Chapter 25: Older Adult

16. In the assessment of older adult clients, it is often difficult to discriminate between delirium and dementia. A major difference that the nurse is alert to is that delirium is characterized by which one of the following? a. Lasting months to years b. Involving a normal state of alertness c. Having a slow progression d. Occurring at twilight or in darkness

ANS: D Delirium is characterized by short, diurnal fluctuations in symptoms, and is worse at night, in darkness, and on awakening. Delirium may last hours to less than one month, seldom longer. Dementia may last months to years. Delirium is characterized by fluctuating alertness; the person experiencing it may be lethargic or hypervigilant. With dementia, symptoms are progressive yet relatively stable over time. Delirium has an abrupt onset. Dementia has a slow progression

2. A 70-year-old client must have her blood pressure checked during each shift. She asks the nurse to explain her hypertension. Which of the following is an appropriate response by the nurse? a. Older adult clients often experience hypertension because of vascular changes related to aging; this affects 50% of older adults. b. Older adult clients often experience hypertension because of a reduction in physical activity. c. Older adult clients often experience hypertension because of ingestion of processed foods high in sodium. d. Older adult clients often experience hypertension because of myocardial damage and venous insufficiency.

ANS: A Although hypertension is not a normal physiological change of aging, older adults often experience hypertension because of vascular changes. Vascular changes include thickening of vessel walls, narrowing of vessel lumen, and loss of vessel elasticity. Systolic or diastolic hypertension (systolic pressure >140 mm Hg, diastolic >90mm Hg) is seen in 50% of older adults. Hypertension is not caused by a reduction in physical activity. Older adults with hypertension should be counselled on limiting fat and salt in their diets; however, ingestion of processed foods high in salt is not the reason that older adult clients often experience hypertension. Myocardial damage and venous insufficiency are not the reasons that older adults commonly experience hypertension.

4. A client has been recently diagnosed with Alzheimer's disease. When teaching the family about the prognosis, what must the nurse explain? a. The disease usually progresses gradually, with a deterioration of function. b. Many individuals can be cured if the diagnosis is made early. c. Diet and exercise can slow the process considerably. d. Few clients live more than three years after the diagnosis.

ANS: A Alzheimer's disease usually progresses gradually, with a deterioration of function. No cure is known for Alzheimer's disease, but medications can be given to slow the progression of symptoms. Medications, not diet and exercise, can slow the process of Alzheimer's disease considerably. Clients may live many years after the diagnosis of Alzheimer's disease.

12. The nurse is preparing to discharge an 81-year-old client from the hospital. Which of the following does the nurse recognize as being true for the majority of older adults? a. They require institutional care. b. They have no social or family support. c. They are unable to afford any medical treatment. d. They are capable of taking charge of their own lives.

ANS: D Most older adults are interested in their own health and are capable of taking charge of their own lives. Most older adults do not require institutional care. The majority of older adults have social or family support. Most older adults live with a spouse or have other living arrangements, such as living with a family member. Most older adults receive old-age pension benefits and are able to afford medical treatment.

3. Which one of the following statements related to cognitive functioning in the older adult client is true? a. Reversible systemic disorders are often implicated as a cause of delirium. b. Cognitive deterioration is an inevitable outcome of aging. c. Delirium is easily distinguished from irreversible dementia. d. Intoxication from therapeutic drugs is a common cause of senile dementia.

ANS: A Delirium is a potentially reversible cognitive impairment that is often due to a physiological cause such as an electrolyte imbalance, cerebral anoxia, hypoglycemia, medications, tumours, cerebrovascular infection, or hemorrhage. Cognitive deterioration is not an inevitable outcome of aging. Delirium is not always easily distinguishable from irreversible dementia. Because of the close resemblance between delirium and dementia, the presence of delirium must be ruled out whenever dementia is suspected. The cause of senile dementia is not known. Medications and drug effects can cause delirium.

