Learning System RN: Gerontology 1, Final
I nurse is providing teaching to a patient who is to start taking alendronate sodium which of the following recommendations should the nurse include in the teaching?
"Discontinue the med if you develop heartburn" -contact provider because this is an indication that a Soffa Gille irritation has occurred -ways to avoid this are by taking with 8 ounces of water because food and other fluids interfere with absorption and avoid lying down 30 to 60 minutes after taking -adverse effects: heartburn -must be taken home; crushing or chewing med can cause esophagitis or a esophageal cancer
An older adult patient tells the nurse at a health fair "I am always forgetting things. I cannot even remember where I parked my car! Do you think I have all Psimer's disease?" Which of the following is a therapeutic response by the nurse?
"That must be very upsetting. Can you tell me about your forgetfulness?" -nurse showing empathy with patients concern and six additional info
What statement by the patient indicates an understanding of the teaching that a nurse provides to an older adult patient who has osteoarthritis of the right hip and lower lumbar vertebrae?
"To relieve the pressure on my hip I can use a cane while ambulating" -use of cane can help patient compensate for weakness in spine by providing some relief of hip pressure; can provide joint support and safety for self-care activities -heat and cold or therapeutic treatment and management of arthritic pain; patient preference -acetaminophen is first med of choice to treat osteoarthritic pain; take as prescribed and do not wait until pain is severe -steroid joint injections are use for persistent and disabling pain in the joints -do not exercise if it causes pain; goals for these patients include balancing rest with Activity and avoiding activities that cause pain/discomfort -consistent activity can produce further damage to joints and tissues
what dietary recommendation should the nurse include in the teaching to a group of older adults patients?
"you should consume 1200 mg of Ca daily" -take in divided doses -good sources of Ca: dairy products, green leafy vegetables, beans, tofu -limit fat intak to 20-30% of total daily intake; increased fat in diet = leads to cardiovascular dz and inflammation -fluid intake of 3.7 L for M and 2.7 L for F; decrease oral intake = leads to constipation and dehydration -protein intake from 10-35% total daily intake; < than that leads to malnutrition and excess amount of ketosis (harmful to kidney function)
I nurse is teaching a newly hired assistive personnel about her role in helping older adult patient with activities of daily living. The nurse should explain that which of the following is the most common factor that affects the patients performance of ADLs?
Chronic physical disability -associated with several physical etiologic factors: activity intolerance, pain, neuromuscular impairment, sensory perceptual impairment, musculoskeletal impairment, cognitive impairment -social withdrawal does not affect ability to perform ADLs -emotional impairment can cause reluctance to perform ADLs and need assistance or encouragement -cognitive dysfunction such as dementia or other neurological disorders May result in adjustment to new situations or routines but does not hinder her ability to learn and perform tasks such as ADLs
Which of the following Ericksons developmental tasks should the nurse recommend as the focus for age appropriate care standards for older adult patients?
Integrity -integrity versus despair - conflict resolves upon reflection of ones life and their role; except death with sense of integrity not fear -intimacy versus isolation - conflict must resolve during young adulthood during development of intimate relationships -identity versus role confusion - conflict resolved during adolescence; a time to ask who am I -initiative versus guilt - conflict resolved during early childhood; children must learn to achieve balance between eagerness for more adventure and taking on more responsibility; learn to control impulses and childish fantasies
A nurse is caring for an older adult patient who is expressing feelings of grief and longing for his earlier life. Which of the following action should the nurse take?
Listen attentively and allow the patient to talk about the past -reminiscence necessary activity for older adults who are in the stage of integrity versus despair -changing the topic implies to the patient that his needs are less important than the nurses -avoid using generalizations are stereotyping when communicating with a patient, this devalues the patients feelings -avoid comparing one's experience to another's because it devalues the patients feelings and does not allow him to develop coping strategies
I nurse is planning care for an older adult patient following up domino surgery for about obstruction. Which of the following information about pain management should the nurse consider when planning care?
Older adult patients are sensitive to the analgesic effect of opiates -likely to require a decreased dose of opiates provide the same level of analgesic as a younger patient, with reduced risk of side effects -do not have diminished capacity to perceive pain, pain not an expected finding of the aging process, narcotic meds for pain control should not be withheld for older adult patients
A nurse is admitting an older adult client who fell at home three days ago. The client has a fractured hip, malnutrition, dehydration. Which of the following lab values noted on admission should indicate to the nurse prolonged malnutrition?
