Week 6 FN Sherpath EAQ Rationales - Older Adults

The nurse is assessing a patient who has gynecomastia. Which is a sign of gynecomastia?

Rationale Enlargement of breasts in males is called gynecomastia. It occurs due to medication side effects, hormonal changes, or obesity. Atrophy of glandular tissue; replacement of milk ducts by fat; and decreased muscle mass, tone, and elasticity of the breast are not signs of gynecomastia. They are normal aging effects. p. 178

When communicating with a patient who has a visual impairment, which techniques should the nurse use? Select all that apply.

Rationale Sitting at eye level helps the patient to see the nurse and understand the words better. Help the patient have a better view of the nurse by providing diffuse and bright light, with no glare. Encourage the patient to wear eyeglasses or use magnifying glasses to improve vision. Covering the mouth when talking may muffle the spoken words, which may make them difficult to understand. Standing at eye level with the patient facilitates effective communication. pp. 176, 189

The nurse is assessing the housing needs of an older adult with severe arthritis who has recently undergone knee replacement surgery. Which kinds of house are appropriate for this patient? Select all that apply.

Rationale A housing unit with only one floor and without exterior steps is appropriate for the older adult with severe arthritis who has undergone knee replacement surgery. There may be restrictions to joint movements after the knee replacement surgery. A house with only one floor may reduce the need to climb stairs. A house with no exterior steps would be safe and prevent risk of falls. Pets may easily move around the patient's feet resulting in a fall. Shiny floors in a house may appear to be wet and cause falls. The presence of throw rugs increases the chances of falls. p. 182

Which type of elder mistreatment involves desertion of a vulnerable elder at a hospital?

Rationale Abandonment may involve desertion by a caregiver of older adults who are unable to protect themselves at a hospital or other public location. Physical abuse refers to the infliction of physical pain such as hitting, beating or slapping. Caregiver neglect refers to failure of providing caregiving activities such as refusal to provide food, water, or clothing. Psychosocial abuse refers to an act that inflicts mental pain or distress such as humiliation and social isolation. pp. 188, 191

Taste buds atrophy and lose sensitivity, and appetite may decrease. As a result, which is the older adult less able to discern?

Rationale As people, age, salivary secretion is reduced, and taste buds atrophy and lose sensitivity. The older adult is less able to differentiate among salty, sweet, sour, and bitter tastes. Often an adult uses heavy spices because of the inability to taste food. Older adults maintain their ability to differentiate between hot and cold temperatures, and moist and dry food. p. 177

The nurse sees a 76-year-old in the outpatient clinic. The patient's chief complaint is vision. The patient has really noticed glare in the lights at home; vision is blurred; and the patient is unable to play cards with friends, read, or do needlework. What is this patient experiencing?

Rationale Cataracts normally result in blurred vision, sensitivity to glare, and gradual loss of vision. Presbyopia is a common eye condition resulting in a person having difficulty adjusting to near and far vision. The symptoms are not reflective of depression, because the patient's vision affects the ability to interact. The patient has not chosen to avoid friends. Disengagement is a term referring to aging theory. p. 186

An older adult is unable to distinguish between the colors blue and black. Which is the most likely cause for this condition?

Rationale Changes in color vision may occur due to aging. The lens in the eye can become discolored, making it difficult to distinguish between dark colors such as blue and black. It is neither a hereditary syndrome nor a mental problem, and it is not due to the effect of malnourishment. It is due to aging. p. 178

What may be the reason for decreased mobility of the ribs?

Rationale Decreased mobility of the ribs is due to calcification of the costal cartilage. This occurs with aging. The curvature of the thoracic spine is known as dorsal kyphosis and is due to vertebral change. Decrease in the respiratory muscle strength and increase in the anteroposterior diameter of the thorax are age-related problems due to configurational changes in the thorax. p. 178

The nurse is caring for an elderly patient who is having difficulty recalling directions after hospitalization. On assessment, the nurse noticed that hypoxia has intensified the condition. What is the possible psychological condition of the patient?

