Chapter 11: Health Care of the Older Adult PrepU

After teaching an older adult about measures to relieve constipation, which statement by the client indicates a need for additional teaching? -"I need to avoid foods that are high in fat." -"I should use a laxative every other day." -"I'll make sure that I drink plenty of fluids each day." -"I'm going to start walking every day for exercise."

"I should use a laxative every other day." Factors that may cause constipation include prolonged use of laxatives. Therefore, the patient should avoid the regular use of laxatives. To promote gastrointestinal motility, the patient should ensure adequate fluid intake, engage in regular exercise, avoid foods high in fat.

Which is a factor that contributes to urinary incontinence in older female adults? -Detrusor stability -Relaxed perineal muscle -Decreased urinary residual -Increased bladder capacity

Relaxed perineal muscle Female older adults typically have relaxed perineal muscle. The relaxed muscle can contribute to urinary incontinence, especially when laughing, coughing, and sneezing. Decreased urinary residual would not be a contributing factor. Most older adults have an increase in urinary residual. Most older adults have a decreased bladder capacity; this contributes to an increase in frequency in urination but not incontinence. Detrusor stability is a normal finding and helps prevent incontinence.

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? -"Evidence shows that there are changes in nerve cells and brain chemicals." -"The numerous drugs that he was taking contributed to his current confusion." -"This condition is most likely due to a stroke that the patient didn't realize he had." -"A specific gene is involved in the development of this disorder."

"Evidence shows that there are changes in nerve cells and brain chemicals." Specific neuropathologic and biochemical changes are found in patients with Alzheimer's disease. These include neurofibrillary tangles and neuritic plaques as well as altered neurotransmitter function, specifically acetylcholine. Vascular dementia is associated with a subclinical stroke. Although genetics is being studied as an underlying mechanism for Alzheimer's disease, no specific gene or genetic marker has been identified. Delirium is often the result of the interaction or use of multiple drugs.

A nurse is obtaining the health history of a 72-year-old woman who has come to the ambulatory care center for an evaluation. When obtaining information about the woman's sleep patterns, which of the following would the nurse expect to assess? -Statements that she rarely takes naps during the day -Reports that she has trouble waking up from sleeping -Complaints about frequently waking up during the night -Reports that she falls asleep more quickly

Complaints about frequently waking up during the night Older adults tend to take longer to fall asleep, awaken more frequently and easily, and spend less time in deep sleep. They may experience variations in their normal sleep-wake cycles. Coupled with the lack of quality of sleep at night, napping during the day is a common complaint.

A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? -Decreased acetylcholine level -Decreased norepinephrine level -Increased norepinephrine level -Increased acetylcholine level

Decreased acetylcholine level A decreased acetylcholine level has been implicated as a cause of cognitive changes in healthy elderly clients and in the severity of dementia. Choline acetyltransferase, an enzyme necessary for acetylcholine synthesis, has been found to be deficient in clients with dementia. Norepinephrine is associated with aggression, sleep-wake patterns, and the regulation of physical responses to emotional stimuli, such as the increased heart and respiratory rates caused by panic.

The nurse identifies which of the following as an age-related change in the respiratory system? -Increased cough efficiency -Increased residual lung volume -Increased diffusion capacity -Increased vital capacity

Increased residual lung volume The older adult experiences an increase in residual lung volume, decreased vital capacity, decreased diffusing capacity, and decreased cough efficiency.

Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? -Presbycusis -Presbyopia -Glaucoma -Cataract

Presbyopia Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. Presbycusis refers to age-related hearing loss. Cataract is the development of opacity of the eye lens. Glaucoma is a disease characterized by increased intraocular pressure.

An age-related change associated with the cardiovascular system is -decreased cardiac output. -thinner heart valves. -increased compliance of heart muscle. -decreased blood pressure.

decreased cardiac output. Age-related changes associated with the cardiovascular system include decreased cardiac output, increased blood pressure, decreased compliance of the heart muscle, and thickening of the heart valves.

A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate? -"Depression may manifest as dementia in elderly clients." -"Drug interactions are the most common cause of dementia in the elderly." -"Dementia is a terrible disease of the elderly." -"The most common cause of dementia in the elderly is Alzheimer's disease."

"The most common cause of dementia in the elderly is Alzheimer's disease." The nurse should inform the family member that Alzheimer's disease is the most common cause of dementia in elderly clients. Dementia is a clinical manifestation, not a disease process. Although drug interactions and overmedication are causes of dementia, these causes aren't as common as Alzheimer's disease. Depression is common in elderly clients, but it doesn't cause dementia.

A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? Select all that apply. -Have routine vision and hearing screenings -Review medications routinely for side effects -Frequently change the furniture layout in the home -Use scatter rugs on hard wood surfaces. -Place grab bars in the shower and tub -Wear nonslip shoes or socks when walking

-Place grab bars in the shower and tub -Have routine vision and hearing screenings -Wear nonslip shoes or socks when walking -Review medications routinely for side effects Grab bars in the shower and tub may decrease the chance of a fall on a slippery surface. Visual and hearing issues may contribute to falls. Medication interaction and side effects may increase the risk for falls, so medications should be reviewed. The older adult should wear proper nonskid footwear or socks when walking to help prevent falls. Changing the layout of the furniture in the home may increase the risk for falls because of items being in unfamiliar locations. Scatter rugs should not be used because they increase the risk for falls.

