B230 Exam 5

Near death physiological manifestations

-As death approaches, metabolism is reduced and body gradually slows down until all functions end. -Sensory: the client experiences blurred vision, decreased sense of taste and smell, decreased pain and touch perception, and loss of blink reflex, and appears to stare (hearing is believed to be the last sense lost). -Respirations: RR may be rapid or slow, shallow and irregular. May be noisy and wet sounding. Cheyne-Stokes respiration is alternating periods of apnea and deep, rapid breathing. -Circulation: HR slows, and BP falls progressively. Skin is cool to touch, and extremities become pale, mottled, and cyanotic. Skin is waxlike very near death. Urinary: output decreases, incontinence may happen GI: motility and peristalsis diminish, leading to constipation, gas accumulation, and distention Musculoskel: gradually loses ability to move and diff. speaking and swallowing, loses gag reflex Integumentary: Kennedy terminal ulcer, signals the dying process, occurs on sacrum as a dark sore and develops rapidly

Fear associated with dying

-Fear of pain -Fear of loneliness -Fear of being meaningless

Middle adulthood Physical changes

-Physical changes occur between 40 and 65 years of age. -Individual becomes aware that changes in reproductive and physical abilities signify the beginning of another stage in life. -Menopause occurs in women and climacteric occurs in men -Physiological changes often have an impact on self-concept and body image -Physiological concerns include stress, level of wellness, and the formation of positive health habits

Middle adulthood cognitive changes

-a person may be interested in learning new skills -person may become involved in educational or vocational programs for entering the job market or for changing careers

Middle adulthood psychosocial changes

-changes may include expected events, such as children moving away from home (post-parental family stage), or unexpected events, such as the death of a close friend. -Time and financial demands decrease as children move away from home, and couples face redefining their relationship -Adults may become grandparents -Adults are achieving generativity

A 22-year-old hospitalized client with a recent diagnosis of AIDS says to the nurse, "The food on this breakfast tray is terrible. Why can't you people do even simple things well?" What is the nurse's best response?

"I hear a lot of anger in your voice that is quite normal and healthy. Do you want a new breakfast or do you want something else?"

Bloom's hierarchy of cognitive levels of the adult learner:

1. Knowledge 2. Comprehension 3. Application 4. Analysis 5. Synthesis and Evaluation

Vigorous exercise recommendations for middle adults:

20 minutes @ 3 times a week

Age of perimenopausal middle adult women:

45-55 years old "around menopause"

Age to receive first colonoscopy:

50 years old, then additionally every 10 years

The nurse recognizes that individuals vary in their readiness to face their own mortality. Which of the following clients newly diagnosed with a terminal illness is least likely to have difficulty facing mortality?

A 70-year-old male who has planned his funeral and enjoys riding his motorcycle at high speeds in rural areas

The nurse provides anticipatory guidance to people during middle age to meet developmental tasks of: Select all that apply. A. helping children become responsible, happy adults. B. rediscovering new satisfaction in the relationship with one's spouse. C. disassociating from one's parents. D. reaching the peak in one's career. E. passing on traditions and skills to grandchildren.

A. Helping children become responsible, happy adults. B. Rediscovering new satisfaction in the relationship with one's spouse. D. reaching the peak in one's career. ?. Developing an affectionate but independent relationship with aging parents.reaching the peak in one's career. ?. Developing leisure-time activities. The developmental tasks of middle age include:• Helping children become responsible, happy adults• Rediscovering new satisfaction in the relationship with one's spouse• Developing an affectionate but independent relationship with aging parents• Reaching the peak in one's career• Developing leisure-time activities• Achieving mature social and civic responsibility• Accepting and adapting to biological changes• Maintaining or developing friendships

A 48-year-old woman complains to her nurse that she is experiencing frequent episodes of insomnia. What are some measures the nurse should educate her about? (select all that apply) A. Insomnia is common for this age group. B. Engage in activity 1 to 2 hours before bed to encourage sleep. C. Avoid or reduce the amount of caffeinated beverages that are consumed. D. Occasional napping should be avoided. E. Have a regular schedule for waking and sleep.

A. Insomnia is common for this age group. C. Avoid or reduce the amount of caffeinated beverages that are consumed. E. Have a regular schedule for waking and sleep.

Which of the following are major activities older adults can engage in to promote health and prevent frailty? (Select all that apply.) A. Maintain a healthy weight and diet. B. Stay active. C. Keep regular medical appointments. D. Take a daily aspirin. E. Practice fall prevention.

A. Maintain a healthy weight and diet. B. Stay active. C. Keep regular medical appointments. E. Practice fall prevention.

Common visual conditions which may occur in middle-aged adults include which of the following? (select all that apply)Select all that apply. A. Presbyopia B. Glaucoma C. Cataracts D. Macular degeneration E. Presbycusis

A. Presbyopia B. Glaucoma C. Cataracts D. Macular degeneration Presbyopia (farsightedness) is common in middle-age adults, even in individuals who have had no previous problems with their vision. Glaucoma occurs as a result of increased intraocular pressure, which can damage the optic nerve. Cataracts, an opacity of the lens, can develop and cloud the vision in later years of middle age. Macular degeneration is a progressive deterioration of the maculae of the retina and choroid structures of the eye (Mosby, 2008). Presbycusis is an impairment in auditory acuity.

The nurse, teaching a class on smoking cessation to a group of middle-age adults, presents the adverse effects of smoking, which include that nicotine: A. acts to stimulate the heart. B. calms the central nervous system. C. assists in decreasing blood pressure. D. causes a decrease in carbon monoxide.

A. acts to stimulate the heart.

he leading causes of death in middle adulthood include: A. heart disease. B. kidney disease. C. respiratory disease. D. gastrointestinal disease.

A. heart disease.

A nurse has received a grant to provide a community-based education series for middle-age adults. Which of the following topics would allow the nurse to have the greatest impact on the health of members of this age group?a. Diet and exerciseb. Seat belt usec. Depression screeningd. Cancer prevention

ANS: A Obesity is a major risk factor for heart disease, metabolic syndrome, and Type 2 diabetes mellitus. An educational series devoted to discussing diet and exercise will have the greatest impact on health.

A 45-year-old client who has experienced a ten pound weight gain during the past year asks the nurse if she thinks iron supplements would help increase her energy. Which of the following would be the most appropriate action for the nurse to take? a. Ask the client to describe her daily activity and diet b. Leave a note requesting an iron supplement on the clients chart for the doctor c. Provide the client with information related to aerobic exercise classes d. Ask the client if she is still menstruating

ANS: A Ask the client to describe her daily activity and diet A lack of routine exercise and activity plus a diet high in calories contributes to weight gain and a lack of energy. The priority action by the nurse is assessment, which will reveal the reason for a lack of energy.

A couple in their sixties has assumed responsibility for raising their two grandchildren ages 9 and 12 because the children's parents died in a car accident. Which of the following is nursing interventions is a priority to help the grandparents cope with the responsibility of raising their grandchildren? a. Connecting them with the Grandparents Raising Grandchildren support group b. Encouraging them by reinforcing how they successfully raised their own children c. Volunteering to provide respite time for them as needed d. Assuring them that their stress level will lessen as they gain confidence

ANS: A Connecting them with the Grandparents Raising Grandchildren support group Stress experienced by grandparents who must raise grandchildren can be lessened by counseling and participation in support groups.

