Chapter 11 Health Care of the Older adult
Students are preparing a class presentation on elder abuse. Which of the following would they include as the most common type of elder abuse? A.) Emotional B.) Financial C.) Neglect D.) Sexual
Answer: C.) Neglect
The nurse is teaching about preventing pneumonia and influenza to a group of clients in a senior citizens' wellness class. The nurse includes which of the following topics in the class? Select all options that apply. - Avoiding environmental smoke - Participating in regular exercise - Ensuring appropriate fluid intake - Avoiding all sun exposure - Following a high-calcium diet
Answer: - Avoiding environmental smoke - Participating in regular exercise - Ensuring appropriate fluid intake
An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to A.) Minimize the use of stool softeners. B.) Ingest five or six small meals each day. C.) Use whirlpool baths for relaxation. D.) Take daily hot showers.
Answer: B.) Ingest five or six small meals each day.
Which is an age-related change in the respiratory system? A.) Increased blood pressure B.) Decreased gas exchange C.) Increase in muscle strength and size D.) Difficulty swallowing
Answer: B.) Decreased gas exchange Rationale: Age-related changes associated with the respiratory system include decreased gas exchange and diffusing capacity; decreased muscle strength, endurance, and vital capacity; and decreased cough efficiency. Age-related changes associated with the cardiovascular system include increased blood pressure. Changes that occur in the musculoskeletal system include loss of muscle strength and size. Difficulty swallowing occurs as an age-related change associated with the gastrointestinal system.
Which action by the nurse demonstrates ageism? A.) Providing the same high quality of care to all clients B.) Encouraging the older adult to develop routines not associated with work C.) Directing all health decisions to the older adult's child D.) Allowing adequate time for the older adult to complete tasks
Answer: C.) Directing all health decisions to the older adult's child
A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? A.) Decreased acetylcholine level B.) Increased acetylcholine level C.) Increased norepinephrine level D.) Decreased norepinephrine level
Answer: A.) Decreased acetylcholine level
An age-related change associated with the cardiovascular system is A.) decreased cardiac output. B.) decreased blood pressure. C.) increased compliance of heart muscle. D.) thinner heart valves.
Answer: A.) decreased cardiac output.
Which neurotransmitter is implicated in depression? A.) Atropine B.) Serotonin C.) Acetylcholine D.) Epinephrine
Answer: B.) Serotonin
Which older adult is at highest risk for medication-related toxicity? A.) An 82-year-old with chronic diarrhea B.) A 65-year-old with renal insufficiency C.) A 72-year-old with a body mass index (BMI) of 22.6 D.) An 86-year-old who has had type 2 diabetes mellitus for 2 years
Answer: B.) A 65-year-old with renal insufficiency
A client with Alzheimer's disease is admitted for hip surgery after falling and fracturing the right hip. The client's spouse tells the nurse about feeling guilty for letting the accident happen and reports not sleeping well lately because the spouse has been getting up at night and doing odd things. Which nursing diagnosis is most appropriate for the client's spouse? A.) Relocation stress syndrome related to hospitalization B.) Defensive coping related to diagnosis of Alzheimer's disease C.) Risk for caregiver role strain related to increased client care needs D.) Decisional conflict related to lack of relevant treatment information
Answer: C.) Risk for caregiver role strain related to increased client care needs
A nurse is preparing a presentation for a local senior center about the health status of older adults. What trends in health promotion and disease prevention activities would the nurse explain as contributing to declining death rates in the older adult population? Select all that apply. - decreased smoking - improved nutrition - screening for hypertension - early detection of elevated cholesterol levels - decreased exercise - decreased community-based services
Answer: - decreased smoking - improved nutrition - screening for hypertension - early detection of elevated cholesterol levels
To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should: A.) stay with the client and encourage him to eat. B.) help the client fill out his menu. C.) give the client privacy during meals. D.) fill out the menu for the client.
Answer: A.) stay with the client and encourage him to eat.
After teaching an older adult about measures to relieve constipation, which statement by the client indicates a need for additional teaching? A.) "I should use a laxative every other day." B.) "I'll make sure that I drink plenty of fluids each day." C.) "I'm going to start walking every day for exercise." D.) "I need to avoid foods that are high in fat."
Answer: A.) "I should use a laxative every other day."
A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds: A.) "What precipitates the outbursts?" B.) "You need to remain calm during the outbursts." C.) "Play quiet music that your grandmother may like." D.) "Start rubbing her shoulders and her back."
