Chapter 11: Health Care of the Older Adult

An older adult female client tells the nurse, "I have lost an inch [2.5 cm] of height and have a hump on my back. What can I do about this?" What is the best response by the nurse? "In order to prevent further bone loss, eat a diet high in calcium and low in phosphorus." "In order to prevent further bone loss, eat a diet high in magnesium and high in phosphorus." "You can reverse the shape of your spine with surgical intervention." "Supplement your diet with a multivitamin."

"In order to prevent further bone loss, eat a diet high in calcium and low in phosphorus." Rationale: To promote musculoskeletal health, the nurse should tell the client to do the following: exercise regularly; eat a high-calcium diet; limit phosphorus intake; and take calcium and vitamin D supplements as prescribed.

The nurse is working in a long-term care facility. When assessing her patients, what body system dysfunction should the nurse look for as the leading cause of morbidity and mortality in the older adult population? Cardiovascular Genitourinary Gastrointestinal Respiratory

Cardiovascular Rationale: Most deaths in the United States occur in people 65 years of age and older; 48% of these are caused by heart disease and cancer (Kochanek et al., 2011).

An elderly client reports fatigue without shortness of breath with walking 30 minutes five times each week. The nurse assesses the resting heart rate as 72 beats per minute; 10 minutes after walking, the client's heart rate is 92 beats per minute. What should the nurse instruct the client to do next? Continue to walk at his current level. Refrain from any form of exercise. Increase walking at a faster pace. Decrease walking frequency to three times each week.

Continue to walk at his current level. Rationale: Elderly clients may report fatigue with increased activity as a result of a slower heart rate recovery, which may be a physiological response to aging. An appropriate nursing intervention is to educate the client to exercise regularly but also to pace activities. The nurse does not want to tell the client not to exercise, to walk faster, or to decrease frequency.

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? Communication difficulties Separation from others Personality changes Impaired memory

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.

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to Ingest five or six small meals each day. Minimize the use of stool softeners. Use whirlpool baths for relaxation. Take daily hot showers.

Ingest five or six small meals each day. Rationale: A client who experiences orthostatic hypotension should eat five or six small meals to minimize hypotension that can occur after large meals. The client should avoid straining when having a bowel movement. A stool softener would be useful. Hot showers and whirlpools should be avoided.

An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to Instruct the family to remove the toddler from the room for the protection of the client. Ask the family to leave the client's room. Inform the family to either wash their hands or use the hand sanitizer. Allow the toddler to remain in the room if a family member wipes the toddler's nose.

Instruct the family to remove the toddler from the room for the protection of the client. Rationale: Elderly clients, particularly those who may be immunocompromised, need to avoid exposure to those who may have upper respiratory tract infections. The toddler needs to be removed from the client's room, not the whole family. It is appropriate for the family to wash their hands or use the hand sanitizer. However, it does not address the runny nose of the toddler, and it is not the most important action of the nurse.

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 Decrease fluid intake. Hold his urine as long as possible before voiding. Limit ingestion of caffeinated beverages. Drink no more than his current 2 to 3 ounces of alcohol each day.

Limit ingestion of caffeinated beverages Rationale: Symptoms that the client describes may be indicative of benign prostatic hypertrophy. The client should limit caffeinated beverages. He does not want to decrease fluid intake; doing so may increase his susceptibility to urinary tract infections. He needs to void frequently and not wait long periods between voiding. The client also should limit his alcohol intake, preferably decreasing it.

Students are reviewing information about visual changes and conditions associated with aging. The group demonstrates understanding of the information when they identify which condition as the major cause of vision loss in the elderly? Cataracts Presbyopia Macular degeneration Glaucoma

Macular degeneration Rationale: Age-related macular degeneration is the primary cause of vision loss in the elderly. More than 25% of people older than 75 years have some signs of this disease, and 6% to 8% have advanced disease associated with severe vision loss. Presbyopia refers to the condition in which the lens becomes less flexible and the near point of focus get farther away. It results in the need for reading glasses to magnify objects, but vision is not lost. Cataracts and glaucoma affect older adults, but these conditions are not the major cause of vision loss.

Students are preparing a class presentation on elder abuse. Which of the following would they include as the most common type of elder abuse? Neglect Emotional Financial Sexual

Neglect Rationale: Neglect is the most common type of elder abuse. Other types include physical, emotional, sexual, and financial abuse.

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

decreased smoking improved nutrition screening for hypertension early detection of elevated cholesterol levels Rationale: decreased smoking improved nutrition screening for hypertension early detection of elevated cholesterol levels