ch 23 the older adult

Based on an understanding of the cognitive changes that normally occur with aging, what might the nurse expect a newly hospitalized older adult to do?

take longer to respond and react

A nurse is providing care to an older adult female diagnosed with incontinence. Diagnostic testing reveals that the incontinence is the result of an overactive detrusor muscle. The nurse identifies this as which type of incontinence?

urge Urge incontinence is caused by an overactive detrusor muscle causing involuntary bladder contraction. Stress incontinence is caused by pelvic floor muscle weakness or urethral hypermobility. Incontinence occurs when the bladder muscle distends and urine is forced out. Functional incontinence occurs when a physical or psychological impairment impedes continence despite a competent urinary system.

A new graduate nurse has accepted a staff position on a geriatric unit. The preceptor determines that the new nurse understands gerontologic nursing when which statement is made?

"Normal changes that occur with aging result from complex interactions."

An adult child accompanies an older adult client to the clinic and states, "I am not sure what is going on with my parent but I think it is depression." What questions should the nurse ask the client to determine if he or she is depressed? Select all that apply.

"Can you tell me what your sleep patterns are?" "Have you had any changes in weight recently such as a gain or loss?" "Have you lost interest in things you previously found pleasurable?"

A nurse is conducting an education session about appropriate measures to promote sleep with an older adult who is experiencing frequent awakenings at night and then awakening early in the morning. The nurse determines that the education was successful when the client states:

"I need to try and go to bed and get up at the same time each night."

The geriatric nurse is evaluating a new nurse's understanding of the theories of aging. Which statement shows the new nurse understands the theories?

"In the wear and tear theory, cells become exhausted from continual energy depletion." The wear-and-tear theory holds that organisms wear out from increased metabolic functioning, and cells become exhausted from continual energy depletion. Cross-linkage is a chemical reaction that produces damage to the DNA and cell death. Free radical theory holds that free radicals formed during cellular metabolism are molecules with separated high-energy electrons that can have adverse effects on adjacent molecules, especially lipids. Age-associated changes in the immune system, known as immunosenescence, are thought to be responsible for the increase in infections such as pneumonia and septicemia, immune disorders, and cancer as adults age.

Which statement shows that the nurse does not practice ageism?

"Neither intelligence nor personality normally decline because of aging."

The nurse is caring for an older adult client who is confused and agitated. When the client's family comes to visit the nurse asks how long the client has been confused. The family states that the client has been confused for a long time and the confusion is getting worse. The client is subsequently diagnosed with dementia. What is the most common cause of dementia in an older adult client?

Alzheimer's disease

A 79-year-old female is admitted to a long-term care facility. She is incontinent of urine and feces and has impaired cognition. What is the best nursing intervention to prevent skin breakdown for this resident?

Assist her to the toilet every 2 hours and after meals

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

Blood vessels lose their elasticity with age.

A nurse is reading a journal article about mood disorders in the older adult population. Which information about these conditions would the nurse expect to find? Select all that apply.

Depression is often misdiagnosed. Symptoms often mimic those of other chronic comorbidities of the older adult. Suicide is the most serious consequence of depression.

A nurse is preparing to medicate an older adult client with an opioid analgesic. Which information will the nurse obtain first to decide about administering the medication?

Determining if the client is able to communicate pain verbally or nonverbally

The nurse understands that when caring for the older adult it is important to assist in maintaining independence and self-esteem. Assisting the client to adjust to a walker or wheelchair is an example of supporting which of Erikson's developmental tasks of the older adult?

Ego integrity and coping with reality of limitations

A group of nursing students is reviewing information about the older adult and mobility. The students demonstrate a need for additional study when they identify which statement as accurate?

Falls are the leading cause of death due to injury in individuals who are over the age of 75 years.

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

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

Based on Havighurst's theory of human development, which nursing intervention would best facilitate the accomplishment of a developmental task of older adulthood?

Helping a client move independently using a walker According to Havighurst, the major tasks of old age are primarily concerned with the maintenance of social contacts and relationships. Successful aging depends on a person's ability to be flexible and adapt to new age-related roles. The person must find new and meaningful roles in old age while being reasonably comfortable with the social customs of the times. The only nursing intervention that addresses this theory would be helping a client move independently using a walker.

