Developmental Stages: Early Adulthood to Later Adulthood

The nurse is told by an older woman that she has begun to be incontinent of urine at night and now drinks no fluids after 6.00 pm. Which is the nurse's best response?

"Incontinence at any age should be evaluated by your primary health care provider." Rationale: Urinary incontinence requires evaluation as to the cause so that appropriate treatment can begin. Incontinence is not expected in old age, and the statement about expecting incontinence represents stereotypical thinking. It is not correct to say that older adults do not need as much fluid intake as younger adults. This is also stereotypical thinking. The idea that most adults are able to judge fluid needs may be true generally but may not apply because of the development of this new problem.

An older client confides to the visiting nurse the fear of falling while going to the bathroom at night. Considering the visual changes affecting the older client, the nurse should make which recommendation?

"Keep a red light on in the bathroom at night." Rationale: Because it takes longer to adapt to changes from dark to light and vice versa, older people are at greater risk for falls and injuries. Any place where there is a sudden change from dark to light or from light to dark can be dangerous. Getting up during the night is hazardous for an older client. Eyes adapt to the dark by using the rod receptors, which are sensitive to short blue-green wavelengths. Red wavelengths are longer and are perceived by the cones. Thus, a red light in the bathroom at night allows for adequate vision to function in the dark without the need for adaptation.

The nurse is monitoring several older adults for adverse drug effects. Which client requires closest monitoring for drug toxicity?

A client who consumes a high-carbohydrate, low-protein diet. Rationale: A client who consumes a high-carbohydrate, low-protein diet is at highest risk of drug toxicity because an unbound active drug still circulates in the bloodstream. A client with a decreased, not an increased, hemoglobin and plasma protein level, is at higher risk of drug toxicity. A client who refuses to take antihypertensive medication would have a low drug level and would be less likely to experience drug toxicity.

The nurse is caring for an older client who is reminiscing about past life experiences in a positive manner. The nurse plans care with the understanding that this behavior indicates which?

A normal psychosocial response. Rationale: According to Erikson, the later years of life are from 65 years of age until death. The adult reminisces about past life experiences, often viewing them in a positive way. The adult needs to feel good about his or her accomplishments, see successes in his or her life, and feel that he or she has made a contribution to society.

The nurse is providing information to unlicensed assistive personnel (UAP) regarding caring for the older adult. The nurse determines the UAP understands the information provided if the UAP identifies which situation portrays ageism?

Advising older adults to forgo aggressive treatment. Rationale: Ageism is a form of prejudice in which older adults are stereotyped by characteristics found in only a few members of their group. Fundamental to ageism is the view that older people are different from "me" and will remain different from "me." Therefore, they are portrayed as not experiencing the same desires, needs, and concerns. Options 1, 2, and 3... Informing the older adult of their rights, Allowing older adults to make decisions, Accepting differences among older adults, ...identify supportive roles of the nurse when dealing with the older adult. Option 4 suggests that the older adult is not worthy of aggressive treatment and demonstrates ageism.

The nurse should plan which to encourage autonomy in the client who is a resident in a long-term care facility?

Allowing the client to choose social activities. Rationale: Autonomy is the personal freedom to direct one's own life as long as it does not impinge on the rights of others. An autonomous person is capable of rational thought. This individual can identify problems, search for alternatives, and choose solutions that allow for continued personal freedom as long as the rights and property of others are not harmed. The loss of autonomy—and, therefore, independence—is a very real fear among older clients. The correct option is the only choice that allows the client to be a decision maker.

An older adult couple requests to room together at a long-term care facility. When some members of the staff question this, the nurse should provide which response?

Although responses may be slower, sexual ability is present in later years of life. Rationale: The option regarding slower response time represents a true statement about sexuality in the older client. The other options... Aberrant sexual behavior is to be expected among older males. Most people do not engage in sexual activity after the age of 70. Physical beauty is necessary for continued sexual activity in older persons. ......indicate stereotypes with no foundation in fact.

The nurse will be caring for several older adults who will be undergoing general anesthesia. Which older adult will require the closest monitoring for a prolonged effect of anesthesia?

An older adult with increased amount of fatty tissue. Rationale: An older person needs fewer anesthetic agents to produce anesthesia, and it takes longer for the older person to eliminate anesthetic agents. One reason for the reduction of dosage is that the percentage of fatty tissue increases as people age. Anesthetic agents that have an affinity for fatty tissue concentrate in body fat and the brain. Another reason is that older clients may have low plasma proteins, particularly when malnourished. With decreased plasma proteins, more of the anesthetic agent remains free or unbound, which results in a more potent action. Reduction in liver size decreases the rate at which the liver can inactivate many anesthetic agents. The decreased functioning of kidney cells reduces excretion of waste products and anesthetic agents.