The nurse brings the older adult patient a dinner tray and observes the patient placing excess amounts of salt on the food. What suggestions for flavoring can the nurse provide to decrease the amount of salt the patient is placing on her food? (Select all that apply.) -Use pepper instead of salt. -Use low-sodium herbs and spices. -Use lemon instead of salt to flavor food. -Use an alcohol-based mouthwash prior to eating. -Drink water before the meal.

-Use low-sodium herbs and spices. -Use pepper instead of salt. -Use lemon instead of salt to flavor food. To add flavor to food without adding salt, the nurse should encourage the use of lemon, spices, and herbs. Drinking water or using an alcohol-based mouthwash prior to eating would not improve the taste of the food.

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 -screening for hypertension -decreased exercise -improved nutrition -decreased community-based services -early detection of elevated cholesterol levels

-decreased smoking -improved nutrition -screening for hypertension -early detection of elevated cholesterol levels Most deaths in the United States occur in people 65 years or older, with one-half of these caused by heart disease and cancer. Decreased smoking, improved nutrition, screening for hypertension, and early detection of elevated cholesterol levels are contributing factors to a decreased death rate in older adults. Older adults are encouraged to increase exercise and increase community-based services.

Which action by the nurse demonstrates ageism? -Allowing adequate time for the older adult to complete tasks -Encouraging the older adult to develop routines not associated with work -Providing the same high quality of care to all clients -Directing all health decisions to the older adult's child

Directing all health decisions to the older adult's child When the nurse directs all health care-related decisions to the older adult's child, the nurse is not respecting the individual choice of the older adult. The nurse is also assuming that the older adult cannot understand the decisions to be made, which is a myth about the elderly. The nurse should provide high-quality care to all clients, no matter what the age of the client. Allowing the client adequate time to complete tasks is appropriate and individualized. The older adult should be encouraged to develop routines not associated with work to decrease the potential for feeling nonproductive.

A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate? -Distract the client with a familiar object or music. -Document the inability to assess vital signs due to client's agitation. -Place the client in a secluded room until calm. -Continue taking the vital signs.

Distract the client with a familiar object or music. 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 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 -Administer an oral dose of prescribed alprazolam (Xanax). -Raise the upper and lower side rails of the bed. -Post a sign stating "You are in the hospital" at the client's eye level. -Place the client in a Posey chest restraint with ties attached to the bed frame.

Post a sign stating "You are in the hospital" at the client's eye level. Client confusion increases the risk of falls. Environmental cues include a sign stating, "You are in the hospital." Measures that are not restraining are used first. Raising the lower side rails is considered a restraint. This increases a confused client's risk for falling. Placing a client in a Posey chest restraint is a last resort. Administering an anti-anxiety medication can increase confusion in a client who is already confused.

A client at an extended-care facility who has Alzheimer's disease is awake throughout the night. The nurse intervenes with activities that will promote sleep at night, which include -Walking the client in the facility yard during the day -Allowing the client to take a 2-hour nap in the afternoon -Having the client sit at the nurse's station during night-time hours -Providing a glass of warm milk for breakfast

Walking the client in the facility yard during the day Regular exercise during the day will enhance sleep at night for clients with Alzheimer's disease. Another activity that helps for interrupted sleep, inability to fall asleep, or both is drinking warm milk at night. The nurse should discourage excessive sleep during the day. Sitting at the nurse's station may be too stimulating at night-time hours.

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? -"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." -"In order to prevent further bone loss, eat a diet high in magnesium and high in phosphorus."

"In order to prevent further bone loss, eat a diet high in calcium and low in phosphorus." 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.

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? -"Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." -"What concerns you most about Alzheimer disease?" -"Once the underlying cause of the confusion is found and treated, your loved one will be better than ever." -"Alzheimer disease can be a great burden on the family. What community resources do you know about?"

"Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." 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.

A hospitalized older adult complains of increased coughing and shortness of breath. The nurse assesses the vital signs as temperature 100.2°F oral, respirations 18, pulse 88, and BP 128/80. What action should the nurse do next? -Instruct patient to use incentive spirometer. -Administer cough medicine as needed (PRN). -Assess lung sounds and sputum. -Notify the physician.

Assess lung sounds and sputum. The older adult's immune system is not as effective, so the older adult may not show typical signs and symptoms of infection. The nurse should assess the lung sounds and sputum for signs and symptoms of infection. A temperature of 100.2°F in an older adult warrants further investigation of infection. The nurse does not have all the required information needed to notify the physician; the nurse needs to listen to lung sounds before notifying the physician. Although the client may need cough medicine PRN, it is not the next action to be taken. The use of an incentive spirometer may help prevent lung issues, but is not the next step to be taken by the nurse.

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 -Respiratory -Genitourinary -Gastrointestinal

Cardiovascular 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).

What is a nurse's role in providing home care for a client with Alzheimer disease? -Provide emotional and physical support. -Support client with household errands. -Provide assistance with administering IV fluids. -Contact the Motor Vehicle Department to have driver's license revoked.

Provide emotional and physical support. Home health care nurses provide emotional support and intervene if family caregivers become overburdened. The nurse also instructs the family about physical care, the disease process, and treatment. Administering IV fluids or supporting clients with household errands is not a relevant role for a home nurse. The nurse should provide education about safety, saying that the client with Alzheimer disease should not drive, but contacting the licensing department is not the nurse's responsibility.

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 -Impaired memory -Separation from others -Personality changes

Impaired memory 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.