Comprehensive Gero Hesi Review Questions

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

2. depression.

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)

An older male client with heart failure (HF) complains of chronic constipation and wants to retrain his bowel. Which information should the registered nurse (RN) offer the client for establishing regular bowel habits? A. Add whole grain foods and fibrous vegetables to diet B. Drink water and fluids up to 3,000 ml daily C. Use a stool softener or glycerin suppository PRN D. Plan daily exercise based on fatigue level

(A) Add whole grain foods and fibrous vegetables to diet. Rationale: Increasing daily fiber (A) with increasing fluid intake are the best tools to use when retraining bowel habits. (B) may cause fluid overload for this older client and potentially exacerbate HF. (C) should not be advised without the healthcare provider's recommendation. The client's fatigue level may curtail how much daily exercise (D) the client can tolerate.

An older male client is seeking counseling about his recent sexual issues with his partner. What issue should the registered nurse (RN) explore in this discussion? A. Certain mediations may impact sexual function B. Normal aging affects sexual function in male clients C. Safe sex is not necessary with older sexually active elders D. Sexual interest usually declines with aging in male clients

(A) Certain medications may impact sexual function Rationale: Certain medications can have a direct influence on sexual function and should be discussed with older clients (A). (B) does not have drastic effects for older male clients. Some men may experience a decline in testosterone and sperm production, but sexual dysfunction is not a part of normal aging in the male client. The incidence of STIs has increased and may be related to a lack of education for this age group about preventative measures (C). Older clients continue to have interest in sex (D) as long as there is not a direct influence of medication side effects that cause sexual dysfunction

The home health registered nurse (RN) is changing an older client's wet to dry dressing. Which observation should the RN evaluate as a therapeutic response with the removal of the dry dressing? A. Debridement and removal of slough and eschar B. Drainage of purulent exudate from the wound C. Moist skin edges around the wound field D. Presence of capillary growth in the wound

(A) Debridement and removal of slough and eschar Rationale: Wet to dry dressings begin with a wet packing inside of the wound, and then a dry gauze is used to cover the wet packing to wick drainage and bacteria away from the wound to promote healing. Removal of dried dressing provides debridement by removing exudate, sloughing tissue, and eschar (A). (B) is evidence of an infection. (C) is indicative of continuous moisture that is causing the skin edges of the wound to be vulnerable to further damage. (D) is manifested by a pink environment with serosanguineous fluid.

An older female client arrives for an annual visit by the urologist due to a history of changes in serum values related to renal function. What changes should the registered nurse (RN) expect for an older client due to normal aging? A. Decrease in glomerular filtration rate (GFR) B. Hematuria during urinalysis C. Chronic bladder infections D. Urinary incontinence

(A) Decrease in glomerular filtration rate (GFR) Rationale: GFR often decreases (A) with normal aging due to a decrease in blood flow through the kidneys, causing renal function test results to vary the clearance of metabolic waste. (B, C and D) are not normal outcomes of aging.

The registered nurse (RN) is observing the skin of an older client. Which finding should the RN document as consistent with the normal aging process? A. Decreased elasticity B. Tough and leathery texture C. Shiny and edematous D. Excessive hair growth on the head

(A) Decreased elasticity Rationale: Loss of elasticity is a common finding of the normal aging process (A). The skin of elderly clients becomes thin and fragile with aging, not (B). When a client has peripheral edema, the skin can be shiny and edematous (C), which is not consistent with normal aging changes. Hair thinning and hair loss are common, not excessive hair growth (D).

The registered nurse (RN) is assigned to the care of an older client with venous stasis ulcers. A primary goal in the client's plan of care is to decrease swelling in the extremities. What action should the RN take to meet this goal? A. Elevate the legs on pillows B. Decrease fluid intake C. Decrease salt intake in diet D. Increase protein intake in diet

(A) Elevate the legs on pillows Rationale: Venous insufficiency is causing intravenous fluids to move into the interstitial spaces, causing edema. To promote gravity drainage, the extremities should be elevated (A). (B) may not decrease the edema, which is due to the inability to mobilize stagnated venous blood. Dietary changes, such as (C and D) may be recommended if prescribed dietary changes are in place, but the underlying etiology is venous insufficiency.

An older client with chronic kidney disease (CKD) has an arteriovenous fistula (AV) in the left forearm for for hemodialysis. After palpating the AV fistula, which finding is an indication that the AV fistula is functioning properly? A. Enlarged veins B. Redness around the site C. Decreased pulses below fistula D. Marked ecchymotic areas

(A) Enlarged veins Rationale: The mixing of arterial and venous blood in an AV fistula causes the veins to enlarge (A), which facilitate cancelation for hemodialysis. (B) may be related to local infection or inflammation and is not a normal finding. (C) and (D) are abnormal findings that should be reported immediately.

