210A Final study guide

The nurse is explaining services provided in assisted living to a couple considering a move to long-term housing for older adults. The nurse explains that assisted living includes: 24-hour protective oversight. medications administered by staff personnel. client responsibility for preparation of own medications. expectation that clients are independent in all care areas.

24-hour protective oversight.Assisted living includes 24-hour oversight for clients. The clients must be mobile; they may require some assistance. All meals and snacks are provided. They may request assistance with bathing and hygiene. Housekeeping and laundry services are provided. They may require occasional assistance with dressing. The client should self-administer medication or may receive personal monitoring of medication administration.

According to the National Resource Center on Nutrition, Physical Activity and Aging, it is estimated that between __ of older residents living in long-term care facilities are malnourished. 10% and 15% 20% and 25% 35% and 50% 55% and 70%

35% and 50% Poor nutrition in older adults not only affects their overall health but also contributes to higher health care costs. Specific nutritional risk factors for US older adults include solitary living, race/ethnicity, low income, social isolation, and low social support. The National Resource Center on Nutrition, Physical Activity and Aging stated that between 35% and 50% of older residents living in long-term care facilities are malnourished and approximately 65% of older adults in hospitals may be malnourished. These data underscore the problems of maintaining good nutrition. For independent seniors, barriers that may interfere with the ability to obtain adequate and nutritional food include limited transportation, income, and social support resources.

According to the US Census Bureau, the fastest-growing group within the older population is: 65 to 70. 70 to 75. 75 to 80. 85 and older.

85 and older. Adults 85 and older are the fastest-growing group within the older adult population, which means that nurses in the community, acute care settings, and long-term facilities will increasingly be caring for these individuals. Women comprise about 4/5 of the centenarians. Many factors have come together to help older adults live longer and healthier. These include continued vaccination development, injury prevention, decrease in smoking, less air pollution, and health-promotion activities.During the past few decades, older adults have used the most health care dollars in the last 7 years of their lives, tending to wait until they became sick before seeking health care. Health care providers focused more on illness care than wellness care, resulting in a high prevalence of illness and limited health-promotion interventions. Misconceptions surrounding health promotion for older adults can impede the ability of nurses and other health providers to provide care that will enhance healthy aging. These misconceptions need to be overcome so that older adults receive health-promotion interventions that help to keep them active and healthy.

Which of the following stressors are intrinsic factors? (select all that apply) a. poor time management b. traffic jam c. death of a spouse d. poor communication e. catastrophic negative thinking

A, D, E Intrinsic factors that create stress for an individual are those that are created or exacerbated by poor time management, procrastination, poor communication, catastrophic negative thinking (expecting the worst), or struggling with self-defeating behaviors. A traffic jam and the death of a spouse are examples of an extrinsic factor, which is something that a person has no control over. Stressors that individuals can modify include changing their environment and social interactions or behaviors.

A 50-year-old man is initiating an exercise program to help improve his cardiovascular health. What are some of the recommended guidelines that the nurse should instruct him on? (select all ) A.Every adult over the age of 50 should start with a daily running program. B. Overexertion should be avoided. C. Increase fluid intake during periods of strenuous exercise in hot weather. D. Adults over the age of 50 benefit from intense strength training. E. Suggested activities include walking, jogging, swimming, and bicycling.

B. Overexertion should be avoided. C. Increase fluid intake during periods of strenuous exercise in hot weather. E. Suggested activities include walking, jogging, swimming, and bicycling. some suggested activities for the middle-aged adult include brisk walking, jogging, swimming, bicycling, and skipping rope as well as walking or biking to work. Activities that focus on skill and coordination should be attempted by the adult over age 40 rather than activities necessitating speed and strength. Moderation is important for all groups of individuals. Caution is recommended for adults nearing age 65 to prevent muscle strains and/or falls, etc. Overexertion, as evidenced by dizziness, chest pressure or chest pain, and unresolved shortness of breath should be avoided. Also, in hot weather, strenuous exercise should be balanced with rest periods and increased intake of fluids to prevent heat stroke.

The nurse initiates an exercise program with middle-aged adults by: planning physical activity for a minimum of 45 minutes. considering activities that have the least potential for injury. counseling the adult that exercise should be rigorous to produce results. advising that the heart rate should double during exercise for cardiovascular benefits to be achieved.

considering activities that have the least potential for injury. Continuous, rhythmic exercise maintained for a sufficient period to stress the cardiac system (increased heart rate and blood pressure) is desirable. Some suggested activities include brisk walking, jogging, swimming, bicycling, and skipping rope as well as walking or biking to work. Activities that focus on skill and coordination should be attempted by the adult older than age 40 rather than activities necessitating speed and strength. Moderation is key for all groups of individuals. Caution is recommended for adults nearing age 65 to prevent muscle strains and/or falls. Overexertion, as evidenced by dizziness, chest pressure or chest pain, and unresolved shortness of breath, should be avoided. Also, in hot weather, strenuous exercise should be balanced with rest periods and increased intake of fluids to prevent heat stroke.To achieve maximal effectiveness, physical exercise should involve as many muscles as possible and be performed on a regular basis. Adults should spend 30 minutes or more of brisk physical activity every day for a total of 3 to 4 hours per week. Optimal performance level varies for each individual and should be based on parameters set by one's physician in advance of starting a fitness program. The following formula to calculate target heart rate is shown on the American Heart Association website (2012). Begin by subtracting one's age from the value 220 and then multiplying this number by 0.75 to determine a heart rate value that is within safe limits. For example, for an individual who is 50 years old: (220 - 50) = 170; 170 × 0.75 = 127.5 (or 128 beats/min) for the optimal heart rate. Comparatively, the cardiac muscle capacity of a person younger than 50 would be greater than 128 beats/min; and as one increases their functional aerobic capacity, the target heart rate required to tone the cardiac muscle would be increased.