Which of the following statements about alcohol intake is correct? a. Women have a higher death rate related to alcoholism than men. b. A woman who drinks two glasses of wine per day with her evening meal is considered a moderate drinker. c. More women than men are considered problem drinkers. d. Women who experience fewer cognitive effects from drinking are less likely to drink heavily than do women who get a buzz from drinking.

ANS: A Women have a higher death rate related to alcoholism than men. The death rate for female alcoholics is 50% to 100% higher than for male alcoholics. More men than women are considered problem drinkers. Moderate drinking for women is defined as one alcohol-containing drink a day. Women who are able to hold their liquor are more likely to drink excessively than those who cannot hold their liquor.

A nurse is conducting a community health education program about osteoporosis with a group of older adults. Which of the following individuals in attendance is at greatest risk for developing osteoporosis? (select all that apply) a. 65-year-old Asian woman who smokes one pack of cigarettes per week b. 80-year-old White man who has three glasses of wine per day c. 74-year-old White woman on daily oral prednisone for emphysema d. 68-year-old Black man who has a sedentary lifestyle

ANS: A, B, C a. 65-year-old Asian woman who smokes one pack of cigarettes per week b. 80-year-old White man who has three glasses of wine per day c. 74-year-old White woman on daily oral prednisone for emphysema Osteoporosis is a disease of bone loss common to women age 70 and older and men age 80 and older. The disease occurs six times more frequently in women than it does in men. Risk factors include a small, thin frame; White or Asian ancestry; family history; excessive thyroid medication or high doses of cortisone-like drugs for asthma, arthritis, or cancer; a diet low in dairy products and other sources of calcium; physical inactivity; smoking cigarettes; and drinking alcohol

The nurse working in a retirement community for older adults is conducting a psychosocial assessment of all residents. Which of the following questions should the nurse ask during the assessment process? (select all that apply) a. Have you thought about harming yourself? b. Are you still playing bridge every Thursday? c. How does your congestive heart failure affect your life? d. Has your financial situation changed since last year?

ANS: A, B, C a. Have you thought about harming yourself? b. Are you still playing bridge every Thursday? c. How does your congestive heart failure affect your life? Suicide ideation, loss of interest in activities, and chronic illness are signs of, or may lead to, depression. Economic difficulty is not a predictor of suicide in older adults.

An 80-year-old person is admitted to the hospital. During the health assessment process, the nurse should screen for which of the following conditions? A.) Polypharmacy B.) Renal insufficiency C.) Illegal drug use D.) Alcoholism

ANS: A, B, C, D Alcoholism and illegal drug use are often overlooked by health care professionals because of a persons age. Many older adults take multiple over-the-counter and prescription medications and are at risk for drug interactions.

Blacks are more likely than non-Hispanic White Americans to be diagnosed with cancer at a later stage and have a less optimal outcome after the diagnosis is made. Which of the following reasons help explain this difference? (select all that apply) a. Lack of access to, or utilization of, cancer screening b. Lack of health insurance c. Genetic variations d. Lack of resiliency against disease

ANS: A, B, C. a. Lack of access to, or utilization of, cancer screening b. Lack of health insurance c. Genetic variations Although poverty and lack of access may account for lack of screening and early diagnosis, genetic variations in tumor growth and response to medication along with other major health problems also affect outcomes.

A community health nurse is caring for a variety of different people in the community. Which of the following individuals would the nurse recognize as being at risk to experience increased stress related to family dynamics? (select all that apply) a. A 54-year-old couple whose young adult daughter and grandson move back into their home b. A 44-year-old single mother raising three adolescent children without child support c. A 60-year-old couple whose children have established successful careers in another state d. A 36-year-old couple whose child plays competitive tennis

ANS: A, B, D. a. A 54-year-old couple whose young adult daughter and grandson move back into their home b. A 44-year-old single mother raising three adolescent children without child support d. A 36-year-old couple whose child plays competitive tennis Stressors of middle age include adult children moving back home, heading a single parent household, and parents whose child plays competitive sports with an emphasis on winning. The couple who has children living out of state who have established successful careers are at the least risk to have stress related to family dynamics.

Which of the following individuals is at risk for developing osteoporosis? (select all that apply) a. A 55-year-old man who is on a low dose of oral prednisone every day because of rheumatoid arthritis b. A 40-year-old woman who works as a secretary c. A 60-year-old woman who walks three miles a day d. A 50-year-old man who works as a mason

ANS: A, B. a. A 55-year-old man who is on a low dose of oral prednisone every day because of rheumatoid arthritis b. A 40-year-old woman who works as a secretary Osteoporosis occurs most frequently in postmenopausal women who have fair complexions and are small, sedentary individuals, and people on long-term steroid use. It increases with age.

Which of the following nursing interventions implies respect for a persons spirituality? (select all that apply) a. Changing the position of the bed in a Muslim clients room so that it faces east b. Contacting the chaplain to assess the clients spiritual needs c. Saying a silent prayer with a client at the clients request d. Praying out loud in the room of a dying client

ANS: A, C a. Changing the position of the bed in a Muslim clients room so that it faces east c. Saying a silent prayer with a client at the clients request Because of the highly personal quality of spirituality, an unobtrusive and sensitive presence by the nurse is needed to allow the person in any setting to achieve spiritual health. The nurse can provide an environment that is supportive to the practice of the persons spirituality. Praying out loud does not demonstrate respect for a persons spirituality but imposes the nurses belief system on the person. Nurses should be able to assess the persons spirituality initially and determine if it is necessary to further consult the chaplain.

The occupational health nurse working for a large corporation is a member of a task force to improve the work environment. Which of the following suggestions by the nurse would help to improve work conditions? (select all that apply) a. On-site walking paths b. On-site food vendors c. On-site counseling services d. On-site meetings of support groups such as Alcoholics Anonymous

ANS: A, C, D a. On-site walking paths c. On-site counseling services d. On-site meetings of support groups such as Alcoholics Anonymous On-site facilities that improve health (walking paths) and psychological well-being (support groups, counseling) will help to create a positive work environment. Depending on the food vendor who is on-site, the healthy food options may not be beneficial to the employees.

Which of the following middle-age adults has successfully transitioned to Eriksons generativity-versus-stagnation stage of development? a. A 60-year-old woman who retired last year and volunteers at a homeless shelter 2 days a week b. A 63-year-old man who regrets his career choice and feels he cannot change careers c. A 45-year-old woman who resents having to care for her aging mother-in-law d. A 50-year-old man who has not saved for retirement but spends his discretionary income on vacations he takes by himself

ANS: A. - A 60-year-old woman who retired last year and volunteers at a homeless shelter 2 days a week Generativity according to Eriksons theory involves a sense of productivity, creativity, and the desire to help others, whereas stagnation involves a sense of isolation and focus on oneself.

Which of the following medications is generally recommended to help preserve cardiovascular health in middle-age women? a. Aspirin b. Folic acid c. Estrogen d. Estrogen receptor modulator

ANS: A. Aspirin Only aspirin is recommended to help maintain cardiovascular health by lowering the risk of clot formation.

A couple in their sixties has assumed responsibility for raising their two grandchildren ages 9 and 12 because the childrens parents died in a car accident. Which of the following are priority nursing interventions that the nurse can implement to help the grandparents cope with the responsibility of raising their grandchildren? a. Connecting them with the Grandparents Raising Grandchildren support group b. Encouraging them by reinforcing how they successfully raised their own children c. Volunteering to provide respite time for them as needed d. Assuring them that their stress level will lessen as they gain confidence

ANS: A. Connecting them with the Grandparents Raising Grandchildren support group Stress experienced by grandparents who must raise grandchildren can be lessened by counseling and participation in support groups.