After a transurethral resection of the prostate (TURP), an older man returns to the medical surgical floor with a 3-way indwelling urinary catheter. The registered nurse (RN) observes the catheter's tubing for drainage when the client states that he needs to void. What should the RN implement based on this finding? A. Irrigate the bladder through the catheter port B. Remove the indwelling catheter C. Explain that urgency is expected D. Notify the healthcare provider of the symptom

(A) Irrigate the bladder through the catheter port Rationale: The feeling of urgency can be caused by blood clots that can occlude drainage of the catheter, which is a common occurrence in the first 72 hours after a TURP. The urgency is an indication that the client's bladder is not emptying, and the RN should irrigate catheter (A) to relieve symptoms caused by a clot. (B) and (C) should not be implemented. (D) should be implemented after determining if the irrigation was effective in relieving the client's complaint.

The home health registered nurse (RN) is reinforcing instructions to the family about how to prevent pressure ulcers for their older family member who is bedridden. Which measure should the RN discuss? A. Lift the client when turning instead of sliding B. Massage directly over reddened sites C. Change client's position every 4 hours D. Place pillows under both the knees

(A) Lift the client when turning instead of sliding Rationale: Lifting instead of sliding (A) decreases chances of friction and shearing while moving the client. (B) is not recommended for tissue that show signs of early pressure, such as a stage 1 site. (D) does not reduce risk for pressure ulcers. Reposition q2 hours, not q4 hours (C), provides the most benefit in reducing pressure ulcer formation.

The registered nurse (RN) is reinforcing discharge instructions to the family of an older client with failure to thrive. What information should the RN include to promote nutritional intake for the client? (Select all that apply.) A. Minimize stress levels by providing the client with a quiet environment during meals B. Provide food variations that the client can manage without assistance C. Assist the client with eating meals in bed in a semi-Fowler's position D. Encourage fluid intake before meals to decrease dehydration E. Offer any type of food to the client as long as calories are consumed

(A) Minimize stress level by providing the client with a quiet environment during meals (B) Provide food variations that the client can manage without assistance Rationale: (A and B) are correct and continue to promote independence and decreased stress for the client, which will increase the opportunity for nutritional intake. (C) increases dependence for the older client, which can also cause decreased self-worth and depression. (D) will make the client feel full and will decrease the client's ability to consume nutritional calories.

The registered nurse (RN) is caring for an elderly client with functional incontinence who lives in an assisted living community. The client is alert and mildly confused and can self-ambulate. Which nursing intervention should the RN implement? A. Offer assistance with toileting q2 hours B. Use protective disposal undergarment instead of underwear C. Ask if the client has attempted to void q2 hours D. Obtain a prescription for intermittent catheterization

(A) Offer assistance with toileting q2 hours Rationale: Maintaining independence and self-esteem is important for an older client with incontinence. (A) decreases the client's chances of accidents and embarrassment by introducing a toilet training program. (B) is not implemented unless toileting program is unsuccessful and the client's mental status declines. A confused client will not remember how many times he or she frequented the toilet, so (C) is not helpful for the client. (D) is not indicated for clients with functional intolerance and who can ambulate.

During the quarterly evaluations of the clients in the assisted living community, the registered nurse (RN) assesses for findings of failure to thrive in the older population. What findings should the RN document and report as manifestations related to failure to thrive? (Select all that apply.) A. Unintentional weight loss B. Increased weakness C. Increased amounts of sleep D. Irritation and agitation E. Seeking constant attention from caregiver

(A) Unintentional weight loss (B) Increased weakness (C) Increased amounts of sleep Rationale: (A, B and C) are correct. Symptoms of failure to thrive in the older population include weight loss, weakness and excessive sleep, which should be documented and evaluated by a healthcare provider immediately. (D and E) are not usual signs and symptoms of failure to thrive but should be reviewed by the healthcare provider.

An older woman asks the registered nurse (RN) how she can decrease her chances of getting cystitis. What information should the RN provide? A. Void and empty the bladder completely every 2 to 3 hours B. Take warm sits baths with bubble bath to cleanse the vulva C. Decrease fluid volume intake to reduce urgency D. Test urine pH daily using over-the-counter (OTC) dipsticks

(A) Void and empty the bladder completely every 2 to 3 hours Rationale: (A) minimizes over distention, which can compromise blood supply to the bladder wall and cause irritation to the bladder. (B and C) increase irritation to the bladder. Although (D) can inform the client of the risk of developing cystitis, testing does not help decrease the risk of bladder infections.

An older client who is unconscious is admitted after experiencing a head injury from a fall. Glasgow Coma Scale (GCS) is prescribed to evaluate the client. Which focused assessments should the registered nurse (RN) use to determine the client's GCS score? (Select all that apply.) A. Verbal response B. Motor response C. Eye opening D. Pupillary reaction E. Hearing

(A), (B), (C) Rationale: (A, B, and C) are correct. The Glasgow Coma Scale evaluates verbal response (A), motor response (B), and eye opening (C). The GSC does not evaluate pupil reaction (D) or hearing (E).

