(Exam 1) Chapter 11: Health Care of the Older Adult

The client's lab values are sodium 166 mEq/L, potassium 5.0 mEq/L, chloride 115 mEq/L, and bicarbonate 35 mEq/L. What condition is this client likely to have, judging by anion gap? Metabolic acidosis Respiratory alkalosis Metabolic alkalosis Respiratory acidosis

Metabolic acidosis

Which is an age-related change associated with the nervous system? Cerebral hypertrophy Increased nerve impulse conduction Increased cerebral function Postural hypotension

Postural hypotension

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... Inform the family to either wash their hands or use the hand sanitizer. Instruct the family to remove the toddler from the room for the protection of the client. Allow the toddler to remain in the room if a family member wipes the toddler's nose. Ask the family to leave the client's room.

Instruct the family to remove the toddler from the room for the protection of the client

The nurse is describing hospice services to the family of a patient with end-stage heart failure. Which of the following would the nurse be least likely to include as a major focus of care? A) Invasive therapy B) Emotional support C) Pain control D) Symptom management

Invasive therapy

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

Limit ingestion of caffeinated beverages

The reason that federal and state governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement? A) Clients lack different perspectives. B) Clients are unable to make any health care decision. C) Clients lack capacity because of cognitive impairment. D) Older adult clients are vulnerable.

Older adult clients are vulnerable.

A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by

Placing one food at a time in front of the client during meals

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?

Pneumonia

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). 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. 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.

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

Presbyopia

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

Presbyopia

A client with an intravenous infusion is rubbing his arm. The nurse assesses the site and decides to discontinue the current infusion because of concern that the client has developed phlebitis. Which of the following clinical manifestations would the nurse assess with phlebitis? Select all that apply. Cool area around the insertion site Reddened area along the path of the vein Tender area around the insertion site Ecchymosis at the insertion site Rapid, shallow respirations

Reddened area along the path of the vein Tender area around the insertion site

Which is a factor that contributes to urinary incontinence in older female adults?

Relaxed perineal muscle

The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The client continuously yells, "It's 1999 and you are going to hurt me!" What action should the nurse do first? A) Reorient the patient. B) Take the vital signs. C) Notify the physician. D) Assess for infection.

Reorient the patient.

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) Residual lung volume D) Cough efficiency

Residual lung volume

The following information is documented on the assessment form for an older adult: Kyphosis Dry mucous membranes Decreased respiratory excursion Urinary incontinence The nurse is reviewing the information and reports which of these findings to the physician?

Urinary incontinence

Which actions by the nurse will assist in promoting an older adult's adherence to medication therapy? Select all that apply. Educate the client to keep all medications and bottles for future reference. Use easy-to-open lids. Encourage the patient to use multiple pharmacies to obtain cheapest prices. Provide a written medication schedule. Encourage the client to keep a list of medications and review it frequently for updates. Instruct the client not to take herbal supplements.

Use easy-to-open lids. Provide a written medication schedule. Encourage the client to keep a list of medications and review it frequently for updates.

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 lemon instead of salt to flavor food. Use low-sodium herbs and spices. Drink water before the meal. Use an alcohol-based mouthwash prior to eating.

Use pepper instead of salt. Use lemon instead of salt to flavor food. Use low-sodium herbs and spices.

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

"Evidence shows that there are changes in nerve cells and brain chemicals."

An older adult female patient 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." "Supplement your diet with a multivitamin." "You can reverse the bone loss with surgical intervention." "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."

A patient with Alzheimer's disease is prescribed donepezil (Aricept). When teaching the patient and family about this drug, which of the following would the nurse include? "This drug will help to stop the disease from getting worse." "The drug helps to control the symptoms of the disease." "Once it becomes effective, you can stop the drug." "He'll need to take this drug for the rest of his life."

"The drug helps to control the symptoms of the disease."

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?

"The most common cause of dementia in the elderly is Alzheimer's disease."

A clinic nurse is meeting with a group of older adults living in a community that has been experiencing extremely hot summer days. Which of the following measures would the nurse encourage the clients to practice to protect their health during the hot summer days? Select all answers that apply. A) Increase fluid intake. B) Decrease fluid intake C) Circulate air with a fan or air conditioner. D) Wear lightweight shirts and shorts. E) Decrease baths to 3 times per week. F) Take cool showers.

A) Increase fluid intake. C) Circulate air with a fan or air conditioner. D) Wear lightweight shirts and shorts. F) Take cool showers.

A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? Select all that apply. A) Review medications routinely for side effects B) Place grab bars in the shower and tub C) Wear nonslip shoes or socks when walking D) Have routine vision and hearing screenings E) Place throw rugs on any un-carpeted surface

A) Review medications routinely for side effects B) Place grab bars in the shower and tub C) Wear nonslip shoes or socks when walking D) Have routine vision and hearing screenings

A nurse is reviewing the medications of a client who lives alone and reports having difficulty remembering when to take them. To aid in medication compliance, which of the following measures would the nurse employ? Select all answers that apply. A) Suggest that the client use a multiple-dose medication dispenser. B) Encourage the client to use containers with safety lids. C) Recommend to the client to use one pharmacy for all prescriptions. D) Write down the medication schedule for the client.