The nurse is discussing strong evidence on effectiveness of alternative and complimentary therapies in reducing harmful effects of stress. Which of the following therapies has strong evidence of effectiveness?

A variety of alternatives and complimentary therapies are available as techniques to prevent and reduce harmful effects of stress. Common therapies include acupuncture, hypnosis, aromatherapy, reflexology, chiropractic, and herbal therapies. People are increasingly using alternative therapies as self-help measures, and research to study their effects has exploded in recent years. Nurses can assist clients to base their use on evidence of safety and efficacy. Among the variety of alternative therapies available, acupuncture and hypnosis have strong evidence of effectiveness. Herbal remedies require cautions because they can have harmful as well as beneficial effects, and may interfere with other treatments. The text does not provide evidence for the effectiveness of aroma therapy for stress reduction.

The nurse is preparing a class on young adult risk factors for violence. The nurse includes content on which of the following? (select all that apply) A. Homicide is the second leading cause of death in young adults. B. Alcohol but not drug abuse is frequently related to violence. C. Homicide is the leading cause of death for black young men. D. Firearms are involved in less than half of homicides. E. The presence of firearms in the home is associated with the increased risk of firearm injury to children.

A. Homicide is the second leading cause of death in young adults. C. Homicide is the leading cause of death for black young men. E. The presence of firearms in the home is associated with the increased risk of firearm injury to children. In the United States, there are about 51,000 violent deaths a year, and these deaths affect all Americans not only in emotional terms but also through additional medical costs and lost employment productivity. Domestically, in the United States, the recipients of violence may be older adults, children, and women with whom they are familiar. Identification, education, and strategies to prevent bullying, dating violence, and sexual violence among young adults require federal and community attention. Homicide (assault) is the second leading cause of death in the 15- to 24-year-old age group and the leading cause of death for black men in the same age category. Between 1999 and 2008, the homicide rate has remained fairly static around 5.4 deaths/100,000 population; this is a significant decline from the rate seen in the early 1990s and there are ongoing efforts to understand what has contributed to the improvement. Firearms are involved in approximately two thirds of these deaths, and men have twice the risk of dying as do women.When compared with the general population, death rates are higher for men in poorer populations, in urban areas, and with less formal education. Homicide is closely associated with alcohol and drug abuse and frequently is related to other violent acts, such as assaults and robbery. Other risk factors include history of loss of employment, detention or prison experience, access to firearms, abuse in the home, mental illness, social isolation, and homelessness. The presence of firearms in the home is associated with the increased risk of unintentional and intentional injury to children. A target in Healthy People 2020 is to reduce firearm-related deaths from 10.5 per 100,000 population in 2012 to 9.3 per 100,000 population and to reduce the number of nonfatal firearm-related injuries from 20.9 per 100,000 in 2010 to 18.6/100,000. The firearm-related death rate for young black men and boys was nearly 5 times the rate for young white men and boys.

A 48-year-old woman complains to her nurse that she is experiencing frequent episodes of insomnia. What are some measures the nurse should educate her about? Select all that apply. A. Insomnia is common for this age group. B. Engage in activity 1 to 2 hours before bed to encourage sleep. C. Avoid or reduce the amount of caffeinated beverages that are consumed. D. Napping should be encouraged. E. Have a regular schedule for waking and sleep.

A. Insomnia is common for this age group. C. Avoid or reduce the amount of caffeinated beverages that are consumed. E. Have a regular schedule for waking and sleep. Middle-age Americans may not get as much sleep as young adults because of increased demands in their lives. Caring for immediate family, children, and sometimes parents, as well as employment responsibilities consume most of a 24-hour interval.Insomnia is a common finding in this age category. This condition may be the result of overstimulation resulting from drinking too many caffeinated beverages, strenuous exercise within 2 hours of bedtime, or failure to have a regular sleep/wake schedule in a 24-hour period. Frequently occurring insomnia can lead to distractibility, irritability, and fatigue during the daytime hours. Napping during the afternoon or evening will hinder sound sleeping at night. It is best avoided.

Nurses caring for the young adult population maintain awareness about screening for hypertension. Which of the following statements are true about hypertension in young adults? (select all that apply) A. The Mexican American population has the lowest percentage of individuals with high blood pressure. B. African Americans have the highest rates of high blood pressure. C. Health insurance has a direct correlation with hypertension control. D. Adopting healthy behaviors after being diagnosed with hypertension will not reduce the incidence. E. The prevalence of treatment and control of hypertension is lowest in young adults.

A. The Mexican American population has the lowest percentage of individuals with high blood pressure. B. African Americans have the highest rates of high blood pressure. E. The prevalence of treatment and control of hypertension is lowest in young adults. There are also noticeable disparities in the development of hypertension in various population subgroups. Data from 2009 to 2012 indicate the Mexican American and the white-only/non-Hispanic populations have the lowest percentage of high blood pressure individuals (27%); and the non-Hispanic/black African American population has the highest (42%) level of hypertension. The prevalence of control of hypertension was also lowest in young adults (39%). This may be related to lack of a usual source of care, but most surveyed had health insurance, so health insurance alone is not sufficient to correlate with better hypertension control. Gillespie and colleagues also report that adoption of healthy behaviors in young adults, particularly of reducing dietary salt intake from an average of 3400 to 2300 mg daily, could dramatically reduce the incidence of hypertension.