An older resident is newly admitted to an assisted living community. Which actions should the registered nurse (RN) implement to provide the resident ways to maintain safe medication administration? (Select all that apply.) A. Locked medication storage in the client's room B. Medication administration record (MAR) C. Payment forms for prescribed medications D. Delivery of adequate supply of medication E. List of findings indicating medication effectiveness

(A), (B), (D), (E) Rationale: (A, B, D and E) are correct. For safe self-medication in an assisted living community, the resident should be provided a locked storage box (A), create a medication administration record to monitor medication (B), establish adequate medication supply (D) and a reference to evaluate the effectiveness of medications (E). (C) is not the responsibility of the nurse.

An older male client asks the registered nurse (RN) how he can reduce his incidents of hemorrhoidal flare ups. What information should the RN offer the client about how to prevent rectal discomfort? (Select all that apply.) A. Increase fiber and liquids in the diet to help prevent constipation and straining B. Change exercise program to reflect less cardio-exercise and more weight training C. Use a therapeutic cushion or frequent repositioning for periods of prolonged sitting D. Take frequent warm sits baths and do not use abrasive paper that can traumatize tissues E. Establish bowel habits by scheduling daily time to defecate when the client is not rushed

(A), (C), (D) and (E) Rationale: (A, C, D and E) are correct. Fluids, comfort measures, and establishment of a regular bowel pattern help reduce incidents of hemorrhoid inflammation. Weight training can aggravate hemorrhoids and is not effective in reducing hemorrhoid irritation.

An older male client with Parkinson's disease (PD) is discharged home with levodopa-carbidopa (Sinemet) and instructions to his wife for his care. What statement best indicates to the registered nurse (RN) that the wife understands her husband's needs? A. "It is important to keep my husband in a chair or in bed as much as possible and prevent him from falling." B. "I will notify the healthcare provider if my husband has increasing involuntary movements of his extremities." C. "Since it is difficult for my husband to eat, we should stay in the house instead of going out to dine." D. "I should expect that my husband will be incontinent of bowel and bladder as his disease advances."

(B) "I will notify the healthcare provider if my husband has increasing involuntary movements of his extremities." Rationale: Increasing involuntary movements (B) should be reported during the use of levodopa; it is an indicator that the body is failing to readjust to the changes in the level of the intracerebral neurotransmitter dopamine. The client should be encouraged to engage in exercise and regular daily activities (A). Socialization and activities as tolerated help to prevent the client from becoming depressed, so (C) is not indicated. Clients with PD usually are constipated due to muscle weakness, lack of exercise, and decreased fluid intake, but incontinence should not be an expectation related to PD.

Osteoporosis increases the risk for a hip fracture in older adults, and women are more likely to have osteoporosis than men. Women of which ethnic group have the highest risk for a hip fracture? (Arrange with the highest risk first and the lowest risk last.) A. African American B. Caucasian C. Asian D. Hispanic

(B) Caucasian (C) Asian (D) Hispanic (A) African American Rationale: Caucasian women have the highest risk for hip fractures secondary to osteoporosis. Women of Asian descent have the second highest risk, followed by Hispanic women and African American women.

The home health registered nurse (RN) is assessing an older client for a pressure ulcer. Which finding should the RN observe the area for a Stage I pressure ulcer? A. Superficial skin breakdown and flaking B. Deep pink, red or mottle skin C. Subcutaneous damage or necrosis D. Skin that blanches pink when pressed

(B) Deep pink, red or mottled skin Rationale: Temporary blanching of an area can last for over a minute due to poor circulation. Deep pink, red or mottle skin (B) is a finding consistent with Stage I pressure ulcer. (A, C and D) are evidence of a pressure ulcer at different stages of development.

An older client who recently moved into an assisted living community refuses to eat or join any activities. When evaluating the client further, what should the registered nurse (RN) focus on during the next examination? A. Anxiety B. Depression C. Exhaustion D. Confusion

(B) Depression Rationale: Depression is a symptom that an older client is likely to experience with a sudden change in living accommodations when a loss of personal identity can create low self-esteem. (A, C and D) are other symptoms that the client can exhibit, but with the sudden change in lifestyle, (B) is most likely and most important for the RN to focus on.

The healthcare provider prescribes a new medication, atorvastatin (Lipitor), for an older client who arrives at the clinic for an annual physical examination. What common side effect should the registered nurse (RN) advise the client to observe with this medication? A. Constipation B. Headaches C. Muscle weakness D. Nausea and vomiting

(B) Headaches Rationale: Headaches (B) are the most common side effect with this medication, which the RN should direct the client to report. (A and C) are rare occurrences with this medication. (D) is not considered a side effect of this medication.

An older client is admitted with a preliminary diagnosis of Addison's disease. Which skin finding should the registered nurse (RN) document that is typical with Addison's disease? A. Moon face B. Hyperpigmentation C. Excessive acne D. Multiple skin tags

(B) Hyperpigmentation Rationale: Addision's disease is characterized by a deficiency in the production of adrenal cortex hormones, which results in anterior pituitary feedback to secrete stimulating hormones, such as melanocyte stimulating hormone (MSH) that increases melanin production. (B) is seen in clients with Addison's disease. (A and C) are typical of Cushing's syndrome which is due to excessive adrenal cortisol. (D) are not associated with Addison's disease.

