Gero Final

An 88-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She has a history of hypertension and congestive heart failure and is on a total of five different medications for these chronic conditions. The nurse caring for the woman develops a care plan that includes the diagnosis Risk for Falls. A priority nursing intervention for this client is to: A. perform a fall assessment B. keep all of the side rails up on the client's bed at nightime C. place the client on bed rest so that she does not fall D. assess the client's dietary intake for calcium adequacy

A Completing a fall assessment will enable the nurse to identify and correct the risk factors for this patient. Side rails have not been found to be effective in keeping a client in bed and may actually lead to injury. Maintaining a patient on bed rest can lead to deconditioning and actually contribute to falls. Assessing the client's dietary intake of calcium is a good intervention for this age group, but it is not a priority and will not prevent falls.

Risk factors for falls include all EXCEPT: a. bed in low position b. incontinence c. delirium d. restraints

A Lowering a bed decreases the risk that a fall will occur as well as the chance that an injury will occur as the result of a fall.

A nurse is planning care for a group of super-centenarians in an assisted living facility. The nurse considers which of the following? a. Most super-centenarians are functionally independent or require minimal assistance with activities of daily living. b. The majority of super-centenarians have cognitive impairment. c. The number of super-centenarians is expected to decrease in coming years as a result of heart disease and stroke. d. It is theorized that super-centenarians survived as long as they have due to genetic mutations that made them less susceptible to common diseases.

A Research supports that most super-centenarians are functionally and cognitively intact, requiring minimal assistance with ADLs. The number of super-centenarians is expected to increase in coming years as the number of older adults increases. The reason why individuals survived as long as they have in not known.

A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma. The nurse's response is: A. the exact etiology of glaucoma is variable and often unknown B. spasms of the orbicular muscle C. changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves D. bits of broken coalesced vitreous from the peripheral or central part of the retina

A The etiology of glaucoma is variable and often unknown. However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. Spasms of the orbicular muscle can cause the lower lid to turn inward. If it stays this way, it is called entropion. The changes described contribute to decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters.

nurse in a long-term care facility notes that an older resident with Alzheimer's disease awakens frequently at night and is restless and agitated. Which of the following interventions will be most effective to help manage this resident's sleep problems? A. Taking the resident outside in the garden for 45 minutes daily B. Limiting fluid intake for the resident C. Educating the resident on the association between Alzheimer's Disease and insomnia D. Administering a mild sedative hypnotic at bedtime

A Behavioral strategies for persons with dementia include daily walks and exposure to light to enhance sleep. Limiting fluid intake may or may not be effective depending on whether or not the resident has nocturia. Educating the resident about the association between AD and insomnia may be feasible depending on the resident's mental status but will not necessarily ameliorate the problem. Sedative hypnotics are not the first-line treatment for older adults with AD and sleep disturbances

An older client reports to a nurse. "My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around. I had some trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well." Based on the client's description, the nurse suspects which of the following? A. Presbycusis B. Otosclerosis C. Tinnitus D. A perforated eardrum

A Presbycusis is a type of sensorineural hearing loss. It is slow and progressive and often ignored by older adults and considered normal aging. Symptoms include difficulty filtering background noise and understanding women and children's voices. Individuals often accuse people of mumbling. Often, it is recognized by others first, before the affected person notices it. Otosclerosis is a cause of conductive hearing loss, as is a perforated eardrum. Tinnitus is a perception of sound in one or both ears where no external sound is present.

An older adult client shares with the nurse that, "I don't know what it is but it seems that I need more light for reading or even watching television as I get older." The nurse explains that aging may cause this change due to the: A. slower ability of the pupil to adjust to changes in lighting B. impact arcus senilis has on visual acuity C. flattening and thinning of the cornea D. retinal changes that begin to occur with aging

A A slowed ability of the pupil to accommodate to changes in light accounts for the need of this patient to have more light in order to read. Arcus senilis does not affect vision. It is true that the cornea becomes flatter and thinner with aging, which results in astigmatism. Astigmatism does not account for the need for increased light that this patient is reporting. The changes in the retina do not account for the need for increased light that this patient is reporting.

An older man tells a nurse, "The doctor says I have something wrong with my eyes, something called presbyopia. Can you explain why I have this? I was always fortunate to have good eyesight." The nurse formulates a response based on the knowledge that: A. the lens of the eye loses elasticity causing a loss of focus for near objects B. the cornea of the eye becomes thicker and less curved causing an increase in astigmatism C. the lens of the eye increases in opacity causing a decrease in light refraction D. the cornea of the eye forms a gray ring at the edges

A Presbyopia is the loss of focus for near objects, caused by a loss of elasticity and hence a loss of accommodation of the lens of the eye. All of the other options are normal age-related changes; however, they are not related to presbyopia.

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.) A. Yoga B. Tai Chi C. Swimming D. Pilates E. Weight lifting

A and B Yoga and Tai Chi are exercises that improve balance, as they use movements that improve the ability to maintain control of the body over the base of support to avoid falling. Swimming, Pilates, and weight lifting do not do this.

A nurse is assessing an older patient with new onset confusion using the Confusion Assessment Method (CAM). The nurse understands that in order to have a diagnosis of delirium when using the CAM, the patient must exhibit which of the following? (Select all that apply.) A. Acute onset of symptoms or fluctuating course B. Inattention C. Disorganized thinking D. Altered level of consciousness E. Alteration in level of physical activity

A, B, C, and D. In order to be diagnosed with delirium, using the CAM, the individual must have acute onset or fluctuating course and inattention and either disorganized thinking or altered level of consciousness. Although individuals with delirium often have either hyperactivity or hypoactivity, this is not one of the criteria assessed on the CAM

A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (Select all that apply.) A. Difficulty placing hearing aid properly in the ear B. Stigma associated with wearing a hearing aid C. Difficulty changing the batteries in the hearing aid D. Ineffectiveness of hearing aids for individuals with age-related hearing loss E. Hearing annoying loud noises

A, B, C, and E. These are all factors associated with low use after purchase. Option D is incorrect. Even though hearing aids do not restore hearing to normal, most individuals with age-related hearing loss do experience some hearing enhancement with hearing aid use. However, hearing aids do bring challenges, such as distorted speech and amplified background noise.

An older patient ask a nurse,"It seems like all of my friends and I have difficulty sleeping. Is it common among older people?" The nurse formulates a response based on the knowledge that normal age-related changes in sleep include: (Select all that apply.) A. total sleep time and sleep efficiency are reduced. B. rapid eye movement (REM) sleep is shorter, less intense, and more evenly distributed. C. sleep requirements for older adults are less than that of younger adults. D. daytime napping is common. E. sleep tends to be deeper in older adults than in younger adults.

A, B, and D Normal age-related changes in older adults include a reduced total sleep time and sleep efficiency and shorter, less intense, and more evenly distributed REM sleep. Older adults tend to nap during the daytime. Sleep requirements do not decrease as one ages. Sleep tends to be objectively and subjectively lighter in older adults.

A nurse hears a colleague state the following: "Can you believe Mr. Jones' daughter just bought him a tablet computer? He is 90 years old. It is ridiculous to think that he can learn to use it." The nurse formulates a response based on research that shows: (Select all that apply.) A. Older adults comprise the fastest growing population using computers and the internet. B. Internet use is less prevalent in individuals over age 75 than those ages 65-74. C. Older American men are the fastest growing group of social networking site users. D. Older adults use the Internet only for social networking and recreational uses. E. Technology has the potential to improve quality of life for older adults

A, B, and E. Older adults are the fastest growing population using computers and the Internet. Internet use does decrease in those over age 75 as compared to older adults less than 75. Older women are the fastest growing group of individuals using social networking sites. Older adults use technology for a whole host of reasons, both social and to communicate with health care providers and access health information. Technology has a large potential to improve quality of life for older adults.

