Ch 11 Medsurg

Clients with Alzheimer's disease are at high risk for injury because of their impaired memory and poor judgment.

A health care team is involved in caring for a client with advanced Alzheimer's disease. During a team conference, a newly hired nurse indicates that she has never cared for a client with advanced Alzheimer's disease. Which key point about the disease should the charge nurse include when teaching this nurse?

A hip fracture

A nurse is caring for an older adult client who has become increasingly frail and unsteady on her feet. During the assessment, the client indicates that she has fallen three times in the month, though she has not yet suffered an injury. The nurse should take action in the knowledge that this client is at a high risk for what health problem?

How old you feel will be determined by your physical and cognitive abilities.

A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching?

Complaints about frequently waking up during the night

A nurse is obtaining the health history of a 72-year-old woman who has come to the ambulatory care center for an evaluation. When obtaining information about the woman's sleep patterns, which of the following would the nurse expect to assess?

Limiting visitors to one or two at a time

A nurse is working with the family of a patient with Alzheimer's disease to develop an appropriate plan of care. Which of the following would the nurse suggest to foster socialization?

An older client has less subcutaneous tissue and less muscle mass than a younger client.

A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be administering intramuscular (IM) doses of the vaccine. Of what age-related change should the nurse be aware when planning the appropriate administration of this drug?

Report the findings to adult protective services.

Based on a client's vague explanations for recurring injuries, the nurse suspects that a community-dwelling older adult may be the victim of abuse. What is the nurse's primary responsibility?

cardiovascular disease

The leading cause of death in older adults in the United States is

falls

The leading cause of injury in the elderly population:

depression

The most common affective or mood disorder of old age is

A decrease in muscle mass and bone density

The nurse is planning an educational event for the nurses on a subacute medical unit on the topic of normal, age-related physiologic changes. What phenomenon should the nurse address?

macular degeneration

The primary cause of age-related vision loss in the elderly is

presbyopia

usually begins in the fifth decade of life, when reading glasses are required to magnify objects

A 65-year-old with renal insufficiency

Which older adult is at highest risk for medication-related toxicity?

presbyopia

Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away?

Older adults may have cardiac or renal disorders.

Why are IV solutions usually given at a slower rate to older adults?

skilled nursing services

in which continuous nursing assistance is provided.

independent dwelling

in which people manage their own needs every day

assisted living

in which people require limited assistance with their daily living needs.

glaucoma

is a disease characterized by increased intra-ocular pressure.

Serotonin

is implicated in the development of depression.

cataract

is the development of opacity of the eye lens

disability

Chronic conditions, many of which are preventable or treatable, are the major causes of _______ and pain among older adults.

Multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render. Pressure ulcers / incontinence / Falls / delirium.

Define the term geriatric syndromes. Provide examples.

Assess the grandmother for adventitious lung sounds

Family members report to the nurse that their elderly grandmother has had a sudden onset of confusion and that they are having difficulty providing care for her. What is the nurse's best response?

stay with the client and encourage him to eat.

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should:

the relaxed muscle

can contribute to urinary incontinence, especially when laughing, coughing, and sneezing.

calcium

Bone changes associated with aging frequently result from a loss of

Ensure that the mother does not have access to car keys or drive an automobile.

A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to

"What precipitates the outbursts?"

A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds:

Distract the client with a familiar object or music.

A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate?

Risk for caregiver role strain related to increased client care needs

A client with Alzheimer's disease is admitted for hip surgery after falling and fracturing the right hip. The client's spouse tells the nurse about feeling guilty for letting the accident happen and reports not sleeping well lately because the spouse has been getting up at night and doing odd things. Which nursing diagnosis is most appropriate for the client's spouse?

A growing number of people live to a very old age.

A gerontologic nurse is aware of the demographic changes that affect the provision of health care. Which of the following phenomena is currently undergoing the most rapid and profound change?

"All of a sudden my dad seemed to become confused."

A nurse is assessing a client brought to the emergency room by his daughter. Which statement by the daughter would most likely lead the nurse to suspect that the client may have an infection?

incorporate the client's toileting schedule into the pattern of his wandering.

A nurse is caring for an elderly adult client admitted to the hospital from a nursing home because of a change in behavior. The client has a diagnosis of Alzheimer's disease and has started to experience episodes of incontinence. The hospital staff is having difficulty with toileting because the client wanders around the unit all day. To assist with elimination, a nurse should:

exercise

A universal health promotion strategy that strengthens the musculoskeletal system and improves all body systems is

Rigorous control of the client's blood pressure and serum lipid levels

After a sudden decline in cognition, a 77-year-old man who has been diagnosed with vascular dementia is receiving care in his home. To reduce this man's risk of future infarcts, what action should the nurse most strongly encourage?