Cognitive-behavioral therapy (CBT) is an intervention that can be utilized to help clients manage stress. Which of the following statements are true about CBT? a. CBT is effective with stress disorders and mental illness b. CBT is a long-term intervention c. CBT helps people evaluate their thoughts, challenge them, replace them with more rational responses d. CBT can be utilized by any therapist e. CBT teaches people that negative thinking often causes emotional distress

A.CBT is effective with stress disorders and mental illness C. CBT helps people evaluate their thoughts, challenge them, replace them with more rational responses E. CBT teaches people that negative thinking often causes emotional distress Cognitive-behavioral therapy (CBT) is a conceptually based short-term intervention to modify negative or catastrophic thinking and related behaviors, and thereby reduce stress. It is a technique or series of strategies that help people evaluate their thoughts, challenge them, and replace them with more rational cognitive and behavioral responses. Although advanced training is needed, nurses can safely and effectively use basic strategies. Cognitive-behavioral restructuring teaches people that negative thinking often causes emotional distress. This recognition will alter the negative thinking and reduce the negative consequences of stress.

Which of the following statements are correct concerning Alzheimer's dementia? Select all that apply. A.It includes disturbances of the sleep-wake cycle. B. It is the second most common form of dementia in the elderly. C.The Mini-Mental Status Examination can be used as a screening tool. D.The majority of patients are age 75 or older. E. Currently, there are no medications to treat this disease.

A.It includes disturbances of the sleep-wake cycle. C.The Mini-Mental Status Examination can be used as a screening tool. D.The majority of patients are age 75 or older Dementias include Alzheimer's disease (AD), the most common dementia, as well as Parkinson-related dementia, Huntington's disease, Creutzfeldt-Jakob disease, Pick disease, and Lewy body dementia. The Alzheimer's Association estimates that approximately 5.1 million Americans over 65 have Alzheimer's and approximately 81% of individuals with Alzheimer's are 75 or older.The symptoms of dementia include forgetfulness, inattentiveness, disorganized thinking, altered levels of consciousness, perceptual disturbances, sleep-wake disorders, psychomotor disturbances, and disorientation. Assessment for dementia can be made part of the routine assessment of older adults, especially if any of these symptoms arise. One tool that has been used successfully to screen for cognitive impairments among older adults is the Mini-Mental State Examination (Figure 24-4).At present, there is no cure for Alzheimer's disease. Treatment for AD includes the use of medications for memory loss including cholinesterase inhibitors and memantine, treatments for behavioral changes associated with AD, and treatment for sleep changes. Medications to treat Alzheimer's disease are known as cholinesterase inhibitors.

The nurse is providing suggestions to individuals with sleep disturbances resulting from stress-related issues. The nurse advises or recommends which of the following? (select all that apply) a.have a glass of wine b.unrealistic expectations can induce insomnia c.keeping a sleep diary may be useful d.exercise within 1 hr of bedtime e.changing sleep disturbances can not be done quickly

B,C,D Health and the ability to meet life's many demands and manage stress effectively require proper rest. Many people suffer from sleep deprivation and sleep disorders (e.g., sleep apnea) that can cause or exacerbate conditions such as depression and fatigue and contribute to poor concentration and ineffective problem-solving. Insomnia can be induced by stress or other cognitive-behavioral factors, such as unrealistic expectations, inappropriate scheduling of sleep, trying too hard to sleep, consuming caffeine, getting inadequate exercise, and a number of other factors including illness, alcohol use, or drug use. Determining the extent to which sleep disturbance is the result of behavior or stress-related issues is a necessary assessment. Overcoming sleep disturbances cannot be done quickly.Changing these behaviors requires patience and persistence. Once factors associated with sleep disturbance are identified, nurses can help individuals improve their sleep patterns by counseling them to follow several sleep hygiene or behavior guidelines (keeping a sleep diary, having a regular sleep-wake cycle, and making prudent dietary changes). Referral for appropriate evaluation of possible disorders such as sleep apnea also is a necessary nursing intervention. Assisting people to make healthy behavior changes in their sleep habits provides another opportunity for people to increase self-regulation, confidence, and control, thereby reducing stress and improving quality of life. Alcohol and exercise within 1 or 2 hours before bedtime can contribute to insomnia. A warm room can hamper sleep; a cool room is preferable.

Which of the following statements are correct concerning biological agents and cancer in the context of the older adult? Select all that apply. A. The immune system becomes more efficient with aging. B.Many older adults have not received primary tetanus and diphtheria immunizations. C. Influenza has high mortality and morbidity in older adults. D. Cancer disproportionately affects older adults. E.Twenty-five (25) percent of all diagnosed cancers are found in older adults.

B.Many older adults have not received primary tetanus and diphtheria immunizations. C. Influenza has high mortality and morbidity in older adults. D. Cancer disproportionately affects older adults. Because of decreased immune system response, older adults are susceptible to bacterial and viral disease. In many cases, older adults have not received primary immunization against diphtheria and tetanus. A large emphasis is placed on immunizing young children against communicable disease; however, older adults can also be protected by commonly available vaccines that have been shown to lower both morbidity and mortality. Two disease processes that are associated with higher mortality and morbidity are influenza and pneumonia.Cancer rates for older adults are disproportionately high in the United States. Although only 12% of the population is considered older adult, more than 50% of all diagnosed cancers are found in this population and the death rate for cancer is highest among adults 65 years of age and older. The reason for the large proportion of cancer in this country is unknown. Theories include longer exposure to carcinogens, increased susceptibility to cancer in the older body, decreased cellular healing ability, loss of tumor-suppressing genes, and decreased immune function.

