Chapter 23: The aging adult

The nurse is assessing an older adult client who is having difficulty with mobility. Assessment reveals that the client has stiff and awkward muscle movements. The nurse identifies this as: hemiparesis. ataxia. spasticity. disequilibrium.

spasticity

urge incontinence

state in which a person experiences involuntary passage of urine that occurs soon after a strong sense of urgency to void

stress incontinence

the inability to control the voiding of urine under physical stress such as running, sneezing, laughing, or coughing

functional incontinence

the person has bladder control but cannot use the toilet in time

An older adult client comes to the health center reporting difficulty sleeping. Which statement by the client would the nurse need to address? "I try not to be too active once I've eaten dinner." "I find myself napping on and off throughout the day." "I go to bed around 10:30 pm every night." "I don't drink coffee or alcohol."

"I find myself napping on and off throughout the day."

The geriatric nurse is evaluating her orientee's understanding of the theories of aging. The nurse knows that the orientee understands when the orientee states which of the following? "In the genetic theory of aging, cells become exhausted from continual energy depletion." "In the cross-linkage theory, molecules with separated high-energy electrons can have adverse effects on adjacent molecules, especially lipids." "Free radical theory is a chemical reaction that produces damage to the DNA and cell death." "Immunosenescence is thought to be responsible for heart disease as adults age."

"In the genetic theory of aging, cells become exhausted from continual energy depletion."

The geriatric nurse is evaluating her orientee's understanding of the theories of aging. The nurse knows that the orientee understands when the orientee states which of the following? In the genetic theory of aging, cells become exhausted from continual energy depletion." "In the cross-linkage theory, molecules with separated high-energy electrons can have adverse effects on adjacent molecules, especially lipids." "Free radical theory is a chemical reaction that produces damage to the DNA and cell death." "Immunosenescence is thought to be responsible for heart disease as adults age."

"In the genetic theory of aging, cells become exhausted from continual energy depletion."

The daughter of an elderly client asks the nurse it is safe for her father to continue driving. Which of the following statements by the nurse is most accurate? "Due to increased sensitivity to glare, your father should only drive at night." "When it is obvious that your father should no longer drive, family members should address their concerns in an honest, forthright manner." "He should drive during the morning and evening rush hours." "Loss of driving privileges should not affect interactions with family or friends."

"When it is obvious that your father should no longer drive, family members should address their concerns in an honest, forthright manner."

A nursing student is looking at the demographics related to the older adult and finds that what percentage of the older adult population that is institutionalized falls into the age range of 85+ years? 1.3% 2.4% 3.8% 15.4%

15.4%

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? 1)implementing falls prevention measures in a setting where older adults receive care 2) Providing slightly smaller servings of food for clients who are elderly 3)Speaking to older adults with the presumption that they have mild cognitive deficits 4) Assessing the skin turgor of an older adult differently than that of a younger adult

3

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. Systolic blood pressure decreases with age. Resting heart rate decreases with age. The cardiac output is increased with age.

Blood vessels lose their elasticity with age.

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? A) Excessive drug use B) Depression C) Alzheimer's disease D) Delirium

C

The nurse is assessing a middle-aged adult age 48 years in the clinic. The nurse recalls the changes that occur in middle age as they complete the physical and cognitive examination. Changes that occur include what? Cardiac output decreases. Loss of fatty tissue Low-pitched sounds are more difficult. Visual acuity changes with myopia.

Cardiac output decreases.

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? A) Turn her every hour when in bed B) Ask her to call the nurse when she feels the need for elimination C) Insert an indwelling catheter to prevent urine from causing skin breakdown D) Assist her to the toilet every 2 hours and after meals

D, Assisst to bathroom every 2 hrs

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 Generalized anxiety disorder Realistic caution Bipolar disorder

Depression

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. An older adult experiences numerous factors that increase the risk for falls. Older adults are faced with challenges related to the fear of falling and striving for independence. Medications in the older adult play a major contributing role to the risk for falling.

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

A nurse is assessing a 55-year-old female client. What is a normal physical change in the middle adult? Select all that apply. Skin moisture increases. Hormone production increases. Hearing acuity diminishes. Cognitive ability diminishes. Cardiac output begins to decrease. There is a loss of calcium from bones.

Hearing acuity diminishes. Cardiac output begins to decrease. There is a loss of calcium from bones.

A nurse encourages residents of a long-term care facility to continue a similar pattern of behavior and activity that existed in their middle adulthood years to ensure healthy aging. This intervention is based on which aging theory? Identity-continuity theory Disengagement theory Activity theory Life review theory

Identity-continuity theory

A nurse encourages residents of a long-term care facility to continue a similar pattern of behavior and activity that existed in their middle adulthood years to ensure healthy aging. This intervention is based on which aging theory? Identity-continuity theory Disengagement theory Activity theory Life review theory

Identity-continuity theory

A nurse is assessing middle-age adults living in a retirement community. What behavior would the nurse typically see in the middle-age adult? Believes in establishment of self but fears being pulled back into the family Usually substitutes new roles for old roles and perhaps continues formal roles in a new context Looks inward, accepts life span as having definite boundaries, and has special interest in spouse, friends, and community Looks forward but also looks back and begins to reflect on his or her life

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

A nurse is counseling the caregivers of an older adult male. The caregivers feel that they want to do everything to prevent hospitalization of their loved one. Which of the following can the nurse recommend? Select all that apply. avoiding pain medications whenever possible vitamin D supplementation daily exercise throw rugs with nonslip backing wearing socks at home

vitamin D supplementation daily exercise throw rugs with nonslip backing

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 Presbyopia occurs Menopause occurs Agility gradually decreases

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? Blacks Non-Hispanic Whites Hispanics Asians

Non-Hispanic Whites

When describing the older adult's risk for infection, which aspect would the nurse most likely address? Select all that apply. enhanced immune function decline in humoral immunity lowered antibody responses inadequate nutrition maintenance of T-cell function

decline in humoral immunity lowered antibody responses inadequate nutrition

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? Call the police and tell them to swear a warrant for the arrest of the sister. Report the incident to social service informing them the client has no food or heat. Tell the client to talk with the sister and have her replace the money she has stolen. Take the client to the local hospital Emergency Department.