A) Write down the medication schedule for the client. C) Suggest that the client use a multiple-dose medication dispenser. D) Recommend to the client to use one pharmacy for all prescriptions.

Several staff members are taking a break in the unit's conference room when one of them states, "I dread getting old and having to retire. I don't want to just sit on the porch in my rocking chair." The statement reflects which of the following? Chronological aging Geriatrics Ageism Gerontology

Ageism

A nurse is assessing a client brought to the emergency room by his daughter. Which statement by the daughter would most likely lead the nurse to suspect that the client may have an infection? "My dad told me that he felt a little more tired today." "All of a sudden my dad seemed to become confused." "My dad said he felt dizzy when he stood up from his chair." "My dad's temperature was 97.6 degrees F this afternoon."

All of a sudden my dad seemed to become confused."

A client reports to the nurse that her elderly mother has become increasingly angry and responds inappropriately to conversations within the past few months. She notes that her mother does not respond when the mother's back is turned. The best intervention of the nurse is to

Ask if the mother could come in for a hearing evaluation

An older adult has a score of 12 on the Geriatric Depression Scale (GDS). What action should the nurse complete first? Encourage the client to participate in exercise activities. Encourage the client to discuss feelings. Notify the physician. Assess for the potential for self-harm.

Assess for the potential for self-harm.

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?

Assess lung sounds and sputum.

The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse? Administer intravenous morphine for report of postoperative pain. Assess the need for pneumococcal and influenza vaccinations. Encourage physical activity of 30 minutes following breakfast daily. Instruct the client to receive at least 1 hour of sun exposure each day.

Assess the need for pneumococcal and influenza vaccinations.

An elderly client is contemplating a move to a continuing care retirement community (CCRC). The nurse assesses that the client requires assistance with food preparation and recommends placement in... A) Acute care facilty B) Assisted-living apartment C) Independent dwelling D) Skilled nursing facility

Assisted-living apartment

When administering medications to an older adult patient, which medication does the nurse understand may remain in the body longer due to increased body fat? Diuretics Anticoagulants Barbiturates Digitalis glycosides

Barbiturates

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) Renal filtration rate increases B) Urine is more dilute in the older population. C) Bladder capacity decreases with advanced age. D) All patients develop urinary tract infections.

Bladder capacity decreases with advanced age.

After teaching an older adult about measures to relieve constipation, which statement by the client indicates a need for additional teaching? A) "I should consume more foods with fat." B) "I should drink more water." C) "I should use a laxative every other day." D) "I should exercise every other day."

C) "I should use a laxative every other day."

A nurse is teaching a nutrition class to a group of elderly clients at a retirement center. The nurse tells the clients that as a result of aging, they will need to decrease... A) Activity level B) Calories C) Proteins D) Complex carbohydrates

Calories Chapter 11: Health Care of the Older Adult - Page 199

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

A health care team is involved in caring for a client with advanced Alzheimer's disease. During a team conference, a newly hired nurse indicates that she has never cared for a client with advanced Alzheimer's disease. Which key point about the disease should the charge nurse include when teaching this nurse? A) The nursing staff should rely on the family to assist with care because family members know the client best. B) As long as the client receives the ordered medication, special care measures aren't necessary. C) Clients with Alzheimer's disease are at high risk for injury because of their impaired memory and poor judgment. D) Alzheimer's disease affects memory so the client doesn't need an explanation before procedures are performed.

Clients with Alzheimer's disease are at high risk for injury because of their impaired memory and poor judgment.

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? A) Complaints about frequently waking up during the night B) Statements that she rarely takes naps during the day C) Reports that she has trouble waking up from sleeping D) Reports that she falls asleep more quickly

Complaints about frequently waking up during the night

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? Tetany and increased blood urea nitrogen (BUN) levels Sunken eyeballs and spasticity Flaccidity and thirst Confusion and seizures

Confusion and seizures

An elderly client reports fatigue with increased activity. He states that he walks 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 102 beats per minute. The nurse instructs the client to Increase walking at a faster pace. Decrease walking frequency to three times each week. Continue to walk at his current level. Refrain from any form of exercise.

Continue to walk at his current level.

A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to... A) Ensure that the mother does not have access to car keys or drive an automobile. B) Turn off lights at night so that the mother differentiates night and day. C) Encourage the mother to take responsibility for cooking and cleaning the house. D) Allow the mother to smoke cigarettes outside on the porch without supervision.

Ensure that the mother does not have access to car keys or drive an automobile.