The nurse is implementing cognitive therapy as a stress-management intervention with a group of pregnant teens. The nurse explains that cognitive therapy reduces stress by:

Based on the work of pioneers such as Aaron Beck and Albert Ellis, cognitive therapy has emerged, during the past several decades, as a treatment designed to alter dysfunctional beliefs and thoughts. Such thoughts are commonly associated with depression, anxiety disorders, and other emotional problems. Over time, theorists, clinical researchers, and clinicians recognized the effectiveness of this approach for many persons, as well as the value of linking helpful alterations in thinking to complementary behavioral changes. As a result, CBT emerged. CBT is an efficacious treatment approach for many stress-related and mental health disorders. Glossing over misfortune, suffering or negative feelings is not a therapeutic nor adaptive approach to stress which results from these types of issues. Also nontherapeutic is to focus on persons responsible for an individual's stress. Engaging in blaming or shifting the focus to other persons is not beneficial in reducing stress. Rather, the focus is directed toward the client and in dealing with issues at hand. Choice d is incorrect as focusing on a narrow range of feelings will not be therapeutic in resolving stress-related problems. In fact, doing so may actually intensify the stress. Taking a broader, more holistic approach would be preferable.

Which of the following concepts are accurate regarding the biological changes in the young adult period? (select all that apply) A.Young adulthood sees the highest illness rate of any other age group. B. Physical growth continues into the 30s. C. Most concerns are related to ensuring optimal body functioning. D. Physical abilities of the young adult are at their peak. E. Illness compensatory mechanisms generally operate optimally.

C. Most concerns are related to ensuring optimal body functioning. D. Physical abilities of the young adult are at their peak. E. Illness compensatory mechanisms generally operate optimally. Young adulthood is generally the healthiest time of life. Physical growth is mostly complete by the age of 20; most concerns related to physiological development are focused on ensuring the optimal functioning of body systems. The young adult's physical abilities are in peak condition, and compensatory mechanisms operate optimally during illness to provide minimal disruption in health patterns. Nursing goals for individuals of this age group are oriented toward prolonging this period of optimal physical energy; developing the mental, emotional, spiritual, and social potential; encouraging proper health habits; anticipating and screening for and, therefore, being able to treat the onset of chronic disease at an early stage; and treating disease when appropriate.

The community health nurse performs an assessment on a local family to determine their stress-coping abilities. Which of the following is an example of the primary appraisal of the coping ability of a family experiencing financial hardship? a. the family becomes knowledgeable of info they were not aware of b. The family identifies an issue of concern for that family members c. the family describes perceived actual and potential positive and negative outcomes d. individuals verbalize methods to cope with harm,threat, or challenge

C. the family describes perceived actual and potential positive and negative outcomes Assessment of the stress-coping abilities of an individual, family, or community is part of a comprehensive health assessment that includes past and present subjective and objective data. Primary appraisal of coping includes descriptions of perceived actual and potential positive and negative outcomes. Negative outcomes refer to harm, whereas positive outcomes refer to the challenges resulting from stressors that an individual perceives can be overcome. Secondary appraisal consists of the individual's identification of choices to cope with the actual or potential harm, threat, or challenge. Choice d would involve secondary appraisal, a process which follows primary appraisal. Choice a could apply to any situation and does not necessarily imply stress nor stress appraisal. The family may learn they are related to a particular historical figure and have no issue with this discover. Similarly, choice b is a general statement and does not necessarily imply stress. The family may, for example, be concerned with helping homeless persons within their community. Family members may thus find fulfillment in working with a local organization to promote affordable housing. No stress nor stress appraisal is involved in such a scenario.

A target goal of Healthy People 2020 is to reduce the incidence of hepatitis C. The nurse focuses on individuals most at risk, which includes persons with: A. hepatitis A. B. Epstein-Barr virus. C. human papilloma virus. D. chronic renal disease on hemodialysis.

D. chronic renal disease on hemodialysis. Another target of Healthy People 2020 is to keep the incidence of hepatitis C stable at 0.2 new symptomatic cases in 100,000 people. Chronic hepatitis became a nationally reportable disease in 2003. Individuals most at risk are those who have injected illicit drugs, are undergoing hemodialysis, are seropositive for human immunodeficiency virus (HIV), or have elevated liver function studies. Recent curative advances in drug treatment for hepatitis C have made better case finding more important. The other diseases listed do not have a positive correlation to hepatitis C.

Research has demonstrated the role of stress-hardy characteristics of individuals in promoting better health. These characteristics of stress hardiness include:

Individuals who possess characteristics of stress hardiness are shown to be less vulnerable to stress-related symptoms and disease. The characteristics of stress hardiness are control, challenge, and commitment. For stress-hardy individuals, stress is viewed as a challenge rather than a threat; they feel in control of situations in their lives; and they are committed to, rather than alienated from, work, home, and family. Stress-hardy individuals do experience a sense of internal control, thus choice b is incorrect. There is not a need to focus commitment on only one component in life, thus choice c is incorrect. Stress hardy are less likely to somatize, i.e., report physical symptoms in response to stress as compared to persons who are less resilient to stress, thus choice d is incorrect.