The home care nurse is visiting an older adult client in the home to assess a leg wound and change the dressings. The nurse is aware that the client receives money monthly but there is no food in the house, no adequate heat, and the client states, "My sister takes my check and cashes it every month." What is the correct action by the nurse?

Report the incident to social service informing them the client has no food or heat.

The nurse is monitoring T cell activity following a hematopoietic stem cell transplant in an older adult. Which information will the nurse share with the client and family regarding T cell significance?

Immunity is suppressed following chemotherapy, and T cell counts provide information on susceptibility to infection.

When assessing a client during the middle adult years, the nurse recognizes which of the following as a normal physical change?

Increased loss of calcium from the bones

The nurse is reminiscing with a 72-year-old client with early onset dementia while providing care in a long-term care facility. How does the nurse implement this form of therapy to maximize the therapeutic value?

Listen to the client's stories and ask questions to facilitate ego integrity and provide companionship.

A nurse is assessing middle-age adults living in a retirement community. What behavior would the nurse typically see in the middle-age adult?

Looks inward, accepts life span as having definite boundaries, and has special interest in spouse, friends, and community

The nurse practitioner is examining a 55-year-old female client. Which of the following findings would be uncommon for this age group?

Lower extremity pulses are weak

A nurse is providing care at an ambulatory care center to a wide range of older adults from diverse racial and ethnic groups. Based on recent statistics, which group would the nurse most likely identify as projected to be the largest?

Non-Hispanic Whites

A healthy 52-year-old client asks the nurse what she can do to maintain her health. Which of the following does the nurse recommend?

Perform self-examination of the skin every month

A nurse caring for older adults in a long-term care facility is teaching a novice nurse characteristic behaviors of older adults. Which statement is not considered ageism?

Personality is not changed by chronologic aging.

An client 81 years of age is in a long-term-care facility. His family could no longer cope with his progressing senile dementia, including wandering away and unpredictable behavior. Late one night the nurse finds the client wandering in the hall. He says he is looking for his wife. What should the nursing approach should be?

Remind him of where he is and assess why he is having difficulty sleeping.

A nurse is screening for Alzheimer disease (AD) in clients in a long-term care facility. Which facts regarding AD are accurate? Select all that apply.

Scientists estimate that more than 5 million people have AD. Nearly half of 85-year-old adults have AD AD affects brain cells and is characterized by patchy areas of the brain that degenerate.

A nurse has attended an inservice workshop that addressed the phenomenon of ageism in the health care system. Which of the following practices is indicative of ageism?

Speaking to older adults with the presumption that they have mild cognitive deficits

Which of the following assessment findings of a male client age 77 years should signal the nurse to a potentially pathologic finding, rather than a normal age-related change?

The client is oriented to person and place but is unsure of the month.

A nurse is providing discharge instructions to an elderly client and his daughter. The daughter asks for suggestions to help keep her father healthy. Which of the following could the nurse suggest?

The client should have his eyes examined every year for glaucoma.

A nurse is preparing a presentation for a group of older adults about health promotion. Which statistic would the nurse need to keep in mind about this group?

The group experiencing the largest growth is those 85 years of age and older

A nurse arrives at the home of an older adult client. The agency was called because a neighbor noticed that the client was home alone. The nurse finds the client alone in the living room. When asked about the client's daughter who lives there and has been caring for her, the client says, "She went on vacation for about a month. She'll be back soon." Further assessment reveals that there are no other family members or services currently involved. The nurse would identify this situation as:

abandonment

One of the greatest causes of death in the United States and Canada is colon cancer. The nurse instructs the community on which of the following factors?

annual screening after 50 yrs old

The nurse is evaluating a 42-year-old client who says that he is feeling stressed. Which of the following does the nurse know that could be a cause of stress for this age group?

being caught in the sandwich generation Middle-aged adults may be caught in a "generation sandwich," which includes involvement with children as well as aging parents and other family members. Retirement, the loss of driving privileges, and social isolation are often stressors for the older adult.

When describing the older adult's risk for infection, which aspect would the nurse most likely address? Select all that apply.

decline in humoral immunity, lowered antibody responses, and inadequate nutrition

An older adult client tells the nurse, "I just don't seem to have an appetite and food just doesn't taste as good as it used to." The nurse understands that which factor may be playing a role in this client's lack of appetite? Select all that apply.

decreased number of taste buds and saliva production

An older adult client enjoys good overall health, but has just been diagnosed with pneumonia and has begun receiving an intravenous (IV) antibiotic. Shortly after being administered the first dose, the client pulled out his IV line and is now attempting to scale his bed rails. Which of the following phenomena most likely underlies this change in the client's cognition?

delirium Delirium is a temporary state of confusion that is often precipitated by drug interactions or the effects of new drugs. Dementia is rooted in organic brain changes and rarely has a sudden onset. The client is not showing signs or symptoms of depression. Disorientation is a manifestation of a problem rather than a cause.