Decreased albumin -indicates an adequate protein intake, common finding in patient who has prolonged malnutrition -Hypernatremia indicates dehydration, due to fluid volume deficit -increased BUN indicates renal failure, dehydration, due to fluid volume deficit -decreased blood glucose indicates an adequate intake of glucose, a manifestation that can occur rapidly and any patient who has not eaten in several days, not indicated of prolonged malnutrition
A nurse is assessing an older adult patient for signs of dehydration. What do the following findings should the nurse consider an expected part of the aging process?
Decreased creatinine clearance -declines with age, kidneys have decreased ability to concentrate urine; places patient at risk for dehydration -elevation of USG, dry oral mucous membranes, and poor skin turgor over the sternum are all unexpected findings that could be indicated of dehydration -other causes of dry mucous membranes include side effects of meds, such as decongestants, diuretics, antihypertensive, antidepressants, anti-histamines; radiation therapy; certain medical conditions such as Parkinson's disease -decreased skin turgor = late sign of dehydration, associated with moderate to severe dehydration; fluid loss of 5% of body weight considered mild dehydration, 10% moderate, 15% or more is severe
A nurse is caring for an older adult patient. Which of the following physiologic changes associated with aging can affect medication dosage and the patient?
Decreased gastric motility -results and med remaining and digestive tract for longer periods, leading to slow absorption of med; provider might have to allow for longer time for med onset and peak by extending length of time between doses -decreased glomerular filtration rate causes med to filter at slower rate and remain in body longer -body fat increases with age; meds that are stored in adipose tissue will have an increased tissue concentration, decrease plasma concentration, longer duration in the body -gastric pH increases, but coming more alkaline; nurse should avoid giving preparations that neutralize gastric secretions below gastric pH is required for med absorption
I nurse in the clinic is assessing an older adult patient for the second time in a week. The patient reports a decrease energy level, insomnia, anorexia. The patient's diagnostic tests are within the expected reference ranges. For which of the following conditions should the nurse screen the patient?
Depression -characterized by decreased energy levels, insomnia, anorexia, sadness is most common condition among older adult patients -Sarcopenia impairment of muscle tone caused by physical and activity, change in Central/peripheral nervous system's, and reduce skeletal protein synthesis -DM is a condition caused by inability of pancreas to secrete and enough insulin for carbohydrate metabolism. Manifestations include polydipsia, polyuria, polyphasic - polyuria also a manifestation of DI a condition caused by inability of kidneys to conserve water
A community health nurse is assessing an older adult patient who lives alone. The nurse finds that, although the patient is able to answer all questions appropriately, the patient has a decreased attention span, express his feelings of overwhelming sadness, and has a low energy level. The nurse should identify that the patient is exhibiting manifestations of which of the following disorders?
depression -manifestations: changes in sleep habits, appetite, relationships w/ other, inability to perform ADL's, decreased ability to make decisions/concentrate, anhedonia (inability to feel happy) -manifestation of a delusions: false personal beliefs despite evidence to contrary -manifestation of dementia: severe memory loss and inability to solve problems -manifestations of delirium: sudden onset on confusion, disorientation, altered LOC, inability to focus
A nurse is assessing an 85-year-old patient. Which of the following findings should the nurse report to the provider?
differences in pulse strength b/w lower extremities -can indicate vascular complication -assessment of peripheral vascular system should also include: temp, color, sensations, edema, skin integrity of both upper and lower extremities and identify any differences and report them -expected changes of aging: widened anterior-posterior diameter d/t loss of skeletal mm strength in thorax and diaphragm and age-related hyperinflation of lungs; presence of S4 heart sound; decreased bladder mm tone and contractibility leading to post-void risiduals b/t the range of about 50-100 mL of urine
The nurse is reviewing the medical record of an older adult patient. Which of the following medications should the nurse to conduct a hearing assessment of the patient?
furosemide -d/t a decrease in medcation metabolism in the kidneys of older adults, ototoxicity can occur -adverse effects: ototoxicity (manifestations- tinnitus, difficult hearing) -omeprazole: monitor for bone loss -ferrous sulfate: monitor for GI effects (manifestations-bloating, changes in elimination) -digoxin: monitor for hypokalemia (manifestations- mm weakness)
A community health nurse is visiting home of an older adult patient and her caregiver. The patient has excoriations to her wrists and ankles. Which of the following actions should the nurse take first?
