Gero Exam 2

An adult child caring for an older adult parent calls the nurse, stating concern about the parent's chronic bad breath and stubborn plaque on the teeth. Which teeth-cleaning measure should the nurse recommend for this older adult? "An manual toothbrush is most effective when giving oral hygiene." "Lemon-glycerin swabs should be used to clean around the gumline." "Use a soft swab to clean the teeth as well as gums." "An alcohol-based mouthwash will kill bacteria causing the odor."

"An manual toothbrush is most effective when giving oral hygiene."

A client has been asked to keep a food journal to address ongoing issues with constipation. When reviewing the journal, the nurse notes that the client has a bagel and coffee for breakfast, macaroni and cheese for lunch, and soup and salad for supper during a typical 24-hour period. Which dietary change will the nurse suggest? "Be sure to eat several small meals throughout each day." "Eat oatmeal for breakfast 3 to 4 days per week." "Take a daily multivitamin supplement." "Immediately increase your fiber by eating melon daily."

"Eat oatmeal for breakfast 3 to 4 days per week."

An older adult client asks the nurse for suggestions on how to treat indigestion and heartburn. How should the nurse respond? "Eat several small meals rather than three large meals." "Lay down after meals to allow for digestion." "Drink water before each meal to soothe your stomach." "Use over-the-counter antacids daily."

"Eat several small meals rather than three large meals."

The client is educating an older adult client the risk factors of obesity. Which statement by the client requires further follow up by the nurse? "If I appropriately control my weight, I can be assured that my risk for other diseases is lower." "If my weight is within an acceptable range, I don't have to worry about excess fat on my body." "If my body mass index is above 30 kilograms per meters squared, I am considered obese." "If my body mass index is too high, I may be at a higher risk for a stroke."

"If my weight is within an acceptable range, I don't have to worry about excess fat on my body."

An older adult client asks why he has two normal bowel movements within 30 to 45 minutes in the morning. Which is the nurse's best response? "Try temporarily limiting your fluid intake and see if it helps." "If possible, try to delay defecation as long as possible." "Incomplete emptying of the bowel is expected with age." "When was your last colonoscopy?"

"Incomplete emptying of the bowel is expected with age."

An older adult client is concerned about bleeding gums when brushing the teeth. What should the nurse respond to this client? "Increase your intake of green vegetables to help stop the bleeding." "Bleeding means you are taking too much aspirin." "That is nothing to worry about. Everyone's gums bleed at times." "It could mean you have the beginning of periodontal disease."

"It could mean you have the beginning of periodontal disease."

An older adult reports that the dentures are rubbing against the gums and causing discomfort. The client is not wearing the dentures at all now and states it will be too expensive to buy another set. What is the nurse's best response? "You should clean your dentures thoroughly to help them fit better." "Not wearing your dentures poses a choking hazard." "Sometimes dentures can be lined to ensure a proper fit." "You should eat soups and soft foods since you are not able to chew."

"Sometimes dentures can be lined to ensure a proper fit."

During a home visit, the nurse is asked by an older client if vitamin and nutritional supplements can compensate for decreased food intake. Which response by the nurse would be appropriate? "The risks of excess dosages mean that supplements are best avoided entirely." "Vitamin and nutrient supplements can be useful short-term, but only if they don't interact with prescribed medications." "Supplements can be useful but avoid those that contain calcium." "Supplements should be thought of as supplements, not replacements, so don't use them."

"Vitamin and nutrient supplements can be useful short-term, but only if they don't interact with prescribed medications."

An older adult client reports that he often experiences "indigestion" after each fatty foods. He states that this never used to happen to him when he was younger and asks the nurse why this is now the case. What is the nurse's best response? "With age, reduced pancreatic secretions can affect the digestion of fatty foods." "With age, decreased liver secretions can affect the digestion of fatty foods." "With age, increased liver secretions can affect the digestion of fatty foods." "With age, increased pancreatic secretions can affect the digestion of fatty foods."