What term is used to describe various disorders that progressively affect cognitive function?

dementia Dementia describes various disorders that progressively affect cognitive function. Delirium is a temporary state of confusion that can last from hours to weeks and resolves with treatment. Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in a few members of their group

A 78-year-old woman is status post right hip fracture after a fall. She has stopped going to her church over the past few months. She has also asked her neighbor to help her and do her gardening, an activity she previously loved. The client tells the nurse "I just don't enjoy gardening like I used to. I am always worried about falling." What would most concern the nurse regarding the client?

depression

Gould viewed the middle years as a time when adults increase their feelings of self-satisfaction, value their spouse as a companion, and become more concerned with health. Which nursing action best facilitates this process?

encourage pt to have regular checkups

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

encouraging life review

An elderly client is becoming progressively confused due to Alzheimer's disease. The family can no longer manage the client at home due to wandering. Which of the following living arrangements could the nurse recommend?

extended-care facility

The middle adult is sometimes called the "sandwich generation". According to Erikson, the developmental task of the middle adult is what?

generativity vs. stagnation The developmental task of the middle adult is "generativity versus stagnation." They are in a stage of guiding the next generation, accepting their own changes and adjusting to need of aging parents, as well as evaluating their own goals and accomplishments. "Initiative versus guilt" is the developmental task for toddlers. "Ego integrity versus despair" is the developmental task for older adults. "Goal attainment versus crisis" is not a developmental task.

After graduation, if you especially want to care for the aged population, you would consider the nursing specialty that focuses on the health and illnesses of the aging. This specialty is:

gerontologic nursing Gerontologic nursing combines the knowledge and skills of nursing with specialized focus on the aging in both health and illness. Hospice is end-of-life care, long-term care is a type of care facility, and geriatrics is a branch of medicine.

An older adult client is prescribed a sleep medication. When explaining the medication to the client, the nurse would emphasize which aspect of therapy?

greatest effectiveness with short-term use

A nurse is performing a home assessment for a 90-year-old widower who lives in a third story apartment. The assessment reveals there are smoke alarm and carbon monoxide alarm systems; slip-proof surfaces in the bathtub and shower; no throw-rugs present; handrails on the steps; unlocked cabinets with potential poisons; adequate lighting; large flat screen TV on wall; and the water set at a safe temperature. As the nurse considers the client's home environment, what modification can be made to enhance safety for the client?

handrails in bathroom

A nurse is caring for a 46-year-old male client who is being treated for depression following the death of his spouse. Which action best facilitates the accomplishment of a developmental task of this middle adult?

helping him to see the value of guiding his children to become responsible adults

Mrs. Jimenez, age 79, became a widow earlier this year and now resides alone in the house that she and her husband shared for 30 years. Her children have encouraged her to move, but she expresses a desire to remain in her home, despite some slight mobility challenges. The nurse who provides occasional home healthcare for Mrs. Jimenez should first propose which of the following?

home modification

A nurse is working with an older adult population at a local community senior center. Based on information from the Association of Aging, the nurse would anticipate needing to address which condition as most common?

hypertension The most frequent occurring conditions for older adults from 2010-2012 were hypertension, arthritis, heart disease, cancer, and diabetes (72%, 50%, 30%, 24%, 20%, respectfully).

When the older adult faces illness, the greatest threat to health is:

loss of physiologic reserve of the organ systems.

A nurse is preparing a presentation for a group of older adults about promoting safety while maintaining their mobility. Based on the nurse's understanding of factors placing the older adult at risk for falls, which area would the nurse most likely address? Select all that apply.

medication use, diminished strength, and environmental hazards

In a report, the night nurse tells the incoming nurse that one client with dementia has sundowning syndrome. Which of the following nursing diagnoses would be most appropriate for this client?

sleep deprivation

A public health nurse is participating in a health fair that is being held at a local community center. The nurse should encourage adult participants to completely eliminate which of the following from their diet and lifestyle?

smoking