Answer: A.) "What precipitates the outbursts?" Rationale: A client with Alzheimer's disease may respond to exciting or confusing events with a catastrophic reaction, such as screaming, crying, or becoming abusive. The nurse needs to assess the situation and what precipitates the catastrophic reactions to best address how to prevent these events. Other nursing interventions include telling the client's granddaughter to remain calm and to distract the grandmother with quiet music, stroking, or both.
The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse? A.) Assess the need for pneumococcal and influenza vaccinations. B.) Administer intravenous morphine for report of postoperative pain. C.) Instruct the client to receive at least 1 hour of sun exposure each day. D.) Encourage physical activity of 30 minutes following breakfast daily.
Answer: A.) Assess the need for pneumococcal and influenza vaccinations. Rationale: Activities that help elderly people maintain respiratory function include pneumococcal and yearly influenza immunizations. The nurse is to ensure the safety of the client. It is unsafe to administer an intravenous pain medication and then immediately discharge the client. Elderly clients should limit sun exposure to 10 to 15 minutes daily, and avoid heavy activity after eating to prevent indigestion.
The nurse is assessing the genitourinary status of an older adult female patient who is experiencing stress incontinence. What finding is a common gerontologic finding for this population? A.) Bladder capacity decreases with advanced age. B.) All patients develop urinary tract infections. C.) Renal filtration rate increases. D.) Urine is more dilute in the older population.
Answer: A.) Bladder capacity decreases with advanced age.
An elderly client recovering from a hip repair becomes disoriented and tries to get out of bed frequently. The client states, "I forget I am in the hospital." The best nursing intervention is to A.) Post a sign stating "You are in the hospital" at the client's eye level. B.) Raise the upper and lower side rails of the bed. C.) Place the client in a Posey chest restraint with ties attached to the bed frame. D.) Administer an oral dose of prescribed alprazolam (Xanax).
Answer: A.) Post a sign stating "You are in the hospital" at the client's eye level.
A client reports to the nurse that her mother had macular degeneration and is concerned that she, too, may be at risk. What should the nurse tell the client? A.) Wear sunglasses with ultraviolet (UV) protection when outside. B.) Reduce the amount of cigarettes smoked daily from 20 to 10. C.) Vision loss is not hereditary. It is related to diet. D.) This condition is now curable.
Answer: A.) Wear sunglasses with ultraviolet (UV) protection when outside.
The client asks the nurse why she seems to have bone changes since she has gotten older. What is the best response by the nurse? A.) "Bone changes from aging result from a loss of vitamin absorption." B.) "Bone changes from aging result from a loss of calcium." C.) "Bone changes from aging result from a loss of magnesium." D.) "Bone changes from aging result from most medication therapies."
Answer: B.) "Bone changes from aging result from a loss of calcium."
A client reports to the nurse that over the past few months the elderly mother has become increasingly angry, responds inappropriately to conversations, and does not respond to calls if her back is turned away. What is the nurse's best response? A.) Tell the client it appears the mother has a hearing loss. B.) Ask if the mother could come in for a hearing evaluation. C.) Inform the client to ignore the behavior and the mother will stop. D.) Teach the client techniques for coping with the mother's anger.
Answer: B.) Ask if the mother could come in for a hearing evaluation.
An elderly client is hospitalized. To maintain the client's mobility, the best nursing intervention is A.) Sit the client in a chair for meals. B.) Encourage the client to perform active and passive range-of-motion exercises. C.) Assist the client with passive range-of-motion exercises. D.) Turn the client every 2 hours.
Answer: B.) Encourage the client to perform active and passive range-of-motion exercises.
When assessing an older adult's gastrointestinal system, the nurse would identify an increase in which of the following as normal? A.) Gastric motility B.) Feeling of fullness C.) Stomach emptying D.) Calcium absorption
Answer: B.) Feeling of fullness
A nurse is presenting a safety program to a group of older adults at a continuing care retirement community. The nurse emphasizes measures to reduce the risk of falls based on the understanding that which type of fracture is the most common? A.) Forearm B.) Hip C.) Femur D.) Ankle
Answer: B.) Hip
A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by A.) Converting liquid foods to a gelatin texture B.) Placing one food at a time in front of the client during meals C.) Cutting the client's food into small pieces D.) Serving hot foods at a warm temperature
Answer: B.) Placing one food at a time in front of the client during meals Rationale: Tasks should be simplified for the client with Alzheimer's disease. All options are steps the nurse can take to promote eating for the client with Alzheimer's disease. Offering one food at a time, however, helps to prevent the client from playing with food.
A family of a patient with Alzheimer's disease asks the nurse what causes this condition? Which response by the nurse would be most appropriate? A.) "This condition is most likely due to a stroke that the patient didn't realize he had." B.) "A specific gene is involved in the development of this disorder." C.) "Evidence shows that there are changes in nerve cells and brain chemicals." D.) "The numerous drugs that he was taking contributed to his current confusion."
