Gerontology

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A nurse is teaching an older adult client about methods to improve sleep. Which of the following statements should the nurse include in the teaching? a. "Go to bed at the same time every night." b. "Watch television in bed until you are sleepy." c. "Drink a glass of wine before going to bed." d. "Engage in physical activity in the evenings."

a. "Go to bed at the same time every night" The nurse should recommend that the client keep consistent sleep and wake times, even on the weekends. Having a regular sleep schedule will help minimize the alterations to the circadian rhythm that occurs in the older adult client. b. The nurse should discourage the client from watching television or performing any work in bed because this disrupts sleep quality. Instead, the nurse should recommend light reading or listening to relaxing music to assist the client in falling asleep. c. The nurse should discourage the use of alcohol or caffeine products prior to bedtime because these are stimulants and diuretics and inhibit sleep. Instead, the client can have a light carbohydrate or a glass of milk as a bedtime snack. d. The nurse should recommend the client participate in physical activity during the daytime as this can enhance sleep. However, the client should not participate in physical activity within 3 hr prior to bedtime because this can impair sleep.

A home-health nurse is caring for a client who has cancer and is using a fentanyl transdermal patch for pain control. Which of the following actions should the nurse take when caring for this client? a. Avoid using a heating pad on the area with the patch. b. To decrease the dose, cut the patch in half. c. Dispose of the used patch by placing it in the trash can. d. Assess the client for urinary retention every 8 hr.

a. Avoid using a heating pad on the area with the patch Applying heat over the site of the transdermal patch will increase the rate of absorption of the opioid medication and might cause respiratory depression. b. The nurse should obtain a new patch with the appropriate dosage of medication. Cutting the patch will effect delivery of the medication and will result in inappropriate dosage delivery. c. The nurse should dispose of a used patch by folding it with the adhesive edges together and placing it in a tamper-proof receptacle. d. The nurse should assess the client using a fentanyl patch for urinary retention every 4 to 6 hr.

A nurse at an ophthalmology clinic is assessing a client referred by the provider for a potential cataract. Which of the following client reports should the nurse recognize is consistent with cataracts? a. Halos when looking at lights b. Loss of peripheral vision c. Bright flashes of light and floaters d. Eyestrain and headache with close work

a. Halos when looking at lights A cataract is a cloudy or opaque area in the lens of the client's eye. Cataracts in adults usually develop with advancing age and can be hereditary. Cataracts develop slowly and painlessly with a gradual onset of difficulty with vision. Visual problems include difficulty seeing at night, halos around lights or glare sensitivity, and decreased visual acuity, even in daylight. Cataracts are accelerated by environmental factors, such as cigarette smoke or other toxic substances, or in response to metabolic diseases, such as diabetes mellitus. b. Loss of peripheral vision is an initial report by a client who has open-angle glaucoma. Glaucoma is a condition characterized by increased fluid pressure inside the eye, called intraocular pressure. This increased pressure damages the optic nerve, causing partial vision loss, with blindness as a possible outcome. c. Bright flashes of light, especially in the peripheral visual field, and floaters are associated with retinal detachment. Retinal detachment refers to the separation of the light-sensitive membrane in the back of the eye from its supporting layers. Trauma, the aging process, severe diabetes mellitus, or an inflammatory disorder can cause retinal detachment, but it frequently occurs spontaneously. d. Eyestrain and headache with close work is associated with decreased visual acuity. Both nearsightedness, which is an error of visual focusing that makes distant objects appear blurred, and farsightedness, which is an age-associated progressive loss of the focusing power of the lens that results in difficulty seeing objects close-up, can cause eyestrain and headache. Changes in visual acuity may represent primary eye disease, aging, eye trauma, or a generalized, systemic, illness, but whatever the cause, the nurse should not ignore visual chan

A nurse is performing an assessment on an older adult client who has chronic pain. Which of the following effects of unrelieved pain should the nurse identify as a priority finding to report? a. Impaired mobility b. Decreased independence c. Decreased self-esteem d. Impaired socialization

a. Impaired mobility The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one positing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. The nurse should identify that limited mobility will have an effect on the client's skin integrity, respiratory function, and elimination. Complications of the immobility resulting from unrelieved pain include pressure ulcers, pneumonia, and constipation. b. The nurse should address the limitations to the client's independence that unrelieved pain causes and the increased need for assistance with ADLs because this can negatively impact the client's self-esteem and well-being; however, there is another finding that is the priority. c. The nurse should more fully assess the effect that a decrease in self-esteem has on the client as this can negatively affect nutrition, motivation, and well-being; however, there is another finding that is the priority. d. The nurse should evaluate the impact the impaired socialization has on the client and assist the client in finding ways to regain social contacts since impaired socialization can have a negative effect on mood and cognition; however, there is another finding that is the priority.

The nurses caring for an older adult client who has gout and refuses to eat. That clients provider has approved the family to bring food from home. Which of the following foods should the nurse recommend that the client not eat? a. Lentil soup b. Cheese sandwich c. Yogurt d. Raisins

a. Lentil soup The nurse should encourage the client to eat a purine-restricted diet to decrease elevated uric acid levels. The diet is used for clients who have gout, renal calculi, or both in conjunction with medication therapy. Whole grain breads and cereals, oatmeal, wheat germ, wheat bran, meat gravies, fresh and saltwater fish, beans, organ meats, mushrooms, green peas, spinach, asparagus, cauliflower, and baker's and brewer's yeast are all high in purine. Lentils, which are legumes, are a rich source of purines. b. Ripe cheese is high in tyramine but not purine. MAOIs interfere with the inactivation of tyramine found in various foods, and adverse effects may occur with consumption of foods that contain tyramine. c. Yogurt is a good source of calcium, not purine. Many older adult clients, especially women, do not get enough calcium in their diets and require foods rich in calcium. d. Raisins are rich in potassium, but not purine. A potassium-restricted diet helps prevent high blood levels of potassium in clients who have renal failure.

A nurse is caring for an older adult client who is having a stroke. After assessing airway, breathing, and circulation, which of the following assessments is the nurse's priority? a. Level of consciousness b. muscle tone c. sensory changes d. gag reflex

a. Level of consciousness The nurse should apply the urgent versus nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs to be the priority need because they pose more of a threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The nurse should assess the client's level of consciousness to evaluate for increases in intracranial pressure that might have occurred. The nurse should use the NIH stroke scale or the Glasgow coma scale to evaluate level of consciousness. b. The nurse should assess the client's muscle tone to determine the extent of disability and the hemisphere affected by the stroke; however, there is another assessment that is the nurse's priority. c. The nurse should assess the sensory changes the client is experiencing to determine the extent of disability and the hemisphere the stroke affected; however, there is another assessment that is the nurse's priority. d. The nurse should assess the client's gag reflex to determine the extent of disability and limit the risk of aspiration due to the stroke; however, there is another assessment that is the nurse's priority.

A nurse is teaching a client who has chronic obstructive pulmonary disease (COPD) and has been losing weight about ways to improve his nutritional intake. Which of the following statements by the client indicates an understanding of the teaching? a. "I will choose hot foods to decrease the sense of fullness when eating." b. "I should add grated cheese to sauces and vegetables." c. "I will eat my largest meal of the day in the evening." d. "I should consume a diet high in carbohydrates."

b. "I should add grated cheese to sauces and vegetables." The nurse should reinforce that adding cheese to side dishes will increase the protein and calcium intake as well as increase calories. This will assist the client in regaining weight and stamina. a. The nurse should emphasize to the client that consuming cold foods will decrease his sense of satiety, allowing him to consume more calories. c. The nurse should recommend that the client consumes his largest meal early in the day, when energy is highest. This will allow him to consume more calories without causing fatigue. d. The nurse should emphasize that the client who has COPD should consume a high-protein diet. The client should limit carbohydrates because these break down into carbon dioxide and increase food-related dyspnea.