Rationale Difficulty recalling directions may be a sign of delirium. This is an adverse event seen in hospitalized elderly patients. The risk of delirium in these patients is increased by conditions such as hypoxia. Stress is a nonmedical cause that increases the risk of delirium. Difficulty recalling directions is not necessarily a sign of dementia, which is associated with more pervasive memory loss. Depression is not associated with memory loss and is not exacerbated by hypoxia. Test-Taking Tip: Difficulty in recalling the directions is the sign of psychological condition. Choose the condition, which is aggravated by hypoxia in hospitalized elderly patients. pp. 190

The nurse is explaining the benefits of exercise to older adults. Which statements by the older adults indicate effective learning? Select all that apply.

Rationale Exercise helps to maintain physical activity. The main benefits of exercise are to maintain and strengthen functional ability and promote a sense of enhanced well-being. Exercise promotes the production of chemicals that reduce stress. It also increases circulation of blood to the muscles and increases muscle tone. Exercise promotes the use of joints and improves joint flexibility. Exercise promotes mineralization of bones, thereby strengthening bones. Exercise helps in conditioning the muscles, promotes stamina, and reduces limitations. Test-Taking Tip: Even though the question asks about statements made by older adults, the question is really asking if you know which statements are true. Because the question asks for indications of effective learning, assign 'true' or 'false' to each statement as you consider them one at a time. Then recheck that the choices you marked as 'true' answer the question. p. 186

The nurse has conducted an assessment of a new patient who has come to the medical clinic. The 82-year-old patient has had osteoarthritis for 10 years and diabetes mellitus for 20 years. The patient is alert but becomes easily distracted during the nursing history. The patient recently moved to a new apartment, and the patient's pet beagle died just 2 months ago. Which is this patient most likely experiencing?

Rationale Factors that often lead to depression include presence of a chronic disease or a recent change or life event (such as loss). Patients are alert but easily distracted in conversation. The symptoms presented by this patient do not indicate dementia, delirium, or disengagement. p. 180

The nurse is assessing an elderly patient with a pelvic fracture who has a history of osteoporosis. Which statement by the patient relates to extrinsic risk factors for a fall?

Rationale Fall-related injuries are commonly associated with a patient's preexisting conditions such as osteoporosis. Avoiding or improper use of assisting devices such as canes while walking indicates extrinsic risk factor for fall. Joint pain is an intrinsic risk factor for falls that can be prevented by performing regular exercise to improve joint flexibility. History of frequent falls may be caused by a patient's preexisting illness, but this would be an intrinsic factor. Use of medications such as sedatives increases the risk of falls due to drowsiness and is an intrinsic risk factor, which can be avoided by withdrawing the drug. Test-Taking Tip: Falls may lead to fractures in older adults and this may be due to intrinsic or extrinsic risk factors. Choose the answer that states an extrinsic risk factor for a fall. p. 186

An older patient presents to the nurse with impaired vision, nocturia, and agitation. Which risk is most likely to occur in this patient?

Rationale Impaired vision, nocturia, and agitation may increase the risk of falls in the patient. Diabetes mellitus, hypertension, and hyperlipidemia are the risk factors for stroke. Obesity, stress, and stroke are risk factors for heart disease. Smoking tobacco is a risk factor for chronic lung disease. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. p. 186

The nurse is teaching a group of older adults. Which principles are helpful in promoting learning in older adults? Select all that apply.

Rationale In old age, some sensory changes occur in the body, so the teaching should be adjusted accordingly. By using appropriate teaching techniques, the nurse should be able to help the patient compensate for sensory changes and perform activities independently. The nurse should ask for feedback from the patient to ensure that the patient understands the information. Presenting one idea or concept at a time helps to avoid confusion. Audio and visual cues should be used while teaching, because they help the patient to remember and retain information. These principles help to promote learning in the older adult. The nurse should sit facing the patient so that the patient is able to watch lip movements and facial expressions, because this helps the patient to understand the subject. The nurse should speak slowly and in a normal tone of voice for the patient to understand properly. Test-Taking Tip: When you are unsure of the material in a multiple-response question, use your good judgment and common sense to evaluate each response individually. For this question, you can eliminate two of the choices right away. You know you have learned that facing the patient is best. Because older adults may have hearing problems, it would not be advisable to speak fast. Now, to confirm your answers, reread the question and see if the choices you have not eliminated seem reasonable. p. 184

When a patient experiences kyphosis, which should the nurse recognize as a future risk?