An older person reports hearing whistling in both ears when no external sounds are present and is diagnosed with tinnitus. Which of the following are causes of tinnitus? (Select all that apply.) A. Exposure to loud noises B. Use of a hearing aid C. Cerumen buildup D. Side effects of medications E. Age-related changes in the middle and inner ear

A, C, and D Hearing aids are not known as a cause or a trigger to worsen tinnitus and are at times used to amplify environmental noise to mask tinnitus. Tinnitus is not an age-related change, although it occurs in about 11% of individuals who have presbycusis. Exposure to loud noise and cerumen buildup are known to exacerbate or cause tinnitus. Over 200 prescription and nonprescription medications have tinnitus as a side effect. There are also many ototoxic medications.

An older female resident of an assisted living facility says the following to a nurse: "I am very frightened about getting dementia. I have read a lot about brain exercises, but I am not sure what I should be doing." The nurse formulates a response based on knowledge of which of the following? (Select all that apply.) A. Individuals should engage in some type of brain fitness activity a couple of times a week for at least 25 minutes. B. Brain fitness activities are only effective if an individual has not experienced any memory problems at all. C. Brain fitness activities may include computer-based games, memory training, board games, reading, and engaging in conversation. D. Physical activity is important for wellness but is unrelated to brain fitness

A, C, and E. Brain fitness activities are effective for individuals with normal memory or mild memory problems. Physical activity is important and has an impact on improving reaction time and working memory as well as posture, balance, and socialization.

A nurse is caring for a 92-year-old female patient who was admitted to the hospital 1 day after she had outpatient cataract surgery. The patient who lives in an assisted living facility became very confused and agitated and was found wandering in the lobby of the building in her nightgown. She refused to return to her room and stated that there were "bad men" in her room. The patient has a history of dementia, diabetes, heart failure, and is on seven different medications. She was widowed 1 year ago. The nurse suspects she has delirium. What are the patient's risk factors for delirium? (Select all that apply.) A. Age of 92 B. Residing in an assisted living facility C. History of dementia D. Female gender E. Recent cataract surgery

A, C, and E. This patient's risk factors for delirium include her older age, history of dementia, and recent surgery. There is no evidence that living in an assisted living facility or being female increase risk of delirium

An older patient is diagnosed with diabetic retinopathy. The patient asks a nurse. "Is there anything that I can do to prevent progression of this disease and blindness?" The nurse includes which of the following into the response? (Select all that apply.) A. Strict control of blood glucose levels is important in slowing disease progression. B. Laser photocoagulation treatments can stop progression of the disease. C. Control of blood pressure and cholesterol levels are important steps slowing disease progression. D. Wearing sunglasses to protect the eyes from ultraviolet light can stop disease progression. E. Eating a diet high in beta-carotene can stop disease progression.

A,B,C Constant strict control of blood pressure, blood glucose, and cholesterol and laser photocoagulation treatments can halt progression of the disease. Laser treatment can reduce vision loss in 50% of patients. Neither protecting the eyes from ultraviolet light nor eating a diet high in beta-carotene has been proven to be effective in stopping disease progression.

The FANCAPES assessment tool focuses on the older adult's: A. ability to meet personal needs to identify the amount of assistance needed. B. ability to perform instrumental activities of daily living (IADLs). C. cognitive abilities. D. level of dementia present.

A. The FANCAPES assessment tool focuses on physical functioning and evaluates the individual's ability to meet his/her needs and how much assistance is needed to meet the needs. FANCAPES evaluates physical functioning. IADLs involve more than just physical functioning. FANCAPES does not assess cognitive function, nor does it assess dementia.

A nurse identifies that an older adult needs more education on nutritional needs when the older adult states the following: A. "Since I am an older person I need more calories because my metabolic rate is slower." B. "Since I am an older person, I need fewer calories since my metabolic rate is slower." C. "Even though I am an older person, I still need the same amount of nutrients in order to be healthy." D. "Even though I am an older person, I still need to pay attention to my diet and activity levels."

A. Generally, older adults need fewer calories because they may not be as active and metabolic rates slow down. Older adults generally require the same amount of nutrients for optimal health outcomes. Older adults need to pay attention to meeting nutritional requirements and obtaining adequate physical activity for optimal health.

An older client admitted to the hospital after having sustained a fall at home is diagnosed with a right hip fracture and experienced a surgical reduction of the fracture. At 2:30 a.m., she awakens from sleep insisting that her daughter is in the other room and wants to see her. Attempts to reorient her to the surroundings are unsuccessful. In reviewing the client's record, which of the following would you identify as the greatest risk factor for delirium for this client? A. History of dementia B. Death of the client's husband last month C. The client's age D. History of cardiac disease

A. Older people who have undergone surgery and those with dementia are particularly vulnerable to delirium. While the other options may be factors, they are not as influential as the correct option - "History of dementia".

A hospitalized older adult who recently had surgery and a wound infection postoperatively is noted to be losing weight despite consuming his meal trays and snacks. One reason that this might be occurring is: A. an injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization. B. an injury may cause malabsorption of nutrients. C. most hospitalized older patients do not consume adequate amounts of micro- and macronutrients. D. most hospitalized patients do not have accurate weights recorded upon admission.

A. One trajectory for malnutrition is inflammation-related malnutrition. In this situation malnutrition develops as a consequence of injury, surgery, or disease that triggers inflammatory mediators that contribute to an increased metabolic rate and impaired nutrient utilization. An injury does not necessarily cause malabsorption of nutrients. There is no evidence that most hospitalized patients do not consume adequate diets, and there is also no evidence that accurate weights are not recorded for most hospitalized patients.

Which pharmacokinetic/pharmacodynamic parameter does the aging process least affect? A. Absorption B. Distribution C. Metabolism D. Excretion

A. There is no conclusive evidence that he absorptive process is changed appreciably in older adults. Distribution, metabolism, and excretion are all affected significantly by aging.

Factors that complicate assessment of older adults include: (Select all that apply.) A. presence of multiple comorbid conditions. B. atypical presentation of illness. C. difficulty in differentiating symptoms of disease from normal age-related changes. D. increase in iatrogenic illness. E. lack of assessment instruments specific for the older adult population.

A. B. C. and D. Factors that complicate assessment of older adults include difficulty differentiating disease symptoms from normal age-related changes, the presence of multiple comorbidities, atypical

Which of the following are age-related changes that affect hydration status? (Select all that apply.) A. Decrease in thirst sensation B. Decrease in total body water C. Decrease in ability of kidneys to maximally concentrate urine D. Decrease in bone marrow mass E. Decrease in bladder capacity

A. B. and C. As one ages, thirst sensation decreases and is not proportional to metabolic needs in response to dehydrating conditions. There is a decrease in total body water. The kidneys are less able to maximally concentrate urine resulting in a loss of water. While there is a decrease in bone marrow mass, this does not impact hydration status. Also, as one ages, bladder capacity decreases; however, this does not directly impact hydration status.

Which of the following are examples of elderspeak? (Select all that apply.) A. A nursing assistant refers to one of her patients as "grandma" B. A nurse attempts to medicate a patient and states, "Now come on and be a good girl" C. A nurse explains a procedure to a patient using simple nonmedical terms D. A nurse makes sure that she is directly facing a patient who has hearing loss when she is speaking E. A nursing assistant tells a patient, "It is time for our bath now"

A. B. and E. Elderspeak is a form of patronizing speech. Examples include using diminutives or pet names, speaking very slowly, and speaking to older adults as if they were children, or using collective pronouns. Option C is not an example of elderspeak; it is appropriate to explain a procedure using nonmedical terminology. Option D is the correct manner in which to address an individual with hearing loss; facing the patient allows the patient to read lips.

Many older adults have a vitamin B12 deficiency. Reasons for this include which of the following? (Select all that apply.) A. Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B12 absorption less efficient. B. The major source of vitamin B12 is sunlight, and older adults are less likely to be outdoors and absorb vitamin B12 in this manner. C. Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B12 from food. D. Most older adults do not consume five servings of fruits and vegetables daily, which is the main dietary source of vitamin B12. E. Certain antibiotics and anticonvulsant medication increase the risk of vitamin B12 deficiency.