Answer: C.) "Evidence shows that there are changes in nerve cells and brain chemicals."
A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include? A.) "This drug will help to stop the disease from getting worse." B.) "Once it becomes effective, you can stop the drug." C.) "The drug helps to control the symptoms of the disease." D.) "The client need to take this drug for the rest of his or her life."
Answer: C.) "The drug helps to control the symptoms of the disease." Rationale: Donepezil hydrochloride is a cholinesterase inhibitor used to control symptoms of Alzheimer's disease. It does not cure or slow progression. Typically cognitive ability improves within 6 to 12 months of therapy, but if stopped, cognitive progression occurs. It is recommended that treatment continue at least through the moderate stage of the illness. However, it usually is not prescribed as life-long therapy.
A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate? A.) Continue taking the vital signs. B.) Place the client in a secluded room until calm. C.) Distract the client with a familiar object or music. D.) Document the inability to assess vital signs due to client's agitation.
Answer: C.) Distract the client with a familiar object or music. Rationale: The nurse should try to calm the patient by using distraction with a familiar object or music. Continuing to take the vital signs will cause further agitation and possible harm to the client or nurse. Placing the client in a secluded room may increase agitation and should not be used in this situation. The nurse should document the inability to assess vital signs and the reason why this should be done after the client's basic needs have been met.
An elderly client reports that he feels like he voids frequently during the day and at night but cannot empty his bladder. The nurse instructs the client to A.) Decrease fluid intake. B.) Hold his urine as long as possible before voiding. C.) Limit ingestion of caffeinated beverages. D.) Drink no more than his current 2 to 3 ounces of alcohol each day.
Answer: C.) Limit ingestion of caffeinated beverages.
An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of A.) Degeneration in the efficiency of bone joints B.) The client's failure to exercise C.) Loss of bone density D.) Decreased muscle mass and joint cartilage
Answer: C.) Loss of bone density
Which is a factor that contributes to urinary incontinence in older female adults? A.) Decreased urinary residual B.) Increased bladder capacity C.) Relaxed perineal muscle D.) Detrusor stability
Answer: C.) Relaxed perineal muscle
An older adult develops sudden onset of confusion and is hospitalized. The family expresses concern that their loved one is developing Alzheimer disease. What response by the nurse is most appropriate? A.) "What concerns you most about Alzheimer disease?" B.) "Alzheimer disease can be a great burden on the family. What community resources do you know about?" C.) "Once the underlying cause of the confusion is found and treated, your loved one will be better than ever." D.) "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion."
Answer: D.) "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." Rationale: Delirium is associated with a sudden onset of confusion, not Alzheimer disease. The family needs to be told the correct information, which is that several underlying conditions could be causing the confusion. Once the underlying cause(s) is found and treated, the confusion should subside; however, some clients may not recover from the underlying cause, so telling the family the client will be better than ever is not appropriate. Asking the family about their concerns about Alzheimer disease and what they know about community support related to it is not appropriate because the client is exhibiting symptoms related to delirium.
The plan of care for a patient with advanced Alzheimer's disease includes the nursing diagnosis of risk for injury. The nurse has identified this nursing diagnosis most likely as related to which of the following? A.) Communication difficulties B.) Separation from others C.) Personality changes D.) Impaired memory
Answer: D.) Impaired memory Rationale: Patients with Alzheimer's disease are at high risk for injury because they have impaired memory and poor judgment. They also exhibit impulsivity, which increases their risk. Maintaining a safe environment takes top priority. Communication difficulties could be the basis for several nursing diagnoses such as impaired verbal communication, powerlessness, and impaired social interaction. Separation from others could lead to social isolation, impaired social interaction, and social isolation. Personality changes may lead to a risk for self- or other directed violence, chronic low self-esteem, and risk for suicide.
The reason that governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement? A.) Clients are unable to make any health care decision. B.) Clients lack capacity because of cognitive impairment. C.) Clients lack different perspectives. D.) Older adult clients are vulnerable.
Answer: D.) Older adult clients are vulnerable.
Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to which condition after a rib fracture? A.) Confusion B.) Asthma attacks C.) Bronchospasm D.) Pneumonia
Answer: D.) Pneumonia
Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? A.) Presbycusis B.) Cataract C.) Glaucoma D.) Presbyopia
Answer: D.) Presbyopia
When assessing an older adult, the nurse anticipates an increase in which component of respiratory status? A.) Vital capacity B.) Gas exchange and diffusing capacity C.) Cough efficiency D.) Residual lung volume
Answer: D.) Residual lung volume