A nurse has recently accepted the position of unit nurse manager on a long-term care unit. Which of the following directives should the nurse give to the staff nurses? a. Encourage residents to participate in unit activities such as Scrabble and bingo. b. Demonstrate the caring aspect of nursing by dressing residents before breakfast. c. Fill in missing words during conversation with the residents to avoid embarrassment. d. Instruct the aides to get residents ready for breakfast as quickly as possible to make sure they are ready to eat.

ANS: A. Encourage residents to participate in unit activities such as Scrabble and bingo. To encourage cognitive health nurses should inspire older individuals to take classes, read, engage in stimulating conversation and entertainment, keep their minds active, and continue learning throughout their lives. They are encouraged to continue with self-care activities rather than relinquish them to caregivers. Residents should be encouraged to perform self-care activities themselves. When help is required, it should be provided in an unhurried manner. Filling in missing words makes the resident dependent on the staff and reduces motivation to communicate, and the words supplied may not be the intended words.

Which of the following statements made by a client best identifies someone who would benefit from health promotion interventions? a. I have a new grandchild and want to be part of her life. b. My mother lived until she was 90, so a long life is in my genes. c. Some chronic illness is just a part of aging. d. I hope Ill live a lot longer, but one never knows.

ANS: A. I have a new grandchild and want to be part of her life. Motivation to adopt a healthy lifestyle is a primary predictor of successful interventions. Feeling that illness is just part of aging or leaving health up to chance will not help the person make necessary lifestyle changes.

The occupational health nurse is asked to develop a plan to reduce work-related injuries. Which of the following recommendations would the nurse stress as the most effective way to reduce work-related injuries? a. Make the work environment smoke-free. b. Reduce environmental noise levels. c. Conduct regular walk-through assessments at the worksite. d. Increase paid personal days from one to three.

ANS: A. Make the work environment smoke-free. Accidents are twice as high among smokers than nonsmokers. Possible explanations include the loss of attention, the use of one hand for smoking, and irritation of the eyes. Because smoking has such an impact on accident rates, this would have the largest effect on reduction of work-related injuries.

A man tells a nurse that he is concerned about his risk of developing cancer. Which of the following behaviors would place the man at higher risk of developing cancer? a. Smoking a half of a pack of cigarettes a day b. Exercising three times a week c. Consuming green, leafy vegetables several times a week d. Visiting a chiropractor every week

ANS: A. Smoking a half of a pack of cigarettes a day Habits that place older adults at a high risk for developing cancer: not following nutritional guidelines, high stress levels, not engaging in a regular exercise program, and smoking cigarettes and using other tobacco products.

Which of the following individuals would be at greatest risk of injury? a. 80-year-old who does not have air conditioning or a fan b. 70-year-old who has new dentures c. 68-year-old who has difficulty tasting salt in food d. 84-year-old who needs hearing aids

ANS: A. a. 80-year-old who does not have air conditioning or a fan Sweating decreases in older adults, predisposing them to heat stroke.

A nurse conducted a 5-week education series about health maintenance. Which of the following statements by a participant indicates the analysis stage of cognition as defined by Blooms taxonomy? a. If I eat too much food and do not exercise, I will gain weight. b. Fat is more calorie-dense than is protein. If I eat calorie-dense foods and do not do moderate exercise at least 5 days a week, I will gain weight. c. I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight. d. I can eat more if I exercise more.

ANS: B Fat is more calorie-dense than is protein. If I eat calorie-dense foods and do not do moderate exercise at least 5 days a week, I will gain weight. During the analysis stage of cognition, all aspects of learning come together in thought and the individual is cognizant of the relationships and interactions of all the parts. If I eat too much food and do not exercise, I will gain weight indicates knowledge (recall of facts). I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight indicates application. I can eat more if I exercise more indicates comprehension.

A nurse has accepted a position as director of health services in a retirement community. Which of the following statements about retirees is important for the nurse to consider as she plans programs? (select all that apply) a. Depressed and inactive. b. Left their job to spend more time with family. c. Left their job because of ill health. d. Happy and well-adjusted to retirement.

ANS: B, D B. Left their job to spend more time with family. D. Happy and well-adjusted to retirement. Research has demonstrated that the majority of retirees are in good health and happy with their decision to leave work so as to spend more time with their families.

Which of the following interventions will have the greatest impact on reducing constipation in older adults? (select all that apply) a. Offering pureed foods that are easy to digest b. Encouraging fluids between meals c. Administering laxatives on a daily basis d. Assisting with ambulation

ANS: B, D b. Encouraging fluids between meals d. Assisting with ambulation Nurses can help reduce the incidence of constipation by encouraging older adults to exercise and increase their fluid and dietary intake. Dietary modifications, such as increasing fiber and fluid intake, can stimulate the colon and resolve constipation. Pureed foods do not contain adequate fiber. Increased fluid intake and exercise should be implemented before relying on medication to relieve constipation.

An occupational health nurse is planning injury-prevention educational sessions. Which of the following considerations should be made by the nurse? a. Education should be focused on workers with the least experience. b. All workers need continued education related to safety issues. c. OSHA rules apply to all companies with more than 25 employees. d. Middle-age workers have the lowest rate of injury of any age group.

ANS: B. All workers need continued education related to safety issues. The role of the occupational health nurse is focused on keeping the worksite safe for employees. Experienced workers may not know how to prevent injury. OSHA applies to all companies. There are no data to support that middle-age workers have the lowest rate of injury. Physical and cognitive changes, which are part of middle age, may predispose workers to injury (i.e., decline in vision/hearing).

8. The nurse collects the following assessment data from a woman: Hispanic ethnicity, BMI 29 kg/m2, age 41. Which of the following actions should be taken by the nurse? a. Encourage the client to continue her dietary and exercise patterns. b. Discuss her current dietary and exercise lifestyle habits. c. Counsel the client that she will face chronic health problems because of her weight. d. Encourage the client to adopt a low-calorie diet to help control her weight.

ANS: B. Discuss her current dietary and exercise lifestyle habits. Obesity is defined as a BMI of 30 kg/m2. The client is at risk for obesity. Further data should be gathered related to her dietary and exercise patterns so as to plan appropriate interventions. Adoption of a low-calorie diet may not be an appropriate intervention depending on what additional data collection reveals. Also, dietary changes should be accompanied by regular aerobic exercise.

A 62-year-old person states to the nurse, I have trouble with my peripheral vision. Sometimes, I do not notice objects unless they are in front of me. Which of the following disorders is the client likely experiencing? a. Presbyopia b. Glaucoma c. Cataracts d. Diabetic retinopathy

ANS: B. Glaucoma Glaucoma occurs as a result of increased intraocular pressure, which can damage the optic nerve. Damage to the optic nerve is irreversible, but visual loss can be prevented if damage is identified early and treatment is initiated. Peripheral vision is affected in glaucoma. Presbyopia is farsightedness. Cataracts cause cloudy vision.

A nurse is conducting a community education program. Which of the following should be stressed as the leading cause of death in middle-age adults? a. Automobile accidents b. Malignant disease c. Homicide d. Suicide

ANS: B. Malignant disease The leading causes of death during middle adulthood are heart disease, cancer, and accidents. Accidents are the major cause of death for children and young adults. Homicide and suicide are major causes of death for young adults.