A. C. and E. A normal age-related change in the stomach is the production of less gastric acid, which makes vitamin B12 absorption less efficient. For most older adults, intake of vitamin B12 is usually adequate. Use of proton pump inhibitors and H2 receptor blockers for more than a year can lead to lower serum vitamin B12 levels by impairing absorption of the vitamin from food. Certain antibiotics and anticonvulsants can also increase the risk of vitamin B12 deficiency. While it is true that older adults may be outdoors less, the major source of vitamin B12 is not sunlight. While it is also true that older adults may not consume five servings of fruits and vegetables daily, fruit and vegetables are the major sources of vitamins A, C, and E and potassium

A nurse manager is providing a novice geriatric nurse with guidelines when encouraging an older client to reminisce about his or her life and past experiences. Which suggestions will be included? (Select all that apply). A. Don't correct the client even when you suspect the memory is incorrect. B. When the focus remains on sad topics, assess the client for possible depression. C. Refrain from interjecting personal stories into the reminiscing process. D. Expect and respect a degree of repetition. E. Use close-ended questions to help focus the reminiscing.

A. and C. Suggestions for encouraging reminiscing include listening without correction or criticism, remembering that it is the client's recollections that are important; being patient with repetition since sometimes people need to tell the same story often to come to terms with the experience, especially if it was very meaningful to them; being attuned to signs of depression in conversation (dwelling on sad topics) or changes in physical status or behavior, and providing appropriate assessment and intervention; and keeping the conversation focused on the person reminiscing, but not hesitating to share some of your own memories that relate to the situation being discussed. Use open-ended questions to encourage reminiscing since they encourage free thought.

A nurse is preparing to hand feed an older adult with a history of right cerebrovascular accident (CVA) with facial weakness and dysphagia. Which techniques should the nurse utilize when feeding this patient? (Select all that apply.) A. Sit the patient upright in a chair at 90 degrees. B. Allow the patient to sit upright for 15 minutes after the meal is completed. C. Feed the patient only liquids to make swallowing easier. D. Place the solid food in the left side of the mouth. E. Have the patient swallow twice for every mouthful of food given.

A. and E. When feeding a patient with dysphagia, it is important to have the patient sit upright at 90 degrees and to remain upright for an hour following the meal. Other important techniques include having the patient swallow twice for every mouthful of food given. This patient has a history of a right CVA, which would mean that the patient has left-sided weakness. The food needs to be placed in the nonimpaired side of the mouth, which in this case would be the right side. Since the patient has a CVA, the intake of "thin liquids" can increase risk for aspiration.

An older patient reports the following symptoms to a nurse during a routine visit to the geriatric clinic: blurry vision, the need for more light when reading, and blind spots in the middle of his visual field. He also states, "Strangely enough my peripheral vision continues to be pretty good." The nurse suspects that the patient has which of the following? A. Glaucoma B. Age related macular degeneration C. Diabetic retinopathy D. Cataracts

B Blurry vision, needing more light, and blind spots in the middle of the visual field (scutomas) are all characteristics of age related macular degeneration. The other three eye disorders do not present with these symptoms.

A nurse is educating a group of older adults on the benefits of an exercise program. The nurse includes education on when not to exercise. Which of the following should the nurse include in the education? (Select all that apply.) A. Do not exercise if your resting heart rate is over 80 B. Do not exercise if your blood pressure is greater than 200 systolic and 100 diastolic C. It is important to wait 30 minutes after a big meal before engaging in vigorous exercise D. Do not exercise if a joint that you are using is red, warm, and painful E. Do not exercise if you have a fever and muscle aches

B Older adults are advised to avoid exercise if their resting heart rate is over 120, not 80. It is important to wait 2 hours after a heavy meal before engaging in vigorous exercise, but leisurely exercise such as a walk is fine.

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 following 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: A. postural changes in blood pressure are common in older adults and frequently occur around mealtimes B. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide C. residents of long-term care facilities are often on many different medications, which are given at mealtimes D. It is common practice to take long term care residents to the bathroom immediately following meals

B Postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. Modifications such as increased water intake before eating or substituting six smaller meals daily for three larger meals may be effective. Orthostatic hypotension is a cause of falls in older adults, but does not just occur around meal times. While it is true that residents of long term care facilities are on multiple medications and are usually toileted following meals, neither of these options addresses postprandial hypotension.

A limitation of the KATZ Index of activities of daily living (ADLs) is that: A. completion of the tool requires the joint efforts of the interdisciplinary team. B. all ADLs are weighted equally. C. it puts a heavier weight on the cognitive abilities necessary to perform ADLs. D. it provides a range of performance for each task.

B The Katz index assigns an equal weight to all of the ADLs, and because of that, it cannot be used to identify the particular area of need or change in any one task. Any health care professional can complete the Katz Index, although input from the interdisciplinary team is valuable. The Katz Index does not address the cognitive abilities necessary to perform ADLs. The ADLs are considered in dichotomous terms only, the ability to complete the task independently or the complete inability to do so.

When comparing the Older American's Resources and Services (OARS) with the Katz Index of ADLs, what is true? A. The Katz Index and the OARS both measure only ADL performance B. The OARS is a comprehensive assessment tool that measures ability in five areas: the Katz Index measures only ADL performance C. The OARS is used only for older adults in the long-term care setting; the Katz Index is used in all settings D. The OARS is not valid for use in older adults who are cognitively impaired, whereas the Katz Index is

B The OARS evaluates ability, disability, and capacity at which the person is able to function. Five dimensions are assessed: social resources, economic resources, physical health, mental health, and ADLs. The Katz Index only evaluates ADL ability. Both instruments are used in a variety of care settings and are valid for use with cognitively impaired older adults.

A resident of a long-term care facility is assessed by a nurse upon admission to the facility. The assessment includes a comprehensive health, social, and functional profile. The tool that the nurse utilizes is: A. Outcomes and Assessment Information Set (OASIS). B. Resident Assessment Instrument (RAI). C. Older Americans Resources and Services (OARS). D. Comprehensive Geriatric Assessment (CGS). E. Mini Mental Status Examination (MMSE).

B The OASIS is used in the homecare setting. The RAI is used In the long-term care setting. OARS is a functional status instrument. Comprehensive geriatric assessment is not a specific tool but rather an approach to assessment. The MMSE is a mental status assessment tool.

The daughter of an older hospitalized patient tells a nurse: "I am worried about my father. His memory is sharper when he is at home. He is forgetful, but is functional. Since he has been hospitalized his memory problems are much worse." The best response by the nurse is: A. "Is is common for long-term memory to be more impacted by age-related changes than short-term memory." B. "Memory changes are often worse when an individual is in an unfamiliar or stressful situation." C. "Perhaps you are just noticing your father's memory loss now that he is hospitalized." D. "There is a lot of new information for your father to process here in the hospital; he is overloaded."

B Memory changes are often worse when the individual is in unfamiliar or stressful situations, such as a hospitalization. Option A is not true because short-term memory is affected more commonly with aging that is long-term memory. Options C and D are true; however, they do not address the issue that the patient's daughter is discussing.

A nurse is discussing the importance of exercise with a 78-year-old female who states: "I know I should be exercising, but I have arthritis in my knees and it is painful. Can you recommend a type of exercise that would be beneficial and cause me less pain?" Which of the following exercises should the nurse recommend? A. Tennis B. Swimming C. Dancing D. Use of a treadmill and elliptical machine in the gym

B The high prevalence of joint diseases, such as osteoarthritis, may hamper successful performance of aerobic exercises that cause joint impact. Tennis, dancing, and use of a treadmill and elliptical machine in the gym may all cause joint impact. Swimming is a low-risk activity that provides aerobic benefit, and water-based exercises are particularly beneficial for individuals with arthritis or other mobility limitations.

An older adult's diagnosis of sleep apnea is supported by nursing assessment and history data that include: (Select all that apply.) A. followed a vegetarian diet for last 28 years. B. male gender. C. a smoking history of 1 pack a day for 45 years. D. 30 pounds over ideal weight. E. history of Chron's disease.