Nutrition during pregnancy is important as it significantly impacts fetal health. With of the following nutrients should include supplementation in addition to dietary intake? Vitamin C Niacin Folic acid Magnesium

Folic acid Proper nutrition is particularly necessary for the young adult female during the childbearing years. Contributing factors to iron deficiency in this age group are regular loss of blood (during menses) and pregnancy. The prevalence of anemia in women of childbearing potential was 16.1% in 2003 to 2006 and the 2020 target is 14.5%. A blood loss of 2 to 4 mL per day (1 to 2 mg of iron) can cause iron deficiency anemia; young women who do not eat a healthy diet and have heavy periods or use nonsteroidal anti-inflammatory drugs are specifically at risk for iron deficiency anemia. Iron supplementation is recommended during pregnancy for optimal growth of the fetus and supporting structures.The CDC and USDHHS recommend that all women of childbearing age consume 0.4 mg of folic acid daily to reduce the risk of fetal neural tube defects, including spina bifida. Supplementation should include at least the month before pregnancy and the first trimester during pregnancy. The CDC and Food and Drug Administration also recommend folic acid fortification of food to prevent neural tube defects. In the years 2007 to 2010, only 22.8% of nonpregnant females age 15 to 44 reported a daily intake of folic acid of 400 mcg from fortified foods or dietary supplements and the target for 2020 is 26.2%. Efforts are also being made to reduce health disparities in neural tube defects including the use of better communication modalities with the Hispanic population and other population subgroups that have higher rates of neural tube defects.Most adolescents and adult women fail to meet their calcium requirements, placing them at risk for osteoporosis and bone fractures in later life. Low calcium intake is a direct result of low milk consumption related to soft drink ingestion. An increase in calcium-containing foods is therefore recommended, particularly for teens and young women.

The nurse provides anticipatory guidance to people during middle age to meet developmental tasks of: (select all ) helping children become responsible, happy adults. rediscovering new satisfaction in the relationship with one's spouse. disassociating from one's parents. reaching the peak in one's career. passing on traditions and skills to grandchildren.

Helping children become responsible, happy adults Rediscovering new satisfaction in the relationship with one's spouse Developing an affectionate but independent relationship with aging parents Reaching the peak in one's career Developing leisure-time activities Achieving mature social and civic responsibility Accepting and adapting to biological changes Maintaining or developing friendships While the middle-aged adult gains independence from parents, such does not mean disassociating from parents and/or family of origin. Passing on traditions to grandchildren is a positive and generative activity. It does not, however, comprise one of the developmental tasks of middle adulthood.

Which of the following statements is correct concerning intimate partner violence? A.It occurs primarily in lower socioeconomic settings. B. Physical assaults by intimate partners has increased in last decade. C. The risk increases as age of first marriage increases. D. It is the most underreported form of abuse.

Intimate partner violence has serious health consequences for women and men; however, because of social and legal factors, it is probably the most underreported form of abuse (Box 22-5: Diversity Awareness). Abuse crosses all socioeconomic, racial, ethnic, religious, sex, and age boundaries. About 3 in 10 women and 1 in 10 men during their lifetime reported intimate partner violence or abuse. Women reported higher lifetime and more recent-year intimate partner violence than men. Nurses and other primary health care providers assist in detecting or treating violence or abuse in an optimal manner; they can help others to understand the cultural background of abuse. However, more efforts must be made to recognize the scope of the problem and to provide appropriate counseling (Box 22-5: Diversity Awareness). Physical assaults by intimate partners decreased in the last decade; this improvement is attributed to increased economic opportunities for women, increased age at first marriage, and better access to domestic violence services. A target in Healthy People 2020 is to reduce the rate of physical assault to 19.2 assaults per 1000 from 22 assaults recorded in 2012.

According to Healthy People 2020, the leading causes of death among children and young adults are due to injuries from which of the following? Homicide Suicide Burns Motor vehicle crashes

Motor vehicle crashes Injuries are the highest cause of death in young adults and individuals under age 44. Motor vehicle accidents cause more fatalities than all other causes of death combined. Reducing speed limits contributes to lower fatality rates. Most states have seat belt laws, and all states have seat belt requirements for children. All individuals in the car need to use seat belts, because an unrestrained occupant can cause harm to another passenger in a crash. In 2013, 87% of motor vehicle drivers and front seat occupants used seat belts and the target for 2020 is 92.4%. Distracted driving, texting while driving, and cell phone use are the causes of many motor vehicle crashes. Most states have enacted "hand-free" or "Bluetooth" wireless audio legislation that limits the use of handheld car cell phones. The continued high incidence of vehicle accidents in the young adult age group is related to accessibility of cars to young adults and peer pressure on driving behavior; reckless driving and driving under the influence of alcohol and drugs are now viewed as closely connected to violent and abusive behavior. A number of states have specific rules that limit cell phone use in drivers under 18 years of age.Accident-prevention education, long considered appropriate for young children, is an important part of young adult instruction. Most young licensed drivers have participated in driver education courses, and a number of states have adopted progressive licensing programs. A number of states have "graduated driver licensing" programs which have been shown to reduce younger driver crash rates by 8% to 14%. In 2015, 46 states had banned texting while driving, and two additional states ban texting by novice drivers. The young adult must understand the potentially fatal consequences of aggressive tendencies or thoughtless risk-taking. When young adults are encouraged to reflect on the consequences of their actions, they tend to be more willing to control and change unsafe driving behaviors.

Which of the following statements is correct concerning sleep in the older adult? 10% report difficulty sleeping. Older adults are more likely to report daytime sleepiness. Both alcohol and milk should be avoided before bedtime. Meditation after 6 PM increases bedtime alertness.

Older adults are more likely to report daytime sleepiness. Inability to sleep is a frequent concern of older adults. Neikrug and Ancoli-Israel reported that approximately 50% of older adults state that they have difficulty sleeping. Sleep difficulties may include sleep apnea, the inability to fall asleep, the inability to stay asleep, the inability to fall back to sleep when awakening in the night, or the feeling of not being refreshed when awakening in the morning. The high prevalence of sleep disorders in older adults indicates that it is an important area for health care providers to address. Older adults are more likely to report excessive daytime sleepiness (EDT), which means that they find it difficult to remain awake or alert at appropriate times during the day.Teaching about normal changes reassures older adults that their sleep patterns have changed but are not necessarily harmful. Having this information may decrease anxiety. Identifying normal bedtime rituals, such as drinking a glass of milk, taking a relaxing bath, reading, or meditating, and ensuring that the person is able to continue these practices may help to establish normal sleep routines. Increasing physical activity during the day also helps them fall asleep more readily at night. Taking pain medication or using alternative pain-relief methods before going to bed can help those who suffer from painful conditions obtain better rest at night.

