CH. 31 Functional Assessment of the Older Adult

An older adult with new-onset delirium usually has: A. a short attention span. B. trouble naming common objects. C. outbursts of violent behavior. D. vertigo.

A. a short attention span. RATIONALE: Delirium manifests as an acute change in cognition that affects the domain of attention. A person with Alzheimer disease may have alterations in word finding and naming objects in addition to memory problems. A patient with posttraumatic stress disorder may exhibit outbursts of violent behavior. Vertigo is rotational spinning caused by neurologic disease in the vestibular apparatus in the ear or in the vestibular nuclei in the brainstem.

Assessment of the social domain includes: A. family relationships B. ability to cook meals C. ability to balance the checkbook and pay bills D. hazards found in the home

A. family relationships

When you perform a functional assessment of an older patient, which is most appropriate? A. observe the patient's ability to perform the tasks B. ask the patient's wife or husband how he or she does when performing tasks C. review the medical record for information on the patient's abilities D. ask the patient's physician for information on the patient's abilities

A. observe the patient's ability to perform the tasks

An older adult's advanced activities of daily living would include: A. recreational activities B. meal preparation C. balancing the checkbook D. self-grooming activities

A. recreational activities

An older person needs to be assessed before going home as to whether he or she is able to go outside alone safely. Which test is best for this assessment? A. up and go test B. performance of activities of daily living test C. older americans resources and services multidimensional functional assessment questionnaire D. Lawton IADL instrument

A. up and go test

An appropriate tool to assess an individual's instrumental activities of daily living is a tool by: A. Katz B. Lawton C. Tinetti D. Norbeck

B. Lawton

A patient requests to be discharged to home instead of a rehabilitation hospital after a hip fracture. Which of the following is true about the difference between home care and hospital care? A. Home care is more expensive than hospitalization. B. Patients have less risk for infection in the home setting. C. Patients have been shown to recover more slowly at home than in the hospital. D. Physical therapy is available only in the hospital setting.

B. Patients have less risk for infection in the home setting. RATIONALE: Older adults may avoid the risk of infection exposure when at home. Home care is less expensive than hospitalization. Older adults have been shown to recover more quickly when at home than when placed in an institution. Home care services include skilled nursing care; primary care; physical, occupational, and speech therapy; social work; nutrition; case management; assistance with activities of daily living; and some durable medical equipment.

The Get Up and Go Test would be used to: A. determine a patient's ability to get dressed without assistance. B. assess functional activity of the patient along with safety determination. C. assess swallowing status of the patient. D. assess adults with dementia.

B. assess functional activity of the patient along with safety determination. RATIONALE: The Get Up and Go Test is a reliable and valid test used to assess functional ability and safety aspects. Determination of functional assessment would be able to determine if the individual could get dressed without assistance. This test would not be used to evaluate a patient's swallowing status. The Direct Assessment of Functional Abilities assesses adults with dementia.

An older adult has had surgery for a fractured hip and has a history of dementia. You should keep in mind that older adults with cognitive impairment: A. experience less pain B. can provide a self-report of pain C. cannot be relied on to self-report pain D. will not express pain sensations

B. can provide a self-report of pain

Altered cognition in older adults is commonly attributed to: A. an infection or injury. B. dementia, delirium, or depression. C. the normal aging process. D. medication side effects.

B. dementia, delirium, or depression. RATIONALE: Altered cognition in older adults is commonly attributed to three disorders: dementia, delirium, and depression.