An older male client is admitted for emergency treatment of acute closed-angle glaucoma. The registered nurse (RN) begins administering the prescribed miotic medications and glycerin (Glycol) therapy. Which intervention is most important for the RN to maintain during the client's therapy? A. Maintain lighting control in the room during therapy B. Monitor intake and output q2 hours for 24 hours C. Place an eye patch over the affected eye during sleep D. Administer the eye drops at the scheduled intervals

(B) Monitor intake and output q2 hours for 24 hours Rationale: Monitoring intake and output (B) is most important during the administration of glycerin (Glycol) due to the rapid acting osmotic diuretic effect of glycerin therapy. (A, C and D) are components of care, but the most important action during glycerin administration is evaluation of output.

The home health registered nurse (RN) visits an older woman with heart failure (HF) who is on complete bed rest. Which intervention is most important for the RN to suggest to the client to prevent complications related to immobility? A. Get as much sleep as possible B. Perform leg exercises while in bed C. increase protein intake to combat fatigue D. Invite friends to visit to decrease risk for depression

(B) Perform leg exercises while in bed. Rationale: The client is at risk for complications related to immobility. (B) should be performed frequently to decrease the risk for thrombophlebitis. (A, C and D) are measures to help the client while on bedrest, but the most important complication that the client is at risk for deep vein thrombosis.

The registered nurse (RN) is assigned the care of an older client who returns to the unit after surgery for closed angle glaucoma. What intervention in the plan of care should the RN bring to the attention of the healthcare team? A. Assist with ambulating to commode B. Monitor intake and output q8 hours C. Administer morphine 4 mg IM q2 hour PRN pain D. Place an eye patch on operative eye during sleep

(C) Administer morphine 4 mg IM q2 hour PRN pain Rationale: Morphine side effects include nausea, vomiting and constipation, causing straining on stool, all of which can increase intraocular pressure and cause intraocular bleeding during the postoperative period. Administration of morphine 0.4 mg IM q2 hours PRN pain (C) should be discussed with the healthcare team to determine the risk of the side effects for the client. (A), (B) and (D) are interventions that do not place the client at risk.

The home health registered nurse (RN) visits an older female client with an ideal conduit who has been experiencing chronic urinary tract infections (UTI). Which intervention should the RN recommend to the client to manage the frequency of UTIs? A. Force fluid intake to 1,000 ml daily B. Change appliance every 4 hours C. Attach a larger drainage bag while sleeping D. Allow bag to fill completely before emptying

(C) Attach a larger drainage bag while sleeping Rationale: (C) can prevent urinary reflux if the bag fills to near capacity or greater, which can contribute to UTIs. Forcing fluids is encouraged and should exceed urinary output, which commonly should be greater than 1,000 ml (A). (B) can increase skin irritation and increase risk for infection by exposing the portal of entry frequently. Allowing the bag to fill completely before emptying (D) increases risk of urinary reflux and UTIs.

The nursing assessment of an older female elicits information that the client is diagnosed with Raynaud's phenomenon. Which exposure should the nurse instruct the client to avoid? A. Alcohol consumption B. Warm climates C. Cold climates D. Active exercise

(C) Cold climates Rationale: Exposure to cold environments (C) can cause prolonged painful vasoconstriction of the peripheral extremities (especially in hands) in client's with Raynaud's phenomenon. (B) provides the best environment for clients suffering from this disease. There is no correlation between (A) or (D) that exacerbates Raynaud's symptoms.

A frail elderly woman visits the healthcare provider because she has been getting out of breath easily when walking long distances. Which pulmonary function change should the registered nurse (RN) expect to commonly occur with aging? A. Decreased residual volume B. Mild respiratory acidosis C. Reduced vital capacity D. Increased alveoli function

(C) Reduced vital capacity Rationale: With aging, a frail elder is likely to have a reduced vital capacity (C) due to the loss of elasticity of the lung tissue. With reduced elasticity, residual volume increases (A). Arterial pH should not change with normal aging (B). A decrease, rather than an increase, in alveoli function (D) can occur due to a thinning of the alveolar walls with age.

An older female client who is a new resident at an assisted living facility cannot remember how to get to her room. What action should the registered nurse (RN) implement? A. Schedule therapy and social activities in her room B. Ask another resident to help the client C. Show client how to follow hallway signs to her room D. Move client to a room close to nurses station

(C) Show client how to follow hallway signs to her room Rationale: Teaching the client how to follow hallway signs to her room (B) provides cues and reminders that foster independence. (A) limits social stimulation in her residential environment. (B) may be helpful and fosters peer relationships and trusts, but the client's independence should be fostered first. (D) often contributes to further confusion.

When assessing an older client, which age-related changes in the cardiovascular system should the registered nurse (RN) document? (Select all that apply.) A. Dyspnea B. Chest pain C. Cardiac murmurs D. Widening pulse pressure E. Irregular heart rate

(C), (D) Rationale: For older clients, the expected age-related changes in the cardiovascular system include murmurs (C) and widening pulse pressure (D). (A, B and E) are not normal findings and require further evaluation.