A woman who is being discharged from the hospital is oriented to person, place, and time, and her memory is intact. She has occasional forgetfulness without a consistent pattern of memory loss. Which of the following housing options would be most appropriate for this woman? a. Independent living b. Retirement community c. Assisted living d. Nursing facility

ANS: B. Retirement community Retirement community living is suited for a person who is oriented to person, place, and time and has a memory that is intact, but has occasional forgetfulness without a consistent pattern of memory loss. Independent living may be appropriate for the person if she had a consistent pattern of memory loss. Assisted living or nursing facility living may be appropriate if the woman has difficulty with orientation to person, place, or time or has difficulty with confusion that results in anxiety, social withdrawal, or depression.

Which of the following nursing diagnoses is a priority related to the problem of urinary incontinence? a. Risk for social isolation b. Risk for impaired skin integrity c. Risk for inadequate fluid intake d. Risk for impaired coping

ANS: B. Risk for impaired skin integrity Although social isolation and decreased fluid intake may occur because of urinary incontinence, impaired skin integrity is a major concern because of its impact on physical and psychological health.

The clinic nurse has seen the following four people today. Which of the following people is demonstrating a healthy coping pattern? a. Discusses very little except the loss of her husband 3 years ago b. Talks about the good times she and her husband had before his illness and death 1 year ago c. States that life is not worth living without her husband, who died 2 years ago d. Blames herself for her husbands death because she did not make him go to the doctor

ANS: B. Talks about the good times she and her husband had before his illness and death 1 year ago Research has demonstrated that rumination, self-blame, and catastrophizing have negative effects on coping, whereas positive reappraisal has a positive effect.

A nurse has been asked to develop a visit plan for a mobile mammogram van. Which of the following considerations would be made by the nurse when deciding which neighborhoods to visit? a. Hispanic women have the highest rate of breast cancer of all minority groups in the United States. b. The death rate from breast cancer is higher in Hispanic women than for women in other ethnic groups. c. The death rate from breast cancer in Hispanic women has risen in the past 10 years. d. Breast cancer in Hispanic women is usually diagnosed at an early stage.

ANS: B. The death rate from breast cancer is higher in Hispanic women than for women in other ethnic groups. Even though Hispanic women have a breast cancer rate approximately 40% lower than non-Hispanic White women, their death rate is higher and the cancer is diagnosed at a later stage.

Which of the following statements is the best definition of polypharmacy? a. The use of more than five medications prescribed by different physicians b. The use of multiple medications for the same or different health problems c. The use of multiple pharmacies and self-management of medications d. The use of multiple medications and supplements simultaneously

ANS: B. The use of multiple medications for the same or different health problems Polypharmacy is the use of multiple medications for the same or different health problems. It is a major concern for elderly people, with the rate of polypharmacy in this population being between 9% and 39%.

A nurse is conducting a staff development program about human sexuality for nurses who work in a long-term care facility. Which of the following statements is accurate? a. The desire for sexual intimacy declines rapidly with age. b. Older adults are very well-informed about sexuality. c. Older adults need to practice safe sex. d. The danger of contracting STDs during sexual intimacy is extremely low in older adults.

ANS: C Older adults need to practice safe sex. The desire for sexual intimacy remains a primary force throughout life. Older adults need teaching related to safe sexual practices, STD transmission, and so on. HIV infection is a concern in all age groups.

Which of the following is a normal physiological change that occurs during middle age? a. Increase in gastric emptying resulting in acid reflux b. Reduction in height caused by kyphosis c. Reduction of glomerular filtration by 50% d. Increase in the amount of estrogen produced in both genders

ANS: C Reduction of glomerular filtration by 50% Gastric emptying is decreased, kyphosis is not an expected part of aging, and estrogen levels decrease in women and increase in men as male testosterone levels decrease.

1. A 35-year-old person asks the nurse working in a dermatology clinic what causes skin to wrinkle. Which of the following statements would be most appropriate way for the nurse to reply? a. There is really nothing you can do to prevent a lot of wrinkles. It is part of aging. b. As we age, we lose fat beneath the skin so wrinkles appear. There is nothing we can do to prevent it. c. Wrinkles appear for a number of reasons, including loss of fat beneath your skin and too much sun exposure. d. Wrinkles are caused by genetic factors

ANS: C Wrinkles appear for a number of reasons, including loss of fat beneath your skin and too much sun exposure. Loss of subcutaneous fat and collagen damage related to sun exposure cause wrinkles.

According to Eriksons theory of development, which of the following older adults has successfully navigated the stage of ego integrity versus despair? a. 72-year-old man who is reluctant to retire because work is everything to me b. 78-year-old woman who has scheduled her third face lift c. 80-year-old man who has informed his children that he has made his funeral arrangements d. 67-year-old woman who is depressed because she has not been promoted at work for the past 10 years

ANS: C. 80-year-old man who has informed his children that he has made his funeral arrangements Successfully navigating the stage of ego integrity versus despair requires that the individual accept normal bodily changes associated with aging, find meaning in life apart from work, accepts the inevitability of death, and is at peace with his or her life.

A nurse working in a rural location is interested in starting a weight management group for clients in the area. Which of the following interventions is most likely to ensure success? a. Using a pre-set list of topics for discussion b. Relying on printed material to relay information to the group c. Asking for a list of topics that interest the group d. Beginning each session with a 2-mile walk

ANS: C. Asking for a list of topics that interest the group When participants plan the topics of discussion, interest is maintained. A pre-set list of topics may not meet the learning needs of this particular group. A 2-mile walk may not be realistic for participants.

A nurse is conducting a community education program about cognition in older adults. Which of the following information should be included? a. Some form of mild dementia is a normal part of aging. b. All forms of dementia have the same symptoms, but progress at different rates. c. Assessment for dementia should be part of routine physical exams. d. Elders who score below 27 points on the Mini-Mental State Exam (MMSE) are not likely to have a cognition problem.

ANS: C. Assessment for dementia should be part of routine physical exams. Cognitive alterations are key symptoms that indicate changes in physiological function among older persons. Thus, assessment of cognition is an important part of routine assessments. Dementia is not a normal part of aging. Dementia symptoms vary according to the specific type of dementia. A score of 23 or lower on the MMSE indicates a problem with cognition.

Which of the following effects of divorce on middle-age adults and children has been documented by research? a. Children adapt to divorce more rapidly than do adults. b. Emotional healing after a divorce takes approximately 24 months in adults. c. Children of divorced parents may have life-long difficulty forming relationships. d. Children of divorced parents undergo similar emotional turmoil as their parents.

ANS: C. Children of divorced parents may have life-long difficulty forming relationships. Although research is continuing, longitudinal studies by Wallerstein and her colleagues beginning in the early 1970s indicate that children bear the emotional scars of a divorce for a lifetime. The emotional response to divorce is different for children and parents, with most parents adjusting to the divorce within 3 years after the event.

A nurse is assigned to provide care for a 96-year-old bedridden man who experiences severe pain from a chronic neurological disease. The man asks the nurse to please help him leave this world so that his suffering ends. Which of the following actions would be most appropriate for the nurse to take? a. Assist the doctor with the mans request b. Refuse to care for the man c. Contact the pain care specialist d. Provide the man with names of doctors who participate in assisted suicide

ANS: C. Contact the pain care specialist Nurses caring for chronically ill older adults have the added responsibility of determining who is at risk for wanting physician-assisted suicide and helping them to be as comfortable as possible and free of pain through the use of pharmacological and nonpharmacological interventions. Refusing to care for the man could be construed as abandonment and is not necessary. Consulting a pain care specialist is the correct action.

