Geriatric Ch. 13-16

During a routine physical examination, the patient reports, "I have problems falling asleep at night. I regularly engage in vigorous exercise to tire myself every evening." What response by the nurse is indicated?

"Exercise is helpful, but vigorous exercise can lead to restless leg syndrome, which can contribute to insomnia."

Which assessment finding is a contributor to an older client's risk for falls? (Select all that apply.)

-The client is awaiting cataract surgery on right eye. -The client type 2 diabetes is poorly controlled with diet and exercise alone. -The client reports a fall in the past year.

The nurse will be educating a group of senior citizens on adaptations for safer driving. Which adaptations should the nurse include? (Select all that apply.)

-Wide rear-view mirrors -Pedal extensions -Global positioning system (GPS) devices

An older woman who receives intravenous (IV) fluids is making wide gesticulations with her arms and loudly insulting the nursing staff. Which intervention should the nurse implement to maintain safe, effective nursing care initially?

Determine the patient's needs.

The nurse cares for an older man who has a malignant melanoma. Which intervention should the nurse implement for this man to prevent a recurrence or advancement of this condition in the future?

Instruct him to wear sun-protective clothing and a hat at all times.

Which attempt by the family to prevent an older frail adult from falling causes the home health nurse concern?

Keeping the side rails up on the client's bed at night

A dermatologist should promptly evaluate which one of the following skin lesions?

Multicolored raised lesion with a fuzzy border

Which of the following is a true statement about impaired skin integrity?

Muscle and fat cannot regenerate.

The nurse wants to use exercise according to the recommendations of the American Geriatrics Society (AGS) for an older woman who lost her balance and fell. Which nursing intervention is suitable for this older adult according to the AGS?

Provide information on group exercises for balance training.

Which of the following is a true statement about sleeping in older adults?

Sleep disturbances in older adults can be caused by chronic illness.

Which of the following is a true statement about sleep in older adults?

The time spent in bed increases, but the time spent asleep decreases.

Which of the following is a true statement about skin care for older adults?

Maintaining oral hydration may reduce the incidence of xerosis.

Exercises are prescribed for older adults as therapy to improve which one of the following qualities?

Muscle strength

A home care nurse in an area of the country that is prone to tornadoes routinely discusses disaster preparedness with older adult clients. What is the primary rationale for this intervention?

Older adults are less likely to seek formal and informal help when affected by natural disasters.

Which of the following statements is true about a safe, effective care environment for older adults?

Older drivers are more likely to be in a fatal motor vehicle accident than younger drivers.

The health care provider has not ordered the use of a restraint for an alert patient at high risk for falling. The nurse should implement which side rail use?

One 1/2-length rail

An older adult is vitamin deficient. Which of the following does the nurse offer to the older adult to provide the important missing vitamin for maintaining healthy skin and enhancing tissue repair?

Orange slices

The nurse completes an admission assessment on an older adult patient. The nurse identifies which factor that may contribute to sleep problems?

Polypharmacy

The nurse can place an older adult into one of four patient rooms. Which is the most suitable room for an older adult?

Room with orange carpeting and soft lighting

The nurse is discharging an older woman who uses a walker from rehabilitative care. Which observation does the nurse use to determine whether the patient is prepared for discharge?

She takes the walker to the elevator.

Which of the following is an important consideration about the skin of older adults?

Skin becomes more vulnerable to damage.

What is the difference between rest and sleep?

Sleep is restorative and recuperative.

A nurse will be conducting an educational session on preventing skin cancer at a local senior citizen's center. Which should the nurse include in the session?

Squamous cell cancer may appear similar to a wart.

An older man was oriented and responded appropriately in the hospital, but he is now disoriented and confused in his home after discharge. Which of the following issues is the first that the home nurse should examine to determine whether an environmental issue is contributing to the patient's condition at home?

Temperature of household

A homecare nurse visits an older patient who lives in a smart medical home community environment. The nurse understands that smart homes are:

an emerging technology to enhance safety of older adults by using environmental control systems.

When an older adult patient is diagnosed with restless leg syndrome (RLS), the nurse is confident that patient education on the condition's contributing factors has been effective when the patient states:

"I've cut way back on my caffeinated coffee, teas, and sodas."

An older person is admitted to the hospital with an exacerbation of congestive heart failure. The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse, "How did I get something like this?" The best response by the nurse is:

"Scabies is highly contagious and spreads easily through physical contact."