An older male client is admitted to the hospital with left-sided heart failure (HF). Which finding should the registered nurse (RN) document that is consistent with HF? A. Ascites B. Pitting edema C. Jugular distention D. Coarse and fine crackles

(D) Coarse and fine crackles Rationale: In left-sided heart failure, the inadequacy of pumping blood into the aorta causes blood to back up into the pulmonary capillaries; this pushes intravascular fluid into the alveoli, which is manifested as crackles or rales. (A, B and C) are manifested in right-sided heart failure.

After a recent total hip replacement, an older female client, who transferred to a rehabilitation facility placement, asks the registered nurse (RN) if she broke her hip because she is old. How should the RN best respond? A. Hip fractures can occur in any age group and require strength conditioning B. With aging, everything tends to break down more easily the older one gets C. Older people tend to look down instead of ahead, increasing the risk of falls D. Older women commonly lose bone calcium, which increases the risk of fracture

(D) Older women commonly lose bone calcium which increases the risk of fracture. Rationale: The best response is to provide the client with an explanation based on aging and demineralization of the bone (D) in older females, especially after menopause. (A, B and C) offer other responses but are not client centered in response to her expressed self-concern.

A 64-year-old client is admitted to the hospital with a fractured right hip. One of the concerns following surgical repair is to promote dorsiflexion. Which intervention would a nurse implement? A. Begin early ambulation B. Monitor pain level C. Provide PCA instructions D. Provide a foot board

(D) Provide a foot board Rationale: A footboard supports the feet in dorsiflexion and helps prevent foot drop throughout recovery (D). (A) and good body alignment may also reduce the possibility of foot drop, however the footboard is maintained throughout recovery. (B) and (C) will alleviate pain but does not promoted dorsiflexion.

An older male client returns to the hospital after discharge 4 days ago for a TURP. The registered nurse (RN) evaluates the function of the 3-way indwelling urinary catheter and the continuous bladder irrigation system. Which finding should the RN report to the healthcare provider? A. Irrigation bag of normal saline is hanging at the level of the client's head B. The urinary output is greater than the amount of irrigation fluid instilled C. The irrigation tubing is attached to the irrigation port on the 3-way catheter D. The tubing that drains the urinary bladder has bright red urine with clots.

(D) The tubing that drains the urinary bladder has bright red urine with clots. Rationale: The presence of bright red urine with clots in the tubing draining the bladder (D) is an abnormal finding indicating active bleeding, which should have resolved 36-72 hours postoperatively and should be reported. (A, B and C) indicate that the system is functioning properly.

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.

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

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

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.

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."

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 home health registered nurse (RN) is visiting an older client with chronic hypertension. What evaluation is most important for the RN to complete with each visit? A. Effectiveness of medication B. Ability to ambulate C. Signs of dehydration D. Familial support

A. Effectiveness of medication Rationale: The highest priority in the care of an older client with chronic hypertension is evaluation of the effectiveness of blood pressure medication (A) and the client's compliance in order to prevent complications related to chronic disease. (B, C and D) are issues common in the older population, but the effectiveness of the blood pressure management is most important.

An older female client recently moved to an assisted living facility. The family explains to the registered nurse (RN) that the client is unmanageable and always confused, disoriented and depressed. The client asks the RN repeatedly, "Where am I?". How should the RN respond? A. Explain that she is in a new home called an assisted living community B. Question the client about her perception of where she might be now. C. Distract the client with a scenario that she is on an outing with her family. D. Reassure the client not to worry because she will meet new friends.

A. Explain that she is in a new home called an assisted living community. Rationale: Reality re-orientation (A) is the best response for a client who is confused because the response is consistent and true. (B, C, and D) do not provide the client with feedback that is reality based.

Older clients are at highest risk for abuse and neglect due to which factors? (Select all that apply.) A. Needs are greater than the caretaker's abilities B. Client's declining strength C. Fixed income D. Longer life expectancy E. Lack of exposure to technology and trends

A. Needs regretter than the caretaker's abilities B. Client's declining strength Rationale: When needs are not being met due to lack of ability of the caretaker (A), stress and feelings of failure may be expressed through neglect and abuse. Decline in strength (B) increases the older client's vulnerability to resist or respond to elder abuse. (C, D, E) do not increase the risk for neglect and abuse.

An older male client arrives at the clinic for an annual physical examination. While the nurse assesses the client, the client states that he is having intimacy problems with his wife. Which information should the nurse provide to elicit more information from the client? A. Query client to clarify the client's idea of an intimacy problem. B. Discuss benign prostatic hypertrophy (BPH) and ejaculation. C. Explore the frequency that he experiences erectile dysfunction (ED) D. Determine if the client's wife is young enough to get pregnant

A. Query client to clarify the client's idea of an intimacy problem. Rationale: Clarification of the client's concern is needed to appropriately address the specific concern about intimacy issues (A). (B), (C), and (D) are details that the client should present, not the RN.