Which of the following disorders, affecting older adults, is characterized by loss of visual accommodation causing the inability to maintain focus on objects close to the eye? Glaucoma Sclerosis Cataracts Presbyopia

Presbyopia A variety of structural changes cause visual acuity to decrease, color discrimination to become less acute, pupil size and constriction ability to decrease, and peripheral vision to diminish. Presbyopia is a loss of accommodation that occurs as people age and results in the inability to maintain focus on objects close to the eye. The lens of the eyes thickens and becomes yellow and predisposes the older adult to cataracts. The older adult is also at increased risk for glaucoma, a group of eye disorders characterized by increased intraocular pressure. Because of the normal changes in the aging eye and the high risk for disease, a baseline eye assessment should be done to identify age-related changes and any disease processes. Follow-up eye appointments should be scheduled annually. Atrophy or sclerosis of the tympanic membrane affects hearing.

Common visual conditions which may occur in middle-aged adults include which of the following? Select all that apply. Presbyopia Glaucoma Cataracts Macular degeneration Presbycusis

Presbyopia Glaucoma Cataracts Macular degeneration Presbyopia (farsightedness) is common in middle-age adults, even in individuals who have had no previous problems with their vision. This condition occurs because of the loss of elasticity in the lens of the eye so that the adult cannot focus on objects that are in close range, such as reading without using their prescription lenses. Presbyopia is corrected with prescription lenses which may be needed only for reading or for close work.Glaucoma occurs as a result of increased intraocular pressure which can damage the optic nerve resulting in vision loss and blindness. Loss of peripheral vision or "tunnel vision" is a common complaint associated with glaucoma. Damage to the optic nerve is irreversible but visual loss can be prevented if damage is identified early and treatment is initiated.A cataract, opacity of the lens, can develop and cloud the vision in later years of middle age. Often cataracts develop in people who have diabetes. Another disorder, diabetic retinopathy, gradually causes rupture of vessels in the retina, which leak into the eye causing lack of color differentiation and central vision changes.Macular degeneration is often referred to as age-related macular degeneration (AMD). This age-related disorder is a progressive deterioration of the maculae of the retina and choroid structures of the eye and results in damaging sharp and central vision. Approximately 1.8 million Americans aged 40 years and older are affected by AMD and the number of people with AMD is estimated to reach 2.95 million by 2020. This condition is very serious because it represents the effects of several disorders. Once a diagnosis of macular degeneration has been made, retinal ophthalmologists should be involved in the care of the individual. Presbycusis is an impairment in auditory acuity.

When an individual utilizes techniques to reduce stress through controlling and changing negative thought patterns along with nonjudgmental mindfulness, which stress-management skill is being practiced?

Self-awareness is one of the most effective stress-management tools. Self-awareness helps people learn about interactions among mind, body, and spirit; increases a sense of control; and counters self-defeating perceptions. Interventions that promote self-awareness help people make sense of life events and circumstances that may be bewildering or discomforting. Many experiences in life lead to feelings of emptiness and disharmony, because people are unable to connect the experience with thoughts, feelings, actions, and physiological responses. Self-awareness helps individuals recognize stress that they create through negative, exaggerated, unrealistic thinking. This recognition affords an opportunity to change these negative thought patterns, thereby decreasing stress and increasing control.A closely related concept is mindfulness, nonjudgmental self-awareness characterized by intentional acceptance of unfolding of experience in the moment. Mindfulness interventions can be combined with other efficacious treatments or serve as primary interventions for stress management. An affirmation is a positive thought, in the form of a short saying or phrase, that has meaning for the individual. Empathy is an effective stress-management intervention because it assists with communication. Empathy is the ability to consider another person's perspective and to communicate this understanding back to that person. Healthy pleasures involve engaging in positive activities which bring about feelings of peace, joy, and happiness. An example would be gardening as a means of stress reduction.

Physiological effects of stress include:

Stress causes physiological arousal along three pathways: the musculoskeletal system, the autonomic nervous system, and the psychoneuroendocrine system. The musculoskeletal system responds to stress by increasing tension and tone. The autonomic nervous system causes an increase in heart rate, blood pressure, and respiratory rate. The heightened awareness of the environment is triggered, and the blood shifts from the visceral organs to the large muscles. The psychoneuroendocrine system stimulates the secretion of glucocorticoids and other neuroendocrine substances into the systemic circulation, which increases glucose levels and the anti-inflammatory response. Stress increases musculoskeletal tone, thus choice b is incorrect. Stress shifts blood toward the large muscular groups, consistent with "fight or flight" response, thus choice d is incorrect. Stress does not decrease anti-inflammatory response, thus choice a is incorrect as well.

Independent seniors may experience which of the following barriers to obtaining adequate nutritional intake? Select all that apply. Transportation issues Income Socialization Social support resources Cultural food preferences

Transportation issues Income Social support resources Cultural food preferences For independent seniors, barriers that may interfere with the ability to obtain adequate and nutritional food include limited transportation, income, and social support resources. Problems with access to food are compounded by the effect of normal changes of aging. Declines in gastrointestinal organ function can lead to changes in digestive metabolism and the absorption and elimination of nutrients. A deterioration of the smell, vision, and taste senses and the high frequency of dental and swallowing problems make maintaining adequate daily nutrition even more difficult. Additionally, side effects of required medications may affect appetite. Cultural food preferences and lifelong eating habits, such as diets high in fat and cholesterol, are other obstacles to maintaining optimal nutrition.