A nurse is caring for an older adult client who is expressing feelings of grief and longing for his earlier life. Which of the following actions should the nurse take? a. Listen attentively and allow the client to talk about the past. b. Change the topic of conversation. c. Let the client know that this is a common issue for older adult clients. d. Tell the client about some younger clients who are in worse shape than he is.

a. Listen attentively and allow the client to talk about the past The nurse should encourage the client to reminisce as a means of dealing with his feelings of grief and longing. This is the therapeutic technique of offering self. Listening to the client allows for venting of the client's feelings about the loss of a healthy, active life. According to Erikson's theory, reminiscence is a necessary activity for older adults, who are in the stage of integrity vs despair. b. The nurse should avoid changing the topic of discussion, even though the topic might be uncomfortable for the nurse. Changing the topic implies to the client that his needs are less important than the nurse's. c. The nurse should avoid using generalizations or stereotyping when communicating with the client, as this devalues the client's feelings. d. The nurse should avoid comparing one individual's experience to another because this devalues the client's feelings and does not allow him to develop coping strategies.

A nurse is performing skin assessments for a group of older adult clients. Which of the following findings should the nurse identify as a benign, age-related skin change commonly seen in older adult clients? a. Liver spots b. Nevi c. Atopic dermatitis d. Psoriasis

a. Liver spots Liver spots, also known as age spots or lentigines, are flat, brownish-black macules that usually occur in sun-exposed areas of the body. Aging and exposure to sunlight, or other forms of ultraviolet light, can result in increased pigmentation. Liver spots are extremely common after 40 years of age; they occur most often on the forearms, shoulders, face, forehead, and backs of the hands, which are also the areas of highest sun exposure. They are harmless and painless, but they can affect the client's cosmetic appearance. b. Nevi are moles, a growth of pigment-forming cells that might be benign or malignant. The nurse should identify that nevi occur throughout the lifespan. Further evaluation of the nevi should include evaluation of any asymmetry, border irregularity, color variation, diameter, and evolution, which can indicate melanoma. c. Atopic dermatitis, or eczema, is a chronic skin disorder that occurs in all ages, but is more common in infancy and childhood. Clients who have atopic dermatitis can have scaly and itching rashes. d. Psoriasis is a common skin inflammation with frequent episodes of redness, itching, and thick, dry, silvery scales on the skin. The nurse should identify that while generally a benign condition, psoriasis is a chronic, recurring condition in clients of all ages, most commonly in clients from 15 to 35 years of age.

A nurse at an assisted living center is conducting an orientation session for a group of newly hired assistive personnel (AP). Which of the following instruction should the nurse include regarding plans for hearing impaired? a. Maintain eye contact with the clients. b. Stand to one side of the clients and speak into their good ears. c. Speak loudly with exaggerated enunciation. d. Ask only questions with yes or no answers.

a. Maintain eye contact with the clients -Many older adult clients who are hearing impaired use lip-reading and gestures to help understand what is said to them. Maintaining eye contact and speaking slowly will promote lip-reading. b. Many older adult clients who are hearing impaired use lip-reading and gestures to help understand what is said to them. Speaking to one side of the client will not give him the ability to use lip-reading or see gestures. c. Many older adult clients who are hearing impaired use lip-reading and gestures to help understand what is said to them. The client can hear better when the nurse speaks in a moderate tone of voice. d. This is not a helpful action. To respond, even with just a yes or no, the clients must be able to hear or understand what is being said to them.

Play nurses teaching an older adult client who is on bed rest falling development of deep vein thrombosis (DVT) about methods to increase peristalsis. Which of the following high fiber food choices show that nurse recommend? a. Navy bean soup b. Canned fruit juice c. White rice pudding d. Soy milk

a. Navy bean soup An older adult client who is on bedrest has an increased risk for constipation due to the decreased peristalsis associated with the aging process. Increasing dietary fiber by adding foods like legumes to the diet, as well as ensuring adequate fluid intake, will promote bowel regularity. b. The nurse should recommend canned fruit and fruit juices without pulp as a low-fiber choice, which can help decrease peristalsis. c. The nurse should recommend white rice pudding as a low-fiber choice, which can help decrease peristalsis. d. The nurse should recommend soy milk as a low-fiber choice, which can help decrease peristalsis.

A nurse is caring for an older adult client who has dementia. The clan becomes agitated and confused at night and wanders into the hallway. Which are the falling action should the nurse take? a. Place the client's mattress on the floor. b. Restrain the client during the nighttime hours. c. Provide continuous orientation to the client. d. Turn out the lights in the client's room at night.

a. Place the clients mattress on the floor -To ensure the client's safety and prevent falls when he is confused at night, the nurse should place his mattress on the floor. b. The nurse should use a sensor device to alert when the client is wandering. Restraints can cause the client to become frightened and struggle against them. c. The nurse should provide orientation information only if it calms the client. When a client is agitated, the nurse should not try to force orientation and further increase his distress. d. The nurse should keep the area well lit, because lighting can reinforce orientation for the client and minimize illusions.

A nurse is caring for a client who has aphasia following a stroke. Which of the following actions should the nurse take? a. Present one idea in a sentence. b. Avoid using nonverbal communication techniques. c. Speak loudly. d. Use simplified language.

a. Present one idea in a sentence The nurse should present one idea or thought in a sentence to avoid creating frustration for the client. Additionally, the nurse should allow time for the client to process and respond to the nurse. b. The nurse should use nonverbal techniques, such as body language, to help convey meaning to the client through gestures, body movements, and touch. It can reinforce verbal communication. c. The nurse should speak slowly and clearly to the client who has aphasia. Speaking loudly will not assist the client in understanding what is being said. d. The nurse should use language that is appropriate for an adult and avoid using childish tones. The inability to speak does not reflect on the client's intelligence.

A nurse working in a community health center is completing an assessment of an older adult female client. Which of the following findings should the nurse identify as a priority? a. Rales heard in the bases of the lungs b. Constipation c. Urinary frequency d. Painful intercourse

a. Rales heard in the bases of lungs The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning - having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life, and is therefore, the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. b. Although bowel motility slows somewhat with aging, it does not normally result in constipation. More likely, this is the result of medications, life habits, immobility or inadequate fluid intake. Although constipation is not an expected finding, another finding is the priority. c. Urinary frequency is a common report among older adult clients. Bladder capacity decreases, and weakened contractions during emptying of the bladder can result in post-void residual amounts and increased risk of infection. The nurse should further assess the client's urinary frequency d. A report of painful intercourse is common in older adult clients due to vaginal narrowing, loss of elasticity, and decreased secretions. The nurse should discuss this finding further with the client

A nurse is planning to administer diphenhydramine hydrochloride to an older adult client. Which of the following actions should the nurse plan to take prior to administration? a. Review the medical record for a client history of glaucoma. b. Plan to administer the medication 30 min prior to a meal. c. Explain to the client he will need to restrict his fluid intake once he takes the medication. d. Remind the client that his appetite might increase when starting the medication.

a. Review the medical record for a client history of glaucoma The nurse should review the medical record for a history of glaucoma prior to administration of the medication. Diphenhydramine is contraindicated for clients who have narrow-angle glaucoma because diphenhydramine can dilate the pupils. Clients who have glaucoma are administered medication to constrict the pupils, which improves circulation of the aqueous humor for absorption. b. The nurse should administer diphenhydramine with food or milk to decrease gastrointestinal adverse effects. c. The nurse should plan to inform the client to increase fluid intake. This medication has an atropine-like drying effect and thickens bronchial secretions. d. The nurse should remind the client that anorexia, nausea, and vomiting are gastrointestinal adverse effects of the medication.