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

Nursing actions for an older adult should include health education and promotion of self-care. Which is most important when working with an older adult client? A.Encouraging frequent naps B.Strengthening the concept of ageism C.Reinforcing the client's strengths and promoting reminiscing D.Teaching the client to increase calories and focusing on a high-carbohydrate diet

C. Reinforcing strengths promotes self-esteem; reminiscing is a therapeutic tool that provides a life review that assists adaptation and helps achieve the task of integrity associated with older adulthood. Frequent naps may interfere with adequate sleep at night. Reinforcing ageism may enhance devaluation of the older adult. A well-balanced diet that includes protein and fiber should be encouraged; increasing calories may cause obesity.

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

An older client who is a resident in a long-term care facility is receiving medications through a gastric tube (GT). After interrupting the continuous GT feeding in which sequence should the nurse implement these actions for administration of crushed medications? (Arrange in order from first to last step.) A. Flush the feeding tube of feeding solution B. Crush the medication into a powder or fine granules C. Administer each medication separately D. Dissolve each crushed medication in a medicine cup E. Flush GT to clear the medication from the tubing F. Reconnect the gastric feeding tube

B - D - A - C - E - F Rationale: The sequence begins with crushing and dissolving the medications. Then flushing the GT of feeding formula and giving each medication separately. When all medications have been given, the feeding tubing should be flushed to clear the medication, and the GT should be reconnected. If the medications are compatible with food, the continuous GT formula can be restarted.

A nurse is assessing the skin of an older adult. Which findings will the nurse determine are expected? Select all that apply. A.Scaly skin B.Tenting of skin C.Transparent skin D.Increased wrinkles E.Pigmented lesions

B, C, D, E Decreased subcutaneous fat with degeneration of elastic fibers allows tenting of the skin and increased wrinkles. Decreased dermal thickness results in paper-thin, transparent skin. Pigmented lesions (liver spots, solar lentigines) increase in number, size, and distribution with aging. Scaling of the skin is more commonly associated with psoriasis than aging.

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 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."

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."

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."

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.

Since his arrival in an assisted living community, an older male client is having difficulty going to sleep. Which intervention should the registered nurse (RN) implement first? A. Encourage client to take a warm bath at night B. Ask the client what has helped him in the past C. Recommend that the client not take daytime naps D. Offer the client a glass of warm milk before bedtime

B. Ask the client what has helped him in the past. Rationale: Asking the client (B) about his sleeping habits involves the client in his own care and preserves his autonomy as he adapts to living in a new community. (A, C, and D) are common ways to promote nighttime sleep but these should be explored with the client and his preferences.

A frail, elderly client is admitted to the unit with a diagnosis of pneumonia. Which finding is most important for the registered nurse (RN) to report to the healthcare provider? A. Fever and chills B. Confusion and dehydration C. Crackles in the lung fields D. Nausea and vomiting

B. Confusion and dehydration Rationale: Confusion and dehydration (B) are findings of inadequate oxygenation and perfusion in this frail elderly client. (A), (C) and (D) are all common with pneumonia, but the most important finding is confusion and evidence of dehydration, which require treatment for this frail elderly client.

After taking a 10-day course of an antibiotic that was ineffective, a frail, elderly client with chronic obstructive pulmonary disease (COPD) is admitted for pneumonia. The client has a long history of smoking and still smokes a pack of cigarettes a day. Which finding should the registered nurse (RN) report to the healthcare provider? A. Barrel chest with increased chest diameter B. Crackles and pulse oximetry level of 88% C. Low hemoglobin and hematocrit levels D. Arterial blood gases indicating respiratory acidosis

B. Crackles and pulse oximetry level of 88% Rationale: With pneumonia, crackles in the lungs and low O2 saturation (B) can impact adequate oxygenation, which should be reported to the HCP. (A) occurs due to chronic hyperinflation of the lungs and is common in clients with COPD. Anemia (C) is frequently identified in clients with COPD, and respiratory acidosis (D) due to CO2 retention contributes to a lower blood pH.

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

A family member brings their aging father to the clinic because he has been alert and oriented during the day but agitated and disoriented in the evening. The registered nurse (RN) reviews the client's list of current medications with the client and family. Which action taken by the RN is most important? A. Medication review with family caregivers is the RN's responsibility B. Multiple medications can contribute to sundowner-like symptoms C. Medication recall is the best way to evaluate the client's memory D. Reviewing medication actions is a component of effective client care

B. Multiple medications can contribute to sundowner like symptoms. Rationale: Older clients may see a variety of HCP which can increase the chance of polypharmacy that compounds the workload of metabolic pathways that may be less efficient due to the aging process. Multiple medication interactions may contribute to sundowner like symptoms; reviewing medication actions and interactions provides the information that may indicate polypharmacy leading to sundowner syndromes.