15. The nurse is presenting an information session on nutritional guidelines at a senior living centre. Incorporated into the discussion are recommendations for nutritional intake for older adults. Which of the following meets the recommended nutritional guidelines for older adults? a. Limited intake of fat b. Increased intake of salt c. Increased sugar intake d. Limited intake of fibre

ANS: A Good nutrition for older adults includes limited intake of fat, salt, refined sugar, and alcohol. Good nutrition for older adults includes limited intake of salt. Good nutrition for older adults includes limited intake of refined sugars. Good nutrition for older adults includes adequate fibre, as the older adult experiences a slowing of peristalsis.

13. To assist older adults to meet their needs for sexuality, which of the following should the nurse recognize? a. Therapeutic medications may alter sexual function. b. Physiological changes do not adversely influence sexual activity. c. Sexual interest declines and then fades completely with age. d. Prevention of sexually transmitted infections is no longer an issue with this age group.

ANS: A Many older adults use prescription medications that depress sexual activity, such as antihypertensives, antidepressants, sedatives, or hypnotics. Some drugs increase libido in older adults. For example, phenothiazines increase sexual desire in women, and levodopa has a similar effect in men. Physiological changes in older adults may have an adverse influence on sexual activity. The older man may experience decreased firmness in his erection, a decreased need for ejaculation with orgasm, or a longer recovery period between episodes of intercourse. The older woman may experience vaginal dryness. It is a common misconception that older adults are not interested in sex. The older adult's libido does not decrease, although frequency of sexual activity may decline. Information about the prevention of sexually transmitted infections should be included when appropriate.

1. The nurse is performing a physical examination of an older adult client in an assisted living facility. On completion of the exam, the nurse compares the results with findings expected for individuals in this age group. Which of the following is an expected finding for this client? a. Increased tactile responsiveness b. Increased sensitivity to glare c. Increased hearing acuity for higher tones d. Increased thoracic expansion during ventilation

ANS: B A common physiological change in the older adult client is an increased sensitivity to glare. Increased tactile responsiveness would not be an expected finding in the older adult client. An expected physiological change in the older adult client is a loss of hearing acuity for high-frequency tones (presbycusis). The older adult has decreased thoracic expansion during ventilation because of musculoskeletal changes.

8. A long-term care facility sponsors a discussion group on the administration of medications. The participants have a number of questions concerning their medications. Which of the following is the most appropriate response by the nurse? a. "Don't worry about the medication's name if you can identify it by its colour and the way it looks." b. "Please feel free to ask your physician why you are receiving the medications that are ordered for you." c. "Remember that the hepatic system is primarily responsible for the pharmacotherapeutics of your medications." d. "Unless you have severe side effects from taking your medications, don't worry about the minor changes in the way you feel."

ANS: B The nurse should encourage the older adult to question the physician and/or pharmacist about all prescribed drugs and over-the-counter drugs. The older adult should be taught the names of all drugs being taken, when and how to take them, and the desirable and undesirable effects of the drugs. The hepatic system is not the only system responsible for the pharmacotherapeutics of medication. Older adults are at risk for adverse reactions because of age-related changes in the absorption, distribution, metabolism, and excretion of drugs. Changes in the GI system may affect absorption, distribution may be affected by changes in body composition and by reduced serum albumin levels, and changes in kidney functioning may impair excretion. The nurse should teach the client how to avoid adverse side effects and to report them to the care provider if they occur. If the client is disturbed by minor side effects, it could be an indication of beginning drug toxicity. Another possibility is that the client may become noncompliant with the medication because of a dislike of how the side effects make him or her feel.

7. The nurse works with older adult clients in a wellness-screening clinic on a weekly basis. Which of the following is the best statement made by the nurse to clients in the older adult age group? a. "Your shoulder pain is normal for your age." b. "Regular exercise will maintain and strengthen your functional ability." c. "Don't worry about taking that combination of medications because your doctor has prescribed them." d. "Why don't you begin walking 3 to 4 km per day, and we'll evaluate how you feel next week?"

ANS: B The primary benefits of exercise include maintaining and strengthening functional ability and promoting a sense of enhanced well-being. Shoulder pain is not a normal finding in the older adult. It may indicate a condition such as arthritis. Periodic and thorough review of all medications being used is important to restrict the number of medications used to the fewest necessary. Concurrent use of medications increases the risk for adverse reactions. Exercise programs should begin conservatively and progress slowly.