B, C, and D Risk factors for sleep apnea include being male, a smoking habit, and excess weight. There is no current research to support a connection between a vegetarian diet (possible low protein) or Crohn's disease to the development of sleep apnea.

An older female patient tells a nurse the following: "In my culture, women are the silent partner in the family. Men make all of the decisions. However, when we came to the United States, all that changed. I became an American. I am in charge of my family just like my husband." This is an example of: a. enculturation b. acculturation c. ethnicity d. cultural competence

B. Enculturation is defined as cultural beliefs passed down from one generation to the next. Acculturation is the process by which persons from one culture adapt to another. Ethnicity is defined as the cultural group that one identifies with. Cultural competence involves stepping outside our own biases and understanding that others bring a different set of values.

An older woman asks a nurse. "You always seem to be telling me that I need to drink more water. How much water do I really need to drink?" The nurse bases her response on the knowledge that older adults should consume at least: A. 1000 ml of fluid per day B. 1500 ml of fluid per day C. 2000 ml of fluid per day D. 2500 ml of fluid per day

B. Older adults, with the exception of those who require a fluid restriction, should consume at least 1500 ml of fluid per day.

A nurse is caring for a patient with a diagnosis of delirium. Which of the following is an expected assessment finding for this patient? A. Normal attention span B. Fluctuation in symptoms C. Normal sleep cycle D. Increased appetite

B. A hallmark of delirium is fluctuation of symptoms. Patients with delirium typically have decreased attention spans and an altered sleep-wake cycle. Classic symptoms of delirium do not involve changes in appetite; however, patients often have a decreased appetite.

The Beers Criteria is an effective tool for health care professionals prescribing and/or managing the medication therapy of older adults since it identifies medications that for this population: A. are not typically covered by drug benefit plans B. have a higher than usual risk for injury C. are likely to be abused D. generally cause allergic reactions

B. Drugs on the Beers' list are those that have been identified to have a higher than usual risk when used in older adults. The Beers Criteria have no relation to medication financing. There is no evidence that the drugs are likely to be abused by older adults. There is no greater likelihood of these drugs causing allergic reactions.

One reason why many "baby boomers" have multiple chronic conditions such as heart disease, diabetes, and asthma is that: a. they have less access to medication and other treatment regimens. b. there was a lack of importance placed on healthy living as they were growing up. c. they did not have access to immunizations against communicable disease when they were children. d. they grew up in an era of rampant poverty and malnutrition.

B. The baby boomers, individuals born between 1946 and 1964, post-WWII, have better access to medication and treatment regimens than other cohorts. They have had the benefit of the development of immunizations against communicable diseases. They grew up in an era of prosperity post-WWII. However, there was a lack of importance placed on what we now consider healthy living when they weer younger. Smoking, for example, was not condoned, but was considered a symbol of status. Candy in the shape of cigarettes was popular, and there was much secondhand smoke

A nurse is performing an admission assessment on an older patient who presented with a high fever and cough, reduced oral intake for 3 days, and lower extremity weakness. The patient has sunken eyes, and the patient's turgor over the sternum is poor. The nurse suspects that he patient is dehydrated. Which of the following are indicators of dehydration in this patient? (Select all that apply.) A. Poor skin turgor over the sternum B. Lower extremity weakness C. High fever D. Sunken eyes E. Cough

B. and D. Older adults often present atypically when dehydrated. Skin turgor over the sternum is not a reliable marker in older adults due to the loss of subcutaneous tissue with aging. Lower extremity weakness and sunken eyes may indicate dehydration. High fever and cough can be associated with many other conditions and are not typically signs of dehydration.

An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse? A. Refer the resident for an evaluation for a hearing aid B. Raise her voice when speaking to the resident C. Examine the resident's ears for cerumen impaction D. Teach the resident to read lips

C When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all types of hearing losses. Raising one's voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.

Which attempt by the family to prevent an older, frail adult from falling causes the home health nurse concern? A. Keeping several low wattage night-lights on in the evening B. Installing wooden railings on the stairway to the bathroom C. Keeping the side rails up on the client's bed at night D. Encouraging the client to use a cane when ambulating

C Keeping side rails up have proven to be a risk factor for falls rather than a positive intervention. The remaining interventions are appropriate and generally effective.

Which technique is most effective when communicating with a client who is positioned in bed? A. sitting in a chair at he foot of the bed B. standing near the client's head on his or her dominant side C. sitting in a chair at the bedside facing the client D. standing at the foot of the bed

C When communicating with individuals in a bed or wheelchair, position yourself at their level and directly face them rather than talking over a side rail or standing above them.

Essential components of a fall assessment include all EXCEPT: a. medications b. location of the fall c. hearing ability d activity at the time of the fall

C Many medications can increase the risk of a fall. Certain medications such as sedatives and antihypertensives carry significant risks. The location of the fall and the activity at the time of the fall can give clues as to the cause (slipping on a wet floor in the bathroom or losing balance outside on uneven surfaces.) Although hearing can be a risk factor for depression or confusion, it is not known to increase the risk of falls.

An older patient is prescribed warfarin for stroke prevention. A nurse is providing patient education. Which of the following foods should the patient be taught to avoid? (Select all that apply.) A. Milk B. Whole grains C. Kale D. Spinach E. Red meats

C and D. It is important to avoid "leafy green vegetables" when taking Coumadin.

Regarding health care disparities, it is true that older adults of color have: a. equal risk factors for vulnerability as do all older adults. b. equal risk factors for vulnerability as do the young adults of color. c. increased risk factors for vulnerability if they are female. d. an increase in risk factors for vulnerability if care is provided by public facilities.

C. Older females of color have an added risk factor for vulnerability (gender) than do males of the same age and ethnic group. Ethnicity is an added factor for vulnerability. Age is an additional risk factor for vulnerability. Health care disparities are found across a wide range of clinical settings.

Which of the following statements describing oral care for the older population is correct? A. Oral malignancies seldom occur in older adults so oral examinations are of low priority. B. Losing one's teeth is considered a normal part of the aging process. C. Regular dental examinations can prevent tooth loss and improve the ability to chew healthful foods. D. Preventative dental care is covered under Medicare.

C. Regular dental care is essential and can prevent tooth loss. Losing one's teeth is not a normal part of aging; about one-quarter of adults over age 65 are edentulous. Oral cancers occur more often in older individuals. The median age at diagnosis is 61. Oral examinations can assist in early identification and treatment. Medicare does not provide any coverage for oral care services

When performing the initial assessment on a new client in a geriatric outpatient practice, the most effective method the nurse can implement to elicit an accurate medication assessment is to ask that the client: A. make a list of all her current medications B. work with a family member to make a list of her medications C. bring in all of the medications that she is currently taking D. allow her previous primary care provider to provide a list of medications

C. The gold standard is to use the "brown bag" approach. The patient is asked to bring all medications including prescription drugs, OTC drugs, and herbal and dietary supplements. The patient may not remember all of the medications that are being taken. As each medication is removed from the bag, necessary information is obtained. A complete medication assessment includes OTC drugs, as well as herbal and dietary supplements, not just prescription medications. Your primary source of information should be the patient if she is able to provide the information; the previous provider may not be able to provide information on supplements or OTC and herbal medications. The nurse needs to include more than just prescription medications. In addition, prescribed medications do not always reflect what is being taken

In a long-term care facility, a nurse is having a discussion with the nurse aides about ways to deal with dementia clients who are uncooperative with mouth care. Appropriate methods to use include: A. speaking to the client sternly and instructing the client to open the mouth and cooperate immediately. B. having another nurse aide assist in holding the client's mouth open with a tongue depressor. C. involving the client in the process of oral hygiene, such as using the hand over hand technique to brush the client's teeth. D. quickly performing oral hygiene without explanation since the client is uncooperative.

C. With uncooperative individuals, it is important for the caregiver to be at eye level and explain all actions with step-by-step instructions. Speaking to the client sternly, having another nurse aide hold the patient's mouth open, or performing oral hygiene without an explanation will only serve to agitate the patient. Involving the client and having the client participate to the extent possible is important. Using a hand over hand technique is effective.