An older female client who has been taking hydrocodone/acetaminophen (Lortab) q4 hours for chronic back pain for the past 5 years tells the registered nurse (RN) that she cannot live without her pain pills. When asked if she is addicted, the client states that she is not an addict because the healthcare provider prescribed the pain pills. Which coping mechanism should the RN determine the client is using about her addiction? A. Lack of knowledge about narcotic medications B. Rationalization to support narcotic use C. Transfer of blame to healthcare provider D. Justification of narcotic use due to chronic pain

B. Rationalization to support narcotic use. Rationale: The client is using rationalization to maintain self-esteem when she is questioned by stating that she is not addicted because she is taking medication prescribed by a healthcare provider. (A) may be possible, but the client is being specifically asked about possible addiction. (C) and (D) underlie the complexity of denial in addiction, but the client is trying to maintain self-esteem through rationalization.

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

The registered nurse (RN) is caring for an older female client with a 20 year history of rheumatoid arthritis (RA), who is admitted for carpel tunnel release. Which finding associated with RA should the RN document? A. Asymmetrical joint deformity B. Small joint involvement in fingers C. Crepitation or grating sensation in joints D. Weight bearing joint involvement

B. Small joint involvement in fingers. Rationale: Small joint involvement (B) is common in rheumatoid arthritis. (A), (C) and (D) are findings that different OA from RA.

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.

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.

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

B. choose a place without distracting environmental stimuli.

A nurse has provided discharge instructions to a client who received a prescription for a walker to use for assistance with ambulation. The nurse determines that the teaching has been effective when the client: A.Picks up the walker and carries it for short distances. B.Uses the walker only when someone else is present. C.Moves the walker no more than 12 inches in front of the client during use. D.States that a walker will be purchased on the way home from the hospital

C. Moves the walker no more than 12 inches in front of the client during use

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.

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."

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

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.

Which age-related change should the nurse consider when formulating a plan of care for an older adult? Select all that apply. A.Difficulty in swallowing B.Increased sensitivity to heat C.Increased sensitivity to glare D.Diminished sensation of pain E.Heightened response to stimuli

C. D. Changes in the ciliary muscles, decrease in pupil size, and a more rigid pupil sphincter contribute to an increased sensitivity to glare. Diminished sensation of pain may make an older adult unaware of a serious illness, thermal extremes, or excessive pressure. There should be no interference with swallowing in older adults. Older adults tend to feel the cold and rarely complain of the heat. There is a decreased response to stimuli in older adults.

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

An older client is transferred to a telemetry unit after placement of a pacemaker. What action should the registered nurse (RN) take first? A. View incision site B. Obtain a blood pressure C. Establish telemetry monitoring D. Evaluate client for pain

C. Establish telemetry monitoring. Rationale: The first action is to establish continuous telemetry monitoring (C) to ensure the pacemaker is functioning properly. (A, B and D) should be implemented after the client's heart rate and rhythm are successfully being monitored.

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.

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.

The hospice nurse is completing a focused assessment of an older female client with end stage Alzheimer's disease, who recently fractured her hip. What technique should the registered nurse (RN) use to determine the client's pain? A. Use the FACE pain scale B. Ask the client to rate pain on a scale of 1 to 10 C. Observe for facial grimacing D. Review documentation of recent eating habits

C. Observe for facial grimacing Rationale: Observing for facial grimacing (C) is the best method for evaluating pain for a client who cannot communicate due to Alzheimer disease. (A) and (B) may not be understood by a client with end-stage Alzheimer's disease. (D) is not a helpful tool for pain assessment.

The registered nurse (RN) is re-enforcing discharge instructions with the family of an older client who was recently admitted for an intestinal obstruction. Which statement indicates that the family understands the instructions? A. Increase protein and carbohydrates in the daily diet B. Limit activity to bed rest for the first week and increase mobility incrementally each week C. Report abdominal distention, constipation or any other nausea and vomiting to the healthcare provider D. Drink liquids 2 hours after meals instead of during meals

C. Report abdominal distention, constipation, or any nausea and vomiting to the healthcare provider. Rationale: (C) are symptoms that occur with intestinal obstruction and should be addressed immediately. (A, B, and D) are not indicated for a client who has been discharged for intestinal obstruction.

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

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."

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."

An older adult is hospitalized for weight loss and dehydration because of nutritional deficits. What should the nurse consider when planning care for this client? A.Financial resources usually are unrelated to nutritional status. B.An older adult's daily fluid intake must be markedly increased. C.The client's diet should be high in carbohydrates and low in proteins. D.The nutritional needs of an older adult are basically unchanged except for a decreased need for calories.

D. A well-balanced diet with fewer calories because of decreased metabolism is suggested for older adults. Limited financial resources are one cause of malnutrition in the older adult. Fluid needs do not increase. An older client who becomes dehydrated probably is not maintaining a minimum fluid intake. High carbohydrates will provide excessive calories, which may result in obesity. Balance should be maintained among the food groups according to dietary guidelines advocated by the United States Department of Agriculture and the United States Department of Health and Human Services (Canada: Canada's Food Guide, Health Canada); protein is needed for tissue replacement.