A nurse at a long term care facility is providing teaching to a group of adolescents who are new volunteers. The nurse should explain that older adult clients are most likely to exhibit a decrease in which of the following? a. Short-term memory b. Creative ability c. Decision-making skills d. Cognitive capacity

a. Short term memory The ability to process short-term memories decreases as part of the aging process. As a result, older adult clients might require reminders regarding their medications, ADLs, or daily schedules. The nurse should tell the volunteers that residents might have difficulty remembering their names from day to day, ask the same question repeatedly, or need assistance remembering recent events. b. Creative ability does not decrease in older adult clients. Most long-term care facilities provide recreational activities, including opportunities for creating things through artistic expression, for clients. Clients who have dementia and other neurologic disorders might still be able to participate in creative activities. c. Decision-making skills do not decrease in older adult clients as a result of the aging process. Clients who have dementia and neurologic disorders might still be able to participate in making decisions about themselves or their care. Unless the client is found to be incompetent, the client will retain decision-making rights, including self-determination and autonomy. d. Cognition does not decrease in older adult clients as a result of the aging process. Clients who have dementia or other organic or traumatic brain disorders might still be able to learn simple tasks or adjust to new situations or routines. The client's speed, rather than ability, to perform a task might decrease.

A nurses providing discharge instructions about calcium supplements to an older adult female client who has osteoporosis and a recent repair from her fracture in her right hip. Which of the following instruction should the nurse include? a. "You should take your calcium supplement with a large glass of water." b. "You should increase your intake of grain cereals while taking calcium supplements." c. "You should take at least 2600 milligrams of calcium supplements daily." d. "You will not need to take vitamin D with your calcium supplement after menopause.

a. You should take a calcium supplement with a large glass of water -The nurse should instruct the client to take calcium supplements with a large glass of water, with or after meals, to promote absorption of the supplement. b. Foods such as oatmeal and other grain cereals contain phytic acid, which can decrease the absorption of calcium supplements. c. The recommended dietary allowance (RDA) of calcium for the older adult female client is 1200 mg. Supplements are taken to make up the difference between what the diet provides and the RDA. There is a risk of calcium toxicity if calcium supplementation exceeds the RDA. d. Clients who are taking a calcium supplement should also take vitamin D to increase absorption even after menopause.

A nurse at a long-term care facility is teaching an older adult client about ambulating with a quad-cane. Which of the following statements should the nurse include in the teaching? a. "Adjust the height of the cane so that you can flex your elbow at 45 degrees." b. "Hold the cane in the hand on the stronger side of your body." c. "Place the flat side of the cane away from your foot." d. "Move the cane and your stronger leg at the same time."

b. "Hold the cane in the hand on the stronger side of your body." The client should hold the cane with the hand on the stronger side of her body so that she can move the cane to support the weaker leg. This action allows for a more normal gait, with the ipsilateral arm and weaker leg moving at the same time. a. The nurse should instruct the client that the cane's height should allow the elbow to be slightly flexed. Having a flexion of 45º would make the cane too tall for safe use. c. The client should place the flat edge of the base of the cane facing toward her foot. This allows the client to ambulate without the risk of getting her foot caught in the base of the cane and falling. d. The nurse should instruct the client to move the cane and her weaker leg at the same time. This action allows for a more normal gait with the ipsilateral arm and weaker leg moving at the same time.

A nurse is providing teaching to an older adult client who has osteoarthritis of the right hip and lower lumbar vertebrae. Which of the following statements by the client indicates an understanding of the teaching? a. "I should avoid the use of a heating pad on my back." b. "To relieve the pressure on my hip, I can use a cane while ambulating." c. "I will have steroid injections to my joints as the first medication of choice to treat my pain." d. "I will exercise even when it causes pain."

b. "To relieve the pressure on my hip, I can use a cane while ambulating" Using a cane as an assistive device enables the client to compensate for weakness in the spine by providing some relief of hip pressure. Use of a cane can provide joint support and safety for self-care activities. a. The use of heat and cold are therapeutic treatments in the management of arthritic pain. The preference of the client drives the decision between the two therapies. c. Acetaminophen is the first medication of choice to treat the older adult client's pain from osteoarthritis. The nurse should instruct the client to take the medication as prescribed and not to wait until the pain is severe. Steroid joint injections are used for persistent and disabling pain in the joints. d. The nurse should teach the client to not exercise if exercise causes pain. Goals for clients who have osteoarthritis include balancing rest with activity and avoiding activities that cause pain or discomfort. Consistent activity is not beneficial for a client who has an arthritic joint disease because it can produce further damage to the joints and tissues.

A nurse is conducting an admission assessment for an older adult client. Which of the following actions should the nurse take to collect subjective data? a. Leave the client a written questionnaire to fill out in private. b. Allow sufficient time for the client to respond to the questions. c. Talk to family members to obtain the client's health history. d. Obtain the health history from the client's medical record.

b. Allow sufficient time for the claim to respond to the questions The nurse should recognize that it might take an older adult client longer than other clients to process and respond to questions. Consequently, the nurse should allow adequate time for the client to respond without appearing rushed. The client's verbal responses formulate the subjective data of the health history. a. The nurse should obtain subjective data by asking the client questions and having the client provide verbal descriptions of her health problems. c. Family members can serve as a source of information for the nurse and they can confirm findings that a client provides. However, only the client can provide subjective data relevant to her health condition. d. The client's medical record is a source for her medical history, laboratory and diagnostic test results, and current physical findings. However, only the client can provide subjective data relevant to her condition.

A nurse is developing a plan of care for a client who had a recent stroke and has a history of gastroesophageal reflux disease (GERD). For which of the following disorders should the nurse plan to monitor this client? a. Duodenal ulcer disease b. Aspiration pneumonia c. Viral pneumonia d. Esophageal varices

b. Aspiration Pneumonia GERD results in reflux of gastric secretions from the stomach into the lower esophagus. When regurgitation occurs, the client is at high risk for pneumonia. Pneumonia occurs due to aspiration of gastric contents into the airway. This client is at increased risk for dysphagia due to the stroke and history of GERD; therefore, the nurse should monitor closely for aspiration pneumonia. a. The acidity of stomach contents that reflux back into the esophagus results in an inflamed esophagus, not duodenum, which is a section of the small intestine. With duodenal ulcer disease, there are ulcers in the duodenum, usually associated with stress, COPD, pancreatic disease, and chronic renal failure. c. The cause of viral pneumonia is an inhaled virus that settles in the lungs. GERD does not increase the risk of viral pneumonia. d. Esophageal varices occur in clients who have portal hypertension, usually due to hepatic cirrhosis.

A nurse is teaching a newly hired assistive personnel about her role in helping older adult clients with activities of daily living (ADLs). The nurse should explain that which of the following is the most common factor that affects a client's performance of ADLS? a. Social withdrawal b. Chronic physical disability c. Emotional impairment d. Cognitive dysfunction

b. Chronic physical disability Physical disability is the most common reason older adult clients have difficulty performing ADLs. Self-care deficit, the nursing diagnosis that describes the inability of the client to perform self-care activities necessary for optimum health and function, is associated with several physical etiologic factors: activity intolerance, pain, neuromuscular impairment, sensory-perceptual impairment, musculoskeletal impairment, and cognitive impairment. c. Emotional stability does not decrease in older adult clients as a consequence of the aging process. While depression is common in older adult clients, it is often associated with a serious or disabling medical diagnosis, physical impairment, or as a side effect of medications. Clients who are depressed might, as a result of their mood disorder, be reluctant to perform their ADLs and need assistance or encouragement. d. Cognition does not decrease in older adults as a consequence of the aging process. Even clients who have dementia and other neurologic disorders might still be able to learn and perform tasks, such as ADLs, or adjust to new situations or routines.

