Chapter 8: Management of the Older Adult Patient

The presence of a gerontologic advanced practice nurse in a long-term care facility has benefited both the clients and the larger community in which they live. Nurses in this advanced practice role have been shown to cause which outcome? A. Greater interaction between younger adults and older adults occurs. B. Older adults recover more quickly from acute illnesses. C. Less deterioration takes place in the overall health of clients. D. Older adults are happier in long-term care facilities than at home.

C

A nurse is caring for an 81-year-old client who has become increasingly frail and unsteady when standing. During the assessment, the client reports having fallen three times in the month, though the client did not suffer any injury. The nurse should take action in the knowledge that this client is at a high risk for which type of injury? A. A hip fracture B. A femoral fracture C. Pelvic dysplasia D. Tearing of a meniscus or bursa

A

An 80-year-old client is being admitted for dehydration and syncope. The client is found to be hypotensive, and intravenous fluids are ordered. What are some teaching strategies that the nurse should review with this client? A. Before ambulation the client should rise slowly and take mini breaks between lying, sitting, and standing. B. Increase consumption of meals to three times a day, with the largest meal being at breakfast. C. The client must use a rolling walker and call for assistance with any change in position. D. The temperature in the room should stay very hot, and bathing in hot water is appropriate.

A

For several years, a community health nurse has been working with a 78-year-old man who requires a wheelchair for mobility. The nurse is aware that the interactions between disabilities and aging are not yet clearly understood. This interaction varies depending on what variable? A. Socioeconomics B. Ethnicity C. Education D. Pharmacotherapy

A

After a sudden decline in cognition, a 77-year-old client who has been diagnosed with vascular dementia is receiving care at home. To reduce this client's risk of future infarcts, which action should the nurse most strongly encourage? A. Activity limitation and falls reduction efforts B. Adequate nutrition and fluid intake C. Rigorous control of the client's blood pressure and serum lipid levels D. Use of mobility aids to promote independence

C

The nurse is caring for a 91-year-old client who reports urge incontinence and sometimes falling when trying to get to the bathroom at home. The nurse identifies the nursing diagnosis of Risk for Falls related to impaired mobility and urinary incontinence. This client's risk for falls is considered to be which of the following? A. The result of impaired cognitive functioning B. The accumulation of environmental hazards C. A geriatric syndrome D. An age-related health deficit

C

A 65-year-old client has come to the clinic for a yearly physical. The client reports enjoying good health, but also reports having occasional episodes of constipation over the past 6 months. What intervention should the nurse first suggest? A. Reduce the amount of stress the client currently experiences. B. Increase carbohydrate intake and reduce protein intake. C. Take herbal laxatives, such as senna, each night at bedtime. D. Increase daily intake of water.

D

Gerontologic nursing is a specialty area of nursing that provides care for older adults in our population. Which goal of care should a gerontologic nurse prioritize when working with this population? Helping older adults: A. determine how to reduce their use of external resources. B. use their strengths to optimize independence. C. promote social integration. D. identify the weaknesses that most limit them.

B

A 69-year-old client is readmitted with heart failure. The client reports taking all medications as prescribed. The client's grandchild usually helps to set up a weekly organizer pill container but is away at college. What should the nurse first do with this information? A. Call the client's home to solicit another family member to help with the medications on discharge. B. Explain the current inpatient orders and make a note on the chart for discharge C. Contact the client's health care provider (HCP) for assistance and direction on how to proceed. D. Complete a comprehensive assessment reviewing the client's medication history, including over-the-counter medications

D

A 76-year-old client is in the emergency department with reports of nausea, dyspnea, and shoulder pain. The spouse stated the client woke up confused, slightly unsteady, and pale. Which problem or condition is most likely occurring? A. Myocardial ischemia B. Urinary tract infection (UTI) C. Lung cancer D. Chronic obstructive pulmonary disease (COPD)

A

A 76-year-old client with Parkinson disease has been admitted with aspiration pneumonia and constipation. Which nursing intervention would help both diagnoses? A. Sitting upright for meals B. Good oral hygiene C. Prolonged laxative usage D. Increase dietary fat

A

The case manager is working with an 84-year-old client newly admitted to a rehabilitation facility. When developing a care plan for this client, which factors should the nurse identify as positive attributes that enhance coping in this age group? Select all that apply. A. Decreased risk taking B. Effective adaptation skills C. Avoiding participation in untested roles D. Increased life experience E. Resilience during change

B, D, E

The nurse is caring for a 77-year-old client who was recently admitted to the geriatric medical unit. Since admission, the client has spoken frequently of becoming a burden to their children and the challenge of "staying afloat" financially. When planning this client's care, the nurse should recognize a heightened risk of what nursing diagnosis? A. Disturbed thought processes B. Impaired social interaction C. Decisional conflict D. Anxiety

D

A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be administering intramuscular (IM) doses of the vaccine. Which age-related change should the nurse be aware of when planning the appropriate administration of this drug? An older adult client has: A. less subcutaneous tissue and less muscle mass than a younger client. B. more subcutaneous tissue and less durable skin than a younger client. C. more superficial and tortuous nerve distribution than a younger client. D. a higher risk of bleeding after an IM injection than a younger client.