The Lawton IADL instrument is described by which of the following? A. the nurse uses direct observation to implement this tool B. it is designed as a self-report measure of performance rather than ability C. it is not useful in the acute hospital setting D. it is best used for those residing in an institutional setting

B. it is designed as a self-report measure of performance rather than ability

When using the various instruments to assess an older person's activities of daily living (ADLs), remember that a disadvantage of these instruments includes: A. the reliability of the tools B. self or proxy report of functional activities C. lack of confidentiality during the assessment D. insufficient detail about the deficiencies identified

B. self or proxy report of functional activities

When completing a spiritual assessment, you should: A. use "yes" and "no" questions as the foundation for future dialogue B. use open-ended questions to help the patient understand potential coping mechanisms C. try to complete this assessment as soon as possible after meeting the patient D. wait until a member of the clergy can be involved in the assessment

B. use open-ended questions to help the patient understand potential coping mechanisms

The Katz Index of Independence in ADL would measure the functional ability to: A. clean the house and take out the garbage. B. wash the face and hands and comb hair. C. pay the electric and telephone bills. D. do laundry and put away the clothes.

B. wash the face and hands and comb hair. RATIONALE: The Katz Index of Independence in ADL is a functional assessment of a person's ability to complete activities of daily living (e.g., eating/feeding, bathing, grooming, dressing, toileting, walking, using stairs, and transferring). Cleaning the house and taking out the garbage are instrumental activities of daily living (e.g., abilities necessary for independent community living). Paying bills is an instrumental activity of daily living. Doing the laundry and putting away clothes are instrumental activities of daily living.

Which is an example of a formal social support network for the aging adult? A. a neighbor who drops by with newspapers and magazines on a regular basis B. An area church that offers a weekly activity and luncheon for seniors in the neighborhood C. a home health care agency that provides weekly blood pressure screenings at the church luncheon D. a senior citizen chess club whose members hold classes at the local Boys' Club

C. a home health care agency that provides weekly blood pressure screenings at the church luncheon

An appropriate use of the caregiver strain index would be which situation? A. a daughter who is taking her older father home to live with her B. an older patient who lives alone C. a wife who has care for her husband for the past 4 years at home D. A son whose parents live in an assisted living facility

C. a wife who has care for her husband for the past 4 years at home

Which statement is true regarding an individual's functional status? A. functional status refers to one's ability to care for another person B. an older adult's functional status is usually static over time C. an older adult's functional status may vary from independence to disability D. dementia is an example of function status

C. an older adult's functional status may vary from independence to disability

When completing a health assessment of an older adult with mobility problems, the sequence should: A. begin with the physical examination followed by the health history. B. be from head to toe to prevent missing any important assessments. C. be arranged to minimize the number of position changes for the patient and the examiner. D. start with the most invasive assessments.

C. be arranged to minimize the number of position changes for the patient and the examiner. RATIONALE: If an older adult patient has limited mobility, the examiner should arrange the sequence to minimize the number of position changes for the patient. The health history should be collected before the physical examination. A head-to-toe approach may include numerous position changes and should be avoided for an older adult with mobility problems. Completing invasive assessments at the end of the examination decreases anxiety and embarrassment for an older adult patient.

Prevention and treatment of ____________ may be one of the most effective interventions aimed at reducing functional decline in an older adult. A. visual disturbances B. muscle weakness C. depression D. bladder and bowel incontinence

C. depression RATIONALE: Prevention and treatment of depression may be one of the most effective interventions aimed at reducing functional decline in an older adult.

Signs of caregiver burnout include: A. going to church every week. B. weight gain. C. headaches and epigastric pain. D. using an adult daycare facility.

C. headaches and epigastric pain. RATIONALE: Signs of possible caregiver burnout include multiple somatic complaints, increased stress and anxiety, social isolation, depression, and weight loss. Social isolation is a sign of caregiver burnout. Weight loss is a sign of caregiver burnout. Use of an adult daycare facility may prevent caregiver burnout.

It is dangerous for a cognitive change to be attributed to the normal aging process because: A. cognitive change is not associated with aging. B. nurses are not trained properly to make these types of judgments. C. this may delay the diagnosis of an underlying disease process. D. the client could be saying confusing comments to avoid detection of addictions.

C. this may delay the diagnosis of an underlying disease process. RATIONALE: Cognitive impairment resulting from disease may be attributed by patients, families, and health care providers to normal changes with aging, which can delay diagnostic workup.