"With age, reduced pancreatic secretions can affect the digestion of fatty foods."

A 78-year-old client states eating 3 full servings of fruits and vegetables per day. What is the nurse's best response? "The majority of this intake should be green vegetables." "Avoid eating too much broccoli due to the risk of high calcium consumption." "You should incorporate at least 2 more servings into your diet." "Substitute 1 or 2 of those servings with yogurt or gelatin dessert."

"You should incorporate at least 2 more servings into your diet."

What is basal cell carcinoma?

(most common type) occurs most often on the head and neck, if caught early treatment is close to 100%.

What is melanoma?

(most serious) is most likely to metastasize and cause death.

An older adult client has just been fitted with new dentures. What should the nurse emphasize when teaching about the care of the dentures? Select all that apply. Clean the dentures every day Clean the gums before applying the dentures Remove the dentures each night Schedule dental exams every 2 months Soak the dentures in water

- CLEAN DENTURES EVERY DAY- SOAK DENTURES IN WATER- REMOVE DENTURES AT NIGHT- CLEAN GUMS BEFORE APPLYING THEM

What do you use for a questionable skin lesion?

-Asymmetric shape, irregular or different-looking sides - Border that is irregular - Color change - Diameter, larger than a quarter of an inch OR increasing - Elevation, the lesion is raised

What is overactive bladder?

. Bothersome urgency, usually accompanied by nocturia and daytime frequency

The nurse is discussing nutritional health with an 89-year-old client. Which factor would the nurse interpret as a potential pathological process rather than a normal age-related change? A decrease in peristalsis of the esophagus and stomach A decrease in the amount of pepsinogen released in the stomach A decrease in the number of teeth and chewing ability A decrease in taste sensations and decreasing food intake

A decrease in the number of teeth and chewing ability

What is stress incontinence?

Associated with activities that increase intra- abdominal pressure

Men with ________________ may experience _______________, decreased urine flow, incomplete bladder emptying, and urinary urgency and frequency.

BPH Nocturia

An older adult client is prescribed a thiazide diuretic as treatment for mild right-sided heart failure. Which herbal supplement should the nurse instruct the client to avoid while taking this medication? Garlic Kava-kava Feverfew Cascara sagrada

Cascara sagrada

What is functional urinary incontinence?

Caused by non-GU factors such as age-related changes, decreased mobility, cognitive impairments

sweat glands age related changes

Decrease in number and functional ability, important for thermoregulation!

Renal blood flow increases or decreases with age related changes?

Decreases

Smooth muscle control increases or decreases with age related changes?

Decreases

After reviewing a client's list of medications the nurse asks if the client ever experiences a dry mouth. Which medication on the list caused the nurse to ask the client this question? Diuretic Oral hypoglycemic agent Vasodilator Anticoagulant

Diuretic

A 78-year-old client reports heartburn on a regular basis after eating. Which topic will the nurse include in the teaching plan? Eat smaller meals. Drink milk with meals. Include a glass of wine with dinner. Lay down after meals.

Eat smaller meals.

A 78-year-old female client who is obese has undergone a bone density scan that reveals bone loss. Which intervention will the nurse implement for this client? Provide a diet high in protein. Encourage weight bearing. Assess for hypertension. Perform activities of daily living (ADLs) for client.

Encourage weight bearing.

A nurse is assisting an older adult client who is being treated for pancreatitis to create a menu. Which food selection by the client would lead the nurse to develop a teaching plan for the client? 2% milk with high-fiber cereal grilled salmon with summer squash tomato sandwich on white bread Fried chicken with collard greens

Fried chicken with collard greens

An older adult client asks about natural means to promote bowel elimination. What should the nurse encourage the client to incorporate into a daily routine? Select all that apply. Organic foods Regular physical activity Increased fruit intake Increased fluid intake A variety of vegetables

Increased fluid intake, increased fruit intake, a variety of vegetables, regular physical activity

What is urge urinary incontinence?

Involuntary urine loss associated with a preceding strong desire to void and the inability to hold it long enough to reach the bathroom

What is mixed incontinence?