An older patient asks a nurse, "I really have trouble sleeping, and my doctor does not want to prescribe a sleeping pill for me. He says they are not good for older people. I really don't understand his response. Can you help me?" The best response by the nurse is:

"Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep."

A 75-year-old woman asks a nurse, "I know I should be moving, but how much is the right amount of exercise for me?" The best response of the nurse is:

"You need to engage in 30 minutes of moderate intensity exercise on at least 5 days a week."

A nurse is admitting and orienting an older adult to the hospital unit. She discusses fall prevention and demonstrates the use of the call bell to the patient. The patient's daughter asks: "Why don't you just put up all the side rails to prevent my mother from getting out of bed by herself and falling? That should work, right?" The best response by the nurse is:

'There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury."

A nurse will be conducting an education session at the local senior citizen's center on the importance of physical activity. Which activities should the nurse include as an example of moderate-intensity aerobic activity? (Select all that apply.)

-Biking -Dancing

The nurse determines the risk for a pressure ulcer in an older adult who is 6 feet tall and weighs 155 lb. Which patient information should the nurse use in planning care to reduce this individual's risk for a pressure ulcer? (Select all that apply.)

-Dry mucous membranes -Prealbumin level of 7 mg/dL -Fasting glucose of 140 mg/dL -Uses food stamps to get food

The nurse identifies which of the following interventions in the treatment of fungal infections? (Select all that apply.)

-Eliminate the conditions that created the problem. -Thoroughly clean and dry the skin daily. -Apply miconazole (Micatin) as directed.

Which of the following are assessed in a fall prevention assessment of an older adult? (Select all that apply.)

-Environment -Physical status -Functional status -Medical history

Which one of the following is a true statement about mobility and safety for older adults?

Lowering the bed and fluorescent tapes are interventions to increase safety.

The nurse plans care to prevent a dangerous thermal environment for an older man who lives in a northern climate of the United States. Which patient assessment data does the nurse recognize that can contribute to his risk of hypothermia? (Select all that apply.)

-Has a history of a cerebrovascular accident (CVA) -Has a history of diabetes mellitus -Builds miniature cars for a hobby -Gets heat from a boiler in the cellar

A group of older women in an assisted living facility are talking about one of the residents who fell and fractured her hip. The women ask a nurse the following: "It seems like so many of us fall and break our hips, and then it is downhill from there. Is this really true?" In formulating a response, the nurse considers which of the following? (Select all that apply.)

-Hip fractures are a leading cause of hospitalization for older people. -The major cause of hip fractures is falls. -Hip fractures are associated with very high morbidity and mortality rates.

The daughter of an older patient states the following to a nurse: "I am so concerned that my dad is still driving. He is dangerous! He has had a couple of accidents, and I am worried that he is going to kill himself, or worse, somebody else. What can I do?" The nurse recommends which of the following involved type action strategies for driving cessation? (Select all that apply.)

-Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem. -Arrange for alternate transportation for the person.

A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. The nurse recommends that the patient eliminate which of the following? (Select all that apply.)

-Loose carpeting on the floors -Excess clutter

A nurse is caring for a frail older adult in a long-term care facility and is concerned about preventing hypothermia. Which of the following interventions should the nurse implement? (Select all that apply.)

-Make sure that the temperature in the resident's room is at least 65 °F. -Cover residents well when in bed and while bathing. -Provide a head covering for the resident. -Provide hot, high-protein meals and bedtime snacks.

The nurse observes that a male patient is snoring every night. Which should the nurse assess in this patient to diagnose the potential for sleep apnea? (Select all that apply.)

-Number of daytime naps -Headaches in the morning -Irritability during the day -Awakening during the night

For which of the following conditions does the nurse identify the patient as at risk for developing fungal infections? (Select all that apply.)

-Obesity -Incontinent -Bedridden

Which factors in the patient care environment should be routinely assessed to decrease the risk of falls? (Select all that apply.)

-Outdoor grounds -Appropriate footwear -Grab bars in place

Although intact skin effectively protects an individual, it functions within physiological limits. Which qualities of healthy skin work synergistically within these limits to absorb, cushion against, deflect, or neutralize potentially harmful forces, as well as protect against potentially harmful substances that might impair skin integrity? (Select all that apply.)

-Strength -Pliability -Durability

The nurse should encourage which of the following exercises to assist with balance for a patient who is at high risk for falls? (Select all that apply.)

