health System Elders (NICHE) project to identify 6 serious "marker conditions". The six conditions are sleep disorders, problems eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown.

Which type of elder abuse is the most common? A. Neglect B. Physical Abuse C. Financial Abuse D. Emotional Abuse

A. Neglect

What is the most important action for the nurse to take when a client is both confused and agitated? A. Place the patient in a quiet, supervised area B. Check the patient every 2 hours C. Sedate the patient using IV medication D. Apply soft wrist restraints for a limited time

A. Place the patient in a quiet, supervised area

Which organization limits the use of physical restraints in hospitals and nursing homes? A. The Joint Commission (TJC) B. State Boards of Nursing C. American Nurses Association (ANA) D. Occupational Safety and Health Organization (OSHA)

A. The Joint Commission (TJC)

Which are health-protective behaviors? Select all that apply. A. Using OTC medications that are acceptable for treating symptoms B. Getting an annual influenza vaccination C. Wearing seat belts in an automobile D. Installing grab bars in showers and tubs E. Having a pneumococcal vaccination as recommended by the HCP F. Consuming alcohol only on weekends G. Avoiding smoking and never smoking in bed H. Putting up smoke detectors and changing the batteries regularly

B, C, D, E, G, H OTC drugs should be approved by the health care provider.

The nurse reviews factors that increase an older adult's risk for a motor vehicle accident and identifies which factor to be a part of normal aging? Select all that apply. A. Sleep disturbances B. Decreased reaction time C. Worsening farsightedness D. Decreased ability to multitask

B. Decreased reaction time C. Worsening farsightedness D. Decreased ability to multitask

Which screening tool should the nurse use when an older adult reports early morning insomnia, excessive daytime sleeping, poor appetite, lack of energy, and unwillingness to participate in social or recreational activities? A. Confusion Assessment Method (CAM) B. Geriatric Depression Scale - Short Form (GDS-SF) C. CAGE Questionnaire D. Brief Abuse Screen for the Elderly

B. Geriatric Depression Scale - Short Form (GDS-SF) The signs and symptoms this older adult reports are classic for depression, so the Geriatric Depression Scale would be the best assessment tool to use. CAM - measures confusion CAGE - measures alcoholism Brief Abuse Screen - assesses risk of elder abuse

Which age-related change affects drug absorption? Select all that apply. A. Decrease in liver size B. Increase in gastric pH C. Decrease in albumin level D. Decrease in total body water E. Decrease in GI motility

B. Increase in gastric pH E. Decrease in GI motility Decreases in albumin level and total body water affect drug distribution.

Which assessment tool would help a nurse focus on factors that increase an older patient's risk for falling? Select all that apply. A. Braden Scale B. Morse Fall Scale C. Glasgow Coma Scale D. Hendrich II Fall Risk Model E. Geriatric Depression Scale - Short Form (GDS-SF)

B. Morse Fall Scale D. Hendrich II Fall Risk Model

Which action will the nurse take for an older client whose creatinine clearance (CrCl) is 70 mL/min? A. Consult the pharmacy to determine if the patient's drugs are harmful to the liver B. Notify the HCP because serum drug levels could become toxic C. Notify the HCP because drug doses will need to be increased D. Document the level in the patient's record as within normal range

B. Notify the HCP because serum drug levels could become toxic Age-related changes in the kidney can result in high plasma concentrations of drugs. These changes include decreased renal blood flow and reduced glomerular filtration rate (as indicated by this client's abnormal creatinine clearance), which lead to a decreased in CrCl.

What are the ingredients of the "colon cocktail" that some older adults may need to prevent constipation? A. Cranberry juice and a stool softener B. Prune juice, applesauce, and psyllium C. Applesauce, a stool softener, and rice D. Prune juice, mashed banana, and water

B. Prune juice, applesauce, and psyllium If the "cocktail" is not effective in preventing constipation, the HCP may recommend a stool softener.

Which action will the nurse avoid using for the older adult with delirium? A. Talking to the patient in a calm voice B. Sedating the client to prevent self-harm C. Assessing the client for possible causes of delirium D. Reorienting the client to place and person frequently

B. Sedating the client to prevent self-harm Delirium includes client inattentiveness, disorganized thinking, and altered LOC. Sedating the client may worsen, not improve the delirium.