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

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. AD accounts for about one-third of the cases of dementia in the United States. AD primarily affects young to middle adults. 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. AD is a progressively serious but not a life-threatening disease.

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.

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 Social isolation Grieving Noncompliance

Sleep deprivation

There is an 86-year-old female on the medical inpatient unit. She explains that the hospital is quite noisy and that she is having difficulty sleeping. Which is not true regarding sleep in the older adult? Sleep medications are usually the first choice in treating sleep disturbance. Stage 1 sleep increases in the older adult. Deep sleep declines in the older adult. Chronic cardiovascular or respiratory illness can interfere with sleep.

Sleep medications are usually the first choice in treating sleep disturbance.

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. Depression is considered a normal part of aging. The stigma associated with depression is less for older adults. Suicide is the most serious consequence of depression.

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

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. The client states that his urine stream is less strong than in the past. The client claims to hear high-pitched sounds less clearly than earlier in life. The client's gait is slow and his posture appears stooped.

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

After obtaining the health history from an older adult client, the nurse develops a plan of care and identifies the client has impaired physical mobility. What information would support this impairment? Select all that apply. The client states the hip and knee joints hurt and are stiff when ambulating. The client states that he or she must use a walker for stability. The client reports weakness on one side of the body following a stroke. The client reports inflammation of a diverticuli, which is causing mild pain. The client reports improvement in vision following recent cataract surgery.

The client states the hip and knee joints hurt and are stiff when ambulating. The client reports weakness on one side of the body following a stroke. The client states that he or she must use a walker for stability.

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? Life expectancy has increased for men but not for women. The group experiencing the largest growth is those 85 years of age and older. The number of older adults has begun to plateau since the year 2000. The older adult population appears to be younger than in the past.

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

When providing nursing care to the elderly, it is most important to provide comfort due to which of the following changes? Dementia Isolation Thermoregulation Sexuality

Thermoregulation Thermoregulation is a process that allows your body to maintain its core internal temperature

An older adult client tells his home care nurse that he doesn't seem to sleep as well as he used to. The nurse is aware that the sleep changes that occur in the older adult client which cause a less restful sleep include: decrease in stage I of the sleep cycle. a decrease in the deep sleep stage of the sleep cycle. a change in the normal progression of the sleep cycle. an increase in stage II of the sleep cycle.

a decrease in the deep sleep stage of the sleep cycle.

Erikson identified ego integrity versus despair and disgust as the last stage of human development, which begins at about 60 years of age. Which intervention would best foster older patients' ego integrity? a) Encouraging life review b) Promoting independent living c) Distracting the patient d) Praising the patient

a) Encouraging life review Rationale: The intervention that would best foster older clients' ego integrity would be encouraging life review. Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified world-wide. In a sense, this is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Integrity versus despair and disgust would not be fostered by distracting the client, praising the client, or promoting independent living.

A nurse is providing an in-service program for a group of nurses who work with the older adult population. After describing the older adult population's risk for abuse and neglect, the nurse determines that the education was successful when the group identifies a vulnerable adult as having which characteristic? Select all that apply. adult 60 years or older lacking self-care ability adult with disability adult without a legal guardian adult in a long-term care facility adult receiving provider services while living in his own home

adult 60 years or older lacking self-care ability adult with disability adult in a long-term care facility adult receiving provider services while living in his own home

A nurse is reviewing the medical records of clients at a long-term care facility who are experiencing weight loss. The clients' medical conditions have been ruled out as a cause. The nurse understands that which situation would most likely be a factor? Select all that apply. evidence of depression use of appetite-suppressing drugs need for staff to assist with meals lack of exercise monotonous food choices

evidence of depression use of appetite-suppressing drugs need for staff to assist with meals

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: hospice nursing. geriatrics. long-term care. gerontologic nursing.

gerontologic nursing.

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 minimal risk of adverse effects rare occurrences of confusion need for follow-up laboratory tests

greatest effectiveness with short term use

overflow incontinence

involuntary loss of urine associated with overdistention and overflow of the bladder

When providing care to a client with dementia, which interventions would be most appropriate? Select all that apply. maintain levels of sensory stimulation that are tolerable ensuring the use of assistive sensory devices employing reality orientation using validation therapy continually correcting the client for mistakes

maintain levels of sensory stimulation that are tolerable ensuring the use of assistive sensory devices using validation therapy

The student nurse is conducting an informal study on pain management in the older adult population in a local long-term care facility. Which older adult client population will the student most likely find to receive the least effective pain management? residents 85 years or older residents with a history of frequent hospital admissions white females residents with diabetes

residents 85 years or older

Changes in T-cell function in older adults will result in: active immunity. inadequate nutrition. risk of infection. onset of chronic disease.

risk of infection.