When conducting an admissions interview with an older client, the nurse observes that the client pauses for a period of time before responding to the questions. The nurse responds to this client based on the assumption that the client is: A. exhibiting signs of mild cognitive impairment. B. nervous and having difficulty concentrating on the questions. C. reluctant to share information with someone with whom he or she has no relationship. D. sorting through his or her vast life experiences in order to answer.

D Basically, elders may need more time to give information or answer questions simply because they have a larger life experience to draw from. Sorting through thoughts requires intervals of silence, and therefore listening carefully without rushing the elder is important. It is an unfounded assumption to assume that the client's response is due to senility based exclusively on his or her age. The remaining options would not be unique to an older client but might be experienced at any age.

A nurse is using the function-focused care approach to care for a hospitalized older adult. The nurse is assisting the patient to transfer from the bed to a chair. Which of the following statements by the nurse is most congruent with this approach to care? A. "Place your hands across your chest and let us move you to the edge of the bed." B. "It is taking you a long time to get yourself into a sitting position. Let me help you sit up." C. "How do you get yourself out of bed when you are at home? Why can't you do the same thing here?" D. "Place both of your hands on the overbed trapeze and pull yourself up to a sitting position."

D FFC is based on a philosophy of care where the nurse acknowledges the older adult's physical and cognitive abilities and encourages the individual to function at the highest level possible. Option D is correct because the nurse is giving step-by-step directions and allowing the patient to move independently. Option A is incorrect because the nurse is moving the patient instead of allowing the patient to move himself/herself. Option B is incorrect because it is not allowing the patient to use as much time as needed in order to be independent. Option C is incorrect because although it does solicit important information from the patient, it is making the assumption that the hospital setting is the same as the home setting.

A client who reported "a problem sleeping" shows an understanding of good sleep hygiene by: A. doing 10 pushups before bed to encourage a "pleasant tiredness". B. seldom eating a bedtime snack. C. engaging in computer games as a pre-bed activity. D. limiting the afternoon nap to just 30 minutes.

D Limiting daytime napping to 30 minutes or less is a good sleep hygiene practice. Exercise should be completed at least 4 hours before retiring while a bedtime snack is acceptable if the food is light and easily digested. Computer-focused activities are not generally encouraged as a part of a bedtime routine.

A home care nurse is caring for an older patient from a different culture who is bed-bound and high risk for development of a pressure ulcer. The nurse discusses the plan of care with the patient's daughter, emphasizing the importance of turning every 2 hours and posts a turning clock on the wall. When the nurse returns later in the week, the turning clock has been removed, and the patient's daughter reports that she turns her mother occasionally. She states, "I am taking very good care of my mother. You just don't understand; our ways do not involve doing things on schedules." The best response by the nurse is: a. "You must follow my guidelines and turn her every 2 hours, or I will not be able to take care of her." b. "I understand that you value your culture, but culture cannot stop you from providing good care to your mother." c. "I understand that you care very much for your mother. Perhaps caring for her is too much for you." d. "How can we best work together to provide the best care for your mother?"

D. In providing cross-cultural care it is important that the nurse work with the patient and family and listen carefully and find a way to include the values and beliefs of the patient in the plan of care.

A nurse is caring for an 85-year-old male client with diabetes in a community setting. The nurse promotes functional wellness by which of the following activities? a. Assisting the client to receive all the recommended preventative screenings that are appropriate for his age group. b. Encouraging the client to attend his weekly chess games c. Teaching the client how to use a rolling walker so that he can ambulate for longer distances d. Encouraging the client to maintain his current levels of physical activity

D. Maintaining existing levels of physical activity is consistent with functional wellness. Teaching the client how to use a rolling walker enables the client to remain active at the highest level possible, which is an example of promoting functional wellness. The use of a rolling walker, however, should only be recommended after an assessment of physical ability and, thus, the need for a walker. Receiving recommended screening is an example of promoting biological wellness. Encouraging the client to attend weekly chess games is an example of promoting social wellness.

What factor is an important contribution to polypharmacy in older adults? A. Increasing popularity of dietary and herbal supplements B. Implementation of Medicare Part D prescription drug benefits C. Use of generic medications D. Inadequate communication among medical care providers

D. Polypharmacy is often the result of inadequate communication among specialists or between specialists and primary care providers. Medicare Part D prescription drug benefits influence the financing of medication but are not directly related to polypharmacy. Generic medications are a way to keep medication costs down. The use of herbal supplements is an important factor when examining drug interactions or adverse reactions but is not a direct factor related to polypharmacy

A nursing student asks the instructor, "Our textbook discussed the obesity paradox in older adults. I am not sure I understand; isn't obesity bad for everyone?" The best response by the instructor is: A. "Obesity in older adults is less of a concern than we once thought; individuals over age 65 with a higher BMI have a lower mortality rate." B. "Obesity is usually not a concern in older adults, as most older people tend to weigh less than they did when they were younger." C. "Obesity is a concern in all age groups; however, over the past decade obesity in older adults has decreased." D. "While there is evidence that obesity in younger people lessens life expectancy, it remains unclear whether being overweight or being obese are predictors of mortality in older people."

D. There is evidence that obesity in younger people contributes to a decreased life expectancy. However, in older adults, it is not clear whether obesity is a predictor of mortality. Recent evidence demonstrated that for people who have survived to 70 years of age, mortality risk is lowest in those with a BMI classified as overweight. Persons who increased or decreased BMI have a greater mortality risk than those who have a stable BMI, particularly in those aged 70-79. Obesity is prevalent in older adults. The proportion of older adults who are obese has doubled in the past 30 years. More than one-third of individuals 65 years and older are obese with a higher prevalence in those 65-74 years than in those 75 years and older.

Which of the following is recommended for the older adult with type 2 diabetes? a. Health eating b. Weight loss c. Annual pneumococcal vaccine. d. Calorie restriction

a Healthy eating of a balanced diet is important; weight loss is not recommended for the older adult. Pneumococcal vaccine (Pneumovax and Prevnar) should be administered only once in a lifetime. Pneumovax may be repeated every 5-10 years.

The initial step to effect the safe management of mild to moderate acute pain that has not been controlled with over-the-counter medications is to: a. administer a single low dose of short-acting opioid and monitor for relief. b. titrate dosage of a short-acting opioid upward over 24 hours to achieve relief. c. begin acetaminophen (Tylenol) every 4 hours for 24 hours. d. supplement with nonpharmacological interventions

a If pain continues, consider a single low-dose, short-acting opioid and observe the effect. Acetaminophen is an over-the-counter analgesic and so its effect is already determined to be ineffective. Nonpharmacological interventions are only appropriate once pain management has been successfully implemented. Titrating an opioid dose upward is appropriate only after the effects of the initial dose have been determined.

Which of the following would be most likely to be a symptom of hypothyroidism in an older adult? a. Confusion b. Muscle cramps c. Weight gain d. Cold intolerance

a The signs and symptoms of hypothyroidism are more subtle or vague in older adults and are not as commonly like those in younger adults

"While there may be some short-term memory loss, most individuals find their memory comes back within a few days." 8. In order to focus on the older population with the greatest risk for suicide, the nurse would conduct a depression screening that targets: a. white men b. white women c. African American men d. African American women

a White men older than age 85 have the highest rate of suicide in the United States; they commit suicide at approximately four times the national rate.

The daughter of a patient who has a chronic illness that has reached the terminal phase talks about the palliative care referral that the primary care provider made for her mother. Which of the following statements indicate that the daughter needs additional education about palliative care? (Select all that apply.) a. "I know that palliative care is only available to people who have 6 months or less to live That is really hard to cope with." b. "I understand that the palliative care team is made up of health care professionals of all different disciplines, not just doctors and nurses." c. "My mom still can be actively treated while receiving palliative care." d. "My mom will have to be transferred to a special unit in the hospital in order to receive palliative care."

a and d. While many individuals are not referred to palliative care until they are at the end of life, ideally, the earlier they are referred, the better. There is no time frame for referral regarding the point that they are in their illness. Palliative care is offered simultaneously with life-prolonging or stabilizing care for those living with chronic conditions. Palliative care uses an interprofessional model of care. Palliative care can be offered in any setting across the continuum of care and on any unit; it is a philosophy of care.