A nurse is caring for an older adult client who has a new onset of type 2 diabetes mellitus. Which of the following physiologic changes can contribute to the development of type 2 diabetes? a. Increased production of insulin by the pancreas b. Decreased sensitivity to the circulating insulin c. Increased rate of glucose metabolism d. Decreased release of glycogen by the liver

b. Decrease sensitivity to the circulating insulin The pancreas in older adult clients demonstrates reduced tissue sensitivity to circulating insulin, leading to an increased risk of developing type 2 diabetes mellitus. a. There is an insufficient release of insulin by the beta cells within the pancreas with type 2 diabetes mellitus. c. There is a decrease in the rate of glucose metabolism in older adult clients. This is especially true if there is a sudden, high concentration of glucose consumed. d. Glucose is stored in the liver as glycogen. A decrease in the amount of glycogen converted to glucose and released to the body results in a decrease in blood glucose, rather than an elevation.

A nurse is assessing an older adult client during an annual physical. Which of the following client findings should the nurse report to the provider? a. BP 118/76 mm Hg b. Fasting blood glucose level 160 mg/dL c. Report of waking to void two to three times per night d. Report of bowel movement every other day

b. Fasting blood glucose level of 160 The nurse should recognize that a fasting blood glucose level of 160 mg/dL is elevated. The nurse should report this value to the provider for further evaluation, as the client might be showing early signs of a tendency for diabetes mellitus. a. The client's BP is within the expected reference range. The nurse should inform the provider if the client's BP is equal to or greater than 140/90 mm HG. The nurse should counsel the client to continue to have his BP checked at regular intervals. c. Waking to void at night can be due to the normal aging process. Bladder capacity decreases with age, causing the client to reach a sensation of fullness and the need to void several times during the night. d. Evacuating the bowels every other day can be due to slowing of peristalsis, which is a part of the aging process. The nurse should counsel the client on the benefits of adequate fluid and fiber in the diet to maintain bowel regularity.

A community health nurse is visiting the home of an older adult client and her caregiver. The client has excoriations to her wrists and ankles. Which of the following actions should the nurse take first? a. Refer the caregiver to a support group. b. Interview the client in private. c. Document the client's wounds. d. Contact adult protective services.

b. Interview the client in private The nurse should apply the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds upon the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, she must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision. The nurse should interview the client in private to gain information about possible abuse because the client might be reluctant to talk with the caregiver present. a. The nurse should provide information to the caregiver about local support groups for individuals who are no longer able to cope with the burden of caring for an older adult client; however, there is another action that the nurse should take first. c. The nurse should carefully document descriptions of the client's wounds for legal purposes; however, there is another action that the nurse should take first. d. The nurse should contact adult protective services as the client might need protective services and abuse of older adult clients is reportable to authorities; however, there is another action that the nurse should take first.

A nurse is caring for a client who is using a continuous passive motion (CPM) device following a right total knee replacement. Which of the following actions should the nurse take when applying the CPM device? a. Apply the CPM device in the flexed position. b. Line up the frame joints of the CPM device with the client's knee. c. Check the range-of-motion settings on the CPM device daily. d. Place the head of the client's bed at 45º during CPM use.

b. Line up the frame joints of the CPM device with the client's knee To avoid damage to the operative knee, the nurse should line up the joints of the CPM machine with the client's operative knee. a. The nurse should apply the CPM device while it is in the extended position for client comfort and to ensure proper placement. c. The nurse should assess the settings on the CPM device every 8 hr to ensure the appropriate flexion and extension cycle is occurring. d. The nurse should initially place the client in a supine position when applying the CPM device. Following placement, the nurse should place the head of the bed at 20º if the client is able to tolerate this angle.

A nurse is caring for an older adult client who has a hip fracture and is rating his pain at 8 on a scale of 0 to 10. Which of the following medications should the nurse administer? a. Capsaicin topical gel b. Oxycodone/acetaminophen 7.5/325 tablet PO c. Celecoxib 200 mg capsule PO d. Aspirin 325 mg tablet PO

b. Oxycodone/acetaminophen 7.5/325 tablet PO A client who rates his pain as 8 on a scale of 0 to 10 is experiencing severe pain, and the nurse should administer an opioid for this type of pain. Oxycodone/acetaminophen is a combination of an opioid and a nonopioid analgesic medication and is an appropriate medication to administer to the client. The nurse should monitor the client for adverse effects, such as respiratory depression, and proactively address constipation that occurs with opioid use. a. The nurse should administer capsaicin topical gel to a client who has minor pain. c. The nurse should administer celecoxib, an NSAID, to treat mild to moderate pain. d. The nurse should administer aspirin, an NSAID, to treat mild to moderate pain.

A nurse managing an adult day care is developing treatment plans for older adult clients. Which of the following therapeutic strategies should the nurse use to help the clients achieve Erikson's developmental task for this age group? a. Music therapy b. Reminiscence therapy c. Meditation therapy d. Pet therapy

b. Reminiscence therapy The nurse should incorporate reminiscence therapy as a therapeutic strategy for the purpose of encouraging clients to engage in life review. The process of sharing memories helps clients to achieve a sense of fulfillment and self-worth and allows a positive outcome to Erikson's developmental task of integrity vs despair. a. The nurse should use music therapy for the purposes of providing sensory and intellectual stimulation, as well as maintaining or increasing the clients' levels of physical, mental, social, or emotional functioning. c. The nurse should encourage meditation therapy to quiet the mind and improve overall health, such as promoting sleep, decreasing pain, and improving cognitive function. d. Pet therapy is beneficial for older adult clients by mitigating loneliness, promoting better physical and mental health, and providing loving companionship.

A nurse is teaching a group of healthy older adult clients about health screenings after age 50 years. Which of the following health screenings should the nurse recommend up the clients complete annually? a. Cholesterol b. Colonoscopy c. Diabetes mellitus d. Visual acuity

d. Visual acuity The nurse should recommend an annual visual acuity screening for all clients over 50 years of age. a. The nurse should recommend cholesterol screening every 3 to 5 years until age 75 years. b. While an annual rectal exam, including a stool specimen for occult blood, is a current recommendation, the recommendation for a colonoscopy is every 5 to 10 years beginning at the age of 50 years. c. The nurse should recommend that older adult clients have a diabetes mellitus screening performed every 3 years, unless the client is high risk, and then the nurse should recommend more frequent screenings.

A nurse is teaching an older adult client who had a total hip arthroplasty about ambulating with a standard walker. Which of the following actions by the client indicates an understanding of the teaching? a. The client adjusts the height of the walker so the hand grips are at the level of his waist. b. The client moves the walker ahead about 15.24 cm (6 in) and then steps into the walker. c. The client uses the walker to pull himself up from a sitting to a standing position. d. The client uses the walker to climb the stairs.

b. The client moves the walker ahead about 15.24 cm (6 in) and then steps into the walker. The correct technique for using a walker is to balance on both feet; lift the walker and place it in front; walk into the walker, using it for support when standing on the affected limb; and then balance on both feet before repeating the sequence. This provides maximum support for the client. a. The nurse should instruct the client that placing the walker at this height will increase the strain on his upper extremities. The client should have a slight bend in the elbow when his hands are on the walker grips. c. The nurse should emphasize the safe manner in which to go from a sitting to a standing position is to push up from the chair, gain balance, and then move the hands to the walker one at a time. Pulling oneself up by using the walker causes instability and can result in a client fall. d. The nurse should instruct the client that the use of the walker on stairs is unsafe and might result in a fall. When climbing or descending stairs, the client should hold onto the hand rails and use the walker only on flat surfaces.