A 63-year-old woman complains to the nurse that she has insomnia and sleeps only 6 hours a night. Which of the following responses should be made by the nurse? a. Do you want a sleeping pill? b. Make sure that you do not nap during the day even if you are tired. c. Do you feel excessively tired during the day? d. The nurse practitioner may want to run some simple tests to find out why you are having trouble sleeping.

ANS: C. Do you feel excessively tired during the day? It is important to assess the quality of sleep as well as the effects that the limited sleep has on this individuals daily activities. Medication should not be the first intervention used to help someone attain restful sleep. People should nap when tired, if they are able to do so, rather than forcing themselves to stay awake.

Which of the following statements concerning urinary incontinence is correct? a. Urge incontinence occurs when one has the urge to void but is unable. b. Stress incontinence is associated with emotional turmoil. c. Functional incontinence occurs is associated with environmental barriers. d. Incontinence with high post-void residual occurs when someone laughs or sneezes.

ANS: C. Functional incontinence occurs is associated with environmental barriers. Functional incontinence is associated with environmental barriers, physical limitations, or cognitive impairment in which the client is unable to reach the toilet. Stress incontinence occurs when someone coughs or sneezes. Urge incontinence occurs when someone cannot wait to void once the urge to void is felt. Urge, mixed, or stress incontinence with high post-void residual is caused by physiological changes that affect voiding, such as an enlarged prostate gland.

A nurse formed a political action committee to advocate for health insurance for the uninsured. On which of the following populations would the nurse focus the groups efforts? a. Asian Americans b. Blacks c. Hispanic Americans d. Working-poor White Americans

ANS: C. Hispanic Americans Hispanic Americans are the largest minority group in the United States and have the highest uninsured rate.

A nurse is conducting a staff development program about human sexuality for nurses who work in a long-term care facility. Which of the following statements would most likely be made by the nurse? a. The desire for sexual intimacy declines rapidly with age. b. Older adults are very well-informed about sexuality. c. Older adults need to practice safe sex. d. The danger of contracting STDs during sexual intimacy is extremely low in older adults.

ANS: C. Older adults need to practice safe sex. The desire for sexual intimacy remains a primary force throughout life. Older adults need teaching related to safe sexual practices, STD transmission, and so on. HIV infection is a concern in all age groups.

A community health nurse is working with a diverse population of older adults within the community. Based on the data from the National Health Interview Survey, which of the following assumptions should be made by the nurse when working with this diverse population? a. White Non-Hispanic older adults tend to require more assistance with their activities of daily living. b. Hispanic older adults tend to rate their health as poorer than other ethnic groups. c. Older adults who tend to rate their health as fair or poor are also financially poor. d. Older adults tend to require more assistance with activities of daily living than with meeting their routine needs.

ANS: C. Older adults who tend to rate their health as fair or poor are also financially poor. The National Health Interview Survey conducted by the Centers for Disease Control and Prevention in 2010 provides interesting information about the perceptions of a variety of ethnic groups regarding their health status, their perceived need for assistance with routine needs, and the need for assistance with activities of daily living. In all groups, those who described their health as fair or poor were also more likely to be financially poor.

A 52-year-old woman going through menopause tells the nurse working in the womens health center that she is interested in slowing down the aging process and asks if she should take estrogen. Which of the following statements would be the best response by the nurse? a. The latest research has shown that estrogen is safe to take and will help keep you healthy. Ill tell the nurse practitioner that you are interested in estrogen therapy. b. Estrogen is safe to take for about 10 years. Ill get you some information on estrogen therapy that you can take home and read. c. The safety of long-term estrogen therapy is inconclusive. It is primarily used short-term to relieve hot flashes. d. You can get the same effects from natural products in a health food store, and each product is backed up by research showing that it is effective.

ANS: C. The safety of long-term estrogen therapy is inconclusive. It is primarily used short-term to relieve hot flashes. Research about the safety of estrogen therapy is mixed, therefore it is only recommended for short-term use (1 to 3 years) and only to relieve hot flashes. Natural products do not need research to back up their claims of safety or efficacy.

The son of a 70-year-old man dying of cancer asks the nurse to tell him about the hospice program, so he can help his father decide if the program would be of benefit to him. Which of the following responses should be given by the nurse? a. At hospice, your father will be heavily medicated, so he will not have pain. b. All of your fathers care will be provided by nurses at hospice. c. Hospice care can take place either at home or in a hospice facility. d. Visiting hours are about the same at hospice as they are here in the hospital.

ANS: C. c. Hospice care can take place either at home or in a hospice facility. Once the person is placed in hospice care, treatment to relieve pain and other symptoms is continued by the physician after they have decided to end all curative treatment. Hospice care can occur in the home, a hospice inpatient facility, nursing home, and acute care hospital. The focus of hospice care is to help the person remain alert but free of pain. Families are encouraged to participate in care giving. There are no restrictions to visiting hours.

Which of the following people has exceeded the recommended guidelines for activity? a. A 36-year-old man who engages in bike riding and has a pulse rate of 137 during activity b. A 45-year-old woman who swims and has a pulse rate of 145 during activity c. A 50-year-old man who jogs and has a pulse rate of 120 during activity d. A 60-year-old woman who walks briskly and has a pulse rate of 125 during activity

ANS: D A 60-year-old woman who walks briskly and has a pulse rate of 125 during activity During activity, the persons pulse rate should not exceed 220 minus the age times 0.75. Thus the woman who is 60 years old would subtract (220 60 = 180); then multiply 180 by 0.75 to give 120 for the optimal heart rate for this client. A pulse rate of 125 exceeds the recommended optimal rate of 120.

A nurse is planning to write a grant for a health promotion project in the community. Which of considerations should the nurse make when determining the appropriate population for this project? a. The fastest growing population is children under the age of 12. b. The fastest growing population is young Black American adults. c. The fastest growing population is White middle-age adults. d. The fastest growing population is non-White older adults age 65 and older

ANS: D The fastest growing population is non-White older adults age 65 and older Adults age 85 and older are the fastest growing population in the United States, and the percentage of White Americans greater than age of 65 is decreasing compared with other ethnic groups.

A person is preparing to return home following a 2-week hospital stay for congestive heart failure and pneumonia. Which of the following referrals would be most beneficial for the person? a. Transportation assistance b. Home-delivered meals c. Adult day care d. Home health nursing

ANS: D. Home health nursing Home care nurses provide health care information and services to individuals and families. The resources available to community health nurses frequently are rich and enable the nurses to draw on a variety of sources to assist in promoting the health of community-dwelling older adults. Although all of the referrals listed may be of benefit to the person, the home health nurse will provide the most comprehensive services and be able to connect the person to necessary community resources.

The occupational health nurse is planning a health fair for employees. Which of the following information about dental health should be included? a. Drinking bottled water helps prevent tooth decay. b. Gingivitis results in bone destruction and can be eliminated by flossing daily. c. Preventive dental care requires a visit to the dentist every 4 months. d. In addition to screening for tooth decay, dentists screen for mouth cancer.

ANS: D. In addition to screening for tooth decay, dentists screen for mouth cancer. Dental health is essential to overall health. Dental professionals may be the first to detect a symptom or irregularity that points to a potentially dangerous condition, such as cancer of the mouth and esophageal cancer. Bottled water does not contain fluoride. Periodontitis is oral bone destruction. An annual dental check-up is recommended for the average person, not a check-up every 4 months.