A

The nurse is providing education to a client with early-stage Alzheimer disease (AD) and the family members. The client has been prescribed donepezil hydrochloride. What should the nurse explain to the client and family about this drug? A. It slows the progression of AD. B. It cures AD in a small minority of clients. C. It removes the client's insight that they have AD. D. It eliminates the physical effects of AD and other dementias.

A

Which age-related physiologic change contributes to heart disease being the leading cause of death in older adults? A. Heart muscle and arteries lose their elasticity. B. Systolic blood pressure decreases. C. Resting heart rate decreases with age. D. Atrial-septal defects develop with age.

A

When implementing a comprehensive plan to reduce the incidence of falls on a gerontologic unit, what risk factors should the nurse identify? Select all that apply. A. Medication effects B. Overdependence on assistive devices C. Poor lighting D. Sensory impairment E. Ineffective use of coping strategies

A, C, D

A 55-year-old client is preparing to retire in the next five years. The client has made both financial and social plans to make a successful transition. What are some examples of social change that the client could plan? A. Additional reliance on the spouse and family to fill in leisure time B. Developing routines and friends not associated with work C. Planning several vacations to expand the client's social circle D. Starting an online social network to keep the client connected with co-workers

B

A 59-year-old client has come to the health care provider's office for an annual physical and is being assessed by the office nurse. The nurse who is performing routine health screening for this client should be aware that one of the first physical signs of aging is what? A. Having more frequent aches and pains B. Failing eyesight, especially close vision C. Increasing loss of muscle tone D. Accepting limitations while developing assets

B

A 72-year-old client has returned to the community following knee replacement surgery. The client takes nine different medications and has experienced dizziness since discharge. The nurse should identify which nursing diagnosis? A. Risk for infection related to polypharmacy and hypotension B. Risk for falls related to polypharmacy and impaired balance C. Adult failure to thrive related to chronic disease and circulatory disturbance D. Disturbed thought processes related to adverse drug effects and hypotension

B

A gerontologic nurse is making an effort to address some of the misconceptions about older adults that exist among health care providers. The nurse has made the point that most people aged 75 years and over remain functionally independent. The nurse should attribute this trend to what factor? A. Early detection of disease and increased advocacy by older adults B. Application of health-promotion and disease-prevention activities C. Changes in the medical treatment of hypertension and hyperlipidemia D. Genetic changes that have resulted in increased resiliency to acute infection

B

An 80-year-old client has been admitted to the hospital for hypertension and now requires oxygen. The client asks the nurse why oxygen is needed because they have never smoked and feel fine. The client requires oxygen in the hospital because of which respiratory changes or requirements? A. As a therapeutic measure to encourage coughing and deep breathing B. Diminished respiratory efficiency and declining aerobic capacity C. To increase inspiratory and expiratory force of lungs D. Lung mass increases and residual volume decreases

B

An occupational health nurse overhears an employee talking to a manager about a 65-year-old coworker. Which phenomenon should the nurse identify when hearing the employee state to the coworker, "You should just retire and make way for some new blood"? A. Intolerance B. Ageism C. Dependence D. Nonspecific prejudice

B

The admissions department at a local hospital is registering a 78-year-old client for an outpatient diagnostic test. The admissions nurse asks if the client has an advance directive. The client reports not wanting to complete an advance directive because they do not want anyone controlling their finances. What would be appropriate information for the nurse to share with this client? A. "Advance directives are not legal documents, so you have nothing to worry about." B. "Advance directives are limited only to health care instructions and directives." C. "Your finances cannot be managed without an advance directive." D. "Advance directives are implemented when you become incapacitated, when you will use a living will to allow the state to manage your money."

B

The nurse is caring for a 78-year-old client with cardiovascular disease. The client comes to the clinic with a suspected respiratory infection and is diagnosed with pneumonia. What should the nurse recognize about the altered responses of older adults? A. Treatments for older adults need to be more holistic than treatments used in the younger population. B. Increased and closer monitoring of older adults' body systems must occur to identify possible systemic complications. C. The aging process of older adults must define all nursing interventions with the client. D. Older adults become hypersensitive to antibiotic treatments for infectious disease states.