A nurse is educating an older adult with diabetes mellitus on minimizing the risk of cardiovascular disease. The nurse focuses on lipid levels. Which of the following are the recommended goals for lipid levels? (Select all that apply.) a. Triglycerides < 150 b. Cholesterol < 200 c. Low-density lipoprotein (LDL) > 100 d. High-density lipoprotein (HDL) > 40 (men), > 59 (women) e. HbA1C value of 6.5%

a, b, and c Goals for acceptable lipid levels include: Cholesterol < 200, LDL < 100, HDL > 40 (men), > 50, (women) and triglycerides < 150, HbA1C levels are not a measure of lipids

Which of the following characteristics are most specifically associated with the concept of "frailty"? (Select all that apply.) a. Slow walking speed b. Low activity level c. Taking at least five prescribed medications d. Self-reported exhaustion e. A diagnosis of at least two chronic conditions

a, b, and d. One common way in which frailty is defined is evidence of three of the following: unexplained weight loss, self-reported exhaustion, weak grip strength, slow walking speed, and low activity. Neither the number of medications that an individual is prescribed nor the number of chronic conditions is part of the diagnosis of frailty.

Dehydration is often a natural process and more comfortable than overhydration at the end of life. a. True b. False

a. Most patients reduce their fluid intake, or stop drinking entirely, long before they die. Dehydration in the last hours of living does not cause distress and may stimulate endorphin release that adds to the patient's sense of well-being.

Which intervention to manage wandering in clients in a long-term care facility should be implemented? (Select all that apply.) a. Camouflaging doorways b. Close observation to identify the person's individual patterns c. Engaging the person in social interactions d. Using physical restraints to prevent wandering to maintain safety e. Providing enclosed pathways for walking

a, b, c, and e Restraints are not an effective or appropriate intervention for wandering. Although they might physically prevent the person from wandering, restraints have many potential negative consequences and patient harm associated with their use. In addition, there are ethical and legal concerns and restraints can under many conditions meet criteria for "assault and battery". Environmental modifications such as camouflaging doorways and providing enclosed pathways, close observation to identify the person's individual patterns, and engaging the person in social interactions are all interventions that are effective strategies to manage wandering.

A nurse is caring for an older adult who has metabolic syndrome. The nurse knows that the following conditions are common in persons with metabolic syndrome. (Select all that apply.) a. Glucose levels that are higher than normal b. Decreased triglyceride levels c. Increased waist circumference d. Blood pressure that is lower than normal e. Increased blood cholesterol level

a, c, and d Metabolic syndrome is characterized by higher than normal glucose levels, increased waist size due to excess abdominal fat, high blood pressure, and abnormal levels of cholesterol and triglycerides in the blood

A nurse understands that the pathophysiology of Parkinson's Disease includes which of the following? (Select all that apply). a. A reduction of dopamine receptors b. The presence of neurofibrillary tangles and amyloid plaques in the brain c. An accumulation of Lewy Bodies, especially in the basal ganglia d. A deficiency of the neurotransmitter dopamine

a, c, and d Parkinson's disease is the result of a deficiency of the neurotransmitters dopamine, a reduction of dopamine receptors, and the accumulation of Lewy Bodies, especially in the basal ganglia. The presence of neurofibrillary tangles and amyloid plaques in the brain is seen in Alzheimer's Disease.

When discussing electroconvulsive therapy (ECT) with an older, chronically depressed adult and his family, which statement will the nurse use to support this intervention? (Select all that apply.) a. "This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications." b. "ECT is a safe intervention for those with psychotic ideation." c. "ECT results in a more immediate response to symptoms." d. "ECT has been found to be more effective in older adults than in younger adults.

a, c, and e ECT has been found to be effective in individuals who have psychotic depression and those who do not respond to antidepressant medications. ECT is equally effective in older adults as in younger adults. It is used for individuals with depression, not psychotic ideation. There is some short-term memory loss associated with ECT; however, it does resolve within a short time frame. ECT provides a more immediate response to symptoms than does medication.

An older patient is concerned that her neighbor was recently diagnosed with Alzheimer's Disease and asks a nurse what can be done to decrease the risk of Alzheimer's Disease. The nurse includes which of the following in her answer to the patient's question: (Select all that apply.) a. Maintain control of blood sugar b. Eliminate fats from the diet c. Maintain ideal body weight d. Smoking cessation e. Maintain blood pressure within normal limits

a, d, and e General recommendations to decrease the risk of neurocognitive disorders include those that are, also, recommended for overall cardiovascular and general health. These include maintaining blood pressure within normal limits, maintaining low-density lipoprotein cholesterol less than 100, maintaining hemoglobin A1C less than 7, taking aspirin (81 mg enteric coated) for persons with risk for heart disease and without contraindications. The actual parameters may be liberalized for those with comorbidities and in the presence of frailty and advanced age. Eliminating fats from the diet is not recommended. Maintaining ideal body weight does not have the same effect on morbidity in advanced age as it does at a younger age and weight is not cited as a factor in reducing the risk of neurocognitive disorders.

An older adult is referred to a geriatric nurse practitioner because of changes in memory and reports by family members that "there is something different about her." The nurse practitioner evaluates the older adult for potentially reversible causes for the changes, which include: (Select all that apply.) a. Medication side effects b. Rheumatoid arthritis c. Osteoporosis d. Depression e. Delirium

a, d, and e Reversible dementia-like conditions include depression, delirium, thyroid disorders, vitamin deficiencies (especially vitamin D), and excessive alcohol intake, as well as side effects from medications. There is no evidence that rheumatoid arthritis or osteoporosis has a dementia-like condition associated with them.

How should the nurse reply when an older adult asks, "How much alcohol is good for you?" a. "Recommendations are for only one regular sized drink a day." b. "Alcohol isn't good for you so avoid it as a general rule." c. "It's been said that red wine has health benefits, but that doesn't mean that you should drink a whole bottle." d. "If you are only drinking on special occasions, limit yourself to two drinks."

a. Clinically significant adverse effects can occur in some individuals consuming as little as two to three drinks per day over an extended period. Because of the increased risk of adverse effects from alcohol use, the National Institute on Alcohol Abuse and Alcoholism has recommended that individuals over the age of 65 limit alcohol consumption to no more than one standard drink per day. Although the Substance Abuse and Mental Health Services Administration (SAMSHA) recommends a maximum of two drinks on any drinking occasion (holidays or other celebrations), that option does not address the more pressing issue of the daily consumption of alcohol. The other options do not address the client's question.

Which of the following nonpharmacological interventions is recommended for excessive fluid accumulation in the back of the throat (often noted as "gurgling") in the dying patient? a. Repositioning of the patient b. Oropharyngeal suctioning c. Sucking on hard candies d. Lying supine

a. If excessive fluid accumulates in the back of the throat and upper airways, it can be cleared by turning and repositioning the patient onto one side. Oropharyngeal suctioning is not recommended. It is frequently ineffective, as fluids are beyond the reach of the catheter, and may only stimulate an otherwise peaceful patient and distress family members who are watching. Neither of the other two responses are appropriate.

An older client diagnosed with dementia resides with his daughter. When the homecare nurse visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, "I don't know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him." How will the nurse respond to the client's daughter? a. "Let's think about what you may have done to anger your father?" b. "Let's try to figure out what your father was trying to say with his behavior." c. "Scratching is usually a sign of untreated pain. Do you think your father is in pain?" d. "Maybe you should consider having a home health care provider take over responsibility for your father's physical care."

b Dementia often interferes with the person's communication and the ability to understand and express thoughts and feelings. The focus needs to be on what the person is attempting to communicate through behavior. Behavioral manifestations are not necessarily signs of anger in persons with dementia. Although behavioral manifestations such as striking out or resisting care are frequently seen in persons with untreated pain, this is not always true. The issue her is not necessarily the individual who is providing the care but perhaps the care activity itself. It is appropriate for the daughter to provide care for her father and she should be supported in doing so.