Which of the following would be an indication that an older adult should stop driving a vehicle? A. Taking insulin to control type 2 diabetes mellitus B. Difficulty walking and getting in and out of the vehicle C. A pacemaker placed 2 months ago for complete heart block D. Difficulty checking over the shoulder when backing up or changing lanes

D. Difficulty checking over the shoulder when backing up or changing lanes RATIONALE: The American Association of Retired Persons has developed warning signs for when to stop driving. One of the warning signs is difficulty turning around to check over the shoulder while backing up or changing lanes. Type 2 diabetes mellitus and taking insulin are not indications to stop driving a vehicle. Mobility problems (e.g., difficulty walking or getting in or out of a vehicle) are not indications to stop driving a vehicle. Having a pacemaker is not an indication to stop driving a vehicle.

Which of the following would be included in an assessment of a patient's ability to perform instrumental activities of daily living? A. Balance, gait, and motor coordination B. Dressing, toileting, and using stairs C. Eating, bathing, and grooming D. Taking medications, shopping, and meal preparation

D. Taking medications, shopping, and meal preparation RATIONALE: Instrumental activities of daily living are functional abilities necessary for independent community living and include shopping, meal preparation, housekeeping, laundry, managing finances, taking medications, and using transportation. Other activities may include yard work or home maintenance and leisure activities (e.g., reading, other hobbies). Mobility or physical performance includes balance, gait, motor coordination, and endurance. Activities of daily living are tasks necessary for self-care and include eating/feeding, bathing, grooming, dressing, toileting, walking, using stairs, and transferring.

You will use which technique when assessing an older individual who has cognitive impairment? A. ask open-ended questions B. complete the entire assessment in one session C. ask the family members for information instead of the older individual D. ask simple questions that have "yes" or "no" answers

D. ask simple questions that have "yes" or "no" answers

An older person is experiencing an acute change in cognition. You recognize that this disorder is: A. Alzheimer dementia B. attention deficit disorder C. depression D. delirium

D. delirium

Functional status

a person's actual performance of activities and task associated with current life roles

Functional assessment

a systematic assessment that includes assessment of an individual's activities of daily living, instrumental activities of daily living, and mobility

Advanced activities of daily living

activities that an older adult performs as a family member or as a member of society or community, including occupational and recreational activities

Lawton Instrumental Activities of Daily Living

an instrument used to measure an individual's ability to perform instrumental activities of daily living; may assist in assessing one's ability to live independently

Katz Index of independence in activities of daily living

an instrument used to measure physical function in older adults and the chronically ill

Environmental

assessment of an individual's home environment and community system, including hazards in the home

Spiritual assessment

assessment of an individual's spiritual health

Caregiver assessment

assessment of the health and well-being of an individual's caregiver

Domains of cognition

domains included in mental status assessments, such as attention, memory, orientation, language, visuospatial skills, and higher cognitive functions

Instrumental activities of daily living

functional abilities necessary for independent community living, such as shopping, meal preparation, housekeeping, laundry, managing finances, taking medications, and using transportation

Social networks

informal supports accessed by older adults, such as family members and close friends, neighbors, church societies, neighborhood groups, and senior centers

Geriatric assessment

multidimensional assessment; physical examination and assessments of mental status, functional status, social and economic status, pain, and physical environment for safety

Home care

supportive serviced provided in the home; skilled nursing care, primary care, therapy (physical, occupational, speech), social work, nutrition, case management, ADL assistance, durable medical equipment

Activities of daily living

tasks that are necessary for self-care, such as eating/feeding, bathing, grooming, toileting, walking, and transfering

Physical performance measures

tests that measure balance, gait, motor coordination, and endurance

Functional ability

the ability of a person to perform activities necessary to live in modern society; may including driving, using the telephone, or performing personal tasks such as bathing and toileting

Social domain

the domain that focuses on an individual's relationships within family, social groups, and the community

Caregiver burden

the perceived strain by the person who cares for an older, chronically ill, or disabled person