B

The nurse is planning an educational event for the nurses on a subacute medical unit on the topic of normal, age-related physiologic changes. What phenomenon should the nurse address? A. A decrease in cognition, judgment, and memory B. A decrease in muscle mass and bone density C. The disappearance of sexual desire for both men and women D. An increase in sebaceous and sweat gland function in both men and women

B

The nurse is providing care for an 82-year-old client whose signs and symptoms of Parkinson disease have worsened over the past several months. The client reports no longer being able to do as many things as in the past. Based on this statement, what issue is of most concern to the client? A. Neurologic deficits B. Loss of independence C. Age-related changes D. Tremors and decreased mobility

B

When the nurse observes physical indicators of illness in the older population, that nurse should be aware of which of the following principles? A. Potential life-threatening problems in the older adult population are not as serious as they are in a middle-aged population. B. Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults. C. The same physiologic processes that indicate serious health care problems in a younger population indicate mild disease states in older adults. D. Middle-aged people do not react to disease states the same way a younger population does.

B

A 54-year-old female client visiting her gynecologist is postmenopausal and reports painful intercourse. What is a physical change that is occurring to the client's reproductive system to account for this problem? A. Thickening of the vaginal wall B. Increased vaginal secretions C. Shortening of the vagina D. Increased pubococcygeal muscle tone

C

A gerontologic nurse is aware of the demographic changes that affect the provision of health care. Which demographic change has the biggest impact? A. More families are having to provide care for their aging members. B. Adult children find themselves participating in chronic disease management. C. A growing number of people live to a very old age. D. Older adults are having more accidents, increasing the costs of health care.

C

A home health nurse makes a home visit to a 90-year-old client who has cardiovascular disease. During the visit the nurse observes that the client has begun exhibiting subtle and unprecedented signs of confusion and agitation. What should the home health nurse do? A. Increase the frequency of the client's home care. B. Have a family member check in on the client in the evening. C. Arrange for the client to see their primary care provider. D. Refer the client to an adult day program.

C

The nurse is caring for clients in the urology clinic. A new, 73-year-old client presents with reports of urinary incontinence and is prescribed an anticholinergic. Why might this type of medication be an inappropriate choice in the older adult population? A. Gastrointestinal hypermotility can be an adverse effect of this medication. B. Detrusor instability can be an adverse effect of this medication. C. Confusion can be an adverse effect of this medication. D. Increased symptoms of urge incontinence can be an adverse effect of this medication.

C

A 62-year-old woman started experiencing urinary incontinence six months ago and now wears disposable incontinent panties. The client does not drink any fluids after 5 pm and considers this problem part of aging. What priority modifications and advice should be given to this client? A. "While urinary incontinence is part of the aging process, you should still see your health care provider (HCP) about this condition." B. "You probably have a urinary tract infection and should start drinking cranberry juice." C. "You could purchase pads to place into washable panties. This would decrease costs and feel less like a diaper." D. "Urinary incontinence is not part of the aging process. You should see your HCP and increase your water intake."

D

A gerontologic nurse is basing the therapeutic programs at a long-term care facility on Miller's Functional Consequences Theory. To put this theory into practice, the nurse should prioritize which task? A. Attempting to control age-related physiologic changes B. Lowering expectations for recovery from acute and chronic illnesses C. Helping older adults accept the inevitability of death D. Differentiating between age-related changes and modifiable risk factors

D

A gerontologic nurse is overseeing the care in a large, long-term care facility. The nurse is educating staff about the significant threat posed by influenza in older, frail adults. What action should the nurse prioritize to reduce the incidence and prevalence of influenza in the facility? A. Teach staff how to administer prophylactic antiviral medications effectively. B. Ensure that residents receive a high-calorie, high-protein diet during the winter. C. Make arrangements for residents to limit social interaction during winter months. D. Ensure that residents receive influenza vaccinations in the fall of each year.

D

A nurse is planning discharge education for an 81-year-old client with mild short-term memory loss. The discharge education will include how to perform basic wound care for the venous ulcer on the client's lower leg. When planning the necessary health education for this client, the nurse should take which action? A. Set long-term goals with the client. B. Provide a list of useful websites to supplement learning. C. Keep visual cues to a minimum to enhance the client's focus. D. Keep teaching periods short.

D

Nurses and members of other health disciplines at a state's public health division are planning programs for the next 5 years. The group has made the decision to focus on diseases that are experiencing the sharpest increases in their contributions to the overall death rate in the state. This team should plan health promotion and disease prevention activities to address what health problem? A. Stroke B. Cancer C. Respiratory infections D. Alzheimer disease

D

The home health nurse is making an initial home visit to a 71-year-old client who is widowed. The client reports having begun taking some herbal remedies. Which should the nurse be sure to include in the client's education? A. Herbal remedies are consistent with holistic health care. B. Herbal remedies are often cheaper than prescribed medication. C. It is safest to avoid the use of herbal remedies. D. There is a need to inform the primary care provider and pharmacist about the herbal remedies.

D