Myocardial hypotrophy__, ____decreased pacemaker cells___, and _ valvular stenosis

Age-related changes reduce the efficiency of the cardiovascular system. These changes include which result in a decreased stroke volume

Delirium of this type is treatable and her cognition will return to previous levels.

An 84-year-old client has returned from the post-anesthetic care unit (PACU) following hip arthroplasty. The client is oriented to name only. The client's family is very upset because, before having surgery, the client had no cognitive deficits. The client is subsequently diagnosed with postoperative delirium. What should the nurse explain to the client's family?

Ingest five or six small meals each day.

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to

Improvement in ambulation

An elderly client experienced a cerebrovascular accident (CVA) and was unable to ambulate following his CVA. The client was transferred from a hospital and is now at a subacute care facility. For continuation of Medicare coverage, the nurse evaluates that the client must demonstrate

Instruct the family to remove the toddler from the room for the protection of the client.

An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to

Increase fluid intake.

An elderly client is reporting changes in bowel movements from every day to every 3 to 4 days. The client also states that the stools are hard. Nursing interventions include instructing the client to

Avoid straining when having a bowel movement.

An elderly client with heart failure reports constipation that has progressively worsened over the last several months. The client's vital signs are pulse 86 beats per minute, blood pressure 94/56, and respirations 18 breaths per minute. It would be best for the nurse to instruct the client to

Loss of bone density

An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of

Risk for falls related to polypharmacy and impaired balance

An older adult client has returned to the community following knee replacement surgery. The community health nurse recognizes that the client has prescriptions for nine different medications for the treatment of varied health problems. In addition, she has experienced occasional episodes of dizziness and lightheadedness since her discharge. The nurse should identify which of the following nursing diagnoses?

Assess for the potential for self-harm.

An older adult has a score of 12 on the Geriatric Depression Scale (GDS). What action should the nurse complete first?

good sleep hygiene, cognitive remediation and memory enhancement treatment of depression and treatment of anxiety MMSE used to assess

Name 3 nursing interventions that can be used to help older adults with learning and memory

dementia occurs between ages 50 to 70/ delirium can occur at any age dementia is a slow gradual onset/ delirium is a rapid onset dementia the sleep wake cycle is often impaired with increased wandering and agitation at night/ delirium takes brief naps throughout the day and night

Name at least 3 differences between delirium and dementia with regard to clinical manifestations

Depression

Nursing students are reviewing different types of mental health problems in the older adult population. The students demonstrate an understanding of this information when they identify which condition as the most common affective disorder?

"Advance directives are limited only to health care instructions and directives."

The admissions department at a local hospital is registering a male older adult for an outpatient diagnostic test. The admissions nurse asks the man if he has an advanced directive. The man responds that he does not want to complete an advance directive because he does not want anyone controlling his finances. What would be appropriate information for the nurse to share with this client?

Reorient the patient

The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The client continuously yells, "It's 1999 and you are going to hurt me!" What action should the nurse do first?

Barbiturates

When administering medications to an older adult patient, which medication does the nurse understand may remain in the body longer due to increased body fat?

Residual lung volume

When assessing an older adult, the nurse anticipates an increase in which component of respiratory status?

ACD

When performing a respiratory assessment on an older adult patient, what changes associated with aging does the nurse expect to find? Select all that apply. A) Increased residual volume B) Decreased residual volume C) Loss of elastic tissue surrounding the alveoli D) Reduced vital capacity E) Decrease pulmonary resistance

Encourage the client to keep a list of medications and review it frequently for updates. Use easy-to-open lids. Provide a written medication schedule.

Which actions by the nurse will assist in promoting an older adult's adherence to medication therapy? Select all that apply.

Heart disease

Which are leading causes of death among the elderly? Select all that apply.

Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore."

Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse?

Relaxed perineal muscle

Which is a factor that contributes to urinary incontinence in older female adults?

decreased cardiac output

Which is an age-related change associated with the cardiovascular system?

postural hypotension

Which is an age-related change associated with the nervous system?

decreased gas exchange

Which is an age-related change in the respiratory system?

Serotonin

Which neurotransmitter is implicated in depression?