interview pt in private -to gain info abut possible abuse b/c pt might be reluctant to talk w/ caregiver present -provide info on local support groups for individuals who are no longer able to cope w/ burden of caring for older adult -carefully document descriptions of pts wounds for legal purposes -contact adult protective services, abuse is reportable to authorities
A nurse is caring for a patient who is using a continuous passive motion device following a right total knee replacement. Which of the following action should the nurse take when applying the CPM device?
line up the frame joints of the CPM device w/ the pts knee -avoids damage to operative knee if the joints of the CPM machine is in line w. the operative knee -apply while CPM device is in extended position for pt comfort and ensure proper placement -assess CPM settings every 8 hr to ensure appropriate flexion and extension cycle occuring -initially place pt in supine position when applying CPM and then raise HOB to 20 degrees if tolerable
what finding should the nurse identify as a benign, age-related skin change commonly seen in older adult patients?
liver spots -also known as age spot or lentigines- flat, brown/black macules in sun-exposed areas (areas of increased pigmentation); harmless and painless -nevi: malignant/ benign moles atopic dermatitis/ eczema: chronic skin disorder occurring in all ages, scaly and itching rashes -psoriasis: common skin inflammation w/ freqwuent episodes of redness, itching, thick/dry/silvery scales on skin; can be chronic and reoccurring most commonly from 15-35 years of age
The nurse is transferring an older adult patient who has right-sided weakness from the bed to wheelchair. Which of the following actions should the nurse take to provide a safe transfer?
maintain straight back and bend at knees -good body mechanics to prevent nurse injury -hold pt close to body when lifting to maintain center of gravity close to base of support -avoid bending at waist d/t lower back injury -place wheelchair on side of bed that allows pt to move toward his stronger side
A nurse is reviewing the records of a group of older adult patients. Which of the following findings should the nurse identify as an unexpected manifestation of the aging process?
obesity -unexpected finding that is found among larger % of older adult population that can lead to cardiovascular disease, diabetes, stroke -expected age-related changes: decreased nutritional absorption (d/t villi in intestine flatten and are less able to absorb nutrients); impaired medication excretion (d/t decreased ability of kidneys to filter metabolites); impaired hearing, or high-frequency hearing loss (makes it hard to discriminate voices from background noise)
A nurse working in a community health center is completing an assessment of an older adult female patient. Which of the following findings should the nurse identify as a priority?
rales heard at the bases of the lungs -air moving into collapsed airways results in rales and can occur in pts w/ bronchitis, pneumonia, chronic pulmonary dz -bowel motility slows w/ aging but not not commonly result in constipation -urinary frequency is common in older adult pts d/t decreased bladder capacity, weakened contractions during emptying of bladder which can result in post-void residual amounts and increased risk of UTI -painful intercourse common in older adult pts d/t vaginal narrowing, loss of elasticity, decreased secretions
A nurse is managing an adult daycare as developing treatment plans for older adult patients. Which of the following therapeutic strategies should the nurse use to help the patient achieved Ericksons developmental task of this age group?
reminiscence therapy -sharing memories helps pt to achieve sense of fulfillment and self-worth and allows for positive outcomes to Erikson's developmental task of integrity v. despair -use music therapy for sensory and intellectual stimulation and to maintain/ increasing level of physical activity, mental, social, or emotional functioning -encourage meditation to quiet mind and improve overall health- improves sleep, decreases pain, improves cognitive function -pet therapy beneficial to mitigate loneliness, promote better physical and MH, and provide loving companion
a nurse is caring for an older adult patient who has moderate hearing loss which of the following actions should the nurse take to enhance communication?
speak at moderate rate -avoid exaggerated lip movements b/c is distorts sounds and makes lip reading harder -speak in normal voice to avoid distorting words -use medium/low pitch b/c higher pitches make it harder for pt to understand
A nurse is caring for an older adult patient who is on bed rest. Which of the following foods should the nurse plan to include on the patient breakfast tray to prevent constipation?
stewed prunes -bananas, hash browns, egg and cheese omlet (can cause constipation) are all low in fiber
a nurse at a long-term care facility is planning care for an older adult patient who has dementia. which of the following interventions should the nurse include in the plan?
use photographs as memory triggers -such as pic of toilet at entrance of BR. pic of pt as young adult at entrance to her room -use consistent staff, changing staff increases confusion -avoid many choices to decrease confusion and frustration, limit to 1-2 choices -offer simple, basic steps and limit steps to 1-2 at a time
A nurse is providing discharge instructions about calcium supplement turn older adult female patient who has osteoporosis and a recent repair of a fracture in her right hip. Which of the following instruction should the nurse include?