Rationale Kyphosis is a curvature of the thoracic spine, which can affect the patient's ability to breath deeply and cough effectively. Although kyphosis may be cause by osteoporosis, the primary concern is the impact on the lungs. Decreased bone density, increased risk for stress fractures, and calcification of the bony tissues of the long bones may coexist with osteoporosis. Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect and reread the information given to make sure you understand the intent of the question. This approach increases your chances of selecting the correct answer and helps you get a clearer understanding of what is being asked. Although there is no penalty for guessing on the NCLEX examination, the subsequent question will be based, to an extent, on the response you give to the question at hand; that is, if you answer a question incorrectly, the computer will adapt the next question accordingly based on your knowledge and skill performance on the examination up to that point. p. 178

Which description is applicable to therapeutic communication?

Rationale Meeting a patient's expressed or unexpressed need is a characteristic of therapeutic communication. Sensory stimulation may be provided through touch therapy. A focus on recalling the past of an older adult is characteristic of reminiscence. The acceptance of time descriptions stated by an older adult is part of validation therapy. p. 189

Which statement about the older adult is true?

Rationale Specialists in the field of gerontology consider older adults to have an optimistic outlook on life, tolerance for others, and good memory recall. The United States census bureau states that only 9.5 percent of older adults are poor and most of them are well-cared for, protected, and financially happy. It is a myth that most older adults are mentally instable. Most older adults have an intact memory even up until the end of life. Some stereotypes consider older adults as worthless after leaving the workforce, but they are actually the ones with more knowledge and experience. p. 174

A nurse who is caring for an older adult patient observes that the patient lacks confidence and is unwilling to take medications. Which statement by the nurse would promote positive perception in the patient?

Rationale Older adults respond to therapeutic medication promptly if there is a positive perception. They may feel happy and respond if spoken to nicely and respectfully. Therefore, suggesting that the older adult try to be happy and spend time talking to friends can help to promote positive perception. Using phrases such as 'old man,' 'older people,' and 'aged people' may make the patient feel discriminated against because of age. Therefore, the nurse should not make statements such as 'you need to take medications on time' and 'you should accept that aging is a universal truth.' Statements such as 'talk with other people who are your age' demonstrate ageism and will demotivate the older adult. p. 174

Older adults experience a change in sexual activity. Which best explains this change?

Rationale Opportunities for sexual activity may decline due to the loss of a loved one or a chronic illness in the older adult or partner. Physical changes may also alter sexual functioning. However, the need to be touched remains. The sexual preference of an older adult does not factor into frequency. Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. More than one choice may be correct, but you are asked to choose the best explanation in this question. p. 182

An older patient is diagnosed with dorsal kyphosis. What is a contributing factor for developing this disorder?

Rationale Osteoporosis is a condition that results in loss of bone mass by crushing bones and leaving the bones brittle and prone to fractures. This causes curvature of thoracic spine, which is known as dorsal kyphosis. Impacted cerumen causes diminished hearing acuity in older adults. Subdural hematomas cause delirium in older adults. Calcification of coastal cartilage causes decreased mobility of the ribs in older adults. Test-Taking Tip: Dorsal kyphosis is curvature of thoracic spine in older adults. Use this information to answer the question. p. 178

Which body system is involved in presbycusis?

Rationale Presbycusis is characterized by the presence of a loss of acuity for high-frequency tones and conversational speeches due to aging. It is a physiological sensory change that may occur in the ears with aging. Sensory changes in the eyes include yellowing of the lens and altered color perception. A sensory change in taste is often characterized by fewer taste buds. A sensory change in the touch might be caused by decreased skin receptors. p. 177

After interacting with an older adult patient, the nurse suspects that the patient has presbyopia. Which action of the patient supports the nurse's suspicion?

Rationale Presbyopia is a visual acuity that leads to progressive decline of the eyes to accommodate vision. Therefore, an older adult patient with presbyopia may not be able to differentiate dark colors such as black and blue. A patient with mental impairment finds it hard to remember things and keeps repeating essential words. Salivary secretion reduces in older adults. Therefore, the patient sips water occasionally to reduce thirst. Older adults may have age-related hearing impairment, known as presbycusis. These older adults may ask others to speak loudly.Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. p. 178

A registered nurse is evaluating the statements of the student nurse regarding reproductive changes that occur in both sexes due to aging. Which statement made by the student nurse indicates a need for further teaching?