A 75-year-old man tells the nurse that he has difficulty staying asleep during the night. Which of the following responses should be made by the nurse? a. Older adults need as much sleep as middle-age and younger adults. Lets talk about your sleep patterns. b. Ill ask the nurse practitioner to prescribe a sleeping pill for you. c. Taking naps during the day can help relieve excessive fatigue and will help you sleep better. d. Lets talk about your sleep schedule and things that may prevent you from getting a restful nights sleep.

ANS: D. Lets talk about your sleep schedule and things that may prevent you from getting a restful nights sleep. Nurses should assist older adults in achieving a good nights sleep through assessment that might reveal possible causes of sleep disturbances. Older adults need less sleep than younger adults. Daytime naps may prevent sleeping adequately at night. Medications to assist in sleeping are not the initial therapy choice because of side effects.

Which of the following statements concerning nutrition and older adults is true? a. Older adults who live in their own homes are more likely to be malnourished than older adults living in a nursing home. b. Older adults lose their desire for high-fat, salty foods. c. Meals served in long-term care institutions are usually more well-balanced than foods eaten by older adults living at home. d. Many older adults are not aware of food assistance programs.

ANS: D. Many older adults are not aware of food assistance programs. Barriers that may interfere with the ability of independent seniors to obtain adequate nutritional food include limited transportation, income, and social support resources. Many older persons are unaware that they are eligible to participate in SNAP. The percent of older adults who live in their own homes and are malnourished is lower than that of older adults who live in a nursing home. Older adults do not lose their desire for high-fat, high-cholesterol, high-sodium foods. Fresh fruits and vegetables are not always available for older adults living in nursing homes.

The community health nurse has obtained a grant to offer a Safe Driving series for older adults. Which of the following information should the nurse stress during the series? a. Traffic fatalities involving older adults occur mainly at dusk. b. The cause of two-vehicle accidents is frequently an older driver striking another car. c. The average blood alcohol level in older adults involved in accidents is higher than the blood alcohol level of younger drivers involved in accidents. d. Relearning the art of defensive driving can help reduce the likelihood that an older driver will be involved in a motor vehicle accident.

ANS: D. Relearning the art of defensive driving can help reduce the likelihood that an older driver will be involved in a motor vehicle accident. Traffic fatalities involving older adults occur mainly during the daytime. The cause of two vehicle accidents is frequently a younger driver striking the car driven by an older adult. The average blood alcohol level in older adults involved in accidents is lower than the blood alcohol level of younger drivers involved in accidents.

Taking into account all of the agents that affect middle-age adults, the nurse plans a health education workshop focused on developing an individualized lifestyle change program for each participant. Which of the following actions should the nurse stress that individuals take first? a. Limiting unprotected exposure to sun b. Starting a smoking cessation program c. Exercising at least three times a week d. Scheduling a complete physical and dental exam

ANS: D. Scheduling a complete physical and dental exam Although limited unprotected exposure to the sun, starting a smoking cessation program, and regular exercise are important to overall health, assessment data must first be collected to create an effective lifestyle change program. Health care needs and issues vary according to race and ethnicity, socioeconomic status, marital status, and so on. Approaches to health care/education must be individualized.

A nurse is discussing sexuality with middle-age men and women. Which of the following information should be stressed by the nurse? a. Contraception usage should be decreased as a woman nears menopause. b. Difficulty with sexual performance among men happens near age 60. c. HIV infection after age 50 is rare. d. The majority of new HIV/AIDS cases occur among middle-age adults.

ANS: D. The majority of new HIV/AIDS cases occur among middle-age adults. Adults in middle age represent 71% of all new cases of HIV/AIDS. Unintended pregnancy occurs most often in middle-age women. Male sexual performance issues begin between the ages of 40 to 50. HIV infection is not rare among middle-age adults.

A nurse is assisting with development of menu items at a long-term care facility. Which of the following menus would the nurse most likely recommend? a. One egg over easy, one slice of whole wheat toast with sugar-free jam, 4 oz orange juice b. 5-oz cheeseburger cooked medium well with lettuce and tomato, 10 baked potato chips, and 1 cup of decaf coffee with low-fat milk and artificial sweetener c. Chef salad with 2 oz each ham and turkey, lettuce, tomato, bean sprouts, onion, green pepper with low-fat dressing, and one small roll with low-fat spread d. Turkey bacon, lettuce, and tomato sandwich on whole wheat bread with two teaspoons of low-fat mayonnaise, 10 vegetable chips, and ice tea with artificial sweetener

ANS: D. Turkey bacon, lettuce, and tomato sandwich on whole wheat bread with two teaspoons of low-fat mayonnaise, 10 vegetable chips, and ice tea with artificial sweetener The United States Department of Agriculture recommends that infants and young children, pregnant women, older adults, and those who are immune compromised should not consume raw (unpasteurized) milk or any products from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or shellfish, unpasteurized juices, or raw sprouts.

en Jaramillo's wife has been diagnosed with stage 4 breast cancer. Kim wants to help Ben deal with some of the stressors and anxieties that come with such a diagnosis. An _____________ is a legal document prepared when an individual is alive, competent, and able to make decisions to provide guidelines for health care providers in the future, when the individual is not able to make decisions because of physical disability (being unconscious) or mental incompetence.

Advance Directive

FALSE: Drivers over the age of 65 have fewer accidents per person than drivers under age 65.

Aged drivers have more accidents than younger drivers.

FALSE: The American family is still the number one caretaker of older Americans. Most older persons live close

American families, by and large, have abandoned their elderly members.

Middle Adulthood interventions to assist the client with Eriksons stages of development

Assist in choosing creative ways to foster social development. Encourage volunteer activities.

A client is grieving over the death of the client's spouse of 65 years. Which of the following would be a goal of nursing interventions for this client?

Assist the bereaved individual to achieve a healthy adjustment to the loss.

FALSE: Only 5% of persons over 65 are living in nursing homes at any given time. Even among those 75+, only

At least 25% of all elderly live in nursing homes.

Karamjit Kaur, a 50-year-old woman, has been referred to Kim because she has excessive work absences related to stress. Stressors "most common" to women in their late forties and fifties include: (Select all that apply.) A. Career changes B. Financial insecurity C. Raising preschoolers D. Caring for elderly parents E. Coping with divorce or death of a spouse

B. Financial insecurity D. Caring for elderly parents E. Coping with divorce or death of a spouse

A 50-year-old man is initiating an exercise program to help improve his cardiovascular health. What are some of the recommended guidelines that the nurse should instruct him on?Select all that apply. A. Every adult over the age of 50 should start with a daily running program. B. Overexertion should be avoided. C. Increase fluid intake during periods of strenuous exercise in hot weather. D. Adults over the age of 50 benefit from intense strength training. E. Suggested activities include walking, jogging, swimming, and bicycling.

B. Overexertion should be avoided. C. Increase fluid intake during periods of strenuous exercise in hot weather. E. Suggested activities include walking, jogging, swimming and bicycling. Some suggested activities for the middle-aged adult include brisk walking, jogging, swimming, bicycling, and skipping rope as well as walking or biking to work. Activities that focus on skill and coordination should be attempted by the adult over age 40 rather than activities necessitating speed and strength. Moderation is important for all groups of individuals. Caution is recommended for adults nearing age 65 to prevent muscle strains and/or falls, etc. Overexertion, as evidenced by dizziness, chest pressure or chest pain, and unresolved shortness of breath should be avoided. Also, in hot weather, strenuous exercise should be balanced with rest periods and increased intake of fluids to prevent heat stroke.