Take your calcium supplement with a large glass of water -with or after meals to promote absorption of supplement -oatmeal another Green serials containing phytic acid can decrease absorption of calcium supplements -recommended dietary allowance of calcium for older adult females is 1200 mg -should also take vitamin D to increase absorption even after Menopause
A nurse in an assisted living facility is assessing an older adult patient who moved in three months ago following the death of his partner. The patient reports awakening early in the morning and admits to feeling very sad. The nurse should identify that the patient is experiencing which of the following types of grief?
acute grief -has somatic and psychological manifestations of distress: inability to sleep well or profound sadness -anticipatory grief: preoccupied w/ impending loss, make extensive funeral arrangements, exhibit change in attitude toward lost thing/individual -delayed grief: unable to accept reality of loss; denial stage of grief and unable to allow oneself to experience feelings of sorrow or loss -disenfranchised grief: can't openly acknowledge loss b/c societal or religious norms
A nurse is assessing an older adult patient who reports feeling anxious about financial concerns and having difficulty sleeping for several months. Which of the following factors should the nurse identify as a factor in the patient sleep pattern?
anxiety can cause disturbed sleep patterns -sleep needs of older adults similar to young adults but they experience more awakenings during night along w/ shorter time periods spent in deep sleep -multiple awakening during night limits ability to obtain rest older adults require -altered sleep patterns in older adults result in decreased amount of time spent in stage III and IV (deep sleep occurs here)
A nurse is completing medication reconciliation for an older adult patient who is receiving multiple medications. Which of the following actions should the nurse take first?
ask pt about OTC med she is taking -Priority: important to list ALL meds pt is taking to compare to full list of med against any new meds pt will take -list should include Px, OTC, herbal and nutritional supplements -nurse should clarify list of meds w/ pharmacist, caregivers, providers, and pt -nurse should compare list to new Px to ensure there's no duplicates or potential interactions -investigate discrepancies on list w/ provider to prevent med errors
The home health nurse is caring for a patient who has cancer and is using a fentanyl transdermal patch for pain control. Which of the following action should the nurse take when caring for this patient?
avoid using heating pad on area w/ patch -increases rate of absorption of opioid and could cause respiratory depression -nurse should obtain new patch w/ appropriate dosage of med; cutting patch will effect delivery of med and result in inappropriate dosage delivery -dispose of by folding adhesive edges together and placing in tamper-proof receptacle -assess for urinary retention every 4-6hrs
what Kubler-Ross stages of grief should the nurse identify the patient is experiencing when a patient with a terminal illness states, "I just want to live one more month so I can see my grandchild get married."
bargaining -third stage of grief that represents last effort at overcoming death by earning longer life; trying to put off death for one last major event/celebration -depression: 4th stage of grief deal w/ full impact of imminent death and grieves for losses both in past and future -acceptance: 5th and last stage, acceptance stage, comes to grips w/ eventual death and makes preparations -denial: 1st stage, unable to admit to themselves that they might die
What statement about the role of folic acid should the nurse make during teaching to a group of older adult female patients your post menopausal about dietary requirements?
"Adequate folic acid intake is associated with a reduced risk for heart disease" -recommended daily intake of 400 MCG can significantly lower levels of homocysteine, a risk factor for heart disease -increase daily dietary intake of food such as orange juice, beans, lipgloss, green leafy vegetables, as well as food and enriched w/ folic acid such as breads and pastas
I nurse is performing an assessment on an older adult patient who has chronic pain. Which of the following affects of unrelieved pain should the nurse identify as a priority finding to report?
impaired mobility -has effect on pts skin integrity, respiratory function, and elimination -complications of immobility resulting from unrelieved pain: pp ulcers, pneumonia, constipation -address limitations to pts independence unrelieved pain causes and increased need for assistance w/ ADL's which can negativity impact self-esteem and well-being -fully assess effect that decrease in self-esteem has on pt as this can negatively affect nutrition, motivation, well-being -evaluate impact on social life and assist in findings ways to regain social life and improve mood and cognition
a nurse is caring for a patient who ahs aphasia following a stroke. what action should the nurse take?