A nurse at a long-term care facility is planning care for an older adult client who has dementia. Which of the following interventions should the nurse include in the plan? a. Vary the staff members caring for the client. b. Use photographs as memory triggers. c. Provide a minimum of three activity choices to the client. d. Break client tasks down to three or four steps at a time.

b. Use photographs as memory triggers The nurse should place photographs on the unit that trigger the client's memories, such as a picture of a toilet at the entrance to the bathroom, or a picture of the client as a young adult at the entrance to her room. a. The nurse should use consistent staff to provide care for the client because changing staff increases client confusion. c. The nurse should avoid offering many choices to the client as this increases confusion and frustration. While a variety of activities is important to stimulate the client, the nurse should limit choices to one or two. d. The nurse should offer simple, basic steps of a task to a client and limit the steps to one or two at a time. The nurse should ensure that the client completes one step before starting another. Providing the client with a number of steps to complete causes confusion and frustration.

A nurse is admitting an older adult client who fell at home 3 days ago. The client has a fractured hip, malnutrition, and dehydration. Which of the following laboratory values, noted on admission, should indicate to the nurse prolonged malnutrition? a. Increased sodium b. Decreased albumin c. Increased BUN d. Decreased blood glucose

b. decreased albumin Decreased albumin is indicative of inadequate protein intake, which is a common finding in a client who has prolonged malnutrition. a. Increased sodium is indicative of dehydration, which is due to a fluid volume deficit. c. Increased BUN is indicative of renal failure, or dehydration, which is due to a fluid volume deficit. d. Decreased blood glucose is indicative of inadequate intake of glucose, which is a manifestation that can occur rapidly in any client who has not eaten in several days. It is not indicative of prolonged malnutrition.

A nurse is assessing an older adult client for signs of dehydration. Which of the following findings should the nurse consider in expected part of the aging process? a. elevation of specific gravity b. decreased creatinine clearance c. dry oral mucous membranes d. poor skin turgor over the sternum

b. decreased creatinine clearance Creatinine clearance declines with age and, therefore, the kidneys have a decreased ability to concentrate urine. This expected part of the aging process places the client at risk for dehydration. a. Elevation of urine specific gravity is an unexpected finding that could be indicative of dehydration. Normal specific gravity should range from approximately 1.005 to 1.03. Results obtained below this range indicate dilute urine, associated with overhydration and some medical conditions, such as poorly controlled diabetes insipidus. Results obtained above this range indicate concentrated urine, associated with dehydration and some medical conditions, such as poorly controlled diabetes mellitus. c. Dry oral mucous membranes are an unexpected finding that could be indicative of dehydration. Other causes of dry mucous membranes include side effects of medications, such as decongestants, diuretics, antihypertensives, antidepressants, and antihistamines; radiation therapy; or certain medical conditions, such as Parkinson's disease. d. Poor skin turgor over the sternum is an unexpected finding that could be indicative of dehydration. Skin turgor is an abnormality in the skin's ability to change shape and return to normal. Decreased skin turgor is a late sign of dehydration. It is associated with moderate to severe dehydration. Fluid loss of 5% of the body weight is considered mild dehydration, 10% is moderate, and 15% or more is severe dehydration.

A nurse is teaching a group of healthy, older adult clients about expected age-related changes and sexual response. Which of the following changes should the nurse include as an age-related change? a. Decreased refractory time b. Decreased vaginal lubrication c. Loss of female clients' orgasm ability d. Premature ejaculation

b. decreased vaginal lubrication The nurse should inform the clients that a decrease in vaginal secretions is an expected age-related change in older adult female clients. Vaginal dryness might result in painful intercourse, which clients can manage with the use of water-soluble lubricants during intercourse. a. The nurse should inform the clients that achievement of an erection is often delayed in older adult male clients due to a slower sexual response, lengthening the refractory time. c. The nurse should inform the clients that some of the physiological changes resulting from female orgasm, such as the vaginal contractions, might decrease in intensity. The ability to have an orgasm, however, is not lost. d. The nurse should inform the clients that an expected age-related change in older adult male clients is a delay in ejaculation along with a decrease in the forcefulness of emissions.

A nurse is teaching an older adult client about osteoporosis. Which of the following statements should the nurse include in the teaching? a. "Cottage cheese is a good source of calcium." b. "Increase your caffeine intake." c. "Brisk walking will help prevent bone loss." d. "Hormone replacement therapy with estrogen will increase your risk of osteoporosis."

c. "Brisk walking will help prevent bone loss." The nurse should encourage weight-bearing exercises to help minimize bone loss in the older adult client. A sedentary lifestyle, on the other hand, leads to a loss of minerals in the bones, especially calcium and phosphorus. a. The nurse should include dietary sources of calcium and vitamin D in the teaching. Cottage cheese, however, is not a good source of calcium as it loses the calcium during processing. b. The nurse should encourage the client to limit caffeine intake because it enhances the excretion of calcium. d. The nurse should provide information about medications for prevention and treatment of osteoporosis. Estrogen can reduce the fracture rate in women who have osteoporosis, although there are other complications related to its use, such as cancer.

A nurse is providing teaching to a client who is to start taking finasteride. Which of the following statements by the client indicates an understanding of the teaching? a. "I will see improvement in my symptoms within one week." b. "I can expect an increased libido with this medication." c. "I should see a decrease in my PSA levels." d. "I must take this medication within 60 min of sexual activity."

c. "I should see a decrease in my PSA levels." The nurse should emphasize that the decrease in PSA levels with this medication will be measured 6 months after starting treatment. The expected decline is 30% to 50% in the PSA level. a. The nurse should reinforce that this medication might take up to 6 months before the client responds. b. The nurse should inform the client that one of the adverse effects of this medication is a decrease in libido. Other side effects include orthostatic hypotension, gynecomastia, and decreased ejaculate volume. d. The nurse should emphasize that this medication decreases mechanical obstruction of the prostate, and it has no effect on sexual activity.

A nurse in an assisted living facility is assessing an older adult client who moved in 3 months ago following the death of his partner. The client reports awakening early in the morning and admits to feeling very sad. The nurse should identify that the client is experiencing which of the following types of grief? a. Anticipatory grief b. Delayed grief c. Acute grief d. Disenfranchised grief

c. Acute grief The client experiencing acute grief will have both somatic and psychological manifestations of distress, such as the inability to sleep well or profound sadness. The nurse should identify that this client is experiencing acute grief and further assess his support system, concurrent stressors in his life, and his ability to manage stress. a. The nurse should identify anticipatory grief as an expected response occurring prior to an actual loss. Clients experiencing anticipatory grief might be preoccupied with the impending loss, make extensive funeral arrangements, or exhibit a change in attitude toward the lost thing or individual. b. The client experiencing delayed grief is unable to accept the reality of a loss. The client remains in the denial stage of grief and is unable to allow himself to experience feelings of sorrow and loss. d. The client experiencing disenfranchised grief cannot openly acknowledge the loss because of societal or religious norms.

A nurse at a long-term care facility is planning care for a client who has Alzheimer's disease and wanders at night. Which of the following interventions should the nurse include in the plan? a. Place the client in wrist restraints at night. b. Request a prescription for a psychotropic medication. c. Assign the client to a room closer to the nurse's station. d. Keep the television on at night.

c. Assign the client to a room closer to the nurse's station. The nurse should place the client who wanders in a room that allows for close observation. The nurse should provide clients who wander a safe place to walk and supervision when the client is ambulating. a. The nurse should protect the client from harm, but restraints can result in agitation. b. The nurse can administer a psychotropic medication to treat depression or emotional manifestations of Alzheimer's disease, but not to treat wandering behaviors. d. The nurse should avoid the use of excessive light and sound stimulation for the client who has Alzheimer's disease. This can cause further agitation and confusion for the client.