Who does the nurse contact when physical abuse or neglect is suspected in a hospitalized older adult? A. The patient's family B. The hospital social worker C. Local advocacy organization D. The local Adult Protective Services agency

B. The hospital social worker

Why does presbyopia make walking more difficult? A. The person experiences tremors in the lower legs B. The person is less aware of the location of each step C. The person has a decreased sense of body orientation D. The person is less stable because the muscles around the hips are weakened.

B. The person is less aware of the location of each step

The nurse is using the Geriatric Depression Scale - Short Form (GDS-SF) to screen an older adult for clinical depression. Which statement about the scale is accurate? A. It is only available in English and German B. It requires the patient to answer 12 questions C. A score of 10 or higher suggests clinical depression D. It assesses the level of confusion in cognitive processing

C. A score of 10 or higher suggests clinical depression The patient has to provide "yes" or "no" to 15 questions for the GDS-SF.

Which chronic health problem is exacerbated by alcohol? A. Anemia B. Arthritis C. Diabetes D. Osteoporosis

C. Diabetes

Which drug(s) is considered an antipsychotic drug? Select all that apply. A. Zolpidem B. Alprazolam C. Haloperidol D. Thiothixene E. Venlafaxine

C. Haloperidol D. Thiothixene Zolpidem is considered a sedative-hypnotic drug used to help with insomnia. Alprazolam is an antianxiety drug. Venlafaxine is an antidepressant drug.

The nurse questions the consumption of which item by an older adult who is taking warfarin for anticoagulation therapy? A. yogurt B. Almonds C. Ibuprofen D. Diphenhydramine

C. Ibuprofen

The nurse questions which item that is listed on the plan of care for an older-adult patient who is being treated for depression after a recent major loss? A. Cognitive behavioral therapy B. Reflective therapy C. Tricyclic antidepressant drugs D. Selective serotonin reuptake inhibitor (SSRI) drugs

C. Tricyclic antidepressant drugs Tricyclic antidepressants are contraindicated in the treatment of depression in older adults as these drugs can cause acute confusion, severe constipation, and urinary incontinence. SSRIs, CBT, and reflective therapies are first-line treatments for depression in older adults.

Which newly admitted client is most likely to need assessment by the nurse for geriatric frailty? A. 72-year-old with mild heart failure who lives alone independently B. 80-year-old with a pacemaker and hearing aid who uses a cane C. 73-year-old with bilateral total hip replacement D. 91-year-old with unintentional weight loss, weakness, and slowed activity

D. 91-year-old with unintentional weight loss, weakness, and slowed activity Frailty is a geriatric syndrome with signs including: unintentional weight loss, weakness, exhaustion, and slowed physical activity including walking

Which older adult has the greatest risk for falls? A. A 73-year-old who takes frequent walking excursions B. A 90-year-old who frequently calls for help to change position C. An 80-year-old who uses a cane when ambulating D. A 68-year-old who has decreased sensation in lower extremities

D. A 68-year-old who has decreased sensation in lower extremities Decreased sense of touch leads to decreased sense of body orientation and an older adult may not be able to determine exactly where his or her feet are in relation to steps, resulting in a fall.

Which condition is the most important predictor for falls? A. A recent knee injury B. Severe farsightedness C. A diagnosis of dementia D. A recent history of falling

D. A recent history of falling

Which exercise will the nurse most likely suggest to a client who is homebound? A. During the winter months, go to the mall and walk around B. Attend an exercise class at a senior citizen's center C. Walk on the treadmill three to five times per week for 60 minutes D. Maintain independent performance of ADLs

D. Maintain independent performance of ADLs The nurse would teach client who are not homebound about the importance of regular exercise.

Which adverse drug event increases the risk for falls in an older adult receiving antipsychotic drugs? A. Tachycardia B. Hypoglycemia C. Anticholinergic Effects D. Orthostatic Hypotension

D. Orthostatic Hypotension Antipsychotic drugs can cause hyperglycemia, not hypoglycemia, in older-adult patients.

Which condition of an older adult is likely to lead to negligence by the caregiver? A. Loneliness B. Acute Illness C. Poor Self-Care D. Physical Dependence

D. Physical Dependence

Which assessment tool can be used to evaluate a patient for delirium? Select all that apply. A. Braden Scale B. Delirium Index (DI) C. Neelon and Champagne (NEECHAM) Confusion Scale D. Confusion Assessment Method (CAM) E. Elder Assessment Instrument (EAI)

The various assessment tools to evaluate a patient for delirium include the NEECHAM Confusion Scale, CAM, DI, and the Mini-Cog.