present one idea in a sentence -avoids creating frustration for pt and allows time for pt to process and respond -nurse should use nonverbal techniques such as body language to convey meaning and reinforce verbal communication -speak slowly and clearly -use language appropriate for and adult and avoid using childish tones, inability to speak doesn't reflect their intelligence level
a nurse is teaching an older adult patient about ambulation with a standard walker. what action by the patient indicates an understand of the teaching?
pt moves walker ahead about 15.24 cm (6in)and then steps into walker -should have slight bend in elbow when his hands are on walker grips; do not place walker at level of waist b/c this puts strain on pt upper extremities -safest way to go from sitting to standing is to push off of chair, not pull oneself up by the walker -do not use a walker on stairs; hold onto hand rails when going up/down stairs
What goals should the nurse identify as the party for a client who had a stroke?
Patient's airway will remain clear, as evidenced by clear breath sounds -priority nursing action is to promote pulmonary hygiene -prevention of skin breakdown, relearning speech, encouraging self help are all important goals for a stroke patient
A nurse at a long-term care facility is providing teaching to a group of adolescents who are new volunteers. The nurse should explain the older adult clients are most likely to exhibit a decrease in which of the following?
Short-term memory -decreases as part of aging and as a result older adult patient might require reminders regarding their medications, ADLs, daily schedules -creative ability, decision making skills, cognitive capacity does not decrease as a result of the aging process
A nurse at a long-term care facility is teaching an older adult patient about ambulating with a quad-cane. Which of the following statements should the nurse include in the teaching?
"hold the cane in the hand on the stronger side of your body" -so pt can move cane to support weaker leg and allow for normal gait w/ the ipsilateral arm and weaker leg moving at same time -cane height should allow for elbow to be slightly flexed; 45 degrees = cane too tall and unsafe for pt -place flat edge of base of cane facing toward pt foot; allows pt to ambulate w/out risk of getting foot caught in base
A public health nurse is planning an immunization clinic for older adults. I would to the following times should an older adult patient receiving influenza vaccine?
Annually in the fall
What action should the nurse take when caring for an older adult patient who has dementia who becomes agitated and confused at night and wanders into the hallway?
Place the patients mattress on the floor -i'm sure his patient safety and prevents fall when the patient is confused at night -nurse should use the sensor device to alert on the patient has worn during; restaurants can cause patient to become frightened and struggle -nurse should provide orientation information only if it calms the patient -nurse should keep the area well lit because lighting can reinforce orientation and minimize illusions
A nurse is coming for an older adult patient who is unresponsive following a stroke. Which of the following actions should the nurse take while providing oral care?
Turn patient on side before starting oral care -allow access foods to run out of mouth into a basin and reduce risk of aspiration -use powdered tongue blade to keep patient's mouth open to prevent nurse injury -use voice in the film swab to clean oral mucosa and use separate swab to clients each area of the mouth to avoid transferring micro organisms from one area to another -apply clean gloves to perform oral care
Which of the following health screenings should the nurse recommend two older adults after age 50?
Visual acuity -annual eye exams for all patients over 50 years -cholesterol screening every 3 to 5 years until age 75 -annual rectal exam, including a stool specimen for occult blood; recommendation for a colonoscopy is every 5 to 10 years beginning at the age of 50 -older adults should have DM screening performed every three years, unless high-risk then screening should be more frequent
And yours is assessing an older adult patient has right-sided heart failure. Which of the following findings is the nurses priority?
weight has increased .91 kg (2 lbs) in 24 hrs -evaluate daily weight of pt w/ HF b/c increase in weight of 1-2 lbs overnight or 3 lbs w/in one week indicates worsening HF -monitor O2 sat b/c decreasing levels <90% indicates worsening condition and potentially pulmonary edema (expected range is >93%) -manifestations of HF: nausea, anorexia, pitting edema -evaluate food intake and appetite d/t possible nutritional deficiencies -report pitting edema b/c it indicates fluid retention
The nurse is caring for an older adult patient who has a hip fracture on his writing his pain at 8 on a scale of 0 to 10. Which is the following medication should the nurse administer?
xycodone/acetaminophen 7.5/325 tablet PO -monitor for adverse effects: respiratory depression, constipation -capsaicin topical gel: minor pain -celecoxib: mild-moderate pain -aspirin: NSAID, mild-moderate pain
And nurses caring for an older adult patient who is having a stroke. After assessing airway, breathing, and circulation, which of the following assessments is the nurses priority?