The nurses caring for an older adult client who has pneumonia. Which of the following physiologic changes associated with aging Places the claim at risk for pneumonia? a. Decreased anterior-posterior diameter b. Increased diameter of the small airways c. Decreased number of cilia d. Increased alveolar surface area

c. Decrease number of cilia A physiologic change associated with aging is a decreased number of cilia. This, along with a less effective cough, leads to diminished efficiency of the normal defense mechanisms for clearing the airway, putting the client at increased risk for infection, such as pneumonia. a. A physiologic change associated with aging is a calcification of the bronchial and costal (rib) cartilage and diminished chest wall compliance, leading to an increase in the anterior-posterior diameter. The resultant reduced total lung capacity puts the client at increased risk for hypoxemia. b. A physiologic change associated with aging is a decreased diameter of the small airways. However, the diameter of the large airways does increase with age, and these two factors combined can lead to an increase in dead space, gas trapping, and ventilation-perfusion imbalance. d. A physiologic change associated with aging is an increase in the size of the alveolar ducts and respiratory bronchioles, leading to a decrease in the alveolar surface area. Consequently, there is less surface area for gas exchange to occur, putting the client at an increased risk for hypoxemia.

A nurse is caring for an older adult client. Which of the following physiologic changes associated with aging can affect medication dosage and this client? a. Increased glomerular filtration rate b. Decreased body fat c. Decreased gastric motility d. Decreased gastric pH

c. Decreased gastric motility Decreased gastric motility results in medications remaining in the digestive tract for longer periods of time, leading to slow absorption of the medication. The provider might have to allow for a longer time for medication onset and peak by extending the length of time between doses. a. The aging process results in a decreased glomerular filtration rate and causes the medications to filter at a slower rate, causing them to remain in the body longer. b. Body fat increases with aging. Medications that are stored in adipose tissue will have an increased tissue concentration, decreased plasma concentration, and a longer duration in the body. d. With aging, gastric pH increases, becoming more alkaline. The nurse should avoid giving preparations that neutralize gastric secretions if a low gastric pH is required for medication absorption.

A nurse is conducting an in-service for a group of assistive personnel about the basic needs of older adult clients. Which of the following statements should the nurse include in the teaching? a. "Caloric needs are increased." b. "Renal function is increased." c. "Deep sleep is decreased." d. "Exercise needs are decreased."

c. Deep sleep is decreased The sleep architecture, or time spent in various stages of sleep, changes with aging. The older adult spends less time in stages III and IV, which are the stages of deep sleep. This decrease in time spent in deep sleep can delay healing. a. The caloric needs of an older adult client are decreased. The basal metabolic rate in older adult clients slows and can decline by 10% from the metabolic rate of a younger adult. b. Older adult clients have decreased renal function, affecting the body's ability to concentrate urine and filter wastes. d. Exercise needs for older adult clients are the same as for younger adults, with recommendations of 30 min a day for 5 or more days a week. Regular exercise provides health benefits for older adult clients, including improvements in blood pressure, lipid profile, and neurocognitive function. Older adults who perform regular physical activity have decreased mortality and age-related morbidity.

A nurse in the clinic is assessing an older adult client for the second time in a week. The client reports a decreased energy level, insomnia, and anorexia. The clients diagnostic test or within the expected reference ranges. For which the following conditions should the nurse of screen the client? a. Sarcopenia b. Dementia c. Depression d. Diabetes

c. Depression Depression, an altered mood state characterized by decreased energy levels, insomnia, anorexia, and sadness, is a common condition among older adult clients. Depression can be a response to an acute or chronic illness. Depression in older adult clients can also be the result of medications such as analgesics, antihypertensives, steroids, and cardiovascular agents. a. Sarcopenia is an impairment of muscle tone. The loss of muscle tone is caused by physical inactivity, a change in the central and peripheral nervous systems, and reduced skeletal protein synthesis. b. Dementia refers to a group of symptoms involving progressive impairment of all aspects of brain function. Most of the disorders associated with dementia are irreversible, degenerative conditions. d. The presenting manifestations of diabetes mellitus, a condition caused by the inability of the pancreas to secrete enough insulin for carbohydrate metabolism, include polydipsia, polyuria, and polyphagia. Polyuria is also a manifestation of diabetes insipidus, which is a condition caused by the inability of the kidneys to conserve water.

A nurse is assessing an 85-year-old client. Which of the following findings should the nurse report to the provider? a. A widened anterior-posterior chest diameter b. Presence of an s4 heart sound c. Differences in pulse strength between lower extremities d. Post-void residual of 75 mL

c. Differences in pulse strength between lower extremities A difference in pulse strength can indicate a vascular complication. Assessment of the peripheral vascular system should also include temperature, color, sensation, edema, and skin integrity of both the upper and lower extremities. The nurse should identify any differences in symmetry of these findings and report them. a. A widened anterior-posterior chest diameter is an expected finding for an older adult client. This occurs as a result of a loss in skeletal muscle strength in the thorax and the diaphragm and age-related hyperinflation of the lungs. b. The presence of an S4 heart sound is an expected finding in an older adult. d. The older adult has decreased bladder muscle tone and contractibility leading to post-void residuals. A post-void residual of 75 mL is within the expected reference range of 50 to 100 mL of urine.

A nurses participating on a committee that is developing age appropriate care standards for older adult clients. Which of the following of Erikson's developmental tots should the nurse recommend as a focus? a. Intimacy b. Identity c. Integrity d. Initiative

c. Integrity Integrity vs. despair is the conflict that older adult clients must resolve when they reflect on their lives and their roles. If the client has achieved a sense of unity and fulfillment about life, she will accept death with a sense of integrity, not fear. a. Intimacy vs. isolation is the conflict that clients must resolve during young adulthood. In this stage, clients develop love relationships and the capacity for intimacy. b. Identity vs. role confusion is the conflict that clients must resolve during adolescence. This is the time when clients ask the question "Who am I?" To answer this question successfully, Erikson suggests that adolescent clients must integrate healthy resolutions from all earlier conflicts. d. Initiative vs. guilt is the conflict that clients must resolve during early childhood. In this stage, children must learn to achieve a balance between eagerness for more adventure and taking on more responsibility, learning to control impulses and childish fantasies.

A nurse is transferring an older adult client who has right-sided weakness from the bed to a wheelchair. Which of the following actions should the nurse take to provide a safe transfer? a. Keep the client at arm's length while performing the transfer. b. Bend at the waist to get down to the client's level. c. Maintain a straight back and bend at the knees. d. Place the wheelchair at the head of the bed on the client's right side.

c. Maintain a straight back and bend at the knees The nurse should maintain a straight back and bend at the hips and knees when transferring a client in order to allow the larger muscles of the thighs to do the lifting. Good body mechanics are essential in preventing injury to the nurse. a. The nurse should hold the client close to the body when lifting to maintain the center of gravity close to the base of support. b. The nurse should avoid bending at the waist while transferring a client because this can cause injury to the nurse's lower back. d. The nurse should place the wheelchair on the side of the bed that allows the client to move toward his stronger side. In this case, placing the wheelchair on the right side of the head of the bed will have the client moving toward his weaker side.

A nurse is assessing an older adult client who states he is homeless. Which of the following findings should the nurse document as comorbidities for this client? a. Inadequate shelter and clothing for the weather b. Malnutrition and poverty c. Dementia and tuberculosis d. Lack of preventive health care and immunizations

c. dementia and tuberculosis The term comorbidity refers to medical conditions known to co-exist in a client. The number of comorbid conditions present in a client is used to provide an indication of his health status and risk of death. Dementia and tuberculosis occurring in an individual client is an example of comorbidity and increases the client's risk. a. Inadequate shelter and clothing for the weather are risk factors for disease but are not comorbidities. b. Malnutrition can be both a risk factor for disease or a symptom of disease, and poverty is a risk factor. However, these are not comorbidities. d. Lack of preventive health care and immunizations are risk factors for disease, but are not comorbidities.