The nurse prepares to discharge a fifty-year-old client who is experiencing family-related stress. Which goal does the nurse include to help the client achieve the primary developmental task?

Assist the client resume her familial role. Rationale: The primary developmental task of middle adulthood is to realize generativity and to help guide children or the next generation through social situations in a productive manner. Thus, the nurse helps the client reclaim her role in the family as mentor and facilitator to avert stagnation in society. Helping the client with acceptance of aging is a developmental task of older adults and developing critical thinking skills are developmental tasks of young adults. Alleviating the stress response includes blocking the action of epinephrine and norepinephrine; the potential benefits from doing so are less directly related to the client's developmental task than helping her resume her role in the family.

An older client is taking multiple medications for a variety of health problems. The nurse should monitor the results of which most important laboratory test(s) when evaluating adverse effects of medication therapy in the older adult?

Creatinine. Rationale: Creatinine should be most closely monitored because it relates to kidney function. Because many medications are excreted by the kidneys, that makes this the laboratory test of choice for ongoing monitoring. The hemoglobin and hematocrit are part of the complete blood cell count, whereas arterial blood gases are not generally measured unless there is a specific problem with oxygenation.

The nurse is collecting data from an older adult client. Which indicates a potential complication associated with the skin of this client?

Crusting. Rationale: The normal physiological changes that occur in the skin of older adults include thinning of the skin, loss of elasticity, deepening of expression lines, and wrinkling. Crusting noted on the skin indicates a potential complication.

When the nurse is collecting data from the older adult, which findings should be considered normal physiological changes? Select all that apply.

Decline in visual acuity. Increased susceptibility to urinary tract infections. Increased incidence of awakening after sleep onset. Rationale: Anatomical changes to the eye affect the individual's visual ability, which leads to potential problems with activities of daily living. Light adaptation and visual fields are reduced. Respiratory rates are usually unchanged. The heart rate decreases, and the heart valves thicken. Age-related changes that affect the urinary tract increase an older client's susceptibility to urinary tract infections. Short-term memory may decline with age, but long-term memory is usually maintained. Changes in sleep patterns are consistent, age-related changes. Older persons experience an increased incidence of awakening after sleep onset.

An older client has been prescribed digoxin. The nurse determines that which age-related change would place the client at risk for digoxin toxicity?

Decreased lean body mass and glomerular filtration rate. Rationale: The older client is at risk for medication toxicity because of decreased lean body mass and an age-associated decreased glomerular filtration rate. Although the other changes identify age-related changes that occur in the older client, they are not specifically associated with this risk.

A client who has been seen in the clinic has been diagnosed with endometriosis and asks the nurse to describe this condition. Which is the best response for the nurse to provide?

Endometriosis is the presence of tissue outside the uterus that resembles the lining of the uterus. Rationale: Endometriosis is defined as the presence of tissue outside the uterus that resembles the endometrium in structure and function. The response of this tissue to the stimulation of estrogen and progesterone during the menstrual cycle is identical to that of the endometrium. Primary dysmenorrhea refers to menstrual pain without identified pathology. Mittelschmerz refers to pelvic pain that occurs midway between menstrual periods. Amenorrhea is the cessation of menstruation for a period of at least 3 cycles or 6 months in a woman who has established a pattern of menstruation. It can result from a variety of causes.

The nurse is conducting a session on the process of fertilization with a group of nursing students. The nurse asks a nursing student to identify the structure in which fertilization of an ovum takes place. The nurse midwife recognizes the teaching has been effective if the student selects which location?

Fallopian tube. Rationale: Fallopian tubes, also called oviducts, are 8 to 14 cm long and quite narrow. The fallopian tubes are pathways for the ovum between the ovary and the uterus. Fertilization occurs in the fallopian tube.

The nurse should implement which activity to promote reminiscence among older clients?

Having storytelling hours. Rationale: Clients who like to retell stories or to describe past events need to be provided with the opportunity to do so. This phenomenon is called life review or reminiscence. In a sense, it is a way for the older client to relive and restructure life experiences, and it is a part of achieving ego identity. Displaying calendars and clocks indicates reality orientation techniques. Pet therapy and pottery classes describe socialization and physical activities.