LOC -Priority after assessing airway: assess to evaluate for increases in intracranial pp that might have occured -nurse should use NIH stroke scale or Glasgow coma scale to evaluate LOC -assess mm tone, sensory changes, and gag reflex to determine extent of disability and hemisphere affected by stroke
a nurse is teaching a patient who has chronic obstructive pulmonary disease and has been losing weight about ways to improve his nutritional intake. what statement by the patient indicates an understanding of the teaching?
"I should add grated cheese to sauces and vegetables" -increases protein and Ca intake as well as calories -consuming cold foods will decrease sense of fullness -consume largest meal early in day when energy is highest -pt w/ COPD should consume high-protein diet and limit carbohydrates b/c they break down into CO2 and increase food-related dyspnea
a nurse is providing teaching to a patient who is to start taking finasteride. what statement by the patient indicates an understanding of the teaching?
"I should see a decrease in my PSA levels" -levels will be measured every 6 mo after starting Tx; expected decline is 30-50% -may take up to 6 mo before pt responds -adverse effects: decreased libido, orthostatic hypotension, gynecomastia (excessive development of breasts in males), decreased ejaculate volume -decreases mechanical obstruction of prostate
A nurse is admitting an older adult patient who has urinary incontinence and smells strongly of urine. The patient's partner, Who has been caring for her at home, states that he is sorry and embarrassed about the unpleasant smell. Which is the following responses should the nurse make?
"it must be difficult to care for someone who has incontinence" -therpeutcic response that uses acknowledgement and empathy -do not make judgmental statements
A nurse teaching an older adult patient about osteoporosis. Which of the following statements to the nurse include in the teaching?
"brisk walking will prevent bone loss" -encourage weight-bearing exercises to minimize bone loss -cottage cheese loses Ca in processing -limit caffeine intake b/c it enhances excretion of Ca -provide info on meds for prevention and Tx of osteoporosis -estrogen can reduce Fx rate in women who have osteoporosis, although there are complications to its use such as cancer
A nurse is conducting an in-service for a group of assistive personnel about the basic needs of older adult patients. Following statements should the nurse include in the teaching?
"deep sleep is decreased" -less time spent is stages III and IV (deep sleep cycles) -decreased time in deep sleep = delayed healing -caloric intake requirements decreases by 10% from metabolic rate of younger adult -decreased renal function, affecting body's ability to concentrate urine and filer wastes -recommendations of 30 min a day for 5 or more days a wk to improve BP, lipid profile, neurocognitive function, decrease mortality and age-related morbidity
A nurse is caring for an older adult patient who reports that he has just retired and express his feelings of loneliness due to loss of daily interactions with coworkers. Which of the following responses should the nurse make?
"do you know about the local senior citizen group?" -therapeutic way to give information -becoming involved in org might assists pt in resocialization -avoid responses that don't address feelings of loneliness -avoid challenging statements b/c this may belittle pts feelings and minimize importance of his message -avoid probing-type q's b/c they're nontherapeutic
A nurse is teaching an older adult patient about methods to improve sleep. Which of the following statements should the nurse include in the teaching?
"go to bed at same time every night" -consistent sleep and wake times, even on weekends -minimizes alterations in circadian rhythm that occurs in older adults -discourage watching TV, performing any work in bed b/c it disrupts quality of sleep -recomend light reading or listening to relaxing music to assist in falling asleep -discourage alcohol or caffeine before bedtime b/c these are stimulants and diuretics and inhibit sleep -encourage light carbohydrate or glass of milk for bedtime snack -physical activity in daytime to enhance sleep, do not participate in w/in 3 hrs prior to bedtime b/c it impairs sleep
The nurse is teaching an older adult patient who is healthy and has chronic constipation about establishing a bell retraining program. Which of the following statements to the nurse include in the teaching?
"increase fiber content of your diet" -increase exercise throughout day to stimulate and promote bowel function -attempt defecation for a period of 15-20 min -increase fluids to 2500-3000 mL/day
A nurse is conducting an admission assessment for an older adult patient which of the following actions should the nurse take to collect subjective data?
Allow sufficient time for the patient to respond to questions -subjective data obtained by asking the patient questions and having the patient provided verbal descriptions of health problems -might take an older adult patient longer to process and respond to questions Family members can serve as a source of info for nurse and can confirm findings that a patient provides; only patient can provide subjective data relevant to their health condition -medical record as a source for medical history, lab and diagnostic test result, current physical findings
I nurses caring for a client who has all Psimer's disease and refuses to take her morning antihypertensive medication. The patient is oriented to name in place and is able to perform ADLs with minimal supervision. Which of the following actions should the nurse take?