A nurse is reviewing the medical record of a client who is postmenopausal and has osteoporosis. The client has a new prescription for alendronate sodium. Which of the following findings in the client's history should the nurse recognize is a contraindication to this medication? a. Glaucoma b. Paget's disease c. Esophageal achalasia d. Long-term corticosteroid

c. esophageal achalasia Clients who have a history of esophageal abnormalities, such as stricture or achalasia, have delayed esophageal emptying, which greatly increases the client's risk for esophageal erosion, bleeding, and perforation. Alendronate sodium is a bisphosphonate, which prevents or slows weakening of bone. It is used to prevent and treat postmenopausal osteoporosis. The nurse should instruct the client to wait at least 30 min after taking alendronate sodium before eating, drinking, or taking other medications, and caution her not to lie down for at least 30 min after taking the medication. Standing or sitting upright ensures that the client gets the full dose and decreases heartburn or the risk of injury to the esophagus. a. Glaucoma is a degenerative eye disease where increased intraocular pressure causes damage to the optic nerve. It is not a contraindication to the use of alendronate sodium. b. Paget's disease is a metabolic bone disease that involves bone destruction and regrowth that results in deformity. Medical treatment with a bisphosphonate, such as alendronate sodium, is considered first-line therapy. d. Long-term steroid use is frequently associated with the development of osteoporosis, and treatment with a bisphosphonate is considered first-line therapy. Alendronate sodium is a bisphosphonate, which prevents or slows weakening of bone. It is used to prevent and treat postmenopausal osteoporosis and Paget's disease.

A nurse in a long term care facility is promoting reminiscence among older adult clients. Which of the following actions should the nurse take? a. Establish a weekly pet therapy visitation program. b. Place a calendar and clock in each resident's room. c. Institute a daily storytelling hour d. Encourage all clients to eat their meals in the dining room.

c. institute a daily story telling hour -A storytelling hour is an example of reminiscence therapy, which allows clients to share stories of their past and reminisce with others who might have similar or shared memories. According to Erikson's psychosocial theory, reminiscence is an important action for older adult clients. a. Pet therapy visitation programs can be beneficial in promoting socialization and social skills for clients, but it does not promote reminiscence. b. Placing a calendar and clock in each client's room will promote the client's level of orientation to date and time, but it will not promote reminiscence. d. Having clients eat their meals in a group dining room is beneficial to promoting socialization, but it will not promote reminiscence.

A nurse is teaching a group of older adult female clients who are postmenopausal about dietary requirements. Which of the following statements about the role of folic acid should the nurse make? a. "Clients who are postmenopausal need to limit their intake of folic acid to reduce their risk of stroke." b. "Dietary folic acid is not of significant importance after the childbearing years." c. "Healthy clients who are postmenopausal require a daily folic acid supplement." d. "Adequate folic acid intake is associated with a reduced risk for heart disease."

d. "Adequate folic acid intake is associated with a reduced risk for heart disease." Clients who are postmenopausal and consume the recommended daily intake of 400 mcg of folic acid have significantly lower levels of homocysteine, a risk factor for heart disease, than those who do not. Older adult female clients need to improve their daily folic acid intake, which can be accomplished by increasing daily dietary intake of foods such as orange juice, beans, legumes, and green leafy vegetables, as well as foods enriched with folic acid, such as breads and pastas. a. Clients who are postmenopausal and consume the recommended daily intake of 400 mcg of folic acid have significantly lower levels of homocysteine, a risk factor for heart disease, than those who do not. b. Folic acid has a role in the prevention of birth defects. However, recent studies suggest that clients who are postmenopausal can reduce their risk of heart disease with a diet rich in folic acid. c. Recent studies have shown that most clients who are postmenopausal need to increase their daily intake of folic acid; however, a supplement is unnecessary to accomplish this. The client can consume adequate amounts of folic acid by increasing daily intake of foods such as orange juice, beans, legumes, and green leafy vegetables, as well as foods enriched with folic acid, such as breads and pastas.

A nurse is providing teaching to a client who is to start taking alendronate sodium. Which of the following recommendations should the nurse include in the teaching? a. "The medication may be crushed if you have difficulty swallowing it." b. "Drink a full glass of milk when you take the medication." c. "Take the medication at bedtime." d. "Discontinue the medication if you develop heartburn."

d. "Discontinue the medication if you develop heartburn." The nurse should instruct the client to stop taking the medication if she develops heartburn or if it worsens and to contact her provider. This is an indication that esophageal irritation has occurred. Ways to avoid this are to take alendronate with 240 mL (8 oz) of water and to avoid lying down for 30 to 60 min after taking the medication. a. The nurse should instruct the client that this medication must be taken whole. Crushing or chewing alendronate can cause esophagitis or esophageal cancer. b. The nurse should instruct the client to take alendronate with a full glass of water. Food or fluids other than water interfere with the medication's absorption. c. The nurse should instruct the client to take alendronate in the morning before eating or drinking. It is also important to reinforce that the client must remain upright for 30 to 60 min after taking this medication to avoid esophagitis.

An older adult client tells a nurse at a health fair "I am always forgetting things. I cannot even remember where I parked my car! Do you think I have Alzheimer's disease?" Which of the following is a therapeutic response by the nurse? a. "Perhaps you should discuss your concerns with your doctor." b. "I am forgetful too. I can't remember where I parked my car either!" c. "You're probably just having 'senior moments.' Everyone has memory lapses." d. "That must be very upsetting. Can you tell me about your forgetfulness?"

d. "That must be very upsetting. Can you tell me about your forgetfulness?" -This statement is an example of the therapeutic communication technique of empathy and clarification. The client has stated a problem with forgetfulness, so the nurse empathizes with the client's concern and seeks additional information with which to counsel the client. a. This statement is an example of the nontherapeutic communication technique of rejecting. The nurse refuses to discuss the topic with the client and can make the client feel as though the nurse is rejecting her as well. b. This statement is an example of the nontherapeutic communication technique of changing topics and subjects. This can block further communication with c. This statement is an example of the nontherapeutic communication technique of unwarranted reassurance by replying with a cliché. This can block the thoughts of the client. the client.

A public health nurse is planning an immunization clinic for older adults. At which of the following times should an older adult client receive the influenza vaccine? a. Once during the client's lifetime b. Every 10 years c. Every 5 years d. Annually in the fall

d. Annually in the fall The nurse should recommend that older adult clients receive the influenza vaccine annually. Influenza outbreaks occur annually, and the influenza virus changes constantly. Consequently, an influenza vaccine from a previous year will not protect a client exposed to this year's influenza strain. Influenza in older adults can result in the development of primary viral influenza pneumonia, which causes several deaths a year. An influenza vaccine given in the fall, prior to the onset of flu season, will be most effective in preventing influenza in this target population. a. The nurse should recognize that the older adult is at increased risk for developing influenza due to changes in the immune system that occur with age. Prior immunization with the influenza vaccine does not guarantee continued life-long immunity from the illness. b. The nurse should recognize that the influenza virus changes constantly, eliminating the possibility of long-term immunity. c. The nurse should recognize that because of constant changes in the influenza virus itself, an immunization received 5 years previous will not protect the client from the illness currently.

A nurse is assessing an older adult client who reports feeling anxious about financial concerns and having difficulty sleeping for several months. Which of the following factors should the nurse identify as a factor in the client's sleep pattern? a. Older adults require much less sleep than young adults. b. Older adults seldom awake at night once they have fallen asleep. c. Older adults have an increase in stages III and IV of sleep. d. Anxiety can cause disturbed sleep patterns.

d. Anxiety can cause disturbed sleep patterns The sleep patterns of older adults are different from those of young adults. However, anxiety and emotional stress can result in sleep disturbances in people of all ages. The nurse should further assess the client's sleep problems and anxiety. a. The sleep needs of older adults are similar to those of young adults. However, older adult clients experience more awakenings during the night along with shorter time periods spent in deep sleep. b. Older adults tend to awaken several times during the night, limiting their ability to obtain the rest they require. c. Altered sleep patterns in older adult clients result in a decreased amount of time spent in stages III and IV, which is where deep sleep occurs.