11. The nurse recognizes that factors associated with aging influence the musculoskeletal system. Which one of the following statements does the nurse recognize as being correct? a. Older men have a greater problem with osteoporosis. b. Muscle fibres increase in size and become tight. c. Exercise reduces the loss of bone mass. d. Muscle strength does not diminish as much as muscle mass does.

ANS: C Older adults who exercise regularly do not lose as much bone and muscle mass or muscle tone as do those who are inactive. Postmenopausal women have a greater problem with osteoporosis than do older men. Muscle fibres are reduced in size with aging. Muscle strength diminishes in proportion to the decline in muscle mass.

9. An older woman reports that she involuntarily releases urine when she coughs or sneezes. What is this type of incontinence called? a. Functional incontinence b. Reflex incontinence c. Stress incontinence d. Total incontinence

ANS: C Stress incontinence is an involuntary release of urine that occurs on sneezing, coughing, or lifting an object and is a result of a weakness of the perineal and bladder muscles. Functional incontinence is the inability of a usually continent person to reach the toilet in time. Reflex incontinence is an involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached. Total incontinence is where an individual experiences continuous and unpredictable loss of urine.

5. For older adults, a number of health-related concerns should be addressed. The nurse incorporates this information to meet the needs of the older adult client. Which of the following statements accurately reflects data that the nurse should use in planning care? a. Approximately 50% of adults older than 65 years have two chronic health problems. b. Cancer is the most common cause of death among older adults. c. The nutritional needs of older adults are affected by older adults' levels of activity and by clinical conditions. d. Adults older than 65 years make up the lowest percentage of users of prescription medications.

ANS: C The nutritional needs of older adults are affected by older adults' levels of activity and by clinical conditions. In assessing nutrition in older adults, the nurse needs to consider sedentary activity, therapeutic diets, recovery from surgery, and dementia. Approximately 80% of older adults living at home have at least one chronic health condition, with arthritis, hypertension, heart disease, vision impairment, and diabetes mellitus being the most common in non-institutionalized older adults. Heart disease is the leading cause of death in older adults. It is untrue that adults older than 65 years make up the lowest percentage of users of prescription medications. Older adults account for 12% of the population, but use as much as 40% of prescription medication—they make up the highest percentage of users of prescription medication.

14. The nurse is presenting an information session on nutritional guidelines at a senior living centre. Incorporated into the discussion are recommendations for nutritional intake for older adults. These recommendations include reducing dietary intake of which one of the following? a. Fibre b. Protein c. Vitamin A d. Refined sugars

ANS: D Good nutrition for older adults includes a limited intake of refined sugars. Fibre intake should not be reduced, as fibre has the benefits of aiding bowel elimination and lowering cholesterol. Protein intake should not be reduced. Protein intake may be lower than recommended if older adults have reduced financial resources or limited access to grocery stores. Difficulty chewing meat also may limit protein intake. Vitamin A intake does not need to be reduced in the older adult. Vitamin intake may be less than recommended if shopping for fresh fruits and vegetables is difficult.

6. Myths exist regarding the older adult population in Canada. Which of the following is the nurse aware is true about the majority of older adults? a. They are forgetful and confused. b. They live in institutional settings. c. They are unable to care for themselves. d. They continue to enjoy sexual relationships.

ANS: D It is true that older adults continue to enjoy sexual relationships. Older adults are described as having a good memory and broad interests. Most older adults live in non-institutional settings. Most older adults are able to care for themselves.

10. In performing a physical assessment for an older adult client, the nurse anticipates finding which one of the following normal physiological changes of aging? a. Increased perspiration b. Increased audio pitch discrimination c. Increased salivary secretions d. Increased airway resistance

ANS: D Normal physiological changes of aging include increased airway resistance in the older adult. The older adult would be expected to have decreased perspiration and drier skin because of glandular atrophy (oil, moisture, sweat glands) in the integument system. A normal physiological change of the older adult related to hearing is a loss of acuity for high-frequency tones (presbycusis). The older adult would be expected to have a decrease in saliva.