Ask the patient expressed her reasons for refusing medication and document the event -evaluate patients competence before intervening or making a judgment; determine reason for refusal -forcing/tricking the patient is unethical and can constitute battery -being confrontational can cause the patient did become argumentative and distrustful -Single incidence of refusing med is unlikely to place the patients competence in question
A nurse is developing a plan of care for a patient who had a recent stroke and has a history of GERD. For which the following disorders should the nurse plan to monitor this patient?
Aspiration pneumonia -GERD results and reflex of gastric secretions from stomach into lower esophagus - high risk for pneumonia; pneumonia occurs due to aspiration of gastric contents into the airway -patient at increased risk for dysphasia due to a stroke and history of GERD and should closely monitor for aspiration pneumonia -acidity of stomach contents that reflux back into the esophagus result in an inflamed esophagus -call is a viral pneumonia is an inhaled virus that settles in the lungs -esophageal varices occurs in patients who have portal hypertension, usually due to hepatic cirrhosis
I nurses caring for an older adult patient who has pneumonia. Which of the following physiologic changes associated with aging places the patient at risk for pneumonia?
Decreased number of cilia -along with less effective cough, leads to diminished efficiency of normal defense mechanisms for clearing the airway putting the patient at increased risk for infection such as pneumonia -calcification of the bronchial and costal cartilage and diminished chest wall compliance, leading to an increase in anterior-posterior diameter and then reduces total long come Pacitti and puts older adult patient at increased risk for hypoxemia -decrease diameter of the small airways does increase with age and can lead to an increase in dead space, gas trapping, ventilation-perfusion imbalance -increase in size of alveolar ducts and respiratory bronchioles leading to a decrease in alveolar surface area which creates less surface area for gas exchange to occur putting an older adult patient at increased risk for hypoxemia
A nurse is caring for an older adult patient who has a new onset of type two diabetes. Which of the following physiologic changes can contribute to the development of type two diabetes?
Decreased sensitivity to circulating insulin -pancreas in older adults demonstrates reduce tissue sensitivity to circulating insulin leading to increased risk of developing DM2 -insufficient release of insulin by beta cells within the pancreas with DM2 -decrease in the rate of glucose metabolism in older adults -glucose is stored in the liver as glycogen. Decrease in amount of glycogen converted to glucose and release to the body results in a decrease in blood glucose
I nurse is teaching a group of healthy, older adult patients about expected age related changes and sexual response. Which of the following changes should the nurse include as an age related change?
Decreased vaginal lubrication and expected age related change an older adult females, -vaginal dryness might result in painful intercourse -manage with use of water-soluble lubricants -erection often delayed an older adult male patients due to slow her sexual response, lengthening the refractory time -vaginal contractions might decrease in intensity -Delayed ejaculation along with a decrease in forcefulness of emission is an expected age related change and older adult males
A nurse is assessing an older adult patient who states he is homeless. Which of the following findings should the nurse document as comorbidities for this patient?
Dementia and TB -comorbidity refers to medical conditions known to coexist in pt -inadequate shelter and clothing for the weather, malnutrition on poverty, lack of preventative healthcare and immunizations are risk factors for disease but not comorbidities
A home health nurse is visiting an older adult patients who has anemia. Which of the following foods should the nurse recommend to increase the patient's iron intake?
Dried fruit -Greek yogurt increases intake of zinc and calcium -bran muffins increases intake of fiber -peanut butter sandwich increases intake of complementary protein
What findings in the history of a postmenopausal patient with osteoporosis should the nurse recognize as a contraindication to the prescription for aledronate sodium?
Esophageal achalasia -delayed esophageal emptying which greatly increases risk of esophageal erosion, bleeding, perforation -Alendronate sodium prevents/slows weakening of bones and is used to prevent entry postmenopausal osteoporosis -wait at least 30 minutes after taking before eating, drinking, taking other meds -cautioned not to lie down for at least 30 minutes after taking; standing/sitting upright ensures patient gets full dose and decreases heartburn or risk of injury to esophagus Not contraindicated w/ med: -Glaucoma a degenerative eye disease were increased intraocular pressure causes damage to optic nerve -Paget's disease and metabolic bone disease involving bone destruction and regrowth that results in deformity; treatment with biphosphonate such as alendronate sodium is considered first line therapy -long-term steroid use as frequently associated with development of osteoporosis, treatment with biphosphonate is considered first line therapy
I nurse is assessing an older adult patient during an annual physical. Which of the following patient findings should the nurse report to the provider?