Leakage of urine with both the sensation of urgency and activities such as coughing, sneezing, etc.

As part of the treatment regimen for the diagnosis of colon cancer, a 73-year-old client has recently received a colostomy. During the early stages of client teaching, which information would be the nurse include as priority? Select all that apply. Modifications in food and fluid intake that surgical creation of the colostomy necessitates The lifestyle adjustments and effect on self-concept that often accompany colostomies Further treatment options that exist for treatment of the client's colon cancer Allowing a caregiver to assist with colostomy hygiene when needed The importance of monitoring for signs of infection at the colostomy site

Modifications in food and fluid intake that surgical creation of the colostomy necessitates The lifestyle adjustments and effect on self-concept that often accompany colostomies Allowing a caregiver to assist with colostomy hygiene when needed The importance of monitoring for signs of infection at the colostomy site

What is urinary incontinence?

NOT an age-related change, a geriatric syndrome

What are pre-renal conditions?

Not within the urinary system, but affecting it (ex. decreased renal blood flow)

A nurse is developing a plan of care for an older adult experiencing dysphagia. Which intervention would the nurse perform first? Weigh the client Thicken liquids Offer the client verbal cues when eating Observe the client's food intake

Observe the client's food intake

What are post-renal conditions?

Obstruction of the flow of urine (ex. stones, blood clots, tumors, BPH)

The nurse notes that an older client has difficulty swallowing a bolus of food when eating. Which suggestion should the nurse make to the health care provider based upon this observation? Referral for a speech-language pathologist Fluid restriction Nasogastric tube for enteral feedings Prescribe a liquid diet

Referral for a speech-language pathologist

The nurse is caring for an unresponsive client who wears partial dentures. Which action will the nurse take to provide oral care for this client? Provide oral care using lemon-glycerine swabs. Remove dentures, brush teeth and dentures daily. Brush teeth and dentures while in the mouth on a daily basis. Remove dentures and place in drawer while the client is responsive.

Remove dentures, brush teeth and dentures daily.

A client's family brings an older adult family member to the emergency department, stating, "My parent is not eating well." The nurse should assess for which sign of malnutrition? Serum albumin level 2.7 g/dL (27 g/L) Weight 5% below ideal range Hemoglobin level of 14 g/dL (140 g/L) Hematocrit level of 38% (0.38)

Serum albumin level 2.7 g/dL (27 g/L)

The nurse is preparing to facilitate a referral for an older adult client with dysphagia. To which member of the multidisciplinary team will the nurse place the referral? Registered dietician Rehabilitation therapist Speech-language therapist Geriatric nurse specialist

Speech-language therapist

The nurse is caring for a client who is diagnosed with xerostomia related to age-related decline in saliva production. Which intervention will the nurse implement for this client? Suck on hard candy during the day. Sip cold water throughout the day. Drink carbonated beverages. Avoid fluids at mealtime.

Suck on hard candy during the day.

Results of Aging

Susceptibility to injury - skin tears, pressure ulcers, decreased healing Response to ultraviolet radiation - increased skin cancer Comfort and sensation - dry skin, decreased sensitivity/sensation, impaired thermoregulation, risk of hypothermia/hyperthermia Cosmetic effects - paler, thinner, more translucent, irregular coloration sagging, wrinkles, growths and lesions

The nurse observes the unlicensed assistive personnel provide mouth care to an older client. For which observation should the nurse intervene? Swabbed the lower back molars with lemon-glycerin swabs Diluted mouthwash with water before providing Dampened the toothbrush with a small amount of water Applied a small amount of toothpaste onto a toothbrush

Swabbed the lower back molars with lemon-glycerin swabs

What is neuropathic bladder?

The bladder will not empty due to nerve damage, especially in diabetes

Manifestations of a _______________ may be very subtle; __________________ may be the initial primary sign.