An older adult with Type II Diabetes mellitus who is being treated with insulin wants to increase his activity level and begin a walking program. What recommendations should the nurse provide to this patient? a. Regular exercise should not exceed 30 minutes three times a week. b. The walking regimen needs to be done on a regularly scheduled basis. c. Insulin can most probably be discontinued if the individual adheres to the walking program. d. A walking program is not recommended for an older adult with diabetes.

b If the person is using insulin, exercise needs to be done on a regular rather than an erratic basis. Exercise is an important part of diabetes self-management. In some cases, exercise in conjunction with an appropriate diet may be sufficient to maintain blood glucose levels within normal levels; however, it is not likely that insulin will be able to be discontinued.

An older man who is a smoker is hospitalized for orthopedic surgery. A nurse takes the opportunity to provide smoking cessation education. The patient asks the nurse: "I have been smoking for most of my life, and I am an old man. Why are you wasting your time telling me to stop smoking? Isn't it too late?" The nurse bases the response on the knowledge that: a. smoking cessation as late as age 75 can completely eliminate premature death. b. smoking cessation as late as age 75 can reduce premature death by 50%. c. smoking cessation education is only effective in individuals under age 75. d. smoking cessation at a late age will not impact the smoker but can reduce exposure of family members to second-hand smoke.

b Smoking cessation as late as age 75 can reduce premature death by up to 50%.

Which of the following are true of hypothyroidism in older adults? (Select all that apply.) a. Most commonly caused by contrast dyes and amiodarone b. TSH level will be increased c. Myxedema coma is a serious complication seen with untreated hypothyroidism in older adults d. New onset atrial fibrillation

b and c A diagnostic measure of a decreased level of thyroid hormone productivity by the thyroid gland is an increased level of TSH as the pituitary tries to stimulate the thyroid gland. Contrast dyes and amiodarone are causes of an iatrogenic hyperthyroidism. Atrial fibrillation is more commonly seen with hyperthyroidism than with hypothyroidism. However, heart failure and resulting A-fib could be seen with hypothyroidism. A confusing aspect of thyroid dysfunction is that similar symptoms can be seen with both hypothyroidism and hyperthyroidism.

An older patient asks a nurse: "I went to a diabetes doctor and everything was stable. The nurse practitioner spent the entire time teaching me about decreasing my risks for heart disease. It seemed odd that she did not focus on teaching me how to better control my diabetes. Do you know why?" The nurse formulates a response based on the understanding that: (Select all that apply.) a. older adults are less receptive to teaching about diabetes than they are to teaching about cardiovascular disease. b. promoting cardiovascular health has the potential to minimize the complications of DM. c. diabetes is not a common chronic condition in older adults. d. there is little evidence that demonstrates that the course of DM can be altered in an older adult. e. the benefits of better control of blood pressure and lipid levels are seen much quicker than the benefits of better glycemic control.

b and d While glycemic control is important, more emphasis is now on the prevention and treatment of cardiovascular diseases. Research has indicated that it may take 8 years of glycemic control before benefits are seen while the benefits of better control of blood glucose and lipids are seen as early as 2-3 years. Promoting cardiovascular health has the potential to be the most efficacious in the minimization of complications I the persons with DM. Education on self-management of diabetes is important for patients of all ages. Diabetes is a common chronic condition in older adults.

An older adult is diagnosed with Alzheimer's Disease. The nurse knows that this diagnosis is made on the presence of which of the following? (Select all that apply.) a. Fluctuation of symptoms over the course of a 24-hour period b. A decline from previous level of functioning c. An insidious onset d. A gradual decline in cognitive abilities

b, c, and d A diagnosis of a NCD due to Alzheimer's Disease requires (1) a decline from a previous level of functioning, (2) an insidious onset, and (3) a gradual decline in cognitive abilities. It is important to note that the changes are "greater than expected for the person's age and educational background" and these changes can be documented with standardized neuropsychological testing. Fluctuations of symptoms over a 24-hour period of time is associated with delirium.

Which of the following statements accurately describes Alzheimer's disease (AD)? (Select all that apply.) a. The symptoms of AD, which include memory loss and altered cognition, are reversible if drug treatment is begun in the early stages. b. Alzheimer's disease results from complex interactions between genetic and environmental factors. c. Advanced age is the single greatest risk factor for development of AD. d. The characteristic pathological changes of Alzheimer's disease are deposition of neurofibrillary tangles and plaques in brain tissue.

b, c, and d Old age is the greatest single risk factor for dementia and nearly half of older persons over age 85 will develop some degree of dementia before they die. However, genetics and other environmental factors play a role in the development of Alzheimer's. When symptoms occur at a younger age (in the 50s and 60s), genetics is known to play a stronger role. Educational levels, mental and physical activity, and presence of other diseases are additional factors. Currently, there is no known treatment to reverse the progressive nature of Alzheimer's disease, which is attributed mainly to the pathological tangles and plaques found in the brains of those afflicted by this disease.

A nurse is caring for an older adult with cognitive impairment who recently had hip surgery. The nurse assesses the client for pain. The nurse would suspect that the client is in pain when the client demonstrates which of the following? (Select all that apply.) a. The client ate all of her meals. b. The client cries out repeatedly when anyone approaches her. c. The client pushes caregivers away when they attempt to change the dressing on her hip. d. The client rocks back and forth repetitively when sitting in a chair.

b, c, and d Pain cues in people with communication difficulties involve changes in behavior including restlessness, resistance to care, repetitive movements, and vocalizations. Other cues include sleeplessness and decreased appetite.

A diagnosis of Parkinson's disease is made based on the presence of which of the following symptoms? (Select all that apply.) a. Progressive decline in cognitive function b. Rigidity c. Orthostatic hypotension d. Resting tremor e. Bradykinesia

b, d, and e A diagnosis of Parkinson's Disease is made based on the presence of the following symptoms: resting tremor, rigidity, bradykinesia, asymmetric onset, as well as a positive response to levodopa. Neither orthostatic hypotension nor progressive decline in cognitive function is one of the diagnostic criteria for PD.

A nurse who is caring for an older patient with bipolar disorder knows that the patient needs additional education when the patient states: a. "Older adults with bipolar disorder tend to be 'rapid cyclers'." b. "Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults." c. "Relapses in bipolar disorder tend to be precipitated by medical problems." d. "Bipolar disorder often results in a 'leveling out' of symptoms as one ages."

b. Depression is the most common psychiatric disorder in older adults. Bipolar disorders tend to level out in later life, and individuals tend to have longer periods of depression. Relapses in older adults are usually precipitated by medical problems. Older adults tend to be 'rapid cyclers,' cycling from mania to deep depression in a much shorter period of time than they did when they were younger.

Which is NOT a principle of end-of-life care? a. At times it may seem that the patient may be waiting for permission to die and family members may be encouraged to give the patient permission to "let go". b. The less the amount of planning and preparation for death that has occurred, generally the more relaxed and less stressful the atmosphere surrounding the death. c. It is prudent to assume that the unconscious patient hears everything and caregivers should talk to and around the patient as if he or she were conscious. d. Terminal delirium may be the first sign to herald the "difficult road to death" and may present as confusion, restlessness, and agitation.

b. An important part of achieving a peaceful death is ensuring that patients and families have the information that they need to be prepared to cope with the emotional and physical aspects of the death of a loved one. All of the other responses are true.

An older client in an adult day care program tells the nurse, "I'm very stressed because another neighbor passed away." The most therapeutic response by the nurse is: a. "Let's get involved in some activities and not think about sad things." b. "What do you mean by stressed?" c. "Tell me what you did when your other neighbor passed away." d. "Are you worrying about your own death?"

c Application of what one has learned from previous situations can help dissipate the intensity of stress. Denial of the stressful event and focusing upon blessings or happiness will not lessen the stress and may in turn intensify it. While it is appropriate to ask the client to clarify what he or she is saying it doesn't help in this situation. This is not necessarily the time to initiate a conversation about the client's feelings about death since doing so is likely to increase the level of stress.