The nurse recognizes that which is the mental process most sensitive to deterioration with aging? A.Judgment B.Intelligence C.Creative thinking D.Short-term memory

D. During the aging process there is a progressive atrophy of the convolutions of the brain with a decrease in its blood supply, which may produce a tendency to become forgetful, a reduction in short-term memory, and susceptibility to personality changes. There should be little or no change in judgment. There is little or no intellectual deterioration; intelligence scores show no decline. Creativity is not affected by aging; many people remain creative until very late in life.

An older adult client who is accustomed to taking enemas periodically to avoid constipation is admitted to a long-term care facility. In addition to medications, the healthcare provider prescribes bed rest and a regular diet. Which action should be implemented initially to help prevent the client from developing constipation? A.Arrange to have enemas prescribed for the client B.Obtain a prescription for a daily laxative for the client C.Place a commode by the bedside to facilitate defecation D.Offer a large glass of prune juice with warm water each morning

D. Prune juice and warm water can be administered by the nurse to promote defecation. Prune juice irritates the bowel mucosa, stimulating peristalsis. Fiber in the diet increases fecal volume, which stimulates intestinal motility and the reflex for defecation. Enemas should be avoided because they can promote dependency and can result in electrolyte imbalance. The routine use of laxatives promotes dependency. The client is bedbound and is unable to use a commode.

The nurse is caring for an older client admitted to the hospital with type 2 diabetes. What is important for the nurse to remember about older adults and type 2 diabetes? A.Older adults secrete no endogenous insulin. B.Older adults have a lower risk of complications. C.Older adults develop a sudden onset of symptoms. D.Older adults seldom develop ketoacidosis.

D. Rationale Lipolysis is not a common response to meeting the metabolic needs of those with type 2 diabetes---ketones are not present to cause ketoacidosis. Adults with type 2 diabetes do secrete endogenous insulin, but secretion is slow and in smaller than adequate amounts.

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.

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

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 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

A new resident in an assisted living facility is an older client who is experiencing short-term memory loss and confusion. Which activity should the registered nurse (RN) schedule the client to do during the day? A. Arts and crafts B. Current events discussion group C. Group sing-along D. Daily exercise group

D. Daily exercise group Rationale: A daily exercise group (D) allows the client to mirror the leader and minimizes the client's stress to remember. (A), (C), and a current events discussion group (B) are thought-provoking activities that require attention to detail and short-term memory to participate in the group activity which may be stressful and frustrating to the resident who has difficulty remembering sequence of the details.

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.

The nurse defines ageism most accurately as: A. The undervaluing of individuals based on their age. B. Perception of a person's worth based on productivity C. Biases directed towards individuals considered aged D. Discrimination based on an individual's increasing age

D. Discrimination based on an individual's increasing age

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

A frail elderly couple asks the registered nurse (RN) if they have to watch their salt intake because food does not taste as good as it used to so they have to season most foods. What information should the RN offer the couple? A. Boredom may influence how the taste of food is perceived, and different seasonings can stimulate taste. B. With age, an increase in sodium intake is needed to compensate for a decrease in renal function. C. Short-term memory loss and confusion may be the reason they want to over-season their food. D. Taste buds often are dull due to atrophy so older clients should use other seasonings instead of salt.

D. Taste buds are often dull due to atrophy so older clients should use other seasonings instead of salt. Rationale: Taste buds atrophy with normal aging, which influences an older client's sensitivity to taste and is often compensated for the use of stronger tasting seasonings. (A), (B), and (C) are not normal aging processes related to taste.

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.

An 82-year-old retired schoolteacher is admitted to a nursing home. During the physical assessment, the nurse may identify which ocular problem common to persons at this client's developmental level?: Tropia Myopia Hyperopia Presbyopia

Presbyopia is the decreased accommodative ability of the lens that occurs with aging. Tropia (eye turn) generally occurs at birth. Myopia (nearsightedness) can occur during any developmental level or be congenital. Hyperopia (farsightedness

A staff member tells a nurse that an older client becomes irritable when asked to assist with activities of daily living. On what general information about older adults should the nurse base a response? A.Decreased ability to cope B.Loss of ability to cooperate C.Ambivalence toward authority D.Difficulty performing step procedures

Rationale A. Fears and anxieties about themselves and their possessions are common in older adults because of a decreased self-concept and an altered body image; these changes result in a decreased ability to cope.

A 93-year-old client in a nursing home has been eating less food during mealtimes. What is the priority nursing intervention? A.Substitute a supplemental drink for the meal. B.Spoon-feed the client until the food is completely eaten. C.Allow the client a longer period of time to complete the meal. D.Arrange a consultation for the placement of a gastrostomy tube.

Rationale C. Older clients may display psychomotor retardation and need more time to complete the tasks associated with the activities of daily living; mealtimes should be relaxing and social. Supplemental drinks should augment meals and be offered between meals, not as a substitute for meals. Clients should be encouraged to feed themselves to remain as independent as possible; spoon-feeding may not mirror the pace of eating preferred by the client, and forcing the client to eat all of the food may precipitate anxiety, frustration, and agitation. Placement of a gastrostomy tube is premature.