Which of the following statements is correct concerning exercise and the older adult? As people age, weight-bearing exercises can be hazardous. Swimming should be avoided running for persons with arthritis. After age 65, exercise should be limited to 3 times per week. Walking is a popular and beneficial activity.

Walking is a popular and beneficial activity. The overwhelming evidence of the positive effects of exercise has led the US Department of Health and Human Services to develop within its program Healthy People 2020 national objectives for increasing the percentage of adults who exercise regularly. Regular physical activity helps and may even prevent many chronic health problems associated with aging, including hypertension, obesity, diabetes, and depression. Normal changes of aging, pathological conditions, and environmental deterrents do not need to prevent the older adult from exercising (Figure 24-2).Walking, which can be done in both community settings and health care facilities, is a popular form of exercise among older adults. Other popular activities for older adults include swimming, weight-bearing exercises, and aquatic exercises. Weight-bearing and muscle-building exercises help to maintain functional mobility, promote independence, and prevent falls. Weight-bearing exercises are shown to be highly effective in reducing bone wasting associated with osteoporosis. Regular exercise promotes maintenance of bone mineral density in older adults. Persons with conditions such as spinal stenosis and arthritis often find that they can exercise in a swimming pool without pain so this is an important way for them to maintain an exercise plan and increase their functional ability. There is no need to limit exercise to three (3) times per week. Senior adults may exercise daily if so inclined.

The nurse, teaching a class on smoking cessation to a group of middle-age adults, presents the adverse effects of smoking, which include that nicotine: acts to stimulate the heart. calms the central nervous system. assists in decreasing blood pressure. causes a decrease in carbon monoxide.

acts to stimulate the heart. Few smokers realize that cigarettes contain 2000 known chemicals including tar, nicotine, hydrogen cyanide, formaldehyde, and ammonia. Cigarette smoking is, for most smokers, an addiction to nicotine, which is absorbed into the bloodstream. Nicotine acts on the two divisions of the nervous system: central (brain and the spinal cord) and peripheral (autonomic nervous system and motor and sensory fibers to the arms and legs). Effects of nicotine stimulation can be observed in both electroencephalographic changes and hand tremors. Nicotine also stimulates the heart, leading to an increased pulse rate and elevated blood pressure. Although smokers frequently believe that cigarettes have a calming effect, this notion is misleading. Nicotine stimulates the body, whereas carbon monoxide causes lethargy. Smokers may feel calm, although they are actually having their sensations dulled by carbon monoxide. Additive effects such as those from chlorine, cotton dust, and γ-radiation can lower mid-expiratory flow values. Profound effects can also be observed with asbestos interaction.

According to Piaget's theory of cognitive development, the young adult is in the stage of formal operational thought and demonstrates abilities to: a. analyze concepts. b. manipulate concrete objects. c. participate in cooperative interactions. d. perceive specific examples.

analyze concepts. Several stage theorists describe the growth of young adult thought and moral development. It is important to note that these stages are fluid and individual differences occur. Within Jean Piaget's cognitive-developmental theory, formal operational thought evolves from concrete operational thought in adolescence and extends through the reasoning process of young adults. Although more recent developmental theorists dispute Piaget's findings, this scheme of cognitive development assists the nurse in learning about and understanding young adult reasoning. Achievement of formal operational thinking allows young adults to analyze all combinations of possibilities and construct hypotheses. Young adult thought becomes more perceptive and insightful; issues can therefore be evaluated realistically and objectively. Young adults are energetic and can therefore contribute substantially to social and occupational decision-making. Although they tend to take greater risks, young adults typically demonstrate the use of appropriate reasoning, anticipation, and analytical approaches.

What are the current recommendations of the US Preventive Services Task Force concerning breast cancer? a. Screening mammograms beginning at age 30 b. Recommends against teaching breast self-examination c. Breast ultrasound screening beginning at age 35 d. Mammogram every 2 years if on birth control pills from age 35

b. Recommends against teaching breast self-examination A physical examination includes measurements of height, weight, body mass index, blood pressure, and blood tests, with an emphasis on the need to avoid inactivity and obesity, which are risk factors for many health problems. The US Preventive Services Task Force currently recommends against teaching breast self-examination and concludes that the current evidence is insufficient to assess the additional benefits and harm of clinical breast examination beyond screening mammography for women 40 and older. Screening is strongly recommended for cervical cancer in women who have been sexually active (Papanicolaou [Pap] smear). Ultrasound is sometimes used to delineate whether a finding on mammogram is a cyst. It is never used as a primary screening modality. Whether a woman takes oral contraceptives is not relevant for purposes of breast cancer screening.

Bloom (1984) has developed a hierarchy of cognitive levels in the adult learner. The analysis cognitive level for the adult learner would be

becoming aware of the relationship and interaction of all the parts. Bloom (1984)developed a hierarchy of cognitive levels in the adult learner. Knowledge is the simplest or most basic cognitive level. Knowledge is the acquisition of information. The adult learner defines "high blood pressure" in lay terms. Comprehension is the second level, as indicated by the learner grasping the meaning of the communicated message and relating the term(s) to other material. For example, the individual can state one way that obesity influences high blood pressure. The third level is application of knowledge. At this level the learner demonstrates an understanding of ideas and concepts by extending them to describe or relate to real-life situations. For example, the individual with hypertension becomes involved in an exercise program.The fourth level is analysis. At this level, all aspects of learning are united in thought and the individual is cognizant of the relationships and interactions of all the parts. For example, the individual considers his or her values and life goals when making decisions about taking action in regard to understanding health care needs. The highest order of learning involves synthesis and evaluation. The person is able to combine various elements to form a plan and then is able to judge the extent to which the actions and results satisfy the original objectives. For example, people may develop plans to improve their health status and increase their disease self-management responsibilities. The next step is to validate the results of ongoing health care programs in relation to their projected expectations.