Rationale Production of sperm declines during the fourth decade of a man's life; that is, it declines at 40 years of age, not at 30 years of age. With increasing age, sexual desire also decreases. A characteristic feature of reproductive change in women is decreased production of estrogen and progesterone. Decreased estrogen and progesterone may cause decreased lubrication of the vaginal mucosa, leading to irritation. Vaginal irritation, which occurs due to lack of lubrication, may result in pain during sexual activity. Test-Taking Tip: The production of sex hormones decreases with increasing age. Relate the effects of sex hormones on reproductive system in geriatrics. This may help you in answering the question. p. 178

The nurse is working with an older adult after an acute hospitalization. The nurse's goal is to help this person be more in touch with time, place, and person. Which technique should the nurse try?

Rationale Reality orientation is a communication technique that can help restore a sense of reality, improve level of awareness, promote socialization, elevate independent functioning, and minimize confusion. Reminiscence recalls the past to bring meaning to the present. Validation is used with confused patients. Body image intervention is not indicated in this case. pp. 189-190

Reminiscence strategies are used to evaluate an older adult patient's memory. What do these strategies do?

Rationale Reminiscence strategies can be used to stimulate memory chains by attempting to recall patterns of association that will improve the patient's recollection. These strategies may help the patient to recollect a coping strategy but do not produce a positive mood or reduce the patient's anxiety. Reminiscence strategies are not necessarily helpful in evaluating the patient's judgment and general knowledge. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the question that are the same or similar in nature to one or two of the answer choices . This item states that reminiscence strategies evaluate memory; the only correct answer also focuses on memory. p. 189

Which body system is affected in presbyopia?

Rationale Sensory change in the eyes is characterized by the presence of decreased accommodation to near or far vision and is called presbyopia. Sensory changes in the ears include thickening of the tympanic membrane and sclerosis of the ear. Sensory changes of smell include diminished sense of smell. A sensory change in the taste is often characterized by fewer taste buds. p. 177

Sexuality is maintained throughout our lives. Which answer below best explains sexuality in an older adult?

Rationale Sexuality is normal throughout the life span, and older adults need to be able to express their sexual feelings. p. 182

The nurse is teaching a group of older adults the importance of daily exercise. Which instructions should the nurse include in the teaching? Select all that apply.

Rationale The nurse should instruct older adults to stop exercising if there is chest pain or tightness, because this indicates exertion. Walking and swimming exercises are good for protecting the musculoskeletal system, because they condition the muscles and strengthen the bones. Good support shoes should be worn to prevent soft-tissue injuries. Clothing should be appropriate for exercise to promote comfort. Older adults should avoid outdoor exercises in extreme cold or warm weather to prevent temperature-related complications. Older adults should drink water before and after exercising to prevent dehydration. STUDY TIP: Regular exercise for you—not just for patients—even if only a 10-minute brisk walk each day, aids in reducing stress. Although you may have been able to enjoy regular sessions at the health club or at an exercise class several times a week, you may have to cut down on that time without giving up a set schedule for an exercise routine. Using an exercise bicycle that has a book rack on it can help you accomplish two goals at once. You can exercise while beginning a reading assignment or while studying notes for an exam. Listening to lecture recordings while doing floor exercises is another option. At least a couple of times a week, however, the exercise routine should be done without the mental connection to school; time for the mind to unwind is necessary, too. p. 186

A patient has presbyopia. Which visual manifestation would most likely be present upon examination of the patient?

Rationale Visual activity declines with age. The decline in the ability of the eyes to accommodate from near to far vision is called presbyopia. Aging may also result in changes in color vision and discoloration of the lens, making it difficult to distinguish between blues and greens or between dark colors such as blue and black. However, these are not caused by presbyopia. As one ages, the ability to adapt to abrupt changes from dark to light areas is reduced, thus causing difficulty in vision when moving from bright to dark environments. p. 178

Aging may cause impairment of urinary function. Which is an effect of weakening of the perineal and bladder muscles on the urinary system?

Rationale Weakening of the perineal and bladder muscles leads to involuntary release of urine. Urinary tract infection, burning with urination, and pain on one side of the back do not occur because of the weakening of the perineal and bladder muscles. p. 178