If you are feeding a person with dementia and they spit out the food, the best immediate action to take is: a. Stroke cheek and say "eat". b. Stroke throat and say "swallow". c. Stop, wait, and try with a bit of another food. d. Hold head forward and slide spoon with food into side of mouth.

c Food refusal becomes a more common occurrence as dementia progresses into the later stages. Food or fluid should never be forced. Use of finger foods, a pleasant environment, a familiar person assisting the person to eat, and honoring food preferences are all important in maintaining adequate nutritional intake.

A nurse is caring for an older adult who is diagnosed with Type II Diabetes. The patient is prescribed oral medication for diabetes. The nurse can expect that which of the following medications is prescribed as a first-line therapy? a. Chlorpropramide b. Insulin c. Metformin d. Sulfonylureas

c Metformin (Glucophage) is community prescribed as first-line therapy; it does not cause hypoglycemia or weight gain. Sulfonylureas were used for many years as first-line agents for all persons with type 2 DM. However, they are associated with hypoglycemia and can only be used in persons who can either be aware of the signs themselves or who have a caregiver capable of doing so; therefore, Metformin is considered the first line of therapy. Insulin is used for individuals with type 2 DM; however, it is not first-line therapy. Chlorpropramide is contraindicated due to a long half-life and the fact that it can cause prolonged hypoyglycemia.

Which is the most likely reason that Type II Diabetes mellitus is often difficult to diagnose in older adults? a. Presenting symptoms occur very quickly b. There are no recognizable symptoms. It is a "silent killer." c. The classic symptoms may not be present in older adults. d. The disease rarely occurs in older adults.

c The symptoms are also often masked by normal aging changes and conditions common in older adults. Polydipsia often does not occur due to the decreased thirst mechanism in older adults, polyphagia is often not recognized due to normal appetite declines associated with aging, and polyuria is often not recognized due to frequent urinary tract infections in older adults. Presenting symptoms usually occur very slowly Type 2 diabetes mellitus is very common in older adults. There are symptoms of diabetes mellitus in older adults; however, they may be different than those seen in younger adults.

1. When performing a pain assessment on a client who is aphasic, the nurse should consider: a. that older adults do not tolerate opioid analgesics well and may exhibit side effects. b. that the patient's previous stroke interrupted pain pathways so she does not feel pain. c. reports from the family or staff about changes in functional status. d. that the patient is lying quietly in bed so she is not likely to be experiencing pain.

c When an individual is not able to verbally communicate complaints of pain, reports from family or caregivers are important. In addition, in older adults, pain is often manifested as changes in functional status. To assume that the patient is not in pain because she is lying quietly in bed is incorrect. One should not assume that she feels no pain due to stroke. Older adults tolerate opioid analgesics

A recommended and commonly used drug to prevent and manage accumulation of secretions in the throat of a dying patient: a. benzodiazepines (Lorazepam) b. neuroleptics (Haloperidol) c. anticholinergics (Atropine) d. Antiinflammatories (Ibuprofen)

c. Anticholinergics are commonly given to minimize or eliminate the gurgling and crackling sounds and may be used prophylactically in the unconscious dying patient. Some evidence suggests that the earlier treatment is initiated, the better it works, as larger amounts of secretions become difficult to eliminate. However, using too soon in the patient who is still alert may lead to unacceptable drying of mucosa

The drug category of choice for treating agitation of terminal delirium where sedation is the goal and not reversal of the underlying problem causing the delirium? a. opioids (Morphine) b. anticholinergics (Benadryl) c. benzodiazepines (Lorazepam) d. barbiturates (Propofol)

c. Benzodiazepines are generally not recommended for first-line management of delirium, especially when the delirium is potentially reversible. However, because they are anxiolytics, amnestics, skeletal muscle relaxants, and antiepileptics they are recommended by palliative care experts for the management of irreversible terminal delirium where the goal of therapy is sedation. It is assumed that pain is being managed, but if the delirium continues to worsen despite opioids being given, the opioids may be accumulating and adding to the delirium. Anticholinergics do not effectively treat delirium and barbiturates should be used only for delirium that is refractory to benzodiazepines

A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to eat or drink. He is alert and oriented, and states that he has no desire to eat, which is causing the family great distress. In order to best address the client and family, the nurse should: a. contact the physician for an order for enteral feeding. b. contact the dietician for feeding supplements. c. educate the family that this is normal behavior in this situation. d. explain the family's concern to the client.

c. The nurse should educate the family that this is a normal part of the dying process and should not pressure the client, contact the physician for enteral feeding, or contact the dietitian for feeding supplements. Because the patient is expressing a desire not to eat, his wishes should be honored. Essential to the facilitation of self-esteem is the premise that the values of the patient must figure significantly in the decisions that will affect the course of dying. Whenever possible, the nurse can have the person decide when to groom, eat, wake, sleep, and so on

The greatest risk for injury for a client with Parkinson's Disease is" a. Respiratory arrest b. Bleeding ulcers c. Suicide d. Falls

d If the client with Parkinson's becomes off-balance, self-correction is very slow, so falls are common. While the client is monitored for depression, suicide is not a common risk for injury. Bleeding ulcers and respiratory arrest are not generally recognized as caused by this disease.

Your client is newly diagnosed with Type II Diabetes mellitus. Which diagnostic test will best evaluate the management plan prescribed for this client? a. Biannual cholesterol testing b. A yearly funduscopic examination by an opthalmologist c. Regular foot examinations by a podiatrist d. Quarterly hemoglobin A1C

d Quarterly or biannual hemoglobin A1C (Hb A1C) is designed to provide information regarding the averaged glucose levels for a 3-month period of time. The periodic measurement of a glycated hemoglobin test (HbA1C) is the best measure of ongoing glycemic control. Eye examinations are important, but proper blood sugar control will help prevent the damaging effects of diabetes to the eyes. Proper foot care is important, but good blood sugar control will help prevent the damaging effects of diabetes on the feet. Biannual cholesterol testing is not relevant to the evaluation of type 2 diabetes mellitus.

An older adult is admitted to the hospital after a serious fall. When noting that the client has been prescribed meperidine (Demerol) for muscle pain, the nurse: a. conducts a pain assessment and determines the client's need for an analgesic medication. b. administers the medication so as to prevent the client from developing the fear of pain. c. questions the client and family concerning any allergies to analgesic medications. d. calls the physician to question the appropriateness of this medication order.

d Some medications used in younger adults, for example, meperidine (Demerol), are always contraindicated in the older adult. The metabolites of Demerol can cause confusion, psychotic behavior, and seizure activity. The remaining options would not be inappropriate, except for the fact that they relate to the administration of an inappropriate medication.

An older client with a history of hypertension and osteoarthritis who has recently fallen and fractured two ribs is prescribed extra strength Tylenol for pain. What statement by the client requires further evaluation by the nurse? a. "I heard that meditation may help me deal with the pain without taking all that Tylenol." b. "I find that when I drink herbal tea and then take my Tylenol at bedtime, I sleep through the whole night." c. "I make sure that I take my Tylenol with breakfast when I first get up." d. "Two extra strength Tylenol tablets (500 mg/tablet) every 4 hours around-the-clock and my pain is gone."

d The maximum dose for Tylenol is 3 g per 24-hour period; two extra strength Tylenol tablets every 4 hours would mean that the client is taking 6 g and would need further evaluation. Herbal tea may have a relaxing effect and help her sleep. Meditation is one of the alternative modalities that help some patients deal with pain. The practice of taking Tylenol with breakfast upon waking is acceptable.

Which of the following often occurs in the final few hours of life? a. significant increase in pain b. significant increase in blood pressure c. seizures d. mottling of skin

d. As perfusion decreases, the skin often takes on a "mottled" appearance in the final hours. Blood pressure more commonly decreases. Seizures and an increase in pain are not common occurrences in the final stages of dying.