A nurse is completing medication reconciliation for an older adult client who is receiving multiple medications. Which of the following actions should the nurse take first? a. Clarify the client's list of medications with the pharmacist. b. Compare the current list against the new medication prescriptions. c. Investigate any discrepancies on the list. d. Ask the client about over-the-counter medications she is taking.

d. Ask the client about over-the-counter medications she is taking. -The nurse should apply the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, she must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision. When performing medication reconciliation, it is important that the nurse collect a list of all the medications the client takes in order to compare the full list of medications against any new medications the client will take. The list should include prescriptions, over-the-counter medications, and herbal and nutritional supplements. a. The nurse should clarify the client's list of medications with the pharmacist, caregivers, providers, and the client; however, this is not the first action the nurse should take. b. The nurse should compare the medication list against any new prescriptions to ensure there is not any duplication of medications or potential medication interactions; however, this is not the first action the nurse should take. c. The nurse should investigate discrepancies on the list with the provider to prevent medication errors; however, this is not the first action the nurse should take.

A nurse is caring for a client who has Alzheimer's disease and refuses to take her morning antihypertensive medication. The client is oriented to name and place and is able to perform ADLs with minimal supervision. Which of the following actions should the nurse take? a. Crush the pills and feed them to the client in applesauce. b. Insist the client comply by informing her of the possible implications of missing a dose. c. Notify the provider of the need for further evaluation of the client's level of competence. d. Ask the client to express her reasons for refusing the medication and document the event.

d. Ask the client to express her reasons for refusing the medication and document the event. Before intervening or making a judgment about the client's competence, the nurse should evaluate the client. The nurse should then determine if the client's reason for refusal can be addressed. a. Forcing or tricking a client into taking medication or receiving treatment is unethical and can constitute battery. b. Being confrontational can cause the client to become argumentative and distrustful. The nurse should not insist the client take her medications. c. A single incident of refusing medication is unlikely to place the client's competence in question.

A nurse is caring for an older adult client who has a terminal illness. The client tells the nurse, "I just want to live one more month so I can see my grandchild get married." Which of the following Kübler-Ross stages of grief should the nurse identify the client is experiencing? a. Depression b. Acceptance c. Denial d. Bargaining

d. Bargaining Bargaining is the third stage of grief, according to Kübler-Ross. Bargaining represents a last effort at overcoming death by earning longer life. Trying to put off death for one last major celebration in the client's life, like the marriage of a grandchild, is a form of bargaining. a. Depression is the fourth stage of grief, according to Kübler-Ross. In the depression stage, the client deals with the full impact of imminent death and grieves for losses both in the past and in the future. b. Acceptance is the fifth and last stage of grief, according to Kübler-Ross. In the acceptance stage, the client comes to grips with eventual death and makes preparations for it. c. Denial of death is the first stage of grief, according to Kübler-Ross. Clients in denial are unable to admit to themselves that they might die.

A nurse is reviewing the medical record of an older adult client. For which of the following medications should the nurse conduct a hearing assessment of the client? a. Omeprazole b. Ferrous sulfate c. Digoxin d. Furosemide

d. Furosemide Furosemide can cause ototoxicity, especially in the older adult client, because there is a decrease in medication metabolism in the kidneys. The nurse should monitor clients taking ototoxic medications, such as furosemide, and teach the client the signs and symptoms of ototoxicity, such as tinnitus and difficulty hearing. a. The nurse should monitor the client who is taking omeprazole for bone loss. b. The nurse should monitor the client who is taking ferrous sulfate for gastrointestinal effects, such as bloating or changes in elimination. c. The nurse should monitor the client who is taking digoxin for manifestations of hypokalemia, such as muscle weakness.

A nurse is reviewing the records of a group of older adult clients. Which of the following findings should the nurse identify as an unexpected manifestation of the aging process? a. Decreased absorption of nutrients b. Impaired excretion of medications c. High-pitched frequency hearing loss d. Obesity

d. Obesity The nurse should recognize that, although obesity is found among a large percentage of the older adult population, this is an unexpected finding and can lead to cardiovascular disease, diabetes, and stroke. a. The nurse should identify decreased nutrient absorption as an expected finding in the older adult client. With aging, the villi in the intestine flatten and are less able to absorb nutrients such as vitamins B and D, calcium, iron, and fat. b. The nurse should identify impaired medication excretion as an expected finding in the older adult client due to the decreased ability of the kidney to filter metabolites. c. The nurse should identify hearing loss of high-pitched sounds as an expected finding in the older adult client. Impaired hearing of high-frequency sounds makes it difficult for older adult clients to discriminate voices from background noise in a room.

A nurse is planning care for an older adult client following abdominal surgery for a bowel obstruction. Which of the following information about pain management should the nurse consider when planning care? a. Older adult clients have a diminished capacity to perceive pain. b. Older adult clients should not take narcotics for pain control. c. Older adult clients have increased pain as a normal part of aging. d. Older adult clients are sensitive to the analgesic effect of opiates.

d. Older adult clients are sensitive to the analgesic effect of opiates. An older adult client is likely to require a decreased dose of opiates to provide the same level of analgesia as a younger client, with a reduced risk of side effects. a. Older adults do not have a diminished capacity to perceive pain. However, older adult clients might have developed excellent coping skills that make it difficult to observe for cues of pain. b. The nurse can administer narcotic medications safely to older adult clients. Although older adult clients might be more sensitive to narcotics, it does not justify withholding narcotic medication for pain control. c. Pain is not an expected finding of the aging process. The nurse should assess, diagnose, and manage pain in older adult clients similar to any other client, regardless of age.

A nurse's planning care for a client who had a stroke. Which of the following goals should the nurse identify as a priority for this client? a. The client's skin will remain intact during hospitalization. b. The client will verbalize one new word each week. c. The client will begin to help turn himself in bed, indicating improved mobility. d. The client's airway will remain clear, as evidenced by clear breath sounds.

d. The clients airway will remain clear, as evidence by clear breath sounds -The nurse should apply the ABC priority-setting framework when caring for this client. This framework emphasizes the basic core of human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life and is the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second highest priority in the ABC priority-setting framework because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the third highest priority in the ABC priority-setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. The priority nursing action is to promote pulmonary hygiene as evidenced by clear breath sounds.

A community health nurse is assessing an older adult client who lives alone. The nurse finds that, although the client is able to answer all questions appropriately, the client has a decreased attention span, expresses feelings of overwhelming sadness, and has a low energy level. The nurse should identify that the client is exhibiting manifestations of which of the following disorders? a. Delusions b. Dementia c. Delirium d. Depression

d. depression The client who has an inability to sleep or complete ADLs is exhibiting manifestations of depression. Depression involves a cluster of manifestations that include changes in sleep habits, appetite, and relationships with others. Clients who have depression might have a decreased ability to make decisions or concentrate and, in some cases, complete ADLs. Anhedonia, the inability to feel happy, is another manifestation of depression. a. A client who has false personal beliefs despite evidence to the contrary is exhibiting manifestations of delusions. b. A client who has severe memory loss and an inability to solve problems is exhibiting manifestations of dementia. c. A client who has a sudden onset of confusion, disorientation, altered level of consciousness, and an inability to focus is exhibiting manifestations of delirium.

A home health nurse is visiting an older adult client who has anemia. Which of the following foods should the nurse recommend to increase the clients iron intake? a. Greek yogurt b. Bran muffin c. Peanut butter sandwich d. Dried fruit

d. dried fruit The nurse should recommend the client eat more dried fruit to increase iron in the diet. a. The nurse should recommend greek yogurt to increase the client's intake of zinc and calcium. b. The nurse should recommend bran muffins to increase the client's intake of fiber. c. The nurse should recommend a peanut butter sandwich to increase the client's intake of a complementary protein, which is when two incomplete proteins are together, making the sandwich a complete protein.


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