The nurse working in a long-term care facility is approached by the son of a resident, who wants his 78-year-old father to have a heating pad because "his feet are always cold at night." The nurse should incorporate which concept when formulating a response to the family member?

Older adults often have slower neurological response times and are therefore more at risk for burns. Rationale: Age-related changes in the older adult make the client more at risk for burns as a result of slower neurological response times. The option describing heating pads being dangerous represents a general statement, but it does not pertain to the individual safety of this client. The option describing resident rights ignores the client's safety and is unrelated to the subject of the question. Quoting facility policy represents a bureaucratic response and does not consider client needs.

The nurse is reinforcing teaching about fall prevention to family members of an older client who is at risk for falls. The nurse realizes further instruction is necessary if the family states which concept is relevant to maintenance of balance for the older adult?

Older clients cannot think quickly enough to respond to emergencies. Rationale: It is not true that older clients cannot think quickly enough to respond to emergencies. That statement is a stereotypical generalization. The statements contained in the other options... Older clients often have slower neurological responses to stimuli. Many medications may have orthostatic hypotension as a side effect. Older clients tend to maintain a broad base of support and thus change direction more slowly; ....indicate the family understands the concepts of balance in the older adult.

Which data would indicate a potential complication associated with age-related changes in the musculoskeletal system?

Overall sclerotic lesions. Rationale: Sclerotic lesions occur as bone resorption increases and results in replacement of original bone with fibrous material. This condition occurs in Paget's disease, an age-related disorder. Options 1 (decrease in height), 3 (diminished lean body mass), and 4 (change in structural bone tissue) identify normal age-related changes in the musculoskeletal system.

The nurse is collecting data from a client who is suspected of having mittelschmerz. Which finding, on data collection, is most closely associated with this disorder?

Sharp pain located on the right side of the pelvis. Rationale: Mittelschmerz (middle pain) refers to pelvic pain that occurs midway between menstrual periods or at the time of ovulation. The pain is due to growth of the dominant follicle within the ovary or rupture of the follicle and subsequent spillage of follicular fluid and blood into the peritoneal space. The pain is fairly sharp and is felt on the right or left side of the pelvis. It lasts generally a few hours to 2 days, and slight vaginal bleeding may accompany the discomfort.

The nurse instructs the unlicensed assistive personnel (UAP) assigned to care for an older adult client to place an extra blanket in the client's room. The nurse provides this instruction because the older adult is less able to regulate hot and cold body changes as a result of alterations in the activity of which gland?

Sweat glands. Rationale: Functions of the skin include protection, sensory reception, homeostasis, and temperature regulation. The skin helps regulate the body temperature in two ways, by dilation and constriction of blood vessels and by the activity of the sweat glands. As aging progresses, alterations in sweat gland activity make the glands less effective in temperature regulation, so the aging person is less able to regulate hot and cold body changes. The parotid glands are responsible for the drainage of saliva, which plays an important role in digestion. The pineal gland is a major site of melatonin biosynthesis. The thymus gland plays an immunological role throughout life.

The nurse is working with a new nurse who is assisting an older client and family with discharge planning following hospitalization. The nurse realizes the new nurse correctly understands the needs of older adults if the new nurse helps the group plan for which situation?

To live independently, but close to their children if possible. Rationale: Most older people prefer to maintain their independence while having the resource of children or family nearby to help in times of need. In general terms, the other options are not as favorably received by the older person, but this would also depend on the specific client and the specific situation.

The nurse has gathered data regarding an older client. The nurse recognizes that which indicator of fluid imbalance is least likely to be reliable for a client in this age group?

Thirst. Rationale: Thirst in the older adult is subjective and is not always consistent with fluid balance. The appearance of oral mucosa, skin turgor, and the differences between intake and output are more reliable measures of fluid balance in the older adult.

The nurse is providing an education class to healthy older adults. Which exercise will best promote health maintenance?

Walking three to five times a week for 30 minutes. Rationale: Exercise and activity are essential for health promotion and maintenance in the older adult and for achieving an optimal level of functioning. One of the best exercises for an older adult is walking, with the goal of progressing to 30-minute sessions three to five times each week. Gardening for an hour each day may not be practical. Not all clients have access to sculpting, and performing the activity once a week for 40 minutes would not provide enough activity. Cycling three times a week for 20 minutes would not provide enough activity, and not all clients have access to cycling.