The nurse initiates an exercise program with middle-aged adults by: A. planning physical activity for a minimum of 45 minutes. B. considering activities that have the least potential for injury. C. counseling the adult that exercise should be rigorous to produce results. D. advising that the heart rate should double during exercise for cardiovascular benefits to be achieved.

B. considering activities that have the least potential for injury.

A client with terminal lung cancer is receiving total brain radiation therapy to control hand tremors due to multiple metastatic lesions. As the nurse assists the client back to the wheelchair, the client comments, "I'm hoping this treatment will let me see my first tomato on the fourth of July." According to Kübler-Ross, this statement is an example of which stage of death and dying?

Bargaining

Which of the following should be a primary focus for Henry when assessing the nutritional content of his elderlyresidents? A. The use of canned versus frozen produce B. The availability of cultural choices C. The content of fat, cholesterol, and salt D. Visual appeal

C. The content of fat, cholesterol, and salt

A condition of the bone that is the result of bone lysis exceeding the rate of bone matrix synthesis is called: A. osteoarthritis. B. kyphosis. C. osteopenia. D. osteoporosis.

C. osteopenia.

During middle adulthood, physiological changes affect most bodily systems. These changes include: A. increased cardiac output. B. increased glomerular filtration rates. C. thinning of the intervertebral disks. D. stable bone density and mass until the mid-60s.

C. thinning of the intervertebral disks.

Bloom (1984) has developed a hierarchy of cognitive levels in the adult learner. The analysis cognitive level for the adult learner would be: A.) recalling specific facts. B.) grasping the meaning of the communicated message. C.) becoming aware of the relationship and interaction of all the parts. D.) applying knowledge in the form of abstractions and ideas to concrete situations.

C.) becoming aware of the relationship and interaction of all the parts.

Erikson's theory of middle adults:

Caring is a middle age virtue

Kohlberg theory of middle adults:

Conventional/Post conventional

FALSE: Depression is one of the most serious mental health problems among older adults. As many as 10% of adults of all ages experience serious depression, but the occurrence is even more frequent among the elderly. An estimated 30-60% experience a episode of depression severe enough to impair their ability to function. Despite the high prevalence rates, few elderly are seen in mental health settings when compared with the young. This is partly attributable to the fact that depression in the elderly often goes undetected or is misdiagnosed as dementia.

Depression is one of the most common problems of the elderly population.

TRUE: All five senses do tend to decline with age, although the extent of these changes varies greatly among

Do all 5 senses decline with age?

No/False. Although the "disengagement" theory was once accepted to explain the relative decrease in activity for some older adults, it has generally been discredited as a valid explanation. More current research has explored the vast diversity among the elderly and many new theories have been developed which better explain the variety of aging observed in this heterogeneous population.

Do elderly naturally withdraw from participation in community life in advanced old age.?

Gilligan theory of middle adult women:

Do not want to hurt others, conflict between selfishness and responsibility

FALSE: Personality doesn't change with age. Therefore, all old people cannot be described as rigid or opinionated, only those who were always rigid or opinionated.

Does personality change with age?

General body changes of middle adults:

Drier skin, hormonal changes (menopause), thinning and greying of hair, male pattern baldness, epidermis thins around age 50

What life stage of Piaget's are middle adults in:

Formal operations (cognitive reasoning/problem solving)

Weight gain in middle adults:

Gains 3 to 4 pounds per decade-need to reduce caloric intake by 2% and increase physical activity to maintain a healthy weight

Middle Adulthood (35 - 65)

Generativity versus stagnation Fufilling life goals that involve family, career and society ability to give and care for others Unsuccessful = self-absorption; inability to grow as a person

What life stage of Erikson's are middle adults in:

Generativity vs. Stagnation

Hearts of middle adults:

Heart deficiency decreases 20% by 30-50 years-unless you exercise/maintain

Late adulthood (65 yr to death)

Integrity versus despair Looking back over one's life and accepting its meaning sense of integrity and fufillment Dissatisfaction with life = unsuccessful

FALSE: Intelligence per se does not decline with age. Most people maintain their intellect or improve as they grow older. While studies have shown that the elderly typically take somewhat longer to learn something new and have somewhat slower reaction times than younger people, this does not impair their ability to reason and function

Intelligence declines with age.

Gilligan theory of middle adult men:

Interested in justice, fairness, rights of individuals

Stagnation in middle adults:

Lack of accomplishment, self-absorption

FALSE: The overall life expectancy for women of all races (78 years) exceeds that for men (71.5 years) by seven years.

Life expectancy Male v Female

Later adulthood interventions to assist the client with Eriksons stages of development

Listen attentively to reminiscent stories about their life's accomplishments. Assist with making changes to living arrangements.

Lungs of middle adults:

Lungs lose elasticity so they don't expand as well. Breathing capacity decreases by 20%

A dying client's spouse is afraid to leave the room to get a meal in the cafeteria for fear the client will die in the meantime. There are no other family members or visitors present. The client is nonresponsive, the pulse is irregular and bradycardic, and Cheyne-Stokes respirations are present. Which of the following represents the best course of action for the nurse?

Make arrangements for the spouse to receive a meal in the client's room.

Metabolism changes in middle adults:

Metabolism slows by 2% per year, increases more adipose tissue

FALSE: Women tend to outlive men by an average of 8 years. Thereare 150 women for every 100 men over age 65 and nearly 250 women for every 100 men over age 85.

More men than women survive to old age.

FALSE: The majority of older adults continue to have both the interest and capacity for satisfying sexual relations well into their 70's, 80's, and even 90's.

Most elderly have little interest in or capacity for sexual relations.

FALSE: Even among those who live to be 80 or older, only 20-25% develop Alzheimer's disease or some other incurable form of brain disease. Among the overall elderly population, it is estimated that less than 10% are disoriented or demented; ofthese, some have conditions which reversible through treatment. In either case, dementia or memory loss is not a normal part of aging, but typically indicates some organic condition. Further, the word "senility" is a meaningless term which should be discarded in favor of specific description of the cognitive impairment.

Most people will become "senile" sooner or later if they live long enough.

"Midlife crisis" in middle adults:

Occurs around age 40-45

FALSE: Older persons have less acute illnesses than younger persons. Older adults have more chronic illnesses than younger age groups however.

Older adults have more acute, short term illnesses than younger persons.

True. Suicide is a more frequent cause of death among the elderly than among any other age group, primarily due to the high suicide rate among older men, especially older white men age 85+. People age 65 and older have a50% higher suicide rate than the rest of the population.

Older adults represent the group at most risk for suicide.

FALSE: Older people do not tend to become more religious as they age. While it is true that the present generation of older persons tend to be more religious than younger generations, this appears to be a generational difference rather than a characteristic of aging. In other words, the present older generation has been more religious all of their lives rather than becoming more so in older age.

Older people tend to become more religious with age.

FALSE: Older people require fewer calories, but adequate intake of calcium for strong bones is important as we age. This is particularly true for women whose risk of osteoporosis increases after menopause; men also develop osteoporosis, but in fewer numbers than women.

Only children need to be concerned about consuming enough calcium.