UTI Urinary incontinence

The nurse is teaching a class to older adults about oral health practices. What health promotion activity should the nurse recommend? Visit a dentist every six months to check dentures Visit a dentist every six months to detect oral diseases Schedule visits to a dentist solely on the basis of tooth pain Visit a dentist every three months after the age of 80

Visit a dentist every six months to detect oral diseases

A health care provider has prescribed a calcium supplement for an older adult. Which other important nutrient should the nurse teach the client to eat to promote calcium absorption? Sodium and Vitamin B12 Potassium and Vitamin K Vitamin E and potassium Vitamin D and magnesium

Vitamin D and magnesium

An older adult client has a history of a deep vein thrombosis. The client should be taught to avoid excessive intake of which vitamin or nutrient? Vitamin K Calcium Vitamin D Potassium

Vitamin K

The nurse suspects that an older adult's diarrhea is related to medications. Which medication should the nurse consider as causing this client's problem? codeine ampicillin propranolol prednisone

ampicillin

Bacteriuria

bacteria in the urine

Epidermal cells age related changes

become larger and more variable in shape, the rate of turnover decreases

Age related changes in nails

become soft, fragile and brittle, growth is slowed

hematuria

blood in the urine

age related changes in hair

color and distribution changes, a progressive loss is seen

Kidney mass increases or decreases with age related changes?

decreases

Thirst perception increases or decreases with age?

decreases

epidermis age related changes

decreases in moisture

Dermal vascular bed age related changes

decreases which contributes to atrophy of hair bulbs, sweat and sebaceous glands

The nurse suspects that an older adult client is having problems with eating. What assessment finding may cause the nurse to make this clinical determination? dentures fitted with a liner 6 months ago last dental appointment 3 months ago dentures in a glass of water in the bathroom completes mouth care twice a day

dentures in a glass of water in the bathroom

Teaching to promote urinary wellness:

drink 8-10 glasses of non-caffeinated liquids each day, do not depend on thirst sensation, avoid foods and beverages that irritate the bladder (alcohol, caffeine, sugar, chocolate, artificial sweeteners, spicy and acidic foods), avoid smoking, maintain an ideal body weight, prevent constipation, pelvic muscle exercises

Glycosuria

glucose in the urine

Risk factors for urinary incontinence:

increased age, functional limitations, impaired cognition, obesity, smoking, white race, constipation, vaginal delivery, low vitamin D, medications, pathological conditions (diabetes, stroke, arthritis, etc.)

Sebaceous glands age related changes

increased in size but less sebum

Bladder wall (hypertrophy increases or decreases with age?

increases

When you have urinary infrequency and incontinence what happens?

it results in residual urine and an increased risk of bacteriuria.

ketonuria

ketones in the urine

Melanocytes age related changes

number of active cells decrease

pyuria

pus in the urine

Papillae age related changes

retreat causing a flattening of the dermal-epidermal junction

What is squamous cell carcinoma?

second most common type) occurs on the head, neck, forearms and hands.

The nurse is concerned that an older adult client is experiencing undiagnosed malnutrition. What information may cause the nurse to make this clinical determination? hemoglobin level 13 g/dL (130 g/L) serum albumin level 2.8 g/dL (28 g/L) serum calcium level 9 mg/dL (2.25 mmol/L) hematocrit level 37% (0.37)

serum albumin level 2.8 g/dL (28 g/L)

Subcutaneous tissue

some areas atrophy, however, overall hypertrophy causes a gradual increase in the proportion of body fat

What are the functions of the skin?

thermoregulation, excretion of metabolic wastes, protection, synthesis of vitamin D, maintenance of fluid/electrolyte balance, sensation of pain/touch/pressure/temp

An older client has esophageal dysphagia. What intervention should the nurse plan for this client? restrict fluids thicken liquids avoid foods 3 hours before bedtime raise the head of the bed 30 degrees

thicken liquids

Dermis age related changes

thickness decreases and collagen thins resulting in decreased elasticity and tensile strength

pelvic floor dysfunction can lead to what and why?

urinary infrequency and incontinence because it interferes with complete emptying of the bladder