Fasting blood glucose level 160 mg/dL -further evaluation needed as patient might be showing early signs of a tendency for DM -Inform provider if the patients BP is equal to or greater than 140/90 -waking to void it night can't be due to normal aging process; brighter capacity decreases causing patient to reach sensation of fullness and need to void several times during night -call movement every other day can be due to Salina. Sauces and expected part of the aging process
A nurse at an ophthalmology clinic is assessing A patient referred by the provider for a potential cataract. Which of the following patient reports should the nurse recognizes consistent with cataracts?
Halos when looking at lights -cataract is it cloudy/OPEC area in lines of I would usually develop with advancing age and can be hereditary; develop slowly and painlessly with a gradual onset of difficulty with vision which include difficulty seeing at night, halos around lights are glare sensitivity and decreased visual acuity even in daylight -cataracts are accelerated by environmental factors such as cigarette smoke or other toxic substances or in response to metabolic disease such as DM -what's the peripheral vision is initial report for patient with open angle glaucoma a condition characterized by increased fluid pressure inside eye (IOP) which damages optic nerve causing partial vision loss or blindness - retinal detachment causes bright flashes of light especially and peripheral visual field, floaters; caused by trauma, aging process, severe DM, inflammatory disorder, but frequently occurs spontaneously -Eye strain and headache with close Work is associated with decreased visual acuity; changes may represent primary eye disease, aging, I trauma, generalized, systemic, illness
I nurse at a long-term care facility is planning care for a patient who has all Psimer's disease and wonders at night. Which of the following intervention should the nurse include in the plan?
I signed patient to a room closer to the nurses station -provide safe place to walk and supervision -protect pt from harm, no restraints -can admin psychotropic med to Tx depression or emotional manifestation of Alzheimer's dz, doesn't treat wandering behaviors -avoid excessive light and sound stimulation, can further agitation and confusion
What action should the nurse take in a long-term care facility to come out reminiscent I'm older adult patients?
Institute a daily storytelling hour -Pet therapy can be beneficial in promoting socialization and social skills -placing a Calendar and Clock in a patient room will promote the patient's level of orientation to date and time -having patience eat their meals in a group dining room is beneficial to promoting socialization
I nurses caring for an older adult patient who has gout and refuses to eat. The patient provider has approved the family to bring food from home. Which of the following foods should the nurse recommend that the patient not eat?
Lentil soup -encourage a purine restricted diet to decrease elevated uric acid levels -diet used for patients with gout, renal calculi, or both in conjunction with med therapy -whole grain bread and cereal, oatmeal, wheat germ, wheat bran, meat gravy's, fresh and saltwater fish, beans, organ meats, mushrooms, green peas, spinach, asparagus, cauliflower, lentils which are legumes? bakers and brewers yeast are all high in purine -cheese high in tyramine; Contra indicated with MAIOs -yogurt good source of calcium -raisins rich in protein
A nurse at an assisted living center is conducting an orientation session for a group of newly hired assistive personnel. Which the following instruction should the nurse include regarding patients who are hearing-impaired?
Maintain eye contact with patient -lipreading and gestures help hearing impaired patients understand what is said to them; maintain eye contact and speak slowly to promote lip reading
The nurse is teaching an older adult patient who is on bed rest following developmental of DVT about methods to increase peristalsis. Which of the following high-fiber food choices should the nurse recommend?
Navy bean soup -increasing fiber by adding foods such as legumes to diet and ensuring adequate fluid intake will promote bowel regularity -canned fruit and fruit juices without pulp, rice pudding, so I milk are all low fiber choices and help to decrease peristalsis
What action should the nurse plan to take prior to administering diphenhydramine hydrochloride to an older adult patient?
Review the medical record for a patient history of glaucoma -Contra indicated for patients with narrow angle glaucoma because diphenhydramine can dilate pupils; glaucoma patients are the ministered medication to constrict pupils, which improve circulation of aqueous humor for absorption -administer med with food or milk to decrease G.I. adverse affects -inform patient to increase fluids due to atropine-like drying effect and thickening of bronchial -anorexia, nausea, vomiting or G.I. adverse effects of this med