Emphasis on disease prevention for the young adult, after age 25, is on modifying risk factors related to: coronary artery disease. cirrhosis of the liver. cervical cancer. colon cancer.

coronary artery disease. After age 25, the preventive emphasis is on modifying coronary disease risk factors. There is evidence that healthy lifestyle changes during young adulthood are associated with decreased cardiovascular risk. Recommendations for screening for young adults are undergoing revision as more information becomes available about the interactive risks of sedentary lifestyle, high cholesterol levels, familial high lipid levels, diabetes mellitus, and smoking. USPSTF makes no recommendations for men 20 to 35 for or against routine screening for lipid disorders unless they are at increased risk for coronary disease. Aging is responsible for some degenerative changes in respiratory and cardiac function, but during the young adult years this decline amounts to less than 1% per year and is largely determined by an individual's fitness level. Cardiovascular assessment of the young adult includes determining the presence of hyperlipidemia, hypertension, diabetes, chest pain, or heart disease. A Healthy People 2020 target is to reduce the mean total blood cholesterol levels among adults to 177.9 mg/dL; the baseline between 1988 and 1994 for adults 20 and older was 197.7 mg/dL.

The leading causes of death in middle adulthood include: heart disease. kidney disease. respiratory disease. gastrointestinal disease.

heart disease. The leading causes of death during middle adulthood are heart disease, cancer, and accidents. While the data analysis showed some progress toward reaching many of the Healthy People 2010 target goals, there were a number of areas of "backsliding." Most notably, greater proportions of Americans are obese and have symptoms of high blood pressure compared to findings reported for Healthy People 2000. Hypertension and obesity are conditions that significantly affect the middle-aged adult. They often lead to heart disease, stroke, and the development of diabetes. Harton suggests that the 2010 goals were perhaps too ambitious; however, findings of other research positively confirm that more Americans were obese in 2010 than earlier in the decade.The most recent national data from 2011 to 2012 on obesity prevalence indicates obesity was higher among middle-age adults (39.5%) than among younger (30.3%) or older (35.4%) adults. Cancer is the leading cause of death for black men and black women (combined incidence rates) in middle age. Findings in recent years show an encouraging decrease in both the incidence and the mortality rates for cancer among black adults since 1993.

Characteristic behaviors of older adults who have successfully met Erikson's ego integrity vs despair developmental task include: fear of death. feelings that life has been lived in vain. identity is related to career and work only. honest acceptance of the life that has passed.

honest acceptance of the life that has passed. Ego integrity vs despair is the developmental stage of older adults. The quality associated with successful passage of this stage is to achieve a balance between integrity and despair. "The process of bringing into balance feelings of integrity and despair involves a review of and a coming to terms with the life one has lived thus far." Based on the increasing life span, this stage of development was expanded into three additional stages: ego differentiation vs work role preoccupation, which involves achieving identity apart from work; body transcendence vs body preoccupation, which focuses on adjusting to normal aging changes; and ego transcendence vs ego preoccupation, which involves accepting death.Successfully meeting this developmental task would involve an honest acceptance of the life that has passed and the stage of life that is currently being lived. Individuals who have reached this stage are said to be at peace with themselves. The inability to reach this stage leads to fear of death and despair that life has been lived in vain. Ego differentiation, which is a part of the developmental stage of ego integrity, involves achieving an identity apart from work.

A condition of the bone that is the result of bone lysis exceeding the rate of bone matrix synthesis is called: osteoarthritis. kyphosis. osteopenia. osteoporosis.

osteopenia. Osteopenia is a condition of subnormally mineralized bone, usually as a result of a rate of bone lysis that exceeds the rate of bone matrix synthesis. Thoracic kyphosis is an angulation of the posterior spine that is sometimes referred to as "hunchback." Osteoarthritis is a degenerative joint disease that influences activity and endurance and is most frequently seen in the knees and hands, followed by hips, spine, shoulders, and ankles. Osteoporosis is a disorder characterized by abnormal loss of bone density and deterioration of bone tissue, with an increased fracture risk. It occurs most frequently in postmenopausal women who have fair complexions and are small, sedentary individuals, and people on long-term steroid use.

During middle adulthood, physiological changes affect most bodily systems. These changes include: increased cardiac output. increased glomerular filtration rates. thinning of the intervertebral disks. stable bone density and mass until the mid-60s.

thinning of the intervertebral disks. In the musculoskeletal system, bone density and mass progressively decrease. When 55-year-old adults say that they were 1 inch taller when they were 18, the observation is likely to be true. A 1- to 4-inch (2.5 to 10 cm) loss in height occurs as a person ages; thinning of the intervertebral disks accounts for approximately 1 inch. Bone density and mass gradually decrease throughout adult life. There is not a physiological scenario where these parameters are stable and unchanged until late adult life. Similarly, cardiac output and glomerular filtration both decrease throughout middle adult life although the changes are gradual and not readily noticeable due to considerable reserve in both of these systems. As functional aerobic capacity decreases, there is a resulting decrease in cardiac output. For individuals who maintain regular exercise programs that provide stretching and strengthening of skeletal muscle, cardiac output remains essentially undiminished for many years. The remaining nephrons increase in size and undergo degenerative changes. The entire weight of the kidneys decreases. Because blood supply is also diminished, the glomerular filtration rate is decreased by nearly half.