Sleep apnea common in:

People with short necks, men over 50 years old, and post-menopausal women

Poor/near poor rates for certain elderly subgroups far exceed the average 19% poor/near poor figure for all elderly:elderlyminorities are two and three times more likely as non-minority elders to be poor/near poor; 23.4% of elderly women were poor/near poor in 1990; 25% of the elderly aged 75+ were poor/near poor in 1990. In 1989, the elderly as a group had a poverty rate of approximately 11.4% as compared with those age18 to 64 whose poverty rate was 10.2%. However, the near poverty rates are more instructive ("near poverty" means125% of the poverty level): in 1990, 19% of the elderly were poor/near poor as compared to 14.4% of the 18-64 group. Poverty rates for children exceed those for both the elderly and other adults at 26% poor/near poor in 1990.

Poverty in Elderly most common age.

Perceptual changes of middle adults:

Presbyopia, Glaucoma, Cataracts, Diabetic retinopathy, Presbycusis (loss of high frequency hearing)

Health issues in middle adult men:

Prostate problems, testosterone declines, longer to ejaculate, testes shrink, menopausal symptoms

A 90-year-old client has been told that there is not much time left for the client to live. The client states, "I want to go home to die. It has been a good life and I'm ready to die." The nurse selects which of the following nursing diagnoses for this client?

Readiness for Enhanced Decision Making

Which of the following indicates to the nurse that a noncommunicative client's pain is not well managed?

Restlessness and constant leg movement

Health issues in middle adults:

STDs can be obtained still, lower levels of progesterone, testosterone, estrogen

Henry arranges a health fair at the community center. He is focusing on blood pressure and cholesterol screenings. This is an example of _______ prevention.

Secondary

Generativity in middle adults:

Sense of productivity, creativity, desire to care for others

Muscle size in middle adults:

Size of muscles decreases 10% from middle adulthood

Health promo needs for middle adults:

TDaP, tetanus booster every 10 years, Flu, Pneumonia, screenings for depression, colon cancer

TRUE and FALSE: In general, the life expectancy for whites is 72 for men and 79 for women; the life expectancy for Afro-Americans is 65 for men and 73 for women. However, the average life expectancy for Afro- Americans begins to exceed that for whites after age 80 for reasons that are not well understood.

The life expectancy for Afro-Americans is about the same as for whites.

FALSE: The majority of the elderly are not socially isolated and lonely. According to one study, about two- thirds of the aged reported that they are never or hardly ever lonely or identify loneliness as a serious problem. Most elderly have close relatives within easy visiting distance and have frequent contact. They also reported fairly high rates of socializing with friends and participation in church activities and/or voluntary organizations. This level of activity does tend to decline somewhat with advanced age and/or disability, but contact with relatives remained fairly constant or increased.

The majority of the aged are socially isolated and lonely.

After arthritis and heart disease, hearing loss is the most common chronic disorder reported in the elderly population.

True

Health issues in middle adult women:

Vaginal dryness, more infections due to Alkaline secretions

Amount of time between fecal occult exams:

Yearly

The leading causes of death in middle adulthood, in both White and Black populations, are the same and include: a heart disease. b kidney disease. c respiratory disease. d gastrointestinal disease

a heart disease. The three leading causes on both White and Black populations are the same: heart disease, cancer, and cerebrovascular accident. Reducing disabilities and deaths from these chronic conditions are national health-promotion and disease-prevention objectives. Most of the diseases and conditions targeted in the Healthy People 2020 goals and objectives are preventable, or at least, modifiable. Health education, often conducted by professional nurses, is effective with adults who want or must change their life style behaviors.

As part of a community-wide flu vaccination program for older adults, the nurse is assisting at a vaccination clinic. Which of the following questions should the nurse ask before administering the vaccine? a. Do you have any food allergies? b. Have you had the pneumococcal vaccine? c. Have you had the flu in the past 5 years? d. Do you have Medicare?

a. Do you have any food allergies? An allergy to eggs is a contraindication to receiving flu vaccine grown in chick embryo cells.

A nurse is conducting a home visit for an older adult in the summer. Which of the following items should the nurse should locate in the home in the interest of preventing a heat stroke? a. Fan b. Porch chair c. Synthetic blend clothing d. Thermometer

a. Fan Older adults are susceptible to heat stroke. The availability of a fan will help cool the ambient air. Light-weight cotton clothing breathes and facilitates cooling, whereas synthetic material retains heat.

The nurse, teaching a class on smoking cessation to a group of middle-age adults, presents the adverse effects of smoking, which include that nicotine: a acts to stimulate the heart. b calms the central nervous system. c assists in decreasing blood pressure. d causes a decrease in carbon monoxide.

a. acts to stimulate the heart. Nicotine acts in the two divisions of the nervous system to affect the central part of the brain and the spinal cord, and the peripheral portion that controls the arms and legs. Nicotine stimulates the heart, leading to an increased pulse and elevated blood pressure. Although smokers frequently believe that cigarettes have a calming effect, this notion is misleading. Nicotine stimulates the body, whereas increasing levels of carbon monoxide causes lethargy. Smokers may feel calm, although they are actually having their sensations dulled by the elevated level of carbon monoxide.

The nurse initiates an exercise program with middle-aged adults by: a planning physical activity for a minimum of 45 minutes. b considering activities that have the least potential for injury. c counseling the adult that exercise should be rigorous to produce results. d advising that the heart rate should double during exercise for cardiovascular benefits to be achieved.

b considering activities that have the least potential for injury. Moderation is the key, along with increased caution as the adult approaches age 65. The exercise program should be realistic, and the activities selected should be activities that the individual enjoyed in the past. Activities should be selected with consideration of the potential for injury. Physical exercise should involve as many muscles as is possible, performed on a regular basis, preferably 3 to 4 times a week, for a minimum of 30 minutes each time. The appropriate level of performance for aerobic exercise is determined by achieving a pulse rate that is established for each individual: taking the number 220, subtracting the person's age, and then computing 75% of that number.

Bloom (1984) has developed a hierarchy of cognitive levels in the adult learner. The analysis cognitive level for the adult learner would be: a recalling specific facts. b grasping the meaning of the communicated message. c breaking down material into its constituent parts while noting their relationship. d applying knowledge in the form of abstractions and ideas to concrete situations.

c breaking down material into its constituent parts while noting their relationship. Bloom (1984) developed a hierarchy of cognitive levels in the adult learner. The first level is knowledge, which is the recall of specifics. The second level is comprehension. The learner grasps the meaning of communicated messages and relates it to other material. The third level is application. The learner applies knowledge in the form of abstractions and ideas to concrete situations. Analysis is the fourth level, wherein the adult breaks down the material into its constituent parts while noting their relationship. The final and fifth level is synthesis, wherein the person is able to combine various elements to form a plan and then judge the extent to which the ideas and materials satisfy the established criteria.

A community health nurse is working with a diverse population of older adults within the community. Based on the data from the National Health Interview Survey, which of the following assumptions should be made by the nurse when working with this diverse population? a. White Non-Hispanic older adults tend to require more assistance with their activities of daily living. b. Hispanic older adults tend to rate their health as poorer than other ethnic groups. c. Older adults who tend to rate their health as fair or poor are also financially poor. d. Older adults tend to require more assistance with activities of daily living than with meeting their routine needs.

c. Older adults who tend to rate their health as fair or poor are also financially poor. The National Health Interview Survey conducted by the Centers for Disease Control and Prevention in 2010 provides interesting information about the perceptions of a variety of ethnic groups regarding their health status, their perceived need for assistance with routine needs, and the need for assistance with activities of daily living. In all groups, those who described their health as fair or poor were also more likely to be financially poor.

Amount of time between sigmoid oscopy exams: and Capsule Endoscopy exams:

every 5 years