-Tai Chi -Walking heel to toe

A homecare nurse visits a client in the home to conduct a fall risk assessment. The nurse assesses the client and the home for extrinsic risk factors for falls. Which of the following are extrinsic risk factors? (Select all that apply.)

-The client uses a cane but the cane is not the appropriate size for the client. -The client's home is cluttered. -There are no grab bars in the client's bathroom.

An older adult who has a balance disorder and has sustained repeated falls is recommended to start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual? (Select all that apply.)

-Yoga -Tai Chi

Benefits of telehealth include that it (Select all that apply.)

-promotes self-management of illness in rural and underserved areas. -facilitates remote physical assessment and monitoring of chronic conditions. -decreases costs by reducing hospital readmissions.

Which of the following is a true statement about assistive devices to aid older adults with impaired mobility?

A cane is most useful for unilateral disabilities but not bilateral problems.

The nurse is conducting an admission assessment on an older adult and notes a small lesion with a multicolor appearance. Which assessment approach should the nurse use?

ABCD (asymmetry, border, color, diameter) rule

The overall temperature in your gerontological unit is 62 °F during the evening shift. In documenting this concern to the administration, which factor is the most important for the health and well-being of older adults?

An ambient temperature of 62 °F is unsuitable for older people because they have impaired thermoregulation.

The nurse at an assisted-living facility uses the Exercise and Screening for You (EASY) tool to plan an exercise program for a female resident who is in good health except that her height has decreased inch. Which exercise safety tip from EASY calls for the nurse to assess the resident before planning care?

Avoid stretches that cause you to bend at the waist.

The nurse assesses the quality of which of the following patient characteristics when applying the Get Up and Go test from the Hendrich II Fall Risk Model?

Balance

The nurse monitors for which clinical indicator when the older adult complains of pruritus?

Coarse skin

Which infection-control practice should the nurse implement when caring for an older adult who has active herpes zoster?

Cover ruptured skin lesions with a nonabsorbent dressing.

The nurse recommends that a client diagnosed with moderate stage Alzheimer's disease attend a support group when he becomes defensive about not driving his automobile and the effects it will have on "being stuck at home." Which is the priority outcome expected for this client when attending the group sessions?

Helps with minimizing the loss as a factor in causing depression

The nurse plans care to protect the skin covering an older adult's greater trochanter. Which of the following interventions is the nurse's priority when the older adult is positioned on the side?

Implement a turning schedule.

An older woman maintains an active lifestyle playing various games with friends. She reports to the nurse that she experiences wakefulness during the night and an inability to fall asleep after waking up at night. Which intervention should the nurse implement to improve the quality of this woman's sleep?

Inquire about her nightly sleep rituals.

During the night, an older woman complains to the nurse that she has not slept more than 2 hours since admission to the hospital. Which intervention should the nurse implement to increase the duration of this woman's sleep?

Inquire about her sleep habits used at home.

After assessing an older man in his bed, the nurse determines that he is at high risk for falls. The nurse leaves the room to get a fall risk sign and returns to find him on the floor pleading for help. Which of the following was the most important intervention the nurse should have implemented to prevent this event?

Instruct the patient to call for help.

An older man has Alzheimer's disease, and his wife says he is up and wandering around the house at night. Which intervention should the nurse implement to increase the man's duration of sleep?

Instruct the wife to increase his daily physical activity.

Which nursing intervention is most likely to prevent the creation of an environment conducive to fungal growth?

Use mild skin cleansing agents and blot dry.

An older patient complains of dry skin and asks for advice. Which advice should the nurse offer for improving dry skin?

Use tepid bath water.

A nurse is providing an educational session on vaccines to a group of older adults. The nurse is discussing the zoster vaccine (Zostavax). Which of the following information should the nurse include in the education?

Zostavax is recommended for all individuals older than 60 years of age that have no contraindications to the vaccine.

A 79-year-old client resides independently in the community. The visiting home health nurse finds even though it is 90 °F outside, the windows are closed, and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to

age-related neurosensory changes that diminish awareness of temperature changes.

A patient who reported "a problem sleeping" shows an understanding of good sleep hygiene when

limiting the afternoon nap to just 30 minutes.

A nurse in a long-term care facility notes that there has been an increase in falls on one unit and that many of the falls are occurring immediately after mealtime. The nurse recommends that the nursing home conduct a trial of six smaller meals instead of the three traditional meals. The nurse makes this recommendation on the understanding that

postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide.