More 260 Prep U (mostly from test 1 + 2)

What phenomena most likely accounts for the progressive loss of hearing that an 83-year-old man is experiencing?

Presbycusis (Multiple changes in the structures of the inner ear)

RN suspects undiagnosed UTI in client. What assessment finding did the nurse use to make this clinical determination

new onset of delirium

RN suspects client has an undiagnosed neurologic problem. What did nurse assess to make this clinical determination?

new onset of left ear deafness

RN asks an older client to state their name, date, and their location. Which cognitive function is the nurse assessing?

orientation

presbycusis

progressive hearing loss that occurs as a result of age-related changes to the inner ear

Pink frothy sputum may be an indication of

pulmonary edema.

You are caring for a client admitted with chronic bronchitis. The client is having difficulty breathing, and the family asks you what causes this difficulty. What would be your best response?

"Conditions such as chronic bronchitis cause thickening of the bronchial mucosa so it makes it harder to breathe." **COPD obstructs airflow**

What dietary advice should the nurse provide to an older patient who is experiencing pain and inflammation due to rheumatoid arthritis?

"Cutting back on your consumption of meat, fatty dairy products and oils might have a positive effect on your pain."

Nurse R is providing care for a 71-year-old woman who has been admitted to the surgical unit following her post-anesthetic recovery from a bilateral mastectomy. The patient has been physically stable but disoriented to place and time since admission, but the nurse knows that a history of dementia is noted in the patient's chart. The patient's daughter is distraught, however, because "mom was always just a bit forgetful, but nothing at all like this." What would be the most appropriate response by the nurse?

"Delirium can also cause an alteration in mental status and can be caused from a new environment, altered level of consciousness, excess stimuli, adverse drug reactions, and physiologic disturbance, all which your mother has likely experienced as a result of her hospitalization and surgery."

RN assesses risk factors for vision loss in older adult client. Which question should RN include in this assessment?

"Do you have high blood pressure or diabetes?"

RN discusses driving w/older adult who continues to drive but, probably unsafe on the road. Most important RN statement?

"I am concerned about your safety as well as the safety of others."

RN provides diet teaching to an older adult client with gout. Which statement indicates additional teaching required

"I can eat bacon with my eggs for breakfast."

RN teaches client about use of equipment to monitor congestive heart failure. Which statement demonstrates understanding

"I need to step on this scale and use this automatic cuff each day."

Effective pain management begins with

qualitative and quantitative assessment of the pain (where, when, freq etc)

A patient often actively engages in reminiscence when the nurse is delivering care. The nurse recognizes that:

reminiscence is a normal process in achieving ego integrity.

The nurse is preparing to administer an opioid analgesic to an older adult. What is the priority assessment before administration?

resp rate

A hospital clinical educator is espousing the disengagement theory of aging when teaching staff how best to meet the needs of older clients. Which of the nurse's teaching points best captures the disengagement theory of aging?

"Older adults often benefit from a gradual and controlled withdrawal of their own interests from society's interests."

An 81-year-old female patient has just been admitted to the hospital following a stroke. The patient's daughter is upset that nurses are trying to carry out discharge planning early in the admission, characterizing their efforts as evidence that they "just want to get her out the door as soon as possible." How can a nurse best respond to the daughter's concern?

"Our goal is not to rush your mother's discharge but rather to have as many supports in place as possible when it does come time for her to go home."

Which of the following directives by the head nurse at a long-term care facility is most reflective of the activity theory of aging?

"We have to treat our residents like younger people and keep them engaged in meaningful acts."

Advancements in what have increased life expectancy for most Americans.

(1) Disease control (2) Health technology (3) Better living conditions

Which of the following are goals that a nurse may have in the case of a myocardial infarction in an elderly person? (Select all that apply.)

1. Aid in prompt diagnosis 2. Dec cardiovascular stress 3. Prevent + promptly identify complications

During an assessment of an 82-year-old woman, a gerontological nurse learns that the woman has lost over 4 inches in height over the last several years. Which factors have likely contributed to this phenomenon? 1) The woman's overall proportion of body water has decreased. 2) The client has experienced a loss of cartilage. 3) The woman's thyroid hormone levels have declined since the sixth decade. 4) The client's vertebrae have thinned. 5) Loss of stature is a consequence of the woman's diet. 6) The woman's long bones have decreased in length.

1. The woman's overall proportion of body water has decreased. 2. The client has experienced a loss of cartilage. 4. The client's vertebrae have thinned.

The acceptable range of blood pressure for older adults is usually under .....

140 mm Hg systolic and 90 mm Hg diastolic.

RN is caring for a group of clients diagnosed with chronic illness. Which client is at highest risk for depression

65-year-old client who has irritable bowel syndrome and lives alone.

Which of the following clients of a nurse practitioner is demonstrative of a growing trend in the role of grandparents in contemporary American society?

A 70-year-old grandmother is raising her two grandchildren because their mother is in prison.

The occupational therapist on a geriatric rehabilitation unit of a hospital has integrated a life review into a group therapy session. Which of the following statements best captures the nature of life review among older adults?

A life review can help reflect on accomplishments but can also bring painful mistakes to light.

Which interventions would be appropriate for the nurse to use to improve the tissue perfusion of an older patient? (Select all that apply.)

A) Reminding about frequent position changes B) Ensuring an adequate body temperature C) Encouraging physical activity when possible D) Assessing for and preventing sources of pressure on the body

The family of a 90-year-old female hospital patient is worried about her chances of making a full recovery from her recent fall once she returns home. Which of the following factors are likely to have a positive effect on the woman's post-discharge health outcomes? (Select all that apply.)

A) The presence of a reliable and an adequate social support network. B) The patient's understanding of her health and her prognosis. C) The presence or absence of other health problems. D) The self-care habits that the woman had prior to her fall.

For which of the following reasons are emergencies in older persons particularly problematic?

A) They occur frequently because of the age-related changes that lower resistance and make the body more susceptible to injury and illness C) They often present an atypical picture that complicates diagnosis. D) They can be more difficult to treat or stabilize because of older persons' altered response to treatment. E) They carry a greater risk of causing serious complications and death.

Which action should the nurse take first in caring for a client during an acute asthma attack?

Administer bronchodilator as ordered.

Infections are common acute conditions that demand prompt attention. A variety of factors can be responsible for the high risk of infection in the elderly. Gerontological nurses should suspect an infection when which of the following phenomena occurs?

Any abrupt, unexplained change in physical or mental function is detected.

An older patient recovering from surgery is experiencing left calf edema and the area is red and painful to touch. Which actions should the nurse anticipate to be prescribed for this patient?

Application of elastic stockings and administration of anticoagulants as ordered

How should the gerontological nurse initially promote optimal health and wellness after left-sided stroke in client?

Assess mobility limitations (want to assess to see pts mobility then decide next step)

A nurse is caring for a patient following lung surgery. The patient has a shallow, monotonous respiratory pattern and is reluctant to cough. What may the patient may be at an increased risk for?

Atelectasis

Client is diagnosed with chronic venous insufficiency of the lower extremities. Priority teaching?

Avoid prolonged sitting.

A 66-year-old man has undergone a digital-rectal exam (DRE) during a visit to his family physician. The exam reveals that the client's prostate has become enlarged since his last DRE. The most accurate conclusion that his care provider will draw from these findings is that they suggest: A) Prostate cancer B) A risk of malignancy that should be followed up C) A normal age-related change unlikely to have consequences D) A urinary tract infection

B) A risk of malignancy that should be followed up

A patient with newly diagnosed emphysema is admitted to the medical-surgical unit for evaluation. Which of the following does the nurse recognize is a deformity of the chest wall that occurs as a result of overinflation of the lungs in this patient population?

Barrel chest

A gerontologic nurse practitioner has a large patient population with heart disease problems. This nurse practitioner is aware that heart disease is the leading cause of death in the aging adult. What is the cause of this trend?

Blood vessels lose their elasticity with age.

A 74-year-old woman has presented to the emergency department with a suspected hip fracture following a fall on the sidewalk outside her home. The nurse's assessment of the client would recognize what factors as most likely contributed to the suspected injury?

Bone minerals and mass are reduced as part of the aging process.

An older patient is experiencing nociceptive pain in the shoulder. For which potential consequences of debilitating pain should the nurse assess in the patient? (Select all that apply.)

C) Depression D) Dec oral intake E) Immobility resulting in skin breakdown

An older patient has a triglyceride level of 300 mg/dL. Which dietary changes would be indicated for this patient? (Select all that apply.)

C) Increase the intake of fish and chicken D) Use skim milk and nonfat cottage cheese E) Add fresh fruit and vegetables to meals each day

A 78-year-old man has received a recent diagnosis of community-acquired pneumonia. Potential pathological findings on a recent chest x-ray have prompted his physician to order a bronchoscopy and lung function tests. Which of the following findings would be most likely suggestive of pathological processes rather than normal, age-related respiratory changes? A) The client has fewer cilia than would be found in a younger client. B) Lung function tests reveal that both maximum breathing and vital capacity are diminished since his last test. C) There is an accumulation of serous fluid between the lungs and the pleural membrane. D) The lungs are smaller than younger adults' and there are fewer alveoli.

C) There is an accumulation of serous fluid between the lungs and the pleural membrane.

What is the best nursing action to implement for the client who has presbycusis?

Check for cerumen impaction before audiometry.

An older resident with dementia has been pacing and holding his right arm up against his chest. What should the nurse do first to help this patient?

Check the resident's record for the history of this resident's behavior

What statement most accurately captures the role of chronic illness in the lives of older adults?

Chronic illnesses constitute the leading cause of death for older adults.

A newly admitted older patient has severe edema in the lower extremities and no hair on the legs. What do these manifestations most likely indicate to the nurse?

Circulatory problems related to age and a chronic illness

What finding by the nurse may indicate that the patient has chronic hypoxia?

Clubbing of the fingers

Client uses a cpap machine at night for sleep apnea. RN should assess for which effect of chronic hypoxia?

Cognitive impairment

An older patient who has been treated for diabetes mellitus for 10 years continues to have difficulty controlling the blood glucose level. Which potential complication of diabetes should the diabetes educator include when instructing this patient?

Complications of arteriosclerosis

Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation? A) An 81-year-old woman's glomerular filtration rate (GFR) is low. B) A 78-year-old male's stomach pH is increased. C) A 71-year-old male client's echocardiogram reveals slight left ventricular hypertrophy. D) A 78-year-old man has recently developed urinary incontinence.

D) A 78-year-old man has recently developed urinary incontinence.

An older patient with a history of anginal syndrome and congestive heart failure is admitted to the Cardiac Care Unit with a myocardial infarction. Which assessment finding should the nurse report to the health care provider?

Decrease in blood pressure and increase in temperature

An older patient has been diagnosed with a venous thromboembolism. Which age-related change most likely contributed to this diagnosis?

Decreased elasticity of blood vessels

A nurse is preparing to medicate an elderly patient with an opioid analgesic. What does the nurse consider in the use of this medication?

Delirium, sleep disturbances, cognitive changes, and diminished functional abilities may result when pain is not managed adequately.

RN teaching staff assessment criteria for delirium and dementia. Which is most important to include?

Dementia is irreversible.

Bone fractures are a serious risk to the elderly. What is a contributing factor?

Diminished calcium absorption

Ms. E, an 80-year-old, is gradually withdrawing from society and wants society to gradually withdraw from her. She believes that this mutual withdrawal will free her from societal roles and give society the means for transferring power from the old to the young. Ms. E's grown children are concerned and say her belief has no scientific basis. On which of the following theories of aging can Ms. E say she bases her belief?

Disengagement theory

RN caring for aging client w/diabetes who has developed peripheral neuropathy. What nursing diagnosis best relates

Disturbed sensory perception

A medical nurse is aware that older adults tend to have a significantly decreased rate of hepatic blood flow compared with younger adults. What effect is this likely to have on pharmacokinetics and pharmacodynamics in an older adult?

Drug clearance is likely to be slower.

RN providing instructions for a client diagnosed with oropharyngeal dysphagia. Which instruction will RN include?

Eat in an upright position to improve swallowing.

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care?

Encouraging increased fluid intake

Erikson identified ego integrity versus despair and disgust as the last stage of human development, which begins at about 60 years of age. Which intervention would best foster older patients' ego integrity?

Encouraging life review

An older patient with hypertension has been admitted to a nursing home to recover from minor orthopedic surgery. What should the nurse include in this patient's nursing care plan to improve tissue perfusion?

Encouraging the patient to ambulate several times each day

RN caring for older adult client and notes DNR orders on file for client. Which intervention will these orders impact

Endotracheal intubation to maintain airway

Decreased renal mass and reduced glomerular filtration make it especially important that nurses

Ensure that age-adjusted drug dosages are prescribed

What are factors that affect the aging process ?

Environment Heredity Nutrition Health status Life experience Stress Activity

A gerontological nursing course syllabus includes the topic of helping elders ambulate safely. The major factor contributing to an increased risk of falls in the elderly is

Flawed response to changes in balance

An 80-year-old female who enjoys good health explains to her primary care provider that she attributes her health status to her regular intake of berries, fruit juices, and green tea, which she states "help cleanse the damaging molecules out of my body." Which of the following theories of aging underlies the client's health behaviors?

Free radical theory (antioxidants!!)

What is the most common urinary problem among men aged 65 years and older?

Frequent urination

It is important for the nurses to be aware of their patients' financial situations, which can affect patients' nutritional needs and access to medical care. Which of the following applies to the majority of older people?

Get more than half their income from Social Security and live above the poverty level

The nurse is admitting an older patient to the care area. What is the first step the nurse should take when evaluating the patient's circulation in the extremities?

Health history and then inspect the legs (cap refill!!)

age identity

How old or young people feel compared to their chronological age (ex: someone may feel 30 when they are actually 40)

Riverdale has a small budget for community health programs aimed specifically toward its African American population. Nurse G advocates free blood pressure screening in supermarkets and shopping malls in this town because:

Hypertension and heart disease occur at a higher rate in the black population than in the white population

On arrival at the intensive care unit, a critically ill client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client's arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values?

Hypotension

A nurse encourages residents of a long-term care facility to continue a similar pattern of behavior and activity that existed in their middle adulthood years to ensure healthy aging. This intervention is based on which aging theory?

Identity-continuity theory

A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs?

Impaired gas exchange

Which of the following statements is evidence that supports the programmed theory of aging?

In cultures, cells go through a finite number of cell divisions before dying.

RN assesses a 90-year-old client who has COPD. The nurse should include which intervention in the plan of care

Infection prevention measures

A patient diagnosed with diabetic ketoacidosis would be expected to have which type of respiratory pattern?

Kussmaul respirations

Nurses need to understand the aging process in order to help their patients

Postpone the negative consequences of the aging process

Which assessment finding indicates that an older patient is experiencing congestive heart failure?

Moist lung crackles are audible on auscultation with shortness of breath on exertion

Gerontological nursing will become an increasingly important profession, compared with in the past, because:

More people are spending a longer time span in old age

An older patient with type 2 diabetes mellitus is complaining of burning feet. The nurse determines that the patient is most likely experiencing which type of pain?

Neuropathic pain (abnormal sensory stimuli processing)

Mrs. H and Mrs. J are the same age. While in the doctor's waiting room, they discuss their ailments and their beliefs about aging. Mrs. H argues that Mrs. J must be older because she has more ailments. The nurse settles the argument by stating a cornerstone of all biological theories of aging. Which of the following statements did the nurse most likely make?

No two individuals age identically.

As she began to wake after surgery, Mrs. P became extremely restless. Which of the following should the recovery room nurse likely administer first?

O2 to correct hypoxia

When teaching staff about glaucoma screening for the older client, what is the most important information to include?

Open angle glaucoma can be asymptomatic until advanced stages.

A physician stated to the nurse that the patient has fluid noted in the pleural space and will need a thoracentesis. The nurse would expect that the physician will document this fluid as which of the following?

Pleural effusion

Which of the following common infections is a leading cause of death among older adults?

Pneumonia

An 80-year-old client tells the nurse that he has been dizzy since starting to take an herbal remedy for arthritis in addition to prescribed medications. The nurse recognizes that the client may be experiencing the effects of which of the following?

Polypharmacy

The nurse is caring for a patient who has returned to the unit following a bronchoscopy. The patient is asking for something to drink. What criteria will determine when the nurse will allow the patient to drink fluids?

Presence of a cough and gag reflex

An older patient is recovering from hip replacement surgery. Which risk factor would most likely affect tissue perfusion in this older patient?

Prolonged immobility after surgery

An operating room nurse is assisting with the positioning of a 78-year-old female patient on the operating table prior to the patient's abdominal surgery. Which of the following actions should the nurse prioritize?

Protecting the patient's skin integrity by padding bony prominences

82-year-old client suffers from arterial insufficiency. Which nursing intervention will need to be included in the care?

Provide rest periods between activities.

A patient who is cognitively impaired is demonstrating signs of being in pain. How should the nurse assess this patient's pain level?

Provide the patient with a visual analog scale to gauge pain

Which nursing intervention should the nurse anticipate after the client begins hospice care?

Providing an opioid analgesic to a client with bone metastases.

A patient exhibited signs of an altered ventilation-perfusion ratio. The nurse is aware that adequate ventilation but impaired perfusion exists when the patient has which of the following conditions?

Pulmonary embolism

The nurse is caring for a client with chronic obstructive pulmonary disease. The client calls the doctor and states having difficulty breathing and overall feeling fatigued. The nurse realizes that this client is at high risk for which condition?

Respiratory acidosis (cant get rid of O2 and bring in O2)

The husband of a 78-year-old postsurgical patient has approached the nurse, upset that his wife has become incontinent of urine during her hospital stay. The husband states that this is without precedent and he is adamant that the matter be looked into further. The nurse would recognize that which of the following factors may have contributed to this course of events?

Sedative effects of medications

RN would include which of the following important information about severe UTIs in the older adult?

Severe UTIs leading to septicemia occur more frequently

Older client prone to chronic constipation and asks RN why. RN should explain what age-related physiological change

Slow peristalsis

An older patient with a diagnosis of osteoarthritis complains of stiffness in the joints, tenderness, and pain. Which type of pain is this patient most likely experiencing?

Somatic pain (bone + soft tissue pain)

A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia?

Streptococcus pneumoniae

The heart muscle commonly weakens with age. What is a consequence of this fact?

The heart beats faster but pumps with less force.

RN assessing a 71-year-old client's urinary function. Which finding would the nurse identify as a cause for concern?

The pH of urine sample is 9.0 **normal is 4.5 to 8**

When reviewing the medical record the nurse notes that a newly admitted older patient has a history of angina. Which assumption can the nurse make about this patient?

The patient will have an order for nitroglycerine as needed and will be intolerant of vigorous activity

The nurse is caring for an older patient with a fractured hip. Which pain control goal would be the most realistic for the patient?

The patient's self-report of pain will remain below 5 out of 10 while hospitalized. **specific + realistic**

RN concerned that client w/type 2 diabetes mellitus is at risk for cardiovascular problems. What info caused concern?

Triglyceride level 200 mg/dL

An elderly woman suffering from abdominal pain, nausea, urinary incontinence, fever, and vomiting is brought to the emergency department. What is the most likely preliminary diagnosis?

UTI

An older patient who recently retired from working as a waitress for 40 years complains of leg cramps that interfere with sleeping. The patient also experiences dizziness when getting out of bed first thing in the morning. What problem should the nurse suspect is occurring with this patient?

Varicose veins

Elderly hospital patients need special care in some respects. What is one thing a nurse can do to ensure that they leave the hospital in good condition and can return to a normal life?

Wash hands between patients and use other infection control practices.

An older male patient taking medication for hypertension asks what else can be done to reduce the blood pressure. What measures should the nurse recommend to the patient?

Weight loss and a reduction in sodium intake

The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high-pitched, sibilant, musical sounds that are heard?

Wheezes

RN explores resources available to assist client. Which older adult meets the eligibility requirements for hospice care?

a client who has experienced a stroke and been given 3 months to live

An occupational health nurse overhears an employee talking to his manager about a coworker 65 years of age. What would the nurse be concerned about when she hears the employee state "he should retire and make way for some new blood"?

ageism

As a person ages, muscle tone decreases throughout the digestive system, causing a slowing movement of food through the esophagus. Delayed esophageal emptying in the elderly increases the risk of

aspiration

An elderly woman falls in her home. Paramedics are called to help her get up and take her to a nearby hospital. What action is the paramedics' priority?

assess vital signs (dont move pt till full assessment is done)

The nurse assessed a 28-year-old woman who was experiencing dyspnea severe enough to make her seek medical attention. The history revealed no prior cardiac problems and the presence of symptoms for 6 months' duration. On assessment, the nurse noted the presence of both inspiratory and expiratory wheezing. Based on this data, which of the following diagnoses is likely?

asthma **wheezing**

RN assessing eyes of a 77-year-old client. Which finding would lead RN to suspect that the client is developing cataract

client states, "My vision is becoming more and more blurry."

With aging the skin becomes thinner and more fragile. The thinning of the skin's subcutaneous fat layer makes older adults more sensitive to:

cold

The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation?

crackles at lung bases

____ is a late sign of hypoxia

cyanosis

An older patient who enjoys good health is experiencing a decline in stamina despite being physically active over the years. The nurse recognizes which age-related change as likely affecting the patient's stamina?

dec heart contractility

RN suspects that an older client is developing Parkinson's disease. What did the nurse most likely assess in this client

hand tremor

An older patient has been treated with acetaminophen for chronic pain, and it is no longer effective. What would be the next drug of choice for this patient?

ibuprofen (start w/ non opioids!!!)

The nurse is caring for a patient at risk for atelectasis and chooses to implement a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis?

incentive spirometry (atelectasis = collapsed lung)

The nursing instructor is talking with senior nursing students about diagnostic procedures used in respiratory diseases. The instructor discusses thoracentesis, defining it as a procedure performed for diagnostic purposes or to aspirate accumulated excess fluid or air from the pleural space. What would the instructor tell the students purulent fluid indicates?

infections (purulent = pus filled thats usually yellow/green)

An older adult client is diagnosed with hypertension. Which recommendation will the nurse include in the client teaching

low sodium foods

A patient with a diagnosis of lung cancer has recently developed metastases to the bone which is causing severe pain. The nurse would characterize this patient's pain as being which type?

somatic nociceptive (pain originated from bones + soft tissue)

Perceived Age

term that is used to describe how people estimate a person's age based on appearance

Functional Age

term used by gerontologists to describe physical, psychological, and social function

presbyopia

the inability to focus or accommodate properly due to reduced elasticity of the lens

Client who is a vegetarian is diagnosed with early signs of osteoporosis. Which food item should the nurse encourage?

tofu (high in iron)

An older client with a history of a deep vein thrombosis should be taught to avoid excessive intake of which vitamin or nutrient?

vitamin K

A nursing student is studying the normal physiologic changes of older adults. The faculty member knows that the student comprehends the information when she says which of the following?

• "Height may decrease 1-3 inches." • "There is an increased sensitivity to glare." • "Fluids and electrolytes remain within normal ranges."

The nurse is assigned to care for a client age 87 years admitted to the medical unit for congestive heart failure. It is the fourth hospital day, and the response to treatment has been good. The client is no longer short of breath and the lung sounds are clearing. There is still a diet restriction of decreased sodium and fluids are limited to no more than 1000 mL per day. The nurse is preparing the client and family for discharge. The nurse's discharge education, in order to promote the older client's health, will include which instructions? Select all that apply.

• Gradually increase activities as tolerated. • Do not use the salt shaker at meals. • Increased stress may interfere with recovery.

The nurse is taking a respiratory history for a patient who has come into the clinic with a chronic cough. What information should the nurse obtain from this patient? (Select all that apply.)

• Previous history of smoking • Previous history of lung disease in the patient or family • Occupational + environmental influences