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. Following a high-calcium diet Ensuring appropriate fluid intake Participating in regular exercise Avoiding all sun exposure Avoiding environmental smoke

Ensuring appropriate fluid intake Participating in regular exercise Avoiding environmental smoke

When assessing an older adult's gastrointestinal system, the nurse would identify an increase in which of the following as normal? A) Feeling of fullness B) Gastric motility C) Calcium absorption D) Stomach emptying

Feeling of fullness

A nurse is preparing to assess an older adult patient. Which approach would the nurse most likely use? Body system assessment Functional assessment Head-to-toe assessment Body region assessment

Functional assessment

What is the leading cause of death among the elderly? A) Heart disease B) Cancer C) Pneumonia D) Cerebrovascular disease

Heart disease

A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching? A decline in sexual activity is a normal occurrence as you age. Most older adults reside in a long-term care facility. How old you feel will be determined by your physical and cognitive abilities. As an older adult, you will not be able to learn new skills or knowledge.

How old you feel will be determined by your physical and cognitive abilities.

A client in a nursing home is diagnosed with Alzheimer's disease. He exhibits the following symptoms: difficulty with recent and remote memory, irritability, depression, restlessness, difficulty swallowing, and occasional incontinence. This client is in what stage of Alzheimer's disease? A) IV B) III C) I D) II

II

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? Impaired memory Personality changes Separation from others Communication difficulties

Impaired memory

An elderly client reports to the nurse that food does not taste right. During a dietary assessment, the nurse learns that the client uses a lot of sugar and salt. The client states, "It makes the food taste better." The nurse intervenes by... A) Encouraging the client to use lemon, spices, and herbs in the diet B) Increasing the amount of hot foods served to the client C) Bringing 8 ounces of the client's favorite drink to the client D) Instructing the client to eat small, frequent meals

Encouraging the client to use lemon, spices, and herbs in the diet

Which factor alters urinary elimination patterns in older adults?

Decreased muscle tone

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."

"What precipitates the outbursts?" Chapter 11: Health Care of the Older Adult - Page 213

Approximately what percentage of home care required by elderly people with Alzheimer disease is provided by informal caregivers? 80 90 70 60

80

A nurse is teaching nursing assistants in an extended-care facility measures to protect the skin of elderly clients. Which of the following measures is the nurse likely to recommend?

Encouraging clients to avoid cigarette smoking

Which older adult is at highest risk for medication-related toxicity? A) A 86-year-old who has had Type-2 diabetes for the past 6 years B) A 40-year-old with severe diarrhea C) A 56-year old with gastric ulcer disease D) A 65-year-old with renal insufficiency

D) A 65-year-old with renal insufficiency

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) Take daily hot showers. C) Use whirlpool baths for relaxation. D) Ingest five or six small meals each day.

D) Ingest five or six small meals each day.

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)Increased norepinephrine level B)Decreased acetylcholine level C)Increased acetylcholine level D)Decreased norepinephrine level

Decreased acetylcholine level

Which is an age-related change in the respiratory system? A) Decreased gas exchange B) Increased blood pressure C) Difficulty swallowing D) Loss of muscle strength and size

Decreased gas exchange

Which is an age-related change in the respiratory system? A) Decreased gas exchange B) Loss of muscle strength and size C) Difficulty swallowing D) Increased blood pressure

Decreased gas exchange

You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? Hypovolemia Dehydration Hypervolemia Fluid volume excess

Dehydration

Which condition is characterized by a decline in intellectual functioning? Delirium Delusion Dementia Depression

Dementia

Which is the most common affective or mood disorder among older adults? Anxiety disorder Phobias Depression Schizophrenia

Depression

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

Directing all health decisions to the older adult's child

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) Place the client in a secluded room until calm. B) Continue taking the vital signs. C) Distract the client with a familiar object or music. D) Document the inability to assess vital signs due to client's agitation.

Distract the client with a familiar object or music.

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

decreased cardiac output

A nurse is caring for an elderly adult client admitted to the hospital from a nursing home because of a change in behavior. The client has a diagnosis of Alzheimer's disease and has started to experience episodes of incontinence. The hospital staff is having difficulty with toileting because the client wanders around the unit all day. To assist with elimination, a nurse should: A) have the client wear two briefs at a time to ensure absorption of incontinent urine. B) ask the physician to order sedation to allow the client to rest. C) incorporate the client's toileting schedule into the pattern of his wandering. D) ask the physician to order restraints to prevent wandering.

incorporate the client's toileting schedule into the pattern of his wandering.

Oncotic pressure refers to the...

osmotic pressure exerted by proteins.

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should:

stay with the client and encourage him to eat.

A client with Alzheimer's disease is being treated for malnutrition and dehydration. The nurse decides to place him closer to the nurses' station because of his tendency to: A) not change his position often. B) exhibit acquiescent behavior. C) wander. D) forget to eat.

wander.